PTSD & Politics
PTSD & Politics: When the War Comes Home
NEW SITE: What happens when stressed-out vets return from the war theatre and try to resume their lives with business-as-usual? Many, if not most, find that to be impossible, because they are not the same as they were prior to deployment. In fact, many contend with sleepless nights, inability to focus, depression and Post Traumatic Stress Syndrome.Veteran's PTSD is a multidimensional issue involving disabilities, traumatic brain injury, psychophysical regulation, stress-management, depression, grief, dissociation, and perhaps ADHD, T-type behavior, chronic pain management, alcohol and drug use, and compulsive disorders. Soldiers in the 101st Airborne claim most use alchol and drugs in excess, including Valium and marijuana. That is the short list, as each unique individual will have particular adjustment issues depending on their life and combat histories. Some also have service-related chronic health issues from vaccines, Gulf War Syndrome, DU, etc.
THE PERFECT PSYCHOLOGICAL STORM
A PERFECT DESERT STORM
Can We Continue Playing Politics with PTSD Vets
Who Are a Clear & Present Danger to Themselves & Others?
Toxic Vaccines, Toxic Environments, Toxic Treatment
PTSD * Shame * Grief * Anxiety * Depression * Talk Therapy and Medication
“We have men and women walking around here like zombies--medicated to the gills. Personally, I've been diagnosed with "Adjustment Disorder," which is incorrect. I'm still fighting. I attend group counseling sessions three times a week with men and women who are burned out--some suicidal, some homicidal, and some both. Many are afraid.”-Anon
Threats From Vets
A "perfect storm" is an expression that describes an event where a rare combination of circumstances can aggravate a situation drastically. There is growing awareness surrounding the issue of dangerous vets returning from combat. Highly trained in military mayhem, stealth and special ops, many of these vets declare themselves to be ticking time bombs. Who knows where or when they will “go off”?
Have returning vets become “Dangerous Minds” aimed at society, without a mission but with an omnidirectional target? Are they just another symptom or casualty of our “sick” society? Perhaps we all need a remedy for our emotional pain.
We are all in it together. The troops who defend us are not “the enemy.” But we need a new vision, a new paradigm for our society. We can empower ourselves to resist status quo politics and shape ourselves a better destiny - a 21st century Manifest Destiny that fulfills our positive spiritual potential. We need creative repatterning.
If we don't want a dark future for humanity, we must reinvent ourselves and our culture from the foundation upwards. Even if that is fantastically radical, it can still happen, one inspired person at a time and cascade toward a visionary approach to large-scale societal transformation that heals personal and global socio-economical scars.
We live in a POST-TRAUMATIC CULTURE: PTSD is a chaotic, hyper-reactive state of being. Our cultural crisis is characterized by symptomatic numbing, dissociation, impulsive aggression, depression, denial, shame and anxiety. We are haunted by a sense of injury -- victimization. "Victim speech" is used for economic and military gain. First- and second-hand trauma shapes our central narratives of overwhelming personal and collective change.
Our returning Vets are broken, but who will fix them? How can they overcome the societal taboos and personal shame that go along with mental illness to get the help they need upon re-entry to the
The Veterans Administration is utterly overwhelmed by the problem. They have no recourse but to medicate military troops both going into and returning from hotzone combat. But drugs do not solve the problem and may exacerbate the problems at every point in their service arc, from pre-deployment vaccinations to societal re-entry to discharge.
Studies in depression have shown that pills alone are not enough. They not only don’t produce any better results than talk therapies, they come with a plethora of sideffects from zombification to physiological problems. Much the same can be said for isolated medication of Post Traumatic Stress Disorder (PTSD), once known as “Shellshock” in combat veterans. Psychiatry has made itself the authority on authority and to question its protocols is considered “crazy.” Yet in this arena, it has failed utterly, putting lives in a holding pattern, rather than providing true relief, much less rehabilitation.
The main characteristic of PTSD is that the trauma doesn’t recede into the past, but is perceived as perpetually happenING. When does this internal torture end? What do we do when normal counseling and talk therapies fail? How do we help rebuild shattered personalities? We need to listen, as one Vet says to the blunt fact that, “there are many more crippling mental conditions that exist that should be addressed other than just PTSD. We're just scratching the proverbial "tip of the iceberg.”
Playing Politics with Soldiers’ Lives
Many vets suffer unknowingly from PTSD and other combat-induced disorders far more severe than civilian forms of personality disorders. According to a Truthout report, Chuck Luther, served 12 years in the military and is a veteran of two deployments to
"I see the ugly, I see soldiers beating their wives and trying to kill themselves all the time, and most folks don't want to look at this, including the military."
Luther, who founded and directs "The Soldier's Advocacy Group of Disposable Warriors," knows about these types of internal problems in the military because he has been through it himself. Other symptoms include sleepless nights/nightmares, headaches, bouts of anger, lack of focus, weight loss, depression, high stress and extreme exhaustion.
Anti-depressants may compound the situation: "in EVERY walk-in, shoot up an office/school/hiway full of people case, I've looked at the attacker(s) has
1) been on meds -- most often anti depressants.
2) somewhere has had a military background/training- even ‘Columbine.’" (M. Fox)
A Torturous Existence
As if the horrors of combat aren’t enough, there is no let-up when troops return to the
The treatment received by quiet patriots that put their hearts, minds ,ears ,eyes on the line is appalling and hurts me in a deep way. We are taught to be tough, we are trained to the level of not being able to un train without the proper understanding of
WHAT IS TO COME FOR THE VETERAN WHEN THEY GET HOME , AND FOR SOME, WHILE THEY ARE STILL DEPLOYED. IT IS LIKE GOING FROM THE MOST HIGH SPEED ENVIRONMENT, AND THEN (RETURNING HOME) TO cold molasses. Everything is way to slow for their "not to be something up."
Then you hear from everybody in the
I learned not to answer that second question. I broke a glass of coke in the middle of a party because of a memory, while trying to answer that second question. Then there are those Servicemen that are specop trained , trained to the point of secrecy , wounded in the critical moment that determines a successful mission , but keep their mouth shut because they KNOW how important tomorrows mission is and WHO it is we are going after. Now remember, I was on the 15th MEU in
What about NOW?
Yet another vet says:
"Everybody talks about how many programs their are for the OEF/OIF, or Veterans in general"
Programs may exist , but how many of you know of them, how many commercials are shown of these programs, who is limiting the SHARING OF THEM?
Here are two:
These are just two, there are more projects, and some including the WW project having ties with the DNI and IC.
You go and speak to these people at the VA trying to hold back tears from memories you witnessed because of the same government that is showing you its back now, but of course, on the battlefield giving you certificate of commendations.
YOU RETURN HAVING NO IDEA WHAT YOU WILL BE FACING when you get back to the so-called civilian world.
Everything seems chaotic, different, unstructured, and it makes you want to go back to your comfort WAR zone, it just doesn't make sense that our Military servicemen who are treated like complaining kids seek help in foxholes , , , again,,,,,who in the hell really runs this country????
You feel in your heart fear that is confusing
Your mind tells you can't do this and their is no way possible for you "to get out of this one."
Your eyes begin to show the disproportionate chances of success through smoke and doubt.
Your ears hear everybody laughing at the dinner table and hopefully praying for your safety, and then a shell brings you back to reality.
You miss what you bleed for.
And then you go home, noticing the empty seats on the helicopters with one M16A2 service rifle and helmet. How can one mistake a persons willingness to put his life down for another as fulfilling just a contract or enlistment?. TAKES A BIT MORE THAN INK TO SUSTAIN.
I am sorry if feathers ruffled but glad that maybe one or two eyes were open to the reality of our Wounded Warriors, and their mistreatment.
Therapist’s View: Addicted to War?
This is a big story and one I've been following for some time, as insider therapeutic 'shop talk' among my counselor friends and medical colleagues. A psychiatric nurse practitioner [male] friend is the sole practitioner dealing with PTSD vets at a VA Domiciliary, and the only treatment is medication. It is not working. This person says many of them -- most actually -- remain suicidal. He deals with this all day long, everyday, working as fast as he can go.
When I tell this expert, "drugs won't do it," he just says "don't tell me that," and hangs his head knowing it is true and he cannot do more, being already slammed for time everyday. He is taking on all this negativity of the vast volume of returnees needing this treatment. Realize in PTSD, the trauma did not occur, but is perceived to continue to be OCCURRING. It comes at them from every angle including replaying 'tapes' inside their heads, with 'coulda, shoulda, woulda' about incidents where people were let down or died.
Another counselor friend turned over his business space to someone with this specialty who says the vast numbers of PTSD and other disorders in vets pose a serious threat to the country -- in other words they are societal wild cards, who can go ‘postal.’ There is no time limit on that because the re-adjustment is not occurring.
Hark back to the
It is a very deep issue. It is like all these vets went through the breaking down portion of brainwashing and are still unglued. The complication is that only those of similar experience can be trusted, so 'talk therapy' is limited and useless done by those who don't know the blunt experience or war, firsthand. You see how our friend reacted when asked to talk about his experiences. It is like saying 'have a hypnotic regression NOW' and they are back 'in it', immersed in toxic traumatic memories. They don't want to think about or discuss it, yet are compelled to do so internally -- physiologically always on Red Alert.
I have some therapeutic processes that do NOT use the historical or realtime dimension, but work through metaphor. It helps clients move from the 'storm' to a calmer place, but without regressing them BACK into the situation. I think you've seen enough colleagues in this state to realize what I am saying and why normal 'adjustment' therapies and talk are just too mild. One has to help them rebuild and mend their personality from the ground up.
Further, there is tremendous shame associated by themselves and the military for being in this state. Also, this extends to their collective, and their relationship with society. No one likes to think that 'something is profoundly wrong with me.' And asking for help is taboo and compounds the shame professionally, at home and at large.
These are just a few of the immediate challenges. Halfway houses may compound the sense of separation and isolation, most wanting to return home. The former are usually used for addiction behavior, so there is the implication. Shall we call it "Addicted to War"?
We take our best and brightest and impose this on them instead of finding other solutions to our cultural greed to consume a disproportionate amount of the global resources. The least we can do is commit to healing them once we've assured the rest of their lives will be disrupted. You know I have personally dealt with those of
If someone in our group has a viable treatment option, I would sure like to hear it, because as usual I am skeptical of half measures. Further, who is supposed to PAY for this treatment, which is not brief and likely will not come to any form of therapeutic 'closure.'
Where are the clinical directors and large numbers of available suicide prevention experts for such a program, which is tough duty in itself. Much more that halfway houses and halfway measures are required. Who among us has any expertise in the treatment end? And what are they thinking regarding actual treatment? What is the method of changing the toxic internal dialogue? How can we translate what we know about ‘ordinary’ PTSD to the extreme and recurrent issue of the battle arena? What can we do when soliders bring the battle home?
When You Can’t Just Stop
What happens when you can’t help yourself, can’t stop the racing thoughts and psychphysical symptoms of fight/flight that accompany them? What happens when there is no “escape” from compulsive thoughts and alienation? What happens when suicide seems the only possible release? What is the remedy for such a Dark Night of the Soul, not just behaviorally but spiritually? PTSD is a disorder of the soul as well as of the mind. What happens when the life-giving magic is sucked out of a person by harsh realities too overwhelming to deal with? What could possibly be a creative solution to such misery?
The concept of the internal dialogue is only of use to us by stopping it. The issue isn't whether violence is caused by the internal dialogue, but the fact that we are mesmerized by the internal dialogue. Stilling the internal dialogue leads us into a separate reality.
Stopping the internal dialogue is much more powerful than a mantra, which is a lame way of doing the same thing which can become a mesmerizing distraction. The way of the hunter is to focus silently on the second attention without the distraction of the internal dialogue leading us back into the merry-go-round of uncontrolled folly.
PTSD Culture - We are All shellshocked by Shock Doctrine
What is Shellshock?
Post-traumatic stress is a disorder, that automatically implies a chaotic state of being. The experiences that tend to induce PTSD include combat trauma, crimes, rape, grief, kidnapping, natural disasters, accidents, torture, and imprisonment. Predisposition to dissociation can arise in violent family environments.
Those with PTSD become hypervigilant and hyperreactive to environmental threat, real or imagined. The frozen traumatic syndrome is ever present and unchanging. Emotionally, it is as if it keeps on happenING. State-related learning and memory encoding help maintain the trance-like steady state. Depression, shame, anxiety, substance abuse, over-medication and survivor guilt are complications.
The nucleus of the disorder is a physioneurosis, somatization, depersonalization, and dissociation. Psychosomatic symptoms are expressions of the dissociation. Therapy proceeds by facilitating information transduction between them. Sufferers exhibit poor impulse control and explosive aggressive reactions. There are persistent and profound alterations in stress hormone secretions and immune function.
Therefore, PTSD is a toxic biochemical cascade that prevents homeostasis or recalibration of the whole person. They cannot “stand down.” Integration of traumatic memories proceeds by verbal and nonverbal means in therapy. However, time does not heal all wounds.
Different treatments are needed at different stages of posttraumatic adaptation. Consciousness restructuring offers a way of restructuring the frozen structure of this disorder at the most fundamental level, in the sensory terms in which it is encoded. The healing processing and imagery must come from within the individual, not be imposed or mandated from without.
PART II: WHAT IS POSTTRAUMATIC STRESS DISORDER?
The development of a chronic trauma-based disorder is qualitatively different from simple exaggeration of the normal stress response. In those affected, a cascade of biobehavioral changes leads far beyond simple conditioning. Symptoms are intrusive and lead to hyperarousal and/or avoidant behavior. Frightening and vivid flashbacks are the most striking phenomenon. Prime victimization comes from memories of the event, rather than simply the event itself. Development of PTSD depends on personality and genetic make up, and on whether or not the trauma was expected. Prolonged exposure to severe trauma may cause permanent psychological scars.
Dissociation at the moment of the trauma has been shown to be an important factor in developing full-blown PTSD. Therefore, adults with a predisposition from childhood in chaotic, threatening, sexually abusive or violent families are at greater risk. Dissociation is characterized by feelings of detachment, estrangement, depersonalization, an unusual sense of one’s own reality, being an outside observer of one’s own actions and body, feeling like an automaton, or as if in a dream. Ability to feel emotions of any type, (especially those associated with intimacy, tenderness, sexuality), is markedly decreased, as is ability to express angry feelings. Attacks appear like a psychological seige, therefore “bunkering” mentality prevails.
Flashbacks can be triggered by overreactions to sounds, smells, feelings, or images. During the flashback, the person relives the traumatic event and may completely lose touch with reality, suffering through the trauma for minutes or hours at a time, believing that it is actually happening all over again. There is activation of sensory areas of the brain during flashbacks, right-hemispheric activation, and limbic-system activation.
The psychological function of emotions is to alert us to pay attention to what is happening, so that we can take adaptive action. Generally, we stop having an emotional response when we have realigned our expectations of what is supposed to happen with what is actually happening. We either take action that adjusts the given situation to our expectations, or change our expectations to fit better with what is actually going on.
But in PTSD, emotional arousal and goal-directed action are disconnected from one another because of emotional numbing. Arousal is no longer a cue to pay attention to incoming information. There is no gap between stimulus and response with fight-flight reactions. They either freeze or overreact. The emotions of fear, terror, and helplessness characterize any traumatic event, and avoidance of these feelings would seem to be the result, but chronic reenactment of the damaging event is compulsive.
Those with PTSD are more sensitive to sound intensities than average. They are “reducers” in whom inhibitory feedback loops are activated to dampen a tonic state of hyperarousal. They have difficulty neutralizing stimuli in the environment in order to attend to relevant tasks. To compensate, they tend to shut down, which of course means decreased involvement in ordinary, everyday life. Rather than reacting to the daily environment flexibly, they react to internal stimuli that are irrelevant to current demands.
Trauma effects the hormones of both brain and body creating more psychophysical stress.
Intense distress is accompanied by release of stress-responsive neurohormones which seek to mobilize the energy required to deal with the stress. Chronic and persistent stress inhibits the effectiveness of the stress response and produces desensitization and sleep disturbances combined with hypervigilance.
Time does not heal all wounds. Therapy allows an inner search for healing alternatives within the “deeper” state-dependent psychobiological levels until the sought-for structure is transduced into the verbal level and emerges as a new psychophysical form. The recursive process which manifests in flashbacks and immersive rumination is facilitated, unblocked, and allowed to flow to its healing conclusion. This creates a shift in recurrent intrusive recollections and in recurrent distressing dreams and nightmares.
CRP helps probe into the state-dependent patterns of physiology, memory, and learning that have been encoded during circumstances of stress-released epinephrine by the autonomic nervous system and related responses by the endocrine and neuropeptide systems, and their related existential meanings and sensory images. It provides a healthier means of dissociation and reiteration leading to creative self-organization.
DIAGNOSIS OF POSTTRAUMATIC STRESS DISORDER
The diagnostic criteria for PTSD are listed in the DSM IV:
A. The person has been exposed to a traumatic event in which both of the following were present:
(1) The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.
(2) The person’s response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior.
B. The traumatic event is persistently reexperienced in one or more of these ways:
(1) Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: in children, repetitive play may occur in which themes or aspects of the trauma are expressed.
(2) Recurrent distressing dreams of the event. Note: in children, there may be frightening dreams without recognizable content.
(3) Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: in children trauma-specific reenactment may occur.
(4) Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
(5) Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspects of the traumatic event.
C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:
(1) Efforts to avoid thoughts, feelings, or conversations associated with the trauma.
(2) Efforts to avoid activities, places, or people that arouse recollections of the trauma.
(3) Inability to recall an important aspect of the trauma.
(4) Markedly diminished interest or participation in significant activities.
(5) Feeling of detachment or estrangement from others.
(6) Restricted range of affect (e.g. unable to have loving feelings).
(7) Sense of foreshortened future (e.g. does not expect to have a career, marriage, children, or normal life span).
D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:
(1) Difficulty falling or staying asleep.
(2) Irritability or outbursts of anger.
(3) Difficulty concentrating.
(5) Exaggerated startle response.
WHAT CAUSES POSTTRAUMATIC STRESS DISORDER?
Any overwhelmingly stressful life situation (surgery, war, natural disaster, robbery, traumatic bereavement, torture, physical battery, accident, rape, malnutrition, etc.) that stimulates excessive arousal by the autonomic and endocrine systems can lead to the symptomology of post-traumatic stress. State-dependent memory, learning, and behavior (SDMLB) is the essential feature of posttraumatic stress syndrome, and the many more subtle dysfunctions associated with it. Fear-conditioning and parasynaptic cellular modulation mediates SDMLB, (Rossi, 1986).
PTSD seems to be the basic process underlying Freud’s original concept of the “traumatic neurosis” as the organic basis of psychopathology. Therefore, the entire history of depth psychology and psychotherapy can now be understood as a prolonged clinical observation of how dissociated or state-dependent memories remain active at unconscious levels, giving rise to “complexes.” These complexes are the source of psychological and psychosomatic problems.
Trauma affects our capacity to regulate bodily homeostatsis. Even years after the trauma has ceased, memories continue to dominate people’s perceptions, and affect capacity to think and make sense out of current experience. Psychological interventions can only effect the degree of reversal of a disorder with such strong biological underpinnings.
Healing those who develop PTSD in the aftermath of overwhelming experience is a complex process, whose dynamics cannot be described like a cookbook recipe--it requires tremendous sensitivity and intuition. Reestablishing a sense of personal safety and equilibrium is a primary goal of all treatment, and this happens within the therapeutic alliance.
Recognition of each person’s unique situation and reactions is paramount. It is critical that the therapist continue to take stock of the safety of the relationship and progress in achieving therapeutic goals. Participants are encouraged to make meaning of their life experiences when they feel personally supported by their therapists. A primary goal is to not retraumatize the person with therapies that force them to relive the original trauma in historical, rather than metaphorical or sensory terms, or compound the episodes with fallacious material.
Because traumatic memories are stored in state-dependent fashion, they are often rendered inaccessible to verbal recall for prolonged periods of time. Because memories are dissociated, they are stored outside of ordinary awareness, and expressed in incomprehensible symptoms as physical ailments, behavioral reenactments, and vivid sensory reliving experiences. Reenactment of the trauma in personal and social relationships is a major source of shame for the victims and is a source of ongoing tragedy.
Constricted ego functioning is a feature of all traumatized individuals. It is even more complex when traumatization comes in childhood, because trauma early in the life cycle fundamentally affects maturation of systems in charge of regulating psychological and biological processes. It can result in lack of emotional control, destructuve behavior against self and others (or animals), brutality (victim/victimizer), learning disabilities, somatization, dissociative problems, and distortions in concepts about self and others.
Reaction to trauma is a process of adaptation over time. In Chaos Theory, attractors describe the characteristic behavior of a dynamical system changing over time. Traumatic events, especially chronic events, act as “strange attractors” in consciousness which keep everything in their orbit, cycling wildly, unpredictably, but within the parameters of the attractor, reiterating the same cues over and over. Memories are embedded in all layers of psychophysical self in, what is known in Chaos Theory, as infinite nesting.
Psychological siege describes the dominance of trauma in memory and its crucial maintenance over time. The feeling of being constantly beseiged or barraged leads to a bunkering mentality which may be acted out, particularly in combat veterans. Over time some people’s PTSD may become subclinical, and yet it may continue to influence their level of functioning.
PTSD is the result of complex interrelationships among psychological, biological, and social processes--one that varies depending on the maturational level of the victim, as well as the length of time for which the person was exposed to the trauma, and the source of the trauma. Central to understanding these processes is awareness of the nature of traumatic memory and its biological substrates that lead to the dominance of the trauma in memory and to its maintenance over time.
Social cues are important for recovery -- whether people are encouraged to attend to their pain and learn from the past or cultivate a “stiff upper lip,” suppressing the profound meaning of their experience. There is often resistance to acknowledging the trauma or depth of its impact. Reality can profoundly and permanently alter people’s psychology and biology. Individuals make a choice whether to examine their reactions to the trauma in order to overcome it, or ignore it and try to go on with their lives. There is a range of reactions from acute trauma to long-term outcome.
The inner structure of the disorder overlaps catagories of dissociative disorder and stress responses. Adjustment disorder, grief reactions, and a variety of characterological adaptations are germaine. The interaction between external events and subjective response can vary widely, even among victims of the same trauma, based on internal processing and approach to life in general.
Predisposition and vulnerability reflect on recovery from acute symptomology and long-term resilience. Critical issues include the emergence of chronic patterns of adaptation, in which lack of involvement in current reality, rather than preoccupation with the past are the most pathological features.
The ways people view themselves and their world can be compounded by a host of self-destructive behaviors (e.g. suicide attempts, self-multilation, and eating disorders). Complexity of adaptation includes both hormonal and autonomic nervous system dimensions. This includes unusual patterns of cortisol, norepinepherine, and dopamine metabolite excretion; the role of serotonergic and opioid systems (arousal and numbing); receptor modification by processes such as kindling; and involvement of central pathways involved in the integration of perception, memory and arousal.
Traumatic memories are qualitatively different from memories of ordinary events, in that amnesia co-exists with vivid recollections. Information processing and dissociation affect a person’s ability to perceive and integrate overwhelming experiences. Dissociative fragmentation of the self is common, leading to shattered psyches and lives.
Trauma is particularly devastating in childhood, including traumatic bereavement. Because of their dependence on caregivers, their incomplete biological development, and immature self-concepts and concepts of surroundings, children have unique patterns of reaction and needs for intervention. Although they may suffer from subclinical PTSD in middle age, memories recur and come to dominate their lives as seniors. There is generally greater lack of flexibility or capacity to repair damage with increasing age.
CONVENTIONAL TREATMENT OF PTSD
In actual practice, most clinicians use an eclectic approach, in which we must constantly reevaluate what is being accomplished. The core symptoms of PTSD (including paranoia, intrusions, numbing, and hyperarousal), occupational disabilities, dissociative phenomena, and interpersonal problems and alienation may all need widely different approaches. Treatment, therefore, depends in large part on clinical judgement.
In order to respond to current life and reach their fullest potential, people need to regain control over their emotional responses. It helps to place the trauma in the larger perspective of their lives--as a historical event (or series of events), that occurred at a particular time in a particular place, and that can be expected not to recur if the traumatized individuals take charge of their lives.
The key element is integration of the alien, the unacceptable, the terrifying, and the incomprehensible; the trauma must come to be “personalized” as an integrated aspect of one’s personal history. The therapeutic relationship is the cornerstone of effective treatment.
Critical incident stress debriefing has been proposed as a way of modifying the stress reactions of emergency service workers. Acute stress reactions, with the absence of stable symptom patterns and extreme degrees of physiological hyperarousal at this stage mean that there are unique problems in the treatment of this group.
Traumatized people with high levels of avoidance are often most reluctant to expose themselves to their traumatic memories, even when they seek help. Systematic desensitization and Eye Movement Desensitization and Reprocessing (EMDR) have been applied with limited results. Any positive results with EMDR probably come from mimicing the REM state.
Representations of trauma are more complex than roles like “perpetrator,” and “victim”. They are embedded in numerous affect states, defenses, object relations, and deep meaning configurations. Pertinent to these are subjective decision points in which critical self-judgements are embedded.
They include insufficient anticipation of danger, naive trust, impossible choices, guilt and shame, and terror at revealing the content of the traumatic experience to someone new. Other elements include temporally continguous ego states, such as splitting, denial, and dissociation, coupled with temporally contiguous fantasy states, such as murderous vengeance and wishes to die. Intrusions can also remind the person of moments of fantasied safety within the trauma.
The conventional view is that hyperarousal, sleep disturbances, and embeddedness of the trauma makes effective pharmacological treatment essential. Whether antidepressant, antianxiety, or sleeping medications are prescribed or not, dealing with traumatized people requires a staged process of treatment that is responsive to how much the victim can tolerate. Here again, the specific nature of the therapeutic relationship is a critical variable in outcome.
PTSD plays a role in the dysregulation of neurohormones and their roles in the stress response. Intense stress is accompanied by the release of endogenous, stress-responsive neurohormones, such as the catecholamines (including epinephrine and norepinephrine), serotonin, hormones of the hypothalamic-pituitary-adrenal (HPA) axis (including cortisol and other glucocorticoids, vasopressin, oxytocin), and endogenos opioids. These stress hormones help us mobilize energy required to deal with emergency stress by increasing glucose release for quick energy and enhancing immune function. Chronic stress inhibits their effectively and induces desensitization.
Drug therapy for PTSD is based on several biological models and has a few different purposes, (which also can be met with CRP’s intregrative approach). (1). Noradrenergic dysregulation is treated with MAO inhibitors, tricyclic antidepressants, beta-adrenergic blockers and benzodiazepines to calm the body’s alarm center. (2). Serotonergic dysfunction is treated with antidepressant SSRIs to regulate stress resilience, sleep, and for impulse control. (3). Anti-kindling drugs, such as carbamazepine, allegedly regulate an excitability threshold that has been lowered. (4). Anxiolytic drugs, such as clonazepam and buspirone are given in an attempt to reduce the startle response, which is one of the most persistent symptoms of PTSD.
The principle goals of using medication in PTSD are as follows:
1. Reduction of frequency and/or severity of intrusive symptoms.
2. Reduction in the tendency to interpret incoming stimuli as recurrences of the trauma.
3. Reduction in conditioned hyperarousal to stimuli reminiscent of the trauma, as well as in generalized hyperarousal.
4. Reduction in avoidant behavior.
5. Improvement in depressed mood and numbing.
6. Reduction in psychotic or dissociative symptoms.
7. Reduction of impulsive aggression against self and others. (Davidson, van der Kolk).
Intrusion is the active force creating anxiety.
Psychiatrist Mardi Horowitz catalogued these intrusions, and Goleman lists them in Vital Lies, Simple Truths (1985). They refer to unbidden ideas and pangs of feeling which are difficult to dispel, and of direct or symbiotic behavioral reinactments of the stress event. They are unbidden thoughts and feelings impinging on awareness. Every variety of intrusion is some aspect of the stress response taken to an extreme. They include the following:
* Pangs of emotion, waves of feeling that well up and subside rather than being a prevailing mood;
* Preoccupation and rumination, a continued awareness of the stressful event that
recurs uncontrollably, beyond the bounds of ordinary thinking through of a problem;
* Intrusive ideas, sudden, unbidden thoughts that have nothing to do with the mental task at hand;
* Persistent thoughts and feelings, emotions or ideas which the person cannot stop once they start;
* Hypervigilance, excessive alertness, scanning and searching with a tense expectancy;
* Insomnia, intrusive ideas and images that disturb sleep;
* Bad dreams, including nightmares and anxious awakening, as well as any upsetting dream. The bad dream does not necessarily have any overt content related to a real event.
* Unbidden sensations, the sudden, unwanted entry into awareness of sensations that are unusually intense or are unrelated to the situation at the moment.
* Startle reactions, flinching or blanching in response to stimuli that typically do not warrant such reactions.
Anxiety swamps attention; denial can erase anxiety. The forms of denial include:
* Avoided associations, short-circuiting expected, obvious connections to the event that would follow from the implications of what is said or thought.
* Numbness, the sense of not having feelings, appropriate emotions that go unfelt.
* Flattened response, a constriction of expectable emotional reactions.
* Dimming of attention, vagueness or avoidance of focusing clearly on information, including thoughts, feelings, and physical sensations.
* Daze, defocused attention that clouds alertness and avoids the significance of events.
* Constricted thought, the failure to explore likely avenues of meaning other than the obvious one at hand; an abbreviated range of flexibility.
* Memory failure, an inability to recall events or their details, a selective amnesia for telling facts.
* Disavowal, saying or thinking that obvious meanings are not so.
* Blocking through fantasy, avoiding reality or its implications by fanciful thoughts of might have been or could be.
The operative principle that unites these forms of denial is that they are all ways of blanking from awareness a troubling fact. These tactics are countermoves to the intrusions listed previously. Denial and intrusion are two sides of attention, the one an avoidance, the other an invasion.
Self-deception involves forgetting and forgetting we have forgotten. Repression creates no trace when it is in progress--it is the sound of a thought evaporating.
There are secrets we keep even from ourselves. They are retrievable only under the most extraordinary circumstances, since the essence of repression lies simply in the function of rejecting and keeping something out of consciousness. It suppresses the single class of items which evoke psychological pain. This fear-based pain can be of many varieties: trauma, “intolerable ideas,” unbearable feeling, anxiety, guilt, shame, etc.
Repression lessens mental pain by creating a blind spot as does its cousin denial. It protects a core of forbidden information. The nearer to that core one probes the greater the resistance. The deepest schemas encode the most painful memories, and are the hardest to activate.
Defensive postures include:
* Repression. Forgetting and forgetting one has forgotten.
* Denial and Reversal. What is so is not the case; the opposite is the case.
* Projection. What is inside is cast outside.
* Isolation. Events without feelings.
* Rationalization. I give myself a cover story.
* Sublimation. Replacing the threatening with the safe.
* Selective inattention. I don’t see what I don’t like.
* Automatism. I don’t notice what I do.
American Psychological Assn., DSM IV
Blackmore, Susan, The Meme Machine,
Brodie, Richard, Virus of the Mind, Integral Press, 1995.
Goleman, Daniel, Vital Lies, Simple Truths: The Psychology of Self Deception, Simon and
Lynch, Aaron, Thought Contagion, Basic Books, 1996.
Rossi, Ernest, Psychobiology of Mind-Body Healing, W.W. Norton & Co., Inc.,
Rossi, Ernest and Cheek, David B., Mind-Body Therapy, W.W. Norton & Co., Inc.
Swinney, Graywolf, Holographic Healing, Asklepia Pub., 1997.
Vallee, Jacque, Dimensions, Contemporary Books,
van der Kolk, Bessel; McFarlane, Alexander; Weisaeth, Lars, Editors;Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society, Guilford Press, New York, 1996.
Jamail, Dahr, "Iraq War Veteran on a Mental-Health Mission" Truthout, Saturday 21 November 2009