PTSD and Trauma
Just because you haven't experienced combat doesn't mean your trauma is not real.
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PTSD and Trauma in Depression and Bipolar. Although the link between past events and present behavior is not fully understood, a picture is emerging of a biologically vulnerable brain being rendered even more vulnerable by horrific events. This makes us sitting ducks for even routine stresses in our daily lives. Our brains become oversensitized to the point where our entire world feels unsafe.
The Freudian view of mental illness was that our strange and often scary behaviors were maladaptive reactions to stress, fueled by early trauma. Of all things, this is reemerging as the modern view.
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Fifty percent of those diagnosed with bipolar report incidents of childhood trauma. Throw in adult trauma - or simply the stresses of modern life - and we are certainly talking about just about all of us. On top of that, trauma enormously complicates the course of depression and bipolar. This raises the rather obvious question that maybe we should be putting a lot more emphasis on treating the trauma - namely to find and fix whatever it is that is driving our moods.
Thus, if a treatment works for PTSD, maybe we should be applying it - off-label, if necessary - to dealing with our own particular trauma issues, as well.
So – what is PTSD? According to Francine Shapiro, the originator of eye movement desensitization and reprocessing (EMDR) in a 2012 NY Times blog, PTSD “occurs when an experience is so disturbing that it disrupts the information processing system of the brain.” Memory of the incident is stored, replete with its unexpurgated emotional content. When these memories are triggered by current events, “encoded negative emotions, thoughts and sensations can emerge and color the perception of the present.”
The DSM mandates that the individual experience a major trauma, such as rape or a battlefield experience. But Dr Shapiro points out that for many of us, PTSD symptoms can result from less dramatic events, such as hurtful childhood experiences. One could argue that the event need not have any significance. Trauma is trauma, no matter what the real world cause, just as depression is depression, mania is mania, and so on.
(Note: in a much different context, in numerous articles, I make the argument that depression is NOT depression, etc. See, eg: Depression: What Is It?)
As it happened, the PTSD diagnosis had its roots in the observable phenomenon of soldiers mentally falling apart from the horrors of combat. Needless to say, this severely colored how the diagnosis came to be applied to those who never experienced combat.
According to Nancy Andreasen, the person responsible for the DSM-III version of the PTSD diagnosis (the DSMs IV and 5 do not significantly vary), in an editorial in the 2004 American Journal of Psychiatry:
Giving the same diagnosis to death camp survivors and someone who has been in a motor vehicle accident diminishes the magnitude of the stressor and the significance of PTSD.
Do you detect a fatal flaw in Dr Andreasen’s logic? Many death camp survivors - most notably the Italian writer Primo Levi - also experienced severe depression. In 1987, Levi fell victim to suicide. According to Nobel Laureate Elie Weisel, "Primo Levi died at Auschwitz forty years earlier."
So, would we deny recognizing and treating the depression in a person who can’t get out of bed in the morning on the basis that it would diminish the death camp hells that Primo Levi went through? Of course not.
Depression and bipolar and other illnesses had their origins in everyday life. PTSD came out of the heat of combat. It is an historical anomaly, but hardly a biological fact. Ironically, biological psychiatry tends to lose sight of that.
This article is the second in a three-art series. Previous article: Facing Trauma Next article: Treating Trauma
Published Sept 1, 20012
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