Does everyone who suffers trauma have PTSD?

http://aeon.co/magazine/living-together/does-everyone-who-suffers-trauma-have-ptsd/

by drjohnson • 12 years ago

57 32 12 years ago

dreen• 12 years ago

very interesting and eye opening read

h1karu3• 12 years ago

MDMA-assisted psychotherapy can be an effective treatment for people who do not respond to traditional therapies for PTSD.

https://www.youtube.com/watch?v=t-4L5vRZ_g8 < three minute rundown that explains MDMA

http://www.mdmaptsd.org/

https://www.youtube.com/watch?v=BNxuRs6tTuw < The Verge / Ecstatic states: treating PTSD with MDMA

http://www.mdma.net/psychotherapy/ptsd.html

Pitarou• 12 years ago

Did you read the article?

h1karu3• 12 years ago

Yes, but I don't wish to discuss 'PTSD diagnosis politics' in this forum instead I'd rather just add value by pointing people to a non-commerical modality that actually works for treating those who suffer from the types of symptoms commonly associated with PTSD.

Alex3917• 12 years ago

The rise of biological psychiatry and its focus on mental illnesses as ‘brain diseases’ had failed to remove the taint of moral and personal failing associated with the majority of psychiatric disorders. But here was a disorder that came packaged with a clear-cut cause that was obviously not the patient’s fault, and which set them in the sympathetic and dramatic light of victimhood.

Actually the original definition of PTSD was only supposed to apply to Vietnam veterans who came back from the war, realized what they had done was morally abhorrent, and were no longer able to function because of that realization. However the committee that wrote the DSM ended up stripping out the all the theory behind the disorder before publication. There is a summary of this here: http://www.vva.org/archive/TheVeteran/2005_03/feature_Histor...

Although the history of PTSD in Ethan Watters book Crazy Like Us is better written.

pmoriarty• 12 years ago

The terminology may be different, but "shell shock"[1] was well known back as early as World War One.

[1] https://en.wikipedia.org/wiki/Shell_shock

robg• 12 years ago

And many stories from even ancient times. War is hell.

jonah• 12 years ago

And the "1,000-yard stare."

SoftwareMaven• 12 years ago

It's hard to read about PTSD and not think of George Carlin: shell shock to combat fatigue to PTSD. I have a mentally ill daughter, and it never ceases to amaze me how poor our knowledge and treatment of mental illness really are. I also can't help but wonder if the DSM is for physicians and pharmacists more than patients. We seem to have gone from no knowledge due to stigma to no knowledge due to symptom-masking drugs (a definite improvement but not remotely near great).

rangibaby• 12 years ago

Here is the George Carlin piece mentioned, from his excellent book "When Will Jesus Bring The Pork Chops". http://youtu.be/CNk_kzQCclo

pyre• 12 years ago

That whole thing just came across as annoying to me:

- I don't agree that calling it Post-Traumatic Stress Disorder somehow shields us from the truth just because it sounds more clinical.

- Not all PTSD is due to combat, so having the term 'vividly' referring to combat doesn't really make sense. How does "shell-shocked" accurately describe a rape victim suffering from PTSD (for example)?

- The terms "combat fatigue" or "shell shock" don't imply the on-going nature of PTSD. The make it sound like all you need is a little R&R and you'll be in tip-top shape.

- Personally, I find the term "shell shock" to have a less serious connotation than PTSD, but this could be my childhood associations of the term with puns about the Teenage Mutant Ninja Turtles (prior to knowing the real meaning of the term).

vacri• 12 years ago

Carlin threw out a lot of populist quotes, but that doesn't mean they translate into actuality. While it's a funny skit, in real terms keeping on calling it 'shell shock' would have been bad - because the PTSD hits you in other situations too. Victim responding badly to a rape? "It's not like it's shell-shock, get over it". That sort of thing. It was called PTSD because the same symptoms were being seen in relation to all sorts of traumatic experiences.

I also can't help but wonder if the DSM is for physicians and pharmacists more than patients.

I think you're overly concentrating on the failings of the DSM rather than the successes. Without something like the DSM, there isn't anything canonical for doctors to compare notes on given diseases, and that is definitely bad for patients.

Also, mental illness is notoriously difficult to diagnose in the first place, which is why it's the weakest area of the DSM, and why there's a lot of overlap between mental illness diagnoses. Mental illness is one of the most difficult areas of expertise in the human experience, if not the most difficult.

mercer• 12 years ago

I like to see much of the field of psychology as similar to 'early' medicine, or perhaps even our current treatment methods for cancer.

The methods are often primitive, inaccurate, and, in hindsight, sometimes even harmful. But we're doing the best we can, and the goal is (generally) good. And often it's better than nothing.

This should not prevent us from criticizing what we deem to be bad or at least faulty solutions, but it is also important to realize that this is an ongoing process, and not to reject the efforts because they're not perfect.

USNetizen2• 12 years ago

The US Army has done a lot of studies in this area of late, and found that a certain percentage of the population is somewhat resistant to PTSD after a traumatic event, but there are upwards of 20% or so that are pre-disposed to it as well (http://www.ptsd.va.gov/professional/newsletters/research-qua...). It's sad that it has taken centuries of warfare for people to wake up to the realization of this and finally just start learning how to identify and treat it.

A good friend of mine, an Iraq war combat veteran, runs a blog and non-profit on this subject as well at http://www.combatveteranswithptsd.com

If only we could do away with the stigma associated with it now which is falsely based much upon wild dramatizations in movies and elsewhere of eccentric, crazy or violent veterans (http://flcourier.com/2013/07/03/post-traumatic-stress-disord...).

001sky• 12 years ago

It is clear than only a fraction of people who are exposed to trauma develop the full syndrome of PTSD. Thus despite the high prevalence of trauma exposure around the world, the lifetime prevalence of PTSD is no more than 7%. At any given point in time, 1 to 3% of the civilian population and higher proportions of Veteran populations will have currently active cases.

re: Title-query of the submitted HN article.

USNetizen2• 12 years ago

OR, only that small fraction is adequately diagnosed. This is a relatively new field, after all, and people fear what they don't understand. Given the stigma associated with it today many people would rather deny it or self-medicate than seek treatment unfortunately.

philwelch• 12 years ago

Anecdotally, this explains a lot. My father was a combat veteran of three wars and had gone through many life-and-death experiences and didn't suffer any of the obvious PTSD symptoms. It was obviously unpleasant for him to think about certain things but he was never afraid to share things he had experienced either.

terranstyler• 12 years ago

As a political side note: I think the amount of personal responsibility of getting PTSD for a voluntarily subscribed soldier is way higher than for civilians finding themselves in a conflict.

I know this doesn't help - neither the soldiers nor the PTSDed civilians, yet, paradoxically, often the former are to some degree responsible for the PTSD of the latter.

graeme• 12 years ago

PTSD gets a lot of press, but post-traumatic growth is widely ignored:

http://en.wikipedia.org/wiki/Posttraumatic_growth

I had cancer, and experienced exactly this. I feel better than before I was diagnosed. I had a particularly low impact form of cancer (testicular, one-side) and feel I'm actually improved for having gone through it.

Not sure how this applies to combat veterans. Some papers indicate post-traumatic growth occurs in ex-POWs.

bane• 12 years ago

We're really at the beginning of understanding PTSD I think.

Some anecdotes:

I spent a few months in a war zone years ago, it was beyond stressful. I didn't participate in any combat, and other than a few close-ish calls, came away relatively unscathed. But I was very "wired" for months and months afterwards. The innocent sound of cars driving slowly on gravel, the popping sound of the rocks under the tires, made me hunt for cover from incoming gunfire for example. I was supremely agitated and on edge for maybe a good year after I got back. But after a while, most of it went away and other than the occasional night sweat but I don't have nightmares or anything else. I'm pretty sure I was just very stressed and my adrenaline reaction was primed for a while, but it's not anymore. I don't believe I have or had PTSD.

I once worked with a Vet, long after he had retired. He was textbook untreated PTSD. Decades after he saw conflict, a loud noise, like a piece of equipment falling on a concrete floor, would send him into immediate action mode, one time diving out of his car at a stoplight when another car backfired. He was highly stressed, argumentative over little things and had lots of trouble keeping a job. I met him when I was working a low waged computer service job in the mid 90s.

My father was in the Korean conflict, landed with MacArthur's forces at Inchon and saw quite a bit of action North of the 38th. He was shot in the leg, spent time in Japan recuperating, got hooked on morphine, beat it, went back in, got shot again and finally made his way home. Along the way, he was field promoted from Sergeant to LT simply because everybody above him kept getting killed. Other than 2 or 3 stories he told me once, he doesn't really talk about it. PTSD wasn't a word back then, so he went entirely untreated. Decades later when it was finally understood to be a thing the stigma meant he never sought treatment (in fact he avoids all things military, won't use VA benefits, or hang out at the VFA, that's how he's been treating his PTSD all these years, avoidance). My father doesn't display really any of the daytime symptoms, irritability, chest pain, hyper-vigilance, etc. But my mother tells me that he's always had night issues. Waking up screaming, reliving nightmares in his sleep, sleep walking. It settled down over the years till it was just a rare occasional thing. My mother tells me that when I announced my engagement to my South Korean wife, his PTSD came back in full force. But then as he got to accept her, it went away just as quickly. I found him one day looking at some old National Geographic Magazines one day, looking at pictures of Korea from around the time of the war, then looking at pictures of Korea from today -- this is the first time he's ever looked at anything Korean since the war. My mother says his night issues appear to have gone away completely.

When I was very young, I got to know Nguyễn Ngọc Loan [1][2] quite well. He was a local businessman near D.C. after the Vietnam war. And my family had gotten to know him and his family well and we frequented his restaurant at the local shopping mall. His kids worked summer jobs for my parent's business and watched me from time to time and I think my father and him even did some business together. Obviously he saw, experienced and participated in some pretty brutal stuff. Little known is that he also lost one of his legs in the war so he got as good as he gave. He complained every once in a while about phantom pain in his leg, but AFAIK didn't suffer from PTSD.

I worked another time with a recent Vet or the Iraq War, his unit was blown up in an IED explosion in Iraq, he was a few meters from the blast and was violently thrown to the side with just a few bruises. A couple soldiers in his unit were not so lucky. The VA classified him as partially disabled with Traumatic Brain Injury and PTSD. He said he had nightmares from the incident and trouble sleeping. To treat his PTSD they put him on some kind of medication, which caused him to balloon in weight, but didn't appear to have resolved his night issues. Which lingered on several years later. Other former soldiers who had seen it worse (some with and without PTSD diagnoses) gave him endless grief over his PTSD diagnosis and his weight gain. He felt like he didn't deserve it and it led to lots of depression and social issues. His symptoms sounded almost exactly like mine, only they hadn't gone away, and being a vet, he was part of a social circle that should have given him more sympathy or understanding, but didn't.

It seems that to me that PTSD shows up in many many forms, and it's very complicated. I think it's likely that we'll start to identify patterns in it and produce some finer grained group of related diagnoses: high stress short-term sensitivity, chronic long term hyper-vigilance, etc. And we'll get to know this family of recognized issues and "PTSD" will seem like a brutish and ignorant way of calling all these different and discrete issues.

1 - http://news.google.com/newspapers?nid=950&dat=19781102&id=MW...

2 - https://en.wikipedia.org/wiki/General_Loan

polarix• 12 years ago

Say we do consider all suffering mental illness, what then?

Surely not all suffering precipitates PTSD, but why not make the broader category of mental illness categorically equivalent to unnecessarily prolonged suffering?

gaoshan2• 12 years ago

I was diagnosed with PTSD after having spent my childhood being raised by a child molester. Since the molester was my dad I could never escape him, could never go to my parent for help. He kept it up for the first 12 years of my life (he told me he started when I was 2 months old). He also did this to my sister and forced us to engage in incestuous behavior to boot. The end result was that we were utterly unprepared for normal, caring, relationships.

I, a shy, weak, easily intimidated young man, reacted very poorly and became the opposite of my father. Unfortunately he is a hard charging, successful go-getter that is considered "Mr. Capable" so I became a slacking, stress avoiding "Mr. Loser". My sister, on the other hand, adopted all of his good traits, earning 2 PhDs from top schools and forging a career as a very highly paid scientist living a luxurious life in LA (and I was the "smart" one, lol). Thing is, we were both damaged quite badly, both attempted suicide, both suffering from debilitating depression, PTSD symptoms, etc.

My salvation, such as it is, came in the form of a loving wife who has nurtured me when needed and helped me grow into a more normal mode of living (this led to me teaching myself to program and finally, at age 45, earning a pretty decent living doing it). She cushioned the things that trigger me, guided me in making correct choices and basically taught me, over the almost 20 years we have been married, to be "normal" and I truly believe she saved my life. Her kindness and understanding has allowed my PTSD symptoms to fade over the years and minimized them when they do appear.

In three words, love saved me.

p.s. if you are a parent and have the sorts of feelings my father did towards us I beg of you to seek help. Please understand that acting on those desires will result in the harming and potential destruction of your children and the utter obliteration of your parent/child relationship. Imagine yourself being confronted by your broken and damaged adult children... do you really want to endure that? Seek help... if you haven't acted on it, you can get it with no consequences. If you have... stop now. On behalf of your children I beg you.

jacquesm• 12 years ago

Holy crap. Both you and your sister have gone through hell, and you still have so much grace. And your wife is an amazing person. I'm not sure if I'll ever be able to write about my own childhood, especially so frank. And yet, compared to yours it was a walk in the park. Thanks for sharing this.

gaoshan2• 12 years ago

Appreciate it, man. I've been confronting it for many years now and writing about what happened gets easier the more often I do so. My wife is indeed amazing. A tough yet gentle, kind yet firm completely reasonable, intelligent, clear minded person. I feel like meeting her was my winning lottery ticket. It's amazing what a kind, reasonable person can do for a disturbed but otherwise "normal" mind.

harimau• 12 years ago

For a historical view of PTSD and warfare, I recommend Lt. Dave Grossman's "On Killing".

I don't agree with his conclusions about video games and violence, but the picture he draws of how soldiers used to demobilize, and how that adjustment period related to coping with PTSD, in different eras can provide some insight into some of the extenuating circumstances around the issue.

Essentially, the speed with which a soldier comes back from combat to the 'real world' (such as a flight from Kabul-Dubai-USA) might exacerbate disorientation and adjustment in our current era. Similar, to a very small degree, to reverse culture shock, etc.

fapjacks4• 12 years ago

FWIW, I have heard recommendations for this book as well. Actually, it was recommended to me by my good friend and former commanding officer, whom I consider to be the best officer I've ever served with.

aosmith• 12 years ago

@bane is right. I had similar experiences. Is it something you can get over? Sure. Is it something you want to get over? Maybe not. I still feel "numb" in day to day life.

Does everyone who suffers trauma have PTSD?

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