Posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) is a mental disorder that can develop after a person is exposed to a traumatic event, such as sexual assault, warfare, traffic collisions, or other threats, either real or imagined. Symptoms may include disturbing thoughts, feelings, or dreams related to the incidents, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in how a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. A person with PTSD is at a higher risk for suicide and intentional self-harm.



A

 * Previous studies have shown that exposure to traumatic events that put one’s life at risk may affect processing of facial expressions. Thus, for example, individuals suffering from PTSD have difficulties in differentiating between fearful and neutral faces (e.g., Felmingham, Bryant, & Gordon, 2003).
 * David Anaki, Tamar Brezniak, Liron Shalom, “Faces in the face of Death: Effects of exposure to life-threatening events and mortality salience on facial expression recognition in combat and noncombat military Veterans”, Emotion, 12(4):860-7 (August 2012), p.860.

B

 * In recent clinical trials, 61 percent of 107 participants no longer had PTSD symptoms two months after MDMA-assisted psychotherapy. Sixty-eight percent were still PTSD-free a year later. In light of findings like these, the FDA recently deemed MDMA a "breakthrough therapy," putting it on the fast track for approval.
 * Joseph Bennington-Castro, “Will Psychedelic Therapy Transform Mental Health Care?”, NBC News, Sep.28.2017

G

 * Psychologists are re-thinking Post Traumatic Stress and other combat-related issues applied to multi-tour combat soldiers. According to [New York] Times writer Benedict Carey, the challenge these days is less emotional healing than how to unlearn the hyper-vigilance and shoot-first, ask-questions-later violence necessary for survival in a combat zone. That is... can experienced warriors be adjusted from a wild, adrenaline-fueled state of barbarism to one emphasizing community and civilization?This is a politically tricky matter, since this sort of question inevitably leads to areas critical of US war policy. It’s notable that the research cited by the May 30 Times story is being conducted in civilian universities...not by the military or the Veterans Administration, federal government agencies naturally reluctant to wade into anything that might be critical of US war policy.
 * Barbarism, Civilization and Modern Politics: PTSD as a Political Football in a Hobbesian Age, CounterPunch, John Grant, (22 June 2016)


 * The new, re-thought hero that would help open a path to healing for this torn nation is the hero who stops trying to argue that our debacles of war were patriotic necessities rather than tragic stepping-stones for further cycles of vengeance and violence. It’s true, we need to better respect and honor our wounded veterans; but we also need to understand that “the wild” brought back by multi-tour combat vets from the “edge of the human circle” is not constructive for community or for civilization itself.
 * Barbarism, Civilization and Modern Politics: PTSD as a Political Football in a Hobbesian Age, CounterPunch, John Grant, (22 June 2016)


 * Normally, when someone [with PTSD] would be instructed to relive the traumatic experience, they would be overwhelmed with fear, anxiety, and despair. But while under the influence of the MDMA, it's as if they can navigate the experience more safely.
 * Charles Grob as qtd. in “Will Psychedelic Therapy Transform Mental Health Care?” by Joseph Bennington-Castro, NBC News, (Sep 28, 2017).

H

 * It was out of all these moments that the idea for Modern Warriors rose. While politicians and media can whitewash a conflict, the legacy always remains for those who fought there. The warriors who left their families, friends, and comfort to do the dirty work of their country. We need to tell those stories. And then veterans come home, with hopes and dreams- and scars of war. They struggle to transition to civilian life; many are wounded (seen and unseen); many wrestle with post-traumatic stress; suicide was taking more lives than the battlefield ever did. We cannot allow ourselves to look away, to shrug, and say that's just the way it is.
 * Pete Hegseth, Modern Warriors (2020), New York: HarperCollins, hardcover first edition, p. xiii


 * Pavlov’s findings were confirmed in the most distressing manner, and on a very large scale, during the two World Wars. As the result of a single catastrophic experience, or of a succession of terrors less appalling but frequently repeated, soldiers develop a number of disabling psycho-physical symptoms. Temporary unconsciousness, extreme agitation, lethargy, functional blindness or paralysis, completely unrealistic responses to the challenge of events, strange reversals of life-long patterns of behaviour—all the symptoms, which Pavlov observed in his dogs, re-appeared among the victims of what in the First World War was called ‘shell shock’, in the Second, ‘battle fatigue’. Every man, like every dog, has his own individual limit of endurance. Most men reach their limit after about thirty days of more or less continuous stress under the conditions of modern combat. The more than averagely susceptible succumb in only fifteen days. The more than averagely tough can resist for forty-five or even fifty days. Strong or weak, in the long run all of them break down. All, that is to say, of those who are initially sane. For, ironically enough, the only people who can hold up indefinitely under the stress of modern war are psychotics. Individual insanity is immune to the consequences of collective insanity.
 * Aldous Huxley, Brave New World Revisited (London: Chatto & Windus, 1959), Chapter 7: "Brainwashing", p. 88

J

 * The impact of relativity was especially powerful because it virtually coincided with the public reception of Freudianism. By the time Eddington verified Einstein's General Theory, Sigmund Freud was already in his mid-fifties. Most of his really original work had been done by the turn of the century. The Interpretation of Dreams had been published as long ago as 1900. He was a well-known and controversial figure in specialized medical and psychiatric circles, had already founded his own school and enacted a spectacular theological dispute with his leading disciple, Carl Jung, before the Great War broke out. But it was only at the end of the war that his ideas began to circulate as common currency. The reason for this was the attention the prolonged trench-fighting focused on cases of mental disturbance caused by stress: 'shell-shock' was the popular term. Well-born scions of military families, who had volunteered for service, fought with conspicuous gallantry and been repeatedly decorated, suddenly broke. They could not be cowards, they were not madmen. Freud had long offered, in psychoanalysis, what seemed to be a sophisticated alternative to the 'heroic' methods of curing mental illness, such as drugs, bullying or electric-shock therapy. Such methods had been abundantly used, in ever-growing doses, as the war dragged on, and as 'cures' became progressively short-lived. When the electric current was increased, men died under treatment, or committed suicide rather than face more, like victims of the Inquisition. The post-war fury of relatives at the cruelties inflicted in military hospitals, especially the psychiatric division of the Vienna General Hospital, led the Austrian government in 1920 to set up a commission of inquiry, which called in Freud. The resulting controversy, though inconclusive, gave Freud the world-wide publicity he needed. Professionally, 1920 was the year of breakthrough for him, when the first psychiatric polyclinic was opened in Berlin, and his pupil and future biographer, Ernest Jones, launched the International Journal of Psycho-Analysis. ij
 * Paul Johnson, Modern Times: The World from the Twenties to the Nineties (1991), ISBN 9780060168339

M

 * "I'll be fine if we'd just move on, sir." "I assure you, these are things you do not just move on from."
 * Man Down (film), directed by Dito Montiel, screenplay by Adam G. Simon, story by Adam G. Simon and Dito Montiel


 * Anger has been found to contribute to a range of difficulties among individuals with PTSD, including aggressive behavior, interpersonal conflict and most recently suicide risk. For example, recent research with military soldiers found that risk of aggression was elevated among soldiers with PTSD and high levels of anger, but not among those with low anger (Wilk et al., 2015). Furthermore, anger appears to play a mediating role in the relationship between PTSD and various presentations of aggression. For example, trait anger has been shown to contribute to the relationship between PTSD and verbal and physical aggression (Bhardwaj, 2019). Additionally, research has provided evidence that combat exposure is associated with aggression and violent behavior, with various studies finding that violent combat experience predicts risk-taking behaviors, criminal behavior, and physical aggression with a significant other (MacManus et al., 2015). Most recently, research has examined anger as an emotional risk factor for suicide (Hawkins et al., 2014; Wilks et al., 2019).
 * Leslie Morland, Eric Elobogen, Kirsten Dillon; “Anger and PTSD”, PTSD Research Quarterly, Volume 31/No.3, p.1


 * Recent research has suggested that the association between PTSD and suicide is driven by comorbid depression (e.g., DeBeer et al., 2016), so it is notable that the studies presented here all covaried for depression diagnosis or symptom severity, suggesting that anger uniquely contributes to suicide risk in the context of PTSD (Dillon et al., 2020a; Hawkins et al. 2014; Wilks et al., 2019). Overall, there is evidence that among individuals with PTSD, comorbid dysregulated anger significantly increases risk for engaging in both interpersonal and self-directed aggression. Furthermore, increased anger appears to play a mediating role between PTSD and these negative outcomes (e.g., Bhardwaj, 2019; Dillon et al., 2020b).
 * Leslie Morland, Eric Elobogen, Kirsten Dillon; “Anger and PTSD”, PTSD Research Quarterly, Volume 31/No.3, pp.1-2

O

 * I have instructed the Joint Chiefs, and up and down the chain of command, that they have a responsibility to de-stigmatize mental health issues and issues of PTSD, and help to explain to everybody in all of the units under their command that there's nothing weak about asking for help.
 * Barack Obama, "5 things you may not know about post-traumatic stress", Sara Cheshire, CNN, (October 4, 2016).

R

 * People with PTSD are afflicted with three primary types of symptoms. The first type of symptoms involves all manner of intrusive memories of the event that often come with startling clarity via flashbacks and nightmares. Along with anything else that reminds a person of the trauma, these intrusive memories produce profound psychological distress and physical symptoms, such as a pounding heart. The second type of symptoms revolves around avoidance and emotional numbing. Bedeviled as they are by unwanted memories, images, nightmares and flashbacks that keep the terrifying reality of their experience emotionally alive for them, people with PTSD often go to heroic lengths to avoid anything in the personal or physical environment that reminds them of the trauma. They often also report feeling emotionally deadened, unable to love and disinterested in things others find pleasurable. Often they feel like they will die young or have less of a future than other people. The third and final symptom domain of PTSD is known as hyperarousal. Hyperarousal symptoms include difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, being hypervigilant and finally, demonstrating an exaggerated startle response. These PTSD symptoms usually don't travel alone, unfortunately, but are frequently accompanied by depression and difficulties with drugs and alcohol.
 * Charles Raison, "PTSD: Know the symptoms and when to get help", CNN, (August 24, 2012).


 * There is another symptom of acute trauma that can be easily missed if you are not on the lookout for it that strongly predicts the development of later PTSD. In layman's parlance, we might call it "being spaced out." More technically, we call it dissociation. When people dissociate, things come apart in a variety of ways. Often they feel separated from themselves, as if they are watching themselves from some outside vantage point. Frequently they feel that there is some type of invisible wall between themselves and the rest of the world. Sometimes they will feel that everything in the world, including themselves, is somehow unreal. I've heard patients describe this experience as being like looking at the world through the wrong end of a telescope, so that everything seems smaller and distorted. In extreme instances, people so thoroughly lose track of things that they develop amnesia.
 * Charles Raison, "PTSD: Know the symptoms and when to get help", CNN, (August 24, 2012).

S

 * For years I have agitated against the diagnostic jargon, Post-Traumatic Stress Disorder (PTSD), because transparently we are dealing with an injury, not an illness, malady, disease, sickness, or disorder. My insistence comes from awareness that within military forces it is entirely honorable to be injured, and that if one is injured and recovers well enough to be fit for duty, there is no real limit to one's accomplishments, even if a prosthesis is employed. Witness the honored career of General Eric Shinseki, who lost a foot in Vietnam, and eventually retired from the U.S. Army as chief of staff. We do not describe him as suffering "Missing Foot Disorder."
 * Jonathan Shay, "Casualties," Daedalus, vol. 140, no. 3 (2011), p. 181.