After experiencing a traumatic event, the mind has been known to horde away the details and memories and then send them back at unexpected times and places, sometimes after years have passed. It does so in a haunting way that makes the recall just as disturbing as the original event. Post Traumatic Stress Disorder is the name for the acquired mental condition that follows a psychologically distressing event “outside the range of usual human experience” (Bernstein, et al). There are five diagnostic criteria for this disorder and there are no cures for this affliction, only therapies which lessen the burden of the symptoms.
The root of the disorder is a traumatic event which implants itself so firmly in the mind that the person may be shackled by the pain and distress of the event indeinately, experiencing it again and again as the mind stays connected with the past rather than the present, making it difficult to think of the future.
The research on this topic is all rather recent as the disorder was only added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in the last twenty years. Yet, the disorder is quite common, threatening to control and damage the lives of approximately eight percent of the American population [5% of men and 10% of women]. Any person is a potential candidate for developing PTSD if subject to enough stress. There is no predictor or determining factor as to who will develop PTSD and who will not. Although all people who suffer from it have experienced a traumatic event, not all people who experience a traumatic event will develop PTSD. Each persons individual capacity for coping with catastrophic events determines their risk of acquiring PTSD. And not everyone will experience the same symptoms; some may suffer only a few mild symptoms for a short period of time, others may be completely absorbed, still others who experience great trauma may never develop any symptoms at all (Friedman).
More than any other psychological problem, symptoms are a reaction to an overwhelming external event, or series of events. From a historical perspective, the concept of PTSD made a significant change in the usual stipulation that the cause of a disorder could be outside of the self, rather than some inherent individual weakness (Friedman).
There are many situations that may lead to developing PTSD, including: “serious threats to one’s life or well being, or to children, spouse or close friends/relatives; sudden destruction of home or community; and witnessing the accidental or violent death or injury of another” (Bernstein, et al).
Characteristic symptoms include re-experiencing the event, avoidance of stimuli associated with the event or numbing of general responsiveness, increased arousal not present before the event, and duration of the disturbance for at least one month (Johnson).
When a bomb exploded the Oklahoma Federal building in 1996, hundreds of lives were affected. Not only are the people who were in the explosion in danger of re-experiencing it over and over, but so are the people who witnessed the aftermath, from bystanders to the rescue workers on scene. The surviving employees not only were physically injured in the blast, but saw the deaths of their coworkers and children. Surviving a horrific trauma that many others did not is enough to cause serious emotional harm. For the rescue workers who arrived, many of them saw death and people who they could not help; feeling helpless and guilty may manifest into intrusive recollection and nightmares.
To explain further, the first criteria is that the person was at one time exposed to a traumatic event involving actual or threatened death or injury, where the response was marked by intense fear, horror or helplessness (Pfefferbaum). This event may have taken place only weeks ago, or as far back in memory as forty years. The disorder is most commonly found among survivors of war, abuse and rape. It also occurs after assorted crime and car accidents, as well as after community disasters such as hurricanes and floods. Workers of rescue missions are subjected to situations of severe stress frequently. Many emergency response workers (police, nurses, and medics) may become overwhelmed by the trauma they see so many people go through and end up with intrusive recollections themselves.
Secondly, the trauma is re-experienced in the form of nightmares, flashbacks, intrusive memories and/or unrest in situations that are similar to the traumatic experience by an associated stimuli (Pfefferbaum). Auditory or visual stimuli can evoke panic, terror, dread, grief or despair. Commonly, in the case of war veterans, the patient may be mentally “sent back” to the time and location of the original traumatic experience. A veteran who hears a startling noise like a car backfiring may “hear” gunfire and it will trigger flashbacks. These flashbacks can last a little as a few seconds, minutes, or up to days where the person behaves and reacts to everything as if they are in that original traumatizing setting.
Thirdly, there is a numbing of the emotions and reduced interests in others and the outside world. The person is attempting to reduce the likelihood that they will either expose themselves to traumatic stimuli or if exposed will minimize the intensity of their psychological response (Pfefferbaum). For this reason, it is extremely difficult for people with PTSD to participate in meaningful interpersonal relationships.
Forth, there are random associated symptoms including insomnia, irritability, hypervigilance and outbursts of rage. The natural startle inhibitor may be dulled and the patient is easily surprised or upset by unexpected stimuli.
Lastly, symptoms of each category must show significant affect on the person’s social/vocational abilities or other important areas of life. Which appears to be an unavoidable effect if a person is in fact experiencing the symptoms listed. All of these symptoms must persist for at least one month
An example from the textbook Psychology introduces a 33-year-old nurse named Mary who suffered severe trauma in the weeks following an attack in her apartment by an intruder who raped her at knife point (Criterion one). In the weeks after the attack Mary suffered from an immense fear of being alone in her apartment (the second criterion), and preoccupied with attack, she feared it could happen again. Her worry developed in to an obsession with protection and she installed numerous locks on all her windows and doors, eventually Mary became so overly preoccupied with the attack that she could no longer go out socially or even return to work (Criterion three and five). She became repelled by the idea of sex. Her associated behaviors encompass criterion four.
In the seven years since the Gulf War, three percent of United States Soldiers have so far been diagnosed as having Posttraumatic Stress Syndrome. Those with greatest exposure to combat are the most likely sufferers, which lends to the idea that the more severe a traumatic event are more difficult it is to overcome. Additionally it develops predominantly in soldiers who were categorized as having the least “stress resistant personalities” coupled with low levels of social support. Essential to recovery of any stressful event is the knowledge that the sufferer is not alone or unique in the grief and that others care about his or her recovery. Those soldiers who returned from war with no one to share their experiences with are likely to re experience warfare in the form of nightmares and flashbacks. After witnessing the deaths of both enemies and comrades those without social support are likely to internalize their pain which have a good chance of escaping out of the body in the symptoms listed (Bernstein).
“Acute” PTSD occurs within six months of the traumatic event, while “Delayed On-set” PTSD occurs anytime afterwards. In some instances, patients have developed symptoms decades later. Holocaust survivors, experiencing terrifying nightmares of events they thought they had buried so long ago, have been diagnosed forty and fifty years after the attempted genocide of the Jews with PTSD.
PTSD can become a chronic psychiatric disorder that can persist for decades and sometimes a lifetime. Chronic patients go through periods of remission and relapse like many diseases.
Some problems associated with leaving PTSD untreated are clinical depression and addictions, such as alcoholism, drug abuse, and compulsive gambling. Addictions are a common way of “self-medicating.”
There are instances when a person suffers from involuntary recall of events that they cant quite place or understand. Sometimes adults who were abused in some form as children do not fully know what is tormenting them but still struggle with similar symptoms. For these people hypnosis in a controlled environment is beneficial. After hypnosis the patient and doctor will discuss what has come out and together deal with what has been learned. Drugs in general are not a cure for Post Traumatic Stress Disorder, but they can calm the patient long enough to rationally discuss what is torturing them. Also it is possible that children who survived the Oklahoma bomb blast may not be told for some time what they lived through. Their first recollections may be hazy pictures that only hint as to what happened. Hypnosis may bring out the details that the mind isn’t willingly sharing. When the details are known the patient then has the opportunity to accept them and develop an understanding and an acceptance (if they are lucky enough to get that far) of what they have survived (Foy).
Therapy is the only known method of treatment, but there have not been substantial gains in this field for recovery of patients. After four months of intensive treatment, Vietnam veterans showed no long term effects of their therapy in a study conducted by the “National Center for Post-Traumatic Stress Disorder” in New Haven. The men received individual and group psychotherapy and behavior therapy as well as family therapy and vocational guidance. Although they left reporting increased hope and self-esteem, a year and a half later their psychiatric symptoms had actually worsened. They had made more suicide attempts and their substance abuse was dramatically increased (Johnson).
The Harvard Mental Health Letter published February/March of 1991 asserts the important result of therapy (of any kind) is the enabling of the patient to think about the trauma without it taking over and being able to control their feelings without systematically avoiding or diverting their attention. People who are afflicted with PTSD never feel safe because they are controlled by their fears; nightmares and flashbacks only confirm their perceived helplessness and remind them of how they were unable to protect themselves from the event. Healing has taken place only when the person can invoke and dismiss the memories at will, instead of suffering the intrusive involuntary recall (Johnson).
Bernstein, Douglas A., Alison Clarke-Stewart, Edward Roy, Christopher D. Wickens. Psychology. Boston: Houghton Mifflin Company, 1997
Bower, Bruce. “Exploring trauma’s cerebral side.” Science News. 149.20 (1996) : 315
Foy, David W., ed. Treating PTSD : cognitive-behavioral strategies. New York: Guilford Press, 1992.
Friedman, Matthew J. “Post Traumatic Stress Disorder: An Overview.” National Center for PTSD. Dartmouth Medical School, 1997.
Johnson, David R., Robert Rosenheck, Alan Fontana. “Post-traumatic treatment failure.” Harvard Mental Health Letter. 13.9 (1997) : 7
Matsakis, Aphrodite. I Can’t Get Over It : a handbook for trauma survivors. Oakland.: New Harbinger Publications, Inc., 1996.
Pfefferbaum, Betty. “Posttraumatic stress disorder in children: a review of the past ten years.” Journal of the American Academy of Child and Adolescent Psychiatry. 36.11 (1997) : 1503-12
“The Harvard Mental Health Letter.” Feb./Mar. 1991. Online. Internet. 14 Oct 1998. Available. http://www.mentalhealth.com/mag1/p5h-pts2.html