Healthy Minds is a 13-part award-winning TV series about the latest research and insights about mental illness, created to help reduce the stigma associated with psychiatric disease, which often prevents patients and their families from getting needed help. This 30-minute segment on PTSD features guests who share their stories and experts who talk about diagnosis and the latest in treatment.
Post-Traumatic Stress Syndrome
[WLIW21] This week on Healthy Minds--post traumatic stress disorder can develop after surviving or witnessing a life-threatening event, including military combat. Guests share their stories, and experts talk about diagnosis and the latest in treatment. That's this week on Healthy Minds. Healthy Minds on WLIW21 is made possible in part by NARSAD. NARSAD is dedicated to supporting innovative scientific research to find the causes, better treatments, and cures for severe mental illness. And by ValueOptions, working with health plans, employers, and government programs, ValueOptions manages behavioral healthcare and substance abuse services for people throughout New York, New Jersey, and Connecticut. By the New York Academy of Medicine, working to enhance the health of people living in cities worldwide through research, education, efficacy, and prevention. By the van Ameringen Foundation. Since 1950, the foundation has supported prevention, education, and direct care programs that seek to promote positive change in the mental health field. And by the New York State Office of Mental Health, promoting the mental health of all New Yorkers. [Healthy Minds] [♪ lively music ♫] [Post-traumatic Stress Disorder - PTSD] Post-traumatic stress disorder or PTSD has been with us for thousands of years, and has a history as old as war itself. The condition was referred to as "soldier's heart" during the Civil War, "shell-shock" during World War I, and "combat fatigue" during World War II. PTSD doesn't confine itself strictly to war. Other traumatic events, such as natural disasters, violent assaults, auto accidents, and terrorist attacks can also cause post-traumatic stress disorder. PTSD affects over 5 million Americans. Not every traumatized person gets PTSD, but for those who do, the important thing to remember is with help, there's hope. [Healthy Minds] [Borenstein] PTSD may develop after exposure to a terrifying ordeal or event, in which there was the potential for serious physical harm or death. A person with PTSD has 3 main types of symptoms. One, re-experiencing the traumatic event, for example, nightmares and flashbacks. And for that person, it really feels like they're back in that terrible situation again. Two, avoidance and emotional numbing, feeling detached from others, and a loss of interest in activities that used to be enjoyable. And three, increased arousal in the form of feeling hyper vigilant or on guard, as well as irritability and outbursts of anger. In addition, the person often experiences insomnia. Let's learn more about the symptoms and treatment of PTSD with Dr. Krishnamoorthy from the Northport VA Medical Center. [Healthy Mind] [Dr. Borenstein] What is post-traumatic stress disorder? [Dr. Krishnamoorthy] In reality, it is something that a person who has been through a traumatic experience actually has for the rest of his life, so to speak. Trauma is defined as a life-threatening situation, a situation that actually in some ways threatens a person's life or the person witnessed something that was life-threatening. And the person that was traumatized usually is very isolated, feels very unsafe, doesn't trust too many people, and in the clinical syndrome, the person really experiences the traumatic experiences in certain ways. [Dr. Borenstein] Is that the flashbacks that we hear about? [Dr. Krishnamoorthy] Absolutely. Flashbacks is one of the commonest things that people talk about, but one of the unusual things. Nightmares and repeated recollection of the event--these are the two things that are much more common than flashbacks. [Dr. Borenstein] People who experience this, obviously, it's very uncomfortable when they relive these events. What are we able to do to help them? What do you do to help them with this? [Dr. Krishnamoorthy] What happens in the clinical syndrome is that in order to avoid reliving this experience, a person becomes extremely isolated, emotionally numb and isolated from people, and they become hyper aroused from time to time, and they become irritable, angry, depressed, and rageful. The first and foremost thing is to actually help the person to heal from the experience, and the healing consists of validating the experience, helping the person to actually talk about it in a safe setting, and to accept what has happened to this person. [Dr. Borenstein] When you say validating the experience, what do you mean by that? [Dr. Krishnamoorthy] In regular life, usually what we do in common experience is that if you've been through a bad experience, you tell the people the following day, "Look what happened to me yesterday. I got beat up outside a bar." That's not necessarily a trauma. It may be something the person may be able to talk about comfortably. But if somebody had been beaten up outside of a bar and raped, the person may not be able to talk about it, so in the validation, since the person has been holding onto this experience for a long time, and has doubts about oneself and probably feels some guilt about it, You sit down and let the person talk about it and encourage the person to talk about it at the same time, understand how difficult it may have been to this person to go through this experience. [Dr. Borenstein] Tell us about what the treatment is. What do you do at the onset and then as treatment continues? [Dr. Krishnamoorthy] Well, as you know, that people come to treatment after an experience like that at the various times. Somebody who comes right after a trauma, they may be in a state of shock, and that in clinical terms is called an acute stress reaction. Up to a month the person may go through a state of shock when there is disbelief. There is a confusion, a detachment, feeling very angry about what happened, questioning, "Why did this happen to me?" kind of a thing. There the treatment consists of actually helping the person to vent a little, and to be supportive, and provide some rest and respite, and, in some cases, medication. [Dr. Borenstein] Before we get to the medication, for the person actually talking about the traumatic event, is helpful to them? [Dr. Krishnamoorthy] Absolutely because the purpose of trauma, of the traumatic memory is this. If you have a bad experience, you need to find out how are you going to survive it and avoid being exposed to it in the future. A very simple example is if a child sticks a finger in the fire, he knows not to do it again, and that experience is something that is going to be very deep into the person's mind. It's very unlikely somebody will experience a tsunami twice in a row, but tsunami victims know what it looks like. If the water recedes from the shoreline, don't go near the water will be their lesson. And they probably have a recording of that in their brain, and that will be indelible for the rest of their lives. If they ever see water receding from anyplace that they are in the future, even in a natural occurrence of tides, low tides, they may start to relive that experience. The original intent of that memory was to help the person to avoid being caught in another tsunami. Same with the volcanoes, same with the earthquakes, and the same with human-created tragedies, like rape, for example. A person who has been rapes knows when not to be on a given day or a given night, and where you don't want to get caught, so that memory immediately-- that memory which is deep in the brain helps the person to avoid a future catastrophe. >> Sometimes other interactions or incidents can bring out the memory, so a loud noise may bring back a difficult memory for the person. [Dr. Krishnamoorthy] Correct. [Dr. Borenstein] What do we do to help them? [Dr. Krishnamoorthy] Though this may be a beneficial thing to have this memory sealed in the brain, in certain situations like combat, if, for a year or more, a person has recorded a million bits of information that can trigger a memory, the person is, instead of benefiting from that memory, is now suffering from it. That's what PTSD is. Something that could be physiological and helpful for the person now becomes a sickness that actually interferes with the person's normal life. In treatment, you get the person who has pictures in the brain, to talk about it, write about it, so they become words. Once they become words, words can be processed. Pictures cannot be processed that easily, So from the older part of the brain where the recording is, you bring it to the new part of the brain, which is the speech, writing kind of the brain, and get the person to process the information a little bit more intelligently. [Dr. Borenstein] Given what you were describing about the isolation, and difficulty sometimes trusting people, what is it like for family members whose relative has post-traumatic stress disorder? [Dr. Krishnamoorthy] It, again, depends. My experience is this. Anybody who is not traumatized will not be able to understand the full magnitude of how this affects a person's life. It's a very pervasive thing. The affliction is pervasive. It affects every aspect of the person's life, so in the beginning as a person returns-- say a combat soldier returns from combat front to civilian life, the persons will just gather around and give acoladyes and say, "You are a hero." "Let's just give you a party." A lot of times the returning soldier's response is not, "Let's just go and join the party." It is, "Why in the hell do you have to do this for me?" Actually, I know people who saw the party banners in the house and just went into the back door, in order to avoid the crowds. The isolation starts immediately. What the families would say is, "Why do you have to do this?" "We just went through all of this trouble to give you this party." "Why can't you just relax and enjoy it?" [Dr. Borenstein] The part is to educate the families, so they understand what their loved one is going through. [Dr. Krishnamoorthy] Yes. I think the education of that is getting done , for a lot of Iraq veteran's families either the agencies like VA are educating them, or they're just going about their own way to find out more information about it from the Internet and stuff. That's a very important part. The other thing is to give some space. The expectation of the family is that he is going to be over this in a matter of days to weeks. A lot of returning veterans say this to me because the military intent in educating combatants right in the field about PTSD-- What is being taught and what is being learned are two different things. What they're learning, many of them are learning, is that it doesn't go away in about 6 months. They come back and wait for 6 months for this syndrome to be over, and once it is not over, they just say, "Okay, what is wrong with me now?" so they seek treatment. Educating the family, educating the combatant or the soldier or the marine, is a very important part of initiating treatment. The third part of PTSD I left out in the description is actually called hyper arousal. In general terms, it means being at a high state of alertness all of the time. If you look at people who are in combat, they have to be in a very alert state in order to recognize danger before it happens. When that gets into civilian life, a person tends to be extremely alert, focused, to a degree irritable, and if pushed too hard, getting enraged. That is a third cluster of symptoms that happens in PTSD. If you put the person in a military context, in the battlefield, it makes sense because a person has to be in that state . [Borenstein] Those are all good coping mechanisms to avoid injury in battle. [Dr. Krishnamoorthy] Correct. The way the anger spreads in the brain and goes from anger to rage is a very common phenomenon. A lot of veterans who had been in combat will recognize once a rage sets in, they just become totally blind to the situation, and many of them have hurt other people, especially in early stages of PTSD. [Dr. Borenstein] What would you say to someone who is watching now who might be experiencing some of these symptoms and is afraid to go and get treatment? What would you say to them to get them to come and get help? [Dr. Krishnamoorthy] Yes, I think that is one of the primary reasons, again, to talk today. This is not a disease. Post-dramatic stress disorder is the normal consequence of participating in something that is extraordinarily difficult. Combat is probably the most difficult thing there is for the young person to participate in. The consequence is not just going to go away and seeking treatment for the condition will improve the quality of the person's life because, upon returning from the military, the person's life trajectory changes because the person has changed. The longer the person waits to seek treatment, the more different they are going to be from the way they would've been if they had not been exposed to trauma. My suggestion to people is please do seek treatment because treatment is effective. It will make your life as close to a normal life responsible for yourself and the people around you, your neighbors, and the community at large. [Healthy Minds] [Dr. Borenstein] We just heard about the symptoms and current treatment for PTSD. I also had the opportunity to visit Dr. Bruce McEwen at his lab in Rockefellow University, where we spoke about cutting edge research on stress and PTSD. This basic research will ultimately lead to new and more effective treatments. [Healthy Minds] [Dr. McEwen] It appears that people who have PTSD have an overactive sympathetic nervous system. The system that makes the heart beat faster, makes the blood pressure go up, which is important in the flight or fight response. They have an overactive production of adrenaline, an over-reactivity to things that happen to them. At the same time, there is some relatively new evidence that they are not producing enough of the other stress hormone cortisol. They're not really deficient, but they just produce not quite enough to make things go along normally. There is some evidence that people who are likely to develop PTSD, who have lower than normal cortisol, if you give them supplemental cortisol, it actually prevents the development of the disorder, or at least the symptoms of the disorder. [Dr. Borenstein] In some people, making up for the shortfall? [Dr. McEwen] Exactly, exactly. And, in fact, it reinforces the idea that cortisol actually has some very beneficial effects on the brain and the body, as well as doing the bad stuff that we tend to recognize too much cortisol doing. One of them maybe is protecting against PTSD. [Dr. Borenstrein] There is also some anatomical issues that we see? [Dr. McEwen] Yes, part of the brain called the hippocampus, which is very important in memory of events in our daily lives and spatial ability and so forth is often found to be smaller in people with PTSD. There is a bit of controversy because there is some evidence that says that it's smaller because of the trauma, because of the stress that is associated with the trauma. There is other evidence that suggests that people who are most vulnerable to PTSD, may actually have a smaller hippocampus to begin with, and it probably is a matter of both. That is, having a bit of a smaller hippocampus and then, perhaps the hippocampus becoming smaller when the disease appears and actually then goes on for a long time, as it unfortunately does in many people. [Dr. Borenstein] These findings lead to potential improvements in treatment of PTSD and hope for people who have experienced it? [Dr. McEwen] Exactly. One of the problems is if somebody has a traumatic event, such as a rape or an accident, some violence and so on, would giving them a dose of cortisol perhaps help reduce the symptoms? It certainly did in these studies on people who are undergoing major cardiovascular surgery who were in a clinical situation. Perhaps giving people cortisol might help. I mean--after 9/11, if people have been popping Prednisone tablets, who knows if there might have been less PTSD? We'll never know that, but on the other side, I think that some of the things that we're finding out about what makes the hippocampus smaller, and in depression and in PTSD, leads us to believe that it may not be brain damage as such, but a process that can be treated and possibly reversed with the right kinds of drugs. There is some evidence that-- [Dr. Borenstein] These basic scientific findings will ultimately lead to new treatment to help people with the condition? [Dr. McEwen] Absolutely, yes, so it's very likely that maybe we can find drugs, pharmaceutical agents that will actually help to reverse some of these changes in the volume of the hippocampus and improve some aspects of the thinking and behavior of people with PTSD. [Healthy Minds] [Dr. Borenstein] When a soldier comes home with physical wounds, it's there for everyone to see, and people respond with support and treatment. But PTSD has been called the "silent combat wound." You can't see it, but the person with PTSD certainly feels its effects. [helicopters landing] [♪ Buffalo Springfield - Somethings Happening Here ♫] I was drafted May 1, 1967, and I wound up in the 1st Cavalry A company, 2nd to 12th in Vietnam. I was 22 when I was drafted. [♪ Buffalo Springfield - Somethings Happening Here ♫] It was a shock. We went into Bien Hoa Air Force base, and getting off of the plane, the heat hit us first, and then mortar rounds came in. I wasn't in the country 3 minutes, and it started. This is the CIB, the combat infantry badge. and a purple heart that is--I had gotten hurt on--this was January 7th. And the bronze star was for actions during the Tet Offensive and my unit was almost annihilated. I just got chills. (laughs) I haven't talked about it in a long time. We were sent then from the Quine Tre area into the Wai area in the rain with no backpacks, and we walked into the NVA CP. We had 60 percent casualties the first day, and we escaped the area in the middle of the night. The Tet went on for a few days after that, and I was wounded twice. Since I came home--and I got out of the service in 1969-- it's Memorial Day weekend, is the worse time of the year. I mean--the other ones affect you also because things happened on different holidays and on New Years, but Memorial Day is the time when you reflect back to the ones that you were with, and they're still 22 and 21 years old, and it's a time to remember and it's a time to mourn. A lot of it is, I guess, survivor guilt. Why am I still here and they're not? In the beginning, I would have my dreams and actions, and the Fourth of July, with the loud explosions, and I usually don't like people sitting behind me. I put myself against the wall, but I didn't think much of it. It got progressively worse over time. It was getting to a point where it was a daily thing and a nightly thing, and I'd dream and I'd still be running and screaming and yelling. My wife would wake me up in the middle of the night with cold sweats. I still feel--I feel like I'm still in the service sometimes. The experiences or memories at nighttime carry on during the day, and you do have flashbacks. Sometimes they get worse, and I've had times when I had to pull my car off the road because of flashbacks and memories. You're not here anymore. You're back there, and that can be a dangerous situation. You never think that there is something wrong with you until things get worse, and, like I said, I lived with it every day. I have the same dreams. I say goodnight to the same guy every night. I shot a guy. He was over a half a mile away, and he keeps waving to me every night. That's something that sticks with you forever. When you're in a combat situation, you do whatever you have to do. I think a big help for me too was being married. My wife and I got married first March 24th of '67. I got drafted April 1, and we had the big church wedding and the reception on September 16th, and I left for Vietnam on September 28th. Then while there, I had an R&R, and I went to Hawaii. I met her at the airport, so we finally had a honeymoon. But it was an experience because when I went back, I didn't know if I was coming home after that. [♪ Beetles song Let It Be ♫] My wife stuck by me, and now it's 38 years later, and I'm still dreaming, and she's still with me. [♪ Beetles - Let It Be ♫] There's always been a stigma over PTSD or any mental health issues. You're afraid to say anything because it might hinder your advancement or promotions. The same thing is happening today because some of the Iraq vets that I meet and we talk, and they're afraid to go for counseling because it might affect their ability to gain rank. We have to support our troops, and they're going to go through these experiences. There's something that comes to mind, and--you know--freedom isn't free. We're going to have to always fight for it, and we're always going to have this type of problem. PTSD is something that's always been there, First World War, Second World War, Korea, Vietnam, and now in Iraq and Afghanistan. And it's going to continue, and these people have to be offered the help that they need. [♪ Beetles - Let It Be ♫] [Healthy Minds] [Dr. Borenstein] One of the purposes of today's show is to honor the sacrifice and committment of our servicemen and women and their families. To those of you who have given so much to our nation, the most important thing I can say to you is that with help, there's hope. If you're experiencing symptoms of PTSD or depression, don't suffer in silence. Seek the help you deserve. Until next time, I'm Dr. Jeff Borenstein. [Healthy Minds] For more information, please visit our website at wliw.org/healthyminds Next time on Healthy Minds--broadcast journalist Jane Pauley shares her personal struggle with bipolar disorder. That's next time on Healthy Minds. [HOST - Dr. Jeffrey Borenstein PRODUCER - Theresa Statz-Smith] [CO-PRODUCER - Mary Puma] [credits] [♪ dramatic music ♫] Healthy Minds on WLIW21 is made possible in part by NARSAD. NARSAD is dedicated to supporting innovative scientific research to find the causes, better treatments, and cures for severe mental illness. And by ValueOptions, working with health plans, employers, and government programs, ValueOptions manages behavioral healthcare and substance abuse services for people throughout New York, New Jersey, and Connecticut. By The New York Academy of Medicine, working to enhance the health of people living in cities worldwide through research, education, efficacy, and prevention. By the van Ameringen Foundation. Since 1950, the foundation has supported prevention, education, and direct care programs that seek to promote positive change in the mental health field. And by the New York State Office of Mental Health, promoting the mental health of all New Yorkers.
Posted on BrainLine January 26, 2009.