Post Traumatic Stress Disorder

The greatest discovery of any generation is that human beings can alter their lives by altering their attitudes. — William James

Post Traumatic Stress Disorder (PTSD) is a complex, devastating disorder brought on by exposure to extreme stress and/or threat to life. From a psychodynamic standpoint, PTSD can be seen as a condition that arises when a person is deprived of their autonomy and there is a kind of obliteration of their internal view of themselves. We psychiatrists often view our sense of “self” as comprising internalized objects, what we call self objects. A self object is an internalized representation of a relationship that reflects real, present and past real relationships. With PTSD, we will often see patients “losing touch” with their internal “selves” and often feel like they are literally “coming apart”. It is interesting that I will often have patients with PTSD telling me about dreams where they are in a house that is being “torn down”, and that people in the house are being murdered or killed. It is a poignant vision of what PTSD feels like to sufferers.

PTSD changes the way the brain functions. If we have a person think about a trauma while they are in an MRI, we see the neurons in the brain firing exactly the way they did while being traumatized. It is as if the person is actually reliving the event in their minds. The “thinking” part of their brain shuts off, and the overwhelming emotional sensation seems to take over. The longer a person is exposed to stress, the more the brain changes. People with PTSD are literally different after prolonged exposure to trauma. This has real and serious implications for those combat soldiers who have been at war for years now.

Those who suffer from PTSD don’t remember trauma in the same way we remember other events. There is an old experiment where a person runs into a classroom, acts out an aggression that was arranged between the participants, and then runs out again. After the event, students are asked to describe the person who perpetrated the aggression. A lot has been made of the fact that students are not really good at describing what the person actually looks like, and this has been the basis of questioning the use of recall as evidence. It affects how we view victims of violence because we assume memory is the same for them. It turns out that people with PTSD don’t remember things the way a student does (whose life is not in danger during the experiment). PTSD sufferers have very vivid and complete memories of traumatic events, though the memory tends to come back in bits and pieces. It is rare that a trauma victim will remember much immediately after an event, but over time, they will begin to piece together a pretty clear and complete picture of what happened. The memories are much more reliable than the memory of someone whose life is not in danger,  and it has become a miscarriage of justice that such experiments have been erroneously linked to memory associations of PTSD sufferers.

The last thing I will say about PTSD is that stable and safe support after trauma is probably the most important thing we can do for those suffering from PTSD. During WWII, when British children were being sent off to the country side to protect them from the bombing going on in London, levels of war related stress and trauma (what we would call PTSD today) were higher in the kids in the country, away from family, than in those who stayed in London with their families and suffered the trauma of being bombed.

To wrap it up, we need to understand that PTSD changes the brain and the way it works. Sufferers need time to remember, and need to be in a safe holding space to process their experience. Memory is not the same for PTSD sufferers as it is for the rest of us, and a close stable core group (family or any nurturing group) is critical for recovery.

Stephen Taylor, M. D.

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