post traumatic stress disorder

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How Trauma Brings Fear, Yes, But Also More Nuanced Reactions

A woman breaks down while paying her respects at a makeshift memorial near the Inland Regional Center Friday in San Bernardino, California, where several people were shot and killed by two shooters on Dec. 2. (Jae C. Hong/AP)

A woman breaks down while paying her respects at a makeshift memorial near the Inland Regional Center Friday in San Bernardino, California, where several people were shot and killed by two shooters on Dec. 2. (Jae C. Hong/AP)

By Mary C. Zeng, MD
Guest Contributor

November and December have been months of trauma.

The Paris terror attacks and the American shootings in San Bernardino and Colorado Springs have taken a heavy toll on both survivors and witnesses. Media coverage depicting scene after scene of carnage has also generated painful and lingering emotional reactions by secondhand exposure. A recent New York Times article describes “a creeping fear of being caught in a mass rampage has unmistakably settled itself firmly in the American consciousness.”

It’s true that trauma breeds fear. Those who were directly victimized in the attacks are, of course, likely to develop both short- and long-term fear reactions. But even indirect victimization, such as through the media, can be psychologically damaging. One study of New Yorkers after Sept. 11 found that people who watched more news coverage were over three times more likely to develop post-traumatic stress disorder (PTSD), a hallmark disease of fear.

However, if we are to truly understand and appreciate each other’s emotions during these troubling times, we must talk beyond fear. Failure to do so would be a disservice to those who are suffering.

A variety of responses is expected, and normal, in the aftermath of trauma. Fear is only one of several emotions that may arise — one of a cluster of experiences collectively known as peri-traumatic distress. Other feelings in this cluster include helplessness, sadness, grief, guilt, shame, anger and horror. Certain cognitive responses, such as a worry about fainting or dying, are also common, as are physical sensations such as loss of bowel or bladder control and shaking, sweating or a racing heart.

Another common response immediately following a trauma is peri-traumatic dissociation: a state of disconnectedness from oneself or from reality, memory loss, reduced awareness or time distortion that is triggered by a traumatic event.

Both of these sets of responses are normal short-term reactions to trauma. They may be experienced with varying levels of intensity, depending on how directly or indirectly someone was exposed to the trauma. They are expected to phase out, or extinguish, for many people over a course of weeks after the traumatic event.

It is when these reactions do not extinguish that the long-term and potentially crippling effects of trauma begin to show in individuals with a genetic predisposition. Peri-traumatic responses then turn into PTSD, a psychiatric illness affecting 7-8 percent of all Americans over their lifetimes. The classic signs of PTSD, aside from exposure to a traumatic event, include intrusive memories of the event; avoidance of people, places and situations associated with the event; negative mood and cognitions; and hypervigilance and hyperarousal.

In the same way that a veteran who saw IEDs in Iraq now sees IEDs everywhere, the mass shooting survivor forgets how to feel safe even on the home front. The world turns into a permanently dangerous, uncontrollable place.

Besides peri-traumatic distress, peri-traumatic dissociation and PTSD, which are widely researched because they can lead to psychological disability down the line, a whole range of emotions is possible in light of the recent tragedies. Numbness, bewilderment, resignation — there is no one right way to react to trauma. Traumatized individuals are also at higher risk of developing psychiatric disorders other than PTSD, such as major depression and substance abuse.

But positive adaptations to trauma have also started to receive research attention. Continue reading

Harvard Doc To Wikipedia: You’re Not Playing Fair On Alternative Trauma Therapy

By Dr. Eric Leskowitz, M.D.
Guest Contributor

Up until recently, I’ve thought of Wikipedia as one of the great breakthroughs of the Internet era — a gigantic encyclopedia of everything, right at our fingertips, with real-time updates in all spheres of human knowledge. I even consult it regularly for medical information as part of my work as a practicing psychiatrist.

But in the past few months, I’ve been reconsidering the venture. Why? In a nutshell, it appears that the folks at Wikipedia have a problem with a fairly new sort of therapy that I practice and find helpful for certain patients.

Here’s the backstory.

Dr. Eric Leskowitz, a Harvard psychiatrist, wonders why the founder of Wikipedia called practitioners of Energy Psychology "lunatic charlatans.'

Dr. Eric Leskowitz, a Harvard psychiatrist, wonders why the founder of Wikipedia called practitioners of Energy Psychology “lunatic charlatans.’

For several years now, I have increasingly deployed this new form of psychotherapy, called Energy Psychology (EP), in my work with chronic pain patients at Spaulding Rehabilitation Hospital’s outpatient clinic in Medford, Mass.

Energy Psychology uses a combination of exposure (intentionally re-experiencing the unpleasant emotions surrounding a stressful situation) and desensitization (affirmations of self-acceptance despite the persistence of symptoms), along with a somatic component (tapping on one’s own acupressure points) to defuse the emotional charge of those upsetting memories.

Without getting into the details of how it might work, suffice it to say that Energy Psychology has helped many of my patients make great strides, especially when Post-Traumatic Stress Disorder (PTSD) is involved. (For example, when a frightening automobile accident triggered the disorder). For some patients, full recovery is possible. I’ve seen it.

A large body of research over the last 10 years shows just how effective Energy Therapy can be for a wide range of clinical problems, as described in this review article from the American Psychological Association’s journal, Review of General Psychology.

Energy Psychology has been particularly effective in treating PTSD in combat vets. And Energy Psychology has even gotten some fairly mainstream attention, from television’s Dr. Oz to The Huffington Post.

Jimmy Wales, founder of WIkipedia (Robert Huffstutter/flickr)

Jimmy Wales, founder of WIkipedia (Robert Huffstutter/flickr)

But you’d never know about any of this from consulting Wikipedia. Their entries use a range of emotionally loaded and downright pejorative terms to describe Energy Psychology and make no mention of promising new research published in the last ten years. Their article about the related topic of Energy Medicine, for example, only includes studies conducted prior to 2004 (though more recent critical reviews are cited).

Wikipedia’s entry on the most widely used Energy Psychology protocol (Emotional Freedom Techniques, or EFT) refers to the field of Energy Psychology as “pseudoscience” and relies on judgements rendered by a non-peer-reviewed blog whose name – Quackwatch – reveals just how objective it is(n’t).

To counter what we feel are gross misrepresentations, the international Energy Psychology community and members of the national Energy Psychology organization — the Association for Comprehensive Energy Psychology (ACEP) — attempted to add new research citations to the Energy Psychology article, in accord with Wikipedia’s promise to update their entries to include scientifically validated findings.

However, new entries supporting Energy Psychology appear to be scrubbed from the site. Fortunately, many of the details of this process are stored on the “Revision History” link of any Wikipedia article, so that much of the back-and-forth process can be tracked and the inconsistencies between policy and practice become evident. (Emotional Freedom Technique’s revision history is here).

Even studies from prestigious peer-reviewed journals like the Journal of Nervous and Mental Disease whose editor-in-chief is past president of the American Psychiatric Association, have not been cited by Wikipedia, nor has it been mentioned that the American Psychological Association now allows its approved Continuing Education providers to offer Energy Psychology training for Continuing Education Units, the result of a lengthy appeals process.

Because these obstacles persisted despite several years of good-faith effort in the face of repeated “scrubbing” of Energy Psychology-favorable information from the Wikipedia website, ACEP recently initiated a petition drive through change.org, asking Wikipedia to show fairness discussing newer holistic therapies. Over 11,300 supporters have signed, and, much to our surprise (and I say “our” because I am an active member of ACEP), the founder of Wikipedia – Jimmy Wales – responded personally to the petition. Here’s what he wrote on the change.org site:

No, you have to be kidding me. Every single person who signed this petition needs to go back to check their premises and think harder about what it means to be honest, factual, truthful.

Wikipedia’s policies around this kind of thing are exactly spot-on and correct. If you can get your work published in respectable scientific journals – that is to say, if you can produce evidence through replicable scientific experiments, then Wikipedia will cover it appropriately. What we won’t do is pretend that the work of lunatic charlatans is the equivalent of “true scientific discourse”. It isn’t.

Continue reading

Silent Wars: Helping Vets Fight Mental Health Battles At Home

By Evan Bick
Guest Contributor

The movies have it wrong. Combat, at least in my experience, was not non-stop or action-packed. Those who have experienced it know that modern warfare usually involves a lot of starting and stopping. Long stretches of quiet, even boredom, can be broken in an instant.

I was deployed to Iraq as an infantry platoon leader in 2008-2009. During that time, there may not have been constant action but there was tension — my fellow soldiers and I were on edge most of time, soldiers among civilians, going on patrols in the northwest corner of Baghdad.

Evan Bick, a veteran of the Iraq war, now works with other vets struggling with mental health problems. (Courtesy)

Evan Bick, a veteran of the Iraq war, now works with other vets struggling with mental health problems. (Courtesy)

On our first day in the city, the leaders from the unit we were replacing took us on a walk through their area of responsibility. We saw the sidelong glances from civilians as Americans walked through their streets, hidden behind rifles and sunglasses, and weighed down by cumbersome body armor. We also saw an area filled with stark contrasts — stucco houses with gated courtyards in one neighborhood, and refugee camps for Iraqis displaced by ethnic violence in the next.

Deployment is a challenging experience even when it’s boring. Whether you are patrolling ‘outside the wire’ or working behind the scenes, the sense of danger is real and omnipresent. While deployed, soldiers typically work far longer hours, and with less opportunity for relaxation than they experience at their home station. Isolation from loved ones, of course, is an important challenge both for the deployed soldier and family members back home.

Even with all those challenges, the bigger battle for many veterans begins when they return home. Without a unit that shared in your experience of war, you can feel lost — more lost than you would ever feel on patrol. It’s easy to get trapped inside your own head, and to dwell on what did not go well, and what you should have done differently. The quick reflexes and adrenaline that may have helped keep you alive overseas are probably no longer helpful.

Strategies that kept you and your fellow soldiers safe, like driving fast and straight down the middle of a road, become dangerous, and loud noises or crowds may make some part of you feel like you’re back in the desert. Continue reading