PTSD

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A Podcast For Your Brain: The Checkup, Episode 8

It’s the only organ in the human body that tries to understand itself (though not always successfully).

Still, the brain is on our brains in the latest episode of The Checkup, our recently relaunched health news podcast, a joint venture between WBUR and Slate.

Can you enhance your brain through music? Detect dyslexia even before kids learn to read? Alleviate the symptoms of deep depression with a brain implant?

Carey and I explore these and other questions as we delve into some of the latest advances in brain research.

And in case you missed our last episode, “Scary Food Stories,” where we tell the tale of a recovering sugar addict and offer sobering news to kale devotees, you can listen now, or download it anytime.

Make sure to tune in next week, when we present: “Grossology,” an episode on how the dirty corners of your life might benefit your health.

Each week, The Checkup features a different topic — previous episodes focused on college mental health, sex problems, the Insanity workout and vaccine issues.

Beyond Sexual Assault: How One Victim Evolved Into An Activist

Ali Safran founded a website dedicated to supporting victims of sexual assault. (Courtesy of Erinn Lew)

Ali Safran founded a website dedicated to supporting victims of sexual assault. (Courtesy of Erinn Lew)

By Dr. Gene Beresin

Alison Safran is a 22-year-old who graduated from Mount Holyoke College in May 2014. She was the victim of a sexual assault as a senior in high school in one of Boston’s suburbs.

She initially didn’t confide in her parents because she was unsure that they’d understand. However, when her symptoms of post-traumatic stress disorder (PTSD) increased, she sought help from a clinician who referred her to the psychiatrist she is currently seeing. She has since improved immensely.

Ali’s story is about her resilience, but it’s also about how good can emerge from a terrifying experience.

Symptoms After An Assault

“After I was assaulted,” Ali said. “I developed what I now understand as PTSD symptoms, but at the time, I didn’t even know what PTSD was. I was miserable. My symptoms continued into my first year of college, which made an already stressful time even more difficult. It was hard to sleep and function normally.”

When Ali attended a local university, she was assigned to a co-ed dorm, under the conditions of her housing contract. This situation was not easy for her; her PTSD was at its peak and she filed a criminal complaint against her assailant, adding more stress to her life. It was very difficult for her to live near male students who were often partially undressed in the common room.

“Even though living in a co-ed dorm is a normal part of college life, dealing with being around men while I was engaged in the criminal justice process made me feel unsafe,” she said.

Stress Of A Co-Ed Dorm

While Ali, her parents and even her psychiatrist tried to release her from her dorm contract, the university declined until eventually the administration was persuaded to alter its stance by a member of the Board of Trustees. Ali felt that though her professors were understanding and helpful in providing accommodations when needed (i.e. missing class for court), the university administration itself did not understand or appreciate the impact of her living situation given the sexual assault and upcoming trial.

“My stress level was already far above that of the average college freshman. Despite the legal process I was pursuing, my school could have at the very basic level chosen to help me relieve some of that stress. It chose not to do so,” Ali said.

The unfortunate failure on the part of her university preceded the recent focus on college campus sexual assaults, in which awareness has increased and schools are beginning to take steps to address the widespread problem. Continue reading

The Psychological Aftermath Of The Sydney Siege

A hostage runs to armed tactical response police officers for safety after she escaped from a cafe under siege at Martin Place in Sydney, Australia, on Monday. (Rob Griffith/AP)

A hostage runs to armed tactical response police officers for safety after she escaped from a cafe under siege at Martin Place in Sydney, Australia, on Monday. (Rob Griffith/AP)

By Jessica Alpert

The images of five hostages escaping from the Lindt Chocolate Cafe in Sydney are striking. A woman runs into the arms of law enforcement, her trauma and fear palpable.

This story is still developing, but one thing is for sure: “It really doesn’t take much to instill fear,” says Max Abrahms, a professor of political science at Northeastern University and an expert on terrorism. “This one guy managed to shut down an entire city, divert many planes away from Sydney, and transfix the world in real time following this story.”

As of press time, police were reporting that the hostage taker and two people were killed. For those who survived, what lies ahead psychologically?

Dr. David Gitlin, Brigham and Women’s Hospital vice chair of clinical programs and chief of medical psychiatric services, says recent research suggests reliving or “debriefing” survivors is counterproductive and “actually may precipitate the development of PTSD.”

Instead, health professionals are encouraged to use a resilience model in the immediate aftermath of an event like this one, “helping people think about the things they need to do to feel safe and secure…to deal with things on their timetable,” says Gitlin. Of course, this may come into conflict with the needs of law enforcement, who are looking for further control of an event or preparing evidence for prosecution. As this siege has ended and it’s believed that the assailant acted alone, Gitlin hopes that those now released will not be interrogated at this time.

Gitlin, who led the Brigham’s psychiatric team after the Boston Marathon Bombings, explains that “people need to be surrounded by their loved ones, put into a safe environment, and only process this when they are ready to do so.”

Acute Stress Reaction and PTSD

There are two types of trauma, says Gitlin. Continue reading

Related:

The Bionic Mind: Building Brain Implants To Fight Depression, PTSD

Liss Murphy this summer, with husband Brian, son Owen and sheepdog Ned. (Courtesy)

Liss Murphy, who had surgery to implant Deep Brain Stimulation for depression in 2006 and got much better, on Cape Cod in summer, 2014, with husband Scott, son Owen and sheepdog Ned. (Courtesy)

Ten years ago, with little warning, Liss Murphy fell victim to paralyzing depression, a “complete shutdown.”

She was 31, living in Chicago and working in public relations. The morning of Aug. 13, 2004, she had gone in to the office as usual. “It was Tuesday, and I remember the day so clearly,” she says. “The sun — everything — and I walked out — it was about 11 o’clock — and I never went back. The only time I left the house was to see my psychiatrist, who I saw three times a week.

“I have a hard time believing it was depression, in a way, because it was so pervasive and powerful,” she says. “It invaded every aspect of my life. It took so much away from me. And it happened so fast, and it was so degrading — it took everything from me.”

Murphy came home to Boston, and she tried everything — medications, talk therapy, even repeated rounds of electroshock. But she was barely able to get out of bed for months — then years. Her husband and family and top-flight doctors cared for her, but she sank so low she tried twice to commit suicide.

Finally, a psychiatrist told her about a cutting-edge trial to implant stimulation devices deep in the brains of patients with severe depression. She signed up. In June of 2006, she had the operation.

“My greatest hope that day was to have something go horribly wrong and die on the table,” she says. “I didn’t care.”

She didn’t die. Over the next few months, she got better. These days, eight years after the surgery, if you saw Liss Murphy walking her Old English Sheepdog, Ned, or playing with her 3-year-old son, Owen, only the faint silver scars on her clavicles would hint at anything unusual: That’s where the batteries that power her brain stimulator are implanted.

“We’re taking a wall of computers, basically, and putting it into something that would easily fit inside a box of Tic-Tacs.”

– Jim Moran, Draper Laboratory

But though the surgery changed Murphy’s life, “the trial, on average, didn’t work,” says Dr. Emad Eskandar, the Massachusetts General Hospital neurosurgeon who operated on her. “When you pooled everyone together it didn’t work. But there were like five people out of the 10 we did that had remarkable benefits and went into complete remission. We couldn’t continue with the study because on the average it failed, but for those people in whom it worked, boy did it work.”

Now, as part of a $70-million project funded by the military, researchers are aiming to take brain implants for psychiatric disorders to the next level.

Over the next five years, they aim to build a device that can sit inside a patient’s head, pick up the onset of depression or post-traumatic stress disorder, and head it off before it hits. One implant researcher calls it “a moonshot for the mind.” Continue reading

‘Did You Ever Kill Anyone?’ 5 Things Not To Say To A Veteran

U.S. Soldiers depart Forward Operating Base Baylough, Afghanistan, June 16, 2010, to conduct a patrol.  (Photo: Staff Sgt. William Tremblay, U.S. Army/Released)

U.S. Soldiers depart Forward Operating Base Baylough, Afghanistan, June 16, 2010, to conduct a patrol. (Photo: Staff Sgt. William Tremblay, U.S. Army/Released)

By Tommy Furlong and Dr. Paula K. Rauch
Guest contributors

“So, did you ever kill anyone?”

It’s not a question you would ask a police officer, but it’s one that many veterans get all the time. Most people have good intentions, but that doesn’t seem to be enough to guide people in what to say and what not to say to a returning veteran. It has become commonplace to say, “Thank you for your service,” but then what?

So here, in advance of our most patriotic holiday, is a brief guide for speaking with post-9/11 veterans and their families. We begin with five things not to say, and end with five that maybe you should:

1. I can’t understand why anyone would join the military.

Oftentimes, people hear the word “military” and immediately think of warfare. In reality, that is just one of the components. The military puts a lot of its resources toward humanitarian efforts. And if you list almost any civilian job, that same position can be found in the military.

So why would someone join the military? They might enjoy the structure. The job security is alluring, as are the benefits. Many young people also choose to serve for educational or economic opportunity, family tradition, seeking a challenge or as a path out of a difficult situation.

Serving our nation is an intense and rewarding career choice. So is being a firefighter, a nurse or a surgeon. Different individuals are drawn to different vocations. Choosing military service is one choice — and it’s not a crazy one.

Family members often hear “Why did you let him (or her) enlist?” or “I would never let one of my kids join the military.” The suggestion is that loving parents don’t let their children serve in the armed forces. These types of comments leave parents and spouses of veterans feeling isolated and unappreciated because, as any military family knows, when one member serves, the entire family serves. Family members have pride in their service member, but they also live with anxiety during the years of service. But all that aside, most parents don’t get to choose their adult child’s life path — and that includes career, partner and place to live.

2. How could you leave your children? Continue reading

Study: Among Kids At 2013 Marathon, 11 Percent Show Signs Of PTSD

A neighbor is escorted to safety as police surround a home while searching for a suspect in the Boston Marathon bombings in Watertown, on April 19, 2013. (Charles Krupa/AP)

A neighbor is escorted to safety as police surround a home while searching for a suspect in the Boston Marathon bombings in Watertown, on April 19, 2013. (Charles Krupa/AP)

This just out in the journal Pediatrics: A survey of Boston-area parents finds that the 2013 marathon bombings left about 11 percent of children who attended the race reporting post-traumatic stress, a rate six times higher than kids who did not attend the marathon.

Of particular note: exposure to the “manhunt” — which I recall in my civilian way as “the lockdown” — “was more robustly associated with children’s broad mental health problems than exposure to the attack itself.” (Maternal thought: Well, yes, telling children it’s not considered safe to go outside their own homes? What better reinforcer of anxiety?)

The press release from the American Academy of Pediatrics:

Research has documented the psychosocial toll of terrorism on young people, but most of that work has focused on large-scale attacks like Sept. 11. A new study in the July 2014 Pediatrics, “Adjustment Among Area Youth After the Boston Marathon Bombing and Subsequent Manhunt,” published online June 2, examines how young people in the Boston area were affected by the 2013 bombing at the marathon, a civilian family event, and the subsequent manhunt that impacted nearly 1 million Boston-area residents. Continue reading

Mental Health Parity: If Not Now, When?

According to ABC News, the latest alleged Ft. Hood shooter was struggling with a number of mental health problems, “ranging from depression to anxiety to sleep disturbance,” and in the midst of being evaluated for post-traumatic stress disorder.

If true, it’s a familiar story of a stressed-out soldier with mental health issues and easy access to guns: we’ve been here before.

Of course, we don’t know exactly what kind of care or treatment this shooter was receiving — and the VA system is generally better than others. Still, it’s worth reviewing the history of legislation to put mental health services on equal footing with all other medical care.

(ndanger/flickr)

(ndanger/flickr)

The latest policy brief published in the journal Health Affairs, documents the convoluted history of mental health parity, the idea that mental health care and treatment be comparable with all other types of “physical” medical care (and why make the distinction, anyway)?

Parity efforts began in earnest in the late 1990s, but still aren’t fully implemented today, despite widespread support, including from notable advocates like former Congressman Patrick Kennedy.

The paper examines some of the obstacles remaining to true mental health parity, including these:

…”Critics have argued that parity legislation alone is not enough to fix other underlying problems in how our health system provides access to treatment of mental health and substance use disorders.

The supply and availability of mental health providers has been the subject of numerous research articles. A 2009 Health Affairs article by Peter Cunningham found that two-thirds of primary care physicians reported that they were unable to get outpatient mental health services for their patients–more than twice the percentage who reported trouble finding specialist referrals, nonemergency hospital admissions, or imaging services. Mental health professionals tend to be concentrated in high-population, high-income areas, and the lack of mental health care providers in rural areas as well as in pediatrics has been well documented. Finally, there is still a stigma associated with receiving mental health or substance use treatment. Eliminating the stigma and increasing the availability of high-quality providers are two keys to increasing access to care.

…Much of the debate in implementing parity is around determining equivalence of services between mental health/substance use benefits and medical/surgical benefits. Some of the treatments for mental health and substance use disorders do not have an equivalent medical/surgical treatment, Continue reading

Memories Of A Veteran’s Son: Living With Undiagnosed PTSD

Victor E. Beresin, DDS, was discharged as a Major from the Army, having been promoted to Captain, and won the Bronze Star for his work on the battleship in the Pacific. (Courtesy Gene Beresin)

Victor E. Beresin, DDS, was discharged as a major from the Army, having been promoted to captain, and won the Bronze Star for his work as a medic on a battleship in the Pacific. (Courtesy Gene Beresin)

By Dr. Gene Beresin
Guest Contributor

Waking my dad early in the morning was terrifying. I learned not to do it – not an easy thing for a very young kid.

When I crept into my parents’ bedroom across the hall, I found that if I jumped into bed from my mom’s side, it all went just fine. But if I even tapped my dad and woke him from a sound sleep, he jumped a mile high, looking absolutely terrified, screaming, “What is it! What’s happening? What’s going on?”

It was damn scary. I learned quickly to go to the right side of the antique maple bed, never to the left.

And if I woke Dad from a nap in his study (he would often crash on the tiny bed there, working endlessly on lectures, slides and writing his books) he would jump and scream just as loudly. I stayed away and let my mom do it.

There were also the bouts for a week or two of shaking, sweating, and turning beet red, up night after night – events I recall once or twice during my childhood. Mom said not to worry; he was just having some kind of reaction to an illness he got in the war. “Malaria,” she said. “It will pass.”

Don’t worry? My dad was convulsing. He looked like he was going to die.

No one ever told us about PTSD. The term was not even a term back then. It was the 1950’s, and later the 60’s. My generation only knew that our dads had fought in “the war,” and that now they were home.

In fact, my dad loved to watch World War II movies. We watched them together ritually, just as we watched football games. I knew he hated the Nazis, and I was glued to the screen. As I got older, I started asking questions. Continue reading

Tumblr Blocks Some Mental Health Topics, Thwarts Therapy

LibbiAs a member of the Millennial Generation, Libbi Gildea, 20, discovered a new coping mechanism for dealing with an age-old mental health issue – social media.

But just as she started to heal from a personal trauma, she found that a tech giant was starting to dismantle her new, safe space.

In December 2012, Libbi was raped on the campus of a prestigious school in Massachusetts. She was 19 at the time, a college sophomore. After the attack, she developed PTSD and depression and took time off school, trying to heal. She spent time recovering in the hospital, and traditional talk therapy helped. But, she says, she found the most comfort in a more contemporary setting. Libbi joined the microblogging site Tumblr and started browsing posts tagged with topics she was interested in, like depression and PTSD, meeting others that were going through similar experiences. In an interview, she gave me permission to use her name, and explained how she evolved from feeling totally alone after the assault, to much more connected and supported through social media:

I felt really isolated because I didn’t know anyone else that had PTSD. You don’t realize that what you’re experiencing is normal … After I was done with the hospital and I didn’t have group therapy anymore, a friend mentioned that there was a pretty vibrant mental health community on Tumblr.

So I made a blog there. I started randomly one day, posting that I wished I could make a mental health “resume” so I wouldn’t have to go through my experience every time I saw a new doctor. I did another post of more of a personal nature on the night of my birthday because I was angry and feeling that my attacker had taken a lot away from me. I wrote him an open letter that said, “You may have raped me, you may have taken this from me, but I’m still here, and my life is only going to get better, and frankly, I feel sorry for you.” Continue reading

Study: Higher Risk Of Abuse For Kids Who Don’t Conform To Gender

two children sitting on the sidewalk

New research out today from the Harvard School of Public Health and published in the journal Pediatrics has found that children who don’t “conform” to their gender are more likely to have suffered childhood abuse (physical, sexual and psychological) and to have a risk of post-traumatic stress disorder (PTSD) in early adulthood.

Researchers analyzed data from nearly 9,500 young adults (mostly in their 20s, part of the Growing Up Today study) and asked them to recall events from early childhood, when they were younger than 11.

Defining “Gender Nonconformity”

Participants were asked behavior-based questions “regarding media characters imitated or admired, roles taken in pretend play, favorite toys and games, and feelings of femininity or masculinity.” Continue reading