Friday, May 28, 2010

PTSD: The State of Treatment

This is the second part of a series on Post Traumatic Brain Syndrome.  Let me recap last week and expand on what we know about the neurobiological mechanisms (how the brain works) of PTSD, and then discuss treatment strategies.

When something stressful happens, the brain prepares the body for action.  The hypothalamus, pituitary gland, amygdala, locus ceruleus and opioid system all release hormones to speed up respiration, raise blood pressure, reduce sensitivity to pain, all useful conditions for the proverbial fight or flight.

Under normal stressors, as soon as these hormones are released, feedback systems go into operation.  The hypothalamus tells everybody else that their job is done and they can back off.

These hormones, especially cortisol, damage brain structures, notably the hippocampus, whose job is to regulate emotion and to perform the "that was then, this is now" function.  I named it that, and am very proud of it.  My own brain has almost no "that was then, this is now" function.  Pretty much zip.

Saturday, May 22, 2010

PTSD and the DSM: Science and Politics -- Again

Several weeks of what I call "swiss cheese brain" interrupted my series on PTSD.  Now with a couple posts in reserve and a two week cushion, I am trying again.  To get us back on the same page, here is a (tweaked) reprint of March 28, a history of the issue in the Diagnostic Statistical Manual and current context, to be followed by PTSD: The State of Treatment, and then PTSD: Hope for Prevention.

With the ongoing war in Iraq, Post Traumatic Stress Disorder -- PTSD is much in the news nowadays.  We can expect that to continue.

Nancy Andreasen, author of The Broken Brain, traces the social history of this mental illness in a 2004 American Journal of Psychiatry article.  The features of what we call PTSD have long been noted in the annuls of warfare.  More recently, in World War I it was called shell shock, and those who had it were shot for cowardice in the face of the enemy.  In World War II it was recognized as a mental illness and called battle fatigue.  Afflicted soldiers were removed from the front and given counseling designed to return them to battle within the week -- though there is one infamous story about General Troglodyte Patton who, while touring a hospital, cursed and slapped one such soldier for his "cowardice."

The DSM I, from the post-WWII era, recognized battle fatigue as Gross Stress Disorder.  It was removed from the DSM II in the early 1960s , when U.S. society was not regularly confronted with this cost of war.

Thursday, May 13, 2010

NAMI Walks for the Mind of America

Saturday, May 8 -- It was COLD!!! and windy.  No upright displays this year.  But there were the usual belly dancers, musicians, dogs, fabulous bagels, cream cheese, fruit, granola bars, cookies...

And volunteers -- serving food, registering walkers, taking photos, cheering us on.  The clown making toy balloons!

And the walkers.  And the strollers.  And the dogs.

Speaking of which:
Here she is, in a rare moment walking the designated path.  Mazie had never been to City Park before.  So many new smells!  So many new trees!  So much marking to do!

After we walked a mile, the short loop, Mazie's back leg began to falter -- the one that has done twice the work of the other two for the last thirteen years.  What with all the zig-zagging between trees, it's likely she did do 5K, and it was just her people who gave out.

Meanwhile, she cooperated magnificently, wearing her own shirt.  As soon as she returned to the start, she got into her therapy dog mode, sitting stock still while little girls with various levels of petting skills mobbed her, countless adults pondered her, and one woman who lives in a group home asked to be photographed with her. -- If her staff person is reading this, we are waiting for your email, so we can send the photo!

There were the requisite speeches from the requisite politicians.  Thank you, Dave Loebsack for doing your part to get mental health parity, more or less, into the health care bill.  Please support the President's interpretation that case management and reimbursement rates for psychiatrists have to match other forms of health care.  -- That issue has cost me thousands, because my care providers won't contract with my stingy health insurance company.

But I had to listen to speeches only from a distance.  They had serious competition.  The Old Capitol City Roller Girls were giving a demonstration in the parking lot.  No, it is not the chaos and brawling that I remember from childhood tv.  It probably wasn't then.  There are rules.  There is a point.  There are fabulous outfits!

This video is a bit long.  But it gives you the idea:



Anyway, as always, a fabulous day.  NAMI Johnson County raised $65,983.99 by walk day, 88% of its goal on the way to $75,000.  Did I mention that it was COLD?!

And Team Prozac Monologues, dressed in layers, but still proudly sporting our t-shirts, has raised $2395 of our $3500 goal so far.

Yes, there still is time to help us reach our goal!  In fact, for a limited time you, too, can receive one of our t-shirts.  They are cotton tagless t's, navy blue, with logos front and back.

The front is a shameless bid to win the t-shirt contest.


while the back says:


-- a shameless bit of self promotion!

Just make a donation of $30 or more or MORE by clicking the link up top on the right.  Then send your size and your address to: wmgoodfe@yahoo.com.  I'll make one up custom for for you!  This offer expires June 25!  So do it today!  Thanks!!

On a more sober note,  Gay and Ciha Funeral and Cremation Service was one of the main sponsors, and got a promo on the official walk t-shirt, while Lensing Funeral & Cremation Service sponsored a kilometer.  Their support reminds me that mental illness is potentially fatal, just like heart disease and breast cancer.  They might sponsor those walks, too.

As a priest I occasionally worked with those who provide funeral services.  I respect these people immensely, as do most clergy I know.  They do things for the bereaved that communities used to do, communities that don't much exist anymore.  Hospice has re-created a way for friends and family to talk with and support one another in the sorrow of many forms of death.  But funeral homes are the ones who step up to the plate for survivors of suicide.  They offer resources and support groups to friends and family.  I appreciate the work that they do.  And I appreciate their support of NAMI, in its work to stomp out the stigma of mental illness.

With them, with you, one step at a time, we shall overcome.

Oh yes, and it was COLD!!?!