Showing posts with label PTSD. Show all posts
Showing posts with label PTSD. Show all posts

Want a Sneak Peak to the Healing Trauma Conference?

The third annual Healing Trauma Conference: Come to the Table: Nourish your Body, Mind, and Spirit, Because No One Heals Alone takes place April 30-May 2, sponsored by Haelan House of Bend, OR -- Healing the Root Causes and Effects of Trauma.

My bit is Sunday morning's keynote address:

Suicidal Thoughts as Trauma:

Taking Charge of My Own Recovery.

Description: Trauma can be both the cause and the consequence of suicidal thoughts. Suicidal ideation is considered a symptom of a mental illness. The mental illness model (what's wrong with you? instead of what happened to you?) suggests that if the illness is treated, then the symptoms resolve. But often, while the thoughts themselves go away, the trauma can go unrecognized, untreated, and underground.

Soldiers on Psych Meds

Lies, damn lies and statistics. -- It's a mantra used by people who don't accept the conclusions somebody else draws from statistics.  Today it is my mantra.

Here is a statistic:  Since 2005 there has been a remarkable eightfold increase in psychiatric prescriptions among our active duty troops.  An incredible 110,000 soldiers are now taking at least one psychotropic drug, many are on more than one, and hundreds die every year from accidental overdoses.

Saving Normal: Here I Go Again

Allen Frances uses this statistic (and I do not dispute the fact) in support of his contention, that normal people are being misdiagnosed, and hence overmedicated for mental illness.  The suggestion is that normal soldiers are put on dangerous psychotropic medications that they do not need.

Well, let's put to one side the implied accusation of nefarious, or at least incompetent conduct by medics and their commanders, and instead look at some facts.

The Brain on Tetris

What happened to that hour?  That other hour?  The one after that?  Where did they go?

My son's best friend from childhood, whom I haven't seen in ten years, sent me a message with this link to a BBC story, The Psychology of Tetris.  When he saw it, did he remember that I used to ask my son to hide the Gameboy?

Is Recovery Possible? - Kayla Harrison Continued

A few weeks ago I published a video interview with Kayla Harrison, USA's first gold medalist in judo.  The story was dated before her win, and showed her determination: if not London, then Rio...  (The source is the Boston Globe.  Kayla didn't make NBC's radar screen until after she won.)

Lots of shots in the gym.  A young lady you wouldn't want to mess with.

Except, her former judo coach did, starting when she was twelve years old and for three years.

Today, her former coach is in jail, and she has her gold.

Well, of course we love this story.  It follows the USA's favorite narrative arc: misery, struggle, justice, triumph.  We will listen to this story, read this book, watch this movie every night of the week.

Some of us will ponder it a little longer than others.  I expect Kayla is one.

Get Over It, Already

Purple Heart for PTSD

I am pleased to have scooped NAMI and Fox News on this one by two years.

Some people say we have dumbed down PTSD, and that we dishonor the suffering of soldiers when we give the diagnosis of PTSD to people who have the same symptoms and same brain dysfunction of PTSD, but whose traumas were of a lesser severity.  In other medical departments, a broken leg is a broken leg, whether the person fell three feet or thirty.

Back in May, 2010 I proposed that the way to honor soldiers whose PTSD is the result of war injury is the way we honor any soldier wounded in war -- the Purple Heart.

Better yet, let's honor their sacrifice by preventing their trauma in the first place.  No more!

Meanwhile, check out Guitars for Vets.

Support the Troops - Stop Shopping

So I am back from getting my head examined, that three day intensive evaluation.  I had my doubts about this enterprise.  At my most anxious, my therapist reminded me I would get air miles.  That would be something, at least.  To my surprise, I also received some surprises.  And the experience was worth a couple of blogposts.  This one will be about PTSD, or make reference to it.  Next week we will play with the DSM.

I start at the Hilton.  Well, before that, my pension plan, which is how I ended up at the Hilton, not to mention how I ended up getting a three day psychiatric evaluation at the Gabbard Center, which does not usually happen for loonies in my tax bracket. 

Decent Benefits For People With Mental Illness? 

The Episcopal Church Pension Fund was established by one of the biggest robber barons of the 19th century, J.P. Morgan, doing penance for his sins.  Like how Charles and David Koch aren't.  Since then, clergy have put the equivalent of a whopping 15% of our salaries into the fund.

Unlike United Airlines or General Motors, this retirement fund is not run by people who have the option of stealing it by threatening to close up shop unless the pensioners just hand over their hard-earned savings to increase the compensation of the CEOs.  The shop being the Episcopal Church.  Plus for some reason, in defiance of the way managed mutual funds work in the real world, the Pension Fund beats its performance indexes year after year after decade after decade.  Maybe this has something to do with karma.  Maybe the angels.  Choose your metaphysical system.  Whichever, for me, this is good.

As a consequence, my disability pension comes from one of the last defined benefit plans in America.  And it regularly has to come up with ways to spend its excess revenues, like by providing good benefits for its disabled beneficiaries, even those whose disability is of the loony variety.

And since the people who manage that much money are used to staying in places like the Houston Hilton, then that is where they put up their loony beneficiaries when we are getting our heads examined.

Which is how I came to spend four days there, two blocks north of the Galleria. 

Galleria As A Tourist Attraction 

Malls called Galleria don't have stores with names like Old Navy.  They have stores with names like Giorgio Armani, Christian Dior, Chanel, Louis Vuitton, Saks, Baccarat, Tiffany's, Cartier, De Beers.  A whole store called De Beers, for God's sake.

Galleria is where the restaurants are, where we went when we were tired of sitting next to tables at the Hilton where we had to overhear earnest mentors training earnest mentees for their presentations to their big clients.  The oil companies were meeting at the Hilton.  Down the street, Bechtel was meeting at the Westin.  Bechtel is the construction company to the Saudi monarchy.  So it may be the timing was not a coincidence.

We walked to the Galleria.  The neighborhood isn't really designed for walking.  Houston is more of an internal combustion engine kind of place.  So as we picked our way through parking lots, we overheard a father and young son comparing their Beemer to the Beemer they parked next to.  We dodged  Maseratis and Mercedes while crossing streets.  Well, you get the idea.  There was a closer restaurant.  But the doorman appeared to be wearing Kevlar under his vest.  Well, you get the idea.

One of my docs, making small talk as we entered her office, asked if I was getting to look around Houston in the off hours when I wasn't getting my head examined.  I said, No I am too tired.  Except, we went to the Galleria.  She responded, Well, THAT's something! 

It was something alright. 

Galleria As A Mental Health Hazard 

One evening on our way toward sushi, a young man held out soap samples.  I said, No thanks, I don't do scents.  Then he grabbed my hand.  Okay, he asked permission.  I see your nails are clean.  You don't paint your nails?  No I don't.  Let me show you something.  So he explained about ridges and natural oils while he did his flirty little small talk and buffed one of my nails.  Now don't scream when you see the results.  Indeed, the nail was beautifully shined, and made the notion of painting nails seem cheap.  I agreed it was beautiful and said I was not going to buy the buffer anyway.  Why not?

Because I don't buy things. 

That took some explaining, both to him and to myself, since I had never said those words before.  He decided I had made a life style choice.  Well, okay.  That would be one way to look at it.

But it was more like a commitment than a choice, made then and there.  I would no longer buy things.

Don't get me wrong.  I am as fem as they come -- short of destroying my feet in those instruments of torture that women willingly put on their feet nowadays.  Evidently, all that work we did in the 1970s to get women to love ourselves was a waste.  In other cultures, women are forced to deform their feet.  Having stopped in the 70s, now we do it again.  In the US, we call that freedom.

Where was I?  Oh yes -- I found those beaded dresses in the Gucci windows quite lovely.  And I have some beaded things in the back of my closet from pre-loony days.  Maybe not pre-loony, maybe just not-yet-identified hypomanic days, who knows.

But tripping past them, dodging the Lexus SUVs, all of that, I felt this growing sense of doom about the American way of life.

What The American Way Of Life Costs 

I couldn't shake the images of three young men.  One is a friend of my son's, who came home from Iraq with a TBI and PTSD.  Another is a relative with a couple tours of duty in Afghanistan and a troubled marriage.  The third is a young man I counseled, who signed up, hoping to come home a hero in a box. 

Support the troops, people say.  Support the ones who are protecting our freedom.  Freedom to shop at Galleria.

There I was, surrounded by the way of life they were protecting at the cost of their brains and their families and their lives.

It is too high a cost.

It is too high a cost.

These thoughts, coming in the midst of getting my head examined, make me think we need to get America's head examined.

Money, Military and Mental Health

This isn't a political blog.  I do advocacy about mental health issues.  I am not here to plug political opinion.

This is not an opinion.  This is a photograph.


This is another photograph.

And here is another.

And now we return to the shoes.

As I look at one picture, then another, as I listen to those young men, and then to the people in that restaurant next to me, I do have an opinion.  Here it is.

These shoes cost too much.

They cost too much.

Actually, I don't think this is about mental health, after all.  It is a sickness of the soul. 

What Is The American Way Of Life? 

I did meet some very nice people at the Houston Hilton.  One man was from Ethiopia.  He drove the shuttle, and we got to know each other in twenty-minute conversations each day on the way to the Gabbard Center.  He came to this country because he wanted opportunity.  And he found it.  He drives a shuttle bus.  His eldest is a policeman.  His daughter is about to graduate from college, and his youngest about to enter.  He doesn't need a Maserati to have the American way of life.

The other shuttle driver came to the US during the war in El Salvador.  We talked about Archbishop Romero, and the strength we still get from his witness.  If I remember right, somebody gave Archbishop Romero a pair of shoes for his consecration.  People gave him lots of things, but his friend asked him what he wanted, and he said shoes.  This former refugee, now shuttle driver, also found the American way of life.  Emphasis on life.  He doesn't need a Lexus. 

Freedom And Addiction 

People say our young men and women are sacrificing their minds and their bodies to protect our freedom.

We need to protect our freedom ourselves.  We are not free.  We are addicted.  Addiction is a disease of the soul.  And it is progressive.  The more you feed it, the worse it gets.

Our freedom begins when we acknowledge our addiction for what it is. 

Step One -- We admitted we were powerless over our addiction - that our lives had become unmanageable.

I don't want those shoes.  But I do want that beaded dress.  And having resisted it, having told that young man I don't buy things, the very next day I still almost bought an Eileen Fisher sweater at Nordstrom's across the street.  Because it was on sale.

Just in time I remembered those three young men.  That sweater cost too much. 

My Bit For The War Effort 

PTSD, Post-Traumatic-Stress-Disorder is bankrupting the defense budget.  Researchers are trying to figure out how to prevent it.  Does it take a neuro-scientist to figure out that you prevent Post Traumatic Stress Disorder by preventing the trauma?

I have decided to support the troops the way the troops do, by caring about what happens to their buddies and acting to prevent harm from coming to them.  I will not wrap a flag around my shoulders nor post one on my facebook page for Veterans' Day.  I will hold before me the faces of those three young men, and wrap myself in my love for them.

I will work the Steps, always remembering that I am just as addicted to things as any of you.

With God as my higher power, the next time I buy something, it will be a bicycle.  So I can leave my Civic in the garage.

photo of J.P. Morgan by Edward N. Jackson and in the public domain
photo of Bacarrat Chrystal Sculpture used under the terms of the GNU Free Documentation License 
photo of Maserati, Gran Turismo by Rudolf Stricker and usedunder the terms of the GNU Free Documentation License
photo of Louis Vuitton shoes used under the Creative Commons Attribution-Share Alike 2.5 Generic license
photos of medical evacuation and coffins in public domain 

Recovery In Progress -- My First NAMI Convention

Dr. Ken Duckworth's job at the Ask A Doctor about PTSD session was to make some opening remarks and then let people ask their questions.  He rattled off a list of treatments and said, The good news about PTSD is, we know what causes it -- trauma that was not able to be processed adequately.  The bad news is, the treatments just don't work so well.

Short and to the point.  Actually, I am not so negative (right this very minute, anyway) about treatment as Dr. Duckworth, because I am not looking for the magic med anymore.  I know about recovery.

Recovery is about collecting tools and pulling them out when the occasion requires.  I will illustrate.  But first the setting...

Last week I attended my first NAMI (National Alliance on Mental Illness) Convention in Chicago -- 2300+ people who have mental illnesses, family members, advocates, volunteers and caregivers, with a few scientists thrown in for good measure.  As a friend said to prepare me, A NAMI Convention has a certain kind of energy.  Yes, it does.

I have been to big conventions before, used to be a legislator (called Deputy) for the Episcopal Church, which gathers 8-10,000 or so Deputies, Bishops, exhibitors, visitors, volunteers and the like every three years.  I stopped doing that when I figured out that every three years General Convention tripped my hypomania and was followed hard on by a depressive episode.

So this was my largest gathering in some time, with plenaries, workshops, symposia, networking and ask-a-doctor sessions, drumming, theater, yoga and talent show, internet cafe and peer counselors, exhibitors, book sales and an information booth which was the best hidden spot of the whole damn Chicago Hilton.

You can expect a number of blogposts out of this event, including dueling comments between me and fellow blogger John McManamy.  Now that we have finally shared a beer, does that make us blogmates?  I began writing this piece in the hotel room, late after the last gasp, the rawest of my posts to come.

I knew it was a mistake to make Ask-The-Doctor-About-PTSD the last thing I attended.  It's just, that was the schedule.  Most helpful take-away: The brain is simply not designed to metabolize certain experiences.  PTSD is the result of incompletely metabolized traumas.  Bottom line, it is a normal response to an abnormal event or series of events.

The brain keeps trying to metabolize these unprocessed events/memories/emotions/bodily sensations.  They lurk beneath the surface, waiting for the next opportunity to emerge, when triggered by some reminder.

Oh, I was triggered, alright.  The last question of the day was about a particular symptom I don't talk about and religiously avoid.  I left the room reliving it, dizzy and disconnected.

Walking out, I heard the voice of my therapist, who once ended a session saying, The things we have talked about today probably have triggered your past traumas, and you will be dealing with the effects after you leave.  So how are you going to take care of yourself today?

Time to pull out that toolbox.

The Ask-A-Doctor doctor listed half a dozen treatment modalities for PTSD: meds, support groups, EMDR (Eye Movement Desensitization and Reprocessing), sleep regulation and aerobic exercise.  He mentioned Prazocin for nightmares.

First off, pop my anti-anxiety rescue med, put on my walking shoes and go get some aerobic exercise.  Work off that negative energy.

Just outside the door was Grant Park.  An art exhibit diverted me from my aerobics.  But art is good, very good.  Change the channel -- that's Cognitive Behavioral Therapy 101.

I stood still and drank in paintings inspired by water.  Not this painting, actually, which is exhibited just down the street.  But I thought of it.

Water is good.  It evens out the emotional turmoil. -- So says my other therapist, the one who does eastern-based energy work.  You see, when even the doctors acknowledge that western treatments (they don't call them western, because they don't speak of there being any other treatments) work poorly, I am not going to limit my tool box to only half the planet, especially not the more rigid half.

I spoke with the artist about perspective.  He paints on a flat surface, so doesn't think it matters which side is up.  I breathed into the here and now.  Thich Nhat Hanh taught me here and now.  But here and now is my worst subject.  And somebody interrupted to talk about showings and art business.  There were too many people -- had to reduce stimulation.

My energy therapist would recommend grounding.  I headed back to the gardens, flowers, trees, dirt, all good, all grounding.  Eating is good for grounding, too.  Maybe I should eat something.

From Alcoholics Anonymous: HALT = pay attention to when you are Hungry/Anxious/Lonely/Tired.  No, a martini is not in the recovery toolbox.

So I bought my inner child a strawberry ice cream -- a drippy cone instead of my usual adult cup.  Sugar isn't really the best choice, but it was red and a gift to my inner child.  Then I head off to find some meat.  Meat feeds the first chakra.  First chakra is about safety.  PTSD is about the amygdala is about safety is about the first chakra.

Still I was struggling.  I don't just have my own pain; I suck up the pain of every person with whom I have spent the last three days.  All those stories -- how can there be such a world?  How can I live in such a world?

I picked up my whole personal Book of Traumas, the traumas that never got resolved, that get retriggered today when I try to resolve them in therapy, the distrust I try to pretend does not exist toward the people who try to help me but they end up retriggering the traumas I can't resolve because they never seem to address that they are retriggering them and my retriggered shame prevents me from telling them and I truly believe the result will be retrauma anyway.

There are exceptions to that negative thought.  List the exceptions -- Cognitive Behavioral Therapy 102.  But how do I know who is for real...?

So I head back to the convention, walk over the train tracks.  And there is another trigger, another overpass, another trip to Chicago, another episode, another long time ago.  How quickly is that train traveling?  How far away?  How fast does a body fall that far?  How to time the collision of the two?  Velocity problems were the one thing that defeated me in high school math.

But I am not in the right spot anyway.  Geometry I got.  I need to be right -- there -- where -- a woman is pushing a baby stroller.

Oh.  Okay.  Not tonight.  I have an Iron Rule.  In a world filled with trauma, to the extent that it lies within my power, I will not cause trauma.  A two-year-old is sitting where my demon would call me.  The two-year-old wins.

God bless the internet that led me to David Conroy some years ago.  The first sentence of his book Out of the Nightmare brought sense out of the chaos that compounded the pain of my suicidal symptoms.  Suicide is not chosen; it happens when pain exceeds resources for coping with pain.

Tonight my pain was painful.  But I have survived worse, much worse.  And tonight my resources are many.  Tonight the thought was more than a mosquito, but it wasn't a tiger.  I do not underestimate the lethality of this disease.  One in five people with bipolar II do not survive it.  Tonight, I am still of the four.

I know people freak out over the suicidal ideation part of mental illnesses.  I apologize to my friends for causing them pain by bringing up the subject -- even though my need to protect you from this pain adds to my own.  I try not to bring it up, except with people who know what I am talking about.  But this is one of the tools in the Recovery Toolbox.  Those who do know what I am talking about need this tool.  And this post is for us.

Ironically, the state of the art treatment for people who have a lot of suicidal ideation and behavior, people with a diagnosis of Borderline Personality Disorder, is Dialactical Behavioral Therapy, radical acceptance.  Starting, not ending, but starting with acceptance even of that symptom that freaks out so many of you.

Yes, sometimes I have those thoughts.  They are well-worn grooves in my neurological pathways.  Any number of things will trip the cascade that leads there, including things you might not imagine, a cold sunny day, my doctor suggesting a new medication, an overpass.  These are not reasons.  Suicide is not about reasons.  These are triggers of neurological pathways that have a current of their own.

It is what it is.  Those five words sum up Dialectical Behavioral Therapy, an offshoot of CBT.  They were the chorus sung by one of the players in the lunchtime drama troupe.  Saturday night, I repeated them to myself.  Often when that thought appears, somewhere between a mosquito and a tiger, I say, There it is again.  That's all.  Mindfulness.  The thought doesn't have to freak me out, doesn't have to freak you out.  It is what it is.  Move on.

As I crossed the overpass, I felt a draw, a pull toward the hotel.  It was an energy, a spiritual energy on the side of life, two thousand people in that building, rooting for me, for my life, for one another, for you.  One of them even blowing a didgeridoo, accompanied by a flute, to be followed later by another who whistled Somewhere Over The Rainbow, all spiritual energy on the side of life.

The wisdom is ancient.  Two are better than one, because they have a good reward for their toil.  For if they fall, one will lift up the other; but woe to one who is alone and falls and does not have another to help.  Again, if two lie together, they keep warm; but how can one keep warm alone?  And though one might prevail against another, two will withstand one.  A threefold cord is not quickly broken.  [Ecclesiastes 4:9-12, New Revised Standard Version]

So that is my first report of my first NAMI Convention, the most confusing and most compassionate experience I have ever had with 2300 people.

(Find your local NAMI Chapter here.)

photo of toolbox by Per Erik Strandberg and used under the Creative CommonsAttribution-Share Alike 2.5 Generic license
General Convention Seal for the Episcopal Church in public domain
Olaus Magnus's Sea Orm, 1555 in public domain
Water Lilies by Claude Monet, 1906, in public domain
photo of Grant Park in Chicago by Alan Scott Walker and used under the Creative CommonsAttribution-Share Alike 2.5 Generic license
root chakra by Muladhara Chakra and used under the Creative CommonsAttribution-Share Alike 2.5 Generic license
photo of Chicago Orange Line by Daniel Schwen and used under the Creative Commons Attribution-Share Alike 2.5 Generic license
photo of Coal Creek Falls by Walter Siegmund and used under the Creative CommonsAttribution-Share Alike 2.5 Generic license
fresco at the Karlskirche in Vienna by Johann Michael Rottmayr, in public domain
book covers by

Cognitive Deficits -- on the way to Getting My Brain Back

The speaker at our monthly NAMI meeting was tall, mid-60's, military bearing, a former ER doc who did a couple tours of duty in Iraq.  You know the type.  Only, a little less of that ER doc -- I'll call it self-assurance.

He showed us slides of the work he used to do, the before shots (which we really did not want to see) and the after shots of young people, kids he patched together at the medic stations.  He told us about the sticky dark trail running from the helicopter pad to the table, and what made it sticky dark.

His passion for his work lit the room.  We listened to stories of kids for whom he had after shots.  There weren't always after shots.

He told us about TBI's, traumatic brain injuries and PTSD and how war does damage to brains.

He was taking a break after two tours of duty, back in an ER state-side when he had the stroke.

Now it became a different story.

Stroke -- The Brain Is Part Of The Body

They told him it would be a long recovery.  Two months later, he was astounded at how long it was taking.  They told him again, it would be a long recovery.  Six months later, the frustration overwhelmed him.  His body was back, the use of his limbs, his balance, more or less.  But his brain wasn't.  And the rehab people said, This is good.  Rehab has begun.

See, we know a stroke is a physical event, something that happens inside the body.  But still we have trouble thinking of the brain as the body.  We have trouble thinking of the functions of the brain, like thinking, as physical functions.  The injured body has to rehabilitate.  We know that.  Doesn't the brain just come along for the ride?

But thinking is done by a body, the part of the body called the brain.  Thinking is a physical process, electrical charges tracing a pathway from one cell to the next, within an organ of the body called the brain.  And when the brain is injured, it has trouble performing its physical functions, like thinking.

Cognitive Deficits

This emergency medicine doctor with battle front experience can't work anymore.  He used the phrase cognitive deficits.

To illustrate, he told us about the work of an emergency room doctor.  When somebody comes into ER with a potential heart attack, there is a protocol.  There are 17 steps to this protocol.  [It might be 23 -- I wasn't taking notes.]  He told us the first step.  Check.  Then he told us the second.  The second step requires a certain mathematical calculation.  He told us what needs to be calculated, the ratio between two measurements.  [I didn't write them down.]  He knows how to do the calculation.  He can do it in 18 minutes.  The whole process is still in there, inside his brain.

The thing is, this entire 17 step protocol has to be done in 93 seconds.

So he can't work as an ER doc anymore.  His job is to do rehab for his cognitive deficits.  In rehab he is learning how to connect all the bits that are still in there.  His brain is finding new pathways around damaged areas to turn all those bits into coherent and accessible thoughts.

And I thought -- That's it!  That's my swiss cheese brain!

My Swiss Cheese Brain

I am told, now that I have lost half of my cognitive functioning, I am still smarter than 80% of the people in the room.  Well okay, between 10 and 11:30 on alternate Wednesday mornings.

All the bits are in there.  If only I could connect the dots.  I wander inside this brain like the hallways of Hogwarts, wondering what's behind those locked doors, getting caught on moving staircases that take me to places I shouldn't be, sitting cross-legged on the floor in front of the Room of Requirement, desperately requiring entrance, but not a clue how to get in.

Sometimes all the bits taunt me.  They light up like little Christmas tree lights, blink off and on.  But if I grab one, the whole chain goes out.  Other times, all of a sudden, it's back, my brain.  I can get it to take me exactly where I want to go.

You don't notice.  You don't see the day spent on a paragraph, the week that is lost when the wall will not yield.  It hurts to write.  But I don't know who else to be, if not a writer.

Brain Damage

I have been writing about this stuff for years now.  Listening to somebody recovering from stroke, it finally hit me, brain damage.  I have brain damage.  The source is not the same.  A stroke kills brain cells through oxygen deprivation.  Trauma kills brain cells through chemistry, a surge of catecholamines, depression of thyroid function and hypoxia... an outpouring of other neurotransmitters, neuropeptides, and hormones... heightened catecholamine endorphin secretion with eventual depletion... the secretion of corticotrophin releasing hormone (CRH), adrenocorticotrophic hormone (ACTH) and cortisol... always more cortisol...

All of which really screws your hippocampus, seat of memory.  Here is the source of my cognitive deficits.  They say that, unlike cancer or a broken bone, there is no picture of depression.  Actually, that is not true.  MRI's show that anxiety and mood disorders damage and shrink the hippocampus.  They do have the pictures.  It is real.  It is brain damage.

Traumatic Brain Injuries, Post Traumatic Stress Disorder and severe depression all do the same brain damage.  They look the same.  By that, I mean the same MRI's.  They act the same.  By that I mean the same dysfunctions.  And, what do you know, they respond to the same treatments.  [I wrote about this in more detail back on March 28, 2010, one of my most frequently viewed posts.]

You can rehabilitate brains damaged by TBI's, PTSD and depression, just as you can rehabilitate brains damaged by stroke.  Just like stroke, some damage is reversible, some is not.  And just like stroke, expect it to take a long time.

A Long Recovery

A friend who has been my mentor through this life transition of mine told me, Yes, your brain will come back.  Give it five years.

So then my brain did its half-full/half-empty thing.

Five years -- that takes the pressure off.  I can give myself a break, and give myself time.  I can have hope.  Maybe my brain will be brilliant like my friend's brain again.

Five years -- my career really is over.  I will be too old to go back.  There is no reclaiming what I lost.  The presenter will never work in the ER again, and I will never be Diocesan Ministry Developer again.


I do tend to focus on the half empty part.

But my brain stretches out to as healthy as I can imagine, if only for a moment --

So I will do something else, instead.

to be continued...

photo of army doctor during training in Baghdad in public domain, (not the speaker referred to in this post)
flair by facebook
reproduction of hippocampus from Gray's Anatomy in public domain
fresco of The Visitation from the 14th century, Museo Matris Domini in Bergamo Italy

PTSD: Prevention -- Sort Of

Readers will know that I am firmly in the camp that calls for  the "trauma" in Post-Traumatic Stress Disorder to include more than war and rape.  Nevertheless, as I write this third in my PTSD series on Memorial Day weekend, I write with love, honor and respect for my parishioners, friends and family members who have served this nation in combat.  As it happens, all of my people have come home.  But none of them ever really.

Now know this.  It frames the whole conversation about research into prevention of Post Traumatic Stress Syndrome.  All the efforts currently being studied and tried for prevention are about preventing PTSD in those who have already experienced trauma.  (That's called "secondary prevention.")  They are not about preventing the trauma in the first place.  Read it again and remember that point.  I shall return to it.

[If you want to skip the research, you can scroll down from here to the **** where I take up my conclusions.] 

A number of medications are being tried post-trauma (the "morning-after" pill) to interrupt stress mechanisms and to impede the particular memory consolidation that leads to PTSD.  If memories of the trauma, including sights, sounds, smells, sensations are not associated with the conditioned fear response, then triggers will not elicit symptoms and PTSD will be prevented.

One strategy is to damp down the activity of the adrenal gland.  Propranolol is a prime candidate for this use.  It is used now to treat hypertension and anxiety disorders, because it reduces the fight or flight mechanism, the release of catecholamine from the adrenal gland and speeding up of the heart rate, among other things.  Propranolol interferes with the memory of emotional events, because the mental image is not "consolidated" with the bodily experience of adrenaline.

Studies of propranolol have been conducted on trauma victims.  Usually it is administered in the emergency room, within a few hours of the trauma, and then continuing over the course of several days.  The results are mixed.  In some studies, those who received the medication experience fewer PTSD symptoms one or two months later.  A NIMH study in 2007 did not replicate these results.

Another approach is to address the damage done farther downstream, by changing the balance of neurotransmitters.  Neurotransmitters sit in the space between brain cells (called synapse) and help messages move along from one to the other.  Serotonin (of Prozac fame) carries the messages and is the best known by the general public, but there are several others, as well.

Glutamate is a neurotransmitter that speeds up the action between brain cells.  There is a lot of glutamate in the hippocampus, where it helps develop long-term memory.  GABA slows down the passage of messages, which gives it a tranquilizing effect on glutamate.

The balance of these two affects the health of neurons.  Persons with PTSD have more glutamate and less GABA on board than those without PTSD.  The Defense Department is currently funding a study to discover whether an intervention to redress the balance might make communication between brain cells less efficient -- again, interfering with the consolidation of long term memory.

Another option is an earlier and more aggressive use of serotonin.  Serotonin supports brain-derived neurotrophic factor (BDNF).  So it indirectly helps the brain repair itself, reversing shrinkage in the hippocampus.

The neurotransmitter Neuropeptide Y (NPY) inhibits the release of stress hormones norepinephrine and corticotropin releasing factor.  There is some evidence that enhancing the production of NPY might reduce the problems caused by stress overload.  But there are no such medications available yet.

Then there are the opiates, such as morphine.  It would be unethical to conduct the typical research using morphine, i.e., giving the medication to one group and placebo to another.  This January, the New England Journal of Medicine reported an "observational study" of morphine use in the battlefield.  The medical records of 696 injured military personnel were examined after treatment.  Those with moderate or severe traumatic brain injuries were excluded from the study, because severe brain damage protects against PTSD.  How's that for irony.

The study concluded that morphine does provide some protection against PTSD.  Among the patients in whom PTSD developed, 61% received morphine; among those in whom PTSD did not develop, 76% received morphine.  The odds of this difference occurring by coincidence are less than one in a thousand (odds ratio, 0.47; P<0.001 in statistics-speak.)  Severity or mechanism of injury, age and amputation -- none of these factors made a significant difference in the findings.

It is speculated that morphine has this protective effect because severe pain increases the trauma of the injury, and hence of the memory.  I wonder if it might prove more effective in nonmilitary use, among those whose brains are not being primed for PTSD every single day.

Okay, the limitation of any of these medications is that they are directed at single event traumas, rape, injury, one time devastating experience.  The brains of soldiers and abused children are injured and prepared for PTSD daily.  What are we going to do, sprinkle propanolol into the cornflakes of everybody deployed in a battle zone, make it part of school lunches?

There are also more creative, nonpharmocological approaches being explored.  Louisiana State University Health Sciences Center is going to study hyperbaric oxygen treatment for those with traumatic brain injuries. TBI has been called the signature wound of the wars in Iraq and Afghanistan. A RAND Corporation study released in April estimates that about 320,000 service members may have experienced a traumatic brain injury during deployment. 

In hyperbaric oxygen treatment, burn and carbon monoxide victims are placed in a pressure chamber to increase oxygen in the blood stream, and hence in the brain.  Think of deep breathing to relieve your anxiety attacks.  LSUHSC will compare TBI victims who receive or don't receive this treatment, in hopes of discovering a new approach to help this subset of injured soldiers.

Like the medications, hyperbaric oxygen treatment (if it works) will be given to those with one time traumas, not so useful for continuing trauma.  Here is another approach that might work on a daily prophylactic basis.  Tetris!

An admittedly small study conducted at the University of Oxford examined whether "visiospatial cognitive stimulation" could provide a vaccine against flashbacks.  It was based on the capacity of the brain to process just so much stimulus at one time.  If that capacity is used up by the intrusion of non-traumatic images, then perhaps the traumatic ones would be encoded in memory less deeply. 

So they showed the Trauma Film, a twelve minute piece that is known to produce flashbacks.  After thirty minutes, ten subjects played Tetris, and ten sat quietly.  Tetris was chosen because it is known to intrude upon image-based memory (people see images of the game at a later time after playing).

In fact, these intrusive memories are why I stopped playing it.  It was additively soothing, but I kept seeing the Tetris shapes around me in everyday objects.  Like, the silhouette of a head and shoulders became that L-shaped piece.  At one point I asked my young son to hide his game-boy, so I couldn't find it!  Now I play other games that intrude on image-based memory.

I digress.  Anyway, in the following week, the Tetris-playing group had fewer flashbacks to the Trauma Film than the others.

Now this is an application that could be used in the battlefront.  I understand that soldiers often play computer games when they return to base, though usually they are war games.  Tetris or maybe some other matching three type game could push the day's images out of their brains.


Okay now, I have spent months gathering these studies of secondary prevention of PTSD, and struggling with two issues regarding the vast numbers of new sufferers of PTSD who are created every day in Iraq and Afghanistan.

The first is a dilemma.  After we have put our young people in harm's way, after they have been injured in the service of their country, surely they need -- and deserve -- the best medical care we can give them.  And better.  Surely we need to do more research for better medications and better treatments.

What troubles me is that the medications and treatments are designed to obscure from them the horror of their experiences.  While we treat them, we are creating more effective soldiers, soldiers who can do more and more terrible things, because we have undone part of their most human response to these terrible things.  And we are creating in ourselves denial about what war is.  The healthy human being would go crazy.

And we can't do this so selectively as we would like.  When we interfere with the consolidation of traumatic long term memories, we also interfere with all long term memories.  Which, ironically, is what PTSD does.  Part of how the brain protects itself from horror is to go numb to all feeling.

And yet, their suffering is real and urgent.  How can we not relieve their pain by any means possible?

See what I mean?

My second issue is this.  All the medications and treatments I have described are secondary prevention. -- I said at the beginning that I would return to this point.

What is primary prevention?  It's what we do with lung cancer.  We don't invent treatments that intervene between inhaled carcinogens and the lungs.  We conduct public campaigns against smoking.  We don't make the liver more efficient in processing poison.  We prohibit the use of lead-based paint.  We don't prevent Froot Loops and the sugar in even salad dressing from overwhelming the pancreas and kidneys.  We educate about high fructose corn syrup and our epidemic of diabetes and obesity.  -- Okay, there's a little hypocrisy in that last one, when we compare the money spent on health education to the subsidies given to produce high fructose corn syrup.

What about primary prevention of PTSD?

When is the Surgeon General of the United States of America, Vice Admiral Regina M. Benjamin going to stand up and tell us the truth -- that war is a health hazard?

The frontal cortex of the human brain, the part that comprehends the consequences of actions, is not fully developed until age 25.  When are recruiters going to be banned from high schools and college campuses and malls?  Or federal funding refused to schools that permit ROTC programs?  When are those ads for the Marines going to be banned from the Super Bowl and other sporting events?  When are parents going to teach their children, Just say no?

Defense Secretary Robert Gates said recently that leaving aside “the sacred obligation we have to America’s wounded warriors, health care costs are eating the Defense Department alive.”  Imagine how much money we could save is we stopped putting them in harm's way.

Before automated warning systems were developed, coal miners used to take canaries with them into the mine.  When the canary died, the miners knew the air was poisonous.  It was time to get out of the mine.

So here is the last thing I am going to say about PTSD for a while:

We gotta lot of dead canaries.  When will we get out of the mine?

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.

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.

The Mood Chart Video

I call this video Mood Chart for UltraRapid, Ultradian Cycling Bipolar, with a Touch of PTSD.

To the Therapy Theme Song.

Much more fun than some old DSM code, doncha think?

A family member said, "If you can relate to that song and video, now I know your mind works on a completely different level."  To which I responded, "Then we are making progress."

Yes, this is the inside of my head today.  Someday when it's not, I'll write about mood charts.  Very useful things, mood charts.  A basic tool for recovery.  My favorite is here, also listed among the Resources on Mental Illness over there on the left.

But that's all for this week.  See ya.

PTSD and DSM: Science and Politics -- Again

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.

Cognitive Behavioral Therapy -- aka Cake or Death

Cognitive-Behavioral Therapy (CBT) is a... treatment that focuses on patterns of thinking that are maladaptive and the beliefs that underlie such thinking... In CBT, the individual is encouraged to view such beliefs as hypotheses rather than facts and to test out such beliefs by running experiments. Furthermore, those in distress are encouraged to monitor and log thoughts that pop into their minds (called "automatic thoughts") in order to enable them to determine what patterns of biases in thinking may exist and to develop more adaptive alternatives to their thoughts. -- 

Books on Cognitive Behavioral Therapy

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