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Misunderstood and Mistreated: The Case of PTSD

I walked in circles around my empty house, wishing I had someone to talk to at the

moment. I was only in fifth grade, but my life had taken a big turn that year: I was diagnosed

with general anxiety disorder and obsessive-compulsive disorder. The origins of these devils in

my mind remain unclear; one second I was fine and the next my mind was clouded with murky,

unanswerable, anxious thoughts. It consumed me and my personality like a plague, leaving me

trapped in a room with my thoughts. My nights became sleepless and my days restless with no

time to relax. Simply put, it was exhausting. I did not realize that others noticed my change in

demeanor until years later when my mom quietly whispered to her friend, “It was like she was a

whole different person,” at a family party.

The recovery for me was tough. Luckily, my parents were able to provide me with the

help I needed through resources my mother found at the local library. Every few weeks, she

would come home with a new book about anxiety that she would read to me before bed in an

attempt to help me understand what these thoughts were and how they could be controlled. One

book she read to me, “What To Do When You Worry Too Much,” by Dawn Huebner, still

remains crystal clear in my mind. The cover page of this novel had an illustration of a young boy

standing next to a tomato plant that was growing out of control; the inside pages were full of

methodical procedures that directed me to put my worries into a “worry box” and so forth. After

continued practice and guidance from my parents, I was able to release myself from the tight

hold of anxiety and OCD. I no longer let the tomato plant of my anxiety overshadow me.

I subsequently realized, however, that I was not the only person that struggled with

mental health. Mental health was not discussed much in school, leaving me and my classmates

rather uneducated on this topic. It was not until I took AP Psychology as a sophomore in high

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school that I learned about all the types of mental illnesses that affect millions across the globe.

While covering this unit on mental health, I was reintroduced to the mental illness of Post

Traumatic Stress Disorder, also known as PTSD. PTSD was one of the only mental illnesses that

had been mentioned previously in my other classes; specifically in American History and World

History. I remember learning about World War I and World War II in both of these classes, and

how many soldiers suffered from PTSD due to the horrific events they watched unfold on the

battlefield. However, despite the sheer volume of people affected by PTSD and the prevalence it

has had throughout history, the disorder was not nationally recognized until many years later.

Even worse- it was mistreated for ages and held a negative connotation to its name. All of these

elements made me wonder: How is further research into Post Traumatic Stress Disorder

redefining this once misunderstood and mistreated condition?

PTSD is a nuanced mental disorder. The National Institute of Mental Health simplifies

the explanation behind this mental illness by providing the following definition: “Post-traumatic

stress disorder (PTSD) is a disorder that develops in some people who have experienced a

shocking, scary, or dangerous event” (“Post-Traumatic Stress Disorder.”). This definition,

although short, pioneers discussion for the various depths that PTSD contains. Before delving

into the history of PTSD and the structured timeline of treatments, I believe that it is important to

be knowledgeable on how PTSD affects the chemistry of the brain. The brain regions that are

affected most by this mental disorder- the hippocampus, amygdala, and medial prefrontal cortex-

are the principal brain regions responsible for emotions and fear. The hippocampus is the area of

the brain that stores and differentiates memories periodically through time. PTSD affects the

hippocampus by making it unable to discern the past trauma occurrence from the present

situation, which in turn, activates the amygdala and the fight-or-flight response (Thatcher). Dr.

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Todd Thatcher elucidates further on this peculiar brain response by stating the following: “Often,

stimuli can trigger overactivity in the amygdala if somehow connected to the traumatic event a

person is suffering from. This might lead to chronic stress, heightened fear, and increased

irritation. This might also make it harder for those suffering to calm down or even sleep” (“Can

Emotional Trauma Cause Brain Damage”). This disorder also makes the prefrontal cortex lose its

ability to rationalize certain emotions, which leaves the brain more vulnerable to fear (Thatcher).

This is one of the most common, simplified explanations behind PTSD in terms of what brain

regions are responsible for the symptoms and cognitions most associated with the illness.

However, I feel that it is important to note that various clinical trials have shown that PTSD can

affect the brain in many different ways and that the description provided above is not the full,

labyrinthine breakdown of how this mental illness exerts influence on the brain.

The Tale of Gilgamesh. Romeo and Juliet. The Industrial Revolution. World War I.

Although these elements of history seem divergent from one another, they share one common

element when analyzed from a psychological standpoint. After further research, I ascertained that

this interconnecting link was PTSD. In famous pieces of literature, PTSD is portrayed through

the stories' multiplex characters, whereas in historical and political events, PTSD was observed

and recorded in many people during these tough times of change. Personally, I was not aware of

the prevalence of PTSD throughout history, and now wonder why it was not a more emphasized

topic of discussion in previous History and English curriculum classes I have taken.

The first recorded observation of PTSD was during the French Revolutionary and

Napoleonic Wars. After observing soldiers on the battlefield, physicians saw that, “...soldiers

collapsed into [a] protracted stupor after shells brushed past them, although they emerged

physically unscathed. This led to the [physicians developing the] description of the “vent du

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boulet'' syndrome, where subjects were frightened by the wind of passage of a cannonball”

(Crocq). Countless soldiers who were involved in the numerous wars throughout history faced

similar symptoms and were often described to be skittish and frightened after going through the

battlefield. Take World War I for instance; throughout the entire war, there was a greater number

of soldiers checked into the hospitals for psychological turmoils than there were for physical

injury. This is when the term “shell shock” was coined to describe the soldiers who had PTSD.

However, I believe this phrase also marked the beginning of the misunderstanding and

mistreatment of this mental disorder, as shown in the following quotation: “In the British

military, patients presenting with various mental disorders resulting from combat stress were

originally diagnosed as cases of shell shock, [until] this diagnosis was discouraged in an attempt

to limit the number of cases” (Crocq). The sheer amount of soldiers who began to express

symptoms of PTSD was overwhelming, so much so that the war generals and leaders of

countries tried to control and constrain the number of cases by dismissing the diagnosed as

cowards. Unfortunately, this brought a negative connotation to the name of the disorder, often

making said soldiers feel ashamed of themselves and their state. However, these soldiers were

anything but cowards and should never have been demeaned for their mental health. The same

occurrences presented above were also observed in World War II.

The rise in PTSD in soldiers during times of war ultimately led physicians to look for a

treatment or cure for the mental illness. Yet, not much was known about the physiological brain

structure back then which made finding an effective treatment much more difficult. One of the

most popular treatment methods was nicknamed the “forward treatment” and was created by

American physician Thomas W. Salmon. His treatment method consisted of the following five

parts: immediacy (treatment as soon as possible), proximity (treating the patient as close to

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frontline as possible), expectancy (persuasive psychotherapy), simplicity (simple treatments such

as sleep), and centrality (an organization that regulated psychiatric casualties during the

war)(Crocq). This treatment was questionable, but it was more ethical than the other ubiquitous

form of treatment- electrotherapy. In electrotherapy, patients were repeatedly shocked in an

attempt to rid them of their shell shock. This procedure was agonizing and futile. Eventually, it

caused uproar in the affected community: “In Britain... electrotherapy evoked disquiet not just

from ordinary soldiers but from other doctors who worried that the over-use of simple

electrotherapy would condemn patients to the care of untrained "medical electricians”(Reid).

Many physicians abused their power over injured soldiers and forced them to feel vulnerable

while receiving the treatment. If these treatments were not performed, then the next most

common “solution” was to send the soldiers to a mental asylum, where they had no access to

family support (Reid). In conclusion, the treatment methods for soldiers and any persons affected

by PTSD were very limited and quite cruel for an extensive period of history.

No one should be judged for having a mental illness. Sadly, there are many occasions in

which people are frowned upon for struggling with their mental health, just as the soldiers who

had PTSD were. Needless to say, PTSD is a mental illness that has been gravely mistreated in

history. Luckily, as time and technology have progressed, the research and treatment types for

PTSD have as well. While conducting my research, I discovered that this progression began with

the addition of Post Traumatic Stress Disorder to the Diagnostic Manual of Mental Disorders in

1980. Now, the fifth edition of this manual is widely used by psychologists around the world

when diagnosing patients with PTSD.

The Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

outlines the specifications of the disorder in eight symptom-based parts that a licensed clinical

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professional is to look for when diagnosing a patient six or older with PTSD. The first diagnostic

element is the exposure to a trauma-inducing stimulus, such as death, serious injury, domestic

abuse, or sexual violence (“DSM-5 Diagnostic Criteria for PTSD.”). One common

misunderstanding among the general population is the belief that the trauma must be experienced

firsthand. Dr. Gretchen Palau, a licensed clinical psychologist in the Bay Area, helped me

understand this element of the disorder further in our interview:

A person doesn’t have to experience the traumatic event/s firsthand to have PTSD. You

can be diagnosed with PTSD if you witnessed or heard about a traumatic event. It’s

important to know that what makes an event traumatic is the subjective assessment by

victims of how threatened and helpless they feel. So, at the core of PTSD is the actual

traumatizing event/s, but it’s the meaning that victims attach to these events that are as

fundamental as the trauma itself.

This mental illness is quite personal and is unique in regards to each patient it affects, which Dr.

Palau made clear in our discussion; therefore, the DSM-5 only provides a general guideline for

the diagnoses. The next diagnostic tactic outlined is the presence of any of the following

intrusion symptoms: recurrent distressing memories, recurrent distressing dreams, dissociative

reactions, intensive and prolonged psychological distress, and marked physiological reactions to

internal or external cues (“DSM-5 Diagnostic Criteria for PTSD.”). All of the following

symptoms listed above are concerning the trauma-inducing stimulus. The following two

diagnostic categories in the DSM-5 address negative alterations in cognitions and mood and any

alteration in arousal and reactivity. The final three criteria outline the time and severity of the

symptoms listed above and specify that none of the following diagnostic principles were caused

by substances such as drugs and alcohol (“DSM-5 Diagnostic Criteria for PTSD.”). These

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distinct guidelines are used by therapists and clinical psychologists around the globe today as a

resource in determining whether or not a patient has PTSD.

To further understand the DSM-5 and the most effective PTSD treatments used today, I

reached out to Dr. Gabriele Goodman, a local psychologist in my area. Dr. Goodman is a

licensed therapist who specializes in trauma and PTSD and has been in practice for 20 years.

Before our interview, I reflected on the types of treatment I found while researching this mental

illness. These treatments include but are not limited to: Cognitive Behavioral Therapy, Exposure

Therapy, and Eye Movement Desensitization and Reprocessing (EMDR) Therapy. Although I

was familiar with the general premise of each type of treatment, I knew that to truly understand

each one I had to ask Dr. Goodman for an in-depth explanation. She began with describing

Cognitive Behavioral Therapy:

Cognitive Behavioral Therapy is when a person tries to match their behaviors with their

thoughts. Your thoughts, whether positive or negative, have an effect on your emotions,

which then trigger your physiological response. Then there is a behavior and

consequence that come along with those, which can be thought of like a self-fulfilling

prophecy. So if you have a negative thought, your emotions are negative and you get

tense… CBT is designed to change your thoughts to be more positive so that your

emotions and behaviors will be more positive and benefit you as well.

I learned that CBT is one of the most common and effective forms of therapy used by therapists

when treating their PTSD patients. There are also many subcategories of therapy derived from

CBT, such as Cognitive Processing Therapy, Cognitive Therapy, and Prolonged Exposure

Therapy (“Treatments for PTSD.”). The next type of talk therapy I discussed with Dr. Goodman

was Exposure Therapy. Exposure Therapy is just how it sounds: it is designed to expose and

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reintroduce the traumatic experience to the patient until the stimulus becomes less frightening.

Repeated exposure to the thoughts, situations, and feelings helps decrease the amount of distress

the patient feels (“Treating PTSD Can Include 'Exposure Therapy'.”). Dr. Goodman described

this form of therapy by describing a situation in which it would be used: “For example, if a

person was afraid of elevators, then they might start exposing themselves to the elevator by first

walking up to it, then clicking the button, then going inside, and so forth until they can ride the

elevator all the way up to the top floor without being afraid.” Finally, the practice of EMDR has,

“the patient briefly focus on the trauma memory while simultaneously experiencing bilateral

stimulation (typically eye movements), which is associated with a reduction in the vividness and

emotion associated with the trauma memories” (“Treatments for PTSD.”). Dr. Goodman

delineated to me that the main objective of EMDR is to help patients create images and senses in

their brains.

During the interview, I also learned that many PTSD patients are prescribed medication

to help with their symptoms. Dr. Goodman explained to me that, “Medication can help with

nightmares and the anxiety components of PTSD” and that medication and talk therapy “work in

tandem with each other, and one can not completely replace the other”. The medications that are

most often prescribed to patients with PTSD include sertraline, fluoxetine, and paroxetine, which

are all selective serotonin reuptake inhibitors (“Medications for PTSD.”). However, these

medications include a variety of side effects and may not work for all patients. Both treatment

components have been successful in the past and may be used as the first line of defense for a

patient based upon what their medical professional decides. Dr. Goodman emphasized to me that

“traditional talk therapy” is not always the preeminent treatment option for patients, as other

developed treatments such as somatic-based therapy may be more effective depending on the

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patient at hand. It is also important to note that other support-based treatments such as the use of

an Emotional Support Animal (ESA) can be extremely effective in helping patients navigate their

PTSD on a day-to-day basis.

Fortunately, a multitude of new treatment options for PTSD are coming about with the

concurrent development of technology. One of the most groundbreaking treatments is the

injection of anesthetic into the stellate ganglion block (a collection of nerves that are part of the

sympathetic nervous system) in the neck. In a study conducted with various veterans who had

PTSD, the injection of medication into the ganglion block significantly helped them with their

symptoms: “One veteran, who said the injection began alleviating his PTSD symptoms within

five minutes, likened it to “having a weight taken off [his] shoulders and chest.” Other

PTSD-stricken vets have reported similar immediate results'' (“Search Continues for Effective

PTSD Treatments."). This treatment method could be revolutionary based upon the

extraordinarily positive results seen in clinical trials. Another treatment that has been under

development for some period now is neurofeedback, a type of biofeedback in the body. For this

treatment, patients perform sensory activities such as watching movies or playing video games

while hooked up to sensors that send therapists information about the patient's brain waves. This

allows the therapists to create a stop-and-start feedback system over various sessions. This type

of treatment, although effective for many patients with PTSD, is difficult to describe:

“Researchers who endorse the technique say they don't know exactly how it works but they say

the changes in brain waves result in improved ability to focus and relax” (Karidis). While both

these treatments for PTSD are proving themselves effective, they are both physiologically based;

to truly overcome the mental disorder, patients should still possibly participate in talk therapies

to understand their thoughts and overcome them.

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When PTSD first arose in history, physicians were not knowledgeable as to what it was

or how to treat it. Quite frankly, there still is no definitive cure for this mental illness today.

However, there is progress in this era regarding the treatment and understanding of PTSD, which

was almost entirely absent in the times of our ancestors. As we saw, this mental illness was

gravely misunderstood and defined as cowardice and nothing more. Luckily, this definition has

grown and become more accurate with the research that many practitioners have put in over the

last multitude of years. Now, millions of licensed therapists, psychologists, and psychiatrists

around the world are trained and prepared to help people treat their mental illness, whether that is

PTSD, anxiety, OCD, and so forth. People with mental illnesses are no longer labeled as “weak”

or “cowardly”; they are respected, loved, accepted, and viewed as strong for taking the next steps

to better their mental health. At last, the stigma surrounding PTSD is beginning to recede. People

can improve their quality of life and end their suffering by seeking help and guidance from

medical professionals. They are able to have better jobs, relationships with their families and

friends, and can find happiness within themselves. Back then, those things were a luxury, not

normality. So, although there is still work to be done, we must realize how far we have come in

the conversation of mental illness. And I for one, believe that we will only continue to make a

proactive change in our society, and thus rewrite the definition of Post Traumatic Stress Disorder

even more.

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