Post Traumatic Stress Disorder

Introduction

A mental health disorder can be classified as a psychological state of being that manifests itself as an altered, inhibited or otherwise thoroughly abnormal thought process, behavior or method of action (Greeson, 2011). Examples of this range from the severe such as: mental retardation, psychotic behavior (i.e. behaviors displayed by serial killers) depressive disorders, sexually dysfunctional behavior (i.e. necrophilia); to the relatively mundane such as: ADHD (attention deficit hyperactivity disorder), sexual dysfunction (ex: cases of erectile dysfunction), and various types of sleep disorders (Greeson, 2011).

As it can be seen from the various examples presented, a mental disorder prevents an individual from leading an otherwise normal life due to its psychological impact on how they perceive and interact with the world around them. It is quite interesting to note though that some mental disorders can be classified as resulting from distinctly biological, psychological or artificial origins.

For example, in the case of mental retardation such cases often involve some form of biological trait that was altered in some way which resulted in abnormal brain development Greeson, 2011). On the other end of the spectrum are mental health disorders brought about by psychological factors, these commonly take the form of phobias and various types of anxiety disorders that were brought about as a direct result of events within a person’s life that left a deep seated psychological impression that created a lasting effect within their mental state (Greeson, 2011).

Do note though that there are quite literally a plethora of other possible disorders created as a direct result of abnormal psychological processes, however, for this paper it will be limited to cases involving deeply traumatic events which result in severe psychological stress. It is based on this that this paper will explore various aspects related to post traumatic stress disorder (PTSD) and how it is generally perceived by both the general public and mental health professionals.

What is PTSD?

PTSD is normally characterized as a mental disorder that is a direct result of an anxiety related syndromes that came about as a direct result of a traumatic event. One example of this can be seen in the case of natural disasters such as flooding which occur as a direct result of excessive rain fall which creates a PTSD response in certain individuals wherein they continue to respond negatively to various external stimuli such as storms, videos of flooding or other such examples.

Victims of various floods within the Philippines, the 2011 Japan tsunami disaster as well as several flooding instances within the U.S. appear to develop a particular form of reluctance towards returning either to their homes where the flooding occurred or to large bodies of water. It is assumed that such locations act as a trigger to their varied experience which ranges from nearly drowning, being swept away by fast moving currents or being stuck in a home with water rapidly rising to the upper levels where they are currently taking refuge.

When dealing with such individuals specific risk factors often include emotional outbursts, shaking and at times even depression. Patients also show distinct signs of mental trauma as a result of their experiences and are often initially unresponsive to initial attempts to alleviate the effects of their experience.

PTSD as a Social Construct

It is interesting to note that mental health experts such as Derek Summerfield state that the concept of mental health and psychology are a form of social product brought about through collectively held beliefs. As such, the relationship of society with such aspects involves a collective belief regarding what is a normal experience, what is an unpleasant experience and what experience might one expect to develop some form mental problem.

As Summerfield states “our collective belief until fairly recently has invoked notions of stoicism and understatement…and of fortitude” (Cash, 2006). According to him, this resulted in general acceptance of unpleasant experiences that most people should endure as a part of life and as such should not make such problems a central issue in their lives (Lee, 2012).

Summerfield notes though that as of late there has been a considerable cultural and economic shift wherein what is considered a normal experience and what is abnormal has experienced a dramatic reconfiguration. (Lee, 2012) Summerfield thus describes this as a form of “victimhood” wherein a pervasive sense of experiencing emotional or psychological damage has become quite normal (Meltzer, et al. 2012).

This apparent reversal in expectations and how people now deal with life’s difficulties has manifested itself as a state where more people consider themselves psychologically ill despite the fact that mental illnesses are usually confined to small percentage of the population. It is based on this that for Summerfield PTSD is a form of diagnosis indicative of a period of disenchantment within society at the present. What you have to understand is that the logic behind the arguments of Summerfield lie in the assumption that actual mental illnesses are rare and do not occur frequently within the general population (Meltzer, et al. 2012).

As such, according to Summerfield, for an accurate diagnosis for a mental illness to be created it should be: “a disease that has an objective existence in the world, whether discovered or not, and exists independently of the gaze of psychiatrists or anyone else” (Meltzer, et al. 2012). From this particular point of view, Summerfield goes on to elaborate that psychiatric disorders akin to aforementioned characteristics mentioned should be discovered by psychiatrists.

For him this is in direct contrast to disorders such as PTSD which are invented and cannot exist independently of social processes but rather are a direct construct of them (Chemtob, 2011). Such a case will be elaborated on in the following section detailing the origins of modern day PTSD.

History

While the classification of the symptoms behind PTSD was established in the post Vietnam war era as a result of cases involving Vietnam war veterans, the origins of PTSD stretch far back into antiquity as seen in various cases involving war and conflict. It has been called a number of different things throughout history such as: soldier’s heart, combat fatigue, battle fatigue, gross stress, and shell shock. Yet, what must be understood is that the conflagration of symptoms that make up the present day classification of PTSD was previously thought of as individual symptoms of entirely different psychological cases with no apparent overarching correlation between them (Gibbons, et al. 2012).

It was often thought that soldiers who displayed symptoms akin to PTSD where either displaying varying aspects of cowardice, weakness or a distinct unwillingness to fight. It was only after the Vietnam War that brought significant public attention to such emotional disorders when doctors began to diagnose them as post- Vietnam syndrome. PTSD as a diagnostic category emerged in 1980, when first published in Diagnostic and Statistical Manual of Mental Disorders (DSM).

It must be clarified though that it was the political and campaigning activities surrounding the Vietnam veterans that were actually at the heart of the creation of what is known today as PTSD wherein various symptoms which are now attributed to PTSD were actually “glued together” in the past by various practices and narratives without sufficient overarching evidence as to their direct attribution to each other (Katsounari, 2011).

Researchers such as Eric T. Dean Jr. state that PTSD was more a result of the anti-war fervor at the time wherein psychologists who lacked a distinct level of neutrality in their examination of data fashioned PTSD as a political instrument to display the horrors of war and their subsequent effect on human mental states (Cash, 2006). This is not to say that PTSD is a fabrication, rather, how it was created as a means of classification were highly ambiguous and were not entirely motivated by objective scientific discovery but rather were influenced by political idealism.

Issues on diagnosis and classification

This particular form of abnormal behavior has been observed as originating from 4 distinct categories, namely:

1. Constant Re-experiencing – takes the form of constant flashbacks to the traumatic event resulting in severe stress and anxiety or the equivalent thereof in the form of a negative psychological response. This symptom is often brought out as a direct result of distinct triggers (such as in the case of the previously mentioned example where images of floods, rain etc. acted as the necessary trigger to bring about the memory) (Muldoon & Lowe, 2012).
2. Emotional Numbing – this symptom manifests itself as a distinct detachment from people, social situations and activities that were previously thought of to be enjoyable. It also happens to manifest itself a form of detachment or state of withdrawal where these individual are unresponsive to external stimuli (Muldoon & Lowe, 2012). For example, in the case of Jane Doe (a person affected by the events of hurricane Katrina) when she was found she was in state of shock as direct result of being stuck on a roof while flood waters surged around her (Muldoon & Lowe, 2012). While the shock did initially wear off the apparent PTSD response in such individuals is an apparent state of withdrawal wherein they stare blankly off into space and shiver at times despite being given a warm blanket and any apparent source of cold air within the immediate area. Such a symptom often leads to severe depression due to the necessity of social linkages in ensuring a normal mental state.
3. Exposure to a Traumatic Event – A traumatic event in this particular case comes in the form of even that elicited a great deal of intense fear, resulted in serious injury or had the very real possibility of death for the individual involved (Muldoon & Lowe, 2012). It is thought that such events are necessary for the development of PTSD since they leave a deep psychological “scar” so to speak which interacts with the fear and anxiety mechanisms within the brain which create the various symptoms associated with PTSD. It must be noted though that various studies have yet to determine what constitutes a sufficiently traumatic event to cause PTSD. What is considered as “traumatic” apparently varies per individual with some cases (i.e. a severe car accident, war, near death experience etc.) causing no apparent symptoms of PTSD in one person but manifesting in another who endured a similar event. For example, just as PTSD develops differently in various individuals (as seen in the case of returning U.S. soldiers from Iraq) several individuals who experience similar experiences to Jane Doe were noted as being completely fine after a few hours in a recovery center (Muldoon & Lowe, 2012). Other cases were shown to gradually improve after a matter of days and in the case of Jane Doe notable improvement was seen within 4 days after the event.
4. Increased arousal – this particular aspect of PTSD manifests itself as being in a constant state of readiness resulting in difficulty falling asleep, being in a constant state of agitation and even manifests itself as a form of hyper vigilance. It is thought that such a state comes about as a direct result of a traumatic event with the need for constant vigilance and readiness being imprinted on the mind (Muldoon & Lowe, 2012). Various experts are actually at odds over this particular aspect of PTSD as to whether or not it has its background in a repressed evolutionary response mechanism (i.e. the behavior of constant vigilance displayed by herbivores when watching out for predators) or if the condition is merely a form of anxiety syndrome (Wells & Colbear, 2012).

Issues

It is interesting to note that patients with PTSD have been noted as having a comorbid psychological disorder of up to 80% of the time in the various cases that have been examined. It is based on this that many researchers believe that a psychiatric diagnosis before a traumatic experience increases a person’s risk for developing PTSD.

Related illnesses

It has been shown that features of PTSD and psychosis can exist together as part of a spectrum of experiences related to traumatic events. One famous example of this can be seen in the last movie of the Rambo series where the main character shows characteristics similar to PTSD but as a direct result develops a degree of psychosis wherein he believed he was still in a warzone.

Social factors vs. Biological factors

Social Factors involving PTSD

PTSD as of late has received a certain amount of “fame” as a direct result of its popularization through movies, personal accounts and the supposed “horrors of war” that have created the consensus that any traumatizing event can and will lead to some form of PTSD. Based on the arguments of Derek Summerfield, such an assumption is a direct result of shifts in collective beliefs regarding the response of certain individuals to traumatic situations wherein the concept of “victimhood” which is a pervasive sense of experiencing emotional or psychological damage has become quite normal for people at the present yet was not prevalent in the past (Wells & Colbear, 2012).

This in itself reveals how PTSD is in itself a social construct which is a direct result of changing perceptions regarding how a person must deal with particular situations. It must be noted though that while certain individuals are more prone to PTSD than others such individuals must experience some form of social trauma for PTSD to manifest itself. That is, you cannot have a diagnosis of PTSD if you have not experienced or witnessed a traumatic event.

Biological factors

It is interesting to note that aside from affecting a person on a psychological level PTSD also affects them on a biological level as well. This often comes in the form of lack of REM sleep, increased feelings of anxiety which lead to high blood pressure, and overall feeling of exhaustion despite not enduring any form of strenuous physical activity, a distinct lack of desire to eat and in the case of certain women fluctuating period rates (Wells & Colbear, 2012). It must be noted though while social factors are the prevailing main cause of triggering PTSD not all people are affected similarly and as such the biological symptoms of PTSD vary from person to person.

Biological (Drug Therapy) vs. Psychological Therapy

Currently, there are 3 effective forms of treatment which are being utilized at the present to cure PTSD, namely: patient education, pharmacotherapy and psychotherapy.

• Pharmacotherapy – this method of treatment utilizes the administration of drugs as a way of dealing with the symptoms and resulting adverse mental conditions that come about from PTSD (Trickey, et al., 2012). It is often the case that mild sedatives, anti-depressants, and various other forms of psychoactive drugs are utilized to help deal with abrupt “episodes” of PTSD as they occur. It must be noted though that pharmacotherapy is often utilized as a method of last resort when it comes to dealing with PTSD should treatment methods such as psychotherapy and patient education fail to produce relevant results.
• Psychotherapy – this particular form of treatment involves 1 on 1 (or at times group sessions) between the patient and a trained psychotherapist. These particular forms of treatment often involve an exploration of what triggers instances of re-experiencing and attempts to help resolve such issues through progressive methods of disassociation till the event no longer elicits the same amount of stress (Trickey, et al., 2012). This particular method of treatment also involves the implementation of a variety of coping mechanisms to lessen the degree of anxiety generated by PTSD.
• Patient education – this particular aspect of the treatment procedure imparts relevant information to patients to help them better alter their behaviors and improve their overall mental health (Trickey, et al., 2012). This process often involves helping patients understand their current condition, how it is negatively affecting their mental and physical well-being and the various methods they can employ to get better.

It must be noted though that it is not an issue of which method produces the best treatment outcome since all of the methods of treatment have varying levels of results. Rather, it has been discovered by clinical psychologists that by implementing all therapies in conjunction with one another, this often creates a more effective outcome as compared to using the aforementioned treatment methods individually.

Conclusion

This paper has introduced aspects related to the history of PTSD, the characteristics and origins of its symptoms and the current methods of treatment advocated by mental health professionals. Based on the various aspects of PTSD presented in this paper it can be seen that this particular mental illness is mired in a degree of ambiguity when taking into consideration the various arguments presented regarding how it was created and how it is merely a social construct. Despite this, I believe that the social construct behind PTSD perceives its sufferers correctly in that they do suffer from a mental illness brought about by severe mental trauma.

Reference List

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