Healing Combat Trauma

Veterans, PTSD and Suicide: The Overlooked Element of Contagion

This is an article I'd first started writing two years ago now. I did the research, and located the main, most often-cited study's principal investigator, long since retired, and asked him to confirm whether the trend is still true, though he first published it back in the 1970s. He affirmed that it was. What it is is an important and often-overlooked "connection" that will make more sense when we start describing it. It also fits into the category of things where the information is out there, but for some reason is also strangely ignored. Another instance was a few years ago, when the military kept saying, "We don't know what PTSD is tied to"; essentially, "we have no idea." Yet at the time, and this goes back several years now, I was able to read through the existing literature and learn, PTSD is tied to combat exposure. In other words, the more combat, the greater the chances of developing PTSD. And I wrote about it, here, at the time the military was saying, in essence, we don't know what it's linked to.

So it isn't that that wasn't known...it's that no one was paying attention to what was out there. (And these days, several  years later, they ARE admitting publicly that more exposure = greater chance of developing PTSD. But it does make me laugh a little bit to hear that now, thinking, we were talking about it here well before that was being said publicly. And not because of some strange prophetic abilities on our part; just from reading the available literature, and drawing what seemed like obvious conclusions.)

There's the old saying that "those who refuse to learn from history are condemned to repeat it." Well, much of what's known about PTSD has been known for decades now, with another fair part of the knowledge base has been increasing exponentially. I read an article the other day about a Harvard-trained psychiatrist who worked at the V.A. in Boston during the Vietnam war, and was "shocked" to learn that there wasn't a single book on war trauma in the library there. Today, one would hope, that situation has changed quite a bit. 

But to the point at hand...

As I read through my Twitter feed today (you can follow us @HealingPTSD on Twitter), I noticed several suicides being Tweeted by various sources. One was that of Mel Turpin, a former All-American basketball player and NBA star, dead at 49; and then the troubling news, especially to us in the veterans community, of a Marine Corps veteran, James F. Popkowski, 37, who apparently died in a "suicide-by-cop" or armed confrontation outside the V.A. in Bangor, Maine. (See those stories linked here and here, as well as a longer quasi-obituary of Popkowski, here.) At first the headline said only "an armed man" had died in a confrontation with police near a local VA -- and as soon as I read that, I hoped -- but yet somehow knew -- that it would be a veteran, with a painful story of his own. Later the news matured to show that in fact he was a veteran, who was struggling with this illness (cancer) and its treatment. But the fact he was a veteran and committed suicide reminded me instantly of the news from the last few days, where the Seattle Times did such a good job covering the suicide of a veteran with PTSD from Whidbey Island, Orrin McClellan. (I wrote about Orrin's life and death here and here.) So many suicides in the media, and superstitious types tend to think those run in threes -- though technically McClellan's death was in mid-May, with the coverage of it in the media happening over the last few days.

I need to branch off in two different directions here, to cover this material. 

One is to talk about the V.A. suicide's statements about his own condition, because veterans with PTSD and their family members may recognize their own veterans in those words. And the other is to introduce something very different, which is the effect that media coverage of suicides has on "successful" suicide attempts by others during the same general news cycle, especially young men (who are, after all, the majority of those who serve.) 

On that second point, as the military has generally speaking tried and failed to lower the suicide rate lately, I haven't seen much recognition (OK, any) of the idea that suicides are to some degree contagious. There's quite a bit of medical literature on the subject...and it's been documented in studies around the world, starting in the 1970s, that suicides reported in the news will have a demonstrated effect on increasing suicide attempts from specific populations who hear the news. Since suicide is a broad category -- many single-car or single-motorcycle accidents are also suicides -- and the military attempts periodically to crack down on motorcycle safety, etc., it would also be wise to enlarge the conversation to not only what other methods qualify as suicides, but also to take a look at how one suicide making the news can, depending on how it's portrayed, have an effect on increasing the number of other suicides that take place in the same general time frame, especially among those prone to committing suicide, because of depression and other factors. And we haven't even mentioned yet here the effect that some prescribed pharmaceutical medications can have on increasing suicidal thoughts.

(While it's somewhat unlikely that Popkowski, in Maine, was reading the Seattle Times' coverage of Orrin McClellan's death -- one, we never know; and two, in the age of the Internet, geographical barriers have disappeared and the news is instantaneous -- especially if you include other social media, like Facebook and Twitter, which can serve as additional sources of the same news. We're so much more wired now than when these studies first started being done, so we can't assume Popkowski didn't read the Seattle Times coverage, even though it's most likely that he didn't. For the sake of this argument -- because if it didn't happen with this case, it surely does with others, let's pretend that Popkowski did spend some time over the last few days reading the coverage of McClellan's suicide on the Internet.)

There's enough material to cover here that I need to go as far as I can with it now and then circle back around to it again soon. We'll introduce the science (below) but also cover what Popkowski said about his failing health, because his words will resonate with other veterans, who struggle not with cancer but with PTSD.

According to the article in the Portland, Maine Press Herald today, Popkowski, who had undergone a stem cell transplant for his cancer back in 2003 at the National Institutes of Health, struggled valiantly with the effects of the cancer and its treatment (both difficult), as well as sleep problems, depression and the like. In a letter to the editor of the magazine "New Scientist" back in 2008 he wrote,

"Suicide is like a little devil, always on my shoulder and always tempting me. Concern for the care of my three dogs after I am gone, my dogs being the only things I feel anything resembling passion for, is the only thing I think that has kept me from pulling the trigger on the loaded pistol, which rests next to my pillow."

He continued,

"The best way to describe the mental and emotional issue is that I am numb and passionless. Nothing brings joy or pleasure. I graduated magna cum laude with a (Bachelor of Science degree) in computer info systems and business management in just three years. Now, I cannot mentally focus enough to read a newspaper."

He added,

"I have lost count of the number of sleep aids NIH and my local VA have tried. Like the anti-depressants, none have worked."

And he described leaving his bunker, in terms that a veteran with PTSD would understand, only for brief forays out to re-provision with groceries and return, if his health even allowed him that. He wrote:

"For weeks at a time I will only leave my house once, and only briefly at night, to buy groceries and other supplies. Most of the time, the only time I drag myself into the shower, is when I have to go into town to buy groceries."

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Now, we hope that no veteran ever crosses the bridge to suicide in his or her lifetime, and especially is not discouraged enough reading news of how another distressed veteran felt to contemplate it. Please use the resources at your disposal, including hotlines, buddies, and compassionate others as lifelines to not give up hope, because there IS hope, and you can get better. But for the rest of us, we need to keep pushing on with this narrative because there's something to learn here, including for decisionmakers who wonder about how better to educate about suicide prevention. This is where the element about the notoriety/publicity level of a suicide influences other at-risk populations.

To the science on this.

• Back in 1977, in the journal Science, DP Philips showed that "motor vehicle fatalities" (including "suicides by motor vehicle") increase in the time frame "just after publicized suicide stories." From the abstract: "The average increase in motor vehicle fatalities is 9.12 percent in the week after a suicide story. The more publicity given to the story, the greater the rise in motor vehicle deaths thereafter. This rise apparently occurs because suicide stories stimulate a wave of imitative suicides, some of which are disguised as motor vehicle accidents."
• In 2006, an Australian journal, Social Science Medicine, published a similar study, further demonstrating the "relationship between media reporting of suicide and actual suicide." They studied data on "4,635 suicide-related items appearing in Australian newspapers and on radio and television news and current affairs shows between March 2000 and February 2001. The study found that 39% of media items were followed by an increase in male suicides, and 31% by an increase in female suicides. Media items were more likely to be associated with increases in both male and female suicides if they occurred in the context of multiple other reports on suicide (versus occurring in isolation), if they were broadcast on television (versus other media), and if they were about completed suicide (versus attempted suicide or suicidal ideation). Different item content appeared to be influential for males and females, with an increase in male suicides being associated with items about an individual's experience of suicide and opinion pieces, and an increase in female suicides being associated with items about mass- or murder-suicide." They concluded, "Further research on this topic is required, but in the meantime there is a need to remain vigilant about how suicide news is reported. Mental health professionals and suicide experts should collaborate with media professionals to try to balance 'public interest' against the risk of harm."
  
• Versions of the original study were repeated over and over in the intervening years, and 30 years later, in 2007, the International Journal of Epidemiology published a study which showed "the influence of media reporting of the suicide of a celebrity on suicide rates," where a male television celebrity in Taiwan committed suicide, followed by a wave of somewhat "copy-cat" suicides among young men. (The "celebrity" element may initially confuse, but think of it this way -- it's a well-publicized suicide when it happens, which means it reaches most of the target audience. It also happens, according to other studies, when non-celebrities commit suicide. The distinguishing factor is how well publicized the suicide is/how much media attention or coverage is given to it. The more coverage, the more people know about it, including those in somewhat fragile populations.) Back to the study's results: "After controlling for seasonal variation, calendar year, temperature, humidity and unemployment rate, there was a marked increase in the number of suicides during the 4-week period after media reporting (relative risk = 1.17, 95% CI 1.04-1.31). The increase was in men (relative risk = 1.30, 95% CI 1.14-1.50) and for the individuals using the same highly lethal method (hanging) as the TV  actor did (relative risk = 1.51, 95% CI 1.25-1.83). However, the age groups in which the increase occurred were younger than the age of the celebrity. CONCLUSIONS: The extensive media reporting of the celebrity suicide was followed by an increase in suicides with a strong implication of a modelling effect. The results provide further support for the need for more restrained reporting of suicides as part of suicide prevention strategies to decrease the imitation effect."
• Also in 2007, a study was conducted in Taiwan around the fact pattern of the same television celebrity's suicide and published in the Journal of Affective Disorders. It attempted to define the "influence of media reporting of a celebrity suicide on suicidal behavior in patients with a history of depressive disorder," and what it found was "Among 438 depressive patients exposed to the media report, 38.8% reported an influence on subsequent suicidal behaviors, including 24 (5.5%) with a suicide attempt. The risk of such influence was highest among patients in a severe depressive state just prior to the media report (adjusted OR 7.81, 95% CI 3.28-18.59). Such influence on a subsequent suicide attempt was highest in patients with a most recent suicide attempt within one month prior to the media reports (adjusted hazard ratio 11.91, 95% CI 3.76-37.72)." The authors concluded, "This study has provided more convincing evidence suggesting negative influences of media reporting of a celebrity suicide on subsequent suicidal behaviors among depressive patients. Particular attention in terms of potential negative media influences should be paid to patients who are younger and currently depressed and have made a recent suicide attempt."
• This year (2010), another Taiwanese study took a look at suicide rates after media reporting of another celebrity suicide, this time a female singing star. Their premise was that "Suicide attempters are known to be vulnerable to the influence of media reporting of suicide events. This study investigates possible influences of media reporting of a celebrity suicide on subsequent suicide attempts and associated risk factors among suicide attempters." In their study, "Sixty-three suicide attempters registered in a surveillance system of Taipei City Suicide Prevention Center were assessed using a structured interview soon after media reporting of the suicide of a young female singing star." Their results? "Forty-three (68%) respondents had encountered with the suicide news. Among them, 37% reported being influenced by the media reporting on their subsequent suicide attempts." Most hard-hit by the news? "Men (adjusted OR 6.36, 95% CI 1.29-31.44) and younger age groups (adjusted OR 4.93, 95% CI 1.04-23.45) were more susceptible to the media reporting." And the authors concluded, "This study has provided further evidence for suicide imitation among vulnerable people encountered with media reporting of celebrity suicide, and for the need to actively restrain reporting of suicides to decrease the imitation effect."

It's also true that young men -- the dominant demographic of who the all-volunteer military is these days, though approximately 11% are women -- are more prone to suicide than other age groups. Back to the science:

• According to statistics from a fact sheet on youth and violence provided by the CDC, "In 2005, 17% of high school students seriously considered attempting suicide, and 13% made a plan about how they would attempt suicide during the 12 months preceding the survey." (The reference cited is CDC. Youth Risk Behavior Surveillance - United States, 2005.  Morbidity and Mortality Weekly Report 2006; 55 (SS-5): 1-112.)
• Similarly, according to the CDC, "approximately 14% of all deaths among children and adolescents aged 5-19 years result from suicides."  The numbers climb according to age ranges, with younger children having the fewest, and older children the most.  Suicided ages 10-14: 283.  Suicides ages 15-19: 1,700.  (The reference cited is CDC, National Center for Injury Prevention and Control, Office of Statistics and Programming. Web-based Injury Statistics Query and Reporting System (WISQARS). Online at http://www.cdc.gov/ncipc/wisqars/. Accessed September 6, 2007.)

There's more that we could talk about here -- responsible reporting guidelines about suicide, when disseminated and implemented, seem to have the effect of reducing the number of copycat suicide attempts after a successful publicized suicide (a study in Austria shows that) -- but the intended effect here, which we can elaborate on in future posts, is to introduce the idea that one publicized suicide by, say, a veteran, can also most likely encourage an increased number of suicide attempts, some of them successful, by members of at-risk populations, such as young/depressed/men. Do any of those words correlate with anyone who might be suffering from PTSD, or taking medications that might also increase suicidal thoughts? And we haven't even added into the mix the effects of alcohol, which many PTSD sufferers self-medicate with, and how that would affect suicidal thinking. There's much, much, much more to talk about on this topic -- not just here on this site but nationally -- but we hope this dense, rather convoluted post has at least gotten you thinking about not so much that we need to protect veterans with PTSD from seeing or reading the news, which might contain an item about another veteran's suicide -- but that suicides can almost go in waves (read the literature on prison populations, etc. for this), where one suicide spurs others in the same population -- because publicity surrounding a suicide has the unintended consequence of increasing suicidal tendencies in other affected people. Since many, many veterans with PTSD are to a degree on edge already...it might be good to realize the effect that reading about another veteran's demise could have on an already depressed, stressed or demoralized individual.

And since the larger goal for all of should be preventing suicides among PTSD-injured veterans, it's highly worth having this conversation.

Study Shows Young Adults with PTSD More Likely to Commit Suicide

On the one hand, this sounds like fairly self-explanatory science.  So why the inclusion on this blog?  Because of the (young) age of many active duty military, and even recent veterans -- news like this is relevant.

Young Adults With PTSD May Be More Likely to Attempt Suicide

"Posttraumatic stress disorder (PTSD)—but not exposure to traumatic events without the development of PTSD—may be associated with subsequent attempted suicide in young adults, according to a report in Archives of General Psychiatry.

Approximately 421,200 to 842,400 Americans aged 15 to 24 attempt suicide every year, according to background information in the article. Holly C. Wilcox, PhD, of Johns Hopkins Children’s Center, Baltimore, and colleagues studied 1,698 young adults of a group of 2,311 who had been tracked since entering the first grade in Baltimore public schools. Fifteen years later, 90-minute interviews were conducted with the participants (average age of 21) to assess the occurrence of traumatic experiences, suicide attempts, and the development of PTSD.

Of the participants interviewed, 1,273 (81%) had been exposed to a traumatic event and 100 (6%, or 8% of those exposed to trauma) developed PTSD. Suicide had been attempted by 10% of those with PTSD, compared with 2% of those who were exposed to trauma but did not develop PTSD and 5% of those who had never been exposed to traumatic events.

“The mechanisms involved in the association between PTSD and suicide attempts are not known,” the authors wrote. “There could be a common pre-existing predisposition to PTSD and suicide attempts that was present before the trauma occurred. Studies of early trauma and suicidal behaviors have implicated depression and impulsivity as possible mediators or possible pre-existing susceptibility traits.”

— Source: American Medical Association

The Dose-Response Relationship with PTSD: More Combat = More PTSD, Earlier Study Shows

"If you aim for simplicity, you must first master complexity" -- said the 17th century Chinese painter, Wang Kai. Almost 400 posts in on this blog, I still enjoy the moments when something profoundly complex like combat trauma is nevertheless reduced to something quite simple to understand.  Here's one such observation: the more combat one is exposed to, the greater the chances of experiencing PTSD.  Makes sense, doesn't it?  Although we've talked about that concept recently on this blog -- with a great graphic that shows the linear relationship quite profoundly, that entry linked here -- here's another, earlier study that says the same thing, in an article linked here.

Researchers who went back and analyzed two conflicting, large-scale studies of PTSD -- one done by the Centers for Disease Control (CDC), the other the National Vietnam Veterans' Readjustment Study -- found, among other things, that although "most veterans who experienced very highly traumatic events did not develop PTSD," still, the more war trauma a veteran experienced, the higher a veteran's odds of developing PTSD.  Researchers called this the "dose-response relationship," and said their work, going back over the two major studies and attempting to reconcile their findings, found that it was "even stronger than previously reported."

SOURCES: Dohrenwend, B.P. Science, Aug. 18, 2006; Vol. 313: pp. 979-982. McNally, R.J. Science, Aug. 18, 2006; Vol. 313: pp. 923-924.

Army Broadens View of Possible PTSD Therapies, Includes Complementary and Alternative Medicine

A Military.com article published on May 29th reports on the U.S. Army's increasing openness to non-traditional therapies to treat PTSD.  The article by Bryant Jordan is called, "East Meets West in Army Mental Therapy," and it quotes Col. Elspeth Ritchie on the Army's increasing openness to options beyond traditional counseling and medication, to include items like yoga, acupuncture, meditation, and of course, virtual reality. The headline is positive, but in truth, the Army may be taking only baby steps towards including nontraditional therapies, often known as Complementary and Alternative Medicine (CAM).

(Some "definition of terms" is in order.  "Alternative medicine" means treatment choices other than conventional medicine, to be used instead of conventional medicine; "complementary medicine" means treatment choices to be used in addition to conventional medicine -- so the term "CAM," or "Complementary AND Alternative Medicine" is meant to be inclusive of both approaches.  This ends up being an important distinction, because responsible M.D.s are often more in favor of patients adding complementary therapies in to their treatment protocol, rather than replacing a conventional treatment protocol with fully alternative therapies. "Complementary" is misspelled in the Military.com article as "complimentary," which further confuses the terminology.) 

The article states that "Therapies that are "kind of tried and true" remain at the forefront of treating Soldiers with behavioral problems, [Col.] Ritchie said. These include behavioral therapy and exposure therapy -- where patients are "exposed" by degrees to scenarios that may be at the core of the problem -- and medication."  And it further quotes Col. Ritchie as saying that although CAM therapies "are interesting, we don't have the hard data to show which therapies are useful for what population. So we're really in the research phase of this for yoga, acupuncture and some other therapies."

The Military.com article is linked here.  A previous article by Noah Shactman in Wired magazine on March 25 discussed similar material, and mentions a Department of Defense grant opportunity with a closing date of May 15, providing $4 million in funds to study therapies with possible benefits for PTSD and/or TBI, including but not limited to "music, animal-facilitated therapy, art, dance/movement, massage therapy, EMDR program evaluation, virtual reality, acupuncture, spiritual ministry, transcendental meditation, yoga and other novel approaches."  (The grant opportunity announcement is linked here.)  According to the Wired article, reading from the grant application, the Army is willing to contemplate as well the potential effectiveness of "biologically-based treatments, botanicals, and nutritional supplements for enhancing cognitive function and mood in patients with trauma spectrum disorders, including TBI and/or PTSD, depression, anxiety, and/or substance dependence/abuse," and adds, "Even proposals for wild-sounding "therapies using bioenergies such as Qi gong, Reiki, distant healing and acupuncture" would be accepted."  The Wired article is linked here.

I'm unclear whether the Army is leading the way of all the military branches in considering the potential of CAM for PTSD; but whether it is or isn't, kudos to it for being reasonably open-minded.  One of the problems that seems to keep coming up with PTSD is that no one obvious choice comes up in treating it, that works every time.  There are a variety of pharmaceutical drugs that are prescribed, but no one remedy in particular appears to be the wonder drug, or cure-all.  (You hear the frustration about this when you listen to the stories of combat veterans who are taking a handful of pills to combat PTSD, sometimes as many as 20 or 30 separate medications - a scary cocktail, indeed.)  Other approaches for PTSD, such as talk therapy, cognitive therapy, EMDR, etc., all have their place in the pantheon of treatments, and each has their adherents/proponents, but again, there doesn't seem to be a one-size-fits-all, cure-all for PTSD.  In the absence of the medicinal "silver bullet" that cures all PTSD, it's great that the Army is at least embracing the concept of possible adjunct therapies, while asking them to prove themselves clinically, as much as possible.

In the following weeks, we will report on complementary and alternative therapies that appear to have some benefit in treating PTSD; in addition to the more mainstream approaches that are already in use.  (Virtual reality is another type of treatment entirely: dependent on technology, it doesn't fit the typical rubric of CAM, nor should it.)

PTSD Elevates Risk of Other, Chronic Health Problems

Geisinger research finds that veterans suffering from posttraumatic stress disorder (PTSD) are as likely to have long-term health problems as people with chronic disease risk factors such as an elevated white blood cell counts and biological signs and symptoms.

However, few healthcare providers screen for PTSD in the same way as they screen for other chronic disease risk factors. “Exposure to trauma has not only psychological effects, but can take a serious toll on a person’s health status and biological functions as well,” Geisinger Senior Investigator Joseph Boscarino, PhD, MPH says. “PTSD is a risk factor for disease that doctors should put on their radar screens.”  (Click here to listen to a podcast of Dr. Boscarino discussing the study.)

For this study, Dr. Boscarino examined the health status of 4,462 male Vietnam-era veterans 30 years after their military service. Results are being published in the current edition of the Journal of Nervous and Mental Disease. The study finds that having PTSD was just as good an indicator of a person’s long-term health status as having an elevated white blood cell count. An elevated white blood cell count can indicate a major infection or a serious blood disorder such as leukemia.

The study also found that veterans with high erythrocyte sedimentation rate (ESR), which indicates inflammation, were also at risk. There was a similar finding for a possible indicator of serious neuroendocrine problems. While these disease markers are measured with a blood test, PTSD is commonly measured with a psychological test or a mental health examination.

This research comes as Geisinger is organizing a national conference on May 13 to address PTSD in combat veterans from rural parts of the country. Boscarino says that almost anyone who experiences a traumatic event can experience PTSD, meaning accident and disaster victims are also predisposed to the biological risk factors associated with PTSD. (Click here for the link to that conference.)

Although therapy doesn't necessarily have to be extensive, Boscarino says it should occur shortly after a person has experienced a traumatic event. Early treatment may be critical to avoiding depression, PTSD and substance abuse-related problems following trauma. “As the conflicts in the Middle East continue, we’re seeing a new wave of our service members who have posttraumatic stress,” says Boscarino, a Vietnam veteran. “If we don’t get these personnel help earlier, our research shows that they may experience more serious health problems down the road.”

Dr. Boscarino is one of the country’s leading authorities on PTSD and has published extensively on the topic. His prior research has established links between PTSD and the increased likelihood of death by unnatural causes and between PTSD and individual soldiers’ dexterity levels.

Founded in 1915, Geisinger Health System (Danville, PA) is one of the nation’s largest integrated health services organizations. Serving more than two million residents throughout central and northeastern Pennsylvania, the physician-led organization is at the forefront of the country's rapidly emerging electronic health records movement. Geisinger is comprised of three medical center campuses, a 700-member group practice, a not-for-profit health insurance company and the Center for Health Research—dedicated to creating innovative new models for patient care, satisfaction and clinical outcomes.

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Editor's Note: the figured featured in the statue is Asclepius, the ancient demi-god of medicine and healing.

Clinical Trials Underway on PTSD

Here's a list from the National Institutes of Mental Health ("NIMH"), government recipient of our tax dollars at work, of the clinical trials presently underway that are studying aspects of PTSD.  Not many of the studies having much to do with combat trauma (yet), it would seem.  In any case, here's a link to them: there are fourteen (14) clinical trials, total, including one with the somewhat rosy title of, "Using Affectionate Communication as a Response to Acute Stress."  Mmmmn, sign me up! :-) We can never have enough of that...  One or two do relate specifically to PTSD and combat trauma, including

• Effectiveness of Virtual Reality Exposure Therapy and D-Cycloserine to Treat Iraq War Veterans With Post-Traumatic Stress Disorder.
  Interventional study. This study will determine whether a combination of virtual reality exposure therapy and D-cycloserine will reduce post-traumatic stress disorder symptoms in Iraq war veterans. Ages 21-65. Location in Atlanta, GA.

Here's a link to a page of worthwhile information about PTSD on the NIMH's website, with links to other information worth reviewing, or keeping on hand to share with others.  One is, "Post-Traumatic Stress Disorder: A Real Illness" -- click here for that; and "Post Traumatic Stress Disorder Research Fact Sheet" -- click here for that.  (Lack of continuity in hyphenating style thanks to the NIMH, not this blogger.)

And, finally, If you're in the Bethesda, MD area, and you'd like to participate in an NIMH study (not necessarily the one above), click this link to learn more about how to participate.  Not all studies looking for participants take place in the D.C. area, though -- many are in other large metropolitan areas such as Atlanta and Boston -- so check the main site above for clinical trial topics and locations.

PTSD - Normal Reaction to Abnormal Events

Trying to catch up on some blog posting from a while back, here is a link to an excellent article from Salon magazine on PTSD, and why talk therapy doesn't really help it much -- and can actually make symptoms worse, at least initially.  The article, called "My Heart is Back," by Lynn Harris, also includes one of the few great explanations in print of how PTSD happens in the body, and takes a look at some treatments that do offer hope, with quotes from therapists who use them, including ones who were frustrated by what they couldn't offer their patients a few years back.  Quite an excellent, overall article about PTSD and how to overcome it - and worth keeping on hand to share with friends and foes alike who may not understand, or believe, in what PTSD or combat trauma really is.  (And the article, since it came out in 2004, talks about not just combat-triggered PTSD, but PTSD as a reaction to violent events over which we have no control.)

The gist of the article: "Talk therapy only increases the suffering for some trauma victims -- but alternative treatments offer new hope."  (The book highlighted here on the left, Invisible Heroes: Survivors of Trauma and How They Heal, by Belleruth Naparstek -- is written by one of the therapists quoted in the article.)

Some quotable quotes from the article, including these great ones, that sums it up: "PTSD is a normal reaction to abnormal events" -- and "what we do know is that susceptibility to PTSD has nothing to do with, say, cowardice, or weakness of character."

"[A]pproximately 5 million Americans who suffer from post-traumatic stress disorder." "In fact, more people may have PTSD today than anyone ever realized. But because of recent advances in biochemistry, brain imagery and epidemiology, researchers are finding out that all manner of conditions -- some psychiatric, but some also physiological, such as chronic pain -- can be traced to PTSD."

Here's what some of the experts quoted in the article say:

• "...People with PTSD aren't crazy, and they get better," says Belleruth Naparstek.  Today, in fact, their prognosis is the best it has ever been. For many years, "we didn't know how to help trauma survivors in any consistent way," says Naparstek. As she herself discovered while treating Frannie, "Talking about it -- the stock in trade of mental health professionals, pastors, good friends and spouses -- is not necessarily all that helpful, and can sometimes make symptoms worse."
• "PSTD is a normal reaction to abnormal events," says Beverly Donovan, a clinical psychologist at the Veterans Affairs Medical Center in Brecksville, Ohio, who runs an intensive treatment program for combat vets with PTSD.
• "When exposed to trauma, some people will have trouble letting go of the experience, but not because they want to dwell on it," says Steven Gold, Ph.D., director of the Trauma Resolution and Integration Program at Nova Southeastern University in Fort Lauderdale, Fla., and president of the International Society for the Study of Dissociation. "There are various techniques for helping people move beyond it, which may have as much to do with the body's reaction to the experience as with the mind's. A few years ago some of these therapies would have been considered 'alternative, but now the major specialists in treating trauma would consider them more mainstream."

And the patient who they featured in the article, who'd suffered numerous horrific traumas, back to back?  She's doing well. "My heart is back" -- "I'm connected to myself now."  Great news, and what we would wish for all trauma survivors with PTSD.  Be sure to read, and save, the article for future reference.

Heads Up: Traumatic Brain Injury ("TBI") and PTSD

There's a really excellent -- as in relatively comprehensive, considering -- article in today's USA Today called "Doctors Face Rash of Brain-Damaged Vets."  Unfortunately, what doctors are finding is that the two "signature wounds" of the current wars -- traumatic brain injury ("TBI") and post-traumatic stress disorder ("PTSD") can often occur together.  And even more unfortunately, the presence of both in the same person can complicate matters quite a bit.

As the article states, "Odd as it may seem, brain injury can protect against PTSD by blurring awareness of what happened.  But as memory improves, emotional problems can emerge..."

Certain symptoms that show up initially, such as headache, dizziness and balance problems -- perhaps more due to the TBI -- actually subside over time; whereas other symptoms -- including memory problems and 'irritability' -- probably more part of the PTSD complex of symptoms -- actually increase over time, according to data cited in the article, from a study conducted by Walter Reed Army Medical Center.

Current -- and future -- treatment programs are going to need to be able to effectively treat combat veterans who have undergone TBIs in such a way that they can also catch emerging PTSD, even if it comes out after the brain injury has optimistically "resolved."  Also dangerous: the fact that overall, occupational therapy needed to treat brain injury has been downgraded at many private hospitals and outsourced to nursing homes, according to an insider in the field.  With a growing number of combat veterans who've been exposed to TBIs now returning to civilian life, it's going to be important to care for them both within the VA system and also within the private hospital setting.  Affording treatment is going to be another ballooning cost of the war effort, but one that's crucial for us to get behind, in order to ensure that veterans are treated effectively.

Another issue that the article brings up is the number of times deployed military have been exposed to TBIs.  The article mentions vets experiencing at least "an explosion a month."  A few years back, doctors found that high school and college football players who experienced two or more concussions on the field in succession -- separated by days or even weeks -- were at much greater risk from serious injury, including death -- than had ever been thought.  And they started to talk about the cumulative effect of concussions, and how difficult it is for the body to heal from that.  Essentially, what combat veterans are going through now is the same thing: exposure to explosions, that causes an underlying stress on the brain, followed up sometimes by direct injury, such as TBIs.  Now we need to add into the mix PTSD as well, which can show up later, thanks to the body's own capacity to focus first on the TBI. 

Unraveling the complexities of this increasingly all-too-common scenario is going to take a lot of work, and patience, on everyone's part.  Even physicians in private practice are not used to seeing the level of TBIs that returning vets will be bringing into their practices.  The Centers for Disease Control ("CDC") even has an article on its website for doctors about recognizing and treating TBIs, but it doesn't yet reference the combat connection...Their handout, which might be worth vets and their families reading to familiarize themselves better with the subject, is called "Heads Up: Brain Injury in Your Practice - A Tool Kit for Physicians."