Friday, June 10, 2016

A possible root for some cases of PTSD?

The term 'post-traumatic stress disorder' has become something of a cliché these days.  I think it's greatly over-diagnosed by doctors and other medical professionals who have no personal experience of it, and therefore treat it as a 'catch-all' category in which to lump those with a military or security background who have psychological or psychiatric issues for which they have no other explanation.  Nevertheless, it is real.  I've experienced it to some extent myself, during and after eighteen years' exposure to conflict in southern Africa.

One possible cause of at least some sorts of PTSD has come to light.  The Telegraph reports:

Shockwaves from explosions may scar the brains of soldiers in areas linked to post-traumatic stress disorder (PTSD), suggesting a possible physical cause for the condition.

Scientists found distinctive injuries in the brains of eight military personnel who survived bomb blasts but died between four days and nine years after the trauma.

. . .

“Blast-related brain injuries are the signature injury of modern military conflicts”, said senior author Dr Daniel Perl from the Uniformed Services University of the Health Sciences, Maryland, USA.

“Although routine imaging for blast-related traumatic brain injury often shows no brain abnormalities, soldiers frequently report debilitating neuropsychiatric symptoms such as headaches, sleep disturbance, memory problems, erratic behaviour and depression suggesting structural damage to the brain.

“Because the underlying pathophysiology is unknown, we have difficulty diagnosing and treating these ‘invisible wounds’.”

The authors conclude: “This presents the possibility that the scarring, particularly that in the neuroanatomical areas associated with PTSD ... may increase the probability of PTSD symptom expression in people exposed to blasts.”

In five male soldiers who survived more than six months after blast exposure, the scientists found a ‘distinctive, consistent, and unique pattern’ of prominent scarring in parts of the brain that are crucial for thinking, memory, sleep and other important functions.

. . .

The scarring was different to injuries seen in soldiers who had suffered other types of brain injury such as through car accidents or contact sports.

“In these controls we did not see similar scarring to the blast cases, which increases the likelihood that the pattern is linked with high-explosive exposure,” added Dr Perl.

“Although little is known about the effect of blast shockwave on the human brain, the unique pattern of damage that we found is consistent with known shockwave effects on the human body.”

There's more at the link.

I'm intrigued by this discovery.  I've been exposed to high explosive blasts (artillery shells, grenades, etc.) at close range (sometimes very close).  I can well recall the effect;  it was as if my brain had suddenly been clogged with excessive quantities of cotton wool.  I could think, but only very slowly, struggling to form coherent thoughts and finding it difficult, if not impossible, to act on them with any speed.  I can only describe it as the mental equivalent of a sprinter having to run through thigh-deep molasses.  He'd be straining every muscle and sinew, but unable to move at more than a snail's pace.  That's pretty much what it felt like (although, fortunately, the symptoms disappeared after a few minutes or hours, depending on the severity of the exposure).

Interestingly, I haven't experienced (or, at least, I don't think I've experienced) the physical PTSD consequences described in the article.  My PTSD was more psychological in nature, the result of losing 27 friends (including my fiancée) in the 18 years of near-civil-war that South Africa experienced between 1976 and 1994.  I've written about some of those experiences - see here for one example.  They affected me very profoundly.  I was fortunate to be able to make a fresh start by coming to the USA in the late 1990's, and to find a therapist here who'd had to deal with his own PTSD after serving in Vietnam.  He was able to help me find ways to accept and deal with the bad memories, then put them away and move on with my life.

I guess my PTSD (if that's what it was) was transient in nature.  This research appears to have uncovered a more permanent form of PTSD, one that doesn't go away after therapy, and perhaps is physically incapable of going away.  I hope this line of inquiry is pursued further.  If it can help those who suffer from PTSD to find balance and get on with their lives, it'll be invaluable - and, heaven knows, after fifteen years of the War on Terror, we have far too many of them in our midst.



Cedar said...

The first paper I had a professor suggest I publish was on PTS... when do you add that D? And it was related more to the overdiagnosis of PTSD, and where the fuzzy line of normality is found. I eventually put it up on my blog, as I wasn't really interested in doing the academic gerbil wheel. I have resisted a diagnosis of PTSD for myself because I hate being labeled, and because I can cope, like you, with some therapy and awareness of my self (mine is, obviously, not combat related). But the injury you're describing, to the brain, would indeed require a lifelong intervention as it won't go away... although our brains do heal more than was once thought. It's an interesting field of study.

camperbot said...

Peter have you put down your story about your fight in SA anywhere in book form? It's a unique perspective that needs to be told and obviously you're the one to do it.

Ray - SoCal said...

PTSD is a very broad term. Most PTSD therapy does not seem to do that great a job from what I have read. Basically, your mind learns habits. The challenge is how you rewire your mind to change how you react.

My view, is people have limits on how much stress they can deal with. The challenge is we have an society that is on all the time with constant stress. Back before civilization, a person would have one major stressor once in a while, and then relax, exercise, and have a group to help them deal with the stress. The trick is learning how to deal with stress and memories, in order to keep in good mental shape.

Some resources I have found useful:

1. Google set up an institute on Mindfulness that I found great, along with their book. Online videos available. Book explains it from a programmers view point, that is refreshing.

2. Mindfulness

3. Time Cure by Zimbardo (Stanford Prisoner Experiment).

Great video:

If you Google around, you can find a therapist guide for the book.

4. I have found the 5 Minute Journal a great tool.
There is a coupon code if you google around...

Anonymous said...

It seems fitting, in a way, that the malady originally called Shell Shock (and later Combat Fatigue, now PTSD) may actually be caused by the blast effects of high explosive shells. Perhaps that will help some of the population with acceptance. We can only hope.

Sam Helm

deb harvey said...

just read your april, 2011 column.

terrorist= coward

always torture and destroy the helpless. never stand up man to man, face to face.

the minions of the evil one.

i reckon they will spend eternity with or near the evil one, their true father.

as for those who are pure in heart, they shall see God.

Captain Tightpants said...

Peter, this matches some other research I have seen regarding the effects of blast overpressure on the brain structure - obviously a concern in my former line of work.

It is definitely looking more and more as if such exposures - particularly repeated over time - do indeed cause permanent, physical damage to the brain structure. Unfortunately, until recently, very little effort was put into tracking these exposures, or anticipating the effects. Hell, at one time in the bomb community it was just sort of the badge of belonging that you were exposed to the blast wave during training and operations, particularly if you did any sort of explosive breaching work.

Other interesting tidbits? We're seeing evidence that helmets, while they help protect from fragmentation, actually make blast pressure damage WORSE due to the pressure wave reflection and refraction. Never would have guessed that twenty years ago.

Be that as it may, we are fortunately making good strides in changing our practices to better protect people when possible. As the research shows more I find it important to share such things. Thanks for posting this one.

Anonymous said...

I remember reading about "Shell Shock" during WW I.

Anonymous said...

(Not the same "Anonymous" as the previous one)

Yeah, funny how it was known that "shell shock" was known to exist independently from pure combat stress exposure at least by the end of 1944, and the data should've been more widely available by at least 1949, certainly... there were large enough groups that were exposed to just one of those during WWII, to go with the main group with both.

I wouldn't be at all surprised to find that this had already been discovered in WWI and forgotten afterwards, and even earlier too. I mean, there are descriptions from the 1600s and ...

Anonymous said...

Recently read an article (Defense Technology International?) about new research into blast effects on cellular structures. Apparently they think that the shock wave can create micro bubbles in cells (or blood) that short term dissipate but may cause cellular damage. I dont remember the mechanism. There are studies looking into this.