PTSD: Post traumatic stress disorder.

PTSD – Post Traumatic Stress Disorder is much more prevalent than people think. Anyone who has been the subject of a threat to their own life or has witnessed death or wounding/mutilation is at risk of developing PTSD.

I worked as a GP – Family Physician – for about 25 years, and as a Police Surgeon for  about three years. In that time I (hopefully) helped a lot of people with PTSD.

What made me aware of the problem? I have always had an interest in 20th century military history, especially after working in my house officer year in neurosurgery with a famous neurosurgeon, who was the son of one of the progenitors of neurosurgery during WWI. His library had many books on how field surgeons during that conflict had to deal with people who had head-injuries that where not immediately fatal.

Surgeons were faced with a dilemma of whether to treat or not treat, based on the premise at the time, that the skull was an unknown territory. Anyone opening the skull was on their own.

English: Image from The Great War taken in an Australian Advanced Dressing Station near Ypres in 1917. The wounded soldier in the lower left of the photo has a dazed, thousand-yard stare – a frequent symptom of “shell-shock” or PTSD. (Photo credit: Wikipedia)

That was interesting in itself, but the texts on ‘shell shock’ and the way that this phenomenon was dealt with during and after the conflict were much more difficult to comprehend. How could front line troops who became frozen in face of the ‘enemy’ be regarded a cowards and then executed as such?

As I read more I came to the conclusion that PTSD has always followed conflicts and war. It has always followed assault on the body. These could be the result of rape, of road traffic accidents, or any event where the person is in mortal fear.

It has been found in post operative patients who have spent time on Intensive Care Units, and Burns Units.

The incidence of the condition presents in children who have been physically or emotionally abused, but not in the ways that it presents in adults.

How best then to describe it?

Memories are laid down in the brain through complex changes in nerve connections, becoming in some way  ”hard-wired”. This allows the brain to “recall” events and emotions when it is appropriate and necessary to allow some conscious action or behaviour to take place.

The “fright, fight or flight” (FFF) response is present from birth and is itself “hard wired”into our genes. This reflexive response to danger becomes attached to the memories of the extraordinary events that cause the reflex to become active. There then exists a hard-coded link between a memory and  the FFF reflex.

English: Cases of PTSD and Severe Depression Among U.S. Veterans Deployed to Iraq and Afghanistan Between Oct 2001 and Oct 2007 (Photo credit: Wikipedia)

Many people who have the risk factors for PTSD manage to avoid the FFF response by suppressing memories; this may explain the avoidance that survivors of trauma use to prevent triggering of the FFF response. Relatives often say that people who have returned from conflicts “they never talked about their war”.

PTSD may not present for many years after the causative event(s). This makes its appearance difficult for the person and those close to them to understand. I had patients who had served in WWII who presented with signs of PTSD 40 years after the conflict ended.

It is without doubt the most crippling of psychological trauma to be present in the numbers high lighted in the diagram to the right.

The invisible wound it may be, but looking for it where it is most likely to occur can relieve the burden to the sufferer and their families. If you or someone you know has worries about PTSD, then talking with your doctor is the best place to start.

What are the signs of PTSD?

The signs of PTSD are a result of a flooding of the person’s mind with very intense flashbacks to the causative event(s). The memories are so vivid and involve all the senses including taste and smell, that they prevent normal perception to occur. The person becomes disassociated from what surrounds them. heir “minds eye” is focused on the intrusive memories contained in the flashback or nightmare.

English: signs and symptoms ptsd (Photo credit: Wikipedia)

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