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writing for godot

Understanding the Biology of Combat-related PTSD: Safe, Effective Treatment

Written by Sara Stalman MD   
Wednesday, 23 January 2013 02:26

Dennis Perkinson writes authoritatively and movingly about the horrors of the personal experience of combat-related PTSD and its devastating effects on families, children, and our national well-being. (See I would challenge Perkinson’s assertion that current medical and psychological treatment properly address the biology of PTSD. That said, I found his basic premise, the soldier left alone to wrestle with the horror of war, eye-opening and instructive.

“Forty-two years later, I still have nightmares of Vietnam. I sometimes awake at night feeling surrounded by the essence of those whose lives I took . . . It is this struggle to try to come to grips with the violation of our ethics that weighs on many of us who return from combat.”

Experience treating adults terrified as children taught me to understand the neurobiology of the autonomic hyper-reactivity associated with PTSD. “Autonomic hyper-reactivity” neurobiologically describes the consequences of experiencing terror (threat) so great as to overwhelm our reptilian, sympathetic, fight-or-flight response. When our body knows we are going to die, the more primitive parasympathetic nervous system kicks in stopping our heart. We survive because a total-body adrenalin release restarts cardiac pumping. After this, anything reminding us of that terror triggers the parasympathetic > adrenalin cascade (cardiac standstill > explosive adrenalin release). Men typically “see red” and react with uncontrollable violence they often cannot remember. Women are more likely experience a terrifying uncontrollable “panic attack” and the feeling of impending death.

Perkinson’s quote describes a second neurobiological consequence of the experience of war. Many of us, perhaps most of us, grow up pushed not to make mistakes. Learning to be “good” creates an abnormal strain on the developing human nervous system. Children need to play: play is the “work” of childhood. It is through play (making mistakes, laughing, learning from them) that we, like other animal species, maintain the connection between our developing body (and intellect) and our instincts (our feelings). Children afraid of making mistakes teach themselves to “obey” at the sacrifice of their feelings. They create a disconnect in our oldest neuronal system, the serotonin-mediated system. Serotonin is as old as life: it is found in plants and in one-celled animals; it is found in sperm and guides the sperm to the egg.

While seemingly a simple neuro-biological adaptation to worry preventing play, serotonin-neuron communication dysfunction (SNCD) has profound physical and psychological consequences. Sufferers cannot define their feelings -- except a terrible feeling of guilt/shame that constantly haunts them. When instinctively looking to their feelings, they confront instead a black, empty free-fall. The psychological pain of that emptiness is so great that people learn to do anything to avoid its black nothingness. One approach is to dedicate oneself, wholly and utterly, to a cause; one such cause is service to one’s country. On return from combat, men and women with SNCD do not have the neuro-biological resources to rebound from the experience of war. They are alone with the horror, and it is unbearable. Many turn to alcohol and drugs.

Working in an alcohol/drug treatment setting and tasked with understanding and treating people unable to find sobriety through the 12-Steps alone, I learned. People with autonomic hyper-reactivity and/or SNCD could not achieve sobriety because they relied on alcohol and drugs just to make it through the day. With appropriate treatment (with clonidine and/or fluoxetine respectively), their lives were changed. Finding sobriety was easy. Both clonidine and fluoxetine need to be individually dosed. By reacting with single, specific brain receptors, both mechanically correct the disordered neuronal system involved without producing side effects.

Data on the above is available on the website (referring to all of us). The website is written for both laymen and doctors/scientists. Senior editors at both Science and Nature supported the technical aspects of the research.

Required by corporate law to protect the investments of their stockholders, the pharmaceutical industry depends on profits from sales of multiple, ineffective medicines. Our current economy reality forces people to protect their jobs, first and foremost, if they are to protect their families. Nobody, nobody unaffected personally, wants to confront the power of the Pharmaceutical Industry. Medical journals and academic medicine depend on pharmaceutical industry financial support. Doctors fear going against practice guidelines established in this for-profit system.

Unless people affected personally rise to the challenge, nothing will change. The website is designed to help us do that. Readers can understand their symptoms and share the Science with their healthcare providers. The data on using these medications safely and effectively is all there. your social media marketing partner


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+6 # Walter J Smith 2013-02-02 10:37
Where to cut into such an article?

First off, as a Vietnam combat vet living with PTS since long before my first of 2 tours was complete, I have learned that the only possible hope for managing PTS is avoid all medical "professionals" who claim to know something about it, because they see the patient as another wonderful lab rat. He or she is here so they can play their exotic "let's try this one on him" game, and, no matter what the results, keep up the charm-and-sell offensive. The only thing I gained from dealing with them was to learn that accepting offense is not always in your best interest.

Second, every single combat vet friend I have known who went the chemical route was made worse, not just short term, but for life. Some just created a legal dependency and existed in zombie land until some misfortune took them away. Some committed suicide. Some went back to street drugs.

Third, I committed myself to not only understanding what the actual impact of PTS on the individual; but to also seek until I found a successful treatment. I became exceeding lucky in the early '90s. I discovered Judith Hermann, and her brilliant book, "Trauma and Recovery." Dr. Hermann did her homework, and she presented the treatment to me in a book without offending me and without sending me to another lab to become a rat for another "professional."

The chemists have no decent answer for Thomas Kuhn's brilliant question: What must the world look like for science to succeed?

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