I admit to being obsessed with the subject of Post Traumatic Stress Disorder (PTSD). Post-traumatic illness could teach us a lot about how humans function and cope or dysfunction and become essentially demoralized under extraordinary stress. From the biopsychosocial perspective PTSD may very well help us to understand what happens to our brains when “critical mass” is reached and our tolerance for trauma is exceeded. Furthermore, PTSD may be a psychiatric harbinger of the toll that trauma and excessive stress is taking on society and how certain vulnerable individuals, much like childhood survivors of physical and sexual abuse, can end up becoming both self-perpetuating victims and perpetrators.

While we are right to be concerned about the economic cost associated with running a large first world country and waging various wars (on drugs, on terrorism, ISIS, etc.) shouldn’t we be equally concerned with the psychological and physical costs and consequences resulting from what government officials euphemistically call unavoidable “collateral damage”? Such military speak doesn’t begin to do justice to the actual reality of those thousands of civilians killed and wounded, families displaced from their homes and ancestral homelands, and the mounting number of returning soldiers with severe physical injuries and PTSD. Sure there is a lot of lip service paid to helping and supporting our courageous “wounded warriors” but all the parades, handshakes, brain scans, robotic arms and Starship Trooper prosthetics in the world will not adequately repair the damaged psyches of combat veterans with deep psychological wounds and moral injuries at the soul level.

What we know about trauma and PTSD is still far exceeded by uncertainty about how best to treat them. What we know is this:  individuals can fall into a prolonged state of anxiety, depression, pessimism and despair after having exposure to experiences perceived to be either life threatening or serious enough to shatter their belief that the world is safe and sensible (sense of meaning and coherence). Put another way, certain people whether on the battlefield in Iraq, following a nasty prolonged divorce/custody battle, or a particularly horrific automobile accident can lose their fundamental sense of security and their belief that their daily existence is not one of continual threat and that their current situation in life lacks sufficient hope, purpose, positive meaning, and what researchers now call “narrative coherence.” Consider an insecure deeply depressed or suicidal teen who has not only failed to reach sexual, physical or psychological maturity but also views their own life as hopeless and therefore represents a failed “life story” with no redeeming value. Sometimes psychological trauma can result from an acute catastrophic incident, but more often it is an accumulation of these types of “self” shattering experiences that have reached their tipping point.

In addition, such an extreme breakdown of perceived safety, integrated sensorium and personal sensibility is accompanied by the  inability to “work through”  (ie., mentally and emotionally process) the traumatic event(s) necessary for long term adaptation and recovery. PTSD sufferers are essentially stuck in a mental movie theater randomly replaying the horrific memories, stress arousing stimuli and sensory triggers associated with their initial trauma.

On a neurobiological (brain) level there is growing evidence of a persistent dysregulation in the HPA Axis stress response. Instead of returning to a baseline level of physiologic arousal, PTSD leaves the body-mind in a tense state of hypervigilance and hypofunctioning. To be stuck in a physical and emotional state of “fight or flight” is essentially hell on earth and somewhat similar to what it feels like to be having panic attacks and extreme anxiety 24/7. Unlike previous models explaining the normative stages of grief, loss, and recovery, ie. Kubler-Ross, etc., those with PTSD are often unable to reconcile conflicting thoughts and feelings about their traumatic experience(s)and have not managed to achieve a final state of understanding and acceptance.