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PTSD Is A Physiological Response, Not Mental Illness

3/13/2011

4 Comments

 
Warriors who return from combat bring to our collective attention consequences of facing danger and remind us how it can transform the brain’s “wiring.” It is possible and crucial to know how to  successfully “re-wire” it.

Anyone, not just uniformed warriors, who experiences a life-threatening event, and who has an overwhelming sense of helpless terror, can develop posttraumatic stress disorder. Examples in civilian life are plentiful:
a car accident (whether or not there were casualties), rape, child abuse, natural disaster. In these and similar situations invoking a sense of powerlessness in the face of a life-threatening event, our incredible brains produce a flood of biochemical reactions to help meet the crisis. The sympathetic system gears the body up to respond to danger, allows us to take action in the form of immediate fighting or fleeing. The heart rate increases, blood pressure rises, and senses are acutely attuned to the present details of the danger. This is normal, healthy, and amazingly effective in promoting survival.

This flood of biochemicals washing over the brain instructing the body to be agitated, is called a sympathetic response. It has a counteraction, the parasympathetic response, which calms that flood of “action” hormones and brings our heart rate, blood pressure, and sense of safety back to pre-crisis level. The parasympathetic system, then, returns the body to stasis.

Posttraumatic stress disorder is diagnosed only in the presence of several criteria. The first to consider, after exposure to a perceived threat to life and the sense of helplessness, is time. For up to six months after a traumatic event, most everyone will still have somewhat elevated levels of stress hormones. Again, this is a natural and healthy, though not necessarily pleasant response. It is common to be fearful, to have bad dreams, to feel disconnected from loved ones…for awhile. Eventually, these symptoms fade and the person returns to life as, almost, normal.

After that time, though, if the individual’s response systems do not return the body to stasis, but instead fluctuate between being on high-alert and being in an overly “calm” mode, his or her sympathetic and parasympathetic nervous systems need to be addressed therapeutically. High alert, when the danger itself is not present, may take the form of anger, irritability, agitation, jumpiness, inability to sleep peacefully, substance abuse, with unbidden memories of the incident. Its counter system intended to calm, may evidence itself with social isolation, dissociation, lack of focus and inability to concentrate, and a loss of interest in previously enjoyed activities.

 Not everyone who lives through a traumatic event develops posttraumatic stress disorder. And it is not the event itself that determines posttraumatic stress. It is, instead, the mind and body’s physiological response systems that, once learned, do not return to stasis. This is not mental illness, though it may look and feel like it. Neither is this a lack of character or faith. It is a physiological response gone automatically into overdrive.


4 Comments
Michael B
12/30/2012 02:51:46 am

I have PTSD after being attacked and have lived with it for almost 13 years. This is the first time I've heard it put in these words. The stigma of being tagged with "mental illness" has been harmful to me. Your article is matter of fact. I wish all health care members had this message and understood its powerful impact on PTSD survivors. Thank you so much!!!

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Marilyn Miller link
12/31/2012 03:35:59 am

Michael,
I'm so pleased to know that my description resonated so well with you. I wish it reached more people so they understood it better. (You found this nearly two years after I wrote it. I have to wonder how you found it!) Of course, our psychiatric bible, the DSM-IV, lists PTSD as a disorder primarily because it can lead to some pretty severe dysfunction. My hope was that this explanation would help both sufferers of PTSD and clinicians. So thank you for your very welcome feedback. I wish you the best.

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Katherine C
3/28/2013 05:15:11 pm

As a child I was abused, and subsequently abandoned. I HATE the phrase "mentally ill". I don't have the flu or a cold. I did not drink from a germ infested water fountain or by neglect acquire an STD. SOMEONE knowingly did this TO me. I'm not sick. I've been hurt! I've been injured!! No one calls a gunshot wound an "illness". This awful phrase "mental illness" had perpetuated my pain, disempowered my ability to find healing, and invalidated all authentic progress I had made.

I believe a reasonable, though small, change to such a phrase could lessen the stigma and burden felt by victims. I've begun imposing use of the phrase "mentally injured".

Thank you for giving validation and forum to what my heart and mind have needed so desperately to declare. Thank you.

Katherine C

(I found your post by googling "PTSD is not mental illness".)

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Marilyn link
4/3/2013 06:51:27 am

Katherine, It sounds like you have a lot of resilience going for you. I hope you found the professional help anyone with your experience needs in order to heal.
I appreciate your thought that an "assault" by a gun doesn't create an "illness!" I'll remember that when I talk again about the physiological effects of traumatic events.
Thank you for responding here. I'm sure your comments help others who have to live in the aftermath of trauma. And your feedback helps me.

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    Marilyn Miller, MS, LPC ~ Psychotherapist

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