Post-traumatic stress disorder is a mental health disorder and so, like depression or schizophrenia, there can be a stigma associated with it. Dana Alliance for Brain Initiatives member Jordan Grafman, Ph.D., is the Director of Traumatic Brain Injury Research at the Kessler Foundation and is part of team conducting a long-term study on veterans who sustained head injuries in Vietnam. He views PTSD not just from a clinical perspective.
“How does society accept these human expressions of experience?” Grafman asks. “There have been times when society has suggested, ‘Just shut up and go on with your life.’ Then somebody gets dysfunctional and they’re not going to talk about it because society says it’s a bad thing. In some sense, there’s an aspect to this that’s bigger than the medical view—the sociological view. I don’t think that should be lost.
“There were vets in my study who tried going to group sessions and they got sick of people complaining. They didn’t feel the group was helpful in getting them out of their persistent negative experience. So you wonder what the optimal way that society should structure itself, particularly with the military. There is an incentive to some degree not to let people deal with PTSD, especially during wars. You don’t have the time to send a whole bunch of people out for weeks or months. It’s a different level of consideration, but it’s equally relevant.”
The number of people suffering from PTSD is not exact. Grafman suggests dividing the population between civilians and military personnel. Even among civilians there are those with highly stressful occupations, like police officers, and regular citizens who happen to experience a traumatic event, like a car accident. “The range of reports is pretty variable,” Grafman says, but he estimates between 4-10% of the civilian population experiences PTSD at some point. Among soldiers, it can be as high as 40% (though Grafman noted that unbiased samples can show around 10%).
Distinguishing between PTSD and post-concussive syndrome can also be tricky. Grafman says that with moderate to severe brain injuries it isn’t too difficult to separate the two because doctors know exactly where the injury is. “If you have a much more mild concussive injury, then the impairments can overlap with the symptoms you might get from being stressed out. That’s where it gets complicated. For example, if someone benefits from a treatment of the stress—they don’t have intrusions into their daily lives—but they still have some impairment in neurological testing, perhaps they had both the stressful experience and the concussion. It’s a diagnostic dilemma.”
Two people can experience the same event and it’s possible only one will experience PTSD. Why? Grafman says there is no single answer, but rather a variety of factors. Upbringing matters and genetics certainly play a role. There are genes involved with memory and emotion and “if those genes are tweaked in one direction instead of another, you may have a more acute experience of the event and that makes it more likely you’ll retain it in a very explicit manner and you won’t be able to cope with it.” The type of brain injury, if one is involved, matters as well. “If you have an injury to the medial prefrontal cortex, and in particular the amygdala, it really does prevent you from experiencing dysfunctional post-traumatic stress.” Additionally, the development of these two areas, as well as the hippocampus, prior to any stressful experience also plays a role.
June is PTSD Awareness Month, and there is much we still don’t know about the disorder. But we do know there are effective treatments. Different kinds of exposure therapies and cognitive behavioral therapies can be effective in treating PTSD, says Grafman, who will return to his hometown in September to direct a new Brain Injury Research Program at the Rehabilitation Institute of Chicago. “Sometimes redirecting the memory link into more positive experiences can be effective. We’ve seen a 75-80% [success rate] in some of the studies showing remediation of the effects of PTSD—that’s not perfect but it’s pretty good.”