More than a mental health issue, more than a first responder issue, post-traumatic stress disorder is a human issue. Post-traumatic stress disorder is a serious anxiety disorder often associated with the military, first responders, and sexual assault victims, but anyone who experiences trauma can be affected by it. As a one-time or accumulative anxiety disorder, PTSD can be a terribly haunting, unrelenting reality for many people.
People who are most prone to the illness are first responders because they see more trauma more often. Though there is effort on the part of first responder organizations to deal with trauma-stricken employees with early psychological support, peer support, medical attention, and hot lines, first responders continue to take their own lives. It seems that every week, we hear of another first responder suicide. Why is this happening? PTSD is a disorder in which therapies fall into a political game of what is acceptable and what is taboo, complicated by a negative social regard for mental illness, and a society that expects traumatized men to “suck it up” and get on with the job ( this topic to be further discussed in the next and final installment of this PTSD series).
PTSD is as complex as it is terrible.
Treatment of PTSD should be thought of as an investment. Until quite recently, the outlook for PTSD sufferers didn’t look so good unless years of therapy and pill-popping seemed appealing. New alternative therapies have emerged for PTSD, and the options give promise of better things to come, provided that we’re open to acknowledging that we have a problem that affects our normal function, and that we’re willing to reach out and ask for help.
The physical origins of PTSD
University of Toronto psychology PhD candidate, Lauren Drvaric, says “good mental health means good physical health and well-being. Poor mental health influences physical health, and we should be investing in the entire self, mind and body.”
Many professionals in psychiatric fields keep the mind and the body separate; their focus is on the mind, behaviour, and cognitive operations, with no attention paid to the body. This is curious, since the brain commands the body and the body responds to the brain; they cannot be separated.
Toronto psychotherapist, Matt Cahill, says when his clients do not verbally discuss their trauma, he picks up on the non-verbal cues. “Tears, blushing, or tremors, to name just a few,” he explains. “Sometimes a client will comment on how a part of their body feels numb or, alternately, feels constricted during a session where we are covering traumatic experience, rather than openly discuss their feelings. The body tells its own story, so I try to pay attention to everything.”
Dr. Bessel van der Kolk, has been involved with PTSD research for over 30 years and believes that trauma lies in our bodies; PTSD has a physical-basis that prompts “a cascade of physiological catastrophes that affects almost every major system in the body”.
Van der Kolk believes that trauma victims are alienated from their bodies by a response from a brain structure called the amygdala, the brain’s emotional processing and feeling centre. The amygdala responds to threats and traumas with a flood of hormones that set off the “fight-or-flight” response. The physical response subsides when the threat does, but when it doesn’t, as is the case with people with PTSD, the traumatic memories play out in the patient’s mind, and the amygdala continues to produce stress hormones that sustains a heightened state of anxiety.
Dr. Frank Ochberg, MD, psychiatrist, and founder of trauma science, believes that there are possibly two types of PTSD. One type makes PTSD-affected people more prone to flashbacks, and the other causes a numb, dream-like state that cushions people from feeling the anxiety associated with PTSD. Some people experience both types. Ochberg notes a measurable change in the electrical discharge of brain cells in the grey matter of the right temporal lobe in PTSD patients, and believes that this part of the brain is responsible for traumatic flashbacks.
Traumatic brain damage causes other problems in the brain. Dr. Ochberg notes a reduction in the number of pathway cells between the limbic system (of which the amygdala is a part of) and the grey matter (the thinking part of the brain). The hippocampus, another part of the limbic system, is part of the mid-brain that looks like a long wishbone; it organizes and saves memories and associates them with feelings and actions. Studies on combat soldiers exposed to trauma show a correlation between a smaller their hippocampal volume and the tendency to develop PTSD.
Trauma is literally “all in our mind” and also of our brain; it manifests physically as damage to our brains, and brain damage, as Dr. Ochberg sees PTSD, should be considered an injury, an injury that can be healed.
PTSD therapy: the body and mind connection
In her article, A Revolutionary Approach to Treating PTSD, Jeneen Interlandi says “If there’s one thing van der Kolk is certain about, it’s that standard treatments are not working. Patients are still suffering, and so are their families. We need to do better.”
Van der Kolk says psychological trauma should be treated through the body, not the mind. He says trauma has nothing to do with cognition, but the body interpreting the world as a dangerous place. In many cases, the PTSD patient’s body was violated, and they need to find a sense of security in their own bodies. “Unfortunately,” van der Kolk says, “most psychiatrists pay no attention whatsoever to sensate experiences. They simply do not agree that it matters.”
There are no cures in the world of psychiatry; there are no physical tests for mental health disorders, and there are no drugs that can cure brain injuries. However, it turns out that there are a number of promising, albeit unconventional therapies that eclipse traditional psychotherapy, and questionable, side effect-laden psychomeds for treatment of PTSD. Some of these therapies will sound odd, even outrageous, but there are no side effects, no secret ingredients, and best of all, many of them are free that people can do themselves.
Eye Movement Desensitization and Reprocessing (EMDR)
EMDR, or Eye Movement Desensitization and Reprocessing looks bizarre but it has an excellent track record for relieving mental and emotional anguish. During the treatment, the patient holds their trauma in their mind while their eyes follow the therapist’s fingers that move back and forth before them. It sounds crazy, but according to EMDR.com, the therapy works “for reasons believed by a Harvard researcher to be connected with the biological mechanisms involved in Rapid Eye Movement (REM) sleep, internal associations arise and the clients begin to process the memory and disturbing feelings. In successful EMDR therapy, the meaning of painful events is transformed on an emotional level.”
Over 10,000 therapists worldwide use EMDR therapy and millions of people have been successfully treated since its inception in 1989. In fact, EMDR is now recognized as an effective treatment for trauma by the American Psychiatric Association, the World Health Organization, and the U.S. Department of Defence. This unusual therapy may still have its controversies, but van der Kolk, who uses this technique himself, knows what he sees in his own patients and places his faith in the treatment. EMDR is especially useful to people with acute PTSD from isolated traumatic memories like single episode assaults and car accidents.
Yoga and massage
Yoga and massage are complimentary therapies for people with PTSD. A U.S. yoga group specifically for PTSD-affected combat veterans, Yoga Warriors, says that yoga helps veterans “retrain” their fight-or-flight response.
“When vets confront a situation that triggers their memories,” the Yoga Warriors site says, “instead of resorting to aggression or drowning in fear, they have other options: deep breathing, for example, as a means to self-calm.”
Yoga, like dance, focuses on breath and movement and helps with body and emotional awareness, relaxation, and mental clarity. Yoga Warriors says it “allows one to safely express stored emotions such as guilt, shame, anger, sadness and grief so those feelings can be understood and integrated.”
Massage, the laying on of the hands, can help people with PTSD relax and feel safe in their bodies; massage can release toxins, and reduce scar tissue and muscle pain. According to the Canadian College of Massage, the practice may make the PTSD-affected feel more mentally balanced, and can “help to reduce mental anguish, anxiety and trauma by regulating stress hormones. Regular massage therapy reduces cortisol [the stress hormone produced by the amygdala] and stimulates the release of endorphins like serotonin and dopamine”, the hormones that make us feel good.
Acupuncture, the ancient Chinese treatment, is finally being taken seriously. Through the use of small needles, heat, or pressure on points of the body’s energy meridians, pathways that carry blood, body fluids, and Qi, or life force energy, this very effective therapy provides relief of many physical ailments, improves sleep, relieves stress, and balances the emotions. The theory is that when the body’s flow of energy is disrupted due to an injury, trauma, or an emotional disturbance, acupuncture can help to free the energy blockage and release the patient back into health. There is evidence that acupuncture can regulate brain function and modify the activity in the limbic system, where PTSD is thought to originate.
Energy psychology and Emotional Freedom Technique
The energy meridians acupuncture is based on is the root of energy psychology, or energy medicine for the emotions, a method that helps change the way the brain processes thoughts, feelings, and behaviours. Clinical psychologist and pioneer in energy medicine, David Feinstein, says tapping on accupressure points changes the neuropathways to bring about changes in the energies that underlie psychological problems, including PTSD.
Multidisciplinary doctor and healer, Dr. Adonis Makris, says that modern medicine focuses on chemistry, but energy healing has to do with the body’s electricity. Energy work is based on the body’s undeniable electrical nature. Most of us don’t often consider the body electric, but if you’ve ever been to a hospital for tests, you may have experience with the EEG, or electroencephalograph, the system that monitors your brain’s electrical activity, or the EKG, or electrocardiograph that reads the heart’s electricity.
Both energy psychology and Emotional Freedom Technique (EFT) use the energy meridian system to initiate healing. Carol Look, EFT master, explains energy work affecting the entire body: “Our feelings, states, moods, and levels of stress are formed by emotional responses and subsequent chemical reactions to specific events in our lives. These events and chemical reactions are stored in our cellular, physical, and emotional memories.” Her explanation explains how memories, thoughts, sights, smells, and sounds can trigger a PTSD-related flashback or sustain the anxiety related to it.
By tapping on various energy points on the skin and focusing the mind on specific problems (i.e. trauma), the brain’s electrochemistry can be shifted and the body’s energy system brought into balance, which allows the mind and body to resume their natural healing abilities. Studies show that accupoint stimulation (tapping) can reduce production of cortisol, the stress hormone, normalize brain wave patterns, and like massage, increases hormones associated with pleasure.
Gary Craig, EFT founder, says that trauma is a result of a disruption in the body’s energy system, and tapping works to neutralize the emotional charge. “I have helped hundreds of people with traumatic memories,” he says. “After using EFT, not one person – ever – has shown any interest in exploring the issue further or “getting to the bottom of it”. For them, it is completely resolved and they are gratefully relieved of its burden. People’s attitudes about the memory change almost instantly. They talk about it differently. Their words shift from fear to understanding. Their demeanour and posture evidence a dramatic shift.”
“It’s difficult for us to compute EFT because it’s so foreign to us, so unconventional,” Craig explains, “but at the same time, we’ve been conditioned to believe that medicine is the answer and doctors should not be questioned, but second opinions are always a good option.”
This energy work sounds so simple, so amazing, but this seems too easy, I hear you say. Even the pioneers of the treatment and experts in Traumatology agree.
Dr. Charles Figley is a psychologist and expert in Traumatology at the Tulane University in Florida. He says that sometimes the simplest things bring on the strongest results: taking deep breaths can calm anyone down, getting into a warm bath to relieve stress seems to be “a miracle” he says, and EFT is just as miraculous. “We don’t understand it, and it doesn’t make sense, but it works.”
Dr. Figley believes in EFT and the tapping method for trauma. He sees tapping as an alternative to the hierarchy of fear method that many PTSD treatments employ — therapies that begin at the lower level and build up to the terror, like exposure therapy which forces the client to relive their trauma over and over again in an effort to desensitize the patient. “These simple treatments reverse 50 years of psychological research and are turning the scientific community on its head in many ways.”
Gary Craig explains that there is no long, drawn out, tell-me-your-life-story feature to EFT. “There are no pills. There is no painful reliving of past traumatic events. It takes a fraction of the time typically required in conventional psychotherapy, it is often done in minutes. People simply get beyond their emotional luggage, usually permanently, and go about their lives more effectively.”
Compared to EFT, Craig says, “in general, conventional psychotherapy is among the slowest, most ineffective sciences on Earth.”
When we think of psychotherapy, we may envision people who languish on couches, discussing nighttime dreams with cold, our-of-touch Freudians who write prescriptions for mostly useless drugs for years on end. But a new and progressive psychotherapy that you’ve probably not heard of is making headway.
Positive Psychotherapy, born in the late 1960s, focuses on a client’s perception to realize the positive influences in their life instead of focusing on the negative – an all-too-common modern psychological state. This type of therapy directs a client’s attention to such things as positive character strengths, optimistic emotions, and their happiness in the present moment. Positive psychotherapy is much happier and more dynamic than conventional psychotherapies and the treatment typically lasts for weeks, not years.
Tayyab Rashid, licensed psychologist at the University of Toronto and a practitioner of Positive Psychotherapy, explains that the treatment acknowledges the client’s negative emotions, but instead of picking them apart and dwelling on them, the therapy “aims to validate these experiences, whilst gently encouraging clients to explore their effects and seek out potential positives from their difficult and traumatic experiences.”
Positive Psychotherapy has made significant gains in trauma prevention, to the point that it has made its way into a U.S. army program, Comprehensive Solider Fitness. The therapy is used in resilience training to “build mental toughness and identify signature strengths, meaning, purpose, and positive relationships, in addition to preventing pathology.”
Alternative drug therapy: MDMA
“There’s not a single pharmacological treatment out there that has been developed specifically for PTSD,” says Dr. Alexander Neumeister, MD and psychiatrist at the New York University. “There’s a consensus among clinicians that existing pharmaceutical treatments such as an antidepressant simply do not work.”
Long-term medication places a band-aid on the wound at the core of the problem: trauma; its emotions, its energy, and its connection to mind and body. An alternative to pharmaceuticals is psychedelics. These drugs are pure and powerful, and administered under controlled conditions. MDMA, methylenedioxymethamphetamine, also known as ecstasy, is one of these drugs and it has long-term potential for PTSD.
MDMA increases feelings of trust, affection, and compassion for others, could make an excellent combination with psychotherapy for PTSD. Unlike most mental illness medications that are taken daily for years, pure MDMA only needs to be used a few times or less, and there is no threat of addiction to the drug.
Early studies are promising. Dr. Michael Mithoefer is the investigator in MDMA studies through MAPS, the Multidisciplinary Association of Psychedelic Studies. Dr. Mithoefer has seen 90 percent of rape victim’s symptoms vanish after just one intense 8-hour session with MDMA. In another study, combat veterans, fire fighters, and police officers took MDMA and 14 out of 19 patients reported dramatic improvements to PTSD-related issues.
MAPS is the only organization in the world that funds clinical trials for MDMA-based psychotherapy, according to its website. The goal is to make MDMA into an FDA-approved prescription medicine by 2021.
The drugs that they were giving them … they couldn’t get up in the mornings,” said Army first sergeant Gregory Westbrook. “Most of the guys weren’t the type of soldiers who had issues before Iraq or even in Iraq, but they bring them back and put them on these drugs, and they’re falling asleep in the chair. There was no way they could function, especially in a civilian job. So maybe marijuana is an alternative. (Source)
THC, tetrohydrocannibanol, the active chemical in marijuana, binds with cannabinoid receptors in the brain that affect appetite, memory, and pain. Marijuana is associated with forgetting and this is the link to PTSD that researchers are most interested in. “Forgetting well is almost as important as remembering,” says Michael Pollen, American author, journalist, activist, and professor of journalism, and author of Botany of Desire, an investigation of the nature of plants. “Forgetting is about editing, it’s about taking the flood of sense information coming at you, and forgetting everything but what is important.”
Pollen says that life is not about accumulating memory because memory can cripple us, and uses combat experiences in his argument. “Soldiers return from war zones traumatized by experiences that they can’t unlearn. So if you could help them unlearn that, essentially a productive kind of forgetting, with a drug or another kind of regime, it would be incredibly useful.”
Marijuana calms the mind, relieves anxiety, and promotes new thought patterns and behavioural responses. A recent Globe and Mail article reports that marijuana users may be more likely to survive a serious head injury. For people affected by PTSD, cannabis brings users into the present instead of watching the reel of never-ending traumatic scenes that keep them in their mental prison.
Medical marijuana for PTSD looks promising, but unfortunately, marijuana carries a stigma with it, even though it is legal for medical use. Sadly, the social stigma around cannabis is associated with the suicide of another first responder’s life. Just last week, RCMP Corporal Ron Francis, a PTSD sufferer and medical marijuana user, committed suicide.
Cpl. Francis was videotaped smoking pot while wearing his formal red serge, to protest the RCMP’s PTSD policy last year. “I’m trying to draw attention to the fact that the RCMP fails to have a program in place for proper [PTSD] screening for their members and proper information for their families,” he said. The National Post reported Justice Minister Peter MacKay’s condemnation of the stunt, saying it “sets a poor example for Canadians.” Francis was forced to hand over his RCMP uniform, and a year later, was dead.
If we as a society are serious in our support of people who suffer from PTSD, we must let go of old rules and laws that keep relief from those who need it most. Drug stigma is politically based and we have been conditioned to believe that illegal drugs – natural and synthetic substances associated with counter-culture — are harmful and should not be a therapy alternative. What is legal are dodgy, psychotropic medications with sometimes horrendous side-effects that may not do much to help people in dire need of effective therapies.
Through brain scan technologies, early neurological markers have emerged for PTSD. This is exciting because now that PTSD can be “seen”, it gives validation; a visual change in the brain makes it more factual, and this will move us toward a social acceptance of mental illness as something real.
Relief for PTSD sufferers may lie in unconventional therapies that don’t line the pockets of the pharmaceutical companies and are rooted in self-empowerment. We are more powerful than we think. As Dr. Makris says, “We have an incredible capacity to heal themselves in so many ways.”