Up Close and Personal

PTSD is an environmentally inflicted mental disorder. It is unique because it is a direct result of traumatic events that happen in a person's experience and, for this reason, the issues that are raised in treating it are unlike other mental illnesses. The problems that are raised by the traumatic events can be highly personal.and can have devastating effects on how a person understands him/herself, that person's ability to feel safety and security, and demands answers to questions that go far beyond simple brain chemistry and brain function.

To understand what I mean by an environmentally inflicted mental illness, it is necessary to make some contrasts.  Schizophrenia is a mental illness that is understood to be created by a malfunction in the brain, a chemical imbalance.  The first line, but not the only line, of treatment for Schizophrenia is psychotropic medications that are intended to create the balance that is missing, mostly altering dopamine reception.  Bipolar Disorder is the most celebrated of the chemical imbalances and that is what most patients refer to when they go into a doctor’s office, including a therapist’s, and declare that they have a chemical imbalance.  What is implied by this declaration to a non-prescribing therapist is that there is nothing that the therapist can do for the sufferer that can’t be better done with medicine.  My response, on which I intend to elaborate in future posts, is what they believe may be true or mostly true, but is not entirely true and may actually prove false in certain situations, the situations that I, for one, would be addressing, if they only have the patience and forbearance to stick with me.  It may be hard for many to believe, but there is a logic to psychotherapy even when the primary treatment is chemicals.

But, let’s look at chemical intervention.  It’s effectiveness for people suffering from Schizophrenia is fraught with inconsistency. To help address the varying responses to antipsychotics, more medicines are created to better treat those who do not respond as expected.  And even these people are not always happy with the side effects and often don’t like the way the drug feels even as their friends and family tell them they are doing so much better with it.  Treatment for Bipolar can also be received with a mixed reaction by patients, although people with Bipolar usually start out from a better place in terms of being able to function in the world.  For this reason, they don’t always perceive treatment effects as such a radical departure from their normal way of functioning, not so radical as for Schizophrenia in any case.

If you look at these examples of treatment for a misfiring brain (for want of a better term) realistically, especially in terms of claims made for effectiveness of treatment, there is still plenty that has to be accomplished.  The computerized brain mapping is a powerful statement of how far science has come, but the brain cannot be understood by maps alone.  Neurobiologists may know something about the chemicals involved, but there is no reason to think they are even getting close to a magic bullet, something that will have someone with Schizophrenia, say, take a pill and have the scales fall from his/her eyes.  There are reasons for this too, which I also intend to discuss in future.

But, let’s look at PTSD.  It’s a mental disorder, an anxiety disorder that is created by certain types of trauma.  It is caused by certain traumas that are described in the diagnostic manual (DSM).  And here is where things get sticky.  You have arguments for a chemical imbalance created by the trauma and you have environmental factors without which the disorder would not exist otherwise.  Unlike Schizophrenia or Bipolar that have symptoms the effects of which might put the sufferer in traumatic situations that could cause PTSD, a person with PTSD has been put in the traumatic situation through no fault of their own and now has to cope with a set of symptoms that would not otherwise exist.

While I understand all this and you, the reader, may understand this now, most people, including most professionals don’t.  This is largely why I continue to write my blog so that people begin to understand this stuff.

And so a woman came into my office not long ago on the recommendation of her primary care physician (PCP), who suggested she get therapy for an unexpected trauma that was perpetrated by a group of people and was personal in nature, directed at her.  She researched therapists in the area she lives in and chose me.  The reason was that she liked what I had to say about my areas of interest, how I look at things, and how I treat.  She took this to her PCP who said that he thought he heard of me and that he approved of her choice.  He had already begun her treatment with psychotropic medicine and he wanted her to get treated by someone who specialized in PTSD.  He withdrew that approval after she told him of how we used the first session.

Now, if I were Shakespeare, I would deliver an onstage aside from the point of view of one of the characters addressed to the audience to reveal his thoughts.  And so I will.  Because what we are talking about in this type of PTSD has far more involved than an isolated trauma that may occur by accident, like a friend accidentally shooting a victim in the face or being hit by a car while crossing the street.  What is often involved and did happen in this case was planned betrayal, what amounted to personal hatred and a sadistic pleasure in inflicting pain, much like the torture that was inflicted at Guantanamo, but in this case among principal characters who know each other and who acted with purpose to inflict harm.

So, says the MD who did not like my approach, he did what?  You mean that psychologist did not do EMDR, rapid eye desensitization movement, or CBT, cognitive behavioral therapy?  That psychologist must be a charlatan, the PCP must have concluded.  Then, he referred her to someone who met his approval.

And my response is this, the research of treatment with EMDR and CBT shows good results in certain cases, but not all and perhaps not most.  But also, I don’t approach treatment like I am trying to affect neurons so much as help an individual with a history, a sense of self, and a struggle to achieve an understanding of traumatic events with the goal that clients can integrate their experience to better understand and affect how they respond in future.  My treatment affects neurons, too, but assumes that the person has more invested in life than sets of neuronal responses.  The struggle is not about a medicine, but about a drama, the drama of a person’s life.  This is often better understood through reading Shakespeare than through reading brain maps, affecting chemical imbalances, and retraining individual behavioral schemes and responses.  It’s the difference between seeing ourselves as a mass of chemicals and as being at the center of a drama that defines who we are as people who have a purpose to our being here.

This is the reason why I have often said that we are all swimming around in the same soup.

Despite this, there are plenty of physicians who will continue to prescribe both medicines and behavioral intervention without ever recognizing their patient as a protagonist, a person seeking treatment who stands in the middle of a drama in which he or she is the hero.  “Physician, heal thyself!” then heal the person who is not just a repository of discomfort and disease, but is someone who exists at the center of a drama and an entire universe.