Category: Mental Illness

Cultural Aspects of Post-Traumatic Stress Disorder: Thinking on Meaning and Risk

Over the past year and a half, I have been conducting research among male U.S. veterans who have served combat tours in Iraq and Afghanistan, most of whom have been diagnosed with Post-Traumatic Stress Disorder (PTSD). An anthropologist myself, I planned to follow the trail originally blazed by Victor Frankl and Robert Jay Lifton, psychotherapists who wrote a great deal about meaning in their descriptions of trauma and PTSD.

Early on, however, a psychiatrist whose work on trauma I admire opined to me that crises of meaning belong to the realm of depression rather than PTSD. He suggested that combat PTSD was best thought of as the physiological effects of living under conditions of extreme stress, while more meaning-related struggles were best understood as a symptom of depression. Given the frequency of comorbidity between PTSD and depression, I was for some time inclined to go along with his analysis.

Then two things happened. First, I began the work of talking with veterans themselves about their stories of trauma and PTSD, listening to how they describe their own experiences. And second, I began to explore the increasingly dominant Prolonged Exposure model of PTSD, which views the disorder as a pathology that develops when individuals fail to process their traumatic memories in the normal way.

Some background is important here. A recent RAND report suggests that as many as 18.5% of combat troops have gone on to develop PTSD after serving in Iraq or Afghanistan; alarming as that number is, it nonetheless demonstrates that the vast majority of combat-exposed individuals do not develop PTSD. However, most of the veterans I’ve spoken with – even those without a formal PTSD diagnosis – report experiencing some PTSD symptoms for a period of time following their combat deployment. Many of them dealt with such symptoms for a while – a month, three months, a year – before passing through this period of processing their memories and going on with their lives. They may be changed by their experiences in the war zone, but they are not broken by them, and may even describe them as resulting in personal growth and other positive effects.

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Lessons from sarcasm (so useful…)

The New York Times ran a story on brain imaging studies of sarcasm, The Science of Sarcasm (Not That You Care), by Dan Hurley. That’s right — that favourite rhetorical tool of the snarky adolescent has been subjected to brain imaging studies. The Pearson Assessment video — of an actor delivering the same lines twice, once sincerely, and once dripping sarcasm — is fun. I found myself thinking that I could have been MORE sarcastic.

Hurley, the author of the NYTimes article, does a pretty good job of explaining things, although I think that the idea that perceiving sarcasm requires a ‘theory of mind,’ alluded to in the article, is a bit of a problem — but I have that issue with a lot of the ‘theory of mind’ material because I think it ‘over-cognizes’ social perception (that’s my own issue, so I won’t dwell on it). Hurley discusses the research of Katherine P. Rankin, using MRI scans and the Awareness of Social Inference Test, or Tasit. I have looked on the website for the Memory and Aging Center of UCSF, and through PubMed and EurekAlert, but I can’t find the original report on this research (please post a comment if you know where it is).

“I was testing people’s ability to detect sarcasm based entirely on paralinguistic cues, the manner of expression,” Dr. Rankin said. What seems particularly interesting is that the part of the brain which seemed to be linked to sarcasm — damage to it by dementia impeded the ability to recognize sarcasm — was in the right hemisphere, not usually associated with language or social interaction (which are generally associated with the left hemisphere). Instead, sarcasm seemed to require activity in ‘a part of the right hemisphere previously identified as important only to detecting contextual background changes in visual tests.’

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Mad Pride

“Mad Pride” Fights A Stigma by Gabrielle Glaser reports on the frank talk, public exposure, and anti-stigma efforts of people who experience “extreme mental states.” Books like Kay Redfield Jamison’s autobiography of bipolar disorder An Unquiet Mind: A Memoir of Moods and Madness and movies like A Beautiful Mind on the mathematician John Nash’s schizophrenia have brought mental illness further into the public light. Now a grass-roots movement is going further: “these advocates proudly call themselves mad; they say their conditions do not preclude them from productive lives.”

It is a diverse movement, centered on anti-stigma efforts, on quality of life, and on treatment options.

Members of the mad pride movement do not always agree on their aims and intentions. For some, the objective is to continue the destigmatization of mental illness. A vocal, controversial wing rejects the need to treat mental afflictions with psychotropic drugs and seeks alternatives to the shifting, often inconsistent care offered by the medical establishment. Many members of the movement say they are publicly discussing their own struggles to help those with similar conditions and to inform the general public.

Themes such as creating “a new language that resonated with our actual experiences,” better public and medical recognition of the nature of their problems, and being given the same sorts of leeway and freedoms that “normal” people enjoy are what drive the “mad pride” movement. They are at once post-conventional due to their extreme mental states, with behaviors and subjective experiences that society would rather not see (social denial), and want to express themselves and have others understand–such a basic human desire.

Liz Spikol, a bipolar writer in Philadelphia, is one of the emerging voices through her blog at the Philadelphia Weekly and YouTube videos (“trouble spikol” is a good search term). Here’s one to watch.

It’s Our Fault: Denial, Disease and Addiction

By Danny Smith, Jimmy Wilson, Will Yeatman, Rachel Guerrera, and Mark Hinken

It’s our fault. But let’s spread the blame. The burden also lies on the shoulders of the educational community. And society itself. There is a serious misconception that exists. This misconception is that chemical dependence is not a disease. By not recognizing chemical dependence as a disease, society continues to hold harmful stereotypes about alcoholism and drug addiction.

The goal of this blog post is to address this major problem facing drug addicts and alcoholics. Society enables chemical dependence by causing denial. Denial helps create a vicious cycle that traps addicts. They tell themselves they do not have a problem and reject the idea to others that a problem exists.

However, denial is not just prevalent in cases of chemical reliance. It is common in everyday life, seen in issues concerning body image, gambling, sex and social interaction. In these cases, like addiction, denial stems from the social stigmas produced by society.

In today’s culture having a slim and fit body is heavily desired and expected. People who do not conform to the lofty standards set by models and Hollywood elite often feel abnormal and subject to ridicule. As a consequence anorexia, bulimia and dysmorphia have become more common among the current population. However, though these three eating disorders are labeled as real diseases, they are viewed as taboo in society. Therefore, people who suffer from anorexia often deny to others or even themselves that they really have a problem with a serious disease.

US society does not often pair diseases such as anorexia and alcoholism with diseases like cancer and Parkinson’s disease. Yet they are all chronic diseases. If the United States came to view chemical dependence with the same empathy as cancer, we could help eliminate the destructive low self-esteem and denial found in chemically reliant individuals.
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‘Psychological kevlar’ and the burden of remembering war

I just read a fascinating piece by Clayton Dach, America’s Chemically Modified 21st Century Soldiers, on Alternet. Although there’s a sense in which Mr. Dach jumps to some of the worst possible outcomes when he looks at technology in the pipeline, on the whole, it’s a pretty well thought and concerned-but-not-hysterical account of some of the technology being brought to bear on soldiers, including the possibility of removing humans further from the ‘loop’ in combat decisions. I’m less interested with the latter — the robot warriors angle — not only because I think it’s been done better in science fiction movies, but also because I think it’s simply a more remote technology than some of the pharmaceutical work he discusses.

In particular, I found the discussion of ‘psychological kevlar’ to be interesting for neuroanthropology:

In the U.S., where roughly two-fifths of troops returning from combat deployments are presenting serious mental health problems, PTSD has gone political in form of the Psychological Kevlar Act, which would direct the Secretary of Defense to implement “preventive and early-intervention measures” to protect troops against “stress-related psychopathologies.”

Proponents of the “Psychological Kevlar” approach to PTSD may have found a silver bullet in the form of propranolol, a 50-year-old beta-blocker used on-label to treat high blood pressure, and off-label as a stress-buster for performers and exam-takers. Ongoing psychiatric research has intriguingly suggested that a dose of propranolol, taken soon after a harrowing event, can suppress the victim’s stress response and effectively block the physiological process that makes certain memories intense and intrusive. That the drug is cheap and well tolerated is icing on the cake.

With PTSD so prevalent among soldiers, can it be better treated, even if that means blocking the formation of traumatic memories? Daniel did a piece on PTSD rates in soldiers in April, Invisible Wounds of War, and he discussed a RAND Corporation estimate that treatment of soldiers with PTSD would cost ‘6.2 billion dollars in the first two years after returning from deployment.’ (Daniel also provided links to a number of articles on Iraq and its psychological effects in Wednesday Round Up #7.) The potential to use drugs to stop the development of PTSD, even if it also blocks normal memory formation, raises a number of ethical and moral questions as well as some interesting neuroanthropological ones.

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Invisible Wounds of War

The RAND Corporation has just published a new study on the psychological and physical traumas of serving in Iraq and of veterans returning home. It’s entitled Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. Here’s the link to the press release, the summary statement, and the research highlights. You can also check out a round up on Iraq and trauma in my latest Wednesday collection.

The news release carries the title “One In Five Iraq and Afghanistan Veterans Suffer from PTSD or Major Depression.” RAND estimates that these returning veterans will have direct and indirect costs of 6.2 billion dollars in the first two years after returning from deployment, to speak nothing of the distress and disruption felt by the servicemen and women and their families and friends. “If PTSD and depression go untreated or are under treated, there is a cascading set of consequences,” [study leader] Lisa Jaycox said. “Drug use, suicide, marital problems and unemployment are some of the consequences. There will be a bigger societal impact if these service members go untreated. The consequences are not good for the individuals or society in general.”

“We need to remove the institutional cultural barriers that discourage soldiers from seeking care,” Terri Tanielian said. “Just because someone is getting mental health care does not mean that they are not able to do their job. Seeking mental health treatment should be seen as a sign of strength and interest in getting better, not a weakness. People need to get help as early as possible, not only once their symptoms become severe and disabling.”

One of their major conclusions: “Improving access to high-quality care can be cost-effective and improve recovery rates.” The emphasis is on high-quality, something that reaches out to veterans and their families, and that is supported by evidence and not simply a feel-good budget moment.