PTSD

In every life there will be times of great pain and distress as part of our human condition. 

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We experience trauma. There is no sentient life without it. Trauma and our response to  trauma are documented in the historical record since antiquity. There are paleolithic cave  paintings of warring cave dwellers raining horrific violence upon each other. The Assyrians  described victorious soldiers being visited by the ghosts of soldiers killed in battle.  Classical Greek historian Herodotus recounts how an Athenian soldier developed sudden  psychological (conversion disorder) blindness after witnessing a fellow soldier being struck  down in battle. In recent history, the notion of psychological and moral injury following  physical and psychological trauma has been codified as legitimate injury in mainstream  medicine. As a species, we regularly commit horrible things upon each other: physical and  sexual violence has been used as a method of humiliation and crippling of the human soul  for a very long time. Even witnessing violence committed upon others can result in lasting  intrusive memories and nightmares. These experiences were called shell shock in the First  World War, and it was not until the war in Vietnam that the DSM defined these physical and  psychological experiences as posttraumatic stress disorder (PTSD). These ghosts can  haunt for a lifetime. So, what can be done to alleviate the pain and distress?

“Rescue” by Toshiko and Iri Maruki, part of an art series documenting the horror of the atomic bomb, at Maruki Gallery for the Hiroshima Panels in Higashimatsuyama, Japan. (Ann Summa)

The Diagnostic Statistical Manual of Mental Disorders, 5^th edition defines PTSD through the  cognitive, visceral, or psychological reexperiencing of trauma, avoidance of triggering  stimuli, and affective reactivity in the form of subjective anxiety and depression. The  symptoms need to persist for longer than one month, but the symptoms may persist for  years. Not all who experience trauma will have PTSD, so we must have mechanisms which  protect us from developing PTSD impairments following trauma. Savagery has been so  embedded into the historical repertoire of our species, that we are usually able to  acknowledge and function through and after the trauma by using inherited capacities to  dissociate and live mechanically to survive calamity and destruction. 

PTSD occurs when the inborn survival capacities are overwhelmed. PTSD looks like  persistent depression and multiple anxieties such as panic disorder, phobic avoidance, and irritability coupled with cognitively intrusive symptoms of flashbacks, nightmares, and daymares. Treatment entails addressing the underlying biology and cognitive intrusions.  PTSD can respond to cognitive-behavioral treatment (CBT) and eye movement  desensitization and reprocessing (EMDR) to decouple the triggers from the visceral and  cognitive symptoms of PTSD, but the persistent baseline generalized anxieties, and 

depression may require treatment with medications or Transcranial Magnetic Stimulation  (TMS). TMS is an FDA-approved somatic treatment for depression and obsessive compulsive disorder that does not require medications (though medications are not  contraindicated). PTSD can also be described as a complex disorder that encompasses  both depression and intrusive thoughts and somatic experiences (such as panic or  flashbacks) that are obsessive and compulsive in nature. TMS offers the benefit of  avoiding the use of multiple medications or at least making lower doses of medications  possible for the symptoms described as PTSD. TMS stimulates the region of the brain  which modulates mood and anxiety with a magnetic pulse over 36 treatments lasting 20 minutes. In contrast to medications, there is no risk of weight gain, sexual dysfunction, or  metabolic derangements. Also, pregnant and lactating women do not have to be  concerned about exposing their baby to medication. TMS is particularly useful for  individuals who have failed to response to medications and psychotherapy or whose  medication burden for the treatment of medical illness already poses adversity from drug drug interactions.  

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Transcranial Magnetic Stimulation

PTSD is a ubiquitous disorder. According to the 2016 National Epidemiologic Survey  on Alcohol and Related Conditions-III (NESARC-III), the annual incidence of DSM-5 PTSD  in the US was 4.7%, and the lifetime incidence was 6.1%. In times of great calamity,  natural disasters, and war zones, the incidence of PTSD would be much higher. Most  individuals with lifetime PTSD (59.4% in the NESARC-III study) sought treatment, but  treatment was delayed on average by 4.5 years from the onset of the traumatic event.  These are years of dysfunction and unnecessary pain, especially when treatment is  available.