Sunday, June 12, 2016

What if PTSD is Blast Damage to the Brain?

Interesting article in the Times about Daniel Perl, a Neuro-Pathologist who thinks much Post-Traumatic Stress Disorder is caused by physical damage to the brain, possibly from explosive shock waves. It's intriguing, and it would explain one of the most puzzling things about PTSD: why does it seem to be so much more common in soldiers of the modern era than it ever was before?

On the other hand, I would point out that PTSD affects many soldiers who have not been exposed to big explosions, and in fact many who have never been in combat at all. So it is unlikely to be the whole story. But I would not be at all surprised if it turns out to be a big part of the story.


G. Verloren said...

What if PTSD is blast damage to the brain? Well the question is moot, because that's not at all what it is, and we've known that for over a century.

Surely this doctor MUST have known that PTSD occurs in individuals who have received no physical trauma? And surely if he didn't, he would have readily found out in the course of doing the most basic of research on the topic in order to formulate his theory? And surely if he didn't bother to do -that- either, then one of his colleagues would have brought it up at some point before this progressed to the point of an article being written up about it in the New York Times? And surely if -that- didn't happen either, then someone at the Times should have caught this and nixed it before it went to print?

How can such a highly educated neuropathologist make such an ignorant suggestion? How can he take a stance on PTSD without even knowing the origins of the term "shell shock" - which was the exact same wrongheaded notion that the impact of exploding shells was disrupting the brain, a notion which began being dismissed as absurd immediately after the term was coined, for the exact same reason that even soldiers unexposed to exploding shells developed the symptoms.

G. Verloren said...

Maybe the fact that PTSD seems more common in modern conflicts than ever before is precisely that - just how it seems.

After all, it's not as if... for example... domestic abuse suddenly spiked in the 20th century - rather, people simply started reporting it more frequently, and society went from sweeping it under the rug to beginning to take steps to recognize and start to address it.

Historically, soldiers were either wealthy elites devoting their entire lives and careers to a lifestyle of war and preparation for it, or they were conscripted peasants and commoners forced into service as needed. From a logical standpoint, those two facts both work against the general likelihood of any instances of PTSD in pre-modern times being recorded.

The professional soldiers never really removed themselves from a martial lifestyle, and so never suffered the "culture shock" of returning to "normal" society that so many modern PTSD victims deal with. And the common conscripts were poor and illiterate, and their experiences seldom got recorded - especially not their experiences after a war, when they got home to their families and had to reacclimate to regular life. Who knows how many poor soldiers went home to wrestle with demons for the rest of their lives while history simply ignored their plights?

Then there's also the matter of variances in unit composition. Historically, men would be conscripted based on where they lived, then serve in the wars with their friends and neighbors, and then the survivors would all return together. But as warfare got more brutal in the modern era, what with examples like villages and towns in WWI losing all of their army-aged men and entire families being killed off, the practice of joining up together and returning home together was largely rejected, and more and more you had men from entirely different places serving together, growing close through the adversity of it all, and then having to go home and never see each other again.

I don't know much about neuropathology, but I do know that people only have a few ways to cope with traumatic stress. Killing people, or even just watching people be killed, requires you to be conditioned somewhat in order to deal with it. Martial cultures exist precisely to provide that conditioning. Soldiers who seldom leave their military orders, who primarily live with and socialize with other soldiers, and who are always operating under a "war mentality", don't seem to suffer PTSD - and if they do, their fellows give them the support they need to cope and continue on with their martial lifestyle.

As for those who don't remain in such a culture, but instead serve temporarily and then return to a simpler lifestyle, they require the intensive support of their communities to cope. They're expected to shift from being killing machines back to being simple law-abiding citizens, and that transition is incredibly hard to accomplish without communal help. And in the modern era, our communities simply aren't as strong as they used to be - people are far more isolated, and there's less pressure on the returning soldiers to get back to conforming and doing what is expected of them, and there's less commiseration and support to be offered as well.

The notion that blast damage is to blame for PTSD is simply laughable. Look at the Napoleonic wars - full of outrageous amounts of cannonfire, and yet there aren't terribly many reports of PTSD among the troops of those wars. Why is that? Is it because it simply didn't get reported? Is it because the men in the fields and the sailors on the ships of the line fought side by side with their neighbors and community members, and all returned home together if they made it through? Is it because there was a stronger sense of purpose to the fighting, and a more organized, almost ceremonial structure of the battlefield itself?

G. Verloren said...

“Whatever may be the state of mind of the patient immediately after the mine explosion, the burial in the dug-out, the sight and sound of his lacerated comrades, or other appalling experiences which finally incapacitate him for service in the firing line, it is true to say that by the time of his arrival in a hospital in England, his reason and his senses are usually not lost but functioning with painful efficiency. His reason tells him quite correctly, and far too often for his personal comfort, that he had not given, or failed to carry out, a particular order, certain disastrous and memory-haunting results might not have happened. It tells him, quite convincingly, that in his present state he is not as other men are. Again, the patient reasons, quite logically, but often from false premises, that since he is showing certain symptoms which he has always been taught to associated with ‘madmen,’ he is mad too, or on the way to insanity.

If nobody is available to receive this man’s confidence, to knock away the false foundations of his belief, to bring the whole structure of his nightmare clattering about his ears, and finally, to help him rebuild for himself (not merely to reconstruct for him) a new and enlightened outlook on his future—in short, if he is left alone, told to ‘cheer up’ or unwisely isolated, it may be his reason, rather than the lack of it, which will prove to be his enemy…In a word, it is not in the intellectual but in the emotional sphere that we must look for terms to describe these conditions. These disturbances are characterized by instability and exaggeration of emotion rather than by ineffective or impaired reason” (Smith & Pear, 1918, pp. 2-3).

pootrsox said...

I think you're railing at the wrong thing, G. Verloren.

SOME PTSD-like symptoms are caused by specific physiological damage to the brain-- damage that occurs after blasts. So shell shock may indeed-- *sometimes*-- be an accurate descriptor of the complex of symptoms currently lumped into "PTSD."

Clearly *something* happens in the brain after blast damage. That is demonstrable now. What one *calls* it is less relevant that what that "something" does to the individual.

And saying that there is this physiological damage does not discount the psychological damage that may have been suffered concurrently, or may have been suffered by others who have not experienced blast damage.