PTSD and those who suffer.

That people suffer the after effects of traumatic events is indisputable and very unfortunate for those experiencing the emotional and mental upheaval – whether or not they have had it diagnosed as Post Traumatic Stress Disorder (PTSD). Yet this condition – PTSD - was “created” by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) only in their1980 third revision – DSM III. Prior to this date – while people certainly suffered – it was not categorized as Post Traumatic Stress Disorder.

Traumatic and highly stressful experiences rob us of our belief that we can keep ourselves safe in the world and we wait anxiously for the next traumatic event and react nervously to every unexpected sound –compounding our fearful expectations. Whatever our traumatic experience it is important to remember that such events, though terrible, evoke responses that are ordinary human responses to extraordinary circumstances. Everyone going through such an “out of normal” and fearful experience needs comfort and support, just as we all need comfort and support when, for instance, we are injured, lose a close friend or someone we love. But to categorize our ordinary reactions to this fear or grief as a “mental disorder” both diminishes and demeans our experience. We have had this experience, which is outside our normal expectations, and we react by trying to master our memory of the event and the emotions that are evoked. The mind will often attempt to ‘retreat’ from unpleasant life circumstances. It will do so in the only way it can, by going to a place of refuge and shutting off the ‘hurt’. This can manifest in many ways – as ‘depression’, as apparently delusional thoughts or neurotic behaviour. Such reactions far from being an “illness” are but a desperate attempt to preserve our concept of self, our identity, which is in danger of being overwhelmed.

Since humans first evolved millions of people would have experienced highly stressful or traumatic events. People in antiquity, as far as I understand history, would have suffered the after effects of the trauma experienced in battles and ever present likelihood of being captured and taken into slavery. Similarly in their daily experiences with the natural world of their times – wild animal, floods, earthquakes, droughts, starvation and such like would have tested the resilience of the strongest characters.  

With the winding down of the military activities in Afghanistan many military personnel are arriving home with emotional and psychological scars which need to be healed. Assistance is available for those who wish to take advantage of what is offered.

What happens, however, to those Iraqis, Afghans or Sri Lankans who were caught in the middle – between government military and the Taliban, supporters of Al-Qaeda or militants fighting for their cause? Those people who lost their livelihood, family members or were themselves severely injured by Improvised Explosive Devices (IEDs) or who suffered revenge attacks because they happen to support the “wrong” side – what support do they get? Do they cry? Do they dull the pain with opium? Do they get drunk?

As in most wars it is women and children who bear the brunt of trauma; in all countries it is women and children who endure the effects of violence and abuse of any kind. What support do they get from anyone – anyone at all? What is of great concern about any traumatic event is the long term health effects, even generational health effects it may have on people – possibly even those not yet born.  

Drugs, except in the very short term, generally don’t help and are not a “cure” for PTSD. In any event the side effects of antidepressants and antipsychotics are quite severe. Furthermore to suggest chemicals can address the distressing flash-backs, the recurring memories and recollections, the guilt, the “what if …” or the “if only…” is plain wrong. All chemicals do is to help dull the pain and put a brake on the expression of any emotional response – they have the effect of “dumbing down” the sufferer. This may be good – in the very short term – to give a person time to gain strength but let it be known that there is no known test for a “chemical imbalance” in the brain. Let it be known, also, that no one knows how to measure the “chemical balance” for any person’s brain or to determine what such a “balance” should be.

What is needed is counselling and as much love and emotional support that the PTSD sufferer can get – and time, and sleep, that “knits the ravelled sleeve of care” (Shakespeare – Macbeth).

Biology of “Mental illness” – fact or fiction?

The majority of physical illness diagnoses can be verified by objective clinical tests. The majority, if not all, of psychiatric 'mental illnesses' cannot be (those caused by alcohol, drugs and certain real diseases, Alzheimer’s and Huntingdon’s excepted). Many medical diseases have verifiable causes. Psychiatry has none. 'Mental disorders' are simply categorizations of behaviours or thought processes which are then given labels.

The truth is finally – after too long a period of denial – “coming out”:

There have been claims, published in professional journals and in the media for decades, of gene discoveries and that mentally disordered patients have faulty genes and chemical imbalances in their brains. All are now shown to be wrong.

The American Psychiatric Association (APA) has now officially admitted that there are no genes for mental disorders. In an official APA press release dated May 3rd, 2013, Diagnostic and Statistical Manual for mental disorders version 5 (DSM-5) Task Force head David Kupfer MD stated, “In the future, we hope to be able to identify disorders using biological and genetic markers that provide precise diagnoses that can be delivered with complete reliability and validity. Yet this promise, which we have anticipated since the 1970s, remains disappointingly distant. We’ve been telling patients for several decades that we are waiting for biomarkers. We’re still waiting.” 

 In this statement, American psychiatry has at last come clean about its failure to support its claims of a biological basis for “mental illness” with actual scientific findings.

The hope is that one day, as David Kupfer MD plaintively tells us, research may, “culminate in the genetic and neuroscience breakthroughs that will revolutionize our field. In the meantime, should we merely hand patients another promissory note that something may happen sometime? Every day, we are dealing with impairment or tangible suffering, and we must respond. Our patients deserve no less.”

I have raised the fact before that almost by definition, psychiatric disorders are not medical conditions. If they are shown to have a biological basis, they cease being psychiatric disorders and are transferred to other areas of medicine, such as neurology. This point has been made repeatedly by others more qualified than I. As far as I can determine there is no evidence that DSM “mental disorders” are true medical conditions, but if such evidence comes in, they will be treated as medical conditions and not psychiatric disorders.

As I understand it, psychiatry and psychology have been trying to reconcile the irreconcilable. There is an attempt to reconcile the objective, quantitative, scientifically measurable aspects of the biological brain with the subjective, qualitative and immeasurable aspects of the mind with the hope of arriving at some meaningful answer.

I know that various scanning techniques have identified parts of the brain that “light up” when emotions or thoughts are invoked. But no one has ever been able to determine what comes first; do the thoughts “light up” the neurons or do the “lit up” neurons generate the thoughts?

We need to know the answers to this conundrum because the present level of psychiatric research conformity demands that any mental disorder can only be the result of some biological/chemical deficiency in the brain which can be cured by pharmacological products alone. The fact that the APA (above) has had an unusually reflective moment and realised that it may be wrong in promoting the quest for biological markers for mental disorders is illuminating to say the least and well over due.

Pharmaceutical drugs are not the answer – so what now?

I suggest that if it took years for any particular individual to develop whatever mental disorder symptoms are presented to the health professional concerned, popping a pill may, temporarily, alleviate the problem but will not cure it. What is needed is a long and time consuming, gentle, empathetic, holistic approach to the person concerned – listen, LISTEN to what the person has to say. There is always a message in there somewhere. It may need deciphering. The message will undoubtedly be garbled and may, for example, be an attempt to interpret an event which occurred when the person was an infant who would have lacked the relevant emotional or cognitive abilities to arrive at a satisfactory answer.

Once more, pharmaceutical drugs are not the answer. They are only marginally more efficacious than a placebo (and in some cases – generally not reported by the pharmaceutical companies concerned – may actually perform worse than placebos). Drugs, without exception, have severe side effects and have physical effects on the body, which often reduce life span by many years.

So, to answer the question posed at the beginning of this post - it now accepted that the assertions mental disorders are caused by biological factors are myths and based on fantasy, not facts.

Pharma-psychology – is it faith based medicine?

I know this is an inflammatory question – but it still needs an answer, is pharma-psychology, the treatment of mental problems by drugs alone - based on faith – pharmaceutical faith? The medicines, the pharmaceutical drugs that have been developed for use in situations when a person’s mind is deemed to be unhinged or they are behaving in a manner considered to be “abnormal”, work up to a point. But no one (psychiatrists, psychologists, neuro-scientists, pharmacologists et al) knows WHY or HOW they work or what the long-term effects of continuous use are. They are adopting a “suck it and see” approach with people’s brains (and minds) – they are in effect using the affected people as guinea-pigs - which I think is both appalling and unethical.

While I have no faith (that word again) in statistics they are useful up to a point, in generalisations. So, generally, if one considers the commonly used Prozac - the results, compared to a placebo (a “sugar pill”), show that only about 50% of people who take the drug appear to benefit. Up to 33% suffer side effects – ranging from insomnia to reduced libido – that is 33 people out of every 100 who take Prozac. This is an astonishing result – so why use them?

In spite of what the pharmaceutical companies would like us to believe, while antidepressants such as Prozac do increase serotonin levels in the brain, this doesn’t mean that depression is caused by a shortage of serotonin. After all, paracetamol may reduce the unpleasant effects of a headache, but this doesn’t mean that a headache is caused by a deficiency of paracetamol!

The truth is that researchers know very little about how antidepressants work. A test that can measure the amount of serotonin in the living brain has yet to be developed. There is no way to even know what a “normal” level of serotonin is, let alone a low level, and it has yet to be shown if or how medication corrects these levels.

Many studies contradict the chemical imbalance theory of depression. Experiments have shown that lowering people’s serotonin levels doesn’t always lower mood, or worsen symptoms for those already depressed. And, furthermore, while some types of antidepressants may raise serotonin levels within hours, it takes weeks before the medication is able to (apparently) relieve depression. If a deficiency in serotonin actually causes depression, this time lag would not exist.

Also it is essential to be aware that the side effects of these drugs, without exception, are unpleasant – in fact some drugs (i.e. lithium) are positively lethal. It is very important to first read the warnings printed on the document inside every box of any medication.

It may be hard to believe but with some people there is the danger that a total reliance on antidepressant medication may cause an increase, rather than a decrease, in depression and with it, an increased risk of suicide. While this is particularly true of children and young adults on antidepressant medication, anyone taking antidepressants should be closely watched for suicidal thoughts and associated behaviour. The suicide risk is particularly great during the first few months of antidepressant treatment.

So, again, why use the stuff in the first place? It is important to recall the fact that no behaviour or misbehaviour (however aberrant - Alzheimer’s and Huntingdon’s accepted) can be categorised as a disease – in spite of the fact that many people now use the term “mental illness”. If you’re suffering from depression, antidepressant medication, used under the guidance of a mental health professional, may relieve, temporarily, some of your symptoms. But antidepressants aren’t a silver bullet for depression. Medication doesn’t cure the underlying problem and is rarely a long-term solution. As mentioned above there are real questions about their effectiveness and the many profound and disturbing side effects.

So to get back to my original question – is the exclusive use of medication to treat mental disturbances based on a faith in pharma-psychology? I believe it is. I also believe this faith is based on a flawed interpretation of the causes and the many issues associated with mental health. It is a false faith and is doing incalculable long term harm to many people.