Abstract
A number of research findings revealed that post-traumatic stress disorder (PTSD) is a universal phenomenon . The person undergoes the reliving of events through recurrent dreams, nightmares or other threatening situations. An individual with PTSD has excessive feelings of a distressing event triggered by an external factor. In order for the person to shut off traumatic events, he / she resorts to amnesia, psychic numbing, emotional anesthesia, to mention a few. The history of the disorder dates as far as human existence and caused by a number of factors such as serious illness, accidents, natural disasters, terrorism, robbery, sexual abuse, wartimes and other traumatic events. Some of the prevention and/or treatments used for PTSD come in various modes such as pharmacotherapy, chemoprophylaxis, psychotherapy, psychiatric counseling, religious therapy sessions, medication, emotional support from family and friends, and so on. Different people with different level of PTSD, despite cultural differences, have different ways of appraisals: control strategies, mental perspectives and adaptation to sudden changes.
Keywords: Post-traumatic stress disorder, PTSD
I. Introduction
Even from an evolutionary perspective, post-traumatic stress disorder (PTSD) results when a person has been exposed to extreme traumatic stressors. Any direct personal contact or witness of an actual event poses a threat to an individual’s physical integrity (Criterion A1). In most cases, a person who experiences PTSD manifest intense horror, helplessness, fear, agitation and disarrayed behavior due to triggering event (Criterion A2).
Some of the traumatic events experienced by people vary from person to person. Further, the manner in which the traumatic event is processed is dependent on the person’s psychological makeup and the context the traumatic event occurred. Post-traumatic stress disorder recurs to a person in many ways. An individual with intrusive and recurring recollections of events (Criterion B1) re-experiences a traumatic event such as through recurrent distressful dreams (Criterion B2). An individual undergoes dissociative states reliving the traumatic event that may last only for a short while up to several days (Criterion B3). Any resemblance to the traumatic event will serve as a triggering mechanism for intense physiological reactivity or psychological distress (Criterion B4; Criterion B5).
The stimuli that trigger the trauma are usually avoided by a person suffering from PTSD. A person will typically employ deliberate efforts to outmaneuver/avoid conversations, feelings, thoughts or related traumatic events (Criterion C1). He / She may also try to avoid situations, individuals and activities that arouse the recollections of past events (Criterion C2) by means of amnesia (Criterion C3). Anyone who suffers from PTSD may also use decreased responsiveness to his / her surrounding by applying emotional anesthesia or psychic numbing as “enduring defensive reorientation”
Additional characteristic symptoms of PTSD include unreasonable complaints to enjoy participation in an event he / she previously does, diminished interest (Criterion C4), emotional estrangement and detachment (Criterion C5), markedly dissociative behavior, reduced affection, tenderness, sexuality and intimacy (Criterion C6). Further, the person develops a foreshortened future such as lack of interest in his / her surrounding, children, spouse, career or normal life (Criterion C7).
Other persistent PTSD symptoms include increased arousal and anxiety absent prior to the traumatic event. Accompanying symptoms include difficulty staying or falling asleep because of recurrent nightmares (Criterion D1), immoderate wakefulness (Criterion D4) and excessive startle responses (Criterion D5). Other people with PTSD also report anger outburst other than persistent irritability (Criterion D2), difficulty focusing or completing a task (Criterion D3).
II. Historical
Post-traumatic stress disorders (PTSD) is believed to have existed since time immemorial because survivors suffered from traumatic events such as war, famine, slaughter, sexual assaults, accidents, animal attacks, etc. In short, PTSD is just a new name for an old mental disorder where survival from fear is considered as the key emotion for it and “function as its motivating defense” .
PTSD in the Past. During the early 1800s, there was an initial discussion on trauma experienced by soldiers in the battlefield. Military doctors who diagnosed soldiers as physically exhausted and thus need some rest. Later within that century, the medicalization of the disorder was made such that the symptoms for it involves loss of consciousness, tremors, sweating, heart palpitation, dyspnea and extreme fatigue. During war times (e.g., American Civil War and World War 1), the number of soldiers who suffered from the disorder were relatively higher.
The disorder was a serious problems to military physicians in those days because it was hard to diagnose of its ambiguity. Aside from crippling the military force, it has severe and enduring impact. However, in light of new thinking in the medical field during those times, the disorder was delineated into two sections: neurological and psychological. However, like the previous postulate, the delineation would later not stand further medical scrutiny.
During World War 2, soldiers should show more manliness and not “combat fatigue,” not just physically, but more important in avoiding wounding of their minds . In enlisting for the US army, there was already a psychiatric screening test to prevent psychologically-unfit people from not enduring the horrors of the war. Despite that endeavor, there were still soldiers who experienced the disorder.
PTSD Today. There was a great deal of biomedical research that focused on PTSD. The disorder, though, medicalized and became increasingly clinical, the cultural expectations (male strength) for soldiers during wartimes has remained the same. Although PTSD is not confined only to soldiers, but also regarding sexual assault, car accidents, and other traumas, the focus of Eagan Chamberlin’s study was on soldiers’ masculinity during wartimes reached “epidemic proportions” (p. 363).
Many of the soldiers and even victims of war suffered from PTSD. There were also triggering mechanisms where people show intense emotions and prompting additional symptoms such as avoidance. Patients typically have diminished responsiveness and amnesia. They also shut down their thoughts and feelings on people, conversation and related traumatic events. Moreover, people with PTSD also have foreshortened future not to expect successful marriage, career or normal span of life. Thus, it becomes clear that for the entire history of PTSD, a lot of people were injured by it.
III. Cause of the Illness
The cause of PTSD has been attributed to experiencing an event that makes you suffer an intense fear, horror or helplessness. However, doctors cannot pinpoint precisely why individuals acquire PTSD because it is considered as a complex combination of inherited risk of a person’s mental health, severity and extent of the traumatic experience and abnormal brain functioning for internal homeostasis from external stressors.
Some people are more prone to get PTSD in terms of the following risk factors: (1) being female; (2) suffering from trauma for an extensive period; (3) experiencing early childhood traumas; (4) lacking emotional support from friends and family members; (5) having high level of anxiety and depression; (6) having relatives with a known history of mental health problems; (7) having experienced being neglected or abused during childhood; and “traumatic brain injury” (Wisco, et al., 2012).
Additional leading causes of PTSD for most people are: (1) combat fatigue (also known as shell shock and battle stress); (2) sexual assaults, rape or incest; (3) physical abuse; (4) robbery; (5) torture; (6) kidnapping; (7) terrorist attack; (8) medical diagnosis; (9) car accident; (10) plane crash; (11) civil unrest; (12) fire; (13) natural disaster; and, other traumatic events.
Other than the several causes mentioned above, there are researches that focused on neurochemicals responsible for PTSD. Some scientists have studied how a part of the nervous system gives a false alarm for PTSD to manifest in people. Using some medication, the false alarm can be switched off. Ultimately, more promising new treatments in the future will help medical practitioners in the early detection and prevention of this type of mental disorder.
IV. Treatment
Since post-traumatic stress disorder (PTSD) has several potential causes that require multiple treatments, medical practitioners are being cautioned to apply great care using proper informed client consent regarding treatment options, extent of support, as well as, benefits and disadvantages. Practitioners are also required to have familiarity with research and clinical data for the development of an individualized rationale and treatment approach for specific clients.
The rationale should serve as a basis for the use of any treatment or interventions for people who suffer with PTSD. Based on research findings, a part of the brain is responsible for regulating fear. Practitioners should thus be competent enough in the diagnosis of other conditions associated with PTSD. They should also make sure their capacity for legally making diagnosis and treatment for specific conditions that the client experiences. Furthermore, practitioners should have background in the mental health field as a evidence of their competence to assist a client to work through traumas, side effects, and other symptoms before undertaking any treatment.
Practitioners who are well-trained regarding neurofeedback are also successful in minimizing the depression and anxiety of PTSD patients. Because a PTSD patient has an abnormal level of hormones and hyper-vigilance of the nervous system, it triggers the reliving of traumatic situations. Biofeedback, such as relaxation training, is another alternative treatment for people with PTSD. They are taught how to relax for positive intervention combined with other techniques such as guided imagery. A recreated worldview will help PTSD clients to learn how to get rid of incapacity and disruptions in life .
V. Prevention
Pharmaco-therapy or chemoprophylaxis, in the area of PTSD, has been used to prevent the onset and development of mental health disorders. According to Fletcher, et al., (2010), there are many drugs used to prevent PTSD such as alcohol, cortisol, morphine and propanolol.
Alcohol. Alcohol has been used for centuries to prevent stress. Those who are intoxicated have protective effect from decreased likelihood of developing PTSD during traumatic events. Alcohols are readily available and cheap, among the military, it has social acceptability. However, in the long run, the disadvantages of moderate to high alcohol consumptions renders it inappropriate as a prophylaxis to prevent PTSD. Alcohol is also among the top five causes of disability across the world.
Cortisol. Survivors of cardiac surgery and septic shock have shown that the administration of hydrocortisone prevent the likelihood of developing PTSD.
Morphine. Combatants deployed during the Iraqi war and who were given high dosage of morphine were likely to develop PTSD. The same is evident among vehicular accident survivors who were also given high dosage of morphine within 48 hours after the traumatic event. There is a need for more empirical study about the protective effect of morphine.
Propanolol. A beta-blocker drug, propanolol, does not offer compelling evidences for its effective prevention of PTSD like the ones mentioned above. Although it also helps in the likely occurrence of the symptoms of PTSD (e.g., startle, hypervigilance, numbing, re-experiencing and avoidance), there is still a need for more empirical research.
Some of the concerns raised by Fletcher, et al., (2010) are the timing for pharmacotherapy, legal ramifications, and hindrances to chemoprophylaxis. However, they suggested that there is a need for additional studies to further the area of chemoprophylaxis.
VI. Cultural Differences
Cultural differences in appraisals influence responses to traumatic situations. The occurrence of PTSD among trauma survivors is more pronounced among independent than interdependent cultures when self, control, independence and agency (such as control strategies, mental defeat and permanent change) are considered. The reverse is true when trauma appraisals are focus on self in relation with others and interdependence or alienation.
In a study of Jobson & O'Kearney (2009), they included the participants’ trauma history, depression, demographics and trauma narratives. The trauma narratives were analyzed according to the respondents’ experiences of death, family-related trauma, sexual assaults, child abuse, serious physical injuries, illness, natural disasters, serious accidents, kidnapped and/or torture. They found out that independent cultures are less likely to recall war memories than those in the interdependent cultures.
In terms of mental defeat, control strategies, alienation and permanent change, the study of Jobson & O'Kearney (2009) also revealed that there is no significant difference between independent and interdependent cultures. Nonetheless, trauma survivors with PTSD from independent cultures presented more alienation, mental defeat, less control strategies and permanent change that non-PTSD survivors from interdependent cultures. People with PTSD were also found out to have more alienation appraisals than non-PTSD.
Jobson & O'Kearney’s (2009) findings showed the clinical and theoretical implications of their study of “cultural differences in self impact on the relationship between appraisals and post-traumatic psychological adjustments” (p. 249).
VII. Biblical Worldview
Post-traumatic stress syndrome is evident among people who have high levels of anxiety and panic attacks. The root cause of PTSD, however, has not been addressed yet. Although the medical and psychiatric communities brought in pharmaceuticals and therapeutic ‘solutions’ to help prevent, alleviate and treat the syndrome, the underlying issues remain completely unresolved.
Anything in extremes, such as anxiety and panic attacks, are always bad for people; they tip the balance of God’s given amazing gift for man – a normal earthly existence. People with PTSD, are not exceptions, especially if they have experienced traumas as early as childhood or just recently. Most sufferers of PTSD persistently cling to various negative feelings and thoughts; they seem no longer to live without the symptoms of the disorder. People who were victims of traumatic events are thus become vulnerable to Satan’s schemes when they continue to keep on reflecting on their inner pain of unhealed traumas.
Biblical verses, nonetheless, offer feelings of safety, belongingness and joy for individuals who suffer from the disorder. Even though PTSD victims previously reported various negative reactions (such as short of breath, feeling of suffocation, hyperventilation, dizziness, and a host of other symptoms), they were able to improve their coping mechanisms dealing with PTSD because of their dependence on the Word of God.
When people with PTSD learned how to cast all their anxieties on God (I Peter 5:7, NASV), He heals them (the brokenhearted) (Isaiah 61:1). It is, indeed, only through dependency on God that people are freed from various mental health problems. “For God hath not given us the spirit of fear, but of power, and of love, and of a sound mind” (II Timothy 1:7).
VIII. Conclusion
A number of research findings revealed that post-traumatic stress disorder (PTSD) is a universal phenomenon . The history of the disorder dates as far as human existence and caused by a number of factors such as serious illness, accidents, natural disasters, terrorism, robbery, sexual abuse, wartimes and other traumatic events.
Post-traumatic stress disorder was initially evident during wartimes because of the soldiers and victims who suffered from abuses, attacks, and other forms of violence. Still, even in day-to-day occurrences, people may be at risk of PTSD. In case a person has a known history of family-related mental health problems, high level of depression and anxiety, abused childhood, brain injury and other leading causes, he / she can experience the disorder.
Some of the prevention and/or treatments used for PTSD come in various modes such as pharmacotherapy or chemoprophylaxis, psychotherapy or psychiatric counseling, religious therapy sessions, medication, emotional support from family and friends, and so on. However, to date, there is a need for further empirical research about PTSD in order to prevent its occurrence or long-term / permanent treatment for those with severe disorder.
As mentioned above, PTSD is a universal phenomenon, thus, it knows no boundaries. Different people with different level of PTSD, despite cultural differences, have different ways of appraisals: control strategies, mental perspectives and adaptation to sudden changes as viewed by the individual him-/herself and/or in his/her relation or help from other people.
IX. References
Cantor, C. (2009). Post-traumatic stress disorder: evolutionary perspectives. Australian and New Zealand Journal of Psychiatry, 43(11), 1038-1048. doi:10.3109/00048670903270407
Eagan Chamberlin, S. (2012). Emasculated by trauma: a social history of post-traumatic stress disorder, stigma, and masculinity. Journal of American Culture, 35(4), 358-365. doi:10.1111/jacc.12005
Fletcher, S., Creamer, M., & Forbes, D. (2010). Preventing post traumatic stress disorder: are drugs the answer? Australian and New Zealand Journal Of Psychiatry, 44(12), 1064-1071. doi:10.3109/00048674.2010.509858
Iron, Linda L. (2012). Anxiety and panic attacks from a christian perspective. Charleston: Irons' Quill. eBook.
Jobson, L., & O'Kearney, R. (2009). Impact of cultural differences in self on cognitive appraisals in posttraumatic stress disorder. Behavioural and Cognitive Psychotherapy, 37(3), 249-266. doi:10.1017/S135246580900527X
Striefel, S. (2009). A post traumatic stress disorder ethical update. Biofeedback, 37(1), 3-6.
Wisco, B., Marx, B., & Keane, T. (2012). Screening, diagnosis, and treatment of post-traumatic stress disorder. Military Medicine, 7-13.
