The Victim’s Second Assault, Term Paper Example

Each year, thousands of individuals are involved in traumatic events. Incidents such as serious accidents, military combat, natural disasters or severe physical and sexual abuse can leave victims with stress reactions that do not subside on their own, and can even get worse over time, developing into a condition known as PTSD, or Post-Traumatic Stress Disorder. Although this disorder has been redefined to identify sufferers in various demographics, it is not new to researchers and the public at large.  Identification of a clinical syndrome associated with trauma began as early as World War I.  It was studied as a result of combat duty, known as “shell shock” or “war neurosis.” (“The Evolution of Post-Traumatic Stress Disorder,” 2011) The disorder It is estimated that 6.8% of Americans will develop PTSD at some point in their lives, with women twice as likely to develop it over men – 10.4% to 5%, respectively. (“PTSD,” 2011) PTSD sufferers can exhibit a combination of systems that cover three main categories:  Event reliving, avoidance, and arousal.   Event reliving can include flashback episodes, recurring memories and nightmares about the event.  Avoidance brings about activity that allows the patient to dodge situations, people and places that can be reminiscent of the incident.  Avoidance can also make a person develop a “numbing” defense, where they show less of their moods and a lack of interest in what used to be their normal routine.  From the arousal category, a patient can display symptoms ranging from difficulty in concentrating, insomnia and hypervigilance, an enhanced state of sensitivity that makes a person more aware; the slightest noise or disturbance can elicit very startled responses. (Martindale, 2011) While a similar anxiety disorder, Acute Stress Disorder (ASD), will cause a patient to be symptomatic over a shorter period of time after an event, PTSD sufferers will display symptoms for at least 30 days. (“PTSD,” 2011) This means that even though a patient can experience symptoms of PTSD immediately after an event, they may not begin proper treatment until weeks later.  This delay in therapy can certainly create a tougher road back to normalcy that can include bouts of self-medication and attempts at suicide. (Tull, 2008) Post-Traumatic Stress Disorder is a condition that leaves the sufferer isolated from the world around them, which makes identification and intensive and innovative treatment a critical tool.

The mood and behavioral changes of a PTSD victim have been shown to be derived from the disorder’s effect on the structure, function, and chemistry of the brain. As PTSD relates to the memory of a traumatic event, these effects occur in the areas of the brain associated with fear response and memory retention and recall:  the amygdala, prefrontal cortex, and the hippocampus. (Shin, Rauch, Pitman) The amygdala, which is responsible for aiding in the conversion of incidents into long-term memory, has been shown to become more active in PTSD victims, with that activity positively correlated to the severity of the symptoms. (Shin, et al.) This could mean that a person with PTSD has a brain that is actually forcing him to remember the event for an extended period of time, possibly forever without diagnosis or treatment.   There are also some changes to the structure and activity of the prefrontal cortex – the portion of the brain that deals with higher functioning – in PTSD patients.  The prefrontal cortex is believed to help reactivate emotions associated with past events, and in some studies have shown “decreased activity and/or a failure to activate . . . in PTSD.”Moreover, PTSD sufferers in a recent study also show decreased levels of N-acetyl aspartate (NAA), a molecule that is also shown to be decreased in patients with other degenerative conditions like stroke and Alzheimer’s disease.  (Shin,et al.) Also, two studies have shown that PTSD severity is inversely correlated to the volume and of the cortex, which suggest diminished functionality or overall malfunction.  Study of the brain has also shown a relationship between the amygdala and the prefrontal cortex, in regard to the brain activity of PTSD patients.  Those with abnormally functioning amygdala have increased blood flow to the brain along with a decrease in blood flow to the cortex.  Additionally, PTSD is also related to the function of the hippocampus, which coordinates memory forming, organizing, and storage. When in high stress situations the adrenal gland produces a hormone called cortisol, which aids in metabolism and is helpful in stabilizing the body in stressful events.  The onslaught of traumatic memories brought on by PTSD can trigger a physiological response that produces large amounts of cortisol. High levels of cortisol may damage or destroy cells in the hippocampus, and those with severe PTSD can also have smaller, malfunctioning ones. (Tull, 2009) All of these physical bombardments show that PTSD is a degenerative disorder whose severity is determined by both the extent of victimization and the absence of treatment.

Although the physical damage to the body from PTSD is a new frontier, the psychological damage is something researchers have been aware of and studying for decades.  During World War I, there were incidents of hundreds of British and German soldiers being executed by their own armies, due to what was believed to be cowardice, insubordination, and cowardice (“The Evolution of Post-Traumatic Stress Disorder” 2011).  The rise in warfare technology led to these men being grouped by a new diagnosis:  “shell shock.” Unlike any other combat situation before, the evolution of 24-hour warfare and endless barrages of artillery fire left soldiers on a constant alert, conditioning them to use the sounds of explosions as triggers for fear conditioning.  These instances of shell shock increased exponentially in World War II, with psychiatric casualties – the inability to participate in combat due to mental debilitation – increasing by 300%. (“The Evolution of Post-Traumatic Stress Disorder”) The problem subsided with effective, immediate counseling for soldiers in the Korean War, but things changed in the Vietnam War.  Researchers began to notice that while examples of psychological breakdown on the battlefield were decreasing, soldiers were returning home with difficulty reincorporating themselves into their civilian routines.  Studies over the next 20 years after the war saw that veterans were returning with common symptoms:  anxiety, depression, anger, and problems developing interpersonal relationships.  There were documented cases of veterans with these same conditions during and at the close of World War II, but they were rare. At the end of the Vietnam War these cases increased unlike any other time before, due largely in part to a shift in the culture of the soldier. Being on an individualized rotation schedule (each soldier had a tour of duty that lasted a year from their own start date), and fighting in a guerilla war where danger was constantly eminent created soldiers that lived with a heightened awareness.  Add to that the strong anti-war protest in the country, and it is easy to paint the picture of a veteran who is imprisoned by anxiety and fear, which appear to be the building blocks for clinical PTSD.

War may have brought the existence of PTSD to the public’s attention, but the increase over the years in catastrophic events like terrorist attacks, natural disasters, fires and automobile accidents has left many non –veterans grappling with the effects of the disorder .  With these types of singular events, triggers that remind the victim of the event are responsible for developing the symptoms of PTSD.   For example, car crash survivors can be startled by the sounds of traffic (squealing breaks, car horns, sirens etc.). They can also routinely display avoidance symptoms like avoiding the accident site or refusing to ride in cars or drive all together. (“PTSD”, 2011) From the three million car accident victims created each year, 10 – 45 % of these people develop PTSD. Many may go untreated due to the often intangible evidence of the disorder, and the prevalence of the more obvious physical injuries, such as broken bones and bruises. (PTSD Support Services, 2011) Moreover, the aftermath of a car accident can also determine the severity and the duration of PTSD, as things like court trials and police inquiries keep bringing memories to the forefront of the survivor’s life.  Having to recall these memories can help PTSD set in and increase its influence over the person’s life. Like combat-related PTSD, those that develop this disorder from their experience in accidents are subject to a cycle of upheaval and pain if they are not treated.

Before the widespread awareness of PTSD, many of these suffers were left to self-medication, using drug and alcohol addiction to help subdue the pain of the constant memory recall. (Beckham & Beckham) Now, effective treatment for PTSD usually comes in the form of a therapist.  Because the nature of PTSD causes people to avoid the issue that is causing the disorder, and the psychological danger involved in manipulating those memories can be best overcome by the use of therapeutic methods. (Beckham & Beckham) The most common approaches are group and individual therapy.  In group therapy, trauma victims can recondition themselves out of the idea that their experience sets them apart from society, and makes them different. Sharing with others who have experienced the same trauma can be beneficial, since these people can speak with others who have been through a similar incident.  As PTSD can be diagnosed from a combination of different symptoms, the therapeutic approach utilizes a combination of techniques that help patients deal with anger, depression, overcoming triggers of flashbacks and changing negative thought patterns. (Beckham & Beckham) Two forms of therapy include Emotion Freedom Techniques (EFT) and Cognitive Behavioral Therapy (CBT), which both focus on desensitizing the patient from the trauma and reincorporating them into experiencing emotions and reactions that do not relate to their trauma.  While the duration of PTSD varies from person to person, so does the intensity and duration and treatment.

While there has been tremendous advancement in the study of PTSD and the effect on its victims, there are still many mysteries that surround the disorder.  The evidence of physiological damage to the brain varies from study to study, and only relationships between damage and PTSD have been determined (Shin, et al.) However, one of the most important tools in the treating PTSD has been its recognition in instances outside of combat or violent situations.  Strong social support is critical in both diagnoses and treatment, and treatment must be pursued aggressively, yet at a pace that gives the patient the comfort of controlling responses to memory, which will in turn give them back the control over the various aspects of their lives – home, work, and family relationships – that they can lose.  It is impossible to eliminate trauma in life, but with proper care and attention it is possible to dilute its resonance.

References

Beckham, E., Beckham, C. (n.d.) Coping with Trauma and Post Traumatic Stress Disorder, Online. Retrieved August 25, 2011 from http://www.drbeckham.com/handouts/CHAP11_COPING_WITH_PTSD.pdf

Martindale, G. (2011) Post-Traumatic Stress Disorder – Reliving the Past, Online. Retrieved August 25, 2011 from http://www.stateuniversity.com/blog/permalink/PTSD-Reliving-the-Past.html

PTSD, Online.  Retrieved August 25, 2011 from http://www.ptsd.va.gov/public/pages/handouts-pdf/handout_What_is_PTSD.pdf

Shin, L.M., Rauch, S.L. Pitman, R.K. (n.d.) Amygdala, Medial Prefrontal Cortex and Hippocampal Function in PTSD, Online. Retrieved August 26, 2011 from http://ase.tufts.edu/psychology/documents/pubsShinAmygdala.pdf

The Evolution of Post-Traumatic Stress Disorder, Online. Retrieved August 25, 2011 from http://www.ptsdsupport.net/evolutionof_ptsd.html

Tull, M. (2009) The Effects of PTSD on the Brain, Online. Retrieved August 25, 2011 from http://ptsd.about.com/od/symptomsanddiagnosis/a/hippocampus.htm