What I learned about PTSD from the University of Google

childineyeThe Urban Dictionary says that the “University of Google” refers to a major ignoramus who pretends to be an intellectual. Well, I decided to attend the University of Google for a few days to see what I could learn about PTSD. It’s pretty depressing. So-called reputable sites were the worst. There are a couple of interesting exceptions.

I looked at every site listed on the first three pages of my Google search “PTSD.” This was over the days February 18-22, 2016. The top sites changed every day (sometimes every hour), but not by much, and I included sites that paid to be listed first. Since I’ve done a lot of trauma searches with Google on my computer, my rankings were not quite the same as on my wife’s computer, my i-pad, and my school computer, which I rarely use. Google customizes (that is, markets) its information. Nevertheless, the overlap was considerable.

After a while, the sites started to sound the same. There were a couple of exceptions.

Wiki disappoints

Wikipedia’s entry on PTSD was disappointing. “Psychotherapy is the ‘gold standard’ of treatment for PTSD.” A promising start, but under psychotherapy Wiki includes prolonged exposure therapy (PE), cognitive behavioral therapy (CBT), and eye movement desensitization and reprocessing (EMDR). I expected more from Wiki; I’m not sure why.

Rats, mice, ecstasy, and dogs

A surprising number of sites reported on research with mice and rats, and several report the results of delivering electric shocks to people. In one, people with PTSD show heightened brain activity in areas thought to be associated with stress when shown pictures of frightened face when shocked and not shocked (that is, no difference), while people without PTSD show more anxiety when shocked. The significance of this is left unclear.

The same site, The Brain and Behavior Research Foundation, summarizes a study which shows that MDMA — also known as the rave drug Ecstasy — can treat symptoms of post-traumatic stress disorder in mice. At: https://bbrfoundation.org/ptsd?gclid=CIrI-YnshssCFclkhgodKkIKew. Don’t try this at home.

“Reputable organizations”

The Mayo Clinic website is particularly disappointing. After defining PTSD as the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM) does, it comments that

several types of psychotherapy, also called talk therapy, may be used to treat children and adults with PTSD. Some types of psychotherapy used in PTSD treatment include

cognitive therapy (CBT), exposure therapy (PE), and eye movement desensitization and reprocessing (EMDR). Talk therapy evidently now refers to any therapy in which humans exchange words before or during procedures.

Not a word about the role of families or groups. PTSD is the disease of an isolated individual. One who may be treated with drugs, such as Zoloft and Paxil, benzodiazepines for short term use, and prazosin (Minipress) for insomnia and nightmares. (Minipress sounds like one of the ministries in Nineteen Eighty-Four, like Minitrue for the Ministry of Truth.) At: http://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/basics/definition/con-20022540).

The New York Times guide to PTSD is probably the worst single site, mostly for its irrelevance. Not even bothering to sort out disorders, it begins with “obsessive compulsive disorder” and ends with a “normal interior view of an artery,” showing how cholesterol particles stick to arterial walls. The relevance to PTSD: stress can lead to heart disease. The site exemplifies so many, filled with information without constraint or context. At: http://www.nytimes.com/health/guides/disease/post-traumatic-stress-disorder/print.html

The National Institutes for Mental Health (NIMH) website, in its section aimed at the public, is also little more than a list of symptoms and “evidence based” treatments. At: http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml

The Veterans Affairs National Center for PTSD websites for the public state that CBT (what the VA calls cognitive processing), PE, and EMDR are the treatments of choice, the “gold standard,” the only “evidence based treatment.” Anti-depressants are also included. There is more to be said about this site, but this tells you most of what you need to know. At: http://www.ptsd.va.gov/public

The VA does provide an app for the i-phone, PTSD Coach, which according to user reviews seems to help some people manage their distress. Users can add their own soothing music and photos. At https://itunes.apple.com/us/app/ptsd-coach/id430646302?mt=8.  Is this the future of PTSD treatment?

The American Psychological Association website is worthless. It has no content, just a picture of a nice looking woman in combat fatigues, and a news item on a study that is supposed to help families cope with PTSD. It’s dated 2008. A dead zone. It includes a link to buy an e-book, “A Practical Guide to PTSD Treatment,” for $30.00. Not cheap. At: http://www.apa.org/topics/ptsd/

The main thing shared by all these sites is the loss of ambiguity, nuance, and subtlety, not to mention attribution. For example, the PTSD Alliance, which includes the International Society for Traumatic Stress Studies and The American College of Obstetricians and Gynecologists, among others, states “7,000,000 people in US suffer from PTSD. 50% will never reach out for professional help.” How one might come up with the 7 million figure is not discussed. I can’t imagine. At: http://www.ptsdalliance.org/about-ptsd/.

Two interesting sites

There are a couple of interesting sites, both of which do not try to define PTSD, but to say something about it.

A ProPublica news story from 2014 cites a study showing that among inner-city young people, mostly African-Americans, the

rates of PTSD we see are as high or higher than Iraq, Afghanistan or Vietnam veterans. We have a whole population who is traumatized.

The conclusion is based on the research of Dr. Kerry Ressler, whose team interviewed 8,000 residents of Atlanta’s inner city. The story goes on to say that of the 22 largest big city hospitals, none have the resources to treat the psychic trauma they see. None even come remotely close, with the exception of Philadelphia. One of the many advantages of treating psychic trauma among young victims is that it reduces the desire for revenge, part of a cycle of violence. PTSD is a public health problem. At: http://www.propublica.org/article/the-ptsd-crisis-thats-being-ignored-americans-wounded-in-their-own-neighbor

The most interesting story is by Sebastian Junger, “How PTSD Became a Problem Far Beyond the Battlefield,” Vanity Fair, May 7, 2015. At: http://www.vanityfair.com/news/2015/05/ptsd-war-home-sebastian-junger

Junger begins by blaming the victim, arguing that the dose response curve is irrelevant.

According to statistics published in the Journal of Consulting and Clinical Psychology in 2000, if you have an educational deficit, if you are female, if you have a low I.Q., or if you were abused as a child, you are at an elevated risk of developing PTSD. These factors are nearly as predictive of PTSD as the severity of the trauma itself.

Junger then states that many military PTSD victims are faking it to get disability benefits.

Not a good start. But then Junger goes on to argue that PTSD is really about giving up the camaraderie of war.

Awkward as it is to say, part of the trauma of war seems to be giving it up.

Combat veterans miss the war because it was, finally, an experience of human closeness that they can’t easily find back home. Not the closeness of family, which is rare enough, but the closeness of community and tribe.

When soldiers return to modern society, they must go through—among other adjustments—a terrific oxytocin withdrawal. The chronic isolation of modern society begins in childhood and continues our entire lives.

Forget the oxytocin (Junger is bewitched by neuroscience), and you can still get his point.

PTSD is a crisis of connection and disruption, not an illness that you carry within you . . . . PTSD is a disorder of recovery, and if treatment only focuses on identifying symptoms, it pathologizes and alienates vets . . . But if the focus is on family and community, it puts them in a situation of collective healing.

This is interesting stuff. PTSD is what happens when you come home alone. It’s not the whole story, but a fascinating angle.

Where does the average person go to find information about PTSD?

The University of Google is not a very good place. Except for Junger’s piece, one gets no sense that PTSD is a disruption of attachment. This is actually something that can be explained in fairly straightforward terms emphasizing the importance of establishing or reestablishing relationships with trusted people and groups. It is also about reestablishing the sense that one can do something worthwhile with one’s life. This is hard, and takes a lot of work.

I think body work is particularly important, as discussed in my previous post on Bessel van der Kolk. The attachment to one’s own body and its rhythms only develops in relationship to other bodies, and it is lost in PTSD. Conversely, it is bodily attunement present in small groups of soldiers that helps protect them from PTSD. Until they get home. Junger’s piece is particularly good on this point.

In this regard, I don’t know what to think about https://www.reddit.com/r/ptsd. On this and similar sites people post their experiences with PTSD. It can break your heart, but there doesn’t seem to be much communication among sufferers. Just statements of pain and anxiety. Maybe that helps.

The discipline of PTSD

It’s hard to talk about PTSD in a way that is meaningful to experts and sufferers alike. (Does anyone become an expert sufferer?) But a list of symptoms is, in my opinion, not helpful, and the “evidence based” treatments not the best. None of the sites talks about PTSD as an experience, not just a collection of symptoms. In this respect the University of Google reflects the successful “discipline” of PTSD, as Michel Foucault would put it.



Leave a Reply

Your email address will not be published. Required fields are marked *