Post No.: 0904
During WWI, politicians who’d never stepped onto a battlefield dismissed ‘shell shock’, or what’s now known as a type of post-traumatic stress disorder (PTSD), as a cowardly made-up excuse by soldiers who’d recently been fighting on the frontline.
Cases were highly likely under-reported but a sizeable proportion of soldiers returned with PTSD after WWI. But PTSD does not only occur for those in the armed forces. It can arise in anyone who experiences a personally traumatic event.
The symptoms of PTSD include flashbacks, emotional numbness (the blank ‘thousand-yard stare’), hyper-vigilance, feelings of helplessness, tremors, panic, confusion, extreme fatigue, mutism, paralysis, impaired sight or hearing, insomnia and nightmares.
Shell shock is called PTSD nowadays, melancholy is called depression, and hysteria is perhaps called a dissociative disorder… As we learn more, these mental conditions are no longer made to sound fabricated or exaggerated.
War veterans can find it difficult to cope with the moral challenges they face, and they express this ‘moral injury’ through guilt (including survivor’s guilt), shame or anger over the things they had witnessed or felt helpless about whilst in service. These thoughts then haunt their minds as PTSD, or complex PTSD for those who’ve repeatedly experienced traumatic events.
Perhaps it’d therefore help if every person who wishes to join the military first studied military ethics in order to pre-empt and give themselves the ethical tools to process what they might face on the battlefield so that if they do conduct themselves appropriately whilst in service then they can walk away with their heads held high? They might alternatively learn that joining the military isn’t for them and that pacifism is what they believe in – if so, this would be fine too because it’d be better to learn about these things beforehand rather than during or afterwards.
Survivor’s guilt can arise when someone else experiences a loss but one does not. So some people who luckily survive when other people around them unluckily died during a tragic event can later feel such guilt.
Adjustment disorders are responses to trauma too but are different to PTSD. These involve unhealthy or excessive emotional or behavioural reactions to stressful events or changes in one’s life like parental separation or divorce, moving house, the loss of a pet, the birth of a sibling, a sudden illness or injury. They are diagnosed more in children and adolescents than adults.
Peri-traumatic dissociation is when, under severe stress (or boredom), one’s mind wants to go ‘I’m not actually here’, to psychologically and emotionally detach from one’s immediate surroundings as a coping strategy. At the mild end this can lead to mere daydreaming, but at the pathological end this can be a precursor to PTSD.
Some people play videogames, for instance, or abuse substances, in order to more actively escape their real life if they feel that their real life needs escaping from – not that one needs to escape from something in order to want to play videogames or abuse drugs i.e. A often leads to B, but not all B emerges as a result of A.
The emotional freedom technique (EFT) – also known as tapping or psychological acupressure – is based on the principles of acupuncture, and some studies have shown that it can effectively treat active and veteran military personnel with PTSD or those with anxiety generally. But others criticise it as pseudoscience.
For PTSD, or something like drug abuse – remove the associated cues or reminders that trigger a relapse or traumatic memory. For instance, remove the person from the people and places that remind them of the contexts they took drugs, or away from the people or comments that re-trigger their anxieties or depressive thoughts. Or if someone cannot avoid these things then they should try to gradually desensitise themselves to these triggers (under professional supervision).
For drug addiction, going ‘cold turkey’ is tough because the brain has physically adapted to expect the drug. So suddenly withdrawing from an additive substance is difficult, and even sometimes dangerous (e.g. it could lead to seizures, plus one’s tolerance to the substance may drop hence, if one relapses, one can suddenly overdose on a dosage one was alright with before). Withdrawing is the overall aim but this is best done with medical supervision. Relapses are likewise easy to slip into because the brain has biologically altered to make relapsing more likely.
Whereas the repression of memories would be an unconscious process – suppression is a deliberate and conscious attempt at forgetting or not thinking about a painful memory. Not by simply willing ourselves to forget something but we can try to distract ourselves by focusing on other parts of our life, or attempt to substitute the memory with a better thought. This appears to be a healthier approach compared to rumination. We may or may not then simply forget those traumatic memories in time as a result of not revisiting them – in the same way we can forget anything else we don’t revise.
PTSD sufferers who actively attempt to suppress past memories can however end up hampering memory formation in the present. All the while, they can still effectively remember and are affected by their past trauma. Moreover, it prevents them from really coming to terms with the event and getting through to the other side towards acceptance. Overall, the scientific community is really yet to form a strong consensus regarding the effectiveness of attempted memory suppression, or if different methods of suppression or substitution are better? So it’s definitely a scientific area to try to keep abreast on.
The difficulty anyway is that highly emotional, intense and unusual events are consolidated into memories more strongly, which is a problem for trauma sufferers, who may constantly essentially relive their traumas via their vivid recollections of those events. ‘Flashbulb memories’ after a trauma event are probably how the brain learns and says ‘don’t ever forget this event so that you watch out for it and avoid it in the future!’ If so, this evolved mechanism backfires because the vivid memory itself is traumatic because it’s being relived each time it’s recalled. The constant flashbacks can lead to numbing or dissociation, where one can become detached from others, from experiencing emotions, from living life to the full, and from even reality in some cases, as possibly one of the brain’s self-defence mechanisms. This can then lead to PTSD.
Amongst combat veterans with PTSD – around 30 to 40% report auditory or visual hallucinations and/or delusions too, or psychosis. But again, one hardly needs to be in the armed forces to develop psychosis.
It can arise as a symptom of schizophrenia, schizoaffective disorder or be induced by certain psychoactive/psychotropic substances or medications, for instance.
Psychotic episodes are characterised by the dissociation from reality in the form of hallucinations (e.g. visions or hearing voices), delusions (such as of grandiosity) and/or thought disorders (jumbled-up or confused thoughts, a loss of concentration or the diminished ability to keep a clear train of thought). There’s also often a lack of self-awareness or insight that one’s hallucinations or delusions aren’t real, which might lead to one feeling frightened or distressed. Paranoia is therefore common. The voices can be most powerful because they often tell the person what to do.
With psychosis, an excess of dopamine causes an over-sensitivity to sensing potential threats, where everything ambiguous can seem important in case of what might happen next. We see young children talking to themselves (private speech) and do so more when a task is difficult – and this is normal. As we grow older, this voice becomes internal. But one hypothesis is that for those with psychosis, this internal voice(s) sounds like an external voice(s). Like many mental disorders – childhood trauma or upheaval plays a key part.
Post No.: 0607 pointed out that it’s generally never too late to expose the vulnerable to more protective factors and fewer risk factors though.
Some success in treating psychosis has been achieved by understanding that these voices are actually trying to help the host (e.g. that they’re just trying to warn the host and help them, not threaten them), as the brain’s response to traumatic events. Therefore it’s best to not try to suppress these voices but to reconcile with them.
The genetic risk of psychosis alone is not enough for negative outcomes – it depends on the environmental factors too, like being exposed to psychoactive substances and messages of hate, war, division and fear on social media, compared to being exposed to stories of cuddly unicorns and rainbows in a magical fluffy world of love! The latter may possibly cause episodes of ‘wild’, ‘fur-eaky’ or ‘weird’ hallucinations or perceptions in someone with psychosis but at least it won’t cause them to feel the need to inflict revenge or extermination upon others or to express sheer terror for the end of the world. Therefore those especially with harmless hallucinations should not really be socially feared or ostracised as ‘psychos’ or psychopathic, which is a common media-perpetuated stereotype, as well as a common erroneous conflation between the terms ‘psychotic’ and ‘psychopathic’.
For different people, the form of psychosis may be the same but the manifestation of it will depend on one’s own experiences and the culture one is exposed to. For example, in the past, hallucinations and delusions were more religiously ascribed, whilst in more secular societies they’re more to do with modern influences like social media. A member of an ethnic minority may have faced racism when young so that will likely shape the types of visions or voices they’ll hear. So indeed it might be the case that if society were more harmonious, less violent, less stressful and more equal then the hallucinations and delusions of those with psychosis would be relatively more harmless in nature than frightening or dangerous?
Therefore the rest of society has a responsibility towards the influences that psychosis sufferers pick up. The solutions or mitigations aren’t just down to the affected individuals but wider culture too.
And don’t risk taking psychoactive drugs like cannabis or LSD recreationally for the reason that they will physiologically affect and alter one’s brain in some chaotic way and may cause hallucinations. It’s irrational to want to risk messing up one’s brain in such a chaotic way. It’s irrational to want to reduce the rational capacity of one’s mind via recreational drug taking. Alcohol is a psychoactive drug so minimise alcohol consumption too.
There are some people in society who suffer from intense paranoia, psychosis or some other severe perception-altering condition and have been violent towards others as a result, and it is difficult to know what to do with them. It’s hard for their victims, it’s hard for the public to trust they are safe, and it’s hard for these severely mentally unwell people too because they never chose or deserved their condition. This is why prevention is better than attempted treatment or cure wherever possible – and this starts with raising children in more loving and cohesive, less abusive and less neglectful, environments, and reducing or eliminating access to perception-altering drugs that will exacerbate such mental conditions, for instance. Failing the prevention of trauma – the next best thing is helping victims of trauma as swiftly as possible.
We’ve got to remember that mentally unwell people with psychosis are hardly the only people who commit crimes though. We all possess various fantasies, hopes, ambitions or think of ourselves a bit too highly now and again, hence it’s arguably not the fantasies or delusions themselves that are problematic but the selfishness to act upon them without consideration of the negative effects upon others – especially if one is considered mentally well enough to think lucidly.
Woof! Psychosis can be quite an isolating condition because it’s hard to explain the episodes and there’s a stigma attached to ‘lunatics’. But the great news is that it can be successfully treated with medications, talking therapies and social support. The same for PTSD.