Treating Post Traumatic Stress Disorder

Introduction

It stands to reason that if some soldiers coming home from wars in the modern era suffer from Post-Traumatic Stress Disorder (PTSD), men and women coming home from other wars in the past also suffered from the condition.  PTSD has been a part of the war experience since there have been wars, and it is psychiatry and psychology that has lagged in identifying it and finding ways to treat the condition.  Likewise, there are men and women who never went to war who also suffer from PTSD.  Psychiatry and psychology have also lagged in identifying the condition in the population and developing treatments to relieve suffering.  Beginning with soldiers coming home from World War I (WWI), psychiatrists and psychologists worked to develop treatments to relieve PTSD.  The latter half of the 1900s saw more therapies developed and a couple, Cognitive Behavioral Therapy and the Judith Lewis Herman Theory, offer relief and coping tools for PTSD.

History of recognition.  While Americans know that Civil War veterans suffered from the aftereffects of the war, Americans did not come up with an identifier or a treatment for the condition.  Instead, European scholars working in a new field of psychiatry identified and started treating people suffering from trauma.  The first doctor to identify the condition was a Frenchman, Dr. Jean-Martin Charcot in 1887.  Later in the 1890s, Sigmund Freud worked with patients who were suffering from PTSD and eased their symptoms with “talk therapy” (Green, 2017).  The first soldiers treated for “shell shock” came after WWI and the first treatments developed from the need to treat these soldiers. Psychiatric drugs developed in the 1950s to treat a variety of mental disorders.  It is not until the 1970s that doctors and scientists recognize that trauma suffered through domestic or sexual abuse causes the same types of responses in women as war does for soldiers (Green, 2017).  However, the research was quite gender specific and it has taken time for scientists and researchers to understand that PTSD occurs in all humans despite their gender identification.  Specifically, anyone who suffers trauma can suffer from PTSD and there is not just one way to treat trauma.  Developing several different ways to treat PTSD means that there are several ways to relieve people’s suffering.  The DSM-5 has criteria for diagnosing the condition.  There are eight different categories a person must meet in order to have a diagnosis of PTSD:  All of category A, one symptom from each category B and C, three or more from categories D and E, and all of categories F – H (see appendix A).

Case Study

Kirk got permission to skip high school for a week so he could join some volunteer firefighters from Tennessee on a rescue mission to New Orleans after Hurricane Katrina struck the city. Kirk was supposed to write a report about what he did and saw. On August 30, Kirk arrived in New Orleans to the sounds of people screaming for help. But he reported it was too dark and the police wouldn’t let him and other rescuers in. The next morning, while boating around the flooded city, he saw several children “with their heads sticking out of their attics, dead,” he recalled. “Those were the screams we had heard.” Among his other experiences as a rescuer was this: “A woman handed me a bloody pillowcase. Her baby son was in it,” he said. “She gave birth to him on a roof while she was waiting to be rescued, and he died.” Kirk then joined some marines on a rescue mission to the depths of the city. He saw dozens of bloated bodies float past his boat and watched many people drown. He saw a girl clinging to a piece of plywood, only to be pushed off by a man trying to save himself. “I grabbed her into the boat,” said Kirk. “She just kept saying, ‘My family is all gone.’” When the boat arrived at an evacuation site, Kirk had no choice but to leave the girl there, even though there were no officials to release her to and mobs of people were fighting over supplies. “I wanted to stay with that little girl,” said Kirk, who felt she was too small to take care of herself. More chaos awaited—people shooting at attacking alligators and patients deemed too sick to help and put aside to die. Kirk reported, “I still hear voices screaming at me, saying, ‘Help me, help me!’” (provided by the client). When Kirk returned home, he started having nightmares.  He would see that girl and not be able to reach her in order to save her.  He would see alligators eating the dead people in the water and charging those who were alive but injured and bleeding.  When Kirk returned to school, he would day dream in class, flashing back to the sights he saw in New Orleans and when he had to give his teacher his report, he failed to do so.  When the teacher asked him to give an oral report to the class, Kirk ran out of the room in tears.  He has not been able to return to school since and often feels like his life is out of his control.  His dream of being a firefighter is gone.  He is sorry he ever volunteered to help in New Orleans.

Kirk lives with his parents and has two sisters, one older and one younger.  He has been spoiled by his entire family as the only boy.  However, at times, when he has intruded too much into his older sister’s life, she will pull rank on him and treat him unkindly.  The family attends Christian church services weekly, and Kirk has close friends from his church.  He is a good student and participates in some after school clubs. His life has been free from trauma until this incident.  All his grandparents are alive.  He has a dream of becoming a firefighter like his father.  He has listened to his father tell stories of saving people from death when responding to a fire with his fellow firefighters.  His father never tells the family of the condition of the dead people he was unable to save.  Thus, Kirk seems to have a skewed view of what firefighters do.  When his father’s fire house responded to natural disasters, Kirk heard stories of the people they saved.  Kirk never imagined the dead bodies he would encounter among the survivors at all.  He suffered shock at the sights and could not deal with not being a hero.  He could not talk about his experiences when he returned home.  His parents were very concerned about him and decided to get him help before the problem became worse and ruined his life.  His parents were concerned not only with Kirk committing suicide but his getting involved in taking drugs or using alcohol in order to cope with the week’s experiences.  They also realized that Kirk’s dad, in always seeming like a hero in his stories, did not prepare Kirk well for his volunteer experience.  Kirk’s dad is also coming to terms with how he has parented his children to believe firefighters are heroes.  He glossed over the scenes where people died in fires, natural disasters, and car accidents. 

The church-recommended psychologist, after doing some initial testing and talking with Kirk, diagnosed him as suffering from PTSD, and not other types of anxiety disorders.  Kirk and his parents also need to learn how to communicate truthfully and realize what Kirk can and cannot handle that is age appropriate.  

Treatment Options

Doctors have developed several different ways to treat PTSD since Freud said he cured a patient of trauma with “talk therapy.”  Social learning theory, introduced by Albert Bandura, suggests that behavior can be modeled, thus, people can change behavior by modifying their behavior to meet examples they think are positive (Instructionaldesign.org, 2019).  People already seem to do this on a small-scale basis when people want to fit in with others in a group.  Children model their parents’ behavior when growing up.  It seems that Kirk’s expectations were clearly influenced by his father’s heroic stories and when he saw what firefighters really encountered, he suffered trauma.

Thadani (2018) reported that “George A. Miller developed the information processing theory” in 1956 (para. 1).  Miller suggested he “believed that the mind receives the stimulus, processes it, stores it, locates it, and then responds to it” (Thadani, 2018, para. 1).  Since Kirk had no prior experience working in a natural disaster, he responded to the experience badly.  His body responded to what he was seeing.  He developed a case of PTSD.  

Cherry (2018) reported on cognitive behavioral theory (CBT) as a therapy focused on treating anxiety, phobias, depression and addictions. Martin (2018) detailed CBTs beginnings.  He wrote CBT was invented by a psychiatrist, Aaron Beck, in the 1960s. He was doing psychoanalysis at the time and observed that during his analytical sessions, his patients tended to have an internal dialogue going on in their minds — almost as if they were talking to themselves. But they would only report a fraction of this kind of thinking to him (Martin, 2018, para. 4). 

Beck discovered the link between thoughts and feelings and their importance to treating people who experienced trauma.  Beck went on to further discover that it is not the events that upset people but the meaning that people give to the events.  In Kirk’s case, he had no experience with trauma like the events he witnessed in helping firefighters in New Orleans after Hurricane Katrina.  His entire cosmos said that firefighters saved lives when he saw mostly dead people.  After the experience, Kirk started having negative thoughts and his behavior responses continued downward until he could no longer attend school. 

CBT works to help patients return to happiness by modifying dysfunctional behaviors, thoughts, or feelings.  A therapy session might ask the patient to identify the problem and then step away from the problem and ask if the feelings or thoughts they are having are what is really perceived.  Thus, once the false thoughts or emotions are identified, the second step in CBT is to give the patient tools and strategies to change the belief and thoughts.  It also predicts relieving symptoms in short time.

The Judith Lewis Herman Theory is one that deals with PTSD specifically but centers on youth who have experienced sexual or domestic violence.  Her seminal work came out in the 1990s and stresses that people can heal from PTSD only when society stops hiding the perpetrators.  Her view is strictly centered on youthful victims of domestic and sexual abuse.  The work does not delve to any great length on helping soldiers rid themselves of PTSD.  Dell’Omo (2019) represented Herman’s therapy as dealing with overwhelming trauma that removes the patient’s control over their lives and helping those patients recover.  Indeed, 

Individuals display hyperarousal, intrusion, and constriction, sometimes at levels so extreme they force an alternative state of consciousness to form, so that the victim can . . . cope with their reality. This alternative state of consciousness, Herman argues can manifest in a variety of ways including multiple personality disorder, amnesia, and ‘sleep walking.’ One of the most persistent elements Herman describes is ‘intrusion,’ in which traumatized individuals cannot resume the normal condition of their lives due to the repeated interruption of the trauma. These symptoms occur because of a rupturing of the ‘inner schemata.’ This is paramount for understanding both individual and societal trauma: for the individual, their trauma disrupts their inner schemata of safety, protection, and trust in the outside world (Dell’Omo, 2019, para. 4).

Kirk is displaying these types of interruptions in his life.  His life changed so drastically in one week that getting Kirk into therapy quickly to get him back to health and living a normal life is imperative. 

Kirk’s Therapy

Because Kirk is suffering from PTSD, it is decided that he should receive CBT sessions with a psychologist his family trusts who attends their church.  The psychologist chose to use CBT because it works quickly to return patients to mental health and happiness.  It will be a short-term mental health program that will relieve Kirk’s symptoms in short order.  The psychologist also insists on seeing the parents together and separately to inform them about how to handle their son’s problems.  The psychologist needs to work with Kirk’s dad because created a false image of what firefighters do, it will be incumbent on him to repair the damage he caused by not preparing his son for the volunteer week in New Orleans.  Kirk well understands that his life changed after the trip from the things he saw and did not know how to deal with.  Since the psychologist is using CBT, he will work with Kirk to regain his happiness.  However, the happiness Kirk will experience will not be innocent.  Kirk grew up in that week and saw things naïve youngsters should not see.  His reality has shifted, but it does not mean he cannot regain happiness.

It is recommended that Kirk see the therapist two times a week for a month.  In the first stages of therapy, Kirk will receive the tools to cope with the trauma he experienced.  He can be assured that what he saw and witnessed in New Orleans should cause him to be shocked.  He encountered a horrible situation and to be unmoved would be the odd thing.  That he was moved and shocked at what he saw is a good thing.  The therapist needs to start there.  Who would not feel shocked at seeing the trauma in the aftermath of Katrina?  Thus, relaxation can come from seeing the normalcy of Kirk’s response.  Kirk’s religious beliefs were also tested in that week when he saw people hurt others in the struggle to survive.  Kirk’s actions were altruistic, but many people reacted in survival mode.  Using faith to help Kirk understand that not all people act like Christians is something this psychologist can discuss.  Kirk had no knowledge of the people’s faith and cannot make judgements.  The psychologist and Kirk will work together to erase each one of his doubts and prepare him for disasters he might encounter in the future.  After receiving intense therapy for the month, Kirk will see the psychologist once a week, then once every two weeks and so on until therapy ends in about four months.

The psychologist also is aware of the danger that Kirk might develop feelings for him.  Since the psychologist is introducing Kirk to his feelings and dealing with the negative feelings Kirk has so he feels better, Kirk can transfer his feelings of love to the psychologist.  He is aware of transference and will be on guard for signs that Kirk is more affectionate with him.  The plan is to reunite Kirk and his father by rebuilding trust in what his father says (Transference, 2010).

(Appendix A omitted for preview. Available via download).

References

Cherry, K.  (2018).  Cognitive behavioral therapy.  VeryWell Mind.  Retrieved from https://www.verywellmind.com/what-is-cognitive-behavior-therapy-2795747 

Dell’Omo, A.  (2019).  Trauma and recovery by Judith Herman (1992).  Notevenpast.org.Retrieved from https://notevenpast.org/trauma-and-recovery-by-judith-herman-1992/ 

Green, M.  (2017).  Timeline:  The history of post traumatic stress disorder and how we treat it. Newsweek.  Retrieved from https://www.newsweek.com/post-traumatic-stress-disorder-timeline-571664

Instructionaldesign.org.  (2019).  Social learning theory (Albert Bandura).  Retrieved from https://www.instructionaldesign.org/theories/social-learning/https://www.instructionaldesign.org/theories/social-learning/

Martin, B.  (2018).  In-Depth:  Cognitive behavioral therapy.  Retrieved from https://psychcentral.com/lib/in-depth-cognitive-behavioral-therapy/ 

Thadani, R.  (2018).  A well-illustrated overview on the information processing theory.Retrieved from https://www.instructionaldesign.org/theories/social-learning/

Transference.  (2010).  Transference.  Retrieved from https://www.psychologytoday.com/us/blog/learning-play/201001/transference 

Tull, M.  (2019).  DSM-5 PTSD diagnosis criteria:  What’s changed from DSM-IV. Retrieved from https://www.verywellmind.com/ptsd-in-the-dsm-5-2797324