Millions suffer post-traumatic stress disorder

updated 2:42 p.m. ET Aug. 14, 2005

GLENVILLE, N.Y. - For hundreds of thousands of Americans, mental illness is just a drive down the road. Ask Beth Puglisi.

The 45-year-old mother was out to fill her gas tank on a bitter-cold January day last year. She turned the wheel of her pickup, felt a wrenching jolt, and watched the roadway fly into a spin.

“No!” she heard herself screech. The rubbery aroma of spilled antifreeze filled her nostrils.

In the days after her crash with a car, she took to the couch, weeping — but not over her fractured vertebra and dislocated shoulder. Her mind was staggering.

“It felt like a death,” she says.

Her body was quickly tended, but it took months before doctors even put a name to her other injury: post-traumatic stress disorder.

Once associated mainly with the horror of combat, PTSD has stretched to take in more frequent swerves along life’s road — car crashes, house fires, a sudden death or severe family illness, witnessing a disaster, or even learning of one. PTSD has broadened the model of mental illness to cover disturbances set off solely by external events, outside of the mind. Almost anyone can be vulnerable.

Research suggests the disorder is now present in 5 percent of Americans, or more than 13 million, according to the PTSD Alliance, which unites professionals and advocates. It is expected to touch 8 percent of adults during their lives. By contrast, just over 3 percent of Americans have cancer.

Puglisi had been in accidents before, but she never felt this way.

She couldn’t stop picking over this crash in her mind. It wasn’t her fault; it just wasn’t. So why did it have to happen? Why?

Her family encouraged her to talk: “Each time I would tell someone about it, I could feel it and smell it — the whole thing.” In a kind of flashback typical of PTSD, she could still smell the antifreeze.

As PTSD’s debilitating anxiety took hold, Puglisi started to feel nervous, flushed, even lightheaded when she was driven to a doctor or physical therapist. She would tremble, and her chest would tighten: “Just thinking about it was making me crazy.”

When she tried driving again, she’d have to circle around to avoid making the same kind of turn as in the crash. She’d bypass where it happened. Ashamed, she asked her husband to drive the children to their activities.

While television droned war news from Iraq, she felt trapped in her own combat zone: “When you’re in the war, you have no idea if you’re going to be alive or dead in 10 minutes. That’s exactly the way I felt.”

Unexpected deaths, car crashes
Warring soldiers have carried home psychological scars for centuries. The ancient Greeks noticed it.

In American wars, it has been called shell shock, combat fatigue and post-Vietnam syndrome. Though skeptics discounted some cases as shams meant to win compensation, other extreme cases were taken for schizophrenia.

Medical authorities first accepted PTSD as a distinct psychiatric condition in 1980 at the urging of Vietnam veterans and their medical caretakers.

In PTSD, stress hormones like adrenaline scorch a painful event deep into long-term memory, scientists believe. Lab studies show such hormones normally improve memory in animals. They seem to overshoot the mark in PTSD.

People get very edgy and fearful, prone to nightmares or flashbacks. They desperately want to avoid reminders of their shock, even to the point of feeling numb. PTSD happens more often in women, in cases of multiple traumas (Puglisi had another road accident just a couple weeks earlier), and in people with depression.

Once defined, the disease was soon embraced, and insurance coverage expanded. Here was a psychiatric condition touched off by concrete events, not something hidden in the mind’s dim recesses. It could theoretically happen to anyone, even the hardiest and soundest of mind. It wasn’t your fault.

The federal government established the National Center for Post-Traumatic Stress Disorder. It began researching PTSD and treating hundreds of thousands of veterans. Survivors from rape and car crashes began to seek therapy in greater numbers too. In 1994, the sudden death of a relative, or even learning that one was hurt, joined the expanding list of PTSD traumas in the chief diagnostic manual for psychiatry.

By the late 1990s, when Dr. Greenbrier Almond was working as a psychiatrist at a West Virginia veterans hospital, PTSD was already its leading diagnosis, above heart disease and diabetes, he says.

Over the past five years, the number of cases among veterans — mostly from combat — has exploded nationally by almost 80 percent to 215,871 last year, according to the Department of Veterans Affairs. It is the agency’s fastest-growing disability.

No similar statistics are collected for civilians, but the numbers are clearly substantial. Dr. Almond, who has left the veterans hospital, now treats PTSD in abused children at a community health clinic. Research at Henry Ford Health System, Harvard and Georgia State has identified the two leading causes of PTSD as unexpected deaths of relatives and car crashes. Combat ranks far down on the list.

MORE FROM MENTAL HEALTH

Mental health Section Front

Marriage wards off blues, just don't end it Climate change fears may worsen depression Six tips to help you feel instantly calm Autism seen as asset, not liability, in some jobs Coroner: Self-help course led to suicide Teen Internet addicts more likely to self harm Dark shadows loom over ‘facilitated’ talk Compulsive hoarders suddenly in the spotlight Early treatment may help kids with autism Military experiment seeks to predict PTSD Mental health Section Front   Add Mental health headlines to your news reader: