Millions suffer post-traumatic stress disorder

Some bad diagnosticians and purveyors of pop culture have come to consider just about any of life’s shocks — divorcing, losing a job, even failing a test — as triggers for PTSD. Though veterans officials say rising awareness has driven most of their growth, they are also reviewing whether some cases have been diagnosed too readily.

“Anything that happens to you that’s remotely icky now qualifies,” says psychologist J. Gayle Beck, at the University at Buffalo-State University of New York. “It’s been culturally overdiagnosed.”

This psychiatric illness has carried cultural baggage since its birth in the social turmoil over the Vietnam War. The new disorder tied to external events meshed with a Kafkaesque view of society inherited from the 1960s: Outside forces constantly threaten peace of mind.

Since 2001, PTSD has tapped into another source of anxiety: terrorists who can inflict mass death in an instant. A survey found highly elevated rates of PTSD in the New York metropolitan area, where the smoking towers of the World Trade Center could be seen for miles.

Afterward, some companies sent reassuring notices to workers listing PTSD symptoms and saying they were common responses. One compared them to a minor flu.

“It speaks to dangerous times and threats, and that certainly defines our era,” says Dr. Robert Jay Lifton, a Harvard University psychiatrist who helped define PTSD as a condition. “There is bound to be widespread PTSD and an awareness of it.”

Even so, many people with PTSD still do not come forward for help, caregivers say. And even experts may miss the signs.

“My father dropped dead in front of my mother. She developed PTSD for two years, and I was completely unaware of it. I knew something was wrong, but I didn’t know it was PTSD,” says psychologist Terence Keane.

Yet he is director of behavioral science at the federal PTSD center.

The good news is this: Even untreated, PTSD goes away in about half of the cases within six months, research indicates.

The bad news: When it doesn’t, it can last for decades.

Puglisi had never needed therapy before and didn’t think of treating her embarrassing automotive anxiety.

“I would say I’m all right,” she recalls. But she wasn’t.

Her doctor told her she’d soon get over it, but her physical therapists knew better. After several months, they persuaded her to look for help.

She found Edward Hickling, a former veterans psychologist who now specializes in road-accident PTSD.

“I came to private practice, and I saw motor-vehicle accident victims that looked a lot like ... the post-traumatic stress responses I saw in the veterans hospital,” says the therapist based in nearby Albany.

Symptoms can persist
Like many PTSD therapists, he relies on cognitive behavioral therapy. A common psychological treatment, it teaches how to replace negative mental monologues (“I could die on the way to work”) with positive, rational ones (“I’ll probably get there just fine, as usual”). It can be carried out one-on-one or in groups.

Hickling re-exposes participants to memories of the terrifying situation, while desensitizing them over a few months or longer. They start by telling what happened and graduate to driving back to the crash site.

One woman was able to drive back and gaze at the place where her car plunged down a hill, trapping her for more than two hours. Later, she felt as though she had “removed a cloud from her brain,” according to Hickling.

The therapy can work in up to 75 percent of road-accident survivors with chronic PTSD, research suggests.

Some patients, though, can’t tolerate thoughts of their ordeal. “It’s just too painful,” says psychologist Charles Figley, at Florida State University. Lesser symptoms persist in many people.

Psychiatrists often treat PTSD with drugs. The federal government has approved two depression medicines, Zoloft and Paxil, for PTSD. Research suggests they help at least a quarter of PTSD patients.

Other researchers are experimenting with potential PTSD drugs like anti-adrenaline agents and the antibiotic D-cycloserine. In theory, they might disrupt the consolidation of long-term PTSD memories or help the brain forget them later.

Psychological therapy alone conquered Puglisi’s symptoms, though it took a year.

She still hasn’t gone back to work but doesn’t feel so alone. Now she knows of many others like her: “The mind does this sometimes.”

What happened to her, she has learned, is normal.

MORE FROM MENTAL HEALTH

Mental health Section Front

Military experiment seeks to predict PTSD Army helps vets with ‘invisible wounds’ get jobs Army suicides to top 2008, but progress seen Suicides raise worries about recession’s real cost Chill: A little stress may help you live longer Suicide prevention groups protest ‘The Office’ Tokyo train stations use lights to stem suicides Why memory lane is such a mortifying stroll Kids on psych drugs have alarming weight gain Self-help course may have led to her suicide Mental health Section Front   Add Mental health headlines to your news reader: