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A Private War: Why PTSD Is Still Neglected

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NEW JERSEY – Mrs. Nancy Méndez-Booth was diagnosed with PTSD after delivering a stillborn baby in the winter of 2008. Less than an hour after rushing to the hospital, in labor and elated, a doctor told her that the baby she had spent years planning for had no heartbeat.

When she returned home from hospital, Ms Méndez-Booth said she felt like she had “arrived from Mars”; she got lost in her own building. She oscillated between numbness, vivid paranoia – she feared the police would arrest her for the death of her son – and outbursts of anger.

Her kitchen cabinets came loose because she slammed the doors together over and over again, looking for a way to let out some of her rage.

“I was just thinking, who in their right mind experiences four different, incredibly intense mental states in the space of 15 minutes?” said Ms. Méndez-Booth, a writer and educator in New Jersey. She couldn’t tell the difference between past and present; she kept coming back to the delivery table. She thought she was having a psychotic breakdown, but later found out she was suffering from post-traumatic stress disorder, or PTSD.

Ms. Méndez-Booth considers herself lucky to have been diagnosed. According to experts, it is very common for the disorder to go unnoticed. Pervasive misconceptions about who develops PTSD and confusion about its complex set of symptoms can prevent people with the disorder from seeking treatment or even realizing they have it.

“You’re talking millions” of people with PTSD without a diagnosis, said Dr. Bessel van der Kolk, author of the seminal book on the subject, “The Body Keeps the Score,” and a leading expert in the treatment field. trauma.

PTSD entered the Diagnostic and Statistical Manual of Mental Disorders in 1980 as an official diagnosis, in response to symptoms exhibited by Vietnam War veterans, and today, those in combat still report high rates of trouble. According to the US Department of Veterans Affairs, between 11 and 20 percent of veterans who served in Operations Iraqi Freedom and Enduring Freedom suffer from PTSD in any given year.

As Russia continues to wage war on Ukraine and more people enter the fight, researchers expect cases of PTSD to emerge in the coming years.

But civilians are also affected by post-traumatic stress. The trauma most likely to cause PTSD is rape, with combat trauma in “close second”, said Dr Shaili Jain, a Stanford University PTSD specialist and author of “The Unspeakable Mind”. That’s why she, along with Dr van der Kolk and other experts, says it’s vital that more people understand what PTSD really is.

WHY PTSD CAN BE UNTREATED

Dr. Paula Schnurr, executive director of the National Center for PTSD, said about 70% of adults in the United States experience at least one traumatic event, which the Centers for Disease Control and Prevention defines as an experience “marked by a feeling horror, helplessness, serious injury or threat of serious injury or death”.

But only 6% of the population will develop PTSD at some point in their lives, according to the Department of Veterans Affairs, the majority of whom are women. Scientists are still trying to identify the biological and societal factors behind these discrepancies – such as how generational trauma, the notion that some elements of PTSD can be genetically transmitted, work and what “complex” trauma, which is caused by repeated traumatic events, done to his psyche.

“When we first created this diagnosis of PTSD, we said it came from an extraordinary event outside the range of human experience,” Dr van der Kolk said, referring to the scientists. and researchers who treat the disorder. “That’s how completely lunched we were – to think the trauma is exceptional.”

Ms Vanessa Haye, 34, from East Midlands, England, developed PTSD following an ectopic pregnancy in 2019. She rushed to hospital for surgery nine weeks after the onset of her pregnancy; a doctor told her she might not survive.

After three weeks of painful convalescence, she had to decide what to do with the remains of the pregnancy: cremation or burial. Subsequently, she began to have debilitating flashbacks. Mrs Haye woke up just before 3am every night, reeling from nightmares, wondering what the baby would have been like.

Intrusive thoughts hijacked his brain; she was walking with her toddler and imagined a car hitting them both. When her husband didn’t pick up the phone, she imagined he was dead. Everything seemed like a risk. The stress was so intense that her periods stopped.

After six months, she went to see a doctor, who told her that PTSD is common after an ectopic pregnancy. Yet Ms. Haye felt disconnected from the diagnosis, shocked that it could apply to her. It took months for her to start seeing a therapist regularly and to begin to find a way to cope with her symptoms.

RECOGNIZING THE SYMPTOMS

Studies show that early intervention is key to managing and potentially preventing PTSD. But it can take up to two years or more for people with symptoms to get a diagnosis, Dr Jain said, and those who don’t receive treatment in the first two years have a much lower chance of recovery. .

“Hearing I had PTSD – I felt like I didn’t deserve it,” said Ms Natalia Chung, 30, who was diagnosed with the disorder in 2016 after ending an abusive relationship. “Because I didn’t go to war,” she said.

Many people like Ms Chung only start therapy for PTSD after years of battling the disorder, struggling to manage symptoms that, with prior treatment, might never have developed in the first place.

Part of the reason people delay treatment is that “avoidance is the hallmark of PTSD,” said Dr. Vaile Wright, senior director of healthcare innovation at the American Psychological Association. The disorder causes people to ignore reminders of trauma – they make their lives smaller and smaller to block out any evidence of what happened.

For Ms. Michelle DiMuria, 39, rain splashing against her window can trigger an episode. It was raining the day she was raped in 2015, and the weather reminds her of the attack. She can’t stop imagining the face of her attacker.

Since Ms. DiMuria was diagnosed with PTSD in the fall of 2017, she’s struggled to avoid bits of daily life that send her into a flashback: the smell of cologne, the sound of certain songs her abuser liked. Her back was broken during the assault and she tries to avoid looking in the mirror at the surgery scars scattered across her skin.

Ms DiMuria, who founded a mental health advocacy organization called the Bee Daring Foundation, wears a woven turquoise bracelet when out in public. She told friends that if she started fussing with the tissue, she was probably dissociating.

She’s been tinkering with coping mechanisms for bad days — peanut M&Ms, Marvel movies, a coloring app. She watches football and screams at the screen, trying to find an outlet for the outbursts of aggression that sometimes accompany PTSD.

Emotional fluctuation is typical of people with this disorder, Dr. Wright said. “They feel like they’re going crazy,” she said. “They don’t often identify it as PTSD until ideally a well-trained therapist says it’s actually a really normal response to an abnormal event.”

Too few therapists receive this training, however, said Dr. Yuval Neria, director of the PTSD Research and Treatment Program at the New York State Psychiatric Institute. And the disorder is particularly difficult to treat because it is so often linked to other mental health problems: addiction, depression, anxiety. Unless clinicians are specifically trained to ask questions about trauma, they might struggle to identify PTSD as the root problem in a patient.

“We just need to identify people faster, get them on treatment faster, before it becomes this horrible problem,” Dr Jain said. “Because the reality is that it is a manageable and treatable condition.”

For all that experts don’t yet know about the disorder, the language of PTSD has become a mainstay of modern conversation. “Triggered” is a buzzword and a meme; “trauma” trends on social networks.

“The Body Keeps the Score” has been on the paperback bestseller list for nearly 180 consecutive weeks and has won a fervent following. “I’m not sure what impact this is having,” Dr van der Kolk said when asked about the book’s popularity, saying he hadn’t seen any concrete action taken. due to his work – no new congressional hearings focused on PTSD and no widespread changes to medical school curricula.)

Some experts say this pervasiveness has diluted the meaning of PTSD. The disorder stems from severe trauma, said Dr John Tully, clinical associate professor of forensic psychiatry at the University of Nottingham in England. “We talk about life-threatening or closeness,” he said.

The term loses its meaning when people apply it too broadly, he said – and PTSD means more than dealing with the aftermath of an upsetting event.

“When we get to the point where we’re talking about office stress causing PTSD, people are writing nasty things about me on Twitter causing PTSD – that’s when clinicians get skeptical,” he said. he declares.

SEEK HELP

PTSD does not always have a linear trajectory and there is no clear mark of recovery. For Ms. Haye, working closely with a therapist has helped her recognize and respond to her symptoms; it makes it easier for him to sleep through the night.

Traditional talk therapy is not the only treatment option, however. Prolonged exposure—a cognitive intervention that involves patients describing a traumatic event in detail—has been shown to alleviate PTSD symptoms in nine to 12 sessions. And emerging experimental treatments, from virtual reality therapy to controlled doses of MDMA, have shown positive results.

Digital tools can also be helpful in managing the disorder, Dr. Jain said. An app called the Department of Veterans Affairs’ PTSD Coach, for example, provides information about the disorder as well as grounding exercises to help people cope with the symptoms.

Cognitive processing therapy, medications, and a therapeutic technique called eye movement desensitization and reprocessing, or EMDR, are also very effective in treating the disorder, Dr. Schnurr said.

EMDR sessions helped Ms. Méndez-Booth deal with panic attacks; she still suffers from paranoia, but her episodes have become less frequent over the years. She now lives a fuller and more functional life than she thought possible when she first experienced symptoms.

“I know he’s still here,” she said. “It’s part of my fabric. But that’s not all about me.

This article originally appeared in The New York Times.