Another Psychological Disease Bites the Dust: PTSD Now Believed to Be Physical

[Cort]

It's an amazing story. Hundreds of years of soldiers with PTSD being accused of being psychologically weak or unmanly (god knows how many thousands suffered unfairly) - all of whom probably actually suffered from a physical brain disease.

The New York Times today published a long article (What if PTSD Is More Physical Than Psychological?) on how bomb induced PTSD is probably caused by physical damage to the brain. A researcher has recently uncovered a pattern of brain damage unlike he had ever seen before.

[fright]

[/fright]

What they found in these traumatic-brain-injury cases was totally different: a dustlike scarring, often at the border between gray matter (where synapses reside) and the white matter that interconnects it.

Until then shell shock had mostly been viewed in psychological terms:

Perl’s findings, published in the scientific journal The Lancet Neurology, may represent the key to a medical mystery first glimpsed a century ago in the trenches of World War I. It was first known as shell shock, then combat fatigue and finally PTSD, and in each case, it was almost universally understood as a psychic rather than a physical affliction.

Early on a doctor named Mott got close to being right about what was going on but his ideas were pushed aside by, among others, Sigmund Freud.

Mott’s views were soon eclipsed by those of other doctors who saw shell shock more as a matter of emotional trauma. This was partly a function of the intellectual climate; Freud and other early psychologists had recently begun sketching provocative new ideas about how the mind responds to stress. Soldiers suffering from shell shock were often described as possessing “a neuropathic tendency or inheritance” or even a lack of manly vigor and patriotic spirit. Many shell-shock victims were derided as shirkers; some were even sentenced to death by firing squad after fleeing the field in a state of mental confusion.

Even in this modern era with the understanding that the blasts from new, more intense bombs with shaped charges were likely causing more damage it took awhile for the Army to get on board.

One of the first to challenge the military from within was a 44-year-old Army lieutenant colonel named Christian Macedonia. In March 2008, Macedonia was in Arlington, Va., listening to a group of scientists and government bureaucrats talk about roadside bombs. The talk was dry and technical, and finally Macedonia, a square-jawed man with an air of urgent candor, could no longer contain himself. He lashed out against the military’s inaction on brain injury, using what he recalls as “some pretty salty language” to make his point. “I see no movement, and I’m kind of sick of it,” he concluded.

At the time, “you had an entrenched military-medical community that did not want to go down that road,” Macedonia told me. “They didn’t want to give any credence to the idea that these symptoms were anything other than emotional difficulty.” Macedonia, an obstetrician as well as a soldier, knew otherwise. He did a tour in Anbar province in Iraq in 2004 and 2005 with soldiers who were being targeted frequently by mortars and roadside bombs. As an officer and doctor, he felt responsible for younger soldiers and their injuries. “Kids exposed to explosions were asking for help, and I was mouthing the party line: ‘You’ll be O.K.’ I was part of the machine that didn’t help. That’s what haunts me.”

Macedonia and his ideas were saved by one man high up the chain, Commander of the Joint Chief of Staff, Admiral Michael Mullen. Mullen heard the guy out and hired him. (One wonders if Francis Collins is giving the same gift to ME/CFS right now.)

Now things are changing. It's remarkable though that even these tough soldiers have been accused of being shirkers.Even after highly trained special forces soldiers have literally gone crazy and killed themselves, many in the military still thought of the PTSD as "psychological". It demonstrates how deep the belief that something is psychological can get embedded - past all belief, really.

It's notable that it took improved technology to figure what's going on. I think that's good news for ME/CFS and FM.

 

[Remy]

I'd like the stigma around psychological diseases to go away too and come with a recognition that all diseases are biochemically based and need effective treatments.

We are so quick to assume the worst of our fellow humans instead of just simply believing them when they describe their experience. It makes me sad.

 

[Cort]

I'd like the stigma around psychological diseases to go away too and come with a recognition that all diseases are biochemically based and need effective treatments.

We are so quick to assume the worst of our fellow humans instead of just simply believing them when they describe their experience. It makes me sad.

We are soo quick to assume that. It's like our default response. Just think - the article describes the problems the Special Forces - the toughest of the tough -are having. These guys are falling apart....they have been hit by blast after blast - now wouldn't that be the first option for the medical community???

At least the Army and the medical community are starting to come around...

I recently had to sleep out in the desert because of some painting that was done. My Uncle attributed it not to chemical sensitivity which he is well aware of that I have - but suggested I was feeling anxious. This is after he's known that I've had MCS for twenty years....its still anxiety....

I just hope that we're all alive to see the day....

 

[J.A.]

Another condition I'd like to see researched more (biomedical research) is "Psychogenic Non-epileptic Seizures"(PNES). They are seizures that a 20 second EEG says aren't caused by electrical disruption in the brain (like epilepsy). If the EEG is negative, the patient gets slapped with this label, PNES, and is sent for counseling for "traumatic memories in the subconscious mind that the conscious mind can't handle, so they have seizures to protect themselves from traumatic memories surfacing." It's a ridiculous concept.

A close friend of mine was labeled with PNES. He never went for counseling. Much later, he found out he had arthritis in his cervical spine and had several steroid injections on a Wednesday for pain in his neck, shoulder and arm. The seizure symptoms which he had had daily for two-and-a-half years suddenly disappeared the day of the steroid injections. They did not come back until the steroid injection wore off and he went back in for more injections. He had similar positive results.

Nobody thought or told us the steroid injections would help the seizures, and it certainly never crossed our minds, so this was not a placebo effect. We were shocked when we realized he didn't have seizures or episode symptoms later that night, and for months thereafter.

The doctors are still baffled &/or in disbelief about this. However, to me it makes sense that if there is inflammation causing pressure against or in the spinal cord, it could cause seizures and other neurological symptoms. If anyone else has a better explanation, I'd love to hear it.

But, basically, if the seizures were psycological...how did a steroid injection fix it? How many people are labeled with PNES & there really is a physical cause for their non-epileptic seizures?

 

[h3ro]

EEG I had went for a lot longer than 20 seconds.

 

[San Diego]

I'd like the stigma around psychological diseases to go away too and come with a recognition that all diseases are biochemically based and need effective treatments.

You got that right!

My Uncle attributed it not to chemical sensitivity which he is well aware of that I have - but suggested I was feeling anxious. This is after he's known that I've had MCS for twenty years....its still anxiety....

I just hope that we're all alive to see the day....

I hear this a lot. It’s frustrating, especially when we were so high functioning prior to illness.

POTS results in serious anxiety if I’m up too long (minutes), but the anxiety is downstream from the biochemical changes desperately trying to keep me upright and conscious. Regardless, to the average observer or even family member, anxiety is anxiety - and it’s a psych problem. Sigh.

I recently had my urine neurotransmitters tested. The results showed severe deficits of all except epinephrine. No wonder I shake, sweat, etc when I’m up.

Quite frankly, I think I’m doing pretty dang well for someone with neurotransmitters off the bottom of the ranges!!!

I think this is common in ME?

 

[Audrey Brimson]

We are soo quick to assume that. It's like our default response. Just think - the article describes the problems the Special Forces - the toughest of the tough -are having. These guys are falling apart....they have been hit by blast after blast - now wouldn't that be the first option for the medical community???

At least the Army and the medical community are starting to come around...

I recently had to sleep out in the desert because of some painting that was done. My Uncle attributed it not to chemical sensitivity which he is well aware of that I have - but suggested I was feeling anxious. This is after he's known that I've had MCS for twenty years....its still anxiety....

I just hope that we're all alive to see the day....

I can relate to that, I had to go and stay with my daughter when our house interior walls were repainted. Do you consider that MCS Multiple Chemical Sensitivity plus Food Sensitivity are a part of or the same as ME? I have thought they are essentially the same for the last 30 years. Airborne chemicals, perfumes, plastics, food additives, chlorine in water etc. all of them are a problem. Any exposure causes increasing sensitivity again, and another crash. Then there is the problem of finding the new trigger.
The rapid flicking brain spasms too. Psychogenic Non-epileptic Seizures? Far worse at night, especially in hypnogogic state. Have tried to reduce EMRs, cut out decaffeinated coffee with some effect, pulse foods make it far worse as they prevent sleep.

 

[Issie]

Have any of you tried treating MCAS? I had terrible shakes and tremors. Reacted to everything. POTS was horrible. Treating my MCAS and also addressing my autoimmune system and inflammation has helped sooooo much.

Issie

 

[Cort]

I

Another condition I'd like to see researched more (biomedical research) is "Psychogenic Non-epileptic Seizures"(PNES). They are seizures that a 20 second EEG says aren't caused by electrical disruption in the brain (like epilepsy). If the EEG is negative, the patient gets slapped with this label, PNES, and is sent for counseling for "traumatic memories in the subconscious mind that the conscious mind can't handle, so they have seizures to protect themselves from traumatic memories surfacing." It's a ridiculous concept.

A close friend of mine was labeled with PNES. He never went for counseling. Much later, he found out he had arthritis in his cervical spine and had several steroid injections on a Wednesday for pain in his neck, shoulder and arm. The seizure symptoms which he had had daily for two-and-a-half years suddenly disappeared the day of the steroid injections. They did not come back until the steroid injection wore off and he went back in for more injections. He had similar positive results.

Nobody thought or told us the steroid injections would help the seizures, and it certainly never crossed our minds, so this was not a placebo effect. We were shocked when we realized he didn't have seizures or episode symptoms later that night, and for months thereafter.

The doctors are still baffled &/or in disbelief about this. However, to me it makes sense that if there is inflammation causing pressure against or in the spinal cord, it could cause seizures and other neurological symptoms. If anyone else has a better explanation, I'd love to hear it.

But, basically, if the seizures were psycological...how did a steroid injection fix it? How many people are labeled with PNES & there really is a physical cause for their non-epileptic seizures?

I agree! That seems like wiggy default psychological diagnosis.

Another on is psychogenic thirst or something like that. When I drink a lot of water I get that - an intense thirst and dry mouth...It only happens when I drink water (as opposed to juices).....I think something must be going on.

 

[Cort]

You got that right!

I hear this a lot. It’s frustrating, especially when we were so high functioning prior to illness.

POTS results in serious anxiety if I’m up too long (minutes), but the anxiety is downstream from the biochemical changes desperately trying to keep me upright and conscious. Regardless, to the average observer or even family member, anxiety is anxiety - and it’s a psych problem. Sigh.

I recently had my urine neurotransmitters tested. The results showed severe deficits of all except epinephrine. No wonder I shake, sweat, etc when I’m up.

Quite frankly, I think I’m doing pretty dang well for someone with neurotransmitters off the bottom of the ranges!!!

I think this is common in ME?

I'm definitely with you on this one! Remember Maggie's story?

When Panic Isn't: Dr. Bell on Maggie's ME/CFS and Fibromyalgia Story

 

[Cort]

I can relate to that, I had to go and stay with my daughter when our house interior walls were repainted. Do you consider that MCS Multiple Chemical Sensitivity plus Food Sensitivity are a part of or the same as ME? I have thought they are essentially the same for the last 30 years. Airborne chemicals, perfumes, plastics, food additives, chlorine in water etc. all of them are a problem. Any exposure causes increasing sensitivity again, and another crash. Then there is the problem of finding the new trigger.
The rapid flicking brain spasms too. Psychogenic Non-epileptic Seizures? Far worse at night, especially in hypnogogic state. Have tried to reduce EMRs, cut out decaffeinated coffee with some effect, pulse foods make it far worse as they prevent sleep.

I don't know...There is the central sensitization factor - that's similar but my MCS never effected by ability to do "exercise"...it just made me feel awful....So I think they're related and different.

 

[Carollynn]

Some years ago it seemed that questions about brain injury from trauma, not pathogens, in ME/CFS seemed a popular thread. Cort, have you ever offered a survey on that? I remember a bad fall from a swings as a child, a relatively minor traffic accident--slow, but did hit my head on the dashboard--a couple of very hard falls when skiing, a car trunk falling and hitting me on the head... Do all healthy humans accumulate these kinds of "mild" injuries, or have people with ME/CFS accumulated more?

 

[Cort]

I haven't.... I did have a concussion as a teenager - one of the few differences between myself and my twin brother - who does not have ME/CFS....

Some years ago it seemed that questions about brain injury from trauma, not pathogens, in ME/CFS seemed a popular thread. Cort, have you ever offered a survey on that? I remember a bad fall from a swings as a child, a relatively minor traffic accident--slow, but did hit my head on the dashboard--a couple of very hard falls when skiing, a car trunk falling and hitting me on the head... Do all healthy humans accumulate these kinds of "mild" injuries, or have people with ME/CFS accumulated more?

 

[Audrey Brimson]

I don't know...There is the central sensitization factor - that's similar but my MCS never effected by ability to do "exercise"...it just made me feel awful....So I think they're related and different.

During the worst few years going up a third step was impossible, even on the level it felt as if I was wearing deep sea divers boots, still have a problem walking more than 50ms, swimming is better than walking - no gravity, but the chlorine pools rule that out. Finding and avoiding all food & chemical triggers (as much as possible) makes life very restricted but so much better. It is not a cure but IS a way to live.

 

[Audrey Brimson]

Have any of you tried treating MCAS? I had terrible shakes and tremors. Reacted to everything. POTS was horrible. Treating my MCAS and also addressing my autoimmune system and inflammation has helped sooooo much.

Issie

Issie, thank you. First I thought what is MCAS? Wikipedia, oh it is Mast cell activation - right - Histamine/Mast cells an old friend with a new name. 30 years sporadic anti-histamines, steroids, Beta blockers; yes, still shaking, still too often on red alert, but panic label is pinned on rather than ME. Worst scenario a few days after a triple bypass, (which was done because of a severe reaction to an angiogram) massive reaction to hospital chemicals and heparin injection, anaphylaxis, just to be sure repeated 2 days later with anaphylactic response again. Still recorded in notes as "Panic/anxiety, which the patient said was a severe chemical reaction". I refused further Heparin. HOW do you treat histamine reactions??

 

[Issie]

Issie, thank you. First I thought what is MCAS? Wikipedia, oh it is Mast cell activation - right - Histamine/Mast cells an old friend with a new name. 30 years sporadic anti-histamines, steroids, Beta blockers; yes, still shaking, still too often on red alert, but panic label is pinned on rather than ME. Worst scenario a few days after a triple bypass, (which was done because of a severe reaction to an angiogram) massive reaction to hospital chemicals and heparin injection, anaphylaxis, just to be sure repeated 2 days later with anaphylactic response again. Still recorded in notes as "Panic/anxiety, which the patient said was a severe chemical reaction". I refused further Heparin. HOW do you treat histamine reactions??

So sorry for your trauma. I use an H1 (Allegra), H2 (Zantac) and a mast cell stabilizer (GastroCrom ). I pay attention to what always causes reaction and what sometimes causes reaction. Mast cell issues can be unpredictable. I can react one time and not the next. Strong emotion, getting too hot, stress all can cause a mast cell degranulation. I'm still learning and experimenting to tweak what I do. But it is something I have to stay on top of. I think Diet is a big part of what helps me. I'm mostly vegan. (Not perfect, but I try.)
Issie

 

[Carollynn]

I haven't.... I did have a concussion as a teenager - one of the few differences between myself and my twin brother - who does not have ME/CFS....

That's really interesting. And of course awful--I'm sorry you suffered that. May I ask how it happened? Wouldn't it be crazy if physical brain injury AND certain viruses AND genetic predisposition all play a part. Hm. I do know that when a dear friend developed a systemic staph infection, the doctors told him (when he came out of the coma!) that it would settle into areas where he'd had other injuries and surgeries: knee, back, heart, and that there would be a chance that he'd have to surgery again in those places to repair the new damage. He's doing quite well now, but it took a few years.

And I hope that you and your brother are part of all of the biobanks possible for researching ME/CFS. It's none of my business really, but what an opportunity.

 

[Onslow]

Now things are changing. It's remarkable though that even these tough soldiers have been accused of being shirkers.Even after highly trained special forces soldiers have literally gone crazy and killed themselves, many in the military still thought of the PTSD as "psychological". It demonstrates how deep the belief that something is psychological can get embedded - past all belief, really.

The idea that people with PTSD are "shirkers", "psychologically weak" or "unmanly" was a common one during WW1, but today doctors are much more understanding about it. It is understood that PTSD is an actual disorder, and not just malingering. Quite a lot of research has been done over the years, and we know quite a bit about PTSD. PTSD is no more about being "weak" than suffering from depression or a phobia could be considered being weak. It is completely outside conscious control, and yet still caused by psychological factors.

While this new research is interesting and may explain some cases of PTSD, it certainly doesn't explain the many cases (majority?) where there was no blast at all, or the many civilians who suffer from PTSD after rape, etc.

I've seen figures of between 35% and 50% for the number of soldiers who have PTSD after Iraq and Afghanistan. Arguably PTSD is a normal reaction by the brain to war, and perhaps the people who don't have any psychological trauma after killing someone are the ones who are abnormal.

 

[Horizon]

I think a lot of the problem is that scientists are grappling with the fact that a lot of diseases are both in the brain and elsewhere. Example being IBS being a functional disorder that is some miscommunication between the brain and gut. Does that make it psychological or physical? What if it's a bit of both? Almost every disease is exacerbated by stress so I think the idea that something is purely physical or purely psychological is likely too simplistic.