PTSD: A Window into the Bodymind (Part 5)

Once upon a time, conventional science and medicine just ‘knew’ that the mind was different than the body…that the head’s place was to rule the heart…that the nervous system, immune system, and hormonal system were entirely separate…that either nature or nurture was bound to be predominant in the development of human personality…and that certain conditions were all in a person’s head. That someone could suffer inexplicable pain or fatigue (or, alternatively, that someone could get better from a placebo) was attributed to the condition being “psychosomatic.”

Today, we know that just about all those assumptions were wrong. The mind, it turns out, is an amalgam of the brain and the body – two sides of the same coin. The ‘rational’ part of the brain, the neocortex, is literally bypassed in cases of emergency; meanwhile, our gut has its own nervous system that can take precedence over what the ‘upstairs’ brain thinks. The nervous, immune, and hormonal systems are in constant contact, influencing one another reciprocally. Nature and nurture have likewise been found to collude in the formation of personality; genetic predispositions either come to pass or not based on factors in the person’s environment. And a wide range of maladies – such as PTSD, ulcer, allergy, migraine, chronic fatigue, fibromyalgia, irritable bowel, depression, et al – demonstrates that every one of us is psychosomatic – that is, we’re influenced by feelings, memories, and impressions that are no less ‘real’ or valid for being outside of conscious awareness.

The flip side is that people who benefit from placebos more than other people are being found to have certain personality traits, ones that we might expect from our understanding of boundaries. Would a thick boundary person – one who views things as distinctly ‘me’ or ‘not me,’ who isn’t quick to recognize what he or she is feeling, and who’s prone to being habitual or rigid – be more or less likely than a thin boundary person to believe that a particular remedy will help, and make that suggestion real? If you said no, it’s the thin boundary person who’ll benefit more from a placebo, you’d be right. People who are open to new experiences, who show directness and resilience, are the ones who gain the most symptom relief.

Thus, it’s time for two more sacred cows to be overturned. One of these says that all people are essentially the same, so that if person x has the same condition as person y, then they both should derive benefit from treatment z. The second presumption is equally simplistic and unimaginative. It says that someone either has an illness or does not…making him or her either “normal” or “abnormal.”

What we’re learning about PTSD puts the lie to both those axioms. There are at least two ‘flavors’ of this affliction: the kind where past fears are vividly reexperienced, and the kind where the person goes numb. Additional subtypes of PTSD may yet be discovered. For now, though, we can see the condition as a confluence of several factors. These include gender (women are more likely to manifest PTSD), reactivity (high reactors disposed toward one form, low reactors toward another), the nature of the trauma itself (acute or chronic), the timing of the trauma (whether occurring in childhood or adulthood), and the kind and degree of support received by caring family members, friends, or therapists.

People aren’t blissfully normal before they develop PTSD, nor are they irrevocably abnormal once they evince the illness. The type and severity of PTSD varies along a spectrum, just as an individual’s boundary type, as we’ve seen, varies along a spectrum from extremely “thick” to extremely “thin.” Where science and medicine can make the most headway, it seems to me, is through an appreciation that both human nature and chronic illness lie along a continuum. By examining the necessarily complex intersection of person with condition, we’ll be able to learn the most about both, and treat the individual most humanely and effectively.

Bit by bit, questioning – and questing – leaders in philosophy, psychiatry, and medicine are coming to this view of things. They see that the old assumptions are painfully limited, increasingly ineffectual, and manifestly out of step with the accumulating evidence. They seek a "spectrum" approach to both person and illness, replacing the linear model that is today’s convention. Just as the body politic realizes that answers to our society’s most pressing needs will not be found by pulling wholesale from party a or party b, so leaders of the new medicine are pushing for a framework that properly accounts for the complexity of human beings, the salient differences in bodymind functioning between people, and a full appreciation that we not separate from our environment. All of us are embedded in nature…we are social creatures influenced by our fellows…and we are all sentient beings for whom feelings (even the unconscious or dissociated kind) are paramount.

Most of all, we are unified beings, incorporating mental, emotional, physical, psychological, somatic, and spiritual functioning. When a given ‘disorder’ stubbornly defies conventional treatment, it is wrongheaded to segment the problem as either physical or psychological, and to prescribe more or different medication in the hope that the symptoms will just go away. The symptoms – of PTSD, alexithymia, chronic fatigue, chronic pain, depression, anxiety, or many other chronic conditions – are truly a call for attention. These conditions are inevitably of us, even if we would prefer them not to be. Rather than treating them as alien and seeking to stamp out the symptoms, both patients and caregivers would do better to assess the why of the matter. “What is my boundary type?” “How did I become this way?” and “What is my condition telling me?” are all pointed and prospectively illuminating questions. While medication may be called for at least some cases, the overall aim should be for the disorder to be integrated and transformed rather than overcome. This will advance the person’s long-term flourishing rather than merely ‘fix’ his or her current suffering.

For PTSD and other excruciating dilemmas, it’s an approach that we ought to put to use.