Hippocrates famously stated, “It is more important to know what sort of person has a disease than to know what sort of disease a person has.” What he said was correct then and it remains correct today. If anything, the latest discoveries from medicine and psychology are demonstrating that it’s the intersection of person and illness that will surely yield the most useful insights about the nature of chronic illness and, indeed, human nature itself.
Take the modern plague of post-traumatic stress disorder (PTSD), which is debilitating the lives of so many combat veterans (not to mention civilians traumatized by emotional abuse, natural disasters or other horrific events out of their control). Did you know that:
• Trauma experienced before a soldier goes to war – particularly in childhood – may play a greater role in the development of his PTSD than the actual tour of duty. A recent study of 746 Danish soldiers posted to Afghanistan found that 13% actually reported feeling better during and just after their tour of duty. These same soldiers, it turns out, were much more likely than their comrades to have suffered through family violence or other forms of trauma in childhood – experiences that they found difficult or impossible to talk about. The researchers speculate that the camaraderie and feeling of support from fellow soldiers bolstered them during their deployment, only to ebb after their return home.
• PTSD isn’t one syndrome – there are distinctive subtypes. Researchers have found, for example, that some PTSD sufferers (anywhere from 12-25%) show a unique pattern of dissociation. (Dissociation is an extreme reaction to stress whereby a person feels strangely distanced from what is happening to him or her. Life may feel unreal or the person may feel distant from his or her own body.) Rather than the more typical form of PTSD, where the person feels extremely on edge or fearful, life for these dissociating individuals feels unreal, as if their own bodily experience is blurry or indistinct.
• Another variation of PTSD is one where sufferers develop obsessive-compulsive disorder (OCD) following the traumatic episode. Studies have found that anywhere from 4-22% of people with PTSD also have a diagnosis of OCD.
• People differ greatly in their ability to recover from trauma. About two-thirds of people afflicted with PTSD eventually recover. Being supportively touched or held by family members or caring friends seems to be a factor, as does the degree of communication between the emotional and reasoning circuitry in a person’s brain. Animal studies suggest that having a “quieter” or less reactive stress handling system overall may also contribute mightily to resilience.
When we picture PTSD, of course, we think of someone who re-experiences the trauma virtually as a replay – with the sights, sounds, smells and, most importantly, fears registering in his/her system as if the remembered episode were taking place in the present moment. Since one-quarter to one-third of people exposed to the most violent or life-threatening situations don’t develop these symptoms (indeed, less than one-third of individuals who have spent time in war zones develop PTSD), the question becomes: what distinguishes the people who do suffer from PTSD?
The ever-accumulating evidence points to a combination of nature and nurture. People with PTSD may well have a genetic predisposition to be affected by stress more keenly than others, but whether that predisposition displays itself in adulthood depends on what’s experienced in childhood and infancy – and even in the womb. The study of how environmental and emotional influences affect the operation of genes is known as epigenetics. Plenty of evidence suggests that people affected by PTSD not only carry gene variants that make emotional memories especially vivid but also that early life experiences ‘switch on’ this type of disposition.
In this case, epigenetics plays out in a less than gender-neutral way. Women are twice as likely as men to develop PTSD, or at least to come forward and be diagnosed with it. So we might want to consider the myriad ways that women are more sensitive or more susceptible than men: to sensory stimuli, to autoimmune diseases, to pain, to conditions such as migraine, fibromyalgia, and irritable bowel syndrome that are characterized by pain, to anxiety disorders, and to emotional prompts in general. Emotion, in my opinion, holds the key to understanding PTSD – and chronic illness in general – because feelings have such a demonstrable influence on symptom severity and quite likely even the development of the types of conditions noted immediately above.
But following the ‘female’ trail a bit, we happen on something odd. One would suppose that women, who tend to register and remember emotion more keenly than men, would be less likely to manifest the dissociative form of PTSD (since dissociation is a form of emotional distancing). However, that’s not the case – women are still twice as likely to show a dissociative pattern, characterized by complaints of feeling emotionally numb. A closer look, therefore, is needed at this particular subtype of PTSD. What are the differences in neural processing from the ‘classic’ form of PTSD where the person re-experiences the traumatic event as if it’s happening in the here and now?