In his recent posting, “Joe is Not His Amygdala,” Dr. George Mastroianni argues that we should not re-name PTSD “post traumatic brain injury” because this makes PTSD a purely brain-based disorder and fails to separate the brain and the mind.
These points are well taken, especially because this could lead people to confuse the impact of psychological trauma—exposure to the threat of one’s own or others’ death or to life-altering violations of the body—with traumatic brain injuries (TBI), which involve direct physical injury to the brain through concussive assaults such as blast injuries caused by IEDs. PTSD and TBI increasingly are found to co-occur in warzone deployed military personnel, but their causes and symptoms are different.
It’s also true that neuroimaging research does not implicate only the amygdala as the “cause” or source of PTSD. Traumatic stressors that involve a psychological assault, but not a physical assault on the brain, such as those experienced by military personnel in war (or anyone who suffers physical or sexual abuse, sexual assualt, exposure to a life-threatening accident, or natural disaster). Traumatic stressors do not injure the brain, but they DO change how the brain works.
Neuroimaging studies suggest that the change is a shift from a brain in which the stress, reward, and self-reflection systems operate in learning mode—enabling the individual to explore and enjoy the world, to gain and remember knowledge that enriches life—to a brain operating in survival mode. A brain in survival mode is on the defensive and prone to negative emotional, cognitive, and behavioral reactions. This shift is observed in changes in the relationship between the emotional brain’s limbic (amygdala, hippocampus) and deep midbrain areas, and the prefrontal and cingulate cortex.
This is not an injured or damaged brain, but a brain that has been hijacked by primitive areas that are essential to survival. This changes the relationship amongst these brain areas from one of dialogue and cooperation that enhances attention and thoughtful decisions to a struggle for control that leads to hypervigilance, impulsivity, and dysphoria.
Mastroiani is right that parts of the brain are not good or bad, but wrong in saying that we don’t know what happens to people’s brains after exposure to psychological trauma. We have much more to learn, and the science is by no means definitive, but we do know that PTSD involves a change in the brain, in how key sections in the brain interact with each other. This is not an injury, but it is an altered mode of operation, which profoundly changes the way we think and feel. In other words, PTSD changes our state of mind.
PTSD is a change in how the brain operates that changes the nature of the mind. Instead of approaching each new day and experience with interest and optimism, people with PTSD are preoccupied with anticipating and dealing with threats. It's as iif every problem (or opportunity, or even what appears to be a very minor change in themselves, other people, or the environment), no matter how small or large, is now a threat to their survival.
Sounds like a very distorted view of life, especially when the warzone is thousands of miles away and in the past. Have people with PTSD lost their minds? Should they just snap out of it and get back to reality? Or get their thinking back on track and delete those “distorted” thoughts of still being in a survival-threatening situation?
Absolutely not! That’s the serious downside of under-estimating the role that changes in the brain play in PTSD. The mind is more than the sum of the neurons in the brain, but nothing that we think or feel is separate from the brain. When people with PTSD think the world is dangerous and feel a profound sense of threat and danger, it’s not just “in their mind.” It’s the brain operating in survival mode, and the solution is to shift the brain back to learning mode.
Which is much easier said than done. Yet that’s what every evidence-based psychotherapy for PTSD probably does. Although we don’t have the scientific data yet to demonstrate that successful recovery from PTSD involves a shift in the brain’s operations from survival to learning mode, we do know that that is the difference in brain activity between people with and without PTSD.
And we know that effective psychotherapies for other anxiety disorders do lead to shifts in brain system activity that are very similar to this picture: as the mind shifts from fear and anxiety to attentive interest, hope, and enjoyment, the brain is shifting from patterns of activity dominated by primitive areas to a two-way interaction between those primitive areas and the higher cortical and cingulate areas.
Successful treatment for, and recovery from, PTSD involves the mind re-setting the brain—re-claiming self-awareness, self-confidence, and clear thinking in ways that restore the mind to itself by stopping the amygdala from hijacking the brain.