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Traumatic events throw our brain into an adrenaline-fueled defense response. That response helps us detect, avoid, and defend ourselves from danger. But it is supposed to turn off when the danger has passed. Unfortunately for some, the brain gets stuck and they develop post-traumatic stress disorder. And PTSD hurts. The suffering is intense as innocuous events can trigger people to re-experience the trauma as intensely as they did the first time. Even worse, the daily experience of people with PTSD is so out of step with everyone around them, they can feel isolated.
But is it really fair to call PTSD a disorder? After all, the post-traumatic stress response helps people adapt to dangerous environments and survive them. Is it possible that we are misunderstanding something crucial? Advocates for veterans with PTSD are starting to call for a change.
PTSD has had many names in the past: shell-shock, combat fatigue, war neurosis. In 1980 it was added to the DSM and called Post-Traumatic Stress Disorder. That designation was a huge step forward, because prior to that many Vietnam veterans had been incorrectly labeled with schizophrenia.
Shauna Springer, Ph.D., an expert on PTSD, refers to that milestone as a time when people of courage spoke truth to power. “That was an important victory because it said it's not in your head. This is not something you're making up,” Springer says. “PTS is in direct proportion to trauma exposures.”
PTSD is an injury
Since 1980 we’ve learned a lot about PTSD, and the term ‘disorder’ makes less sense than it used to. “Terms and our understanding need to continue to evolve as the science evolves. And now what we know is that a healed brain looks different from an injured brain on a brain scan if you use the right brain scan. So PTS is literally in your head. It is literally an injury, rather than a disorder. And it’s an injury that can be healed," says Springer.
Brains of people with PTSD do look different on brain scans. While the findings are extensive, the most noted change is volume loss in the hippocampus, which has been demonstrated in veterans and survivors of childhood abuse. Of note, how much smaller the hippocampus got depended on the severity of the combat or the repeated nature of the childhood trauma. And research also suggests that communication within the stress circuitry of the brain is disrupted in PTSD.
In line with the work of world-renowned psychiatrist Frank Ochberg and anesthesiologist Eugene Lipov, Springer believes we should change the name from PTSD to PTSI (post-traumatic stress injury). “It's an injury that really is about a mismatch between your environment, and what has been adaptive for you in a different environment,” she says. She joins in a growing recognition among experts that PTS is not properly a disorder, but an adaptive response to an extreme environment that helps us survive.
“If you think about people who are going into a war zone, the kinds of responses that you need to have to survive in that war zone translate directly into many of the symptoms that we assess for as psychologists. For example, the hyper-vigilance that you need to always be scanning for the threat is absolutely adaptive,” Springer explains. “In modern war zones, there is no ceasefire. There is no place that is always behind the wire. As we learned in the Vietnam War, even on secure bases, sometimes the enemy infiltrates our ranks. So, being hyper-vigilant all the time is absolutely adaptive. You need to be always scanning for who is friend and who is foe or for where the threat is.” She also points out that PTS’s exaggerated startle response primes the body for a rapid response to threat. Many might call this a battle-ready state.
The problem comes in when people leave that war zone and come home. “When people come home to their day to day life they have a mismatch with their environment. They get flooded with adrenaline continually and are primed to respond to perceived threats that are not always real threats. Sometimes they are, but usually they're not. They might understand this logically, but their body has changed at a cellular level,” says Springer. “I call this “chronic threat response.” But of course, this is not a recognized diagnosis.”
PTSD is an adaptive response
Air Force veteran JJ Snow is an advisor to Thriving Warrior, an online safe space for veterans. She wants to take the change in terms one step further. Snow acknowledges that calling PTSD an invisible wound helps because it helps people understand that something real is happening to them. She says when veterans get home they want to know why they feel broken, why life is not making sense. “Having somebody acknowledge that you have an invisible wound helps. You have something that has helped you to adapt to a very extreme environment, and that's okay,” says Snow.
But she would rather we called PTS an adaptation rather than an injury. Snow wants her fellow veterans to understand that “There is nothing wrong with you. It’s an adaptation to something extreme.”
“You're in this battlefield environment and you adopt a very different mindset. So PTSD is part of your ability to react quickly to something that sounds strange,” Snow explains. “It's okay because those things that happened to you over there helped you to survive. Then you brought them back with you, but it doesn't mean that you're broken. It doesn't mean that it is going to limit you. In fact, it's an enhancement because it makes you more aware of your surroundings. It's made you more responsive to little things that other people may not pick up on.”
Snow says one of the challenges is explaining PTS to people who’ve never dealt with it. She advises veterans to say, “Hey this is why I do this. It might seem weird to you but here's where it came from.” When people start to understand, they tend to respond, “Oh wow. I've never been in a situation like that or I've never had to deal with that. That totally makes sense.”
Snow emphasizes the need to have a better transition for veterans returning to normal life. She points to the Israeli military, which she feels has an attitude of thriving and helps veterans identify the skills they learned in combat and make use of them.
Healing PTSD
Still, even if the post-traumatic stress response starts for a good reason and helps warriors, it still causes all kinds of problems for people when it continues in civilian life. The issue is that the stress response can get stuck in the on position when it needs to turn off.
Springer emphasizes that PTSI is an injury that can be healed. Her role as a psychologist allows her to learn a lot that people share with nobody else. “Many of the most successful people in our society are actually people who have been impacted by trauma and have become stronger through walking through a valley in a way that has brought post-traumatic growth. With the right insights and the right support people will walk that valley and come out stronger than they've ever been before,” she says.
Treatment for post-traumatic stress is a topic that was covered recently in Psychology Today. But the important thing is to remember hope. In Springer’s experience, “Time and time again, when we call to people's strength and we support them in the right ways, they are capable of achieving things we never would have thought possible.”
