Scientists Work on ‘Trauma Pill’

“Only 14 percent to 24 percent of trauma victims experience long-term PTSD, but sufferers have flashbacks and physical symptoms that make them feel as if they are reliving the trauma years after it occurred.

Scientists think it happens because the brain goes haywire during and right after a strongly emotional event, pouring out stress hormones that help store these memories in a different way than normal ones are preserved.

Taking a drug to tamp down these chemicals might blunt memory formation and prevent PTSD, they theorize.

Some doctors have an even more ambitious goal: trying to cure PTSD. They are deliberately triggering very old bad memories and then giving the pill to deep-six them.

The first study to test this approach on 19 longtime PTSD sufferers has provided early encouraging results, Canadian and Harvard University researchers report.” (Yahoo! News)

There are several aspects of this effort to ‘cure’ worth examining further. To be blunt, this is an example of one of those studies where a distinction will not likely make a difference. While recipients of ‘the pill’ (the beta blocker propranolol) show lower scores on physiological arousal measures in PTSD, that is very different than changing the meaning of the experience or the distress associated with remembering it, stopping the person’s life from being dominated dysfunctionally by the consequences of their trauma, etc. — true measures of ‘cure.’ There is a big difference between trying to prevent the memories of a trauma from being encoded in the first place, at the time of the experience, in the distinctive chaotic and unmanageable way in which we think traumatic memories are laid down; and trying to affect the reexperiencing. This is about as much a cure as saying that you are ‘curing’ a broken bone by giving enough of a painkiller so that it no longer hurts when the sufferer moves the limb. Or curing a brain tumor by giving enough aspirin that the patient no longer feels any headaches. You get my drift.

Moreover, the study seems based on the implicit notion that the distress experienced when a trauma victim remembers the events, e.g. when talking about them in therapy, re-encodes the memories traumatically and plays a role in their reinforcement and perpetuation. To the contrary; this flies in the face of the fact that ‘the talking cure’ — talking about the trauma and reexperiencing it in measured ways with a therapist skilled in helping the sufferer master the modulation of the memories and their impact — is part of the solution rather than part of the problem; in fact, it is the only therapeutic approach with ‘curative’ benefit to PTSD patients.

The modest positive clinical results achieved with blunting the physiological arousal, however do have one benefit. They get more research funding for these bastions of trauma research. The war in Iraq, in which US forces face with futility an interminable insurgency in which civilians are indistinguishable from enemy combatants, there are no front lines and no distinction between safe zones and the war front, is a factory for the manufacture of PTSD, exactly as was the Vietnam War which marked the founding of the modern industry of psychiatric treatment of and research into PTSD. Traumatology was a languishing backwater of psychiatric study and treatment, despite the consciousness-raising perspective of the women’s movement into the exploitation and power differentials in sexual and domestic relationships, until revitalized and animated by joining with the arguably very different area of study of returning Vietnam veterans. Researchers who can plausibly claim they have a chance of treating the epidemic of traumatized vets returning from Central Asia will have it made for the rest of their research careers.

Unlike the futility of treating with beta blockers months or years afterward, modulating the physiological arousal associated with traumatic experience may prevent memories from being encoded in the damaging and inaccessible traumatic mode in the first place, but you cannot exactly get medication to people rapidly enough to make that difference in most trauma sitautions — rapes, car crashes, witnessing violent crimes, natural disasters, industrial accidents, etc. The one situation in which this is possible is with soldiers going into battle. There is much DoD-funded research interest in prophylactic measures with beta blockers and other therapeutic agents, which if successful will turn our forces even more into automatons insulated from any compunctions about or consequences of their actions.

As implausible as the promise of a ‘cure’ held out by the present study is, it does serve as an opportunity to underscore that a traumatic memory is not just a memory of a traumatic event. PTSD develops when certain — but not any — devastatingly disturbing experiences in some — but not any — individuals swamp the human organism’s coping strategies so thoroughly that it is put into a state of physiological arousal outside the bounds of what our machinery evolved to handle, beyond the evolutionary preparedness of the organism and its usual ‘flight or fight’ stress mechanisms. Even the proverbial scenario of the caveman confronted by the sabertooth tiger is within the bounds of expectable human experience.

This ‘outside the bounds’ factor used to be one of the diagnostic criteria for psychiatrists to classify a patient as having PTSD, but it has been dropped in subsequent iterations of the diagnostic criteria. The concept of PTSD has been broadened to the point where it is meaningless when applied by naive clinicians or patients interested in a convenient explanation for their distress or dysfunction. This has been particularly puissant in the sexual trauma arena. Trauma clinics and victim support groups are shared cheek-by-jowl by patients on the one hand who have undergone unendurable experiences of repeated brutal inhuman sexual violations, often under conditions of virtual captivity by people violating the basic trust of their parental or caretaker roles; and on the other hand those who once experienced a single inadvertent brush of the hand or suggestive glance from a babysitter or neighbor. PTSD has become synonymous with being ‘bummed out once in awhile by something negative that once may or may not have happened to me’. Of course, trauma is in the eye of the beholder, true PTSD sufferers have no choice about organizing their life around the terror, while many carrying the diagnosis, or their caregivers, have in effect opted in. This unwarranted expansion of the PTSD concept to the point where it is utterly meaningless is driven by ‘secondary gains’ for both clinicians and patients that have nothing to do with maximizing therapeutic efficacy.

Addendum (looking for feedback): do FmH readers like these extended pieces on mental health-related news? Longtime readers know I have a few pet peeves in the field I air over and over again, the bastardization and cooptation of the PTSD concept being one of them. You have heard them from me before, and I do tend to get pretty didactic and polemic. Not that there are many comments about any of my posts, but the silence is deafening after one of these psychiatric diatribes. They are of some use to me in blowing off steam, but do you get anything out of them? Among other things, I mean them as an insider’s cautionary tales for those of you who are consumers of mental health services. Of course, I may not get any feedback in response to this query because my readers may have not have gotten this far, having long since stopped reading this post far above…

Addendum II: Thanks to walker for reminding me about Warnock’s Dilemma, described thus by Wikipedia: “Warnock’s Dilemma, named for its progenitor Bryan Warnock, points out that a lack of response to a posting on a mailing list, Usenet newsgroup, or Web forum does not necessarily imply that no one is interested in the topic,” and goes on to posit six other possible explanations for reader nonresponse.

Most murderers just need to get a life

Incorrigible curmudgeon Theodore Dalrymple reflects on his consultations in murder cases: “When I look back on all these murders and murderers, what do I feel? And do I remember the murderers as evil men, who joyfully did what they knew to be wrong and were prepared to take the consequences, even as they tried to avoid them? Did they all have black hearts upon which murder had been inscribed since birth?

No. I am overwhelmed by a sense of the unfitness for life of all the participants in these sordid dramas: their main problem was that they had not the faintest idea how to live and yet – this is the hallmark of modernity – they were plentifully supplied with ego.

They had received no guidance from religion, naturally enough, since God is dead for them, and never has been very much alive. As for social convention, it has not so much been destroyed as turned inside out. The poor who once prided themselves on such things as respectability, cleanliness, honesty, orderliness and thrift, often in the most difficult circumstances, now pride themselves on their bohemianism. Disorder and chaos are a metonym for freedom and authenticity. But they are bohemians without being artistic, and the result is a squalor scarcely credible in times of supposed prosperity.” (The Australian)

Scientists Work on ‘Trauma Pill’

“Only 14 percent to 24 percent of trauma victims experience long-term PTSD, but sufferers have flashbacks and physical symptoms that make them feel as if they are reliving the trauma years after it occurred.

Scientists think it happens because the brain goes haywire during and right after a strongly emotional event, pouring out stress hormones that help store these memories in a different way than normal ones are preserved.

Taking a drug to tamp down these chemicals might blunt memory formation and prevent PTSD, they theorize.

Some doctors have an even more ambitious goal: trying to cure PTSD. They are deliberately triggering very old bad memories and then giving the pill to deep-six them.

The first study to test this approach on 19 longtime PTSD sufferers has provided early encouraging results, Canadian and Harvard University researchers report.” (Yahoo! News)

There are several aspects of this effort to ‘cure’ worth examining further. To be blunt, this is an example of one of those studies where a distinction will not likely make a difference. While recipients of ‘the pill’ (the beta blocker propranolol) show lower scores on physiological arousal measures in PTSD, that is very different than changing the meaning of the experience or the distress associated with remembering it, stopping the person’s life from being dominated dysfunctionally by the consequences of their trauma, etc. — true measures of ‘cure.’ There is a big difference between trying to prevent the memories of a trauma from being encoded in the first place, at the time of the experience, in the distinctive chaotic and unmanageable way in which we think traumatic memories are laid down; and trying to affect the reexperiencing. This is about as much a cure as saying that you are ‘curing’ a broken bone by giving enough of a painkiller so that it no longer hurts when the sufferer moves the limb. Or curing a brain tumor by giving enough aspirin that the patient no longer feels any headaches. You get my drift.

Moreover, the study seems based on the implicit notion that the distress experienced when a trauma victim remembers the events, e.g. when talking about them in therapy, re-encodes the memories traumatically and plays a role in their reinforcement and perpetuation. To the contrary; this flies in the face of the fact that ‘the talking cure’ — talking about the trauma and reexperiencing it in measured ways with a therapist skilled in helping the sufferer master the modulation of the memories and their impact — is part of the solution rather than part of the problem; in fact, it is the only therapeutic approach with ‘curative’ benefit to PTSD patients.

The modest positive clinical results achieved with blunting the physiological arousal, however do have one benefit. They get more research funding for these bastions of trauma research. The war in Iraq, in which US forces face with futility an interminable insurgency in which civilians are indistinguishable from enemy combatants, there are no front lines and no distinction between safe zones and the war front, is a factory for the manufacture of PTSD, exactly as was the Vietnam War which marked the founding of the modern industry of psychiatric treatment of and research into PTSD. Traumatology was a languishing backwater of psychiatric study and treatment, despite the consciousness-raising perspective of the women’s movement into the exploitation and power differentials in sexual and domestic relationships, until revitalized and animated by joining with the arguably very different area of study of returning Vietnam veterans. Researchers who can plausibly claim they have a chance of treating the epidemic of traumatized vets returning from Central Asia will have it made for the rest of their research careers.

Unlike the futility of treating with beta blockers months or years afterward, modulating the physiological arousal associated with traumatic experience may prevent memories from being encoded in the damaging and inaccessible traumatic mode in the first place, but you cannot exactly get medication to people rapidly enough to make that difference in most trauma sitautions — rapes, car crashes, witnessing violent crimes, natural disasters, industrial accidents, etc. The one situation in which this is possible is with soldiers going into battle. There is much DoD-funded research interest in prophylactic measures with beta blockers and other therapeutic agents, which if successful will turn our forces even more into automatons insulated from any compunctions about or consequences of their actions.

As implausible as the promise of a ‘cure’ held out by the present study is, it does serve as an opportunity to underscore that a traumatic memory is not just a memory of a traumatic event. PTSD develops when certain — but not any — devastatingly disturbing experiences in some — but not any — individuals swamp the human organism’s coping strategies so thoroughly that it is put into a state of physiological arousal outside the bounds of what our machinery evolved to handle, beyond the evolutionary preparedness of the organism and its usual ‘flight or fight’ stress mechanisms. Even the proverbial scenario of the caveman confronted by the sabertooth tiger is within the bounds of expectable human experience.

This ‘outside the bounds’ factor used to be one of the diagnostic criteria for psychiatrists to classify a patient as having PTSD, but it has been dropped in subsequent iterations of the diagnostic criteria. The concept of PTSD has been broadened to the point where it is meaningless when applied by naive clinicians or patients interested in a convenient explanation for their distress or dysfunction. This has been particularly puissant in the sexual trauma arena. Trauma clinics and victim support groups are shared cheek-by-jowl by patients on the one hand who have undergone unendurable experiences of repeated brutal inhuman sexual violations, often under conditions of virtual captivity by people violating the basic trust of their parental or caretaker roles; and on the other hand those who once experienced a single inadvertent brush of the hand or suggestive glance from a babysitter or neighbor. PTSD has become synonymous with being ‘bummed out once in awhile by something negative that once may or may not have happened to me’. Of course, trauma is in the eye of the beholder, true PTSD sufferers have no choice about organizing their life around the terror, while many carrying the diagnosis, or their caregivers, have in effect opted in. This unwarranted expansion of the PTSD concept to the point where it is utterly meaningless is driven by ‘secondary gains’ for both clinicians and patients that have nothing to do with maximizing therapeutic efficacy.

Addendum (looking for feedback): do FmH readers like these extended pieces on mental health-related news? Longtime readers know I have a few pet peeves in the field I air over and over again, the bastardization and cooptation of the PTSD concept being one of them. You have heard them from me before, and I do tend to get pretty didactic and polemic. Not that there are many comments about any of my posts, but the silence is deafening after one of these psychiatric diatribes. They are of some use to me in blowing off steam, but do you get anything out of them? Among other things, I mean them as an insider’s cautionary tales for those of you who are consumers of mental health services. Of course, I may not get any feedback in response to this query because my readers may have not have gotten this far, having long since stopped reading this post far above…

Addendum II: Thanks to walker for reminding me about Warnock’s Dilemma, described thus by Wikipedia: “Warnock’s Dilemma, named for its progenitor Bryan Warnock, points out that a lack of response to a posting on a mailing list, Usenet newsgroup, or Web forum does not necessarily imply that no one is interested in the topic,” and goes on to posit six other possible explanations for reader nonresponse.