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Curing post-traumatic stress disorder

Post-traumatic stress disorder is a common and complex, and much misunderstood condition, that arises in wartime environments but not only during wartime. It can arise amongst people of different ages and at different times of life, and manifest itself in a multitude of different ways. Military theatre makes it a particularly common phenomenon, because its cause is almost always the same: extended exposure to stressful or traumatic events over a period of time in excess of that which the body and the mind can adequately manage. When faced with extreme danger, the body produces adrenaline, which results in the so-called “flight or fight” reaction: you either run away from the harm anticipated or you face down the danger. This is a natural hormonal and neurochemical reaction to extreme events in which one perceives oneself or one’s loved ones in danger and adrenaline based reactions to some extent are part of everyday life. However when they extend over continuous periods, they exceed the thresholds that the mind and body are able to adjust to and this is what causes a long-term disorder.

In essence, post-traumatic stress disorder is a long-term neurochemical imbalance in the brain in which the chemicals that transmit messages between the brain and the body, and control how you are thinking, are disrupted due to excessive quantities of adrenaline. In this way the symptoms, if not the causes, of post-traumatic stress disorder are similar to those experienced in drug related psychosis, in which consumption of recreational narcotics (including alcohol) in excessive quantities over extended periods can disrupt chemical flows affecting the relationship between the brain and the rest of the body over the longer term because the body has become used to those chemicals being at extreme levels and therefore where the narcotic, stress or trauma is taken away the body cannot re-adjust the chemical balances between the various neurotransmitters to an ordinary level. This can lead to an indefinite period of anxiety, depression or psychosis as one’s emotional reactions do not respond in the same way as a healthy person’s would do.

Moreover certain sorts of event in post-traumatic stress disorder associated with the original trauma may cause the chemical balances in the brain to shift radically over a short period and cause irrational fear, anger or other inappropriate emotional responses. This is particularly the case where a person has been placed in constant fear of some danger or unpleasantness and specific emotional triggers can recreate the adrenalin rush associated with the fight-or-flight reaction even though a repetition or the danger or harm is non-existent. This is particularly the case for people who have been tortured, imprisoned, abused sexually, psychologically or physically, have operated in front line environments in which they have seen people killed and maimed repeatedly, or repeatedly had to deal with civilian atrocities (such as first responders). When used to working in an environment of constant potential danger, it may become tempting to treat every bang as a potential report from a firearm or an incoming artillery round; every person who enters a bar or restaurant as a potential assassin or malfeasor; and so on and so forth. These are all classical symptoms of post-traumatic stress disorder.

The other feature associated with post-traumatic stress disorder is the fear of being alone and in particular sleeping at night; insomnia is a problem, as trying to sleep may cause one to relive experiences the mind has intentionally buried and they may revert in one’s dreams, causing both insomnia of the kind in which it is hard to get to sleep and that kind in which one keeps on waking up. Post-traumatic stress disorder is difficult to diagnose, because it can be mixed up with an number of other underlying psychiatric conditions which it may exacerbate. Also a patient may fail to understand the nature of the condition; friends and family may shun him or her; he or she may feel isolated and unable to obtain help. Although many people leave the military with post-traumatic stress disorder, very few countries’ militaries have sufficient resources or expertise to treat the very large number of people being discharged who are mentally unfit to re-enter the regular world on normal terms without adequate treatment.

Although there is a substantial temptation to “be strong” and wait out the symptoms of post-traumatic stress disorder, this often is not effective and active treatment is required to avoid long-term disruptions to people’s lives including insomnia and anxiety. There is a strong temptation to “self-medicate” with alcohol or other recreational narcotics which may cause short-term relief from symptoms, particularly from anxiety, but my also exacerbate symptoms such as paranoia and may cause long-term health damage in other ways including other serious long-term neurotransmitter imbalances. Alcohol and tobacco consumption can cause serious physical health problems including obesity, cirrhosis and cancer. Psychotherapy can be an initial stage in the treatment of the disorder in order to assist the patient in coming to terms with the causes and symptoms but ultimately because post-traumatic stress disorder is a condition of chemical imbalances in the brain pharmaceutical medication overseen by a qualified psychiatrist is likely to be necessary in order to eradicate the condition.

The psychiatrist must be appraised of the patient’s history of stress and trauma as it is easy for psychiatrists to misdiagnose post-traumatic stress disorder as a different condition within the usual spectrum of psychiatric illnesses. Although depression and anxiety are components of most forms of post-traumatic stress disorder the symptoms are distinctive in the context of PTSD as they are caused by the underlying trauma and eliminating the trauma may require experimentation with a range of different medications. Anxiolytics such as those medications in the benzodiazepine class may be useful in the short term but by reason of their dependency forming qualities they may not be a useful form of treatment in the longer term. A course of anti-psychotics possibly mixed with anti-depressants may be appropriate. Use of these medications must be discussed in detail with the patient as they may have both advantages and disadvantages such as weight gain or sexual dysfunction but these may manifest themselves only in a relatively small proportion of the patient population. Seldom is treatment required for more than a few months.

Ukraine has a torrent of psychiatric healthcare concerns as a result of the extended war in the country and post-traumatic stress disorder is rampant. It is imperative to raise awareness of psychiatric healthcare concerns in the future to ensure the collective health of Ukraine and her people and to deal with the inevitable health consequences of trauma suffered amidst war by civilians and military personnel alike.


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