PTSD – Moving Beyond the Brain Disease Theory

Our understanding of trauma and PTSD is continually evolving. In the past, some theories argued that PTSD was like an injury to the brain with identifiable damage to cortical structures. However, despite considerable research over the past 15 years, the evidence has not been convincing. In the past several years, the focus has shifted to the roles of emotional dysregulation and attachment relationships, especially when it comes to the differences between acute (lasting up to about 6 months) versus chronic PTSD (may continue for years or decades). In sum, what we do about the things we feel deeply can work for or against us. There are differences between those people with short-term PTSD who recover and those who remain chronically traumatized. These studies suggest that people who recover are able to work through and make sense of their feelings, use social supports, and remain connected to important relationships in the process. The people who avoid emotions and compartmentalize bad memories as if they never existed seem to remain stuck in a closed loop: strong emotional arousal → avoidance → intrusive memories/nightmares → further emotional arousal, and so on.

We know that blocking negative emotions (sadness, grief, shame) tends to amplify them – they get worse. Unfortunately, blocking positive emotions works in the opposite direction – they go down in intensity. Early developmental experiences seem to play a role in learning to block emotions but I think we have to consider the roles of training and military identity when it comes to the practice of downplaying and avoiding ‘soft’ emotions.  To be clear, I am not suggesting that early life causes military PTSD.  Unfortunately, some people learned the hard way that parents or friends could not be trusted so they had little choice but to keep their inner thoughts and feelings bottled up. When they are upset or distressed as adults, usually the last thing they want is support from other people because it can bring back the old betrayals and anger, and fears of being let down again.  Instead, they tend to struggle to stay in self-sufficiency mode – including, the alphas and the lone wolves. This does not mean that they can’t get well; it just means they often have a tougher time admitting to vulnerability and lowering their guard.  

Many veterans who had some pretty extreme backgrounds but risked trusting someone again and opened up their old secrets and inner emotions have become much better in the process.  They can learn to understand and manage their inner emotional lives without things becoming a big ordeal or going out of control.  It can be a tough challenge and scary for people who are not used to just being human.  But, this can be the way forward for people who may think there is no hope of change.

  

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