Pressure, Stress and Traumatic Stress

“You’re nothing but a goddamn coward.”

         From the movie Patton (20th Century Fox)

The above scene depicts General George S Patton (played by George C Scott) slapping a soldier hospitalized for battle fatigue during the WWII invasion of Sicily. Patton’s callous act got him pulled from duty, put on probation and transferred to England to cool his heels. But throughout history, soldiers have been collapsing from the carnage and sounds of war, unable to function, and very often accused of cowardice. Some have been executed by their commanders on the spot, but modern times have led medical researchers to delve into this exceptionally common occurrence (found in any serious traumatic experience). We call it post-traumatic stress disorder (PTSD), an extreme and, if left untreated, often permanent impairment of cognitive function, often destroying lives – those who suffer the disorder and those who live with them. Men and, increasingly, women.

“Pressure” is just a fact of life. It is part of raising children, just about any job… in short normal life. Whether it is working on a moving assembly line or having to meet a sales quota, pressure just seems to a translation of the expectations of the moment. Most of us face pressure every day. Pressure entails a sense of urgency that is imposed on someone. Pressure is often used as a motivating factor. However, if a person has to face too much pressure or is under pressure too often, then the pressure may lead to stress. Stress has a negative impact. It causes the person to feel burned out or tensed.

Stress is often a precursor to other health issues, from hypertension, insomnia, right on down to heart attacks, strokes and even suicide. Some believe that continuous stress exacerbates other medical issues (like cancer) and impacts recovery even from common infections and flus. PTSD is extreme stress, induced by severe trauma, that actually impairs the victim’s ability to function normally. It has been associated with outbreaks of violent rage, flashbacks, complete emotional and mental collapse, withdrawal and isolation, a quick reliance on substance abuse and a general inability to sustain relationships and hold gainful employment. The US military started taking PTSD much more seriously during and after the Vietnam War.

While most soldiers are traumatized to some degree from brutal combat, civilians from other comparable trauma or being exposed to death and disorder in an overwhelming reality – from medical workers in COVID wards today to sexual assault victims, to those reviewing online ultra-violence in policing social media and even CIA drone pilots flying missions to take out distant targets with serious risks of collateral damage – why do some escape without succumbing to PTSD… while others are plagued by it? “Among people who have had a diagnosis of PTSD at some point in their lifetime, approximately 27% have also attempted suicide. Another large-scale survey found that 24% of military personnel diagnosed with PTSD had experienced suicidal thinking within the past year.” Matthew Tull (PhD) on VeryWellMind.com, March 22nd.

In a study by Yale researchers with the Veteran Administration, there just might be physiological differences within individuals that makes some particularly susceptible to PTSD after a traumatic experience. “About 8% of the general population has been diagnosed with PTSD. But among those who have experienced severe psychological stress — including combat veterans, refugees, and victims of assault — as many as 35% exhibit PTSD symptoms. These symptoms include re-experiencing traumatic events, avoidance of others, and hyperarousal when exposed to events that remind the individuals of their traumatic experience.

“While the types of cells most profoundly impacted by PTSD were the same in men and women, there were distinct differences between genders in where within the prefrontal cortex the genes impacting those cells were expressed. These differences might help explain why women are more than twice as likely to develop PTSD and other anxiety disorders than men and why they are likely to experience more severe symptoms, the findings suggest.

“About half of PTSD patients are also diagnosed with some form of depression. However, gene expression patterns found in brain tissue are more closely linked biologically with schizophrenia and bipolar disorder than depression, the researchers found…

“A post-mortem analysis of brain tissue from people who had been diagnosed with post-traumatic stress disorder (PTSD) may help explain enduring mysteries about the disorder, such as why women are more susceptible to it and whether a dampened immune system response plays a role in dealing with stress, a team headed by Yale University and the VA’s National Center for PTSD (NCPTSD) researchers has found.

“The analysis of gene expression patterns in brain tissue located in four regions of the prefrontal cortex — areas of the brain associated with higher cognitive function and executive control — revealed distinct differences in those who had been diagnosed with PTSD and those who had not. Major differences in gene activity particularly affected two cell types in PTSD patients — interneurons, which inhibit neural activity, and microglia, immune system cells in the central nervous system, the researchers report Dec. 21 in the journal Nature Neuroscience.

“‘The findings suggest that together these changes might contribute to an impaired ability to respond to traumatic stress,’ said Matthew Girgenti, a research scientist in the Yale Department of Psychiatry and the NCPTSD and lead author of the study.” Bill Hathaway writing for YaleNews.com, December 21st. We aren’t there yet, but exploring these cellular and genetic differences may well lead to more effective treatments, diagnostic metrics and a general understanding of the severity and impact of PTSD on its victims… and on all who deal with victims whether we know it or not.

I’m Peter Dekom, and as we gain knowledge and understanding of PTSD, it is just a reminder of how little we actually know about the human brain.