It’s a Small, Small World: PTSD as Self-Imprisonment.
What's the best way to help someone with PTSD? Understand it.
Rachel Yehuda, PhD, Professor of Psychiatry and Neuroscience, is the Director of the Traumatic Stress Studies Division at Icahn School of Medicine, and the Mental Health Patient Care Center Director at the James J. Peters Veterans Affairs Medical Center.
Dr. Yehuda has authored more than 300 published papers, chapters, and books in the field of traumatic stress and the neurobiology of PTSD. Her current interests include the study of novel treatments for PTSD, the examination of risk and resilience factors, the study of psychological and biological predictors of treatment response in PTSD, genetic, epigenetic, and molecular biological studies of PTSD and the intergenerational transmission of trauma and PTSD. Her team's research on cortisol and brain function has revolutionized our understanding and treatment of PTSD worldwide.
Dr. Yehuda has received many awards in recognition of her work including the Curt Richter Prize in Psychoneuroendocrinology, and the Laufer award from the International Society for Traumatic Stress. She was also awarded the Max Planck Institute for Psychiatry (Munich, Germany) 2004 Guest Professorship in Psychiatry and Neuroscience, and the Marcus Tausk Professorship in Leiden University to honor her accomplishments in the endocrinology of PTSD.
Dr. Yehuda received her PhD in Psychology and Neurochemistry and her MS in Biological Psychology from the University of Massachusetts at Amherst and completed her postdoctoral training in Biological Psychiatry in the Psychiatry Department at Yale Medical School.
She has an active federally funded clinical and research program that welcomes students and clinicians.
Rachel Yehuda: War changes people and this is something that we’ve known since recorded history. It’s spoken about in literature throughout the ages. It’s kind of a brotherhood of combat veterans and for many, many years it stayed in the brotherhood. And a lot of people came back from World War II, our fathers, our grandfathers, didn’t talk about what happened because nobody would understand. But the thing is that you’re transformed inside. You feel different. You’ve seen things; you’ve seen death; you’ve experienced, you’ve tasted fear; you’ve done things that you don’t want to talk about or feel should be talked about because it would be too scary for people to understand.
PTSD is one of the most common mental health conditions in the United States and I think it’s – it might be the fourth most common condition. And that’s because trauma is so prevalent in our society. About 25 percent of women experience interpersonal sexual violence, which is extraordinary. There are accidents and natural disasters. More than half of persons will be exposed to at least one traumatic event in their lives. The way that I like to describe a traumatic event is an event that kind of divides your life into a before and after, a watershed moment that really kind of changes the way you view the world. Whether or not you get post-traumatic stress disorder, it’s big. You’re leading your life a certain way, something very big happens and it changes the way that you look at yourself and you look at the world. So those kind of events are certainly transformative. They certainly have long-lasting marks and one of those effects of trauma exposure can be the development of post-traumatic stress disorder. Imagine if you see danger everywhere and that you’re really worried for your safety. That is going to affect almost every interaction that you have. At work, you’re going to be more on edge, more irritable. It could get you into fights with coworkers or with your employer.
The idea that you can’t really experience pleasure or that you have restricted range of emotions is going to affect you mostly in social and in interpersonal domains. A lot of marriages have been ruined by PTSD. The spouse often really wants to help the affected person, but they’re used to a certain closeness or intimacy that they find is now more difficult to access.
The hallmark of PTSD is that the memory of the event becomes haunting. It kind of takes on a life of its own. You start thinking about what happened just out of the blue or in response to triggers in the environment. And what’s so distressing about the memory is not that you just have an image or remember what happened. You have the physiologic feeling of fear or horror that you had when the event was occurring in real time. So it’s not only a visual or verbal memory out there. It is a physiologic memory and this can happen while you’re awake. It can happen while you’re asleep in the form of your dreams. People that have PTSD have trouble experiencing pleasure and it’s all about trying to become small and not allowing yourself to be affected by the environment. It also includes really changing the way you view the world and yourself. The world’s a bad place. You might feel guilty or worthless. You might feel you’re to blame for what happened or others are to blame. And finally there are symptoms that reflect increased arousal. So people that have PTSD are on edge. Their body and brain chemistry is rigged for danger and for experiencing threat and being very, very concerned about anything in the environment that might threaten them. So the symptoms in this category include being highly reactive to startle responses, scanning the environment for signs of danger, not being able to concentrate, very irritable and angry.
Nobody’s going to wave a magic wand and say I’m going to cure you — bing, bing — and throw fairy dust on you. Getting over PTSD is going to require some hard work on the part of trauma survivors. And there’s no getting around that. It’s work to look in the mirror and know that there’s some part of you that’s gone forever. There’s work trying to understand exactly what has and hasn’t changed and what can happen next. PTSD treatment can be very, very successful and I’ve seen it do wonders for people. I’ve seen people go from being extremely symptomatic to having very low symptoms for a very long period of time. But it’s not something someone does to you. It’s not in a little pill box that you just swallow with water. It really involves confronting what has happened and sometimes feel it’s so much easier to just try to put it in the past, try to avoid it, try not to think about it, try not to deal with it. But if we open ourselves up to perhaps even the benefits or the ways that we can grow the opportunities provided to us by having these unique experiences, then you can get past that hurdle.
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Dr. Rachel Yehuda is one of the foremost researchers in the country studying neurobiology with regard to PTSD. In this video interview, Dr. Yehuda relays common symptoms and struggles associated with the debilitating disorder. Where does one's brain go when traumatic flashbacks emerge? How do you fight these uncomfortable situations? Dr. Yehuda delves into these and other questions.
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