What If PTSD Is More Physical Than Psychological? Evidence from new study
nytimes.com
nytimes.com
I kept thinking it would be more interesting (and aligned to the headline) to look at PTSD sufferers brains when they didn't have a known physical injury to their brains.
This is an additional mechanism, heretofore unidentified, causing a significantly different injury than concussion.
The difference, I suspect, is that rather than the injury being confined to a specific place that has a lesion in the brain, it's rather the entire brain that gets affected.
I was in a car accident ~7 years ago that effectively erased 5 days of my life from my memory, and took me 6 months to fully recover from (though I suspect I'm still not quite the same as I was before the accident, but as far as anyone else can tell I am). The only physical remnant from that accident is a small scar on my scalp.
One of the things I learned from the doctors that attempted to assess the damage to my brain is that the number of TBIs caused by IEDs in Iraq and Afghanistan very much informed and changed the way that doctors treat TBIs here in the states.
Also, always wear a seat belt, whatever the circumstances. I'd be dead if I hadn't been wearing one.
I'm asking this purely out of curiosity and to foster discussion: what is about this aspect of the article you find unconvincing? Thanks!
The symptoms, on the other hand seem very very similar. The progressive degradation in cognitive ability with exposure to explosions is (to my admittedly untrained eye) exactly the same as that of multiple concussions.
Which is not to say I didn't find this article interesting. I think the key difference between TBIs caused by explosions and those due to physical trauma is purely because there's no obvious lesion on the brain visible in a scan. As a result, the military treated it differently, which the article points out was a fundamental error that the military has now taken steps to correct.
I have a serious medical condition and any time I am incredibly physically impaired, it impairs my cognitive function as well. I see no reason why we need to have brain trauma per se to make a connection between physical ailments and mental health issues.
(Edited. I fucking hate autocorrect sometimes.)
https://www.youtube.com/watch?v=tbxPxFiOIKc
http://www.lifeextension.com/magazine/2012/1/Using-Hormones-...
What if SOME PTSD is more physical than psychological.
The are a number of mental conditions that have more than one cause. Brain is a complex system and one disturbs it in one place or another and at the surface it all looks the same. Computers are similar - one place it goes wrong and the screen it looks like BSOD.
There is a real value of finding one clear physical cause->effect opening targeted opportunities for treatment and prevention.
But then there are plenty of people with PTSD that have not been anywhere near a blast. It may be one piece of a huge puzzle.
I have done quite a bit of thinking on the subject, and I think many of the approaches for both treatment and diagnosis are wrong, but thats a thesis paper for another time.
The question then is how would you block it? How would you protect yourself from a compression (blast) wave such that it went "around" your head rather than through it. Is there some material that could conduct that energy preferentially?
However, I'm on the side that thinks that periods of intense stress can produce a permanent, possibly physical, change in a person. These periods can be prolonged or particularly intense moments.
On the other hand, if the majority of people who want to join the army understand the dangers they face (in addition to death and dismemberment) then we might find that they held a war, and nobody came.
An enclosed helmet that "hears" like a human, but filters the spikes (powering your iPod in the process)?
A friend of mine is a big hunter; he has over-the-ear hearing protectors (battery-powered electronics) that do just that.
It was first known as shell shock, then combat fatigue and finally PTSD, and in each case, it was almost universally understood as a psychic rather than a physical affliction.
This underplays a pretty significant history of doctors considering it a physical condition, as the old name "shell shock" itself suggests. The article does mention one such doctor, Fredrick Mott, but there were a number of them, and the debate recurred again during World War II, when a number of doctors used the term "postconcussion syndrome", again implying a disorder caused by physical brain trauma. Here's a review article: http://www.simonwessely.com/Downloads/Publications/Military/...
The article is right though in that in the past 50 years or so it's been mainly understood as a psychological disorder.
That is not really an accurate picture. There was more than just Mott with that view even in the World War I era, and the article forgets one minor European war between World War I and the Balkan Wars, during which the question was reopened, with a number of physicians in the 1930s-50s arguing for a physical cause. The article wants to position this as a radical new proposal overturning 100 years of ironclad consensus, while in reality it's more of a recurring proposal that has had periodic champions.
And don't forget the stories in the late 1800s in the UK related to "railway spine" -- the documentation of psychosomatic effects following a railroad accident, attributed to torsion of the spine and brainstem.
If there is a physical injury that results in similar symptoms, then that syndrome should probably be given a different name in order that it be separated from the wider disease that seems to have no physical trigger.
Far as stress aspect, it similarly ignites electrical and biochemical activity that flows through sensitive parts of the brain. We know those parts organize themselves expecting certain flows or weights. I'd default on position that they could be damaged by overflows slamming them. They'd get damage resulting in impaired function with rerouting of sorts attempted. The result would be replacing that function or maybe new + old happening side-by-side with old still broken. Would explain intermittent failures that seem to relapse to an imprint of whatever caused the stressor.
So, just a few thoughts combining what I learned studying those parts of the brain with my own experience of how a broken one works and doesn't.
Not to mention that the physiology of the mind isn't very well known. Physicalism of the mind isn't unanimously accepted in philosophy.
If you want a better comparison, you could compare the mind to what happens within the CPU. Other chips would be other organs/subsystems, connected by veins, nerves and various canals (power and data buses). Then you'd have peripherals (limbs) with their firmware (reflexes), and sensors (eyes). All of those communicate together and have side effects on each other.
In the analogy, the body is the whole computer, and the CPU is a part of it, they aren't two separate entities that run in parallel.
If you want to compare hardware <> software, for humans it'd rather be flesh <> electrical/chemical signals.
You'll notice that almost all interesting behavior happens on the right side of the <>. Flesh/hardware are pretty boring, they mostly limit performance and just have to be in good enough condition to function. Slight alterations of those (burnt transistor, internal bleeding) will bring everything down.
The CPU+motherboard+ram+hard disks is closer to the brain. You could argue that power supply and the speakers, microphone, nic, and webcam are like the energy supply and inputs to the brain though.
Sure, and nonphysicalists believe in magic.
One can certainly quibble over the historical accuracy of this, but I think Stepanov describes a worthwhile principle. My sesnse is that a lot of clinical psychology is still trying to abstract over imaginary brains (often by boiling away all the nuance and ambiguity from some ancient philosopher's musings) instead of the set of real brains.
The line may be hard to draw, but we are probably better off trying to draw it so that we don't take too many unnecessary drugs or have invasive surgeries when there are other solutions...
Not really, not in any useful way. To draw an analogy to computers, a "lesioned" transistor can be expected to produce an entirely different class of bug than an incorrect line of code. While a missing semicolon is technically a case of misplaced electrons, it really wouldn't be helpful to think of it in the same way you would think of 50,000V of misplaced static charge.
They aren't remotely the same thing. Certainly you can simulate this operation of neural structure, but to suggest they are effectively the same is to suggest that cars and mice are effectively the same. They're both just made of matter aren't they?
That said, programming is "merely" inducing specific alterations to the electrical charge distribution in the hardware of the computer. The computation we ascribe to the computer is the product of the physical changes induced in the structure of the computer by our act of programming it. As far as the physical artifact of the computer is concerned, as opposed to our mental model of it, there is no clear distinction to be made between hardware and software. That doesn't make the distinction we draw in practice an inappropriate metaphor.
What changes when you run a computer program is which pathways turn on and off, and these change based on reading the instruction set, which causes one operational circuit in the CPU to turn on and the results of that operation are stored for the next operation. RAM is simply a series of switches that can be "read" from the bus and passed to parts of the processor.
The only thing that may, arguably, work like that is writing to a storage medium like a hard disk or tape, and even then the circuitry around the medium does not change, just the magnetic or other impression stored on the disk itself.
Neurons are completely different in that they are made up of different connections to other neurons and it is these connections that make up both the storage medium, and the processing medium is what occurs when different neurons fire together.
[edit] The bottom line is that the brain can create new "instructions" on its own by physically rearranging the groupings of neurons. For a computer to do the same requires a new CPU with a different instruction circuit baked into the chip.
Layers of abstraction are useful, especially when we don't fully understand how the hardware works.
One day, perhaps, we will understand how all the layers interact well enough. But until then, we need the descriptive and diagnostic and prescriptive techniques provided by those abstractions.
This is not the accepted wisdom on the subject. The accepted wisdom is: "we don't have any evidence that these things are separate, so for now, while the jury is still out, we consider psychological and physical well-being to be equivalent".
To what extent the mental is distinct (or not) from the physical body/brain, well... we have no frakking clue. We have a laundry list of disorders previously thought to be purely "mental", that are now known to be physical. Then the rest we just kind of blame people for.
I think really what we should ask is, "Does blame work in case X, Y or Z"?
e.g.
- Does blame cause your child to do better in school and stop acting like a monster? Yes? Great, use blame.
- Does blame cause PTSD victims to get over it? No? Then stop blaming them, lets find another way (possibly physical) to fix it.
There is not much of a separation between physical and psychological in the first place. Every part of the body is interconnected--as people develop disease, often times mental symptoms develop secondarily so. Depression and anxiety are super common in all sorts of illness states. There are numerous studies showing cellular dysfunction and rampant oxidative stress connecting to the more serious mental illnesses.
It seems like our consciousness is constructed in such a way that it's very easy for people to forget that we actually have a body connected to our head.
Another interesting idea would be to think that mental health problems in part are caused by the systems inside our body that are outside of our conscious control not working properly communicating their discomfort as mental health problems.
I'm a clinical psychologist and I don't think I've had a patient in therapy who had
1. Sleep 2. Exercise 3. Stress 4. Food
Figured out.
What I mostly notice is that once these things are improved the need for therapy diminish significantly.
Isn't this sort of a chicken-egg problem? I have horrible sleep issues, but they're caused by PTSD related anxiety, and yes, the insomnia then exacerbates the anxiety. I sleep better when my anxiety is under control, but it's not the good sleep that reduces my anxiety--- it's stuff like Xanax and meditation.
I think that is an important construct. It allows us to abstract the notion of an individual and make it something well above a bag of bones and meat. By "above" I mean something superior, trancendant, more important.
A lot of religions have the concept of a soul, and due to Abrahahim religions, the West that concept persisted. Even if people don't believe in a soul there is still a concept of a mind as separate from the body.
In computer terms (because it is hacker news), there is a tempting analogy of software and hardware. The mind / self / personality / soul is the software. The body is the hardware. Of course, we know that software is stored by altering some parts of the hardware (electric charges, etc)). So there is a connection obviously, but we still talk about it as separate things.
But there's a serious problem with scientism in the modern world. I think it's great to develop a way of looking at the world that 'takes people out' - we can predict the motion of the moon without regard to what people think or feel about how the moon will move. The moon's motion does not take our feelings into account.
It starts to get really silly, though, when you try to use those same techniques to look at people. "How do people behave, in the absense of people" is a very silly question to ask, but it seems like that's what we try to do when we look at people through the lens of modern scientific methods.
Every person is different and has a different personal history. The idea that you can formulate some 'general rule' for how people behave is as baseless as trying to come up with a 'general rule' for computers.
It makes much more sense to look at different software patterns and how they operate, rather than trying to snip a transistor and then see how the graphical output changes, which is effectively what we do in mental health medicine.
You can't measure the measurer, so there's a gap in our perception. There's a RI talk on this, where the color purple is discussed. There's really no color purple, for example. It's your eye picking up the absence of green when seeing blue and red light together.
In other words, perhaps purple is a program in your head.
Perhaps our ability to understand the nature of a measurement is an absence of something we yet to integrate into our knowledge base? My vote is for a momentary access to the global consciousness. Like an API with a "search" timer on it. It serves efficient queries faster. It does this in a fixed timeframe using a hierarchical form of evaluation. It knows everything it knows so far.
In other words, perhaps causality in this reality is based on some type of immutable programmable storage. Perhaps that' why it's hard to change things here too.
Heck, swap mind with soul and you may trace it as far back as we have "documented" history.
We have this strong resistance against seeing our thoughts, feelings and such as signal activity between a massive bundle of cells.
[1] for a variety of reasons people with severe mental illness die about 20 years earlier than the general population.
Change in balance of some neurotransmitters can cause symptoms of mental illness - but can purely psychological events (i.e. what you observe and contemplate) cause permanent alterations to that chemical balance, cellular dysfunction, structural damage in the brain, etc?
That is just one example, but there are quite a lot of other long-term structural changes in the brain after chronic stress.
[1] http://www.biologicalpsychiatryjournal.com/article/S0006-322... [2] http://www.biologicalpsychiatryjournal.com/article/0006-3223...
The experience was incredibly shocking for him. The idea that his feelings could actually cause him direct physical harm really freaked him out. Furthermore, the event caused his tantrum to end very suddenly. The tantrum came to a screeching halt, so to speak. Without any training, he was able to use this experience as a form of biofeedback. He had felt something in his brain when it stopped and that allowed him to find some means to interrupt the runaway process at subsequent events.
He didn't like being mad, so being mad made him mad about the fact that he was mad and it created a positive feedback look that caused his anger to just go off the rails. He stopped having tantrums following this incident.
I think, yes, psychological things can literally have direct physical impact. We know it can do things like raise your blood pressure. This is an ordinary thing. With extreme enough experiences, I see no reason why it wouldn't impact the brain in a meaningful way with long term consequences
All psychological facts have physical correlates (in philosophy of mind, this is called "supervenience"). The only limit is our ability to measure things. As our ability to measure our own brains and bodies increases, we should expect to uncover more and more physical correlates of psychological conditions.
Psychological facts having physical correlates isn't the answer - to use a wrong-but-useful analogy; it's clear that hardware can inappropriately alter/damage software in many different ways, but in what ways software can/cannot damage or alter the normal functioning of the hardware? The other answers give some examples where this can happen - are there more direct ways?
I see where you're coming from, but in the case of biological brains and their physiology, the hardware IS the software, no?
Maybe not any that we are currently able to measure, but something's got to be changing. As an analogy, consider your computer: you could open it up, look inside, and feel that temperatures of different parts change over time, but you can't tell what it's doing or how well it is working just by looking at it. Even with fancy electrical equipment you'd have a hard time determining what's going on, beyond detecting that there's a lot of signal activity flowing around. To really see what's happening you need access through the software, and we just don't have that kind of access to the human mind.
It's not a question of being able to measure - I believe that we can measure e.g. synapses being strengthened and weakened as a result of learning skills; but that these changes don't change the physical functioning; it's just part of their normal functioning and it functioned exactly as well before and after - the behavior is different but physically equivalent.
For what I mean as a "meaningful change to the physical functioning", consider your computer - deleting all the software and installing a different operating system would not be a meaningful change to the physical functioning; the temperatures, electric charge and magnetic properties of the involved parts would be very different, but that doesn't matter as all the physical parts would still function in the same normal way although the screen would be displaying very different signals.
On the other hand, a software program that manages to physically disable or re-enable parts of some chip in a way that's not normally possible through software, blow a fuse in a hard drive or trigger a processor bug that "bricks" the processor - those would be the kind of changes to the general physical functioning I'm talking about. In what cases do we have such changes to the physical functioning of (parts of) the brain? Changes that are substantially different from any changes that the brain "does to itself" in the course of normal operation?
> Borderline personality disorder (BPD) is a common disorder associated with emotional dysregulation and other symptoms that have been hypothesized to be related to dysfunction of limbic brain areas including hippocampus and amygdala. The purpose ofthis study was to measure hippocampal and amygdala volumes in BPD. Hippocampal and amygdala volumes were measured with magnetic resonance imaging (MRI) in 10 patients with BPD and 23 control subjects. Patients with BPD had a 21.9% smaller mean amygdala volume and a 13.1% smaller hippocampal volume, compared to controls. These findings are consistent with the hypothesis that alterations in the hippocampus and amygdala are associated with BPD.
Here they see changes in the structure of the brain.
They see changes in the structure of the brain and they see changes in behavior (BPD), but they're clearly not saying that BPD caused these structural changes - they list both causal directions as some of possible hypothesis (altered amygdala/hippocampus causing BPD and/or BPD-related experiences causing these alterations in amygdala/hippocampus), in addition to other possible scenarios e.g. the fact that all of their BPD-group was on psychotropic drugs could also have been a cause for the observed changes, etc. They also aren't making any conclusions about a possible link between childhood abuse and BPD (or link between abuse and these brain changes) beyond the fact that they chose a set of 10 subjects that all had both BPD and suffered abuse; they're not even discussing a correlation as their data isn't sufficient to say anything about that.
All the observations in this paper certainly are compatible with a hypothetical scenario where these brain changes cause BPD (or indeed, are BPD) but it was some factor other than emotional trauma that caused the observed changes in their brains. I don't know if it is that way, but this particular paper also doesn't give any evidence to support or deny it.
[edit] It even seems that they don't even state that there was a change in their brains - instead, they observe a difference between BPD patients and the control group; but it would also be consistent with a hypothesis that these patients had smaller hippocampus/amygdala e.g. since birth, and simply having that property (instead of a change) was a risk factor predisposing them to suffering BPD symptoms later in life; and the authors acknowledge this as a possible option in their conclusions.
The question at hand is whether you can have thought patterns that cause structural/functional changes to happen.
On that note, memory's footprint is all over the brain. Learning judo is more than just filling up a psudo HDD with relevant information.
Granted this link fades over time (and likely therapy helps), but the body is not always good at handling major stresses and the damage can become permanent.
I think so. Amblyopia is an example of structural changes in the brain based on what you observe. It generally happens early in life when the brain is more plastic but it proves it is possible. There is also evidence that amblyopia may be able to be treated in adulthood.
I think they took a different group of people and predicted differences in the amygdala based on psychologic symptoms, and then checked that in MRI scans, and found the differences they predicted. (Although I'm having trouble find the links at the moment.)
Why would experienced trauma be any different from any other extremely powerful (and repeated) (yet traumatic) learning experience, thus causing permanent change in the brain to "capture" and "remember" the incident like any other powerful learning experience?
I mean, not the physical changes that amount to "now your motor neurons have changed so that they swing a golf club more accurately" but physical changes that are like "now your motor system or learning system or the regulation of something seemingly unrelated is structurally different because you've been seeing/hearing/thinking these things" ?
I'm not talking about a memory "subsystem" being changed so that it now contains and remembers the incident; that's the usual function of it; I'm talking about the memory (or other) subsystem being changed so that it is now somehow fundamentally altered, processes things differently from its normal function, or fails to process something that it could before.
The article presents this as an issue of physical vs. psychological, but even stripped of that misconception it's still an interesting article.
Moreover, it's possible, and in fact quite likely, to have both.
Having an IED go off near you might result in blast injury to your brain, which produces one set of symptoms. But it's also pretty likely to cause PTSD as well. That sort of thing is a harrowing experience, more so if you witnessed someone you cared about getting killed or injured in the blast as well, that's an easy candidate for setting you up for PTSD. But the symptoms you experience afterward will end up being a mix of both conditions.
I find it interesting that people seemed to have figured out "shell shock" fairly early on simply intuitively. But whereas early treatments focused on it as an almost mechanical thing, and something to be overcome so that soldiers could be put back into the fight, it took a greater sensitivity to psychological issues to realize that PTSD was also a factor though in so doing there was a tendency to attribute all symptoms to PTSD. Now we've rediscovered shell-shock, but I hope we don't forget that PTSD is real and important as well. And we don't view shell-shock as simply a hurdle to overcome so we can get the greatest battlefield efficiency out of wounded soldiers. We've come a long way since WWI in how we treat soldiers, and I hope we don't regress.
Much philosophy is just bad science. Pontificating over unanswerable questions is little more than a waste of time. Philosophy's greatest achievement was science, which is a better way to explore reality because logic alone isn't enough, it needs to be backed by evidence.
Physicalism is all that is known to exist, those asserting otherwise have no evidence to back their claims and are basically asserting magic.
You clearly don't understand philosophy. Some philosophers like hearing their own voice talk about such questions, just like some physicists are themselves crackpots. Most philosophers are trying to properly define an otherwise ill-defined subject, and the only way to do that is via various types of thought experiments, just like Einstein did when he formulated his theory of relativity. Or did you not know that science is natural philosophy?
How bizarre would that be?
But when people talk about the psychological/physiological dichotomy, they're talking about causes. A psychological cause for an ailment is one that is brought about by thinking — by the brain operating normally without any external interference. A physiological cause is one that requires an external agent, like concussive force applied to the brain, or asphyxiation.
Psychiatric illnesses are an interesting edge case because they usually deal with the balance of various chemicals in the brain that are supposed to be there. That balance can be influenced both by external factors (like taking a psychoactive drug, such as an antidepressant SSRI) and by just thinking. It's not as well understood how thinking influences brain chemistry, but meditation, for instance, certainly does.