Comment by fasthands9 | Hacker News Reader

Comment by fasthands9 | Hacker News Reader

In the US it seems like it is extremely in vogue to talk about trauma and PTSD. From a layman's POV, it seems pretty obvious that talking about something very often (whether it be with a therapist or just friends) would elevate the amount of times someone thinks of something. From my understanding of the paper, this drug is a success if it lowers the amount of time someone thinks of a traumatic memory

>We found that participants receiving hydrocortisone showed a faster reduction in daily intrusion frequency. Voluntary memory was assessed once, at the end of the week, but was unaffected by hydrocortisone.

Ultimately I see some contradictions in what the goal of different types of psychiatry/therapy is. Is the end goal to just be as happy and functional as possible? Is it to avoid the worst case scenarios the most while not caring as much about baseline? Or is there a moral/humanistic good to processing the world even if it results in being less happy and more functional in concrete tasks?

I'm really not an expert in any of these things - but it does sometimes bother me that the discourse on this is jointed. I think it comes up in political/cultural talk quite often.

What they are reffering to as "intrusions" is not just having thoughts about the traumatic event, it is having intrusive and uncontrolable toughts pop into your mind when triggered - it's very disrupting and distracting. Depending on the level of trauma, these intrusions can be debilitating.

In general, PTSD treatment involves changing one's perspective towards the traumatic event so that when triggered, the thoughts it recalls are not intrusive and debilitating - making it so the patient doesn't feel shame, fear, loss of control when trigered.

There’s also the very important distinction between remembering something and experiencing something. People with PTSD and unresolved trauma relive the entire episode with emotions and all.

I realize I am being downvoted so perhaps this is settled in literature.

I know PTSD can be traumatic and takes different forms

I suppose my confusion still comes from the fact that stopping intrusive thoughts is measured as good. But what if these intrusive facts are needed (just like therapy) to process things in the long run?

I would understand if someone could ran a (very costly) experiment that said "Taking this over the course of 5 years lowered the amount of outbursts/negative behaviors someone took" but this is just measuring thoughts.

Presumably, if there had been another group that had been in a therapy group after seeing this traumatic film it is highly possible the number of times someone thought about the film (which is what they were measuring) would have gone up - but would that be bad?

Sure, these are all possibilities. With sufficiently able individuals who are sufficiently informed, we simply create the treatment and permit the individuals to select as required. For instance, the patient can choose to either suffer temporarily with the hope of the future positive outcome for the suffering or they can choose the immediate solution.

If the patient is not sufficiently able to choose due to being mentally unable and the drug is likely to bring them back to lucidity, then it is obvious that bringing them into a lucid state is the logical path, so we should recommend administering the drug.

For my part, I've noticed that people who dwell on these traumas have a hard time. Meanwhile I've suffered numerous things that many of these people claim have led to debilitating mental illness and I operate in a space of mental comfort. So, should I encounter another trauma event, I'll take the forgetting drug.

And presumably you, believing otherwise, should refuse it.

P.S. Here's a thought experiment for you: What if the MMR-2 vaccine instantaneously kills people at the age of 60. It was introduced in 1963 and this year is 2022, so the first recipients are not yet 60. So you simply cannot prove that it does not do this. You have a son. How do you reason whether to risk the possibility of instantaneously killing your son when he hits 60 vs the risk of him contracting any of Measles, Mumps, or Rubella?

Removing a traumatic incident from your conscious memory doesn’t remove the trauma from you. The body keeps the score, and your brain is only a small part of the feedback loops that make you you.

I don't know man. I don't carry that much pain. My life is great and I can tell the tale without suffering the pain.

PTSD is a disorder because people aren’t clearing or processing these things successfully and it becomes disruptive to their life. Sometimes it destroys their lives.

If someone successfully processes the trauma in a way that isn’t disruptive, they by definition don’t have PTSD anymore.

What you’re saying is a bit like saying someone who suffers from persistent, terrible constipation, to the point it causes them health issues should ‘just poop’.

If they could on their own, they wouldn’t have the problem!

I don't really know if the poop analogy works here. If you were going to extend it here then this drug effectively makes you not feel like you have to poop - so instead it keeps the bile piling up in your intense for a few more days. Sure you prevent yourself from pooping but you do have to remove that eventually.

Perhaps therapy is an intervention where they really can remove that waste from you with minimal invasiveness? And that's the argument here? But I still sorta think there is a measurement error here where taking a drug to not think about something so you can only think of it while with others is delaying the issue, not solving it.

If you’re looking for alternative analogies, feel free to use a colostomy one here if you want.

The point remains - saying ‘but can’t you just x’ when the problem is they can’t just x doesn’t really get you anywhere.

It doesn't take much thought to refute this idea. Talking about something can help you process it and feel better.

If you have a bad day, talking to someone about it usually helps.

Hell, bitching to a coworker about the idiot you just got off the phone with is a pastime for the average office workers.

I'm still a bit confused - sorry if I don't sound earnest.

This drug eliminates the amount of time you think about a past event. This is pitched as good. Is the model that thinking about something is bad but talking about something is good? What if talking about something changes how or when you think about something? As you said with your co-worker example (which I realize is not PTSD levels) I think it could be pretty easily argued that fixating about your current situation is actually contributing to negative mental processes.

I have done therapy for specific issues and it worked for me - but nonetheless still dont see some contradictions between therapy and a pill that makes you think about something less.

It eliminates the times you uncontrollably think about a past event - note that voluntary recall isn't affected. So it's saying that this lets you process the trauma in a controlled environment when you're in a position to deal with it, but otherwise resume a life that isn't interrupted or dominated by it.

Much of the therapy I have been involved with has been arranged not just around dealing with negative thoughts, but more fundamentally getting into a position where you can approach negative thoughts without moving into a triggered state.

I think I get what you're saying; I could, for instance, just drink a lot every day to ignore a variety of ideas, but it's much healthier in the long run to deal with those ideas directly.

Unfortunately, the reason why there are so many palliative coping strategies is that unless a person is in a state where they can examine those uncomfortable thoughts, then it's just creating more harm and the person isn't able to deal with the issue. That in turn often leads to the maladaptive coping that leads people into therapy in the first place.

So a common therapeutic goal getting people to a point where they can first recognize that they are in an upset state, second calm themselves without totally disengaging from the event and, then (if possible) work on whatever thoughts or events led to becoming upset in that manner.

That work is contingent on the first two parts of that; palliative care to help people get into a place where they can do the first two things without engaging in more harmful types of coping strategies (drinking, for instance) seems like a reasonable method.

Right. I think I mostly agree with you. Perhaps I just think involuntary/intrusive thoughts in the study is a bit of a loaded term. These words to me sound implicitly negative - but unless they resulted in serious negative behaviors then I don't see why they should be considered such a negative. From my own perspective it seems that even if my own thinking about something a lot may not be as effective as therapy or meditation, thinking about something does help process it and does help you come to a similar calmness about it.

The drug in the paper, to me, seems more like the coping strategies you talk about but without the other physical harms. Like what if alcohol made you not think about something but actually kept your physical and mental health the same/stable? Would that be desired? Isn't that what this drug is hoping to achieve?

This is a pre-clinical study that is designed to model an aspect of a "traumatic" event and assess how the treatment condition (hydrocortisone) can affect behavior. Moreover, this experiment is designed to probe the effects of trauma in the moments immediately after the traumatic event, where the stress response is initiated. This is likely the period of time where the most synaptic changes occur. Of course, this paper doesn't directly posit that forgetting thoughts associated with trauma is therapeutic, as that would require an empirical study that include patients with PTSD.

Also, the purpose of therapy, such as CBT, is not to fixate on one's current situation, but be able to unlearn feelings of trauma / anxiety from the event. This is done by engaging with a trained professional who can help the patient carefully break down their thoughts and feelings. Reflecting on a traumatic situation with a partner is different from reflecting on a traumatic situation amongst oneself.

I think there's a difference between (mediated) constructive reflection with the goal of processing an event, and Repetitive Negative Thoughts (RNT) about an event. The latter can of course have long lasting negative effects.

I think it's probably better to reflect on and process a _potentially_ traumatic event, than it is to repress or otherwise force yourself to forget it. But either of those is preferable to dwelling on it and spiraling in negativity.

Perhaps this is just a matter of degree. For really bad trauma (mass casualty, etc) it's probably good to have stronger tools available.

And there's a big difference between suffering from intrusive thoughts about a traumatic experience, and talking about that experience voluntarily. The former is stressful; the latter is therapeutic.

I guess my skepticism of this is a bit unpopular - but the way they measured intrusive thoughts is whether or not the people mentioned the traumatic film they saw in a journal for a week.

It seems plausible to that thinking (even if involuntary) about any other traumatic memory may result in short term stress but in the long run help you process it and be healthy? Like in my own experience thinking about something a lot on my own is part of therapy - since I really think about how I explain the situation and what really happened - so I guess I'm skeptical that not thinking of something is actually good for mental health in the long run even if in the short run it works.

> I guess my skepticism of this is a bit unpopular - but the way they measured intrusive thoughts is whether or not the people mentioned the traumatic film they saw in a journal for a week.

That's a fair criticism. Doing research on real PTSD is tough -- everyone's experience is a little different, and is colored by their personal history -- and it'd be wildly unethical to put test subjects through an in-person experience stressful enough to induce lasting PTSD. Some studies, like the Tetris intervention one I linked elsewhere [1], used real trauma patients; others, like this one, have to rely on stress simulants like a violent film.

I will note, however, that Irréversible [2] -- the film this study used excerpts from -- is exceptionally violent. It's not a run-of-the-mill action film. One of the scenes the study probably used graphically depicts a man being beaten to death with a fire extinguisher.

[1]: https://www.psych.ox.ac.uk/news/tetris-used-to-prevent-post-...

[2]: https://en.wikipedia.org/wiki/Irr%C3%A9versible

Yeah. Perhaps its a bit unfair to pick out in the weeds details of the study.

I guess maybe the core of my confusion comes with the term "intrusive" or "involuntary" memory. To me, in reference to PTSD, this sounds extremely negative. But perhaps you were in a situation where you saw someone die, perhaps even someone you know, should the goal be to only think about these things in therapy or when you sit down to meditate? Is involuntary/intrusive thoughts on these bad so long as it doesnt have major effects on your stability?

Not nearly as traumatic - but when I went through my last break-up I thought about it non-stop for a few weeks. I was able to get through my work and keep up social engagements fine, but otherwise it consumed me. Would it have been better to only think about the situation in therapy sessions and allotted meditation time? Maybe? But I'm not that sure on that I probably needed a few weeks of internal "involuntary" struggle in order to be free of the negative thoughts around it going forward.

I guess for me the answer is that if your brain is thinking about something, even if it seems a bit disorganized, you are still processing it on your own time and the short term benefits of not thinking about it then may not actually be good for your long term. Though perhaps this runs counter to established literature I'm not aware of.

People routinely cross the threshold from thinking about something and processing it on their own time into a state of nonproductive recurrence of said thoughts in which no real processing is done. Managing this kind of symptom is often the first step in successful long-term recovery; the goal of psychiatry is never just to sweep problems under the rug instead of helping patients process their world effectively.

Oh, I'm quite aware. I spent most of my life dealing with them. Psychosis, paranoia, and flashbacks are a bitch.

I have been and I am still dealing with intrusive thoughts for the past year. I am still unable to talk about most of them or recall them voluntarily - only the rough circumstances, but not the actual situation(s). For the first months after the event, I was unable to drive a car or a bike because the thoughts come with body reactions: muscle spasms, blurred vision, loss of hearing, etc. It is still somewhat dangerous for me to drive because my hands or feet can suddenly cramp and I am unable to release. Intrusions can happen suddenly and without a trigger. Most of my intrusions now come with no "attached memory" at all, just emotions and very painful body reactions. I am still mostly unable to participate in "ordinary life" because you have a lot of situations where you don't want to have that happen around other people, because their reactions will really not help you "feel safe", which then contributes to retraumatization.

I still have this multiple times, every day, even with 2-3x therapy per week since a year.

This is nothing like "recalling a memory". Also, since I am unable to clearly express what I have witnessed/experienced, talking to "ordinary people" (e.g. most my friends) about it is mostly met with reactions that really don't help at all.

>>I'm really not an expert...

A lot more people should come to this conclusion, reflect on it, and then not post whatever thought helped them come to this realization. Just go read enough to inform an opinion on the matter before sharing it.

I strongly disagree. People who are experts in field X are self-selected people who agree with the assumptions that define the field.

There should not be discussion forum on the website if there is a belief that smart people (who have read plenty of books on clinical psychology and neurology) can't ask questions about something they haven't personally worked in.

>>There should not be discussion forum on the website...

I would be fine with this, but the cat's out of the bag now.

Reply on news.ycombinator.com