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• Thursday, December 21, 2006 12:16 PM

  Neuroscience, genetics, and PTSD treatment.

  This is largely a response to Patricia Schwarz's comments, but I'm posting because the information may be useful to anyone interested in PTSD.

  While doubtless well-intentioned, I think Patricia is being (a) a little tough on KMR and (b) a little narrow in her genetic PTSD evaluation.

  First, KMR didn't say there was no PTSD in WWII, she said there was less, possibly because of public support of the war. Since this article offers research showing that lack of support worsens PTSD, that seems a reasonable assumption. Also, as someone who's studied PTSD academically as well as personally (including the neuroscience of it), I know, and Patricia and KMR probably do as well, that shell shock, combat fatigue, and other names for PTSD have been around since before WWI, so it's certainly possible to discuss the syndrome pre-Vietnam. Simply because it wasn't brought up regularly in debates doesn't mean it wasn't being studied. Books and research are available for comparison. From a 1917 text, Shell Shock and Its Lessons:

  A French doctor has said, "Il n'y a pas de maladies." (There are no sicknesses, there are only sick people)

  Whatever the validity of this statement, it is undoubtedly true of the nerve-stricken soldier. Every case is a case by itself, and as such it must be considered by anyone, be he layman or doctor, who is interested in its nature and treatment. For the troubles displayed in the many disorders classed under the official title shell-shock are extraordinarily numerous and different, and their removal necessitates a similarly varied repertoire of "opening moves" on the part of the physician.

  And here, in 1947, Abram Kardiner and a colleague wrote about war strain:

  The subject of neurotic disturbances consequent upon war has, in the past 25 years, been submitted to a good deal of capriciousness in public interest and psychiatric whims. The public does not sustain its interest, which was very great after World War I, and neither does psychiatry.

  So while in WWII the public didn't pay as much attention, it does not mean that "Prior to the seventies, all the problems that typically are exhibited in disturbed veterans were just chalked up to normal masculinity or normal alcoholic acting out."

  My second point is that a purely genetic blame & cure approach is a little narrow. Certainly there are genetics involved. But as with so many things genetic, the results of the genes are interactive with the environment. Let's look at the two aspects of the discussion:

  • It is not known if the gene ensures the problem, predisposes one to it, or requires a trigger to become a problem. It is not know if it works in concert with other genetic markers. People can be genetically predisposed to cancer and never get it. People can be genetically predisposed to verbal genius, but if they're not exposed to language in their environment in early childhood, they will never develop that gift.
  • Even when genetics predisposes a person to a syndrome, it doesn't therefore follow that only genetic therapy can resolve the issue. Many people predisposed to cancer who do contract it are treated with drugs, radiation, and/or surgery successfully. In the case of mental problems, PTSD by its very nature is responsive to therapy and drugs. The overactive amygdala behavior can be assisted with anti-anxiety medication, and may recover enough to maintain itself at a normal level without medication. Similarly, talk and behavior therapy are not magical things standing apart from the brain, but are in essence reprogramming by choice. For the same reason that a practiced musician or mathematician uses different portions of the brain doing their work than a novice, a practiced therapy patient's changed mental response is a change in the brain.

  Having experienced PTSD in myself and witnessed it in my father (who was in WWII, Korea, and Vietnam), I know personally that it's possible to effect a cure without genetic treatment. Patricia may be right that information is being withheld from the public, but she is wrong to say we cannot treat the problem. Simply Googling the terms genetic marker and PTSD show articles from Nature, Science, the NIH, and private companies investigating the issue. A peer-reviewed journal ( Psychiatry Research) article states that "a broadly defined phenotype, specific requirement for an environmental exposure and high frequency of comorhid psychiatric illness all complicate genetic studies of PTSD," so perhaps it's not an attempt to hide something but rather a complex problem which is taking time to disentangle. Also, whether for good or ill, private pharmaceutical companies are also prone to privacy in the interests of profit.

  Just an attempt to explicate the issues involved, and perhaps show that this is a much more gray area than some believe. It's also certainly a place for hope, now as well as in the future.

  —Alex O'Neal
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