A Psychiatrist's Take: “It’s Not PTSD, Is It???”

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As early as the American Civil War, we have record of awareness that some individuals developed physical and emotional symptoms in response to wartime stress exposure . Over time, the terms changed, but were still primarily connected to some form of combat trauma; “soldier’s heart,” “shell shock,” and “combat fatigue” were a few of the terms offered to describe the cluster of physical symptoms that resembled sudden feelings of impending doom, panic, and overwhelming anxiety. All of these implied that there was something internally “wrong” with the person that would lead them to respond in an excessive way.

It was not until the early 1980s that the American Psychiatric Association, in the third edition of their Diagnostic and Statistical Manual of Mental Disorders(DSM), introduced the term Post Traumatic Stress Disorder (PTSD) as an actual diagnostic entity. The basic criteria required exposure to some catastrophic event (directly affecting the person) such as war, torture, rape, or the Holocaust, with subsequent clusters of recognizable symptoms both physical and emotional. At that point there was no inclusion of any reaction to the “normal traumas” of life: emotional or physical abuse, divorce, separation, removal from family or familiar environment.

As medical research and treatment have progressed, PTSD is now recognized as a much more complex reaction. It can occur “indirectly,” as in someone witnessing a traumatic event. It can have both acute and chronic forms. Behavioral symptoms can include intrusive memories, avoidance and distancing, and hyperarousal to situations that evoke memories of the trauma. It was also recognized to be more common than had been previously thought: 4% of men and 10% of women will have symptoms of PTSD at some point in their lifetimes.

Perhaps the greatest change in diagnostic perception has been the recognition that PTSD is a reaction to a whole host of external stressors, and does not represent a “weakness” in a particular person’s response to a particular trauma. That PTSD is more than just “anxiety” has now been recognized; the above-noted APA DSM’s most recent edition (DSM-5) has removed PTSD from the category of “Anxiety Disorders” and assigned it to another newer category: “Trauma/Stressor Related Disorders.” More recent investigations have shown the contribution of genetics (inheritance of higher PTSD risk if generational relatives were exposed to severe trauma), “co-morbidity” of other psychological and medical conditions, and, gratefully, have also led to much improved interventions and treatment: some medical, some behavioral.

Service on the international field can (often does) put an individual at risk of experiencing trauma. Sometimes the trauma is clearly identified (assault; break-ins; geopolitical abrupt relocations; compassion fatigue; witness of poverty, starvation, and maltreatment on large scale).Other times the trauma is more subtle: persistent exposure to deprivation, abuse of various types, current exposure to events that awaken awareness of one’s own personal earlier traumatic exposure. What is clear is that PTSD isn’t just a “wartime combat” condition in the traditional sense, but spiritual warfare, frontline exposure to physical hardships, separation, and persecution can bring every bit of the same risk as being in a foxhole with bullets flying overhead.

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So why do we mention this too-brief history and too-limited description of PTSD? Not all who experience this condition are aware that’s what they are experiencing. We see international workers who describe panic, physical anxiety and medical symptoms, are avoidant of certain situations that might trigger more symptoms, find themselves “numb” in terms of being able to enjoy the good things of life going on around and in them, and experience insomnia, increased startle reflex, irritability, and “everything just sets me off,” with no awareness they might be experiencing PTSD.

When properly diagnosed and approached with specific treatment, PTSD is recoverable; when treatment is sought and successful, the experience often is a springboard for that person to not just re-engage in ministry but to use their own experiences to better reach out to others in their work, in their families, and in their circles of influence toward the growth of the Kingdom. Should you be experiencing any of these symptoms, let us know..Reach out to GRC, talk with a counselor (and perhaps a psychiatrist; we have those, too). Click here to get started.

This article was written by one of our Psychiatrists, Barney. You can read his bio here.

Jim