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心の丸窓/Round window of the mind(31) PTSD

心の丸窓は、心の杜の医師による心の診療に関するコラムです。

Round window of the mind is  the column about mental therapy written by doctors of Kokoronomori Shinjuku Clinic.

 

In March, as we are living in Tokyo, we cannot avoid remembering about traumatic events in the past, such as the Sarin gas attack on Tokyo subway (20th March 1995) and the Great East Japan Earthquake (11th March 2011). This time, I would like to write something about trauma and PTSD.

 

PTSD; post-traumatic stress disorder was featured after the research of US Veterans from the Vietnam War. It occurs after a traumatic event that involved actual or threatened death or serious injury or a threat to the physical integrity of self or others; such as war and terrorism, natural disaster, physical, psychological, or sexual assault, serious accidents and so on. PTSD patient presents symptoms that include hyper arousal, numbing, re-experiencing, and avoidance. Hyper arousal includes insomnia and hypersensitivity with sounds. Re-experiencing includes repeatedly having flash backs or seeing the traumatic scene in the dream. Avoidance is to avoid the places or situations that reminds, or may remind the trauma. Many researches showed evidence that medication therapy with SSRI or other anti-depressants, CBT (Cognitive Behavioral Therapy), and EMDR ( Eye Movement Desensitization and Reprocessing) therapy are effective to PTSD.

 

However, there are a couple of conditions that should be distinguished from normal PTSD; complex trauma and developmental trauma. Complex trauma is a result from chronic repetitive trauma, such as captivity or entrapment in the traumatic experience. Developmental trauma reflects chronic and repetitive traumatization in childhood that has pervasive effects on the development of mind and brain. In reality, the patient's life that had trauma is not as simple as the theory says about PTSD, because the life after the traumatic event would not be the same as before. For example, there were many people who lost their home, family members, jobs or other precious assets in disasters. And often, it was very difficult or taking so much time to recover their normal daily life. It could be felt like they were entrapped in a traumatic situation. Their life might be resembled to the situation with complex trauma.

 

Freud described trauma as piercing a protective shield around the mental apparatus. With this comes an emotional flooding, so that the usual discriminatory processes that protect the mind from being overwhelmed are lost. We can regard this is the first phase of the response to trauma. The patient has shock and disintegration of mental functioning. Then the second phase follows. Feeling powerful anxiety including dread, horror, persecution, and falling apart, the patient may feel that all the goodness in the world is lost, along with an expectation of being protected and loved. Hopelessness is central of trauma. Personally, I don't think it is enough to give drugs or formalized therapy for these patients.

 

British Psychoanalyst, Caroline Garland writes,

 Treatment begins with the sense of being listened to by someone whose intention is to understand. If the therapist can take in something of the magnitude of what has happened to the patient, internally and externally, without being totally overwhelmed by it, there is a hope once more of re-establishing a world with meaning in it.

 

(Gugan)

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