Understanding post-traumatic stress disorder

August 25, 2010 — 7 Comments

The following is a guest post written by Pat Rabjohn, MD, Ph.D, a member of First United Methodist Church as well as psychiatrist in the Mansfield area.  For more information about Dr. Rabjohn or his office in Mansfield, please visit www.rbipsychiatry.com.

We have no idea why some people have a reaction to trauma and other’s do not.  Functional MRI is giving us some ideas, but nothing that is of any practicality.  As a reminder, post traumatic stress disorder [or PTSD] is classified as an abnormal reaction in which the person felt in great danger with a perception that death was imminent.  If that happened (plane crash, 9/11, combat, rape), then the person would need to have some symptoms of each of these three things:

  1. Re-experiencing (nightmares/flashbacks)
  2. Avoidance (not doing things they used to do)
  3. Hypervigilance (over-protective, anxious, on edge)

This is exemplied in great deal in “First Blood” starring Stallong.  John Rambo is isolative/avoidant, becomes very hypervigilant when threatened, has flashbacks during the movie, and tries to run away to the woods.

With PTSD, we know the severity of the reaction is closely related to the severity of the trauma and the proximity to the trauma.  Rear-ended in a car is not necessarily trauma, wedged between two cars on fire with your seat-belt stuck is another.

With 9/11, hundreds of thousands of people had close proximity to that trauma and the scene had to be severe:  sirens, people running everywhere, the dust, the collapse of the building, the flames.  Therefore, 9/11 PTSD tends to be fairly severe.  Also, it was totally unexpected (as opposed to the Marine who can assume it will probably happen).  Also, most of America watched it unfold on TV which brought the possibility of PTSD into some homes.

The average person with legit trauma will tend to ask 2 questions at their Psych Eval:

  1. Why did this happen to me?
  2. How can I get back to how I felt before this happened?

The first question is still a mystery and one that you probably get asked on a weekly/daily basis and my guess is this; even if you have a good answer (which there probably isn’t one), it may not be what the person wants to hear.  Question 2 is trickier.  Some people go on living and adjust.  Others need therapy, prayer, medications, and usually a lot of time.  The time needs to be without additional reminders, stressors, and things that will reactivate the vivid memories.  Current theory suggests that small regions of the hippocampus can’t process the memories accordingly because the emotional content locks them into that organ.  Some meds/therapy approaches work to dislodge the emotional content, so your brain can further process the memory so it will fade like most memories (not as vivid, not as intense).

An issue with this mosque is this?  It is not a New Yorkers job to learn the differences between various sects of Islam.  It is not a New Yorkers job to distinguish the Taliban from a Shi’ite or whoever.  It is a New Yorkers job to go on living which means to get up and go to work, have some fun, enjoy their family.  A mosque for some people can be a pretty big reminder of what happened on 9/11 and I feel runs the risk of worsening some trauma memories.

Is that a sole reason to not build it?

Probably not.

But, all these talking heads that keep stating, “we have to honor the consitution” need to get a grip.

The constitution doesn’t help you sleep at night when your dreams are so vivid you attack your sleeping spouse.  The constitution doesn’t keep your heart rate under 120 when a stranger approaches you in the walmart parking lot 2 weeks after you were sexually assaulted.  There are times when common sense needs to win out.

People like to ‘move-on’ and ‘go on living’ because things were typically better before, than after a trauma.  A mosque down there is a distinct reminder that certain Islamo-fascist groups hate us and want to fly planes into our buildings.  It is also a reminder that certain groups do not want to do that and are peaceful.  But if I’m walking to work in the morning, and I was present south of Canal Street on 9/11, I am probably uncomfortable seeing a group of peaceful muslims going to pray.  That’s reality.

Anyone who doesn’t believe that can go back to last Spring when Obama flew Air Force 1 over Manhattan and the whole city went nuts.

A little trauma goes a long way, even 9 years later.

In Teaching
  • Mara

    The last time I was in lower Manhattan was September 12, 2001. I was passing out water to all of the heroic men and women working to try to find survivors. I saw first hand the destruction and cried along with families who were searching for loved ones. I have been back to Manhattan, but have not been back to Ground Zero even with my many trips to New York. I prefer to stay in areas of New York that give me happy thoughts and good memories.

    From all accounts I have heard from friends, the area around there has died. The disaster ruined a once vibrant neighborhood. Now someone wants to build a community center and try to bring a community back together. They want to try to make the area vibrant again. They want to make it a community again. The constant reminders of the destruction cannot be healthy for those that still live and work in that area. It is time to revitalize that area and bring it back to life, even if it is with an Islamic Community Center. The argument that we should shut out the reminders of Muslims reminds me of the Japanese internment camps of the early 20th century. They started out of anger and fear. While the feelings were understandable at the time, we should be able to learn from history. Will it start with no community center and turn into no Muslims within 4 blocks of Ground Zero? Will the outrage at the community center bring a close to the mosque that is currently there and has been since before the WTC?

    We need to learn from our history and remember, we are Americans. We are supposed to be accepting of all. We are supposed to be able to overcome anything because we are Americans. As Christians we should work twice as hard to find the strength through God to overcome our anger and fear and accept differences between individuals. I will one day return to lower Manhattan and visit Ground Zero, it will not be to the sad neighborhood that is there now though. I want to see that section of the city vibrant again and it can all start with one new building and a community working together. It is not healthy to dwell on one horrific experience, you will live a miserable life that way. New Yorkers have shown their strength pulling together over and over and they need to find a way to do it again.

  • Kimberlee Hughes

    As someone who has personally experienced PTSD, I would like to say that Dr. Rabjohn is right on with his analysis. Not only do negative reminders (like a mosque down the street) trigger PTSD, but also positive happy memories can take you back to the traumatic event. Please do not subject these people to more pain unnecessarily. Philippians 4:7

  • Ann

    I lean toward Mara's position, but the doctor's scientific evidence regarding PTSD gives me pause. Where is the middle ground? How can we move forward without further injuring those who still suffer? I'm not willing to accept that we cannot.

  • Mara

    Kimberlee, I also suffer from PTSD but I have found avoidance only does harm. I still have flashbacks 10 years after the event living 1600 miles from where it took place. There will always be something. If the community center, not mosque, is going to trigger flashbacks it is going to do it anywhere it is located. I would think the rubble that once was the WTC that is still there would cause more flashbacks then the community center 4 blocks away that is not even visible from where the WTC once stood.

    PTSD is different for everyone and you have to learn to live with it and allow others to live also.

  • Kimberlee

    Agreed. PTSD and the grief journey is definitely different for everyone. Given that, we must know that no matter the decision (to build or not) there will be contoversy over the decision and our mission is to show mercy and grace to all. God's grace is sufficient and His love mends broken hearts. God bless.

  • Rabjohn

    Apologies for the typos. It was typed on a cell phone over lunch and I should have proofed it better before sending it to David.

  • Traci

    This was really interesting and thoughtfully presented, thanks.

    I am wondering (from what little I remember of my PSYCH studies) if the reaction could also be attributed to our need to set up boundaries and the possibility that we may set them out too far in fear. We are right to set boundaries so that Al Queda-types should not be allowed in again. But if we extend those boundaries to exclude all muslims from our society, even this peaceful Imam who has devoted his entire career to making peace between Christians, Muslims, and Jews….then I think we are letting fear and not love take the lead. At some point, even with PTSD, do we need to let Jesus' way of love overcome mankind's leaning towards fear? Perfect love drives out all fear so that boundaries can be set in a fair-minded way, not hurting innocent people who did nothing to hurt us and only want peace. PTSD may explain this, but Jesus must still be calling us to healing and a higher way of thinking.