
What If PTSD Is More Physical Than Psychological? Evidence from new study - jcfrei
http://www.nytimes.com/2016/06/12/magazine/what-if-ptsd-is-more-physical-than-psychological.html
======
parasubvert
I found this article interesting but frustrating. Conflating PTSD (a mental
illness that is caused by traumatic experience) with concussive traumatic
brain injury isn't helpful.

I kept thinking it would be more interesting (and aligned to the headline) to
look at PTSD sufferers brains when they didn't have a known physical injury to
their brains.

~~~
PeterWhittaker
Ah, but you seemed to have the point about many of these injuries being non-
concussive, in the sense of not causing concussion.

This is an additional mechanism, heretofore unidentified, causing a
significantly different injury than concussion.

~~~
eric_h
I'm not convinced that the injury is significantly different. The mechanics
certainly are: rather than the the brain trauma being caused by the brain
bouncing off the skull, it's because the whole system is hit by a wave of
pressure, but the end result is likely quite similar, though perhaps magnified
when subject to an explosion (a holistic TBI, if you will).

The difference, I suspect, is that rather than the injury being confined to a
specific place that has a lesion in the brain, it's rather the entire brain
that gets affected.

I was in a car accident ~7 years ago that effectively erased 5 days of my life
from my memory, and took me 6 months to fully recover from (though I suspect
I'm still not quite the same as I was before the accident, but as far as
anyone else can tell I am). The only physical remnant from that accident is a
small scar on my scalp.

One of the things I learned from the doctors that attempted to assess the
damage to my brain is that the number of TBIs caused by IEDs in Iraq and
Afghanistan very much informed and changed the way that doctors treat TBIs
here in the states.

Also, always wear a seat belt, whatever the circumstances. I'd be dead if I
hadn't been wearing one.

~~~
PeterWhittaker
The article discusses the physical differences between concussion injuries and
this other form of injury, as revealed through detailed imagining of brain
tissues.

I'm asking this purely out of curiosity and to foster discussion: what is
about this aspect of the article you find unconvincing? Thanks!

~~~
eric_h
The sense that I got from the article is that unlike "normal" TBIs, this type
of brain trauma is very difficult if not impossible to see on a scan.

The symptoms, on the other hand seem very very similar. The progressive
degradation in cognitive ability with exposure to explosions is (to my
admittedly untrained eye) exactly the same as that of multiple concussions.

Which is not to say I didn't find this article interesting. I think the key
difference between TBIs caused by explosions and those due to physical trauma
is purely because there's no obvious lesion on the brain visible in a scan. As
a result, the military treated it differently, which the article points out
was a fundamental error that the military has now taken steps to correct.

------
heisenbit
A more accurate title for the NYT would have been

What if SOME PTSD is more physical than psychological.

The are a number of mental conditions that have more than one cause. Brain is
a complex system and one disturbs it in one place or another and at the
surface it all looks the same. Computers are similar - one place it goes wrong
and the screen it looks like BSOD.

There is a real value of finding one clear physical cause->effect opening
targeted opportunities for treatment and prevention.

But then there are plenty of people with PTSD that have not been anywhere near
a blast. It may be one piece of a huge puzzle.

~~~
TazeTSchnitzel
Yes, this article seems to reinforce the notion that PTSD is the exclusive
domain of combat veterans, which is very far from reality.

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k-mcgrady
Shouldn't a distinction then be made between 'shell shock' and PTSD as
experienced by people that haven't been in war zones? In other words what
soldiers experience is not PTSD, it's a different physical ailment (probably
in addition to PTSD actually).

~~~
arca_vorago
USMC combat vet of OIF here, and very much this. I now have my "ptsd" under
control and it is mild compared to many of my buddies, but if there is one
thing I can impart is that "ptsd" is simply too broad a term. Combat vets have
different kinds of trauma, from tbi to various psychological ones and more,
and grouping them all up does them all a disservice.

I have done quite a bit of thinking on the subject, and I think many of the
approaches for both treatment and diagnosis are wrong, but thats a thesis
paper for another time.

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ChuckMcM
I can certainly believe that there is more going on than just stress, and the
argument that compression waves travelling through the brain can damage it is
pretty compelling.

The question then is how would you block it? How would you protect yourself
from a compression (blast) wave such that it went "around" your head rather
than through it. Is there some material that could conduct that energy
preferentially?

~~~
glibgil
Stop sending people to war would help

~~~
ChuckMcM
True, although I'm also concerned about people who are in the area when a bomb
goes off (and there has been way too much of that lately). How much does
damage? Is the damage reparable? What how far away must you be? If not
reparable then treatable? The big data point here is the actual injury, vs the
psychological injury.

~~~
jcoffland
Maybe we need to design more friendly bombs which only kill people in the
blast radius (in a nice way) but don't compress the brains of those outside of
that radius. Those soldiers launching bombs need a safe work environment.
Perhaps we should get OSHA involved.

------
_delirium
A historical quibble with the article,

 _It was first known as shell shock, then combat fatigue and finally PTSD, and
in each case, it was almost universally understood as a psychic rather than a
physical affliction._

This underplays a pretty significant history of doctors considering it a
physical condition, as the old name "shell shock" itself suggests. The article
does mention one such doctor, Fredrick Mott, but there were a number of them,
and the debate recurred again during World War II, when a number of doctors
used the term "postconcussion syndrome", again implying a disorder caused by
physical brain trauma. Here's a review article:
[http://www.simonwessely.com/Downloads/Publications/Military/...](http://www.simonwessely.com/Downloads/Publications/Military/historical/Jones%202007%20-%20shell%20shock%20mtbi.pdf)

The article is right though in that in the past 50 years or so it's been
mainly understood as a psychological disorder.

~~~
PeterWhittaker
The article covers this: there were those who suggested physical causes, but
they were, quite literally, out of fashion: Cf the article's mention of the,
in this case, possibly incorrect and ultimately distracting influence of
Freudians and other proponents of non-conscious, non-physical causes.

~~~
_delirium
The article doesn't really cover this. It makes it sound like there was only
"one British doctor" in 1916 who thought the cause was physical trauma, whose
"views were soon eclipsed by those of other doctors who saw shell shock more
as a matter of emotional trauma", a consensus that thereafter "held sway for
decades", not to be questioned again until "yet another European war broke
out", the Balkan Wars of the 1990s.

That is not really an accurate picture. There was more than just Mott with
that view even in the World War I era, and the article forgets one minor
European war between World War I and the Balkan Wars, during which the
question _was_ reopened, with a number of physicians in the 1930s-50s arguing
for a physical cause. The article wants to position this as a radical new
proposal overturning 100 years of ironclad consensus, while in reality it's
more of a recurring proposal that has had periodic champions.

~~~
vwcx
Yeah, and in some ways, the new study is a complete return to 150+ years ago.
In the American Civil War, a theory of "windage" was put forward, that the
concussion from a projectile's blast was responsible for "soldier's heart" in
the head.

And don't forget the stories in the late 1800s in the UK related to "railway
spine" \-- the documentation of psychosomatic effects following a railroad
accident, attributed to torsion of the spine and brainstem.

------
sandworm101
PTSD is common amongst soldiers, but it is far from a soldier's disease. It
hits lots of people far away from any hint of a battlefield. Train drivers
suffer it (they may witness many suicides). Doctors suffer it. Some types may
even suffer it at a higher rate than soldiers (pediatric oncology).

If there is a physical injury that results in similar symptoms, then that
syndrome should probably be given a different name in order that it be
separated from the wider disease that seems to have no physical trigger.

------
nickpsecurity
I have it. I'm pretty introspective, too. I'd say it's almost certainly
physical in many if not most cases. I can actually feel that. The thoughts and
mental energy normally ran smoothly through my mind. After injury to back &
center, especially the stress of it, it's as if a shockwave went through my
mind blowing fuses or something. That's best way I can describe feeling and
effect. Certain paths and things just aren't there or light up when they
shouldn't. The wiring from input(s) to outputs(s) is broken where it's no
longer performing the function it should.

Far as stress aspect, it similarly ignites electrical and biochemical activity
that flows through sensitive parts of the brain. We know those parts organize
themselves expecting certain flows or weights. I'd default on position that
they could be damaged by overflows slamming them. They'd get damage resulting
in impaired function with rerouting of sorts attempted. The result would be
replacing that function or maybe new + old happening side-by-side with old
still broken. Would explain intermittent failures that seem to relapse to an
imprint of whatever caused the stressor.

So, just a few thoughts combining what I learned studying those parts of the
brain with my own experience of how a broken one works and doesn't.

------
ruffrey
With a background in philosophy and neuroscience, I cringe at articles like
this drawing a distinction psychological and physical. They are simply the
same thing.

~~~
kmm
It's still a useful distinction. That's like saying all software is hardware
because the bits and bytes are stored in magnetic moments on hard drives
etc... Or that biology and chemistry are the same thing because all living
things are made of chemicals. Sure, there's some overlap, but the fields are
still very distinct.

Not to mention that the physiology of the mind isn't very well known.
Physicalism of the mind isn't unanimously accepted in philosophy.

~~~
ht85
Except comparing body to hardware and mind to software doesn't make much
sense.

If you want a better comparison, you could compare the mind to what happens
within the CPU. Other chips would be other organs/subsystems, connected by
veins, nerves and various canals (power and data buses). Then you'd have
peripherals (limbs) with their firmware (reflexes), and sensors (eyes). All of
those communicate together and have side effects on each other.

In the analogy, the body is the whole computer, and the CPU is a part of it,
they aren't two separate entities that run in parallel.

If you want to compare hardware <> software, for humans it'd rather be flesh
<> electrical/chemical signals.

You'll notice that almost all interesting behavior happens on the right side
of the <>. Flesh/hardware are pretty boring, they mostly limit performance and
just have to be in good enough condition to function. Slight alterations of
those (burnt transistor, internal bleeding) will bring everything down.

~~~
hueving
That analogy isn't very apt because the CPU by itself doesn't have memory.

The CPU+motherboard+ram+hard disks is closer to the brain. You could argue
that power supply and the speakers, microphone, nic, and webcam are like the
energy supply and inputs to the brain though.

------
InclinedPlane
Sigh. What they mean is "what if two different conditions with different
causes have been previously considered to be the same thing?"

------
jcoffland
The desire for such a distinction is strong. We prefer to attribute illness to
physical causes because in our society we blame the patient for mental but not
for physical illness. This disparity drives the push to find physical causes
to which we can more comfortably redirect blame. Such as DNA, leptin,
bacteria, enzymes, etc. It is wise to be skeptical of any new findings which
fit too well with human desires and thus make "good" articles.

~~~
SmirkingRevenge
I'm not sure. We have both strong desires to escape blame, but also the strong
desires to blame others. And once we've become accustomed to blaming people
for a particular thing, it's hard to let go.

To what extent the mental is distinct (or not) from the physical body/brain,
well... we have no frakking clue. We have a laundry list of disorders
previously thought to be purely "mental", that are now known to be physical.
Then the rest we just kind of blame people for.

I think really what we should ask is, "Does blame work in case X, Y or Z"?

e.g.

\- Does blame cause your child to do better in school and stop acting like a
monster? Yes? Great, use blame.

\- Does blame cause PTSD victims to get over it? No? Then stop blaming them,
lets find another way (possibly physical) to fix it.

------
Madmallard
Or, get this, and this is super radical of an idea I know:

There is not much of a separation between physical and psychological in the
first place. Every part of the body is interconnected--as people develop
disease, often times mental symptoms develop secondarily so. Depression and
anxiety are super common in all sorts of illness states. There are numerous
studies showing cellular dysfunction and rampant oxidative stress connecting
to the more serious mental illnesses.

~~~
PeterisP
It's not so simple - while it is obvious that physical damage to the brain can
cause psychological damage to the mind (e.g. lobotomy), it's not clear (at
least to me) if purely psychological damage (e.g. horrific emotional events,
war situations with no physical effect _to you_ ) can disrupt the physical
functioning of the brain.

Change in balance of some neurotransmitters can cause symptoms of mental
illness - but can purely psychological events (i.e. what you observe and
contemplate) cause permanent alterations to that chemical balance, cellular
dysfunction, structural damage in the brain, etc?

~~~
rntz
If a permanent change in your psychology did _not_ correspond with _some_
permanent change in your physical person, then what would there be that was
causing the change in your psychology? Some non-physical "soul" or "mind"?

All psychological facts have physical correlates (in philosophy of mind, this
is called "supervenience"). The only limit is our ability to measure things.
As our ability to measure our own brains and bodies increases, we should
expect to uncover more and more physical correlates of psychological
conditions.

~~~
PeterisP
As I said, the question (answered by others) is about structural changes. Any
memory is formed by changing something in the brain, but forming this memory
doesn't cause any meaningful changes to the general physical functioning of
the brain; forming memories and having preferences (and changing them!) is
what the brain does; perhaps the _quantity_ of memories affects the structure
of the brain or alters its functioning/learning, but generally the content of
memories will not.

Psychological facts having physical correlates isn't the answer - to use a
wrong-but-useful analogy; it's clear that hardware can inappropriately
alter/damage software in many different ways, but in what ways software
can/cannot damage or alter the normal functioning of the hardware? The other
answers give some examples where this can happen - are there more direct ways?

~~~
DougWebb
_forming this memory doesn 't cause any meaningful changes to the general
physical functioning of the brain_

Maybe not any that we are currently able to measure, but something's got to be
changing. As an analogy, consider your computer: you could open it up, look
inside, and feel that temperatures of different parts change over time, but
you can't tell what it's doing or how well it is working just by looking at
it. Even with fancy electrical equipment you'd have a hard time determining
what's going on, beyond detecting that there's a lot of signal activity
flowing around. To really see what's happening you need access through the
software, and we just don't have that kind of access to the human mind.

~~~
PeterisP
I still don't understand if you're really claiming what I feel you're
claiming, that is, saying that "forming this memory doesn't cause any
meaningful changes to the general physical functioning of the brain" is false?

It's not a question of being able to measure - I believe that we _can_ measure
e.g. synapses being strengthened and weakened as a result of learning skills;
but that these changes don't change the physical functioning; it's just part
of their normal functioning and it functioned exactly as well before and after
- the behavior is different but physically equivalent.

For what I mean as a "meaningful change to the physical functioning", consider
your computer - deleting all the software and installing a different operating
system would not be a meaningful change to the physical functioning; the
temperatures, electric charge and magnetic properties of the involved parts
would be very different, but that doesn't matter as all the physical parts
would still function in the same normal way although the screen would be
displaying very different signals.

On the other hand, a software program that manages to physically disable or
re-enable parts of some chip in a way that's not normally possible through
software, blow a fuse in a hard drive or trigger a processor bug that "bricks"
the processor - _those_ would be the kind of changes to the general physical
functioning I'm talking about. In what cases do we have such changes to the
physical functioning of (parts of) the brain? Changes that are substantially
different from any changes that the brain "does to itself" in the course of
normal operation?

~~~
DanBC
[https://www.researchgate.net/profile/Eric_Vermetten/publicat...](https://www.researchgate.net/profile/Eric_Vermetten/publication/10805021_Magnetic_resonance_imaging_of_hippocampal_and_amygdala_volume_in_women_with_childhood_abuse_and_borderline_personality_disorder/links/0fcfd507333c02d8d5000000.pdf)

> Borderline personality disorder (BPD) is a common disorder associated with
> emotional dysregulation and other symptoms that have been hypothesized to be
> related to dysfunction of limbic brain areas including hippocampus and
> amygdala. The purpose ofthis study was to measure hippocampal and amygdala
> volumes in BPD. Hippocampal and amygdala volumes were measured with magnetic
> resonance imaging (MRI) in 10 patients with BPD and 23 control subjects.
> Patients with BPD had a 21.9% smaller mean amygdala volume and a 13.1%
> smaller hippocampal volume, compared to controls. These findings are
> consistent with the hypothesis that alterations in the hippocampus and
> amygdala are associated with BPD.

Here they see changes in the structure of the brain.

~~~
PeterisP
Actually, not really, the paper doesn't say that - it seems to explicitly
limit its findings to an _association_ and nothing more.

They see changes in the structure of the brain and they see changes in
behavior (BPD), but they're clearly not saying that BPD caused these
structural changes - they list both causal directions as some of possible
hypothesis (altered amygdala/hippocampus causing BPD and/or BPD-related
experiences causing these alterations in amygdala/hippocampus), in addition to
other possible scenarios e.g. the fact that all of their BPD-group was on
psychotropic drugs could also have been a cause for the observed changes, etc.
They also aren't making any conclusions about a possible link between
childhood abuse and BPD (or link between abuse and these brain changes) beyond
the fact that they chose a set of 10 subjects that all had both BPD and
suffered abuse; they're not even discussing a correlation as their data isn't
sufficient to say anything about that.

All the observations in this paper certainly are compatible with a
hypothetical scenario where these brain changes cause BPD (or indeed, _are_
BPD) but it was some factor other than emotional trauma that caused the
observed changes in their brains. I don't know if it is that way, but this
particular paper also doesn't give any evidence to support or deny it.

[edit] It even seems that they don't even state that there was a _change_ in
their brains - instead, they observe a _difference_ between BPD patients and
the control group; but it would also be consistent with a hypothesis that
these patients had smaller hippocampus/amygdala e.g. since birth, and simply
having that property (instead of a change) was a risk factor predisposing them
to suffering BPD symptoms later in life; and the authors acknowledge this as a
possible option in their conclusions.

------
birdDadCawww
It is 2 way street physical damage can cause mental damage, vise versa.Pure
psychological damage takes sometime to really cause physical damage I would
imagine. PTSD Is a thing that we all suffer from as we get older and get bumps
and experience trauma. this is a great find. +1.

------
supgg
And what about a weaponized myco?
[https://www.youtube.com/watch?v=sT25HhAVhhU](https://www.youtube.com/watch?v=sT25HhAVhhU)

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slr555
The title of this article extremely poorly chosen. The DSM-5 criteria for PTSD
defines this condition in terms such that a great number of patients meet the
criteria who have never been exposed to blasts of any kind. Yes, there may be
significant numbers of patients like those the article describes who suffer
from a previously uncategorized blast injury phenomenon that has sometimes
been attributed to PTSD but the author is drawing the wrong Venn diagram for
the reader. The new entity does not begin to subsume the entire PTSD
population. This matters because too many patients whose symptoms have been
stigmatized anyway will now be left with the impression that "real" PTSD is
only associated with a history of blast exposure.

~~~
InclinedPlane
Yup.

Moreover, it's possible, and in fact quite likely, to have both.

Having an IED go off near you might result in blast injury to your brain,
which produces one set of symptoms. But it's also pretty likely to cause PTSD
as well. That sort of thing is a harrowing experience, more so if you
witnessed someone you cared about getting killed or injured in the blast as
well, that's an easy candidate for setting you up for PTSD. But the symptoms
you experience afterward will end up being a mix of both conditions.

I find it interesting that people seemed to have figured out "shell shock"
fairly early on simply intuitively. But whereas early treatments focused on it
as an almost mechanical thing, and something to be overcome so that soldiers
could be put back into the fight, it took a greater sensitivity to
psychological issues to realize that PTSD was also a factor though in so doing
there was a tendency to attribute all symptoms to PTSD. Now we've rediscovered
shell-shock, but I hope we don't forget that PTSD is real and important as
well. And we don't view shell-shock as simply a hurdle to overcome so we can
get the greatest battlefield efficiency out of wounded soldiers. We've come a
long way since WWI in how we treat soldiers, and I hope we don't regress.

------
otempomores
Medieval cure put ptyds near a implosion Inb4 triggered medievalists

------
ginko
[https://www.youtube.com/watch?v=hSp8IyaKCs0](https://www.youtube.com/watch?v=hSp8IyaKCs0)

------
ajarmst
What if we had decades of good research showing that the
physical/psychological distinction is not a helpful one, and therapies that
don't take both into account are generally less effective for most
pathologies?

------
gnaritas
> Physicalism of the mind isn't unanimously accepted in philosophy.

Much philosophy is just bad science. Pontificating over unanswerable questions
is little more than a waste of time. Philosophy's greatest achievement was
science, which is a better way to explore reality because logic alone isn't
enough, it needs to be backed by evidence.

Physicalism is all that is known to exist, those asserting otherwise have no
evidence to back their claims and are basically asserting magic.

~~~
naasking
> Pontificating over unanswerable questions is little more than a waste of
> time.

You clearly don't understand philosophy. Some philosophers like hearing their
own voice talk about such questions, just like some physicists are themselves
crackpots. Most philosophers are trying to properly define an otherwise ill-
defined subject, and the only way to do that is via various types of thought
experiments, just like Einstein did when he formulated his theory of
relativity. Or did you not know that science is natural philosophy?

~~~
gnaritas
Seems you didn't really digest what I said, I understand philosophy just fine.
You've quoted one sentence out of context and pretended I said all philosophy
is wasting time on unanswerable questions, I didn't. Additionally your last
sentence makes it utterly clear you didn't actually read my entire reply as I
said philosophy's greatest achievement was science, so to ask if I know
science is natural philosophy is a dead giveaway you're not paying attention
at all.

~~~
naasking
I commented on that specific line because that exact sentiment is all too
common, and entirely unjustified.

~~~
gnaritas
And I just justified it. "Unanswerable questions" != philosophy, I was
critiquing a subset of philosophy, the useless subset, like arguments for
God's existence, useless nonsense asking meaningless questions.

------
lwwlww99
What if not only PTSD but all psychological phenomena were, by their very
nature, rooted in the physical chemistry of the brain?

How bizarre would that be?

~~~
adrusi
_Sigh_ this topic always comes up. From a materialist perspective (which is
the only perspective that makes sense in medical science), yes, any
psychological phenomenon is ultimately a physical phenomenon.

But when people talk about the psychological/physiological dichotomy, they're
talking about _causes_. A psychological cause for an ailment is one that is
brought about by thinking — by the brain operating normally without any
external interference. A physiological cause is one that requires an external
agent, like concussive force applied to the brain, or asphyxiation.

Psychiatric illnesses are an interesting edge case because they usually deal
with the balance of various chemicals in the brain that are _supposed_ to be
there. That balance can be influenced _both_ by external factors (like taking
a psychoactive drug, such as an antidepressant SSRI) and by just thinking.
It's not as well understood how thinking influences brain chemistry, but
meditation, for instance, certainly does.

