Is PTST incurable?

[Cainkane1]

I have a friendship with a Vietnam vet. He was a chauffer for some American Officers during the Vietnam conflict. He was a heavy drinker and he still is to this day. He was attacked outside of a bar by a much smaller Vietnamese man who stabbed him three times in his chest. He was able to wrest the knife away from his attacker and he killed him. The doctors said of one of his wounds if it had been a quarter inch deeper the small man would have killed him.

He can't get over it. This person was the one and only person he ever fought much less killed. He's a drunk. He can't get the incident out of his mind.

It wasn't his fault so why does it bother him so much after so many years?

Is this common?

 

[portlandatheist]

You may find this PBS series of some interest:
http://www.pbs.org/thisemotionallife/series
Some people have been able to find relief. Also, I think you meant PTSD

 

[HansMustermann]

I have a friendship with a Vietnam vet. He was a chauffer for some American Officers during the Vietnam conflict. He was a heavy drinker and he still is to this day. He was attacked outside of a bar by a much smaller Vietnamese man who stabbed him three times in his chest. He was able to wrest the knife away from his attacker and he killed him. The doctors said of one of his wounds if it had been a quarter inch deeper the small man would have killed him.

He can't get over it. This person was the one and only person he ever fought much less killed. He's a drunk. He can't get the incident out of his mind.

It wasn't his fault so why does it bother him so much after so many years?

Is this common?

Both someone trying to kill you and killing someone are very traumatic experiences, and paradoxically almost the same thing due to these pesky mirror neurons. We're fundamentally social animals and no amount of indoctrination or drilling will make it otherwise. But, of course, different people have different breaking points.

At any rate, it's been known for a long while. In WW1 it was called "shell-shock", for example, and it was recognized as being pretty widespread.

We don't really know much more from before that, as basically WW1 was the turning point where people started figuring out soldiers as they really are, rather than as some idealized perfect warriors. Even in WW1, long after the soldiers themselves had started figuring out that some of them are cracking down under stress, it took a while for the command to really accept it. At first it was thought it was some physical effect of something new, e.g., the artillery shelling which was being used to unprecedented extremes. (Hence, "shell shock".) E.g., maybe carbon monoxide poisoning from the explosions or something.

Even then, anyone fleeing the battlefield because of it, was invariably court-martialed for desertion. And generally having it on the battlefield was most of the time classified as cowardice, so we may not even know how many had it but preferred to wake up screaming another night than be labelled cowards.

We can speculate though about the high numbers of desertions documented after major battles in middle ages and antiquity, even if a lot of them were forfeiting payment for their service or even forfeiting their privileged social class.

E.g., off the top of my head after the siege of Leontini in the second punic war, they found (and executed) about 2000 Roman deserters in the city. You'd think the Romans were all fearless and born with a gladius in hand, listening to their poets and orators, but reality seemed to have been very different. And bear in mind that those were at the time wealthy enough Romans to be eligible for the army, those who could afford their equipment, typically farmers owning a farm or the like. I'd guess it takes a lot of stress to forfeit it all and flee to a foreign city than fight another day.

It's easy to ascribe it to simple cowardice -- as it _was_ explained until WW1 -- but really one has to wonder. But, at any rate, it's hard to find an actual description of a syndrome or something. Just hundreds of thousands of "cowards" scattered across human history.

At any rate, sorry about the dry text above. I'm really sorry about your friend.

 

[Dancing David]

Um, 'curable', maybe (not likely), 'treatable', almost certainly.

But as with many illnesses the goal may be to reduce symptoms to the point where the person functions in their environments of choice. The resolution of symptoms may never occur depending on the vulnerability of the individual, but many people can reduce symptoms to a minor level.

It often requires cognitive behavioral therapy, medications and life style changes. The difficult part of the assessment is teasing out what is the PTSD and what are other issues, there is always the possibility of comorbid conditions, such as another major mental illness. Usually severe PTSD requires a triple diagnosis form of treatment as the collapse of life functioning is often severe, substance abuse/dependence and then the PTSD and other major mental illnesses, all at the same time.

Of course this has to be what the individual wants.

 

[Shadow the Poodle]

I have been having treatment for PTSD for a military service related condition for years , linked with depression and alcohol abuse. Whilst I find CBT and anti depressants very helpful I still suffer from anxiety and anger management issues from time to time,particularly if under heavy stress at work. I have been unable to leave the house for weeks at a time. I dislike taking the medication but function at a much higher level with it than without it as it keeps the nightmares at bay.

So I agree , cure seems unlikely but mitigation to appear to be functioning as a normal member of society is quite possible,provided,as previously mentioned, you want and take the help available.

 

[marplots]

There has been talk of a 'cure' using hallucinogens.

Here's a paper from 2002 -- http://mail.maps.org/news-letters/v12n3/12305dob.pdf

I haven't kept up but heard about some great results for some patients.

More recent, an update of sorts -- http://www.maps.org/news-letters/v16n1/mithoefer_mdma_ptsd.pdf

 

[Cainkane1]

I have been having treatment for PTSD for a military service related condition for years , linked with depression and alcohol abuse. Whilst I find CBT and anti depressants very helpful I still suffer from anxiety and anger management issues from time to time,particularly if under heavy stress at work. I have been unable to leave the house for weeks at a time. I dislike taking the medication but function at a much higher level with it than without it as it keeps the nightmares at bay.

So I agree , cure seems unlikely but mitigation to appear to be functioning as a normal member of society is quite possible,provided,as previously mentioned, you want and take the help available.

Good luck.

 

[Dancing David]

I have been having treatment for PTSD for a military service related condition for years , linked with depression and alcohol abuse. Whilst I find CBT and anti depressants very helpful I still suffer from anxiety and anger management issues from time to time,particularly if under heavy stress at work. I have been unable to leave the house for weeks at a time. I dislike taking the medication but function at a much higher level with it than without it as it keeps the nightmares at bay.

So I agree , cure seems unlikely but mitigation to appear to be functioning as a normal member of society is quite possible,provided,as previously mentioned, you want and take the help available.

The medication issue is a real problem for most people with a possibly long term illness. It is true of almost all patients with all sorts of conditions that they do not want to view themselves as someone who will take medicine everyday.

A lot of it has to do with effectiveness versus side effects as well, if you perceive little benefit and have large side effects then compliance is always an issue. And with psychotropics it often takes a very long process to find the right medication or combination as well. (Sometimes for some people there is not going to be an ideal solution, I have a friend who has injury and autoimmune related neuropathy, he feels his legs are on fire, after years his doctor found the medicine that works well for him, but he is allergic to it.)

While I has childhood trauma that made me very anxious, I also came from a family with a history of OCD, major depression and substance abuse, so i had other vulnerabilities than just the traumatic one, it often takes a very long time to reach a stable level of symptoms in that situation, and stress related rises in symptoms are always going to be there.

I hope that you find what will work for you.

 

[Dancing David]

There has been talk of a 'cure' using hallucinogens.

Here's a paper from 2002 -- http://mail.maps.org/news-letters/v12n3/12305dob.pdf

I haven't kept up but heard about some great results for some patients.

More recent, an update of sorts -- http://www.maps.org/news-letters/v16n1/mithoefer_mdma_ptsd.pdf

Well , that is more a possible direction than any real evidence.

Poorly researched at best.

 

[marplots]

Yeah, I agree. Ongoing, but interesting.

I mentioned it because it is something that can be tried as a 'one off' with few lasting ramifications if it doesn't work.

I don't suffer the condition, so I'm not sure if obtaining and using an illegal drug in a one-shot manner would be an attractive choice. I do think it is permissible to experiment on oneself. It might be the only ethical way to do human experiments.

 

[tesscaline]

Yeah, I agree. Ongoing, but interesting.

I mentioned it because it is something that can be tried as a 'one off' with few lasting ramifications if it doesn't work.

I don't suffer the condition, so I'm not sure if obtaining and using an illegal drug in a one-shot manner would be an attractive choice.

Not when that illegal drug has possibly severe side effects that can have a life threatening possibility (as all drugs do). Then there's the whole "if you get caught" aspect involving possible jail time and criminal records (not really in line with the whole trying to be a productive member of society goal in getting treatment in the first place, you know?). Also -- with these sorts of conditions, self medication is pretty much considered bad. The ill person is not rational enough to be able to appropriately monitor and ration their own doses, or to be able to tell when something is or is not working the way it should.

I do think it is permissible to experiment on oneself.

Why on earth would you think that? It is impossible for a single person to experiment on themselves and maintain the proper scientific standards for such research to be taken seriously. You simply cannot double blind yourself. You cannot rule out confirmation bias, or a variety of other unsound methodologies. Then there's the safety issue of experimenting on oneself.. And, again, one's rationality is involved.

It might be the only ethical way to do human experiments.

No, no it most definitely is not. Bona fide research endeavors can get licensing to use "illegal" substances, as long as they can justify it to the correct agency. The "illegality" of marijuana hasn't stopped researchers from experimenting with it, for example. Human trials are carried out all the time for various other treatments and medications, so why would this be any different?

 

[marplots]

Two different contexts. One is general, as in -- "We'd like to find out if this is a good treatment for X," and the other is specific, "I want to see if this helps me."

So, yes, all of the concerns you expressed are legitimate and I certainly wouldn't want to go down the Amega Wand trail of desperation, but if I were suffering a condition, I might, after some investigation, try an unapproved remedy. I would never try it on someone else, that is why I mentioned ethics.

And I agree there is a real difficulty when the patient decides which treatments to try, because they may not being seeing things clearly. Would you go for a middle-way? Seeking competent advice and an outside opinion? This is more akin to the system of restricting prescribing authority to those who are best trained, but also has some of the flavor of 'off-label' use.

 

[Cainkane1]

I have been having treatment for PTSD for a military service related condition for years , linked with depression and alcohol abuse. Whilst I find CBT and anti depressants very helpful I still suffer from anxiety and anger management issues from time to time,particularly if under heavy stress at work. I have been unable to leave the house for weeks at a time. I dislike taking the medication but function at a much higher level with it than without it as it keeps the nightmares at bay.

So I agree , cure seems unlikely but mitigation to appear to be functioning as a normal member of society is quite possible,provided,as previously mentioned, you want and take the help available.

What medicines are you taking?

 

[Salerio]

Why on earth would you think that? It is impossible for a single person to experiment on themselves and maintain the proper scientific standards for such research to be taken seriously.

What utter nonsense. Barry Marshall and Robin Warren got the Nobel prize for doing such experiments on themselves. Lovelock developed new burn therapy by experimenting on himself (still has the scars to prove it). Doctors practicing on themselves is long tradition in medicine. (can't remember his name) had himself injected with curare to determine the effects of the drug. Priestly, Davy and Wells experimented on themselves when developing anesthesiology. Others too numerous to mention, but I could look them up, have extended medicine by performing similar and equally dangerous self-experimentation.

Dr Smith did the curare experiment

 

[marplots]

Salerio, this probably won't help your case, but Dr. Albert Hofmann is my favorite example.

 

[HansMustermann]

Salerio, burns are objective things. In effect someone treating their own burns is experimenting on the burn, as a distinct conceptual entity.

In stuff that boils down to psychology and subjective observations, I'll side with SkeptiChick: you can't maintain objectivity. Selective confirmation to support one's pet theory is nigh impossible to avoid when you're judge, jurry and sole witness, all rolled in one. I'm not even talking about the temptation to flat out be dishonest, but about something which is built right in.

 

[marplots]

Salerio, burns are objective things. In effect someone treating their own burns is experimenting on the burn, as a distinct conceptual entity.

In stuff that boils down to psychology and subjective observations, I'll side with SkeptiChick: you can't maintain objectivity. Selective confirmation to support one's pet theory is nigh impossible to avoid when you're judge, jurry and sole witness, all rolled in one. I'm not even talking about the temptation to flat out be dishonest, but about something which is built right in.

Well, again, it depends on if someone is interested in publishing to a scientific standard or only looking for something that helps them. If the condition (PTSD) is clear enough to be diagnosed as an actual illness, it ought to be well enough described to say it's been modified by some treatment.

Is this a case of "I have more positive energy" or something more concrete, like "I no longer wake up screaming at night" ? I truly do see the placebo effect here, but this is a psychological condition, the black-box area of medicine where trial and error is the norm.

And I'm considering that the person we are talking about has already tried some of the more common treatments and is dissatisfied with the results. So it isn't a case of ignoring standards of care, but rather one of exploring options for an outlier. And I also recognize my arguments could be used to support the use of magnetic bracelets or other crap, so I'm falling back on whether a person has investigated available studies and is making a rational choice. There is an overlap with woo. There is also a whole argument that revolves around personal freedoms and the right to make mistakes when you, alone are the object of the error.

 

[Dancing David]

Well, again, it depends on if someone is interested in publishing to a scientific standard or only looking for something that helps them. If the condition (PTSD) is clear enough to be diagnosed as an actual illness, it ought to be well enough described to say it's been modified by some treatment.

Is this a case of "I have more positive energy" or something more concrete, like "I no longer wake up screaming at night" ? I truly do see the placebo effect here, but this is a psychological condition, the black-box area of medicine where trial and error is the norm.

Nope a single sa,ple is to prone to other factors and therefore not conclusive.

It could be that the drug was the cause but it could be other things, which is the point of controls.

A single person in an informal use setting, is not controlled or a protocol.

Sorry.

And I'm considering that the person we are talking about has already tried some of the more common treatments and is dissatisfied with the results.

And what is they are using methampetamine?
Or alcohol or any number of uncontrolled factors.

So it isn't a case of ignoring standards of care, but rather one of exploring options for an outlier.

And that assumption is not science, how do you know they are an outlier, how do you know there are not other confounding factors?

And I also recognize my arguments could be used to support the use of magnetic bracelets or other crap, so I'm falling back on whether a person has investigated available studies and is making a rational choice. There is an overlap with woo. There is also a whole argument that revolves around personal freedoms and the right to make mistakes when you, alone are the object of the error.

That is not the subject of the thread.

 

[marplots]

Nope a single sa,ple is to prone to other factors and therefore not conclusive.

It could be that the drug was the cause but it could be other things, which is the point of controls.

A single person in an informal use setting, is not controlled or a protocol.

Sorry.

I think we are talking about two different things here. It sounds like you are interested in establishing the basis for a treatment, including evaluating it for broad application -- a research endeavor with a high standard of proof and something that can be used to support a claim.

I am talking about whether an individual might want to try something based on what amounts to educated guesswork to see what effects they experience.

The difference is one of, "I have seen excellent polls that show about 80% of those who try guacamole find it appetizing." and the rather lower standard of, "I think I might try guacamole because it looks tasty."

Different parameters altogether. I am not disputing proper research methodology at all, different goals.

 

[Dancing David]

I think we are talking about two different things here. It sounds like you are interested in establishing the basis for a treatment, including evaluating it for broad application -- a research endeavor with a high standard of proof and something that can be used to support a claim.

I am talking about whether an individual might want to try something based on what amounts to educated guesswork to see what effects they experience.

The difference is one of, "I have seen excellent polls that show about 80% of those who try guacamole find it appetizing." and the rather lower standard of, "I think I might try guacamole because it looks tasty."

Different parameters altogether. I am not disputing proper research methodology at all, different goals.

Sorry we are talking about medicine and health, not guacamole, which I happen to like.

Self medication is often a huge problem for people with mental illnesses, as in the comorbid use of alcohol and cocaine in bipolar disorder. So no, in a thread that is about a health issue, and is about a serious mental health condition, it is not okay to speculate based upon really poorly designed and poorly run and poorly measured research to go and use a drug that may or may not have benefit and may or may not have major detriment to the user.

People living with a mental illness do not usually benefit from substance abuse or recreational use. (They may or may not have detriment.)

Now if you want to start a thread about 'Why people might use illegal street drugs?' then that would be acceptable.

I would not recommended that anyone consider using ginseng to treat type II diabetes either, especially if the research is as poor as the PTSD and MDMA research.