“The RCMP broke my brain”: Can you be sure it’s broken?
Several days ago I read a news article (Postmedia News, August 25, 2013) in which a high profile member of the RCMP (who has made no secret of being assessed as suffering from PTSD) stated that “The RCMP broke my brain”. If you have a similar “diagnosis” and believe your brain is broken please take pause. Here is some information worth considering (I have included references with this post, just in case you are of a mind to increase your knowledge in an area that is replete with misinformation) :
- Do we know the psychopathology that underlies PTSD?
No, we do not. The use of terms like “diagnosis”, “symptoms”, and “syndromes” and the division of disorders into “diagnostic categories” by psychology/psychiatry constitutes the medicalization of thought and behaviour in the absence of proof that anything medical is occurring (e.g. a broken brain). In addition, the terms have no obvious meaning in light of Woolfolk’s (2001) assertion that while we know what a heart dysfunction is, the concept of behavioural or psychological dysfunction has no clear meaning. In other words, medicine has scientifically based diagnostic tests that follow symptoms, on the surface, to their root causes whereas psychology and psychiatry do not. Mirowsky (1990) added, early, to our understanding by pointing out that symptoms (i.e. your subjective experience) are supposed to be signs that point to something beyond themselves. The signs/symptoms of psychological disorders (including PTSD) point only to the “categories” of disorders in the Diagnostic and Statistical Manual (DSM); and I’m sure you would agree that your symptoms are not caused by words in the DSM through which your care-giver has perceived and organized your complaints.
Moreover, Benight (2012) in an article focused on assisting us to see beyond the current research paradigm, points out how most of the work in the area of traumatic stress focuses on either the risk factors that precede a post traumatic response, or the specific symptoms that follow a potentially traumatic exposure. We know very little about the dynamics of the psychopathology that happens in between (e.g. a broken brain?).
Finally, the near obsession with PTSD in both the lay and professional literatures has tended to overlook the wide diversity of responses that individuals exhibit following a potentially traumatic event. For example, PTSD often occurs along with other types of psychopathology, most frequently depression. How these two may interact over time is poorly understood; not enough study has been done to choose among competing explanations. Do depression and PTSD originate from the same source (e.g. Breslau, et al., 2000) or does depression arise subsequent to PTSD as a response to the failure to get well (e.g. Gilboa-Schechtman & Foa, 2001)? It is also plausible that depressive thinking may precede, and in some cases contribute to, the cause of PTSD (Bryant & Guthrie, 2007).
So to be very blunt, while I understand what the RCMP member was trying to say, the only thing you accomplish by erroneously accusing the Force of breaking your brain, is to provide them with a wrongheaded reason to dismiss you!
- Is PTSD a discrete clinical “category”?
No, it is not. Following the third edition of the DSM the criteria for PTSD began to gradually expand in an attempt to address subjective experience. This initiative has served to lower the threshold for a diagnosis of PTSD which has resulted in the diagnosis becoming less valid (McNally, 2003). In addition, studies that have examined the latent structure of PTSD symptoms have consistently supported a dimensional rather than a categorical structure (Broman-Fulks et al., 2006; Ruscio, Ruscio & Keane, 2002). This means that there is a compelling case to be made for viewing PTSD as existing on a continuum ranging from mild to severe rather than as a discrete clinical category (i.e. either you have it or you don’t).
- Are all “traumatic events” traumatic?
No, they are not. When trauma adjustment is followed over time much variability is discovered. There is so much variability in how individuals adapt to a “traumatic event” the term is being referred to as a misnomer. Researchers in the area are now advocating the use of the phrase “potentially traumatic event” (PTE) (Bonanno, 2004; Norris, 1992) as it seems that most people exposed to PTEs cope remarkably well (Bonanno, 2004, 2005; Bonanno & Marscini, 2008).
Empirical studies suggest that most of the variability in response to PTEs, across time, can be illustrated by four different trajectories: gradual recovery; a relatively stable trajectory of healthy functioning; a delayed reaction; and, chronic dysfunction. Gradual recovery was defined by Bonanno (2004) as “a trajectory in which normal functioning temporarily gives way to threshold or sub-threshold psychopathology (e.g., symptoms of depression or PTSD) usually for a period of at least several months, and then gradually returns to pre-event levels. Full recovery may be relatively rapid, or may take as long as one or two years”. Until recently relatively little was known about the trajectory of healthy functioning (or resilience) as a result of the focus on PTSD as a category. Due to an accumulation of research it is now clear that the ability to maintain normative or baseline levels of functioning, following a PTE, is not rare but often the most common response (Bonanno, 2004, 2005; Bonanno & Mancini, 2008)
Delayed reactions to highly stressful events have been traditionally thought to be the result of inhibition or denial. The literature on bereavement, for example, suggests that when there is an absence of immediate grief, it will eventually surface as a delayed response (e.g. Bowlby, 1980; Osterweis, Solomon & Green, 1984; Rando, 1993). Despite the wide acceptance of this belief, solid empirical evidence has as yet to be produced (Bonanno & Kaltman 1999); Wortman & Silver, 1989). The longitudinal research on PTSD suggests, rather than a genuine delayed reaction, a sub-threshold response that tends to worsen over time (Andrews et.al, 2008; Bonanno et. al, 2005; Buckley et al., 1996). And finally, it is well understood that only a relatively small group of individuals will manifest a chronic pathological reaction to PTEs (e.g. Bonanno, Rennicke, & Dekel 2005; Davis, 1999; Robins, 1990).
So to conclude, I will caution that the field of trauma studies (e.g. PTSD) has become rife with myth and misconception. I hope what I have presented here helps to clarify some of this misinformation. While I understand what the member was trying to say, it is a sign of psychological illiteracy to suggest that anyone who has received a “diagnosis” of PTSD has a “broken brain”. It would have been more accurate to suggest that “as a result of the harassment I have endured at the hands of my employer, I feel broken”.
Dr. Mike Webster, R. Psych.
Andrews, B., Brewin, C.R., Philpott, R. & Stewart, L. (2008). Delayed onset posttraumatic stress disorder: A systematic review of the evidence. American Journal of Psychiatry, 164, 1319-1326.
Benight, C.C. & Bandura, A. (2004). Social cognitive theory of posttraumatic recovery: The role of perceived self efficacy. Behaviour Research and Therapy, 42, 1129-1148.
Bonanno, G.A. (2004). Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events? American Psychologist, 59, 20-28.
Bonanno, G.A., & Mancini, A.D. (2008). The human capacity to thrive in the face of potential trauma. Pediatrics, 121, 369-375.
Bonanno, G.A., Papa, A., Lalande, K., Westphal, M. & Coifman, K. (2004). The importance of being flexible: The ability to both enhance and suppress emotional expression predicts long-term adjustment. Psychological Science, 15, 482-487.
Bonanno, G.A., Rennicke, C., & Dekel, S. (2005). Self enhancement among high exposure survivors of the September 11th terrorist attack: Resilience or social maladjustment? Journal of Personality and Social Psychology, 88, 984 – 998.
Bonanno, G.H. & Kaltman, S. (1999). Toward an integrative perspective on bereavement. Psychological Bulletin, 125, 760-776.
Bowlby, J. (1980). Attachment and loss. New York: Basic Books.
Breslau, N., Davis, G.C., Peterson, E.L., & Schultz, L. (2000). A second look at comorbidity in victims of trauma: The posttraumatic stress disorder – major depression connection. Biological Psychiatry, 48, 902-909.
Broman-Fulks, J.J., Ruggerio, K.J., Green, B.A., Kilpatrick, D.G., Danielson, C.K., Resnick, H.S. & Saunders, B.E. (2006). Taxometric investigation of PTSD: Data from two nationally representative samples. Behaviour Therapy, 37, 364-380.
Bryant, R.A. & Guthrie, R.M. (2007). Maladaptive self appraisals before trauma exposure predict posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 75, 812 – 815.
Buckley, T.C., Blanchard, E.B., & Hickling, E.J. (1996). A prospective examination of delayed onset PTSD secondary to motor vehicle accidents. Journal of Abnormal Psychology, 105, 617-625.
Davis, H. (1999). The psychiatrization of posttraumatic stress: Issues for social workers. British Journal of Social Work, 29, 755-777.
Gilboa-Schechtman, E., & Foa, E.B. (2001). Patterns of recovery from trauma: The use of intraindividual analysis. Journal of Abnormal Psychology, 110, 392.
McNally, R.J. (2003). Progress and controversy in the study of posttraumatic stress. Annual Review of Psychology, 54, 229-252.
Mirowsky, J. (1990). Subjective boundaries and combinations in psychiatric diagnoses. Journal of Mind and Behaviour, 11, 407-423.
Norris, F.H. (1992). Epidemiology of trauma: Frequency and impact of different potentially traumatic events on different demographic groups. Journal of Consulting and Clinical Psychology, 60, 409-418.
Osterweis, M., Solomon, F. & Green, F. (1984). Bereavement: Reactions, consequences and care. Washington, D.C.: National Academy Press.
Rando, T.A. (1993). Treatment of complicated mourning. Champaign IL. Research Press.
Robins, L.N. (1990). Steps toward evaluating post-traumatic stress reactions as a psychiatric disorder. Journal of Applied Social Psychology, 20, 1674 – 1677.
Ruscio, A.M., Ruscio, J. & Keane, T.M. (2002). The latent structure of posttraumatic stress disorder: A taxometric analysis of reaction to extreme stress. Journal of Abnormal Psychology, 111, 290-301.
Woolfolk, R. (2001). The concept of mental illness. Journal of Mind and Behaviour, 22, 161-187.
Wortman, C.B. & Silver, R.C. (1989). The myths of coping with loss. Journal of Consulting and Clinical Psychology, 57, 349-357.