Following a traumatic event, decreased hippocampus activity worsens Post Traumatic Stress Disorder symptoms, according to new research.
The hippocampus is the logical response center in the brain. It encodes new memories, takes stock of spatial and emotional contexts, and processes threats. PTSD affects all these areas. This study measured PTSD symptoms and hippocampal activity in people who had visited the emergency room after a traumatic event like a car crash.
After participants answered a questionnaire about PTSD symptoms, they viewed frightened and neutral faces while the researchers measured their brain activity with an fMRI. People with more severe PTSD symptoms had decreased activity in the hippocampus in response to the frightened faces.
PTSD Through the Years
The brain injury today known as Post Traumatic Stress Disorder has been an issue for combat veterans for thousands of years. As the weapons of war become more destructive, the problem gets worse.
Doctors have misunderstood PTSD since the beginning, especially in the United States. During the Civil War in the early 1860s, doctors saw many soldiers experiencing symptoms like depression and hypervigilance. Doctors were not able to identify the brain injury these soldiers had developed. Instead, they diagnosed them with nostalgia, or advanced homesickness.
According to these doctors, a transfer to a more active area of the front cured nostalgia. Ironically, of course, intense combat action probably caused the injury in the first place.
You have probably noticed that Civil War-era soldiers wore caps and other decorative headgear, as opposed to metal helmets. That is because the artillery of that day primarily used picric acid, a compound similar to the explosive in fireworks. So, unless a shell burst directly over your head, the chance of injury was minimal.
When the First World War broke out in 1914, most armies were using TNT, a much more powerful explosive, in their ordnance. Helmets were a must-have. When a shell burst anywhere on the battlefield, it could kill anyone within shouting distance. Other mechanized weapons, which were even more terrifying for soldiers, included machine guns and poison gas.
So, the appearance of PTSD symptoms was much more common. Nevertheless, doctors, especially American doctors, still did not believe the issue was a brain injury. Instead, doctors diagnosed most of these soldiers with shell shock.
At least the treatment regimen improved. Instead of hearing an order like “once more unto the breach, dear friends,” at least shell shock victims got a few days or weeks in a rear area.
By World War II in the early 1940s, shell shock had become CSR (combat stress reaction), which was more widely known as “battle fatigue” or “combat fatigue.” About a fourth of patients at military hospitals in Europe and Asia were CSR victims.
By the 1960s and the Vietnam War era, American doctors finally understood that combat fatigue was not physical fatigue at all. Instead, it was a brain injury. However, doctors believed that PTSD was a processing disorder which randomly affected some people in unpredictable ways. These ideas created the myths that PTSD victims “couldn’t take it” and some victims became PTSD monsters, like John Rambo in 1982’s First Blood.
The aforementioned study confirms what many researchers already knew. Extreme stress creates a chemical imbalance in the brain. When the hippocampus (area of the brain that controls logical responses) shrinks, the amygdala (emotional responses) enlarges. As a result, victims experience symptoms like nightmares, flashbacks, anger, depression, and loss of interest.
In light of this new evidence, the Canadian Armed Forces recently ditched the PTSD moniker in favor of OSA (operational stress injury). OSI victims are eligible for the Sacrifice Medal, which is the Canadian Purple Heart.
Chemical brain injuries demand chemical treatments. Some PTSD drugs are already on the market, but only one or two new ones have hit the shelves in the last twenty years. So, researchers are experimenting with some very controversial solutions.
Marijuana is a good example. THC, the active ingredient in marijuana, is a mild, mind-altering substance. Some doctors believe that prolonged marijuana treatments could ease symptoms like depression and anxiety. Not much evidence is available, since marijuana is illegal under federal law.
MDMA, or ecstasy, is another example. In some trials, only one dose of this drug significantly reduced PTSD symptoms.
These potential breakthroughs have tempted even more contractors and servicemembers struggling with PTSD to self-medicate. It is very important to resist this temptation. Almost inevitably, self-medication creates many more problems, and many more serious problems, than it addresses.
Group therapy and individual therapy helps as well. Group therapy reminds these victims that they are not alone. Frequently, group therapy also incorporates art therapy or something that helps these victims take their minds off things for a while. Individual therapy helps victims identify PTSD triggers and avoid them.
Injury Compensation Available
If PTSD or another brain injury occurs during overseas deployment, contractors are entitled to benefits under the Defense Base Act. These benefits usually include lost wage replacement and medical bill payment.
For starters, injured contractors must immediately report their situations to their supervisors. The DBA requires written notification. Therefore, electronic notice, like an email, might be insufficient. Insurance companies routinely use trivial technicalities like this one to deny coverage. So, the best approach is to send instant electronic notice and a follow-up “snail mail” letter.
After the insurance company processes the paperwork, if there is no question about liability, the insurance company normally cuts a check. But mostly since the deployment-injury/illness link could be direct or indirect, most insurance companies drag their feet. Other times, the insurance company acknowledges the illness or injury but refuses to pay for appropriate treatment.
Thus, most DBA cases move to the next level, which is a settlement conference between the victim and insurance company. A third-party mediator usually supervises this conference. The mediator reviews the medical records and other documents in the case, then tries to facilitate a settlement between the two parties.
Occasionally, this mediation is successful. However, largely due to a lack of information, these efforts usually fail. At the early stage of a claim, before the other side places all its cards on the table, it is much harder to win a poker game.
Most insurance companies use delay for financial purposes. The longer they hold onto money, the more interest they earn.
As a result, victims often experience significant financial stress during this period. To ease this burden, attorneys normally send letters of protection to medical providers. Because these letters guarantee payment when cases are resolved, the providers charge nothing upfront for their services.
Typically, the final stage in a DBA claim is a hearing before an Administrative Law Judge. The ALJ also supervises pre-hearing activities, such as legal motions and evidence discovery. Since attorneys can make legal arguments, introduce evidence, and challenge evidence at this hearing, victims have an excellent chance of obtaining fair compensation.
For more information about DBA benefits, contact Barnett, Lerner, Karsen, Frankel & Castro, P.A.