About the Author
Erin P. Finley
• Ph.D. from Emory in medical anthropology
• Masters in public health, also from emory
• Investigator with VERDICT, or the Veterans Evidence-based Research Dissemination and Implementation Center at the South Texas Health care system
• Adjunct Assistant Professor at the University of Texas in the Department of Medicine, Division of Clinical Epidemiology
• Her research focuses on PTSD among veterans and their families. Her work has recently branched out to include the affect of relationship within the military and the American public on PTSD suffers.
All trauma starts of as “the sensory and perceptual experience of danger.” That danger can come in any form, from some thing sudden and jarring to something constant and repetitive that requires the person experiencing it to always be on high alert. Regardless of the form that it comes in, trauma comes down to two elements: sensation and perception. It is only after the experience that the effects of the trauma begin to emerge. With PTSD both cognitive and neurophysiological changes result from trauma sustain in combat, in the case of this chapter the wars in both Iraq and Afghanistan. These changes can be seen through the lens of the individuals interactions with their cultural environment.
Trauma is frighteningly common with 60% of men and 51% of women experiencing it, according to the National Comorbidity Study (NCS). That same study put the prevalence of PTSD at 7.8%, not a particularly scary number. However, the more traumas an individual experiences the more likely they are to develop PTSD. Therefore groups like soldiers and refugees are seen to display higher rates of the disorder.
PTSD presents a problem when it comes to research and study. The disorder knows no disciplinary bounds and there are aspects of it that touch anthropology, neuroscience, psychology, epidemiology, psychiatry, social theory, and the humanities. Differing approaches with little to no integration of other disciplines and varying definitions of terms common to the discussion of PTSD, such as trauma and stress, has stunted the study of PTSD. In an effort to assuage the buckshot approach to the study of trauma and the disorder, Finley boiled it down to a six part framework:
1. Cultural enviroment
6. Cultural mediators
It is this framework that allows the neuroanthropological model of PTSD to take shape in an attempt to allow the study of trauma PTSD to move forward in a more focused and holistic way
The cultural environment, meaning everything from the historical and political economic to social norms and gender, shapes the experience of the sufferer. Anywhere from 11% to 19% of veterans from Iraq and Afghanistan have been diagnosed with a disorder that has only been a formal diagnosis since 1980. PTSD is clinically significant impairment characterized by three symptoms: hyperarousal, reexperiencing, and numbing or avoidance. It also culturally salient I that is evoke a connection to mental health stigma, the human aspect of war, and veterans loss and benefits.
A combat zone can require an adaptive change in the sensory perception of one’s surrounding, a neurobiological reshuffling of cognitive tasks if you will. This can be extremely benificial in life-threatening scenarios. Reaction times have been seen to improve signifigantly in such situations and those abilities have been known to remain with soldier even after returning home. However, it is when this behavior begins to interfere with a veteran’s daily life that problems can arise. That hypervigilance in wartime can cause a fundamental change in sensory perception to the point where an innocuous stimulus can trigger a violent or debilitating response. They become unable to distinguish the relevant information from the irrelevant. For example, grocery stores can become a stressful place because all that some one with PTSD can see is bright lights and large, unruly crowds. They are unable to process the fact that they are safe among the shoppers because they are processing it through the wrong lens. What is harmless in this scenario would mean danger in the one they are still living in.
Here we meet Chris, veteran who was caught in a firefight that he had not been train to deal with. He froze, unknowingly urinated on himself, and proceeded to fire wildly at nothing. He remembers the experience by comparing himself to the unrealistic ideal warrior and that moment is a key component of his battle with PTSD. The immediate, knee-jerk reaction one has to stress and its interplay with the what we are culturally primed believe about ourselves and our reactions is important if one hopes to grasp the full effect PTSD can can.
The two main components of trauma are actually or threatened death or injury and horror, an emotion so powerful it overwhelms the individual’s cognitive ability. Horror is often characterized by nightmares or intrusive thoughts forcing an individual to reexperience the trauma.
One veteran, Carlos, experienced horrific flashbacks of an instance where a little Iraqi girl was mistaken for a terrorist and was hit with a grenade launcher. She survived, but that is not how he saw her in his memories. It was the disconnect between moral combat and the senselessness of her shooting that caused the persistence of the unrealistic memories.
Veterans can experience dislocation in many forms, an internal distance from self, from family and friends, or even the world in general. They tend to feel nothing or extremely heightened feelings of anger or anxiety. One theory as to why this is posits that the brain is restructured to the point that when processing information it bypasses the prefrontal cortex, that would allow for higher thinking and consideration, and instead reacts to a perceived threat immediate. In this case the threat would be some thing like a simple disagreement that would normally be quietly resolved. This neuroplasticity can drastically change a person causing a crisis of identity or forming fissure between family and friends if an understanding of PTSD is not had.
Soldiers rarely get the chance to process their grief in combat, it is their job to go back out as long as they are deployed, regardless of the fact that their friends and coworkers may die around them. There is also a sense of responsibility between these soldiers that could and often does lead to feeling of guilt. Some soldiers are overcome in the field and some make it home before the tears fall. Grief can also be felt from simply coming home, in the difference between life as a civilian and life in a combat zone. Some veterans feel that this creates a barrier of understanding between themselves and the civilians in their lives. That perceived disconnect can lead to an inability of a veteran to talk about their experience, which is a key component of rebuilding relationships post-combat.
Grief is not typically thought of as being part of the PTSD paradigm, as anger is more often the associated emotion and due to the fact grief is an experience in its own right. However the dislocations created, be they internal or external, are a major contributor and require consideration.
Cultural mediators are the tools or processes by which the trauma variables can be reconciled and felt with. They are effective therapies that mainly consist of things like reexposure and reassessment. They allow veterans to grow accustom to there own memories that would once terrify them. They also go back an rationalize what happened. Remember Chris? He now realizes that when he froze, it wasn’t for an any length of time, likely no longer than five seconds and that relieving himself unconsciously was his sympathetic nervous system’s way of attempting to lighten him and give him more speed. He is using these cultural mediators to work through what he previously perceived to be a shameful event.
Mediators may not always present as treatment but more as an acceptable way of expressing emotion. Social support, though it can present in different forms, plays a critical role in lessening the impact of these traumas. The presence of cultural mediators speaks not only to the interconnection of the different variable but also to the fact that they can be changed and that people’s lives can improve.
Neuroanthropological Model of Post Traumatic Stress Response
This model serves a method of trauma comparison and of the differing approaches to the study of trauma. It also aims to grow a better understanding of the interplay between the different contributing factors as well as the contributing disciplines. It is not enough to simply understand what is happening physiologically or neurologically, there must be an understanding of why.