Troop Mental Ills: Psychiatric or Organic?

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Army photo / Staff Sgt. Antonieta Rico

U.S. Army troops on patrol in Taji, Iraq.

There’s a continuing tension over whether mental disorders are “organic” or “psychological”. The first is easier to define — a brain injury caused by an insult, such as a bullet wound, blow to the head or bomb blast. “Psychological” is usually chalked up to bad parenting.

Two new debates raise this issue again. One is whether “post-traumatic stress disorder” should be called “post-traumatic brain injury”. The other is the emerging findings on “CTE” — chronic traumatic encephalopathy — which shows long-acting brain changes after concussions.

I am reminded of the controversy about “shell shock” in World War I. Soldiers developed symptoms of anxiety and confusion, after being in the trenches, showered by artillery shells. Initially in WWI doctors believed this to be an organic insult by artillery shells.  Later the belief changed and doctors concluded that it was a psychological reaction to the daily threat of death and destruction. In the current discussion about mild TBI, or concussion, it is worth reviewing the discussion about shell shock being only a “psychological” reaction to warfare.

The term “shell shock” was later re-named “not yet diagnosed, nervous”, “battle fatigue”, “PTSD” and “combat stress reaction”. Now the term “post-traumatic stress injury” is being considered.

Dr. Remington Nevin has proposed that some of these reactions are actually the result of neurotoxic injuries from certain anti-malarial medications given to soldiers over the years, most recently mefloquine, or Lariam®.  He believes that these drugs can induce a “limbic encephalopathy” — a firing-up of the emotional portion of our brains. The powerful emotional side effects of mefloquine, which can include intense feelings of horror, paranoia, and anxiety, have been well known for years.

Today, the Centers for Disease Control and Prevention (CDC) even concedes that these side effects may “confound the diagnosis and management of posttraumatic stress disorder.” An interesting hypothesis is that some PTSD from Vietnam and earlier wars may have been precipitated by chloroquine and similar anti-malarial drugs, which mefloquine later replaced.

But the overall point is that the distinctions between organic and psychological disorders are artificial. Schizophrenia used to be thought of as due to bad parenting. Now we know that the disease has a biological basis; we just don’t know the source of the bad biology.

Likewise, patients with PTSD, in research studies, have a smaller amygdala. In a small but very interesting study, relatively young Soldiers showed CTE on autopsy. Thus, the already blurry distinctions between “organic ” and “psychological” causes of brain dysfunctions may eventually disappear completely.