PTSD: How Much Is Your Brain’s Fault?

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Retired Army General Peter Chiarelli has endorsed the idea that post-traumatic stress disorder should be renamed post-traumatic stress injury to emphasize its putative organic basis.

This proposal has generated a great deal of controversy. The intent seems to be to de-stigmatize and thus legitimize these consequences of trauma exposure by focusing on brain damage hypothesized to underlie PTSD.

The controversy exposes some fundamental aspects of our thinking about soldiers and their behavior, and their brains and minds. Psychologists can and should add some helpful clarity to these issues.

This movement to identify PTSD as a physical injury seems to be a positive, well-intentioned attempt to use the concept of mental illness (or injury) to achieve a social good – to help soldiers feel more respected. As an example, David Phillips writes in Lethal Warriors “…PTSD – or shell shock, or whatever you want to call it – is not just a subjective bundle of feelings. It is not just pop psychology or the invention of an overindulgent political agenda. It is a physical wound of war.”

Is this view of PTSD scientifically and philosophically compatible with what we really know about the effects of trauma exposure on soldiers, though?

Brain parts and their functions have sometimes been recruited as convenient explanatory devices when soldiers behave badly. David Phillips discusses and analyzes the murderous behavior of a group of Army Iraq war vets in Colorado Springs in 2007. In his fascinating and valuable book, Lethal Warriors, Phillips’ understanding of the biological substrate of PTSD relies heavily on the relationship between limbic structures such as the amygdala and hippocampus and the neocortex as a “horse and rider.”

The amygdala is conceptualized as a wild stallion, while the “logical” neocortex reins in the amygdala’s emotional responses. Phillips frequently refers to an individual’s “battle-scarred amygdala” as playing a key role in violent crimes committed by soldiers.

As Phillips sees it, stress weakens the rider (neocortex), inflames the wild stallion (amygdala), and, “In a real, measurable way, on a cellular level, humanity dissolves, soldiers lose themselves, and the primitive, bestial part of the brain starts to take over.”

Do we really know that this is what happens in PTSD sufferers’ brains, and that this is what causes their symptoms? Is our humanity really to be found in our cells?

William R. Uttal has written extensively and thoughtfully about brains and minds, and the importance of keeping straight what one we are talking about at any moment.

When Phillips writes that “Recognizing the cause of PTSD is common sense – trauma creates mental scars that can be permanent. But how and why these scars appear are only now starting to be explained through advances in neuroscience and brain-imaging technologies such as magnetic resonance imaging (MRI) that actually show researchers the physical effects of war on the mind,” he seems to be hopelessly entangling brain-talk with mind-talk.

By engaging in a kind of anthropomorphism in which we begin to think and talk about brain bits as if they were good guys and bad guys slugging it out inside our heads we create a compelling story, but what have we really explained? How does this move us closer to preventing or treating PTSD? If brain bits get some of the blame when we behave badly, why don’t they get any of the credit when we behave well?

In introductory psychology classes, we emphasize the biopsychosocial nature of most of the phenomena in which we are interested. That there is a biological component to PTSD seems likely, and studying it seems worthwhile.

But symbolically elevating and singling out the biological contributions to PTSD by calling it an “injury” simultaneously soft-pedals the psychological and social dimensions of this condition. Confronting the psychological and social (and political and economic) dimensions of PTSD may be messy and difficult compared to a medical/technical approach, but it may be the only practical approach.

Identifying PTSD as an injury may also have unintended consequences: expectations for the development of quick and effective medical therapies might be raised, and go unfulfilled. Viewing PTSD as an injury might shift the balance of perceived personal responsibility too far from the sufferer and toward care providers. Effective non-medical treatments might be viewed less favorably as not addressing the “real” causes of PTSD.

Phillips recognizes and tries to limit the exculpatory implications of the biological analysis of PTSD he offers, but in so doing he really exposes the fundamental tension that we psychologists live with, but rarely confront openly: how are minds and brains related? Perhaps psychologists and philosophers can help clarify the question, at least, and the implications of the answers they find.

Dr. George Mastroianni is a professor of psychology at the U.S. Air Force Academy in Colorado Springs, Colo., and writes the Headspace blog – “a social science look at the military” — on Psychology Today’s website. The views expressed are his own and may not reflect those of the Air Force or Department of Defense.