During the 1990s, we had a group that met to discuss traumatic illness at Emory where I was on the clinical faculty. There were biological researchers, a distinguished group of literature professors from the college, colleagues from the analytic institute, behavioral therapists [EMDR], the staff from the rape crisis unit, a guru from the false memory set, etc. It was an enthusiastic lot that met periodically for a while, though it never coalesced – too eclectic to produce the desired collaboration was my guess. I haven’t thought about the group for a long time, but it came to mind when I saw this report. At the time, Dr. Charlie Nemeroff was chairman of the Department of Psychiatry at Emory, but he wasn’t a member of our group. In fact, it was only in recent years that I even learned that he had an interest in trauma:
Different forms of childhood abuse increase the risk for mental illness as well as sexual dysfunction in adulthood, but little has been known about how that happens. An international team of researchers, including the Miller School’s Charles B. Nemeroff, M.D., Ph.D., Leonard M. Miller Professor and Chair of Psychiatry and Behavioral Sciences, has discovered a neural basis for this association. The study, published in the June 1 issue of the American Journal of Psychiatry, shows that sexually abused and emotionally mistreated children exhibit specific and differential changes in the architecture of their brain that reflect the nature of the mistreatment…
The results showed a correlation between specific forms of maltreatment and thinning of the cortex in precisely the regions of the brain that are involved in the perception or processing of the type of abuse. Specifically, the somatosensory cortex in the area in which the female genitals are represented was significantly thinner in women who were victims of sexual abuse in their childhood. Similarly, victims of emotional mistreatment were found to have a reduction of the thickness of the cerebral cortex in specific areas associated with self-awareness, self-evaluation and emotional regulation.
“This is one of the first studies documenting long-term alterations in specific brain areas as a consequence of child abuse and neglect,” said Nemeroff, who is also Director of the Center on Aging. “The finding that specific types of early life trauma have discrete, long lasting effects on the brain that underlie symptoms in adults is an important step in developing novel therapies to intervene to reduce the often lifelong psychiatric/psychological burden of such trauma”…
Traumatic Illness emerged as a major topic in psychiatry during World War I with an epidemic in the face of trench warfare. It was variously seen as a brain disorder [Shell Shock], a psychological illness [Traumatic Neurosis], or cowardice [firing squads]. After that war, it became clear that there were many instances where symptoms lasted for a lifetime, and the debate between psychological versus biological reasons for the persistence continues to the present.
Disclosure: Anyone reading this blog even casually would know that I’m no fan of Dr. Nemeroff because of his financial connections to the pharmaceutical industry and his history of shady dealings, the cause of his removal as editor of the Neuropsychopharmacology journal and from the Chairmanship of Psychiatry at Emory. I see him near the center of a subgroup of prominent academic psychiatrists whose misbehavior accounts for the corruption of the specialty itself and our credibility. But in this case, I’m skeptical of his research for other reasons. The first has to do with the observation that only a fraction of people in a given situation develop PTSD. Dr. Nemeroff believes that some are genetically predisposed to developing PTSD, and others aren’t [are resilient]. The second is his belief that the persistence of illness has to do with actual changes in the brain in response to trauma. I, on the other hand, believe that PTSD is the paradigm of an acquired psychological illness based on my own clinical experience with many such cases, and that there are cogent other explanations for these phenomena. As they say, I "have a dog in this hunt." So I’m biased against this investigator and against these specific conclusions.
Dr. Nemeroff has mentioned this present study for a while [see the Jan 2012
NYU Grand Rounds video @ 37:11], but only with the conclusions – neither the data nor the particulars. Yesterday, both Google and friends alerted me this article, but it hasn’t yet made it to the mailbox or on-line. While I I’ve read many of his previous trauma studies, I haven’t had much to say about them because they never have sufficient information to judge the clinical findings. There are lots of people who have been through some terrible things in their lives, and those things can have a profound effect on the psyche one way or another. But PTSD is more than that. It’s a specific syndrome with particular symptoms, and his papers don’t address that in enough detail to assess them properly. However, this study doesn’t purport to be about PTSD. It’s about childhood abuse, and the previous mentions don’t really talk about the the patient base. So I’m glad it’s finally made it to print to see if the clinical information is included this time.
1BOM,
You said: “The second is his belief that the persistence of illness has to do with actual changes in the brain in response to trauma. I, on the other hand, believe that PTSD is the paradigm of an acquired psychological illness based on my own clinical experience with many such cases, and that there are cogent other explanations for these phenomena.”
These do not appear to be mutually exclusive concepts (Even aside from the question of how you are defining how any acquired psychological illness would persist without “actual changes in the brain” – which seems so broad a term as to be practically meaningless).:
http://childtrauma.org/images/stories/bios/bdp_bio_2012.pdf
This includes the idea that due to certain changes in the brain that “traditional” psychotherapy may need to be preceded by other interventions that Dr. Perry feels need to be guided by a developmental neuroscience informed approach. Dr. Perry’s ideas are not without controversy, but his represents a vastly different approach to Dr. Nemeroff’s. “Actual changes in the brain” does not validate Dr. Nemeroff’s paradigm to approaching human suffering. Nor does it invalidate non-pill approaches.
As an aside, wasn’t Dr. Perry a major expert witness for the plaintiffs at the risperdal trial you attended?
I’m sticking with BPM (being properly mortified) and have no doubt that it effects the brain long term, but don’t trust imaging right now because it’s a bit young and overzealous at this point.
Have just scoured my history, but can’t find a study I looked at recently on PTSD and psychosis. According to that study they found an anomaly in the blood of combat veterans with PTSD who have had what some researchers believe to be secondary psychotic episodes. I’ve no doubt that being in states of extreme duress requires a body to adapt in such a way that would result in abnormal levels of various chemicals in the body, and require more nutrients than a body normally requires. It makes since that trauma can make changes in the structure of the brain, so can learning. But when I had my only CAT scan following a grand mal seizure, I asked the doctor if my hippocampus was shrunken. According to him, it wasn’t, though I surely have PTSD and had it before I ever heard of it. Now the thinning of the cortex is a sign? What happened to the shrunken hippocampus?
The safest bet anyone could make would be betting that Nemeroff is just looking for another population to drug so that he can profit from it.
With the changes in the DSM-5 a person doesn’t even have to have been afraid to have PTSD now. It appears that KOLs and the APA are attempting to do with PTSD what they did to melancholia and Major Depressive Disorder— “making psychiatric nosological categories insufficient ecologically to sustain efficient practice“. The better with which to fix the drug trials.
That’s funny how the structure of the brain permanently changes with emotional abuse or traumatic experiences.
“The results showed a correlation between specific forms of maltreatment and thinning of the cortex in precisely the regions of the brain that are involved in the perception or processing of the type of abuse. Specifically, the somatosensory cortex in the area in which the female genitals are represented was significantly thinner in women who were victims of sexual abuse in their childhood. Similarly, victims of emotional mistreatment were found to have a reduction of the thickness of the cerebral cortex in specific areas associated with self-awareness, self-evaluation and emotional regulation. ”
“area in which the female genitals are represented”
“specific areas associated with self-awareness, self-evaluation and emotional regulation.”
I was unable to find any such declared areas in the cerebral cortex on Wikipedia. http://en.wikipedia.org/wiki/Cerebral_cortex
I thought that was odd, so i decided to look up the “Cortical Representation of Genital Somatosensory Field” mentioned in the cited study.
I found this: “The sensory cortical representation of the human penis: revisiting somatotopy in the male homunculus.”
http://www.researchgate.net/publication/7767803_The_sensory_cortical_representation_of_the_human_penis_revisiting_somatotopy_in_the_male_homunculus
Evidently, there is no agreement in neuroscience as to where this supposed area actually is in the brain:
“However, regarding the primary cortical representation of the genitals, classical and modern findings appear to be at odds with the principle of somatotopy, often assigning it to the cortex on the mesial wall. Using functional neuroimaging, we established a mediolateral sequence of somatosensory foot, penis, and lower abdominal wall representation on the contralateral postcentral gyrus in primary sensory cortex and a bilateral secondary somatosensory representation in the parietal operculum.”
I concluded that the paper published by Charles B. Nemeroff, and M.D., Ph.D., Leonard M. Miller is most likely total bullshit.
That’s what happens when you try to correlate objective findings with subjective conjecture. You get conjecture, not science.
That had me wondering as well, Speck. Neurologists can’t know which brain lesions cause what malfunctions in people with MS. MS has been studied for a long time, and with it there are definite physical conditions in the brains and bodies that, along with other indicators, can reasonably be considered to be the result of MS; though without other symptoms and tests to back up the diagnosis, those lesions could be attributed to stroke and other conditions.
The idea that one condition, like “thinning” in various parts of the cortex is evidence of PTSD sounds specious to me on its face.
(I’ve tried to find who it was who said, “Don’t you know when I talk about me, that I’m talking about you.” A writer or poet, I think, but a search only brought up “mind control techniques” and lyrics by Daryll Hall).
Where would my trauma from six minutes of being in a combat role after a Soviet decapitating nuclear strike (from where we were sitting) thin walls in my cortex? Where would it be located for other combat veterans, for victims of environmental catastrophes? For kidnapping victims?
It seems to me that the idea that trauma— which is a very complex social and mental animal—- would be localized according to key words or parts of the body is simple-minded in the extreme. Once, after reading speculation on the possibility of erasing traumatic memories, I realized that if my traumatic memory were to be destroyed, that I wouldn’t make sense to myself. Trauma touches on a lot of “nerves” and continues to do so throughout the lives of people who have experienced it whether they have PTSD or not. Even in cases of sexual abuse, there is much more being affected than the genitals, like trust, autonomy, integrity, social value, that are much more profoundly frightening than the touching of the genitals.
My deep suspicion of any ambitious psychiatrist KOL, is confirmed by looking at the picture of dr Nemeroff, with the article from Miller School of Medicine. He seems to have, exteriorwise, what it takes to charm and maneuver around any hindrances, replete with a doctor’s white coat (authority), Clark Gable mustache and crooked smile, poseur pure, in my biased view.
1BOM’s exquisite understatement, “only in recent years that I even learnt he had an interest in trauma” is spelled out by wiley. The Nemeroffses of medicine are interested in certain populations to research/exploit for scientific purposes, as the doctors who have experimented on prisoners, patients, children, twins popular with more doctors than Mengele. Primo Levi’s diagnosis (If This is a Man) stands: The “dr Pannwitz look. If I had known how to explain that look, as if across a glass wall of an aquarium between two beings that lived in different worlds, I would also have explained the essence of the great insanity of the third Germany.” … a great insanity, alive and kicking.
PTSD does not have to be a permanent condition.
People can overcome the symptoms, including phobias.
The brain has neuorplasticity.
“Structural changes” are not permanent. –
http://www.vrphobia.com/research.htm
We ought to encourage hope, rather than continually referring to these conditions as permanent (lifelong, incurable). And, IMO, any mental health professional who does so causes more harm than good…. There’s a lot of that going on.
Duane
I apologize for being off-topic, but would like to share a link.
The Vatican is having a conference this month to discuss the harm caused by psychiatric drugs with children. –
http://www.catholicnewsagency.com/news/vatican-conference-to-reveal-harm-of-prescription-drugs-for-children/
The term “scientologist” is frequently used to dismiss those of us who are concerned about the use of psychiatric drugs.
Well, some of us Catholic are also concerned.
Including those in leadership positions in Vatican City.
Duane
http://www.informationisbeautiful.net/visualizations/punytive-damages-biggest-corporate-fines/
You make a good point, Discover, and the plasticity of the brain is a wonderful thing, but it likely does have some limits. There is a bit of a problem with declaring PTSD cured— a person can be free of it for years then suddenly it comes roaring back. There is no way to tell if it’s gone or just in remission. Even a person who suffers it may have no idea what could trigger it in the future.
Nevertheless, messages of hopelessness are damning, throwing a lot of drugs at it to see what sticks is abusive and brain damaging, and PTSD among combat veterans and rape/sexual abuse victims is a social problem. Treating it as a personal problem misses the forest for the trees. The sure knowledge that our society is doing so little to quell the ubiquitous horrors of war and sexual violence while labeling the victims as being insufficiently resilient rolls out the red carpet for triggers and allows trauma to do what it will.
Great graphics, jamzo. Visual data is wonderful.
@jamzo
Why aren’t these on here? There’s some of the largest fines ever levied against a company in the USA. These were Felony convictions.
http://www.nytimes.com/2009/09/03/business/03health.html?_r=0
http://www.nytimes.com/2012/07/03/business/glaxosmithkline-agrees-to-pay-3-billion-in-fraud-settlement.html?pagewanted=all
http://www.nytimes.com/2012/12/19/business/amgen-agrees-to-pay-762-million-in-drug-case.html
@Jamzo
Oh! I’m sorry.. I didn’t correctly see the decimal place in 8,600m… that’s a lot of fines..
Wiley,
I appreciate your comments.
IMO, we really don’t know much about neuroplasticity, because it’s a relatively new concept.
Not long ago, we thought the brain was hard-wired, unable to regenerate, renew.
Dan Rather put together a good program a few years back, called ‘Mind Science’. It aired on television (Dan Rather Reports), and can be viewed on YouTube (6-parts). –
http://www.youtube.com/watch?v=FkXtz72hjDI
Be well,
Duane