Wednesday, January 19, 2011

Thursday's Therapy - TRAUMA Therapy Toolbox - Treatment and the PTSD Paradox ~Charles W. Hoge (Part One

Thursday's Therapy

TRAUMA Therapy Toolbox

Treatment and the PTSD Paradox

~Colonel Charles W. Hoge, M.D.

(Part One)

Treatment and the PTSD Paradox

Gathered from One a Warrior Always a Warrior, ~author Charles W. Hoge, who is both a medical doctor and a U. S. Army Colonel:

Neurobiological research has helped us to understand that PTSD (Post-Traumatic Stress Disorder) is not an "emotional" or "psychological" disorder, but a physiological condition that affects the entire body, including

  • cardiovascular functioning,
  • hormone system balance, and
  • immune functioning.

PTSD can result in

  • physical,
  • cognitive,
  • psychological,
  • emotional, and
  • behavioral reactions

that all have a physiological basis.

PTSD is a paradox.

For medical professionals it's simply defined by the specific set of symptoms and impairment.

However, every "symptom" included in the definition (of PTSD) can also reflect normal responses to life-threatening events or the normal way the body responds to extreme stress....

Perceptions Matter. Why is this important? ...If you view having a disorder according to what a professional (or society) says, rather than someone experiencing expected reactions from (severe stress), it affects how you feel and think abut yourself....

A negative perception of yourself actually affects your body chemistry.

Perceptions (usually considered in the realm of psychology) involve nerve functions that connect with virtually all organ systems in the body. The mind and body are not separate.

Many therapies focus on helping to correct negative perceptions through a process called "positive reframing." Having a positive view of yourself is an essential starting place toward navigating the reactions resulting from (severe stress) experiences.

Mental health professionals can contribute to the stigma of mental illness through the perception that most everyone coming into their office has something wrong with them. A therapist's role isn't typically one of a minister or coach, but rather that of an educated professional entrusted to make the correct diagnosis so that the right treatment can be prescribed.

This perspective sets up an expectation that this person {the "expert"} is the judge of what's normal or abnormal, rather than an ally helping the client navigate their own way through serious life difficulties.

Some therapists fool themselves into thinking they know what the best treatment is for each individual sitting in front of them. Good therapists understand that they don't know what's best for their client, and set the stage by helping to normalize the experience of the client by saying something like, "I don't see how you could have done anything differently at the time," or "How did you have the strength to respond in that way?"

Everyone who has ever deployed to a war zone (and I would add to a Child-Loss Grief-War) is changed by his or her experiences; it would be abnormal not to be.

Some reactions may seriously interfere with your life, but that doesn't mean there's something wrong with you as a person. There are things that you'll identify and want to change, but, more important,

the journey of one of learning to live with your experiences, and of integrating them into who you are....

If we take each component of the DSM (The Diagnostic and Statistics Manual that psychology professionals use for ascertaining diagnoses) definition of PTSD and break it down...

Every "symptom" of PTSD stems from things your body normally does in response to severe danger or stress. PTSD symptoms can be manifestations of normal stress reactions to threatening situations, as well as a disorder that requires treatment.

That's the paradox of it.

(In other words, what our bodies do to cope with stress at the time of the severe threat is very appropriate to help one deal with the severe distress in a self-preserving way.

The problem comes when the severe threat is gone, but our bodies are still wired for severe distress!

That is when we start to have problems because we cannot seem to get our bodies to gear DOWN as automatically as they geared UP.

Therein lies the conundrum.

We want to take healthy steps to help our bodies gear down so that the stress hormones that help us in a crisis do not STAY in our systems which could lead to tearing DOWN the very systems the hormones were originally trying to PROTECT!)

~author Charles W. Hoge, who is both a medical doctor and a U. S. Army Colonel, from One a Warrior Always a Warrior

(In Hoge's writings which are italicized above, I substituted "severe stress" for Hoge's word "combat" since my audience is distressed by Child-Loss Grief and Trauma, a different kind of "combat" than war. Unitalicized words are mine.)

To be continued...

Picture from

Excerpts were taken from pages 3, 9-11 of Colonel Hoge's book, Once a Warrior Always a Warrior


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