PTSD: The futile search for the ‘quick fix’

The Scientific American guest blog kicks off a series on the limitations of current PTSD research and treatments, and the importance of prevention (which I believe is the only real “cure”).

The timing of the essay was good, since the fight to reauthorize the Violence Against Women Act is currently underway — a form of prevention that definitely works.

In the article I make several points, and accompany them with a wealth of linked supporting evidence:

1. Clinical tests of current treatments test their effectiveness on patients who do not represent the majority of those who suffer from PTSD.

2. The weight of powerful institutions is behind the push for short-term treatments: the military, pharmaceutical companies, and insurance companies.

3. Most people who have PTSD also have other hard-to-cure disorders like substance abuse, depression and anxiety disorders  These have fluctuating symptoms that require long-term case management, rather than a ‘quick fix’ revolving door policy.

4. There is no way to prevent PTSD without preventing violence in the first place. We need to fund violence prevention programs that work, and we need to take a good hard look at what causes violence in the first place.

Here’s an excerpt:

Women are not the only population to suffer disproportionately from violence and, hence, from PTSD. Look again at the figures above, and you’ll note that close to half of Native American women have PTSD, as compared to a third of American women in general. Higher rates of PTSD are evident in communities with high rates of violence, low-income communities with poor social support, populations with a high rate of incarceration, and other markers of social and economic disadvantage. Poverty and racial oppression increase the likelihood that an individual will experience one or more traumatic events; PTSD then lowers the life chances of the individual who suffers it. Thus, a seemingly unrelated circumstance, such as unequal sentencing for possession of crack cocaine vs. powder cocaine (especially when it takes place in an environment of unequal policing, prosecution, and sentencing) can have a significant effect on the level of PTSD in a community where a large number of male residents have served time for possession. Much human-caused trauma is systemic, rather than exceptional. Those of us who want to treat PTSD in the U.S. need to ask ourselves how best to treat PTSD in community under siege, where we’re attempting to help patients who were probably traumatized before, and are quite likely to be traumatized again.

I hope you find the article interesting. And feel free to bring the discussion to SciAm, where I’ll be fielding questions. They tell me 100,000 people read SciAm blogs. I guess we’ll see….

Peace!