CNNhealth's mental health expert, Dr. Charles Raison, shares how PTSD can affect the brain following the traumatic shooting at the Empire State Building on August 24. Dr. Raison is an associate professor of psychiatry at the University of Arizona in Tucson.
(CNN) -- The brain is by far the most complex thing that we know
of in the universe.
And yet, for all its complexity, sometimes the
brain responds to events in ways that are so remarkably predictable that we can
use these responses to help people who are suffering.
Before talking about the predictable way that
the brain responds to traumas, it is also important to emphasize that all of us
have complex and conflicting responses to horrific events such as mass
shootings.
We feel sick with pain for the victims and
distressed at the apparent senselessness of the violence. But we may also be
deeply moved by the bravery of others at the scene or encouraged by the
solidarity shown after the event.
Through this warren of conflicting feelings,
however, a single motive arises in most of us driven by the human brain's
natural sense of empathy. We want to help those directly affected by the
tragedy. We want to know who to help and how to help them.
The first and perhaps most important thing to
know in this regard is that most people who live through an unexpected,
devastating and life-threatening situation such as a shooting suffer
emotionally for various periods of time but do not develop a chronic psychiatric
condition that requires professional intervention.
In this way, people are remarkably resilient.
They will be fine with our love and care.
Unfortunately, a significant minority of
traumatized people will suffer terribly and for an extended period as a result
of developing post-traumatic stress disorder, or PTSD.
People with PTSD are afflicted with three
primary types of symptoms.
The first type of symptoms involves all manner
of intrusive memories of the event that often come with startling clarity via
flashbacks and nightmares. Along with anything else that reminds a person of
the trauma, these intrusive memories produce profound psychological distress
and physical symptoms, such as a pounding heart.
The second type of symptoms revolves around
avoidance and emotional numbing.
Bedeviled as they are by unwanted memories,
images, nightmares and flashbacks that keep the terrifying reality of their
experience emotionally alive for them, people with PTSD often go to heroic
lengths to avoid anything in the personal or physical environment that reminds
them of the trauma.
They often also report feeling emotionally
deadened, unable to love and disinterested in things others find pleasurable.
Often they feel like they will die young or have less of a future than other
people.
The third and final symptom domain of PTSD is
known as hyperarousal. Hyperarousal symptoms include difficulty falling or
staying asleep, irritability or outbursts of anger, difficulty concentrating,
being hypervigilant and finally, demonstrating an exaggerated startle response.
These PTSD symptoms usually don't travel
alone, unfortunately, but are frequently accompanied by depression and
difficulties with drugs and alcohol.
So how can we predict who is in danger of
developing PTSD after experiencing something horrific such as a mass
shooting?
We want to be able to predict this, because it
will help intervene early on in the lives of people most in danger of making a
poor recovery from the event. Fortunately, we've got a lot of scientific
evidence to help guide us in identifying those at high risk for PTSD.
First and foremost, people who have tremendous
emotional upset immediately after the traumatic event are at much greater risk
of going on to develop PTSD than are those who respond with cooler heads.
It is absolutely not the case that people who
are "cool, calm and collected" at the time of the trauma are setting
themselves up for later trouble. Quite the contrary.
People who cope well in the minutes, days and
weeks after a trauma typically do well over the long term. On the other hand,
people who respond with immediate terror or who become "emotionally
unglued" after the event are much more likely to continue having
difficulties as the months and years roll on.
There is another symptom of acute trauma that
can be easily missed if you are not on the lookout for it that strongly
predicts the development of later PTSD. In layman's parlance, we might call it
"being spaced out." More technically, we call it dissociation.
When people dissociate, things come apart in a
variety of ways.
Often they feel separated from themselves, as
if they are watching themselves from some outside vantage point. Frequently
they feel that there is some type of invisible wall between themselves and the
rest of the world. Sometimes they will feel that everything in the world,
including themselves, is somehow unreal.
I've heard patients describe this experience
as being like looking at the world through the wrong end of a telescope, so
that everything seems smaller and distorted. In extreme instances, people so
thoroughly lose track of things that they develop amnesia.
As we care for friends or loved ones who have
experienced a trauma, it is of utmost importance that we keep an eye out for
the development of any of these types of symptoms.
Usually we have to ask people directly about
them. In my experience, people are often not even fully aware that they are
experiencing dissociation, perhaps because it is so strange that they don't
know how to think about it, perhaps because they are "dissociated"
from their dissociation.
So let me try to boil it down to a simple
recommendation.
People who respond to a horrific trauma with
normal upset and anxiety need love, support and space to work through their
feelings. On the other hand, people who respond with overwhelming feelings of
terror, who are emotionally overwhelmed and/or who experience dissociative
symptoms should be encouraged to find competent professional help immediately
before these symptoms transform over time into PTSD.
It is so important that we find competent
professional help for those at risk following a trauma, because early
intervention, which can take the form of medications, therapy or a combination
of the two, can really help people metabolize their horror and loss in ways
that will provide them with a significantly happier and less impaired future.
My first passion in life is horses. I rode my first horse
when I was 2-years old and have ridden ever since. My second passion would
likely be yoga. Yoga is possibly what kept me fairly sane during graduate
school. Throughout my years of horse back riding and yoga I have always
found that I enjoyed and benefited from learning from many different
instructors. 
Be happy - Tara
