147. Why should Allah punish
you if you have thanked (Him) and have believed in Him. And Allah is Ever
All-Appreciative (of good), All-Knowing.
148. Allah does not like that
the evil should be uttered in public except by him who has been
wronged. And Allah is Ever All-Hearer, All-Knower.
149. Whether you (mankind) disclose (by good words of thanks) a good deed
(done to you in the form of a favour by someone), or conceal it, or pardon an
evil, ... verily, Allah is Ever Oft-Pardoning, All-Powerful. 4. Surah An-Nisa' (The Women)
Childhood abuse may be the most common cause of PTSD in American women, 10% of whom suffer from PTSD (compared to 5% for men) at some time in their lives,(2) but many other types of psychological trauma can cause the disorder — car accidents, military combat, rape and assault. Symptoms of PTSD include intrusive memories, nightmares, flashbacks, increased vigilance, social impairment and problems with memory and concentration.
It's Not Just Psychological
While such symptoms are commonly understood to be psychological problems, some or all of them may well be related to the physical effects of extreme stress on the brain.(3)(4) Recent studies have shown that victims of childhood abuse and combat veterans actually experience physical changes to the hippocampus, a part of the brain involved in learning and memory, as well as in the handling of stress.(5) The hippocampus also works closely with the medial prefrontal cortex, an area of the brain that regulates our emotional response to fear and stress. PTSD sufferers often have impairments in one or both of these brain regions. Studies of children have found that these impairments can lead to problems with learning and academic achievement.
Other typical symptoms of PTSD in children, including fragmentation of memory, intrusive memories, flashbacks, dissociation (or the unconscious separation of some mental processes from the others, e.g., a mismatch between facial expression and thought or mood), and pathological ("sick") emotions, may also be related to impairment of the hippocampus.(6) Damage to the hippocampus, which processes memory, may explain why victims of childhood abuse often seem to have incomplete or delayed recall of their abusive experiences.(7)
A Disease of Memory
Memory problems play a large part in PTSD. PTSD patients report deficits in declarative memory (remembering facts or lists — see below), fragmentation of memory and dissociative amnesia (gaps in memory lasting from minutes to days that are not caused by ordinary forgetting).
Psychiatric Symptoms Associated with Childhood Abuse
PTSD
- Nightmares
- Flashbacks
- Memory and concentration problems
- Hyperarousal
- Hypervigilance
- Intrusive memories
- Avoidance
- Abnormal startle reponses
- Feeling worse when reminded of trauma
Dissociative
- Out-of-body experiences
- Derealization
- Amnesia
- Fragmented sense of self and identity
Anxiety
- Panic attacks
- Claustrophobia
Substance Abuse
- Alcoholism
- Drug addiction
Many abuse victims report that they remember seemingly random or minor details of the abuse event, while forgetting central events. For instance, one woman who had been locked in a closet had an isolated memory of the smell of old clothes and the sound of a clock ticking. Later, she connected these details with feelings of intense fear; only then was she able to recall the whole picture of what had happened to her. PTSD also causes problems with non-declarative memory (subconscious or motor memory, such as remembering how to ride a bicycle). This can show up as abnormal conditioned responses and the reliving of traumatic experiences when something happens to remind the sufferer of past abuse. These types of memory disturbance may also be related to physical changes in the hippocampus and medial prefrontal cortex.
How Psychological Trauma Affects the Hippocampus and Memory
Childhood abuse and other sources of extreme stress can have lasting effects on the parts of the brain that are involved in memory and emotion. The hippocampus, in particular, seems to be very sensitive to stress.(8)(9)(10)(11)(12)(13)(14)(15)(16) Damage to the hippocampus from stress can not only cause problems in dealing with memories and other effects of past stressful experiences, it can also impair new learning.(17)(18)Exciting recent research has shown that the hippocampus has the capacity to regenerate nerve cells ("neurons") as part of its normal functioning, and that stress impairs that functioning by stopping or slowing down neuron regeneration.(19)(20)We recently conducted a study to try to see if PTSD symptoms matched up with a measurable loss of neurons in the hippocampus. We first tested Vietnam combat veterans with declaratory memory problems caused by PTSD.(21) Using brain imaging, these combat veterans were found to have an 8% reduction in right hippocampal volume (i.e., the size of the hippocampus), measured with magnetic resonance imaging (MRI), while no differences were found in other areas of the brain (Figure 1).
Our study showed that diminished right hippocampal volume in the PTSD patients was associated with short-term memory loss.(22) Similar results were found when we looked at PTSD sufferers who were victims of childhood physical or sexual abuse.(23)(24)
More recent studies have since confirmed hippocampal volume reduction in PTSD(25)(26) These studies also show that hippocampal volume reduction is specific to PTSD and is not associated with disorders such as anxiety or panic disorders.(27)
Further study on the question of memory and the hippocampus may some day shed light on the controversy surrounding delayed recall, or so-called "recovered memories" of childhood abuse. The hippocampus plays an important role in connecting and organizing different aspects of a memory and is thought to be responsible for locating the memory of an event in its proper time, place and context.
We suspect that damage to the hippocampus following exposure to the stress brought on by childhood abuse leads to distortion and fragmentation of memories. For instance, in the case of the PTSD sufferer who was locked in a closet as a child, she had a memory of the smell of old clothes but other parts of her memory of the experience, such as a visual memory of being in the closet or a memory of the feeling of fear, are difficult to retrieve or completely lost. In cases like this, psychotherapy or an event that triggers similar emotions may help the patient restore associations and bring all aspects of the memory together.
This new understanding of the way childhood trauma affects memory and the brain has important implications for public health policy. One example would be the case of inner-city children who have witnessed violent crimes in their neighborhoods and families. If this kind of stress can cause damage to brain areas involved in learning and memory, it would put these children at a serious academic disadvantage in ways and for reasons that programs such as Head Start may be unable to address. Studies confirm this: in war-torn Beirut, traumatized adolescents with PTSD, as compared to non-traumatized adolescents who were without PTSD, lagged behind in academic achievement.(28)
PTSD and Other Brain Areas
Besides the hippocampus, abnormalities of other brain areas, including medial prefrontal cortex, are also associated with PTSD.The medial prefrontal cortex regulates emotional and fear responses.(29) The medial prefrontal cortex is closely linked to the hippocampus. In several studies we have found dysfunction of both the medial prefrontal cortex and the hippocampus at times when patients were suffering from PTSD symptoms.(31)
We believe that dysfunction in these medial prefrontal regions may underlie pathological emotional responses in patients with PTSD.(30) For example, we sometimes see a failure of extinction of fear responses — a rape victim who was raped in a dark alley will have fear reactions to dark places for years after the original event, even though there is no threat associated with a particular dark place. In a study using combat-related slides and sounds to provoke PTSD symptoms, combat veterans with PTSD had decreased blood flow in the area of the medial prefrontal cortex. Significantly, this did not occur in combat veterans without PTSD32 We saw similar results when we compared women with PTSD and a history of childhood sexual abuse to women with a history of abuse but no PTSD.
The good news is that treatments for PTSD result in an improvement in the brain(33). Treatment with paroxetine for up to a year in PTSD patients resulted in significant improvements in verbal declarative memory and a 4.6% increase in mean hippocampal volume(34). Studies have also shown an increase in right hippocampal and cerebral cortical brain volume with treatment with phenytoin in PTSD(35). Still other recent studies have also shown changes in the brain with psychotherapy for PTSD.
Conclusion
Traumatic stress, such as that caused by childhood sexual abuse, can have far-reaching effects on the brain and its functions. Recent studies indicate that extreme stress can cause measurable physical changes in the hippocampus and medial prefrontal cortex, two areas of the brain involved in memory and emotional response. These changes can, in turn, lead not only to classic PTSD symptoms, such as loss and distortion of memory of events surrounding the abuse, but also to ongoing problems with learning and remembering new information. These findings may help explain the controversial phenomenon of "recovered" or delayed memories. They also suggest that how we educate, rehabilitate and treat PTSD sufferers may need to be reconsidered.
Kim Morn's face is angular and weathered, his eyes pensive. At 68, he relives in his nightmares the terror of Khmer Rouge soldiers taking Cambodians away to be executed.
Morn was a young husband, only 28, when soldiers under dictator Pol Pot forced him and his wife into a mass exodus in 1975 that drove Cambodia's entire population into work camps. The couple were split apart and sent to separate sites.
Morn labored for more than 10 hours each day, carrying baskets of dirt to build dams. Soldiers beat and prodded him to move faster, although his tall frame had weakened from a starvation diet of rice gruel. He willed himself to keep working to stay alive during almost 4 years in captivity. All around him, the Khmer Rouge staged a constant stream of executions.
Morn and other refugees who resettled in the United States outlived an estimated 2 million Cambodians who perished in the Khmer Rouge killing fields. After Morn reunited with his wife in a Thai refugee camp, the two came to the U.S. in 1985 and resettled in San Jose, CA.
The torrent of nightmares has slowed over the years. But, says Morn: "I still struggle with feeling angry."
A Profound Challenge
Doctors diagnosed Morn with depression and post-traumatic stress disorder(PTSD). But the term PTSD might be too limiting to capture the trauma, says Daryn Reicherter, MD. He's a psychiatrist at Gardner Family Care Corporation, a behavioral health care clinic in San Jose where Morn receives treatment. Reicherter has also worked with patients through the Center for Survivors of Torture, which is also in the city.
"Cambodians are basically very similar to Holocaust survivors. They've been through a completely traumatic experience that was pretty hopeless, very violent, very graphic, where they witnessed murders and were physically tortured, raped, beaten," Reicherter says.
A 2005 study of 586 Cambodian refugees in Long Beach, CA, showed that 62% had PTSD. About 51% of the refugees had depression. Many had both.
"Even though it's been more than 30 years... they're still re-experiencing their trauma," says Yeon S. Lee, LCSW, a social worker who supervises Cambodian mental health services at Gardner. "It interferes with their life functioning. A lot of people suffer flashbacks and hear voices. They have nightmares, sometimes of people chasing them." Some endure insomnia orpanic attacks.
Often, dwelling on upsetting thoughts -- an expression of anxiety -- plagues Cambodians with present-day stressors, she says. "They tend to worry about the same things over and over again.".
Chuoi Ho, 55, labored for 6 months in a Khmer Rouge camp when he was 16. His father and brother died. He escaped to South Vietnam, resettled in San Jose, and married a Cambodian woman. They raised a daughter, now 28. He struggles with nightmares, PTSD, and "a lot of depression," he says.
Ho, a small man with a gray goatee, worked at an electronics company assembling computer parts, but was laid off. He hasn't found a new job. "I became more depressed because of the financial situation," he says.
Ed Glimme wants you to take a hike. Toting a backpack up hills and down dales — or without a pack and just walking the flatlands through the La Crosse Marsh and city streets, whichever fits your stamina.
Glimme, 42, is coordinating Wisconsin Rucking the Bluff, a March 7 trek through La Crosse in which civilians are asked to join with veterans to raise awareness of the post-traumatic stress disorder that afflicts many troops and veterans.
A ruck, or rucksack, is the backpack troops carry on marches during field training and when deployed — often including 85 pounds of gear, food and other provisions. Those who participate in the increasingly popular venture outside of the military are called ruckers.
“The goal is to help the community become actively aware that, for some vets, PTSD is a daily struggle,” said Glimme, who owns Ethereal Gateless Barrier, a La Crosse school that teaches meditation, spirituality, Qi Gong, yoga and martial arts.
“Burdened with the stigma associated with mental health issues and the military ‘shame’ surrounding post-traumatic stress, they instead turn to suicide as their only option to relieve suffering,” he said.
“Every day, 22 veterans and one active duty soldier suffering from post-traumatic stress disorder take their own lives,” Glimme said.
Those statistics, the most recent available, are from a 2012 study the U.S. Veterans Affairs Department conducted of veteran suicides from 2009 to 2011. Although suicides among older veterans declined slightly, the rate of suicides among male veterans under 30 increased 44 percent, and the rate among female veterans rose 11 percent, according to the VA report.
Glimme is not a veteran, but he picked up the idea from a friend in Milwaukee involved in a similar event.
“It’s an opportunity for vets and their supporters and loved ones to get together,” he said.
“It’s interesting in the warrior tradition that most people identify PTSD as just with veterans, but it can affect people who have run into troubled times in their lives,” he said.
Marchers will step off at the head trail of Hixon Forest in La Crosse at 10 a.m. March 7. The 8.6 mile course will include the Bicentennial Trail, circling back to the La Crosse River Marsh, following the marsh path to Riverside Park, through downtown to West Avenue, then back on Market Street to the Roy L. Vingers American Legion Post 52 at 711 Sixth St. S. for the Legion’s monthly steak fry at 5 p.m.
“The course we set up has some difficult parts along the bluff that get your heart pumping, but the marsh is flat,” he said.
“You don’t have to ruck the whole thing,” he said. “If you see us going through the streets and you want to support veterans, just fall in.”
Rucksack guidelines are 25 pounds or more for women and 35-plus pounds for men. Glimme advises that your ruck should include supplies you might need, such as food and water, for the distance you plan to march, as well as clothing to suit the weather conditions.
The weight is intended not only to represent the physical loads troops carry during deployment but also to symbolize the hidden burden of PTSD, Glimme said.
However, participants don’t need to burden themselves with a backpack. “If all you have is a water bottle, we’re not going to gig you,” he said.
More than 30 ruckers, including active military and veterans, from across the state have signed up to participate, Glimme said, and he would like to at least match that number locally.
“If I could get 30, 40 or 60 from here, that would be great,” he said.
A veterans group plans to film the march to raise awareness of rucking statewide, Glimme said.
“It’s kind of like the motorcyclists who ride to all events, these guys ruck whenever possible,” he said.
Ruckers and nonparticipants alike are encouraged to mix with veterans at the steak fry, Glimme said.
Glimme is not soliciting donations at this time, explaining, “This ruck is to raise the awareness for vets and PTSD. Spending time with a vet goes much further than the dollar. I’d rather have people buy a beer at the post than throw money at an organization — and the vet would appreciate it, too.”
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