Causes and Manifestations of Post Traumatic Stress Disorder - Research Paper Example

? Critical Analysis of Post-Traumatic Stress Disorder and Contemporary Social Concern Critical Analysis of Post-Traumatic Stress Disorderand Contemporary Social Concern Introduction The quest of solving modern social problems through understanding of historical occurrences of the same or similar predicaments is a subject that has been very active among the philosophical fraternity of the past century. This is so because the current era has presented to us challenges brought about through involvement of electronic data processing which has beaten the human mind in computational abilities. New concepts and social phenomena, deciphered and yet-undefined, have emerged and making collective sense of the modern social environment has become a far cry for a human being. There has been an exponential increase in the past couple hundred years in the number of ways mental powers can be utilised and the predispositions the mind can subscribe to. This has led to a multiplication of instances and occurrences of the mind being overwhelmed by the knowledge it attempts to assimilate or by the way it tries to do this. In other words, the mental health issues of today are dramatically profounder in quantity, type and mode of occurrence than those of the pre-electronic age. And it is no surprise that the medical caregivers have struggled to maintain a coherent portrait of the various mental health conditions that have surfaced across the globe. What role the medical fraternity have played in this era and how to assess it are questions of vital importance to understanding the reality of the state of medical sciences today. To this end an issue that deserves the attention of analysts of academia's role in handling social issues of nowadays is the oft-occurring phenomenon of mental trauma. Advent of the global village has seen a surge in the forms, causes and cases of trauma because of changes in the social climate. Trauma is not a long-lasting injury per se; it is the effects that it has on the individual that are of real concern. The most notorious type of mental predicament caused by trauma is a condition known as Post-Traumatic Stress Disorder (PTSD). PTSD has been a subject of discourse not only in the medical and health circles but in the spheres of philosophy and humanities as well. Famous thinkers like Freud have devoted effort to understanding of the issue of PTSD and on sketching out a fact-check of the neurological and externalist depictions of the problem. This paper aims to build on the sociological debate about the actors involved in determining the visions of the human mind and descriptions of issues like PTSD; as well as in shaping the normal social consciousness and the collective conscience regarding ethics of medical practice. It claims that general perception about advancement in medical science and reliability of trendsetting intellectuals' understanding and description of interpersonal processes in delusionary and flawed. It therefore aims to draw a realistic picture of the state of human understanding of these issues and bearing thereof on them and attempts to do that by employing a constellation of plausible theoretical and empirical attestations. Caring About Health While people struggle for basic life necessities like adequate nutrition and clean drinking water, a select few are spending billions of dollars on research trying to discover ways of notably extending their natural lives. Death is final; and thus far it has not occurred to human kind to give any serious thought to possible methods of ultimately defeating it. Thus death is considered an inevitable finality and that is why the intellectual community as a whole has not been able to clearly define a single ultimate goal of research in medical science. There is debate about what extent and type of medical facilities are to be considered basic human need and what is to be declared opulent healthcare. According to some theories of philosophy, any state better than dead is not to be considered 'basic'; henceforth since living is a desire; any form of yearning for medical help is to be considered a desire. These interpretations of the causes for pursuit of medical research and application make it hard to determine whether contemporary medical research is directed towards fulfilment of a desire or meeting of needs. This is the basis for opening up of an exhaustive debate about the ethicality of pursuit of human desires and distinctions between desires and needs. More relevant to the modern society is the topic of socialization of basic healthcare machinery. On the one hand there are activist groups and humanitarian thought supporting the idea that some degree of medical coverage is to be considered a right of every human being. On the other hand free market proponents argue that free medical facility can only qualify as a right if it calls for a positive obligation of every citizen to provide for the needs of less-resourced human beings. However, since a governmental declaration of healthcare as a right bears political and legal stipulations, the matter no longer entails a right and rather infringes upon the freedom of citizens to choose how and where to spend their money. A famous perspective on the issue that the proponents of social healthcare cite is the view of Karl Marx that the relationship between health care provider and patient should not be a commodity relationship comparable to selling refrigerators or providing piano lessons, where the participants are in some sense adversaries, but one in which they are cooperative and benevolent (Paul & Russo, 1982, p. 186). Another postulation that came out to support this view is the findings of a recent research study conducted in twenty six countries part of the Organization for Economic Co-operation and Development (OECD) to determine whether governmental healthcare expenditure would count as a luxury or a necessity (P. Narayan, S. Narayan & Smyth, 2011, p. 3631). For the eighteen countries where real Healthcare Expenditure per capita was to be obtained using a general GDP deflator, it was found that health care is a luxury in just one country. Whereas in the eight countries where real HE is obtained using a specific health-care price index, HE turned out to be a necessity in all eight. Role of Healthcare Professionals Fundamentally, the greatest responsibility of any sector of society with regards to health issues lies with the people providing medical care to the general public. It is the caregivers, in an elementary profile of the issue, that have the greatest bearing on the collective wellbeing of civilization. By devolution, this holds true for the treatment of trauma patients as well. This is emphasized by J. Chadwick (2010, p. 201) who contends that nurses have an essential role in the care of trauma patients. From a more holistic point of view, doctors play an important role in shaping the medical situation of the society and people's understanding of the causes of health problems. Hence doctors are to be held responsible for the role they play or do not play while being practitioners of their profession, not solely because they have access to sources of the highest echelons of knowledge and should therefore be liable for the lack of enlightenment of the masses regarding the realities of medical science. This is the view expressed by C. Pope in a cover story for the magazine MGMA Connexion: “A key professional responsibility for the medical practice executive is to assess strengths and weaknesses in knowledge and skill base.” Role of Social Theorists It cannot be denied that contemporary thinkers have ventured very deep into analysing and interpreting bygone writings, acknowledging late empirical evidence and collecting their own thoughts to come up with all-incorporating explanations of the realities of societal phenomena. One testimony of this kind of enthusiasm comes from the philosophical sketch of the possibilities and limitations of conceptualizing interrelations of life, death and health by Alan Blum in his book The Grey Zone in Health and Illness (2010). Blum researches the relationship of medicinal knowledge to life as conceived by the famous philosophers Descartes, Plato and Socrates. He states that medical knowledge was perceived by Descartes as the greatest form of knowledge and its practitioner an exemplification of a person of knowledge. This view was based upon the usefulness of medical knowledge in that it relates to the primal topics of life, death and health. In contrast Plato saw that these aspects only became relevant based on the way of living that these did not matter in living a dog's life. Blum argues that in any case it cannot be denied that any hope for mastery in this field was precluded by the fact of the finality of death and the conjunction of this fact with the search for medical expertise constituted a 'Grey Zone' where things are not well defined. Hence for a practitioner to keep his aspirations he should succumb to this ultimate fact and direct his aspirations towards mastering this grey zone or coming to know all about the ambiguity of the matter. Every field of knowledge seeks an ideal state and bends its object towards this ideal; hence this ideal need not be a delusion, but an acknowledgement of the delusion. Descartes in this regard focuses on the benefits of the spread of knowledge whereas Plato illuminates the potential dangerous consequences of the asymmetry between the producers and recipients of knowledge and suggests that the spread of knowledge should be qualified by philosophy. Descartes contends that the loopholes of medicinal knowledge are there simply to evoke the tension of a desire and fulfilling progress just around the corner. Blum predicates the whole discourse about ethics of possession of knowledge on theories from a time when medical knowledge had not passed a vital epoch that it purportedly now has. However there are scientific and social thinkers trying to address the sociological aspects of contemporary ethical issues as well. For instance Ronal Hamowy's article (2012) on medical responsibility published in the Journal of Law, Medicine & Ethics addresses the debate about the governmental control of healthcare in the U.S. from an ethical point of view. In it Hamowy argues that a social welfare program by the government regarding basic medical facilities would imply a departure of the general public from their primary responsibility of charity. He asserts that the notion of the unidirectional profit-seeking nature of private organizations is misleading as it undermines the healthy competition that exists between private enterprises in serving the customer. While Hamowy does a good job of bringing to light the morality of campaigning for governmental provision free medical care he fails to allude to the main talking points of the proponents of the reforms. He compares the health system of the U.S. to only that of Canada in an attempt to prove the efficacy of privatized healthcare even though some of the most reputed systems of medical aid provision are found in Europe. Hamowy's article signifies the scientific fraternity's attempt to influence and provide input to debates about the ethical aspects of contemporary issues. However there had been little notable insight into the standing of the scientific fraternity's progress in their own fields until a research by Michael Hampe in 2007 into mankind's understanding of the human brain. Hampe signals that in the background of the discoveries and breakthroughs of brain neurology there is an intriguing battle being fought between the fields of humanities and biological sciences over validation of each field’s explanation of the concepts of cerebral functionality. Hampe states that while the prerogative for neurological advancement and the bounty for it lie with the biological scientists, it is becoming increasingly evident that observational research will not be able to provide an alternate for the insights of self-examination. Hampe writes that there are very few scientists, like Mark Solms (Solms, 1995, p. 107), who try to combine the reconstructions of the internal perspective of a human being with the external view of brain research. Overall Hampe gives very insightful news about the current state of the understanding and shortfalls of the brain. The Facts of the Brain and PTSD Hempe, in his article, also addresses the ethical dilemma of which humanly attributes should be accepted as facts by psychological theorists and which ones should be tried to be changed. For instance inclination towards violence is a hard fact of human psychology but it is not a desirable quality, hence the determination of whether such a fact is to be accepted as such or the moral obligation of discouragement of a vice is to be exercised is hard to make, because in rejecting the factuality of violence as a truth one is essentially deceiving oneself. This dilemma is even more severe in the case of trying to accept the mortality of lie. Death is a fact; however in all cases it is contingent. According to Freud (1946, p. 72) this is the reason it is impossible to imagine your own death. This inability can be interpreted as a need to deceive oneself in order to deal with a truth. However, contrary to common perception, it is not utilised in dealing with a traumatic experience. Hempe gives an anecdotal example to explain this fact: A Vietnam War veteran suffering from PTSD does not deny having killed the persons he is remembering. Then it is not the fact that a violent act has occurred that is unacceptable, but rather the fact that I am a person who was the victim of this violent act or who committed it. This is not suffering ‘as a result of’ memories but rather suffering ‘from’ memories that cannot be accepted as belonging to one’s own life. Thus Trauma, psychologically, is not an experience of the same category as trying to accept the finality of death which as stated earlier is impossible. Hence since being or experience constitutes a person, could it be that the traumatic event fundamentally disturbs the ability of a person to transform events he or she lived through into experiences and therefore threatens that person’s self-made unity? Post-traumatic stress disorder is more absorbing than distressing. According to doctors, it is like a 'black hole', in that it attracts thoughts that come near the thoughts associated with it. According to one account quoted by Hempe: A war veteran known to us can’t look at his wife’s nude body without recalling with revulsion the naked bodies he saw in a burial pit in Vietnam, can’t stand the sight of children’s dolls because their eyes remind him of the staring eyes of the war dead, and can’t walk on his property without eying the tree line for infiltrators. Because of this characteristic of PTSD, even though the patient metaphorically tries to run away from traumatic thoughts, the ability of recollection of the patient is expanded involuntarily in the same way the ability of recollection is expanded voluntarily in hypnosis or memory art. It has been clinically proven that some level of voluntary thinking is involved in the development of a trauma and the level of consciousness with which a trauma is invented varies in different cases. Jonathan Shay (1994, p. 32) has attempted to draft out a general description of the conditions of the development of a trauma: First, a person acquires stability of character within a fixed social and moral horizon; second, an important person within this horizon breaks fundamental rules governing behaviour and the generation of experience, and this is perceived as a ‘betrayal’; third, an attempt at reorientation within the narrower social and moral horizons is unsuccessful; this results, fourth, in a disintegration of the moral and social habits of the person. Society and Post-Traumatic Stress Disorder The sun is an entity the reality of which is not affected by what it is said about it. However, if a human being can be audience to what is said about him or her, his or her reality includes the description of him or her. The contention here is that the idea of traumatic memory may have been implanted into the subconscious of people by society and the people themselves because there are no accounts of a condition of this profile from before a couple of hundred years ago. Moral and social conventions vary from one culture or historical epoch to another. But it is only in the era of communication technology that mass conveyance of messages has provided for the origination and nourishment of mass perceptions. These in turn may have gained enough might to confer 'an unnatural stature to social normalities' the departure from which may result in trauma. According to A. Young (1995, p. 141), traumatic memory is not an ‘object’ that can be ‘found’ in a process of discovery, it is something people ‘invented’. He also states: Can one also say that the facts now attached to PTSD are true (timeless) as well as real? Can questions about truth be divorced from the social, cognitive and technological conditions through which researchers and clinicians come to know their facts and the meaning of facticity? My answer is no. Does it matter, though? The ethnographer’s job is to stick to reality. Young then refers to the typical case of a Vietnam veteran who was never involved in combat, but has a history of therapy for his psychological problems. He goes to a self-help group for veterans, acquires the habits of trauma victims and eventually develops his own history of having been traumatized, complete with the appropriate symptoms. While it is claimed that PTSD is an invention of the vices of modern society and the overshadowing of coherent thought about social predicaments because of the dynamics of modern civilization, PTSD has had its share of profound effect on society itself. PTSD is a subject of discourse in many facets of society. It has always been a vital asset of literary and performing arts. It is one of the hottest topics of present day literature, theatre and film. An example of its weight as a subject in the performing arts is illustrated by the story of the character of Brooks (played by James Whitmore) in the highly acclaimed drama film "Shawshank Redemption" (1994). It would not be overkill to believe that the film may not have become an all-time hit without the portrayal of the aforementioned character's troubles with post-traumatic stress. An even profounder effect of PTSD on society is that of a political nature. PTSD has been a subject of discussion in discourse about U.S. soldiers' collective health issues surfacing as a result of wartime duty. PTSD first became a prominent political issue after the Vietnam War when U.S. servicemen in large numbers suffered from the condition because of their experiences from the war. However more recently the issue of the troubles of Iraq and Afghanistan War veterans has come to the limelight ("Body of War", 2007). Greater public access to information may have provided for media information about the issue spinning the political debate about the wars and may well have influenced, to a considerable degree, the 2008 U.S. presidential election results. Current Situation and the Future of PTSD Discussion of treatment and diagnosis of the causes of PTSD has been caught up in an intricate puzzle of truth and ethics. A portion of the medical fraternity dealing with PTSD believes that a psychoanalytic stance to common cases is essential in receiving, rendering, and transforming the injuries that are caused by modern warfare and human rights abuse (Nguyen, 2012, p. 308). There are no divisions among mental health practitioners on the fact that medicinal treatment of PTSD has proven fruitless. It is generally agreed that employment of rehabilitation techniques for patients of PTSD requires a subjective analysis of the patient's condition. But such a method of diagnosis requires the physician to explore the causes of the patient's trauma and note down the description of traumatic memories; and such an approach can often be intrusive of the patients privacy and exaggerate the stress the patient experiences by adding elements of shame or guilt to it - for example in the case of traumatic memories of child abuse. Similarly, people who have experienced trauma, often unconsciously re-enact aspects of their trauma through their leisure experiences. This has powerful clinical implications for recreation therapy in the treatment of PTSD. Without awareness of traumatic re-enactments in leisure, recreation therapists may enable maladaptive coping strategies and deeply rooted shame-based beliefs for which the patient is initially seeking treatment (Griffin, 2005, p. 207). As recently as 2008, an article in The British Journal of Psychiatry (Rose, Spitzer & McHugh, 2008) concluded that PTSD's defined clinical syndrome might best be conceptualised as encompassing a broad range of reactions to adverse events that are in turn influenced by multiple dimensionally distributed factors. For the moment, it appears that the very literature spurred by the creation of PTSD has demonstrated, somewhat ironically, that the construct is flawed. Conclusion The fact of the matter is that conditions of trauma-related stress disorders are tremendously understudied and there is a lack of specialization in this field causing most practitioners to resort to medicinal treatment of these conditions. And hesitancy of medical professionals to resort to subjective diagnoses of PTSD patients means that neurology has come to be regarded as the king of human sciences, as though the brain constituted human reality per se so that the internal view of the mind onto itself could be dispensed with. There seems to be no end in sight to the mismanagement of trauma-related stress disorders and at the moment the issue seems to be revolving around neurological aspects of it whereas empirical evidence shows that treatment should indulge in changing the perception of normalcy of the patient and knowledge about humanities for a practitioner may prove to be more affective in handling cases of the condition. References Blum, A. (2010). The Grey Zone in Health and Illness. Bristol, UK: Intellect. Chadwick, J. (2010). Prone positioning in trauma patients: nursing roles and responsibilities. Journal Of Trauma Nursing, 17(4), 201-209. doi:10.1097/JTN.0b013e3181ff2813 Freud, S. (1946). Collected Papers of Sigmund Freud, Vol. 2 (p. 72) ed. by E. Jones. London: Institute of Psychoanalysis. Griffin, J. (2005). Recreation therapy for adult survivors of childhood abuse: challenges to professional perspectives and the evolution of a leisure education group. Therapeutic Recreation Journal, 39(3), 207-228. Hamowy, R. (2012). Medical Responsibility. Journal Of Law, Medicine & Ethics, 40(3), 532-536. doi:10.1111/j.1748-720X.2012.00686.x Hampe, M. (2007). Achilles' brain: Philosophical notes on trauma. History Of The Human Sciences, 20(3), 85-103. doi:10.1177/0952695107079336 Marvin, N. (Producer), & Darabont, F. (Director). (1994). The Shawshank Redemption [Motion picture]. United States: Columbia Pictures. Narayan, P., Narayan, S., & Smyth, R. (2011). Is Health Care Really a Luxury in OECD Countries? Evidence from Alternative Price Deflators. Applied Economics, 43(25-27), 3631-3643. Nguyen, L. (2012). Psychoanalytic activism: Finding the human, staying human. 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