All right, so you might have read "The Hobbit"
or "The Lord of the Rings," you have probably seen them, you've definitely heard of them.
But not everyone knows the story of their author, J.R.R. Tolkien. Tolkien was an English
World War One veteran. A reluctant solider, he joined up with a sense of duty and he lived
through the bloody battle of Somme suffering tremendous shock, guilt, and loss during and
after the war. It took Tolkien years to processes his experiences.
To help him do it he turned to writing fiction and in time he constructed a world that helped
him and all of us better understand war, human nature, loss, and growth. His novels were
the bi-product of trauma and they're among the more beautiful reminders of how it can
affect us. Most of us will experience some kind of traumatic
event in our lives and most of us will exhibit some kind of stress related behavior because
of it, these symptoms usually fade but for some those reactions can linger and start
of disrupt their lives or the lives of those around them. These reactions can develop into
full blown psychological disorders including post-traumatic stress disorder and, in an effort
to cope, sometimes addiction, but it doesn't always have to be that way. Ultimately, Tolkien was able to harness the
effect of his trauma and shape them into something important and to reclaim is own life because there
is such a thing as post-traumatic growth, too. As it does with many other things psychology
approaches trauma related disorders with different perspectives, but they all tend to ask the
same questions. How do you identify and diagnose these disorders?
And how do you treat them, so that the patients can recover? -- With the understanding that
they might never be the same as they were before the trauma, but they can still be healthy
and happy. In a way, psychology helps patients ask themselves,
what Tolkien asks his readers, and what Frodo asks when he is finally safe back in the shire:
"How do you pick up the threads of an old life? How to go on, when in your heart, you
begin to understand that there is no going back." It could be September 11 or a serious car
accident or a natural disaster or a violent crime that you survived but are still haunted
by. Trauma comes in many different forms and sometimes it can stick with you. When it manifests as nightmares, flashbacks,
avoidance, fear, guilt, anxiety, rage, insomnia, and begins to interfere with your ability
to function it can come to be known as post-traumatic stress disorder or PTSD. It was once call "shell shock" a term used
to describe the condition of veterans, like Tolkien in World War One but PTSD isn't limited
to veterans. It's defined as a psychological disorder generated by either witnessing or
experiencing a traumatic event. Its symptoms are classified into four major clusters in
the DSM V. One of these clusters involves re-living the
event through intrusive memories, nightmares, or flashbacks. The second involves avoiding
situations you associate with the event, while the third generally describes excessive physiological
arousal like heart pounding, muscle tension, anxiety or irritability, and major problems
sleeping or concentrating. And finally we have the fourth major symptom cluster: pervasive
negative changes in emotions and belief, like feelings in excessive guilt, fear, or shame -- or no
longer getting enjoyment out of what you used to. PTSD patients may also experience numbing,
or periods of feeling emotionless or emotionally "flat" and dissociation, feeling as if situations
aren't real or are surreal, feeling like time has slowed down or sped up, or even blacking
out. We have been discussing how anxiety or mood
disorders can affect a person's ability to function and how that impairment itself leads
to more suffering and dysfunction. When any of these disorders is left untreated
suffers may start to feel desperate to find some way to cope and one way may be substance
abuse. Unfortunately, addiction and trauma can go hand in hand and it can be hard to
recover from one without also dealing with the other. According to the US department
of Veteran's Affairs more than 2 in 10 veterans with PTSD also struggle with substance abuse
problems and 1 in every 3 vets seeking treatment for substance abuse also have PTSD.
And across many studies, between a third to a half of women in treatment for substance
abuse have experienced rape or sexual assault. For a long time most psychologists understood
PTSD through the lens of fear conditioning or the unshakable memory of being in mortal
danger and the learned responses that stem from that memory. But clinicians have also
begun to recognize that for some the disorder can also be a kind of moral injury, widening
the focus to include hauntings not just of violence done to a person but also what that
person did or did not do to others. Brandon was a combat drone operator in the
air force he enlisted at 21 years old and spent 6 years sitting in a bunker in the American
South-West watching Iraq and Afghanistan from surveillance drones. He watched soldiers die and people get executed.
He also watched kids play, people get married, goats grazing -- and when the time came he
ordered hell fire missiles to strike military targets or people who had no idea they where
even being watched. Although he was half a world away from combat,
he ultimately suffered the psychological trauma felt by many on the ground soldiers. He was
diagnosed with PTSD. Brandon suffers no fears for his own safety, but still experiences
the same intrusive memories, nightmares, depression, anxiety, and substance abuse of many emotionally
traumatized combat soldiers. So do a lot of other drone operators. But why do some victims or trauma suffer from
PTSD while others seem able to move on? Well, its psychology so the risk factors are
complicated. Some findings suggest that there may be genetic predispositions making some
people more vulnerable than others. We also know that context and environment matter,
for instance, someone who has experienced childhood abuse might feel on the one hand
more ready to deal with difficult and traumatic experiences. But on the other hand they might
be more likely to default to the suppression and avoidance in which PTSD suffers frequently
engage, which as we've discussed in previous episodes often makes psychiatric symptoms
worsen over time. As far as whats going on in the brain, PTSD
shares some similarities with anxiety disorders. For example the brains limbic system may flood
the body with waves of stress hormones like cortisol every time images of the traumatic
event bubble up uninvited into consciousness. And we've already talked a lot about how the
amygdala and hippocampus are involved in those classic fight or flight reactions, which when
prolonged can be really rough on the body. In fact, neuroimaging suggests that trauma
-- or the chemical processes set into motion by trauma -- might actually damage and shrink
the hippocampus. Since this region is also associated with how we consolidate memories,
this might explain how memories associated with trauma could fail to be filed away as
long-term memories and instead remain vivid and fresh through flashbacks and nightmares. If there's any silver lining to all of this,
it's that some people may actually experience positive change after a trauma. Treatment
and social support help some suffers achieve post-traumatic growth, positive psychological
changes resulting from the struggle with challenging circumstances and life crises. That's in part what Tolkien did. Though he
suffered great trauma and loss on the battlefield, he was eventually able to use those experiences
to drive those powerful, allegorical stories. Stories that helped not just himself, but many readers
of all ages around the world. It seems that while whatever doesn't kill
you might not necessarily make you stronger, sometimes it really does. But suffering can feed on itself. Many victims
of trauma try to cope through whats colloquially called self-medicating and some can end up
with substance abuse or dependence issues. Psychologists define addiction or dependence
as compulsive, excessive, and difficult-to-control substance use, or other, initially pleasurable
behavior that beings to interfere with ordinary life, work, health, or relationships. This could mean over-consuming drugs or alcohol,
or compulsively gambling, eating, shopping, exercising, or having sex. People with addictions
may not even realize that they have lost control of their behavior for some time. Addiction can refer to a physical dependence,
a physiological need for a drug, that reveals itself through terrible withdrawal symptoms
if the use stops or reduces. Or psychological dependence, the need to use that drug, or
complete that activity in order to relieve negative emotions. People with addiction can sometimes be stigmatized
as pleasure-bound hedonists who have no self-control, but people often compulsively use substances
or do things in reaction to stress and other psychological problems. For various reasons
they have been prevented from coping in other ways or maybe they just never learned how. So in this way addiction itself is often secondary
to the more complicated matter of how a person deals with stress and difficult emotions, or what
kinds of stressful situations they've survived. Few will dispute that much of what makes addiction
possible is chemistry, but people are different -- from their life experiences to their biological
sensitivities. So people respond in different way to different drugs and behaviors. Many
people can drink casually or gamble once in a while without losing control. Others simply
can't. People in recovery from addiction may also
have different needs. Some will need to be completely sober and never again touch that
drug or do that thing. While others may in time be able to regain enough control to use
again in moderation. Likewise, some folks can kick the habit on
their own while others do better with or need support from professionals or support groups. Researchers and groups like Alcoholics Anonymous
debate whether addiction is a mental illness -- like a "software problem" related to thoughts, and
behaviors, and feelings -- or a physical disease -- a "hard wire problem" related to biology
and genetics -- or both, and even whether addiction and dependence are the same thing. Either way it can be hard to recover from
an addiction if you don't get the underlying problem treated. But some people believe that
you can't treat the underlying problem without first getting the addiction out of the way. While this controversy too continues, many
are moving toward a model of treating both at at the same time. The so-called Dual Diagnosis
Model of treatment. Addiction that's rooted in deeper psychological
issues -- especially in emotional trauma like PTSD -- often require some version of dual
treatment to untangle both issues. The good news is while PTSD and substance
dependence may be distressing and complex, people can begin to heal given the chance
and the resources. We're amazingly resilient creatures. When nurtured with
the proper support and practice, we can overcome a lot. Today we talked about the causes and symptoms
of PTSD and how trauma can affect the brain. We also looked at addiction, physical and
psychological dependence, the relationship between trauma and addiction, and why they
can require dual treatment, and we touched on post-traumatic growth with the wisdom of Frodo
Baggins. Thanks for watching, especially to all our
subscribers on Subbable who make this show possible. To find out how you can become a
supporter and help us do this thing just go to subbable.com/crashcourse. This episode was written by Kathleen Yale,
edited by Blake de Pastino and our consultant is Dr. Ranjit Bhagwat. Our director and editor
is Nicolas Jenkins. The script supervisor and sound designer is Michael Aranda, and
the graphics team is Thought Cafe.
