The Road to Stanford

According to the American Psychiatric Association’s fourth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), six diagnostic criteria are assessed to determine a positive diagnosis of Post-Traumatic Stress Disorder (PTSD):

Criterion A:stressor

The person has been exposed to a traumatic event in which both of the following have been present:

A1. The person has experienced, witnessed, or been confronted with an event or events that involve actual or threatened death or serious injury, or a treat to the physical integrity of oneself or others.

A2: The person’s response involved intense fear, helplessness or horror.

Criterion B:intrusive recollection

The traumatic event is persistently re-experienced in at least one of the following ways:

B1. Recurrent and intrusive distressing recollections of the events, including images, thoughts or perceptions.

B2. Recurrent distressing dreams of the event.

B3. Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations and dissociative flashback episodes, including those that occur upon awakening or when intoxicated.

B4. Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

B5. Physiologic reactivity upon exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

Criterion C:avoidant/numbing

Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following:

C1. Efforts to avoid thoughts, feelings or conversations associated with the trauma.

C2. Efforts to avoid activities, places or people that arouse recollections of the trauma.

C3. Inability to recall an important aspect of the trauma.

C4. Markedly diminished interest or participation in significant activities.

C5. Feeling of detachment of estrangement from others.

C6. Restricted range of affect (e.g. unable to have loving feelings).

C7. Sense of foreshortened future (e.g. does not expect to have a career, marriage, children or a normal life span)

Criterion D:hyper-arousal

Persistent symptoms of increasing arousal (not present before the trauma, indicated by at least two of the following:

D1. Difficulty falling or staying asleep.

D2. Irritability or outbursts of anger.

D3. Difficulty concentrating.

D4. Hypervigilance.

D5. Exaggerated startle response.

Criterion E:duration

Duration of the disturbance (symptoms in B, C and D) is more than one month.

Criterion F:functional significance

The disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning.

Acute: if duration of symptoms is less than three months.

Chronic: if duration of symptoms is three months or more.

Delayed onset: Onset of symptoms at least six months after the stressor.¹

¹ American Psychiatric Association. Diagnostic and statistical manual of mental disorders DSM-IV-TR, 4^th edn. American Psychiatric Association, Washington DC, 2000.

I was officially diagnosed with PTSD in 2008, when the first symptoms started to emerge. It blessed me in its full-blown state within this past year. As you can see by the criteria marked in red above, I now fulfill all the criteria necessary for this diagnosis.

I have been seeing my current therapist, a trauma specialist, for almost 3 years, and we have been working with two specific modalities--Eye Movement and Desensitization Reprocessing (EMDR) and Dialectical Behavioral Therapy (DBT). Him alone worked until about a year ago, when it became apparent that I would need additional assistance. So, when a guardian angel emailed information about a study on PTSD taking place at Stanford University/VA Palo Alto, I immediately applied for it, and was quickly accepted.

I have made it through the initial 4.5-hr intake (full cognitive evaluation, psychiatric interview, and complete retelling of traumatic event), first sleep study, and first set off fMRI scans. The next set of fMRI scans is next week. Then the 9-12 sessions of Prolonged Exposure Therapy (a treatment increasingly popular with returning soldiers) will begin. It will end with another sleep study, follow up fMRI scans, and exit interview.

I am especially intrigued by the Prolonged Exposure modality. It will entail the recall of the specific traumatic memory as vividly as possible in first person (as if it was happening immediately in the present moment). Over and over. Basically, talking through the trauma, not avoiding it. I have the tendency to shove the intrusive memories of 9/11 down, and they pop up later as flashbacks, panic attacks, and the nightly barrage of terrifying dreams. The opportunity to desensitize myself to the trauma, and the memories, and make them just a part of my past experience that does not bring about a complete meltdown of emotions, sounds like freedom.

I look upon my initial fMRI scans in complete wonder. I have never seen the entire inside of my head before, only the right ear encompassing the canal, eardrum, labyrinth and cochlea. Indeed, on one of the scans I received, you can visibly see the healthy left labyrinth. Yet, on the right side, the right labyrinth is decimated by disease, now scar tissue that is no longer holding its form. The resulting injury from being in Lower Manhattan on 9/11, and another reminder of why I am here, and what I am doing.

It’s funny how looking at one’s brain does evoke those trite existential questions. What am I? Who am I? Is this body just a vessel for a traveling soul? Are my soul and mind connected? What is this mind, but a mass of tissue and electrical impulses? And, as a practicing Buddhist, it brings into sharp focus the idea of emptiness, ego, and samsara.

This mind of mine has also been the container for vast amounts of fear, anxiety, panic, 10-year-old memories parading as the present moment, and nightmares terrorizing my sleep. Half of the time, I have been determined to escape this daily suffering through addiction and sleep. More recently, I have been increasingly fascinated with the mind’s capacity to heal, and our capacity to learn new ways of coping. It is this line of inquiry that keeps me buoyant and optimistic about my future.