Brain trauma growing problem among veterans
By Barbara Arntsen
Published in News on April 10, 2005 2:04 AM
A Goldsboro psychiatrist is treating a record number of patients, mostly military, for a disorder caused by traumatic events.
And new technology shows that this illness, known as Post Traumatic Stress Disorder, causes physical changes in the brain.
"I follow about 2,000 patients a year," said Dr. Edwin Hoeper. "I already have 120 new patients in April and 150 more are on a waiting list."
Hoeper, who specializes in post traumatic stress disorder, said that 95 percent of his patients are military, either active or veterans.
His patients come from all over the United States, hearing about him through other veterans with the disorder.
Post Traumatic Stress Disorder, or PTSD, can occur after a life-threatening experience, and can include panic attacks, where the person feels the same fear they felt during the trauma.
"People can have vivid nightmares, flashbacks, or an exaggerated startle response," Hoeper said."They are often uncomfortable around people."
Even if the person doesn't consciously remember the traumatic event, they can still experience the disorder.
"I see people who have been in automobile accidents that can't remember the accident, but they're having indistinct nightmares," Haper said. "They wake up in a panic, hot and sweaty."
Research has also shown, he said, that some people are genetically predisposed for the disorder.
Hoeper said that two-thirds of people with the disorder would spontaneously recover, but one-third become chronic.
The recognition of PTSD as a major health problem in this country is quite recent, says the American Psychiatric Association.
Neuro-imaging, mapping of the brain, over the last decade has provided a greater understanding of how the disorder affects the brain.
Hoeper said that the amygdala, located in the front part of the brain, records the traumatic event. The left amygdala records it consciously, while the right amygdala records other details of the event on a sub-conscious level.
With post traumatic stress disorder, the amygdala goes into overdrive.
That in turn overstimulates another part of the brain, called the frontal pre-genual cortex, located above the eyes.
The frontal pre-genual cortex is the part of the brain which allows a person to extinguish the fear that comes from a traumatic experience, Hoeper says.
Chronic long-term post traumatic stress disorder causes loss of glial cells in the pre-genual cortex. Those cells support the neurons, provide some cover on nerves and keep the brain free of infections.
"When there is glial cell loss in the pre-genual cortex, a person can no longer extinguish the fear," Hoeper says. "The overactive amalgula is causing toxicity to the glial cells."
Hoeper says that other disorders, such as obsessive compulsive disorder, don't have the loss of glial cells that is seen in PTSD.
Over time, if left untreated, chronic PTSD can cause a loss of glial cells in other areas of the brain.
That can lead to depression and serious anxiety problems, Hoeper explains.
When people can no longer extinguish their fears, they get depressed, he aid.
"We didn't know about these tiny areas of the brain 10 years ago" Hoeper said.
Part of the brain affected by the glial cell loss also affects the "executive" portion of the brain, the part that makes decisions.
"They'll have a hard time making a decision, or understanding new things," Hoeper said. "And they can't understand why they are feeling the way they are."
The American Psychiatric Association says that PTSD has often been misunderstood or misdiagnosed.
Hoeper says that even today, the government often doesn't recognize the illness in veterans, or active military personnel.
"I think they are falling through the cracks," he said."The Veterans hospitals aren't doing their jobs."
The Army and Marines have the highest incidents of PTSD, and many of the patients Haper is treating are from the Vietnam War.
"Only three percent are from the Navy and one percent are from the Air Force," Hoeper said.
The incidence of PTSD has been higher since the Korean War, Hoeper said, because soldiers have consistently been exposed for longer periods of time in combat situations.
"During World War II, the army knew they had to rotate the troops in combat every 20 to 25 days, or there was a 98 percentage rate of emotional casualties," Hoeper said.
So, except in prisoner of war situations or when soldiers were surrounded by the enemy, the Army usually followed a rotation schedule, he said.
That changed after the Korean War, though Hoeper doesn't know why.
"In the Vietnam War, they didn't get rotated, and there have been a maximum number of PTSD casualties," Hoeper said. "The Army and Marines knew the risk, but they're still doing it in Iraq."
Therapy for PTSD usually consists of medication which can help glial cell regrowth, and of psychiatric counselling sessions.
Talking about the traumatic incident is helpful, Hoeper said, because it consolidates the memory and makes it less fearsome.
But getting military personnel to talk about their experiences is often difficult, and Hoeper said that stems from military training.
Citing statistics from "On Killing: The Psychological Cost of Learning to Kill in War & Society," Hoeper said that the government found, after World War II, that only 15 to 20 percent of the troops were actually firing during combat.
The book was written by Lt. Col. Dave Grossman, a former Army Ranger and trainer at West Point.
"The Army wasn't training out the innate resistance to kill," Hoeper said. "So during the Korean War training, they added pop-up silhouttes, and increased the percentage to about 50 percent."
After the Korean War, Hoeper said, the Army added the sounds of live ammunition during training exercises, and emphasized the "I am a killer" message.
"The study after the Viernam War showed that 95 to 100 percent of the troops were firing their weapons during combat," Hoeper said.
In the late 1970's the Army began worrying about the murder rate among Viet Nam veterans, and conducted a study.
"They found that there was no difference in the murder rate of Viet Nam vets and the general public, Hoeper said.
"There were only two triggers that caused them to kill," Hoeper said. "If their superior officer commanded them to kill or if their life were in danger."
The sad thing, he said, is that many veterans were scared to death of their own anger, which can make them more reluctant to deal with the issues that trigger PTSD.
"They think they are more capable of murder and they're not," Hoeper said.
Left untreated, chronic PTSD can cause people to hurt themselves.
"Generally, if they are not treated they go down hill over years," Hoeper said. "They reach a state of agitation, and these are the people that are most likely to commit suicide."