Military combat is well known to cause psychological problems, usually known as post-traumatic stress disorder (PTSD), although as with several other psychiatric diagnoses, the name has been rather left behind by our knowledge of the condition.
Research into PTSD has had surprising results…
The Daily Telegraph published an article on Monday saying that:
Now…new research from America…has found striking differences in the brain patterns of those suffering from combat stress, raising hopes that we will be able to identify and treat sufferers much more effectively…
But ScienceDaily reported this nearly a year ago:
PTSD is associated with several abnormalities in brain structure and function.
Something odd is going on here. Why report something as new when it’s not?
In part, the Telegraph article is to publicise the charity Combat Stress, which runs treatment centres and provides other help for people who suffer from psychological disability as a result of their military service.
But the article draws on other ideas about PTSD, not just changes in the brain.
Another view is that PTSD really is psychological damage after all, not primarily caused by physical changes in the brain, but instead by changes in cognition. The article quotes Prof. Wessely of the Institute of Psychiatry, King’s College London:
The kind of events that affect [soldiers] are not simply seeing bad things and coming under fire – it is when the rules they have come to expect are somehow broken. It is when errors of omission or commission lead to the feeling they have been let down, or that they have let their comrades down, that mental health problems occur.
So that’s interesting, too. It’s not actual trauma or stress in themselves that cause PTSD. It’s the interpretation of trauma and stress in terms of soldiers’ expectations.
But when it comes to treatment, that’s when the article gets really interesting.
No one is proposing any treatment for PTSD based on those discoveries about structures in the brain. There might have been new research, or there might not, but research of this kind has been coming out for quite a while and it’s a very long way indeed from resulting in any treatments.
That stuff about brains at the beginning of the article was just blather. It sounds exciting, but it is almost entirely meaningless in practice.
There certainly is a treatment for changes in cognition — CBT. The ideas explained in the middle of the article should make it clear to anyone that CBT is an appropriate and effective treatment for PTSD, and NICE recommends it.
But the article doesn’t mention CBT at all. Instead, it mentions a collection of treatments that don’t directly affect brain structure and don’t directly affect cognition — the two theories about the cause of PTSD that the article went to all that trouble to explain.
I find it exasperating when a journalist just slops information from different sources together like this, making an article that’s incoherent about such an important subject.
The real story is that Prof. Wessely and others have identified the cognitive changes that lie at the heart of PTSD, and there’s already a form of therapy, CBT, that can treat those cognitive changes directly.