A Unifying New Theory

1. A Unifying New Theory Of Posttraumatic Stress Disorder

2. Introduction • This is the story of an intellectual journey • As a medical student I was interested in and published on catecholamine metabolism, sharing that interest with one of my medical school psychiatric mentors, Daniel Funkenstein, and endocrinologist Gilbert Gordon, during my internship. • I was also mentored by Mort Reiser, who encouraged my interest in operationalized hypotheses within psychoanalytically informed experiments while I was an interdisciplinary fellow of science and psychiatry under his tutelage.

3. A brief view of the new theory • Today I very briefly present a somewhat related theory of severe posttraumatic stress disorders. It is what Edmund Wilson calls a “consilient” theory. That means it involves similarities among various conceptual and observational levels that seem remote from one another but all have data or predictions in the same direction. • It is much broader than about catecholamines, as it is a whole body and brain theory. It comprises some evolutionary theory in a neurophysiological and especially a social network and psychoanalytic intrapsychic mentalizing and communication context.

4. Introduction, continued • I present it briefly in order allow time to show some videotaped evidence that helped me build and test the theory. Time may permit me to show videotaped evidence of the utility of the theory in discovering and building an intervention strategy with theory relevant and operationally measurable outcomes

5. The Whole Theory in One Slide? • My theory is essentially that severe trauma victims are functioning in part as evolutionarily programmed communicators. They involuntarily convey valuable behavioral information to others in the gene pool. When this effort is not interrupted by therapy or corrective social experience, it damages the memory and associated emotion processing centers of the brain. Those include the hypothalamic pituitary adrenal cortical axis, and adrenal medullas and autonomic nervous system. The whole body is harmed in many ways by the chronic alarm/ danger/ flee and tell process. • The continuing trauma memory response and communication process is associated with chronic cortisol and catecholamine excesses, and other neurotransmitter abnormalities. It literally tends to wear out neurons and causes neuropoptosis, the death and pruning of synapses and neurons, including whole neuronal structures and some myelin structures in the brain.

6. Well, not quite. There’s more… • MEMORY BECOMES ICONIC: As we will see in children’s videos today, the signs and symptoms of PTSD include compressed data packets of iconic signs. These are witnessed by others. The packets are comprehensible behaviorally communicated data about what happened. • Iconic behavioral signs can be understood as much more than what the victim remembers. Iconic behavior has survival value for others. It tells what others in the child’s social surround and gene pool should watch out for. Like living highway signs, traumatized children are repetitively flashing warnings of events. The icons of events that caused extreme fear, severe anxiety, or exceeded defensive thresholds against overwhelming stimulation.

7. The Mirror Neuron System • We have only known about this system for a decade. It is a neurologic basis for empathy. • Empathic functions of the children’s social network viewers are involved when a child begins to become a living icon. The network is probably using multiple individuals’ mirror neuron systems. The more attuned a caregiver is, the better the caregiver reads the iconic behavioral signs.

8. THE PRICE OF REPETITIVELY BEARING WITNESS • The effort to remember extreme dangers and behaviorally communicate to others what has been witnessed is in my theory a psychologically and neurobiologically impoverishing effort. • That impoverishment is especially severe if the iconic form continues long beyond the immediate emergency threat. It very costly in terms of brain efficiency, brain structural integrity, psychological energy, and drive economy. It is associated with reduced cognitive functional scope, general psychosomatic health, and loss of the thrusts of developmental progress, and social adaptedness.

9. THEORY BASED TREATMENT • We will also see today that two manualized and evidence-based treatment have been devised which succeed in reversing some severe trauma effects among children. The treatments’ cognitive as well as interpersonal and emotional effects are to a surprising extent operationally detectible and objectively measurable. The treatment involves empathic processes within a closely attached network of helpers. • IQ drops with posttraumatic stress disorder. The opposite occurs with one of our treatments – Reflective Network (also called Cornerstone). When the treatment is successful, creative and developmental energies and processes are available and flexibly resumed in measurable ways. Sixty out of sixty two consecutive cases treated by one of the methods have had Full Scale WPPSI IQ gains of one to two standard deviations. The gains are in proportion to the number of treatment sessions. 115 control and comparison children have had no gains, in fact a slight drop of IQ. Children’s Global Assessment Scores (CGAS) have similar rises for treatment and not for controls but are not related to the number of treatment sessions.