Keywords: Shell Shock? Post Traumatic Stress Disorder, Internally Displaced Persons, amygdala, hippocampus, Averse Childhood Experiences flashback, detachment, psychotherapy.
Introduction.
Shell Shock? What is post traumatic stress disorder (PTSD)? Do Nigerians suffer from PTSD? What are the main causes of PTSD? How can you tell if someone has PTSD? Complications of PTSD. How do people deal with PTSD and its triggers? Can PTSD be cured?
I wonder how many people reading this write up know have heard the word, Shell Shock. Well if you have not heard about it, your parents have.
When people are faced with moderate to severe stress, they may react by displaying certain abnormal or strange behaviours. This type of stressful situations are usually terrifying or life threatening.
Let us take for example, a woman suddenly lost her husband to death by accident. This woman may seem to overdramatize her reactions to the loss. She could run out of the house, shouting and tearing her clothes, not minding that she is on the streets. This is called acute stress reaction. Then within a few days, she gets herself back would have regretted having made herself naked on the streets. This is a normal reaction and it is not considered as a disorder.
For some people, instead of recovering, the abnormal behavior continues with fearfulness and anxiety. The woman will be re-experiencing the scene that happened when her husband died, as if it is occurring again. She will be having night mares concerning the event and she will not want to go anywhere near the scene of the accident. This can last for one month. It is called acute stress disorder. For some people with acute stress disorder they can recover on their own within one month period.
But unfortunately for some others like this woman, the problem will continue into what is called Post Traumatic Stress Disorder (PTSD).
What is Post Traumatic Stress Disorder (PTSD)?
Post traumatic stress disorder (PTSD), is a psychiatric illness that comes about after one has experienced a terrifying event. It usually starts within one to six months after the terrifying or life threatening event. In the olden days, it was called shell shock, because it was first noticed among soldiers. By 1980, shell shock became known as PTSD.
So, most often PTSD is a continuum from acute stress reaction to acute stress disorder. For some researchers, they believe that these two stress issues are actually subtypes of PTSD.
Suffering from PTSD, makes the person not to be able to function well. So as a student or worker, etc. he or she will not be able to function well in these areas. And if the person is in a relationship, there will be a problem there.
Do Nigerians suffer from PTSD alias Shell Sock?
Post traumatic stress disorder is a psychiatric condition that is a global phenomenon. So, globally, about eight million suffer from PTSD, yearly. This means that about 1% to 5% in the general population globally, suffer from PTSD. But within conflict areas, the prevalence is between 3% to 58%.
This PTSD can happen to anyone be it male or female, old or young. But the disorder occur more in females and in young people, including children.
In Nigeria, in conflict zones, the prevalence is much higher than that of the global results. A research paper published in 2019, documented that among the internally displaced persons (IDP) in Maiduguri, 78% had PTSD. And another published paper in 2022, documented that 88.5% of the IDP in Jos, had PTSD.
Nigerians do suffer from PTSD, and it does not just happen only in the northern parts of the country. Post traumatic stress disorder can also occur in the general population, among Nigerians.
What are the main causes of PTSD?
Post traumatic stress disorder is brought about by a stressful experience that one has undergone within the past six months. Most often it is due to a very severe stressful event. This severe stressful event could involve death or threatened life experience, serious harm or sexual assaults. And the stressor must have happened between 1 month to 6 months before PTSD appeared. The cause of PTSD is beyond war zone shell shock.
The individual could have been involved in any, learnt about it from any means or watched it live happening. And in any of these severe stressful events, life is being threatened or lost.
The most common cause of PTSD is sudden unexpected death of a loved one. This accounts for about 20% of the disorder globally.
Other life threatening events include being exposed to the war front, a shootout or community clash, involving loss of lives. Others are earthquakes, terrorism and tsunami. Another life threatening event is rape or sexual assault.
Physical assault and being threatened with a weapon such as knife, gun, heavy stone, etc. can bring PTSD about. Life threatening accident from road, air, sea transportation, or factory, can predispose to it. Losing a loved one via any of these, is a cause. But unfortunately, in developing PTSD, you don’t even have to know the person involved in the accident.
It is important to note that not everyone exposed to such severe life threatening experiences, suffer from PTSD. And not every soldier fighting at the battle ground has shell shock. So what determines who gets it and who doesn’t?
Biological factors:
The genes –
Genetics has a whole lot to play concerning who gets the disorder and who doesn’t. If someone has a parent(s) who suffers from PTSD, then it is most likely that the person will be at risk. Also, if the parent(s) have either anxiety or depression, the person can develop PTSD. And research has documented that about 30% of cases of PTSD are due to genetic inheritance alone.
Chemical effects –
For those who develop PTSD, their cortisol level is usually low, while the level of noradrenalin is high. There is also low level of serotonin and high levels of thyroid hormones.
Brain areas –
Certain areas of the brain are not functioning well, like the Hypothalamic Pituitary Axis (HPA). The amygdala which is responsible for remembering the traumatic event, is over reacting, bringing in that fear response. And the function of the hippocampus is reduced. With this the hippocampus can no more be able to put in the memories from the amygdala in better perspectives.
The overall brain sizes of those that have PTSD, are usually small in size.
Risk factors:
There are risk factors that can determine who gets PTSD and they are,
Intensity of the traumatic event –
If the event was very severe and long lasting, then there is a likelihood that the disorder may occur. For example, being in a battle ground for days or weeks, when the fighting is fierce.
Adverse childhood experiences (ACEs) –
Having had traumatic events in childhood like physical abuse and neglect, emotional abuse and neglect, etc. are risk factors. This includes parental separation and divorce. With a background of ACEs, together with having faced with a severe traumatic event, the risk of PTDS is high.
A preexisting mental illness –
If someone has a preexisting mental illness, then the risk of having PTSD is high when a sever stressor appears. The preexisting mental illness includes anxiety or depression, schizophrenia, bipolar disorder, etc. This risk of PTSD could be due to the harsh treatment the person received in the hospital or police station. It could also be due to the stigma from the people around or from suicidal attempts made.
Personality factors –
People with certain personalities are at greater risk than others. Such personality risks are avoidant, dependent, compulsive and paranoid types. Other research papers have also implicated schizotype and borderline personality types.
Refugee factor –
Those in Internally Displaced Persons’ (IDP) camps are at high risk of developing the disorder. This is because they have been exposed to wars, hardship and other stressors.
Exposure to Intimate Partner Violence (IPV) –
Having been exposed to a severe form of IPV, is a risk factor for developing PTSD. Also PTSD can develop in women after going through traumatic child delivery, especially if she had IPV.
Medical conditions –
People who have physical medical conditions such as cancer, heart attack and stroke, are at risk of having PTSD. The loved ones of these persons who have these chronic physical illness are also at risk of having PTSD.
Job factors –
Certain jobs can out you at risk of developing PTSD. These jobs include being in the military and paramilitary, and first responders. First responders are the first people who arrive at the scene where traumatic events occur. Their job is to help rescue and bring victims out of dangers into safety. They include the police, firefighters, paramedical personnel, etc.
How can you tell if someone has PTSD?
This brings us to the symptoms of post traumatic stress disorder. Actually, PTSD is due to failure to recover from either witnessing or experiencing an event that is terrifying. And the memory of this terrifying event presents with both emotional and physical reactions.
Emotional reactions:
Intrusive memory –
There are unwanted memories of the traumatic event that keeps intruding into the person’s mind. And there are also what is called flashbacks.
Actually, flashbacks are memories of the traumatic event that plays back in the persons mind. And to the person it seems like the incident happening again. It is as if the traumatic event was recorded and is being replayed, with all the emotions attached to it.
When the person goes to sleep, he or she has night mares concerning the event. And this can wake the person up in the middle of the night, leading to poor sleep.
Avoidance of reminders –
Someone with PTSD, will avoid situations leading up to the memory of the event. And this includes avoiding the place the event took place, and any other reminders. This is because these reminders bring up flashbacks.
Apart from avoiding places that may cause reminders, individuals will also avoid people who will remind them of the trauma. So they may even not want to talk about the incident, because it will bring back the memory and pain.
Changes in thinking and mood –
There are memory issues whereby the person may not be able to remember certain aspects of the event. For example, the person may not remember the date of the death of the loved one.
The person feels numb and detached from family, friends and the environment. Such a person will be unable to react positively to happy events and will lose interest in things once enjoyed. This person also feels hopelessness and helpless, believing that all future hopes are lost.
The person also has irritability and anger, as well as poor concentration. With the poor concentration, the person will be unable to remember what he or she read and discussions are forgotten.
The person feels guilt and shame. Guilt in the fact that he or she should have done something to prevent the tragedy. So the person can blame himself or herself for the death of a loved one. There may even be loss of trust in other people.
Physical reactions:
This reactions include physical and neurological reactions. These are poor sleep, physical aggression like fighting breaking things, easily startled, etc. There are also self-destructive behaviours such as engaging in substance abuse, etc. For example, the person could be going to the club and bar to get drunk every night.
Persons going through PTSD, also have symptoms such as increased blood pressure, heart rate and weakness. They have muscle tension, pains at the joints, headaches, back pain, etc. The hands and feet may feel cold like ice and sweaty.
Complications of PTSD.
Post traumatic stress disorder is accompanied by other mental illnesses. These include depression, anxiety, substance abuse, and even suicidal tendencies as well as eating disorders. There is also increased infections, and other physical illnesses such as heart conditions, etc. If PTSD is left untreated, there will be an increased cost of treatment of the physical conditions and even death.
Because the illness affects one’s function, the individual will not be able to function effectively. This can lead to academic failures, loss of job and unemployment or underemployment, and poverty. And apart from the academic failures, the person can drop out of school.
How do people deal with PTSD and its triggers?
Usually, not everyone who is faced very stressful event goes into acute stress reaction or even acute stress disorder. Also not everyone who starts out with acute stress reaction will transform into acute stress disorder. And not everyone who develops acute stress disorder will transit into PTSD.
Post traumatic stress disorder, is usually not steady in severity as the years go by. For some people, it can fade as the years go by. And for others, the symptoms may increase when the encounter things that will remind them of the event. These include the anniversaries of the event, etc. But there are people whose symptoms last for a life time.
Prevention:
Social support –
Apart from the genetic issues and risk factors described earlier, with social support at the onset, prevention is possible. Getting this social support can prevent acute stress reaction from getting worse.
Family and friends can give that needed social support in the form of lending a listening ear to the trauma survivor. Being an attentive listener and allow the person to unburden his or her heart, may be all that is required. But if the person doesn’t want to talk, don’t force him or her, just be by the person’s side. There may also be need to support by providing food, clothing, shelter or finance, etc.
The religious community can also be of help. They too can support in the way as already described. But the individual will also need to participate in some of the religious practices to help prevent PTSD. This can help the person in socializing and believing that God can solve all problems.
Individual care –
Take care of your physical health by eating right, exercise, good sleep and treat any physical condition promptly.
Can PTSD be cured?
There is no cure for PTSD, but for some people, the symptoms can go away on their own after weeks or months. For those whose condition does not self-remit, the symptoms can be managed and the person can then function well.
The main treatment is psychotherapy, ie. talk therapy. This is carried out by a Clinical Psychologist. Psychotherapy teaches the individual and the family about support, education, and guidance. This means that both the individual the his or her family members get the treatment.
Some of the psychotherapy methods target the symptoms and others will focus on social, family, or job-related issues. The psychotherapies often focuses on learning skills to help the individual identify triggers and manage the symptoms.
Treatment can take place one on one or in a group and usually lasts 6 to 12 weeks but can last longer.
The Psychiatrist also gets involved so as to treat the accompanying mental illness, like depression, anxiety, etc.
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