What if PTSD is left untreated

Post-traumatic stress disorder : Learning to live with suffering

What does not kill me, makes me stronger. The saying sounds harsh, it is not entirely wrong: People can regain their courage to face life and even their happiness after having survived an accident or a life-threatening illness, they can emerge from a difficult childhood as mentally stable adults. Bad experiences can strengthen their emotional resilience. It can even happen that soldiers come back from a combat mission and are rid of a mental problem that existed before the mission.

Injury by fellow human beings is more likely to lead to post-traumatic stress disorder

But be careful. Studies show that it makes a big difference whether such an event remains the exception or whether it repeats itself, like sexual abuse of a child in the family. And that it plays an important role whether it is a stroke of fate or an injury caused by fellow human beings. Only one in ten victims of a serious traffic accident, but half of the rape victims suffer from post-traumatic stress disorder (PTSD), says epidemiologist Frank Jacobi from the TU Dresden.

The term is quickly at hand in the media when it comes to the psychological consequences of war, torture, flight and sexual violence. In medicine, however, it is clearly defined and recorded in the ICD-10 diagnostic manual. "It is one of the few mental disorders in which the cause can be precisely determined," says Iris Hauth, President of the German Society for Psychiatry, Psychotherapy, Psychosomatics and Neurology (DGPPN) and Medical Director at the Alexianer St. Joseph Hospital in Berlin-Weissensee. It always has to be a specific emotional injury that is so great that it would throw many other people off track as well. Days to weeks, maybe months or years, the symptoms that are typical of PTSD occur. Memories keep pushing themselves in, during the day or at night in nightmares. The person concerned becomes nervous and tries to avoid certain key stimuli. He withdraws, may be plagued by feelings of shame and guilt because he believes he is complicit. In the course of a year, two out of a hundred adults meet these criteria at least temporarily, shows a partial study of the German Health Survey.

Psychotherapy often works better than medication

How can they be helped? A 2012 Israeli study showed that psychotherapy works better than medication. This is not about long-term therapies: “Even five hours bring something,” says Ulrich Frommberger, psychiatrist at the MediClin clinic on the Lindenhöhe in Offenburg. The trauma-focused psychotherapy, in which the therapist and patient keep talking about the experience, has proven itself - even if it is very stressful for both of them. In this way it can be possible to assign the incidents their place in the biography. In a life that includes a carefree “before” and additionally has to offer the perspective for a bearable, perhaps fulfilled “after”. It has been proven that cognitively oriented treatments also help, in which one works on the thoughts, images and assessments that the traumatic event led to. For example, the belief "All men are bad" that can arise after serious sexual assault. These are understandable, sometimes weird and in the long run unhelpful thoughts.

Not everyone needs psychological help after a traumatic experience. And it is by no means always PTSD if the soul becomes ill as a result of trauma. Psychiatrists and psychologists therefore speak more generally of "trauma-related disorders". This can include depression or anxiety disorders. And physical complaints, such as headaches, which chronically afflict a torture victim. Meryam Schouler-Ocak from the Psychiatric University Clinic of the Charité in St. Hedwig Hospital and head of the DGPPN section “Intercultural Psychiatry and Psychotherapy, Migration”, reports on a patient from Kosovo with abdominal complaints. She has been gynecologically examined and operated on several times. Unsuccessful. "Later it turned out that she was one of the victims of mass rape, which nobody around her was allowed to know."

Affected people numb themselves with alcohol

Others resort to alcohol. A coping strategy that is effective in the short term, but unfavorable in the long term. It can also lead to PTSD going untreated. Affected people are often told that they have to be “dry” first before they can start treatment. "That is wrong, we can treat both," emphasizes Frommberger.

Leaving one's homeland involuntarily and at risk is undoubtedly a serious emotional burden. In addition to the stress of the flight, there are circumstances that psychologist Maria Böttche from the Treatment Center for Torture Victims in Berlin describes as “post-migration stressors”: living cramped in communal accommodation, not being allowed to work for a long time, possibly being attacked.

According to a study by the psychologist Ulrike Gäbel from the University of Konstanz, 40 percent of asylum seekers meet the criteria for PTSD. According to the law, treatment is only taken over in the event of an acute illness. The DGPPN therefore calls for acute consultation hours to help quickly. “If a medical officer is first intervened, that means a massive delay,” criticized Schouler-Ocak. Therapy offers are readily accepted by those affected if they are well explained beforehand, as Böttche reports. "The glue here are the interpreters."

Ideals of masculinity prevent soldiers from seeking help

Bundeswehr soldiers find help in the psychiatric departments of the Bundeswehr hospitals. 21 percent of soldiers suffer from mental disorders after deployments abroad, according to a study by Hans-Ulrich Wittchen from the TU Dresden. In addition to life-threatening situations, the loss of comrades, exhaustion and internal moral conflicts continue to have an effect. However, a maximum of one in five soldiers who show symptoms is receiving treatment one year after being deployed, reports Peter Zimmermann from the Center for Psychiatry and Psychotraumatology at the Bundeswehr Hospital in Berlin. In addition to concerns about career and reputation, ideals of masculinity play a big role when no help is sought, he says. The Bundeswehr doctors now want to take countermeasures with a program for prevention and with a lot of education.

What does not kill me, makes me stronger? Nietzsche, who cites the sentence in his "Götzen-Twilight", puts a classifying remark in front of it: "From the war diary of life."

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