Jonathan Purtle, MPH, Doctoral candidate and Research Associate, Center for Nonviolence and Social Justice, Drexel UniversityFirst in a series of posts about what is being done to address trauma and toxic stress in the city.
Four years ago, on a train from Philadelphia to Washington, Sandra Bloom told me about the Adverse Childhood Experiences (ACE) Study. I hadn’t heard of it, and was astounded to learn about strong connections it found between exposure to trauma and toxic stress in childhood, and experiencing behavioral, social, emotional, and health problems as an adult. I told almost everyone I knew. I circulated the study’s publications among my public health peers. Hardly any of them had heard of it in 2011, when I wrote the first of several related posts.
On Thursday, I sat with more than 350 Philadelphians at WHHY's studios as the study was discussed at a sold-out symposium entitled “Children and Toxic Stress: A Public Health Response for Philadelphia’s Children and Families.” Awareness about the ACE Study (first findgs were published in 1998) and its implications has spread rapidly over the past few years. And Philadelphia, in the words of Arthur Evans, commissioner of the city's Department of Behavioral Health and Intellectual disAbility Services, has been the “epicenter” of knowledge dissemination. “Philadelphia is the only city where only a few hands pop up when I ask how many people have not heard of the ACE Study,” said Martha Davis, a new program officer at the Robert Wood Johnson Foundation who until recently headed the local Institute for Safe Families. A brief video of her remarks on building resilience is here.
Jonathan Purtle, MPH, Doctoral candidate and Research Associate, Center for Nonviolence and Social Justice, Drexel University
It’s not just military veterans who develop post-traumatic stress disorder. As described in a previous post, what’s known today as PTSD has been observed in people who experienced traumatic events for centuries if not millennia. One relatively common event that can cause PTSD is a serious injury, like from a car accident or a gunshot wound. There are a lot of those. A study of 2,707 surgical trauma patients from across the United States several years ago found that more than a fifth had PTSD one year after their injury.
So why isn’t PTSD screening and referral to treatment the standard of care in trauma centers? Lois Beckett and colleagues have set out to answer just that question. In a group of articles for ProPublica, the nonprofit investigative journalism site, they examine why trauma centers, of which there are quite a few locally, don’t sufficiently address the mental health consequences of traumatic injuries and the burden of PTSD among civilian populations – with a detailed look at the issue in Philadelphia (deep into the piece).
Their work, which is part of a larger series on guns, includes a survey of personnel at 21 trauma centers across the country that asks what, if anything, they do to address PTSD among their patients. The responses – Temple University Hospital said it is developing a program – are posted.
Janet Golden, PhD, Professor of history, Rutgers University-Camden
Last May the American Psychiatric Association released the 5th edition of the Diagnostic and Statistical Manual of Psychiatric Disorders, known as DSM-V. Sometimes called the “Bible of Psychiatry,” the DSM-V provoked complaints about the diagnostic criteria it included, whether new diagnoses promote overtreatment, and the lack of statistical reliability for some of the disorders it lists.
But what about the missing diagnosis? The one known to poets, singers, artists, and lovers since recorded human history: lovesickness. The symptoms are many, but the cause is singular. It’s that profound and overwhelming sensation of despairing for an absent love. Passion. Obsession. Grief. Longing. That’s the stuff of great suffering and great art.
Popular music offers what the DSM does not, some great insights into the deep feelings of lovesickness. The brilliant country singer Patsy Cline expressed it in her cover of “Walking After Midnight.” Hank Williams, the great country music star, gave us the unforgettable version of “Lovesick Blues.” Singer-songwriter Joni Mitchell captured its essence in the lyrical “A Case of You.”
Last week, the International Society for Traumatic Stress Studies had its annual meeting in Philadelphia. I was there, and discussions abound about “Criterion A.” Contrary to what its name might suggest, Criterion A is not a vitamin, nor is it a short-course bicycle race. Criterion A defines the types of experiences that are considered traumatic enough to cause post-traumatic stress disorder (PTSD) according to the Diagnostic and Statistical Manual of Mental Disorders (DSM). Criterion A has long been a point of contention, in part because it has significant bearing on who receives a PTSD diagnosis and is eligible for evidence-based treatments covered by insurance.
There are special rules when it comes to PTSD. As opposed to most other disorders in the DSM, for which diagnoses are based on symptoms alone, PTSD requires that a person be exposed to a “potentially traumatic event” and then develop specific symptoms. Criterion A defines what counts as: 1) a potentially traumatic event, and 2) a level of exposure sufficient to cause PTSD. Last May, Criterion A was changed with along with other modifications to the PTSD diagnosis in the new DSM 5.
What are considered potentially traumatic events in the DSM 5? A potentially traumatic event is one that involves “death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence.” As with the previous version of the DSM(4), a serious car accident is considered a potentially traumatic event, getting laid off, while highly stressful, is not. The definition of a potentially traumatic event in the DSM 5 is quite similar to that in the DSM 4, but differs in that sexual violence is explicitly named instead of being lumped together with other threats to “physical integrity.” This change can be interpreted as a small milestone in breaking the silence about sexual violence and its consequences. Depending upon the circumstances of the event, 30%-80% of sexual assault survivors develop PTSD—a rape takes place about every six minutes in the United States.
Andrea Segal and Dominic Sisti, Penn Department of Medical Ethics & Health Policy
Have you seen Netflix’s new critically acclaimed series Orange is the New Black?
If you haven’t, you should.
The series, based on the real life experiences of Piper Kerman, who served over a year in federal prison for her involvement in a drug trafficking scheme, offers a gripping look at life for women behind bars.
June is post-traumatic stress disorder (PTSD) awareness month. Sure, there are months for almost every medical condition imaginable. But this month’s designation, which came about after Congress named June 27th national PTSD awareness day just last year, is a symbolic milestone in the mental health condition’s history and struggle for legitimacy. The cluster of symptoms now known as PTSD—which can include having nightmares and flashbacks about a traumatic event, avoiding things that remind one of the event, feeling emotionally numb, easily startled, or “on edge,” and others—has gone by many different names over the past 150 years.
In the mid-19th century, surgeon John Eric Erichsen coined the term railway spine to describe the symptoms he observed among people who survived or witnessed train accidents. American Civil War surgeon Jacob Mendez Da Costa described similar symptoms among soldiers he treated on the battlefield—a condition he called soldier’s heart. Psychoanalysts Pierre Janet and Sigmund Freud documented the hysteria caused by childhood sexual abuse among their female patients. British military psychiatrist Charles Samuel Myers referred to the shell shock experienced by World War I soldiers after they returned from combat.
Time and time again, symptoms of PTSD were observed among people exposed to traumatic events, but were not recognized as “real” given social and political circumstances of the times. Things changed, however, when the forces of the women’s liberation and anti-Vietnam War movements converged and PTSD was added to the Third Edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980. The addition legitimized PTSD as a medical condition and provided a shared language and framework to study and ameliorate the effects of overwhelming human experiences.
In a Psych. 101 class many years ago, I remember learning that some mental disorders were more common among people born in winter and spring. The reason was unclear. I pretty much forgot about this interesting factoid until reading about a recent study that found evidence of a link between some mental illness and the seasons: the flu.
The new study, published online this month in the journal JAMA Psychiatry, found that in utero exposure to maternal influenza was associated with a four-fold increase in the likelihood of developing bipolar disorder. The disorder, once known as manic depression, causes dramatic shifts in mood and energy, and can inhibit the ability to carry out day-to-day tasks. It affects an estimated 2.6 percent of American adults each year.
The research analyzed data from the Child Health and Development Studies, a large cohort of 19,044 people born in Alameda County, Calif., between 1956 and 1966. All of the study participants’ mothers were members of the Kaiser Permanente insurance plan when they gave birth—providing the researchers with fairly comprehensive data on maternal health and information on whether or not they had the flu while pregnant.
What interests you: Disease sleuthing? Global bioethics? Protecting the food supply? Protecting yourself when you travel?
A new ranking of the top 30 public health blogs places The Public's Health at No. 14. The complete list is below. Lots of interesting stuff.
And if you want to go beyond reading about public health, join us at 6 p.m. Friday for “Blogging and Beer: Public Health in Philadelphia.” Also with us will be our editor at the Inquirer, public health writer Don Sapatkin, and some of our regular contributors. There is no cover charge for what we hope will be a lively discussion at Rembrandt’s Restaurant in Fairmount, one of several health offerings at the Philadelphia Science Festival that we mentioned last week.