Posts Tagged ‘PTSD’


August 28th, 2011

After a two-decade absence from the East Coast, I decided to pay an overdue visit to an Atlantic beach. A few months back, my wife and I booked 3 nights in a B & B in Cape May, New Jersey, and I took 2 days’ vacation from my university duties. We arrived Thursday afternoon, unpacked quickly, and set out for a couple of hours to survey the lovely beach community. Coming back to the beautiful Victorian guesthouse to change for dinner, we learned of a mandatory evacuation courtesy of Hurricane Irene, bearing down on the heavily populated region from the Carolinas up to New England. Our brief holiday had been cut short. Bummer!

We dined, got to bed early, awoke at sunrise, downed a quick breakfast, and set out for an uncertain drive home. The coastal evacuation stretched from North Carolina through northern New Jersey. We knew there would be serious traffic.

My new car feeds real-time traffic updates into the GPS guidance system. As I drove, my wife sat with an iPad on her lap, receiving live route information and weather reports. We were fed and rested. And since our home in Central Pennsylvania is well inland, we had a safe, secure destination. In short, we were as fortunate as people could be in an unpredictable situation where nature shows its awesome destructive potential. And we live in a country with basically sound social and physical infrastructure. But it was unsettling, nonetheless, and we felt anxious and small in this mass movement of people before a huge storm. When we arrived home, we were drained and exhausted.

My experience, minor in the scope of our lives, and trivial in the eye of the universe, gave me renewed empathy for people dislocated, “turned upside down,” and traumatized by big events beyond their control: natural and human-caused. PTSD, a regular subject of my newsletter, BTP, is painful and disabling—affecting perhaps 20% to 25% of those with a vulnerability when they undergo severe trauma. People with PTSD have trouble restoring their equilibrium after civilian or military catastrophes. They are hurting and need help—from clinicians, social agencies, governments, and neuroscientists.

And when natural or man-made disasters strike—like wars, earthquakes, and hurricanes—the mentally ill are especially vulnerable. The assets I had—an intact marriage, access to information via expensive services, physical and mental health—are unavailable to most people with chronic psychiatric illnesses. Most often, they lack safe, secure, reliable resources. And their ability to make quick, rational decisions under stress is typically compromised. When major threats loom, let’s keep them in mind and look out for their needs.

-Alan J. Gelenberg, M.D.
Editor, Biological Therapies in Psychiatry
Shively/Tan Professor and Chair, Psychiatry, Penn State University
Editor-in-Chief, Journal of Clinical Psychiatry


Dandelions and Orchids

March 11th, 2011

Dandelions are hardy. Give them a crack on a city sidewalk, and they will thrive. The beautiful orchid, by contrast, is much more delicate. To thrive it needs conditions like those in Costa Rica: warm, sunny, and moist.

Increasingly, research on the human genome suggests that important gene-environment interactions may lead to psychiatric syndromes. An example is that two short alleles on the serotonin-transporter (5-HTT) gene may heighten vulnerability to depression under adverse circumstances.

Why would such vulnerability genes survive? Shouldn’t people who inherit them be adversely selected, so their genes would decrease and die out over generations? Or, might such genetic patterns give evolutionary advantage in selected environments—something like sickle-cell trait making people more resistant to malaria?

Emerging evidence, including data from studies by Penn State scientists, suggests that some genetic patterns, such as two short 5-HTT alleles, might confer behavioral advantages in an optimal environment. People with two short alleles who grow up in nurturing, intact families, with educational and economic privilege, may actually show greater resilience and creativity, while others with the same genetic pattern, who come from poverty and dysfunction, may do worse than average. If this theory is correct, the people with two short 5-HTT alleles are “orchids,” doing beautifully in ideal environments, but worse than average in bad environments. The majority of people, who have either a short and a long or two long alleles, are “dandelions,” doing moderately well in a broad range of environments.

As I write periodically in BTP, we stand on the threshold of dramatic and exciting breakthroughs in understanding the brain. In time, these discoveries should help people who suffer from psychiatric syndromes—including autism, ADHD, depression, and PTSD

Alan J. Gelenberg, M.D.
Biological Therapies in Psychiatry
Professor and Chair, Psychiatry, Penn State University
Journal of Clinical Psychiatry