Emory psychiatrist Douglas Bremner has compiled more than 10
years of research, reflection and observations as a clinical psychiatrist
in a book that explains how stress-induced changes in the brain
may account for some psychiatric disorders, including Post-Traumatic
Stress Disorder (PTSD), dissociative disorders, borderline personality
disorder, adjustment disorder, depression and anxiety.
The book, Does Stress Damage the Brain? Understanding Trauma-Related
Disorders from a Neurological Perspective, outlines the theory
that there is a biological basis for trauma-related disorders that
can be essential in diagnosing and treating such disorders. This
view of “trauma spectrum disorders,” as Bremner calls
them, is a departure from the widely held view in psychiatry that
psychiatric disorders are completely different from one another
and have different causes.
The idea of trauma spectrum disorders came out of research conducted
by Bremner and colleagues when he was a young psychiatry resident
at West Haven (Conn.) V.A. Hospital and Yale University Hospital.
During an experience in the wee hours of the morning with a Vietnam
War combat veteran who was trapped in the middle of a post-traumatic
“flashback,” Bremner was struck by the seemingly reflexive
and uncontrollable nature of the symptoms, which were similar to
those of patients having seizures. Bremner wondered if the flashbacks
represented a neurological rather than a psychological condition,
as they were considered to be at that time.
“When patients are having flashbacks, as my veteran was, they
are unaware of what is going on in the present,” said Bremner,
assistant professor of psychiatry and behavioral sciences. “Patients
often describe flashbacks as if a movie were playing in front of
their eyes, complete with visual images, sounds and smells.”
Bremner theorized that the flashbacks could involve the same brain
areas that are affected by seizures, most importantly the hippocampus,
which is affected in 80 percent of epilepsy cases. Subsequent PET
(positron emission tomography) studies with trauma victims showed
a significant and direct link between a reduction in the volume
of the hippocampus and PTSD.
In his book, Bremner emphasizes that all bodily functions are linked
in one way or another to the brain. In a stressful situation, the
brain automatically sends signals that release hormones, including
cortisol and adrenaline. The heart pumps faster, blood pressure
goes up and blood flow shifts to parts of the body that need it
most, such as the brain and muscles. If the brain overcharges for
a prolonged period of time in response to stressful stimuli, the
body does not have a chance to recuperate, and the results can be
deadly.
“If stress has effects on the brain and neurological function,
then stress has effects on all parts of the body—including
the heart, blood vessels, the immune system and the digestive system,”
Bremner said. “The long list of damaging effects can include
heart disease, memory impairment, depression and even increased
susceptibility to stroke and cancer.
“Knowledge is power,” Bremner added. “Our patients
will benefit from a greater knowledge of the potential effects of
stress on mind, body and spirit. It is essential that physicians
talk to their patients and determine what is going on in their lives
before making a diagnosis.”
Bremner’s background includes degrees in both psychiatry and
neuroradiology, fueled by an intense fascination with the link between
trauma and its biological effects. With the help of advanced PET
technology, Bremner and his team of researchers continue to peer
into the brains of individuals with PTSD, hoping to further determine
the relationship between trauma and functionality so that future
victims can be cured. At Emory, he is director of the Center for
Positron Emission Tomography and also serves as director of mental
health research at the V.A. Medical Center.
“Understanding of the human brain is more important now than
ever,” he said. “One thing I can say from my clinical
experience is that people in our country will be sorting out their
response to the tragic events of Sept. 11 for many years to come.
There are many patterns of response to that tragedy that can be
compared to other traumatic events from prior history. However,
in many respects this particular event was unprecedented. The constant
threat of terrorist activity is an anomaly.”
|