Post Traumatic Stress Disorder: Random Thoughts

Living a life of chronic pain is something I never imagined.  One becomes hyper-aware of environmental inputs to the point of morbid intensity.  The stress is unendurable.  The realization that this condition will never improve inspires fatalistic thoughts and deranged conjectures.   For example, when I die will I awake in some religious purgatory with this infernal misery as punishment.  I was indoctrinated as a child and have lasting scars.

I understand the reasoning of our wounded warriors who return from a valorous fight maimed for life and who have been changed forever.  I empathize with these brave patriots who after experiencing unimaginable trauma, can no longer maintain their former personalities.  Brave soldiers who have become so physically and mentally dysfunctional they no longer fit properly in the context of our society, or in the context of their own families.  This may explain the huge number of homeless veterans who sleep on American streets daily, forsaken and cast aside by the most giving of all nations.  This abandonment of our veterans is a national disgrace.

I knew homeless veterans personally, not as a detached social worker, but as a homeless bum.  Our group did not drink alcohol or use drugs.  We did not fly signs, pester people for handouts, receive food stamps, or receive cash assistance.  Some of my old friends were pensioners who actually contributed years of work to society.  Yet these gentlemen preferred to dine at soup kitchens and live under tarps under trees through every type of imaginable weather, exposed, harassed, fearful, hungry, dirty, and insane.  Why am I telling you this?  Stereotypes, as conceived from afar by ivory tower talking heads, don't apply to everyone who lives on the street.  They are not all lazy people either.  Some take day jobs desperately wanting to escape their plight.  The rent-a-bum industry makes a fortune off of down and out hard luck people.  Some even gain long term employment through temporary services, but most aimlessly drift from job to job, from town to town, accomplishing nothing.

When I was in the University of Utah burn unit (costing the taxpayers God knows how many thousands of dollars) I asked to be released before the doctor even considered it.  I had nowhere to go except for the shelter medical bed.  When I was being discharged from the hospital I had a chance encounter with a homeless liaison social worker.  She shamelessly shouted at me in the hallway from afar, that I could not continue to mooch off the hospital forever.  I was never so offended in my life.  Did she think that I was using the hospital as a sort of vacation retreat and that the hospital staff had to force me from my bed?  If that cunt had expended five minutes of her time familiarizing herself with "my case" she would have never been so rude and insulting.  Social workers have no business among poor people.  Her behavior typifies the prevailing response you can expect from these social justice warriors who claim to have a monopoly on compassion for the sick and injured in this world.  Snide condescending jeers and sneers.  Mangled veterans suffering from post-traumatic stress disorder probably run the same gauntlet when dealing with professional psychiatrists who consult their diagnostic manuals, and like pontificating gods, espouse factitious disorder or malingering.  Meanwhile, people are left to dangle in the wind to deal with a constellation of mental horrors alone and unaided.  Have no doubt, people derive a great deal of sadistic satisfaction from the misery of other people.  But when the laughter subsides, when fatigue of supporting a chronically debilitated person takes over, people do get bored with the plight of disability and frustrated being around people who cannot control their moods and who involuntarily express discomfort, sometimes irrationally.  I have been guilty of irrationality on many occasions.  This has lowered my self-esteem, damaged my interpersonal relationships with family members, and has filled me with remorse.

There is a distinction, however.  I am entirely responsible for my folly.  I had a choice to behave like a fool.  I was not serving my country as a loyal patriot.  I was not ordered into battle.  I deserve my misery.  I understand that some injuries change people forever.  I understand why so many people consider suicide.  The country can do better to help people who are not at fault and who served with distinction.

I used to spend days in the library researching depression.  I thought I had rewired my neurons, a firm believer in plasticity.  That was a voluntary effort, but this chronic pain is beyond conscious control due to the sheer number of damaged pain receptors in my bones and skin.  Extinction is impossible.  Recently, I have been fighting suicidal ideation.  There is a concept in psychology known as learned helplessness.  A rat is placed on an electric grid and shocked.  No matter what kind of behavior the rat engages in, it cannot escape the shock.  There is no avoidance response to learn.  So the rat cowers in the corner doing nothing.  The rat has an instinct to survive, but the rat has no language skills to communicate the trauma the rat is experiencing.  Human beings have the ability to conceptualize uncontrollable suffering, even rate pain intensity on a theoretical scale, but there are limited behavioral strategies available to reduce the perceived stimulus.  There are certain pharmaceutical interdiction available, opioid or anticonvulsant remedies, that can be ingested to reduce chronic pain.  Drugs could be considered a behavioral strategy, which produces fleeting medical efficacy.  The effect of pharmaceutical interventions is temporary and implies negative secondary psychoactive side-effects such as increased suicidal ideation.  Pharmaceutical behavior designed to reduce pain is directly contravened with increases in distorted perceptual sensory input; into the association cortex, pre-frontal cortex, and limbic systems; the centers of long term memory assimilation, executive planning, conceptual thought, and emotion.  Gabapentin causes mood swings, and has a high suicide incident rate.  Opioid derivatives have high overdose rates.

Pharmaceutical interventions have a transitory effect, high tolerance, and short half-lives.  Dependency on pharmaceutical drugs becomes a huge problem.  Delta-9-tetrahydrocannabinol (THC), the psycoactive component of cannabis, and similar holistic remedies have theoretical pain relieving medicinal properties.  However, delta-9-tetrahydrocannabinol (THC) is a hallucinogen that fits into the cannabinoid receptor active sites within the brain.*  Delta-9-tetrahydrocannabinol (THC) like opioid compounds alter perceptual awareness, creating transitory euphoric effects.  Endorphins and enkephalins can be theoretically generated by and reinforce euphoria.  Endorphins and enkephalins may be referred to as endogenous opioids.  But altered perceptual awareness is no panacea.  Chronic pain though suppressed below threshold briefly, always returns to remind you that the situation is hopeless.

It is inhumane to force people to suffer, but millions do every day without any possible respite.  We as a nation can do better to help those who cannot help themselves.

A physiological experiment worthy of Sigmund Freud

*I have considered experimenting with delta-9-tetrahydrocannabinol (THC) like the intrepid researchers of yore, to find out if medical marijuana is real or a hoax.  But I don't want to sit around like a stoned zombie all day long.  And I can't stand the stink of Mexican skunk weed.  But there are synthetic variations of THC, dronabinol or marinol, that would be very effective research tools sans the stink.  I have talked to people who smoke marijuana and have asked for their opinions on the painkiller properties of marijuana.  One person said marijuana alters pain awareness, you feel pain, but don't care.  This indifference to pain, under the influence of cannabis, intrigues me. Maybe, even though the brain percieves pain, the brain through some unknown mechanism considers the pain a trivial concern.  Maybe, the solution to the problem can be found in trait-state pain perceptual thresholds.  The pain threshold in the trait mode has value x.  Pain threshold in the stoned state mode has value y.  This idea is most intriguing as a hypothetical construct and should be explored scientifically in controlled experimentation.  However, formulating a measurement tool for threshold would be a daunting task, as all responses to be measured would be subjective opinions of the person being measured.  But pain is measured by opinion now.  Walk into a clinic or hospital and notice the row of cartoon faces.  The faces change from happy to angry, each face is assigned a number.  Zero is assigned a happy face with a broad smile, indicating little pain.  Ten is assigned to a angry frowning face, indicating severe pain.  You ask the person sober to indicate a face that reflects his opinion of his or her pain at the moment.  Then after taking a dose of marinol you repeat the question, which face represents your current opinion of the pain you are experiencing at the moment?  Then measure the difference.  Crude, primitive, unreliable, with very little validity, but what else is there?  You might increase the dose of marinol, or reduce the dose of marinol, or vary the time scale, or monkey around with a million other variables until you establish some approximation to scientific truth.

Controlled medical experimentation is a much better idea than relying upon the hysterical debate of people who are either in favor of, or against, the notion of medical marijuana use.