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What If PTSD Is More Physical Than Psychological? Evidence from new study (nytimes.com)
165 points by jcfrei on June 11, 2016 | hide | past | favorite | 103 comments



I found this article interesting but frustrating. Conflating PTSD (a mental illness that is caused by traumatic experience) with concussive traumatic brain injury isn't helpful.

I kept thinking it would be more interesting (and aligned to the headline) to look at PTSD sufferers brains when they didn't have a known physical injury to their brains.


Ah, but you seemed to have the point about many of these injuries being non-concussive, in the sense of not causing concussion.

This is an additional mechanism, heretofore unidentified, causing a significantly different injury than concussion.


I'm not convinced that the injury is significantly different. The mechanics certainly are: rather than the the brain trauma being caused by the brain bouncing off the skull, it's because the whole system is hit by a wave of pressure, but the end result is likely quite similar, though perhaps magnified when subject to an explosion (a holistic TBI, if you will).

The difference, I suspect, is that rather than the injury being confined to a specific place that has a lesion in the brain, it's rather the entire brain that gets affected.

I was in a car accident ~7 years ago that effectively erased 5 days of my life from my memory, and took me 6 months to fully recover from (though I suspect I'm still not quite the same as I was before the accident, but as far as anyone else can tell I am). The only physical remnant from that accident is a small scar on my scalp.

One of the things I learned from the doctors that attempted to assess the damage to my brain is that the number of TBIs caused by IEDs in Iraq and Afghanistan very much informed and changed the way that doctors treat TBIs here in the states.

Also, always wear a seat belt, whatever the circumstances. I'd be dead if I hadn't been wearing one.


The article discusses the physical differences between concussion injuries and this other form of injury, as revealed through detailed imagining of brain tissues.

I'm asking this purely out of curiosity and to foster discussion: what is about this aspect of the article you find unconvincing? Thanks!


The sense that I got from the article is that unlike "normal" TBIs, this type of brain trauma is very difficult if not impossible to see on a scan.

The symptoms, on the other hand seem very very similar. The progressive degradation in cognitive ability with exposure to explosions is (to my admittedly untrained eye) exactly the same as that of multiple concussions.

Which is not to say I didn't find this article interesting. I think the key difference between TBIs caused by explosions and those due to physical trauma is purely because there's no obvious lesion on the brain visible in a scan. As a result, the military treated it differently, which the article points out was a fundamental error that the military has now taken steps to correct.


I knew someone with PTSD following a brutal rape. He choked her during the rape and she was covered in bruises, etc afterwards. For at least the next two years, she suffered from repeated bouts of bronchitis and yeast infections. She finally insisted the doctor run tests and not just give her a standing prescription for yeast meds (this was before they were available as OTC meds) and they found an infection was the root cause of the yeast infections -- something weird, like vaginal strep.

I have a serious medical condition and any time I am incredibly physically impaired, it impairs my cognitive function as well. I see no reason why we need to have brain trauma per se to make a connection between physical ailments and mental health issues.

(Edited. I fucking hate autocorrect sometimes.)


Here's an interesting discussion between Dr. Mark Gordon, a retired Navy SEAL and the screenwriter of American Sniper.

https://www.youtube.com/watch?v=tbxPxFiOIKc

http://www.lifeextension.com/magazine/2012/1/Using-Hormones-...


A more accurate title for the NYT would have been

What if SOME PTSD is more physical than psychological.

The are a number of mental conditions that have more than one cause. Brain is a complex system and one disturbs it in one place or another and at the surface it all looks the same. Computers are similar - one place it goes wrong and the screen it looks like BSOD.

There is a real value of finding one clear physical cause->effect opening targeted opportunities for treatment and prevention.

But then there are plenty of people with PTSD that have not been anywhere near a blast. It may be one piece of a huge puzzle.


Yes, this article seems to reinforce the notion that PTSD is the exclusive domain of combat veterans, which is very far from reality.


Shouldn't a distinction then be made between 'shell shock' and PTSD as experienced by people that haven't been in war zones? In other words what soldiers experience is not PTSD, it's a different physical ailment (probably in addition to PTSD actually).


USMC combat vet of OIF here, and very much this. I now have my "ptsd" under control and it is mild compared to many of my buddies, but if there is one thing I can impart is that "ptsd" is simply too broad a term. Combat vets have different kinds of trauma, from tbi to various psychological ones and more, and grouping them all up does them all a disservice.

I have done quite a bit of thinking on the subject, and I think many of the approaches for both treatment and diagnosis are wrong, but thats a thesis paper for another time.


I can certainly believe that there is more going on than just stress, and the argument that compression waves travelling through the brain can damage it is pretty compelling.

The question then is how would you block it? How would you protect yourself from a compression (blast) wave such that it went "around" your head rather than through it. Is there some material that could conduct that energy preferentially?


The evidence that TBI is becoming a real problem is certainly compelling, but PTSD occurs in many people who didn't suffer from this.

However, I'm on the side that thinks that periods of intense stress can produce a permanent, possibly physical, change in a person. These periods can be prolonged or particularly intense moments.


Stop sending people to war would help


True, although I'm also concerned about people who are in the area when a bomb goes off (and there has been way too much of that lately). How much does damage? Is the damage reparable? What how far away must you be? If not reparable then treatable? The big data point here is the actual injury, vs the psychological injury.


Maybe we need to design more friendly bombs which only kill people in the blast radius (in a nice way) but don't compress the brains of those outside of that radius. Those soldiers launching bombs need a safe work environment. Perhaps we should get OSHA involved.


Thousands of years of violent human history suggest that designing a better helmet to mitigate TBI is likely to help more people than wishing war would go away.


In the article, if you read all of it, they suggest point to a study that suggests a better helmet may be of no use in preventing the injury. If you search for "animal" in the article, you should find it.

On the other hand, if the majority of people who want to join the army understand the dangers they face (in addition to death and dismemberment) then we might find that they held a war, and nobody came.


Having a war where nobody shows up would be great. Sadly wars usually happen because one side shows up and leaves the other side with no choice.


It's not the matter of material but shape. Soldier would have to wear something that completely surrounds his head, like motorcycle helmet. Which is very uncomfortable to wear if you have to wear it all the time.


When I talk to experienced motorcyclists, the biggest issue isn't the physical sensation of wearing a helmet. The problem is changing the acoustics around your ears.

An enclosed helmet that "hears" like a human, but filters the spikes (powering your iPod in the process)?


> An enclosed helmet that "hears" like a human, but filters the spikes (powering your iPod in the process)?

A friend of mine is a big hunter; he has over-the-ear hearing protectors (battery-powered electronics) that do just that.


The article seems to imply even that wouldn't be perfect- shock waves can and do travel through the bloodstream.


A historical quibble with the article,

It was first known as shell shock, then combat fatigue and finally PTSD, and in each case, it was almost universally understood as a psychic rather than a physical affliction.

This underplays a pretty significant history of doctors considering it a physical condition, as the old name "shell shock" itself suggests. The article does mention one such doctor, Fredrick Mott, but there were a number of them, and the debate recurred again during World War II, when a number of doctors used the term "postconcussion syndrome", again implying a disorder caused by physical brain trauma. Here's a review article: http://www.simonwessely.com/Downloads/Publications/Military/...

The article is right though in that in the past 50 years or so it's been mainly understood as a psychological disorder.


The article covers this: there were those who suggested physical causes, but they were, quite literally, out of fashion: Cf the article's mention of the, in this case, possibly incorrect and ultimately distracting influence of Freudians and other proponents of non-conscious, non-physical causes.


The article doesn't really cover this. It makes it sound like there was only "one British doctor" in 1916 who thought the cause was physical trauma, whose "views were soon eclipsed by those of other doctors who saw shell shock more as a matter of emotional trauma", a consensus that thereafter "held sway for decades", not to be questioned again until "yet another European war broke out", the Balkan Wars of the 1990s.

That is not really an accurate picture. There was more than just Mott with that view even in the World War I era, and the article forgets one minor European war between World War I and the Balkan Wars, during which the question was reopened, with a number of physicians in the 1930s-50s arguing for a physical cause. The article wants to position this as a radical new proposal overturning 100 years of ironclad consensus, while in reality it's more of a recurring proposal that has had periodic champions.


Yeah, and in some ways, the new study is a complete return to 150+ years ago. In the American Civil War, a theory of "windage" was put forward, that the concussion from a projectile's blast was responsible for "soldier's heart" in the head.

And don't forget the stories in the late 1800s in the UK related to "railway spine" -- the documentation of psychosomatic effects following a railroad accident, attributed to torsion of the spine and brainstem.


PTSD is common amongst soldiers, but it is far from a soldier's disease. It hits lots of people far away from any hint of a battlefield. Train drivers suffer it (they may witness many suicides). Doctors suffer it. Some types may even suffer it at a higher rate than soldiers (pediatric oncology).

If there is a physical injury that results in similar symptoms, then that syndrome should probably be given a different name in order that it be separated from the wider disease that seems to have no physical trigger.


I have it. I'm pretty introspective, too. I'd say it's almost certainly physical in many if not most cases. I can actually feel that. The thoughts and mental energy normally ran smoothly through my mind. After injury to back & center, especially the stress of it, it's as if a shockwave went through my mind blowing fuses or something. That's best way I can describe feeling and effect. Certain paths and things just aren't there or light up when they shouldn't. The wiring from input(s) to outputs(s) is broken where it's no longer performing the function it should.

Far as stress aspect, it similarly ignites electrical and biochemical activity that flows through sensitive parts of the brain. We know those parts organize themselves expecting certain flows or weights. I'd default on position that they could be damaged by overflows slamming them. They'd get damage resulting in impaired function with rerouting of sorts attempted. The result would be replacing that function or maybe new + old happening side-by-side with old still broken. Would explain intermittent failures that seem to relapse to an imprint of whatever caused the stressor.

So, just a few thoughts combining what I learned studying those parts of the brain with my own experience of how a broken one works and doesn't.


With a background in philosophy and neuroscience, I cringe at articles like this drawing a distinction psychological and physical. They are simply the same thing.


It's still a useful distinction. That's like saying all software is hardware because the bits and bytes are stored in magnetic moments on hard drives etc... Or that biology and chemistry are the same thing because all living things are made of chemicals. Sure, there's some overlap, but the fields are still very distinct.

Not to mention that the physiology of the mind isn't very well known. Physicalism of the mind isn't unanimously accepted in philosophy.


Except comparing body to hardware and mind to software doesn't make much sense.

If you want a better comparison, you could compare the mind to what happens within the CPU. Other chips would be other organs/subsystems, connected by veins, nerves and various canals (power and data buses). Then you'd have peripherals (limbs) with their firmware (reflexes), and sensors (eyes). All of those communicate together and have side effects on each other.

In the analogy, the body is the whole computer, and the CPU is a part of it, they aren't two separate entities that run in parallel.

If you want to compare hardware <> software, for humans it'd rather be flesh <> electrical/chemical signals.

You'll notice that almost all interesting behavior happens on the right side of the <>. Flesh/hardware are pretty boring, they mostly limit performance and just have to be in good enough condition to function. Slight alterations of those (burnt transistor, internal bleeding) will bring everything down.


That analogy isn't very apt because the CPU by itself doesn't have memory.

The CPU+motherboard+ram+hard disks is closer to the brain. You could argue that power supply and the speakers, microphone, nic, and webcam are like the energy supply and inputs to the brain though.


> Physicalism of the mind isn't unanimously accepted in philosophy.

Sure, and nonphysicalists believe in magic.


"This is the secret of C's portability: it is the best representation of an abstract computer that we have. Of course, the abstraction is done over the set of real computers, not some imaginary computational devices." -- Alexander Stepanov

One can certainly quibble over the historical accuracy of this, but I think Stepanov describes a worthwhile principle. My sesnse is that a lot of clinical psychology is still trying to abstract over imaginary brains (often by boiling away all the nuance and ambiguity from some ancient philosopher's musings) instead of the set of real brains.


I agree with the usefulness of it, particularly if the distinction is that psychological problems can be mitigated or cured through learning and dedication, while physical problems cannot, and require drugs or alterations to the body.

The line may be hard to draw, but we are probably better off trying to draw it so that we don't take too many unnecessary drugs or have invasive surgeries when there are other solutions...


>They are simply the same thing.

Not really, not in any useful way. To draw an analogy to computers, a "lesioned" transistor can be expected to produce an entirely different class of bug than an incorrect line of code. While a missing semicolon is technically a case of misplaced electrons, it really wouldn't be helpful to think of it in the same way you would think of 50,000V of misplaced static charge.


It's a false analogy though. Brains don't run software the way computers run software. The brain's behaviour is emergent from its physical structure.


A computer's behavior is no less emergent from its physical structure.


Except computer behaviour isn't emergent from its structure, it's emergent from its programming which happens after its structure is fully formed. And neural structure changes during its operation, which most computers don't.

They aren't remotely the same thing. Certainly you can simulate this operation of neural structure, but to suggest they are effectively the same is to suggest that cars and mice are effectively the same. They're both just made of matter aren't they?


In order to understand computation it's obviously useful to humans to think in an abstract way about what we're trying to accomplish with a computer, and how. The distinction we draw between computer hardware and computer software is obviously part of that understanding.

That said, programming is "merely" inducing specific alterations to the electrical charge distribution in the hardware of the computer. The computation we ascribe to the computer is the product of the physical changes induced in the structure of the computer by our act of programming it. As far as the physical artifact of the computer is concerned, as opposed to our mental model of it, there is no clear distinction to be made between hardware and software. That doesn't make the distinction we draw in practice an inappropriate metaphor.


No that is completely wrong and it is a common mistake made by people at all levels. The available pathways inside a computer, whether at the CPU level or in memory, or the system bus do not change no matter which program you run (barring exceptional cases of malware which destroy the computer).

What changes when you run a computer program is which pathways turn on and off, and these change based on reading the instruction set, which causes one operational circuit in the CPU to turn on and the results of that operation are stored for the next operation. RAM is simply a series of switches that can be "read" from the bus and passed to parts of the processor.

The only thing that may, arguably, work like that is writing to a storage medium like a hard disk or tape, and even then the circuitry around the medium does not change, just the magnetic or other impression stored on the disk itself.

Neurons are completely different in that they are made up of different connections to other neurons and it is these connections that make up both the storage medium, and the processing medium is what occurs when different neurons fire together.

[edit] The bottom line is that the brain can create new "instructions" on its own by physically rearranging the groupings of neurons. For a computer to do the same requires a new CPU with a different instruction circuit baked into the chip.


Do you debug your code with a microscope and soldering iron?

Layers of abstraction are useful, especially when we don't fully understand how the hardware works.


Yes, this. Exactly what I wanted to add.

One day, perhaps, we will understand how all the layers interact well enough. But until then, we need the descriptive and diagnostic and prescriptive techniques provided by those abstractions.


>They are simply the same thing.

This is not the accepted wisdom on the subject. The accepted wisdom is: "we don't have any evidence that these things are separate, so for now, while the jury is still out, we consider psychological and physical well-being to be equivalent".


FYI: I read the same complaint in the comments of the article and submitted it with a different title. But mods have since changed it.



Sigh. What they mean is "what if two different conditions with different causes have been previously considered to be the same thing?"


The desire for such a distinction is strong. We prefer to attribute illness to physical causes because in our society we blame the patient for mental but not for physical illness. This disparity drives the push to find physical causes to which we can more comfortably redirect blame. Such as DNA, leptin, bacteria, enzymes, etc. It is wise to be skeptical of any new findings which fit too well with human desires and thus make "good" articles.


I'm not sure. We have both strong desires to escape blame, but also the strong desires to blame others. And once we've become accustomed to blaming people for a particular thing, it's hard to let go.

To what extent the mental is distinct (or not) from the physical body/brain, well... we have no frakking clue. We have a laundry list of disorders previously thought to be purely "mental", that are now known to be physical. Then the rest we just kind of blame people for.

I think really what we should ask is, "Does blame work in case X, Y or Z"?

e.g.

- Does blame cause your child to do better in school and stop acting like a monster? Yes? Great, use blame.

- Does blame cause PTSD victims to get over it? No? Then stop blaming them, lets find another way (possibly physical) to fix it.


Agreed, it is certainly worth the skepticism, but also worth the skepticism behind the medical communities insistence that it wasn't related. One aspect of history that always concerned me was why 'modern war' had the effect it had compared to antiquity. The horrors of war have been repeated historically, but not like this.


Or, get this, and this is super radical of an idea I know:

There is not much of a separation between physical and psychological in the first place. Every part of the body is interconnected--as people develop disease, often times mental symptoms develop secondarily so. Depression and anxiety are super common in all sorts of illness states. There are numerous studies showing cellular dysfunction and rampant oxidative stress connecting to the more serious mental illnesses.


The idea of a divide between mind and body is strange.

It seems like our consciousness is constructed in such a way that it's very easy for people to forget that we actually have a body connected to our head.

Another interesting idea would be to think that mental health problems in part are caused by the systems inside our body that are outside of our conscious control not working properly communicating their discomfort as mental health problems.

I'm a clinical psychologist and I don't think I've had a patient in therapy who had

1. Sleep 2. Exercise 3. Stress 4. Food

Figured out.

What I mostly notice is that once these things are improved the need for therapy diminish significantly.


"What I mostly notice is that once these things are improved the need for therapy diminish significantly."

Isn't this sort of a chicken-egg problem? I have horrible sleep issues, but they're caused by PTSD related anxiety, and yes, the insomnia then exacerbates the anxiety. I sleep better when my anxiety is under control, but it's not the good sleep that reduces my anxiety--- it's stuff like Xanax and meditation.


> The idea of a divide between mind and body is strange.

I think that is an important construct. It allows us to abstract the notion of an individual and make it something well above a bag of bones and meat. By "above" I mean something superior, trancendant, more important.

A lot of religions have the concept of a soul, and due to Abrahahim religions, the West that concept persisted. Even if people don't believe in a soul there is still a concept of a mind as separate from the body.

In computer terms (because it is hacker news), there is a tempting analogy of software and hardware. The mind / self / personality / soul is the software. The body is the hardware. Of course, we know that software is stored by altering some parts of the hardware (electric charges, etc)). So there is a connection obviously, but we still talk about it as separate things.


It's not just religious traditions that continue this idea. Ancient Greek philosophy kicked this off as well. To be fair, this separation makes alot of thought easier/possible. But considering how much we don't know about the brain or how consciousness works, it may not be the best way to promote mental and physical health.


I never understood why people rarely take this approach. It's not as if these things occur in isolation.


There is a long medical history of treating things in isolation in order to understand fundamental aspects of biology and such. While the rest of science has more or less moved on from this mindset, the medical field hasn't fully yet.


It's called measuring things. It's what we do, after all.


Measurement is great. I'm all for it.

But there's a serious problem with scientism in the modern world. I think it's great to develop a way of looking at the world that 'takes people out' - we can predict the motion of the moon without regard to what people think or feel about how the moon will move. The moon's motion does not take our feelings into account.

It starts to get really silly, though, when you try to use those same techniques to look at people. "How do people behave, in the absense of people" is a very silly question to ask, but it seems like that's what we try to do when we look at people through the lens of modern scientific methods.

Every person is different and has a different personal history. The idea that you can formulate some 'general rule' for how people behave is as baseless as trying to come up with a 'general rule' for computers.

It makes much more sense to look at different software patterns and how they operate, rather than trying to snip a transistor and then see how the graphical output changes, which is effectively what we do in mental health medicine.


The problem you are referring to is known, although I'm not sure how widely spread.

You can't measure the measurer, so there's a gap in our perception. There's a RI talk on this, where the color purple is discussed. There's really no color purple, for example. It's your eye picking up the absence of green when seeing blue and red light together.

In other words, perhaps purple is a program in your head.

Perhaps our ability to understand the nature of a measurement is an absence of something we yet to integrate into our knowledge base? My vote is for a momentary access to the global consciousness. Like an API with a "search" timer on it. It serves efficient queries faster. It does this in a fixed timeframe using a hierarchical form of evaluation. It knows everything it knows so far.

In other words, perhaps causality in this reality is based on some type of immutable programmable storage. Perhaps that' why it's hard to change things here too.


Mind-body duality have been a strong force in human society.

Heck, swap mind with soul and you may trace it as far back as we have "documented" history.

We have this strong resistance against seeing our thoughts, feelings and such as signal activity between a massive bundle of cells.


It's not that rare - it's made it to UK government national strategy advice over five years ago in "No Health Without Mental Health" which talks about the importance of improving physical health for people with mental illness[1] and improving mental health for people with physical illness.

[1] for a variety of reasons people with severe mental illness die about 20 years earlier than the general population.


The more complex a theory is, the harder it is to draw useful conclusions that people can actually apply.


It's not so simple - while it is obvious that physical damage to the brain can cause psychological damage to the mind (e.g. lobotomy), it's not clear (at least to me) if purely psychological damage (e.g. horrific emotional events, war situations with no physical effect to you) can disrupt the physical functioning of the brain.

Change in balance of some neurotransmitters can cause symptoms of mental illness - but can purely psychological events (i.e. what you observe and contemplate) cause permanent alterations to that chemical balance, cellular dysfunction, structural damage in the brain, etc?


Yes, it is pretty well established that cortisol causes the hippocampus to shrink [1]. Studies also show that the hippocampus shrinkage in PTSD is reversible with treatment [2].

That is just one example, but there are quite a lot of other long-term structural changes in the brain after chronic stress.

[1] http://www.biologicalpsychiatryjournal.com/article/S0006-322... [2] http://www.biologicalpsychiatryjournal.com/article/0006-3223...


When he was really little, my oldest son was prone to having tantrums. When he was four years old, he was literally hopping mad one day and this resulted in him literally bursting a blood vessel. He developed a sudden, really severe nosebleed. He was prone to nosebleeds anyway, but this was one of the worst ones he ever had and I was concerned for a bit that I would need to take him to the ER because I had trouble getting it to stop, in spite of experience and knowledge about this issue.

The experience was incredibly shocking for him. The idea that his feelings could actually cause him direct physical harm really freaked him out. Furthermore, the event caused his tantrum to end very suddenly. The tantrum came to a screeching halt, so to speak. Without any training, he was able to use this experience as a form of biofeedback. He had felt something in his brain when it stopped and that allowed him to find some means to interrupt the runaway process at subsequent events.

He didn't like being mad, so being mad made him mad about the fact that he was mad and it created a positive feedback look that caused his anger to just go off the rails. He stopped having tantrums following this incident.

I think, yes, psychological things can literally have direct physical impact. We know it can do things like raise your blood pressure. This is an ordinary thing. With extreme enough experiences, I see no reason why it wouldn't impact the brain in a meaningful way with long term consequences


Yes. Psychological trauma can result in repeated and excessive flooding of the synapses with neurotransmitters, which can cause lasting physical damage much like drug abuse can.


If a permanent change in your psychology did not correspond with some permanent change in your physical person, then what would there be that was causing the change in your psychology? Some non-physical "soul" or "mind"?

All psychological facts have physical correlates (in philosophy of mind, this is called "supervenience"). The only limit is our ability to measure things. As our ability to measure our own brains and bodies increases, we should expect to uncover more and more physical correlates of psychological conditions.


As I said, the question (answered by others) is about structural changes. Any memory is formed by changing something in the brain, but forming this memory doesn't cause any meaningful changes to the general physical functioning of the brain; forming memories and having preferences (and changing them!) is what the brain does; perhaps the quantity of memories affects the structure of the brain or alters its functioning/learning, but generally the content of memories will not.

Psychological facts having physical correlates isn't the answer - to use a wrong-but-useful analogy; it's clear that hardware can inappropriately alter/damage software in many different ways, but in what ways software can/cannot damage or alter the normal functioning of the hardware? The other answers give some examples where this can happen - are there more direct ways?


> it's clear that hardware can inappropriately alter/damage software in many different ways, but in what ways software can/cannot damage or alter the normal functioning of the hardware?

I see where you're coming from, but in the case of biological brains and their physiology, the hardware IS the software, no?


forming this memory doesn't cause any meaningful changes to the general physical functioning of the brain

Maybe not any that we are currently able to measure, but something's got to be changing. As an analogy, consider your computer: you could open it up, look inside, and feel that temperatures of different parts change over time, but you can't tell what it's doing or how well it is working just by looking at it. Even with fancy electrical equipment you'd have a hard time determining what's going on, beyond detecting that there's a lot of signal activity flowing around. To really see what's happening you need access through the software, and we just don't have that kind of access to the human mind.


I still don't understand if you're really claiming what I feel you're claiming, that is, saying that "forming this memory doesn't cause any meaningful changes to the general physical functioning of the brain" is false?

It's not a question of being able to measure - I believe that we can measure e.g. synapses being strengthened and weakened as a result of learning skills; but that these changes don't change the physical functioning; it's just part of their normal functioning and it functioned exactly as well before and after - the behavior is different but physically equivalent.

For what I mean as a "meaningful change to the physical functioning", consider your computer - deleting all the software and installing a different operating system would not be a meaningful change to the physical functioning; the temperatures, electric charge and magnetic properties of the involved parts would be very different, but that doesn't matter as all the physical parts would still function in the same normal way although the screen would be displaying very different signals.

On the other hand, a software program that manages to physically disable or re-enable parts of some chip in a way that's not normally possible through software, blow a fuse in a hard drive or trigger a processor bug that "bricks" the processor - those would be the kind of changes to the general physical functioning I'm talking about. In what cases do we have such changes to the physical functioning of (parts of) the brain? Changes that are substantially different from any changes that the brain "does to itself" in the course of normal operation?


https://www.researchgate.net/profile/Eric_Vermetten/publicat...

> Borderline personality disorder (BPD) is a common disorder associated with emotional dysregulation and other symptoms that have been hypothesized to be related to dysfunction of limbic brain areas including hippocampus and amygdala. The purpose ofthis study was to measure hippocampal and amygdala volumes in BPD. Hippocampal and amygdala volumes were measured with magnetic resonance imaging (MRI) in 10 patients with BPD and 23 control subjects. Patients with BPD had a 21.9% smaller mean amygdala volume and a 13.1% smaller hippocampal volume, compared to controls. These findings are consistent with the hypothesis that alterations in the hippocampus and amygdala are associated with BPD.

Here they see changes in the structure of the brain.


Actually, not really, the paper doesn't say that - it seems to explicitly limit its findings to an association and nothing more.

They see changes in the structure of the brain and they see changes in behavior (BPD), but they're clearly not saying that BPD caused these structural changes - they list both causal directions as some of possible hypothesis (altered amygdala/hippocampus causing BPD and/or BPD-related experiences causing these alterations in amygdala/hippocampus), in addition to other possible scenarios e.g. the fact that all of their BPD-group was on psychotropic drugs could also have been a cause for the observed changes, etc. They also aren't making any conclusions about a possible link between childhood abuse and BPD (or link between abuse and these brain changes) beyond the fact that they chose a set of 10 subjects that all had both BPD and suffered abuse; they're not even discussing a correlation as their data isn't sufficient to say anything about that.

All the observations in this paper certainly are compatible with a hypothetical scenario where these brain changes cause BPD (or indeed, are BPD) but it was some factor other than emotional trauma that caused the observed changes in their brains. I don't know if it is that way, but this particular paper also doesn't give any evidence to support or deny it.

[edit] It even seems that they don't even state that there was a change in their brains - instead, they observe a difference between BPD patients and the control group; but it would also be consistent with a hypothesis that these patients had smaller hippocampus/amygdala e.g. since birth, and simply having that property (instead of a change) was a risk factor predisposing them to suffering BPD symptoms later in life; and the authors acknowledge this as a possible option in their conclusions.


Yes, a lot of disorders involve physical changes. But that doesn't tell us if the physical changes are cause, effect, or both wrt the mental changes.

The question at hand is whether you can have thought patterns that cause structural/functional changes to happen.


Emotions are generally non local chemical releases in the brain. Stress, fear, love, hate, all bathe most of the brain in the relevant chemical cocktail. So, no it's more than just local memory formation.

On that note, memory's footprint is all over the brain. Learning judo is more than just filling up a psudo HDD with relevant information.


The problem with looking it this way is you are ignoring another thing the brain does, which is to link events in memory with emotions, and triggering these emotional responses in turn release all kinds of chemicals that affect the way the brain functions.

Granted this link fades over time (and likely therapy helps), but the body is not always good at handling major stresses and the damage can become permanent.


>can purely psychological events (i.e. what you observe and contemplate) cause permanent alterations to that chemical balance, cellular dysfunction, structural damage in the brain, etc?

I think so. Amblyopia is an example of structural changes in the brain based on what you observe. It generally happens early in life when the brain is more plastic but it proves it is possible. There is also evidence that amblyopia may be able to be treated in adulthood.


They've put people who've had extreme childhood abuse into brain scanners, and seen differences in the amygdala.

I think they took a different group of people and predicted differences in the amygdala based on psychologic symptoms, and then checked that in MRI scans, and found the differences they predicted. (Although I'm having trouble find the links at the moment.)


Isn't it well-established that learning of any sort produces physical change in the brain?

Why would experienced trauma be any different from any other extremely powerful (and repeated) (yet traumatic) learning experience, thus causing permanent change in the brain to "capture" and "remember" the incident like any other powerful learning experience?


Learning a fact physically "records" the fact in the brain, but is it well-established that powerful learning experiences can cause changes to the overall functioning of the brain?

I mean, not the physical changes that amount to "now your motor neurons have changed so that they swing a golf club more accurately" but physical changes that are like "now your motor system or learning system or the regulation of something seemingly unrelated is structurally different because you've been seeing/hearing/thinking these things" ?

I'm not talking about a memory "subsystem" being changed so that it now contains and remembers the incident; that's the usual function of it; I'm talking about the memory (or other) subsystem being changed so that it is now somehow fundamentally altered, processes things differently from its normal function, or fails to process something that it could before.


I'm sorry, I fail to see the distinction you are trying to draw.


Quantum Biology looks interesting, I'm in no way qualified to opine, yet I am fairly confident we're still a long way from a complete understanding of body and mind!


Although this is true, learning that there is a specific physical sign in the brains of those who have suffered blasts at close range, and that this sign is not present in those who have suffered other forms of stress, is a significant breakthrough!

The article presents this as an issue of physical vs. psychological, but even stripped of that misconception it's still an interesting article.


It is 2 way street physical damage can cause mental damage, vise versa.Pure psychological damage takes sometime to really cause physical damage I would imagine. PTSD Is a thing that we all suffer from as we get older and get bumps and experience trauma. this is a great find. +1.


And what about a weaponized myco? https://www.youtube.com/watch?v=sT25HhAVhhU


The title of this article extremely poorly chosen. The DSM-5 criteria for PTSD defines this condition in terms such that a great number of patients meet the criteria who have never been exposed to blasts of any kind. Yes, there may be significant numbers of patients like those the article describes who suffer from a previously uncategorized blast injury phenomenon that has sometimes been attributed to PTSD but the author is drawing the wrong Venn diagram for the reader. The new entity does not begin to subsume the entire PTSD population. This matters because too many patients whose symptoms have been stigmatized anyway will now be left with the impression that "real" PTSD is only associated with a history of blast exposure.


Yup.

Moreover, it's possible, and in fact quite likely, to have both.

Having an IED go off near you might result in blast injury to your brain, which produces one set of symptoms. But it's also pretty likely to cause PTSD as well. That sort of thing is a harrowing experience, more so if you witnessed someone you cared about getting killed or injured in the blast as well, that's an easy candidate for setting you up for PTSD. But the symptoms you experience afterward will end up being a mix of both conditions.

I find it interesting that people seemed to have figured out "shell shock" fairly early on simply intuitively. But whereas early treatments focused on it as an almost mechanical thing, and something to be overcome so that soldiers could be put back into the fight, it took a greater sensitivity to psychological issues to realize that PTSD was also a factor though in so doing there was a tendency to attribute all symptoms to PTSD. Now we've rediscovered shell-shock, but I hope we don't forget that PTSD is real and important as well. And we don't view shell-shock as simply a hurdle to overcome so we can get the greatest battlefield efficiency out of wounded soldiers. We've come a long way since WWI in how we treat soldiers, and I hope we don't regress.


Medieval cure put ptyds near a implosion Inb4 triggered medievalists



What if we had decades of good research showing that the physical/psychological distinction is not a helpful one, and therapies that don't take both into account are generally less effective for most pathologies?


> Physicalism of the mind isn't unanimously accepted in philosophy.

Much philosophy is just bad science. Pontificating over unanswerable questions is little more than a waste of time. Philosophy's greatest achievement was science, which is a better way to explore reality because logic alone isn't enough, it needs to be backed by evidence.

Physicalism is all that is known to exist, those asserting otherwise have no evidence to back their claims and are basically asserting magic.


We detached this subthread from https://news.ycombinator.com/item?id=11884291 and marked it off-topic.


> Pontificating over unanswerable questions is little more than a waste of time.

You clearly don't understand philosophy. Some philosophers like hearing their own voice talk about such questions, just like some physicists are themselves crackpots. Most philosophers are trying to properly define an otherwise ill-defined subject, and the only way to do that is via various types of thought experiments, just like Einstein did when he formulated his theory of relativity. Or did you not know that science is natural philosophy?


Seems you didn't really digest what I said, I understand philosophy just fine. You've quoted one sentence out of context and pretended I said all philosophy is wasting time on unanswerable questions, I didn't. Additionally your last sentence makes it utterly clear you didn't actually read my entire reply as I said philosophy's greatest achievement was science, so to ask if I know science is natural philosophy is a dead giveaway you're not paying attention at all.


I commented on that specific line because that exact sentiment is all too common, and entirely unjustified.


And I just justified it. "Unanswerable questions" != philosophy, I was critiquing a subset of philosophy, the useless subset, like arguments for God's existence, useless nonsense asking meaningless questions.


What if not only PTSD but all psychological phenomena were, by their very nature, rooted in the physical chemistry of the brain?

How bizarre would that be?


Sigh this topic always comes up. From a materialist perspective (which is the only perspective that makes sense in medical science), yes, any psychological phenomenon is ultimately a physical phenomenon.

But when people talk about the psychological/physiological dichotomy, they're talking about causes. A psychological cause for an ailment is one that is brought about by thinking — by the brain operating normally without any external interference. A physiological cause is one that requires an external agent, like concussive force applied to the brain, or asphyxiation.

Psychiatric illnesses are an interesting edge case because they usually deal with the balance of various chemicals in the brain that are supposed to be there. That balance can be influenced both by external factors (like taking a psychoactive drug, such as an antidepressant SSRI) and by just thinking. It's not as well understood how thinking influences brain chemistry, but meditation, for instance, certainly does.


In a sense, they are. If we accept that the brain is what gives rise to our perception and personality, and to our experience of ourselves, then it stands to reason that all psychological phenomena arise from a configuration of the brain. It turns out that dumping chemicals into the brain can affect its configuration. But it doesn't follow that the new configuration leads to any more desirable psychological state than the old configuration.


Even if it were like that, things like the gut-brain connection (or rather, interaction) would destroy all hope for a neat separation of brain vs the rest.


That's crazy talk!




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