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2007-12-18 - 10:25 a.m.

I read what I consider to be the best article about TRAMA in my local Loudoun Times on line site this morning.

HERE IT IS:

The Real Damage From Combat Trauma

WEDNESDAY, AUGUST 15 2007

I once had a patient who was a Vietnam combat veteran. Upon being discharged, he went from jungle combat to his home in 48 hours. Day after day, he waited on his porch surrounded with his loaded rifles and handguns. He walked into town one day and held up a local bank at gunpoint. Prior to his combat experience, he was a responsible citizen. What happened to him?

The answer can be found by understanding how severe trauma affects our brain.

When we experience abuse, aggression, fear and rage, the part of the brain called the amygdale lights up. This is the fight part of the fight or-flight survival circuitry. What keeps the amygdale in line and quiet is the hippocampus. This is a resource for memory and for making sense of the trials and joys that life dishes out to us. It tells the amygdale that things are OK to calm down and call off the dogs.

Studies have shown that the hippocampus is actually damaged by stress, abuse and trauma. The hippocampus of people exposed to combat trauma is half the size it was before they were traumatized. So the amygdale is left unchecked with the result being increased irritability, insomnia and aggressive or self-destructive tendencies.

The other brain circuit associated with trauma and stress is called the HPA axis. This is the brains connection with the survival response of the human organism, where the entire system becomes mobilized to protect itself from mortal threat. When the HPA axis is fired off, biochemicals are released that actually destroy brain and cardiac cells to rapidly produce energy to survive. It protects the organism much like a desperate person might burn the furniture to keep from freezing to death.

These chemicals are called glucocorticoids.

Unlike World War II, where troops were rotated from the front lines for rest and recuperation, troops fighting in the Middle East may be under constant threat to their lives. And, unlike the Vietnam War, repeated deployments are common. Their nervous systems have been recalibrated to function under combat conditions and do not automatically adjust to civilian life.

The nature of this war with its reliance on reservists and its disconnection from the day-to-day lives of Americans at home, will amplify the isolation of returning troops and the severity of trauma symptoms.

Importantly, the effects of combat trauma can be triggered months or years later by cues or situations that cause the nervous system to relive the terror of combat.

With the future arrival home of thousands of troops who experienced severe combat trauma, additional research and education is crucial. Focus needs to be directed toward understanding how their systems have been effected and to develop improved treatments including diagnostic brain imaging, medicine, brain nutrition and psychotherapy.

Welcoming home our troops with banners and parades needs to be paralleled with a more serious, informed and comprehensive response to the unseen effects of combat trauma.
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