Thursday, September 27, 2018

PTSD, trauma, and memory distortion

Several years ago I started attending Veterans Affairs seminars and workshops relating to pastoral care of veterans, especially combat veterans. The emphasis has been on reservists who come home from deployments to their hometowns, not to a military base with a built-in professional support structure as regular service members do.
On of the things we learned is that PTSD is a real psychological and emotional condition, but that a veteran's recollections of the trauma(s) initiating it are not fully reliable. So when a veteran says "this happened" he is certainly relating what he truly remembers, but what he truly remembers is often a odds with, even contradictory, to:
  • His/her prior statements of the trauma, and
  • The accounts given by other veterans also present
The veteran is not lying. One of the unfortunate effects of PTSD is "memory distortion." It is well  established in medical and mental health science that the memory of PTSD sufferers is flawed, often  seriously so, and that this distortion of memories of the traumatic events worsens over time. 

Here is an excerpt from, "Trauma, PTSD, and Memory Distortion," in Psychology Today from May 23, 2016 (italics added):
In fact, converging evidence demonstrates that experiences of trauma, whether a single event (e.g., a sexual assault) or a sustained stressful experience that might involve multiple trauma types (e.g., experiences at war) are also vulnerable to memory distortion. In fact, traumatic memory distortion appears to follow a particular pattern: people tend to remember experiencing even more trauma than they actually did. This usually translates into greater severity of Post-traumatic Stress Disorder (PTSD) symptoms over time, as the remembered trauma "grows."
During my military career, I escaped violent death a number of times. I recall finding a written account of one such event that I wrote very soon afterward, and that I later forgot about. Many years later I came across the account and was quite taken aback that it differed from my years-later memory significantly. 


But that is wholly unsurprising. The article relates that when Desert Storm veterans, asked to relate "certain events ... (e.g., experiencing sniper fire, sitting with a dying colleague)" over two years after their return home, 
 ... 88% of veterans changed their response to at least one event and 61% changed more than one. Importantly, the majority of those changes were from “no, that did not happen to me” to “yes, that happened to me.” Not surprisingly, this ‘over-remembering’ was associated with an increase in PTSD symptoms.
I have been diagnosed with PTSD but I do not re-see traumatic events over and over. My particular "trigger" is not seeing traumatic sights. but reading or being told about them. But memory distortion is real even among those not suffering from PTSD. 
Critically, post-event processing—such as actively imagining new details or experiencing unwanted intrusive thoughts—can increase the familiarity of new details enough that people may mistakenly claim those new details as genuine memory traces. This is memory distortion.
In 2014, James Hopper, Ph.D., Instructor in Psychology in the Department of Psychiatry at Harvard Medical School, who trains investigators, prosecutors, judges and military commanders on the neurobiology of sexual assault, and David Lisak, Ph.D. a forensic consultant, wrote, "Why Rape and Trauma Survivors Have Fragmented and Incomplete Memories," in Time Magazine after the proven-false charges of rape and other sexual offenses at Phi Kappa Psi fraternity house at the University of Virginia. Their concluding paragraphs:
... Victims may remember in exquisite detail what was happening just before and after they realized they were being attacked, including context and the sequence of events. However, they are likely to have very fragmented and incomplete memories for much of what happens after that.

These advances in our understanding of the impact of trauma on the brain have enormous implications for the criminal justice system. It is not reasonable to expect a trauma survivor – whether a rape victim, a police officer or a soldier – to recall traumatic events the way they would recall their wedding day. They will remember some aspects of the experience in exquisitely painful detail. Indeed, they may spend decades trying to forget them. They will remember other aspects not at all, or only in jumbled and confused fragments. Such is the nature of terrifying experiences, and it is a nature that we cannot ignore.
The Psychologist, the journal of British Psychological Society, published in June 2006, "Recovered and false memories," which is lengthy and not easily excerpted, but basically, the authors conclude that false memories are genuine and that memories of trauma are usually fragmentary and subject to being affected by external stimuli over time after the traumatic event. 

Then we have, "Memory Distortion for Traumatic Events: The Role of Mental Imagery," by the National Institutes of Health, which begins, 
Trauma memories – like all memories – are malleable and prone to distortion. Indeed, there is growing evidence – from both field and lab-based studies – to suggest that the memory distortion follows a particular pattern. People tend to remember more trauma than they experienced, and those who do, tend to exhibit more of the “re-experiencing” symptoms associated with post-traumatic stress disorder (PTSD). 

Here are some key points I have learned in ministry with veterans, especially when I served a church near Fort Campbell, Ky., during some of the intense years of the Iraq and Afghanistan wars:
  1. Persons who relate  recollections of personal trauma are not lying to you. Which is to say, they are not telling you things they know to be false. They are not attempting to deceive you. 
  2. However, that does not mean that their recollections are corresponding closely or even very well to what actually occurred (which unless it happened to have had contemporaneous documentation, such as at-the-time video or other accounts, may never be known). 
  3. Even so, as a confidant or a minister, your job is not to uncover "the truth" about the event, which may be decades in the past, anyway. It is to help the person through this difficult time or to cope with reactions, memories and relived emotions that may include helplessness, a grievous sense of loss, and usually incomprehension why the event and its aftermath remains so powerful.
  4. Therefore, listen compassionately, support the person with prayers and other assistance as may be needed, but do not try to become a PTSD or trauma counselor unless you are actually trained and certified in that. The VA has truly excellent PTSD therapies it has initiated in the recent past and I personally encourage veterans to talk with the VA about them. For non-veterans, such therapy may be more difficult to find. The nearest VA hospital may be able to advise you where to find counselors.
If someone you know suffers trauma (say, an severe auto accident) then it may be helpful to share ABC Science's article with them, "Reliving trauma could ward off PTSD."
Reliving a traumatic event may prevent the onset of post-traumatic stress disorder, according to Australian researchers. ...

They were divided into three groups. One received five weekly 90-minute sessions of prolonged exposure therapy, another getting the same amount of a different therapy called cognitive restructuring, and a third getting neither therapy.

In prolonged exposure therapy, a therapist helps a person vividly relive the trauma in a controlled environment, imaging it in detail and facing objects involved in the event. The idea is to expose people to the very thing that causes them distress to help them learn to better cope with it.

In cognitive restructuring, a therapist helps a person to try to alter negative thinking patterns related to a trauma.
 
Shortly after the therapy, 33% of the prolonged exposure group developed PTSD, compared to 63% of the cognitive restructuring therapy group and 77% of the untreated patients. The untreated patients were offered therapy at that point.
Again, these are therapies for trained counselors to conduct. But the point is that PTSD or other emotional/psychological disorders from trauma is not an inevitable outcome.