Case Study - Posttraumatic Stress Disorder

Case Study 10: A 36-year-old man and his young son were driving through an intersection when another car ran through a red traffic light and struck them. The two were trapped in the car until a fire department rescue team freed them. The patient was bruised but not seriously hurt. His son had a broken leg. The first few days after the accident the patient was preoccupied with arranging care for his son and getting the car repaired. A few days later he began having recurrent distressing thoughts and images of the accident. Theses symptoms lasted for several weeks. The memory of his son’s screams after the car was struck seemed particularly vivid. The patient became irritable, had difficulty concentrating, and avoided talking about the accident. He went out of his way to avoid driving down the street where the accident occurred. As time went on he could no longer remember whether the traffic light was red or green when he approached it.


The patient in this case study appears to be suffering from what the DSM-IV-TR describes as "Posttraumatic Stress Disorder." Many of the patient's symptoms relay this, including his "vivid" memories, flashbacks, irritability, avoidance, and memory loss. The reason this is believed to qualify as Posttraumatic Stress syndrome, and not Acute Stress Syndrome is that the symptoms lasted for several weeks (DSM-IV-TR lists that it must be for about four weeks), and Acute Stress Syndrome is marked more by a "derealization", "depersonalization", and "daze." Perhaps if the patient was to be studied further, and more information given, it could be determined further whether the patient was suffering from PTSD or Acute Stress Disorder, but as it stands it seems the former is the case.


The DSM-IV-TR gives four qualifications which must be met for the label of Posttraumatic Stress Syndrom to be used: "the person has been exposed to a traumatic event; the traumatic event is persistently reexperienced; persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness; [and] persistent symptoms of increased arousal" (DSM-IV-TR). The patient meets all of these qualifications. The traumatic event is the car crash in which the patient and his son took place. The patient also experiences persistent "recurring distressing thoughts and images of the accident," which meets the second qualification. He avoids driving down the same road the accident took place on, which meets the third qualification, and has also forgotten whether the light was red or green ("inability to recall an important aspect of the trauma" is cited by DSM-IV-TR as a symptom of this disorder). The anxiety, lastly, and the disruption of thought pattern by the vivid memories shows that the final qualification has been met, and that the patient suffers from "symptoms of increased arousal" (DSM-TV-IR).


Treatment for this patient should consist of a two-stage process, in which drugs and therapy would be administered. Serotonin reuptake inhibitors would be one such drug that could be given, however drugs can not be the permanent solution. "Structured stress debriefings," are also recommended by the AAFP for patients whose trauma was recent, such as the patient in the case study. Psychotherapy, and these debriefings, can help alleviate the stress incurred by the incident, and help prevent a more severe case of posttraumatic stress syndrome in later life.

http://www.behavenet.com/capsules/disorders/ptsd.htm
http://www.aafp.org/afp/20000901/1035.html

Hemingway's Psychological State

Ernest Hemingway, although one of the greatest American writers, was also a man in a shaky psychological state. Because of his participation in war, leading to possible post-traumatic stress syndrome, Hemingway went the route of alcoholism, and extreme risk taking sport to calm his nerves.

Alcohol in particular would lead later to more psychological problems as his brain functions were severely effected by the long-time use of alcohol as medication. These "defense mechanisms" (Martin) were clearly a result of his continual battle with depression. Hemingway would eventually be admitted to the Mayo Clinic where he would receive shock therapy. In a quotation from him there, he described that a true way to understanding the underlying psychology of a person is through creative writing. "They should make all psychiatrists take a course in creative writing so they'd know about writers," he claimed. From this statement it is obvious that his main source of coping with his disorder was to write, and his personality is found in his stories, which is what makes him the great author critics see him to be.

After receiving a second round of shock therapy, even after disclosing his distaste for it, Hemingway committed suicide. After a life of war, battles with stress and depression, the modes of curing just were not suitable for Hemingway. Hemingway exemplified a recurring group of people in history, masterful artists whose own mind is their downfall. Although paradoxical, it makes sense that the people with the greatest minds would also have the most dangerous.

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