by Cindy Hasz
American Reporter Correspondent
San Diego, Calif.
April 14, 2002
A TRAVEL LOG FROM THE AMYGDALA
SAN DIEGO -- The Man in Black tells Princess Buttercup in Rob Reiner's wonderful film Princess Bride, "Life is pain highness, and anyone who tells you different is selling something."
That's a sell I could never make having made my introduction to the pain of Post Traumatic Stress Disorder (PTSD) early. I was just 17, and traveling in Mexico and Central America when I was first ambushed by life.
During those three months I experienced not only intense psychological battering but life-threatening physical trauma as well. By the time I crossed the border back into the States and found my very tentative way home again, I was a much different girl than the one everyone remembered. I spent the next decade battling overwhelming phobias and hijacked neural circuitry.
Not only travelers with adventure trauma and Vietnam vets are victims of PTSD; I am convinced that many of the elderly suffer from it as well.
Let's get real ... life is a battle and a long life is a very long battle. The elderly do more than know it, they embody it in every tired cell of their bodies, and yet so many of us "younger folks" (defined for purposes of this discussion as anyone under 70 years of age) don't want to hear the truth as it is experienced by them.
Oh, we will write books about "The Greatest Generation," yet they sit languishing in every nursing home in America with no one to listen to their stories or soothe their continuing pain.
"Any day above ground is a good day." So say some, but thousands if not millions of the aged would beg to differ. For them life is unbearably difficult. One such patient of mine starts or ends most every conversation with, "Am I going to make it?" And that's on a good day. On the bad ones she'll ask, "What is the point of going on?"
Sounds like simple depression? It's estimated by the American Association of Geriatric Psychiatry that 8 to 24 percent of older adults in the community suffer debilitating depression, and the number rises sharply to 37percent for those in primary care settings. Of those, only 11 percent receive adequate anti-depressant therapy while 34 percent received inadequate treatment and an astounding 55 percent received no treatment at all.
The symptoms of PTSD can look like depression but are more than that: emotional numbness, sleep disturbance, anxiety, depression, irritability/anger and not uncommonly, intense guilt.
Researching PTSD in the National Institute for Mental Health's literature, I was not surprised that there aren't any statistics on seniors. The age groups sampled are only between 18 and 54. As usual, the elder population gets ignored, which makes the situation all the more dangerous. It is noteworthy that the suicide rate for persons over age 85 is twice the national average.
As the hippocampus is involved in diseases involving memory deficits, a small, almond shaped part of the brain called the amygdala is involved in post-traumatic stress. The reaction of the brain and neural circuitry to prolonged or severe stress is not mere melancholy.
We only barely allow our artists and other productive members of society to be melancholic. We simply do not tolerate it in the elderly, let alone understand something even more complex. We want our elders to be "happy," and "positive," and daily heap coals on their heads about cups being "half full" iand other pithy and perky but thoroughly inane observations on life. Life is hard enough and then, there's the unrelenting optimism of those who "care."
Oh, for someone to just shut up and understand! Understand what it is like to survive decades of generic life-traumas and multiple losses. By the time one gets into their 70's and 80's they've got very tattered hearts and souls along with deteriorating bodies.
The last thing they need is some cavalier young thing still wet behind the ears patronizing them, telling them that it's all in their heads; that their sense of being overwhelmed is maladaptive, their fears infantile and their depression merely self-pity.
Most of the time, psychotherapy alone will not be adequate treatment for the elderly. For either depression or PTSD. They will need concurrent pharmacological therapy with anti-depressants. Many times for the rest of their lives.The selective seritonnin re-uptake inhibitors -- SSRI's -- have a powerful ability to mitigate panic disorders, obsessive-compulsive disorders and PTSD.
For one of my patients in particular, they've made the difference between being curled up in a fetal position and being out gardening and enjoying drives with her grandchildren.
So, here it is, 30 years post my own version of traumatic stress, and when I deal with my elderly patients who are afraid of everything, boxing their own shadows and daily fighting off the Mongol hordes of despair, I understand the pedigree of their fears. I know these are formidable feelings which must be acknowledged and validated if they will ever be able to garner strength enough to go on.
Health care professionals and family members alike need to realize that when we are with our elders, those who've brought us into the world and fought not only their battles bravely but many of our own as well, we are standing on holy ground.
Regardless of their imperfections and what the young and more resourced may consider maladaptive behaviors, they are nonetheless war heroes in their own right, deserving of all our respect and our best efforts to bring solace and comfort in their waning and most difficult years.
Cindy Hasz is a nurse and writer living in San Diego. She can be reached at email@example.com.