For the whole story, see the story “Justice department memos”.

Next, two stories on anxiety levels in Britain in the context of economic strife and unemployment.  At first I thought it sucked to live in Britain, then I realized it was just as bad here.

The first is CBC News: “Anxiety, fear on the rise in Britain.”

The second is from the Telegraph: “Britons ‘living in fear.’”

Now for some helpful news for those job seekers.

From China comes this advice on how to manage anxiety about going on job interviews: “Teach you how to deal with the English interview.”

Now from Everett, Washington, “How to deal with anxiety and ace the interview.”

Finally, remember when teachers wouldn’t let you chew gum in class?  They were wrong not to let us.  It appears that chewing gum improves academic performance and lowers anxiety.  See:  Math + Chewing Gum = Better Grades.

That may be true, but someone experiencing intense anxiety or a panic attack feels under great pressure to do something, anything to relieve the anxiety and improve their situation.

Nevertheless, actions born from anxiety often have poor or unintended outcomes.

Those negative outcomes reinforce one’s feeling of being out of control, or of being inept, flawed. There is no sense of having a certain mastery or competence in the situation. In turn, those thoughts and emotions fuel further anxiety. There is now "objective" proof that the situation is overwhelming and threatening. The anxiety and panic is now grounded in hard evidence. This is the same situation I wrote about in "Anxiety, Self-Esteem and Self-Soothing."

Some recent studies shed a bit more light on this self-fulfilling prophecy.

The Rockefeller University posted "Stress disrupts human thinking, but the brain can bounce back" on January 27, 2009. In sum, they found that:

• "A new neuroimaging study on stressed-out students suggests that male humans…don’t do their most agile thinking under stress."
• "[stressed persons] had a harder time shifting their attention from one task to another than other healthy young men who were not under the gun."
• In research on rats, the workers found further biological basis for poor performance under stress:
  "repeated stress on rats shriveled nerve cells of the medial prefrontal cortex, and that a shrunken prefrontal cortex is linked to slower performance on attention-shifting tasks."
• However, there is good news as well. Within a month after the stress ends, the brain bounces back to its normal state and attention and performance returns to a person’s baseline level.

These findings are generally verified in another recent study: "Driving Under the Influence (of Stress): Regional Effects of 9/11 Attacks on Driving." "The authors found that there was an increase in the rate of traffic fatalities in the three months following the 9/11 attacks, but only in the Northeast, the region closest to the terrorist attack…" Further, there was "a 100 percentage point increase in the rate of drug- and alcohol-related fatal traffic accidents in the Northeast."

The authors theorize that "being close to the location of a traumatic event, such as the 9/11 attacks, may increase psychological stress, which may, in turn, impair one’s driving ability and thus lead to an increase in fatal traffic accidents."

Being under stress, whether from an upcoming test or a nearby terrorist attack, impairs a person’s ability to think, plan, perform. The consequences of choosing a course of action under stress and anxiety (for example, is it a good idea to drink alcohol if I know that I will have to drive later), can be severe. Doing poorly on a test or getting into a car crash can provide the illusory conclusions that I am not smart or I am a really bad person. With those beliefs, one is even more likely to become unduly anxious and underperform in the future.

But again notice the silver lining in the second study-traffic fatalities declined again three months after the stress of the 9/11 attack.

However, the effects of long-term stress or life-threatening events may not be so quickly reversed.

A study from the University of Wisconsin, published in the January 26, 2009 Proceedings of the National Academy of Sciences, looked at the immune systems of children who had lived in orphanages in Romania, Russia or China and were later adopted by American families. They found that, even after ten years of life in "stable, affluent, loving environments…their immune systems are compromised as well. In fact, they look just like the [more recently] physically abused kids."

"’Even though these children’s environments have changed, physiologically they’re still responding to stress. That can affect their learning and their behavior, and having a compromised immune system is going to affect these children’s health,’ says senior author Seth Pollak, a professor of psychology and pediatrics at UW-Madison."

Imagine, if you will, how easy then it would be for those children to form negative opinions about themselves and their abilities. They are ill more frequently than the children around them, have more difficulty making correct judgements. Their behaviors are not as well controlled as their peers’. They have more difficulty learning and in school. All this despite the apparent advantage of now living in "stable, affluent, loving environments." Who else to blame but themselves?

Let’s look at the sheerly biological side of this matter. In 2006, the Department of Neuroscience, Mount Sinai School of Medicine studied rats exposed to 21 days of restraint stress. [Readers interested in the effects of restraint stress on animals, in simpler language, are recommended to read Restraint and Handling of Wild and Domestic Animals By Murray E. Fowler] Mount Sinai’s study found significant impairment of the medial prefrontal cortex. "[N]early one-third of all axospinous synapses on apical dendrites of pyramidal neurons in medial PFC are lost following repeated stress…Dendritic atrophy and spine loss may be important cellular features of stress-related psychiatric disorders where the PFC is functionally impaired."

That’s a dense packet of jargon. Let’s break down those last two sentences a bit.

Click here for a look at the medial prefrontal cortex.

Now, why is the medial pre-frontal cortex important?

Here’s what Wikipedia says about that area of the brain:

"The most typical psychological term for functions carried out by the pre-frontal cortex area is executive function. Executive function relates to abilities to differentiate among conflicting thoughts, determine good and bad, better and best, same and different, future consequences of current activities, working toward a defined goal, prediction of outcomes, expectation based on actions, and social ‘control’ (the ability to suppress urges that, if not suppressed, could lead to socially-unacceptable outcomes)."

So the pre-frontal cortex assists in judgement, planning, decision-making (e.g., should I drink if I am going to have to drive home).

The dendrites bring information into the cells of the medial pre-frontal cortex. A loss of "nearly one-third" of these information carriers would have significant and negative impact on the ability to make judgements, plans, etc.

This same area of the brain has been implicated in Post-Traumatic Stress Disorder. In "Amygdala, Medial Prefrontal Cortex, and Hippocampal Function in PTSD", the authors find that the "medial prefrontal cortex appears to be volumetrically smaller and is hyporesponsive during [PTSD] symptomatic states and the performance of emotional cognitive tasks in PTSD. Medial prefrontal cortex responsivity is inversely associated with PTSD symptom severity."

So, in both PTSD and situations of significant, chronic stress, there is long-term impairment of the medial prefrontal cortex. In turn, the afflicted person’s executive functioning (judgement, planning, decision-making, etc.) is worsened for lengthy periods of time.

It appears that shorter periods of lower grade stresses (e.g., an upcoming important test) produce briefer periods of poor executive functioning and less extensive impairment of the medial prefrontal cortex.

These studies can be used to make another point. We have seen that a stressed person has impaired executive functioning that stems at least in part from damage to the medial prefrontal cortex. Consequently, a stressed person will be cognitively, emotionally and behaviorally functioning at a lower level than their best capabilities. Therefore, these persons should be especially cautious before making and carrying out plans (even one as simple as whether or not to drive to a keg party). Equally important, their choices and behaviors have to be viewed in the context of being stressed and having a damaged prefrontal cortex.

With this knowledge in hand, a stressed, anxious or panic-stricken person can revise their opinions of themselves in a more objective fashion.

We would not judge how good a runner one was if the judgement was based on a 100 yard dash done when the person had the flu. All that can tell us is how they perform when significantly ill and impaired.

Forming your self-image and self-esteem on the evidence of beliefs, judgements and actions while stressed or suffering its after-effects is equally absurd.

Unfortunately, many people with anxiety, panic and other psychiatric disorders do exactly that. The net result is to generate further stress because of the internal self-criticisms and anxiety about their ability to function in the world. That, in turn, yields more impairment of the prefrontal cortex and consequently worsening executive functioning. A person’s self-image and self-esteem will then be in a graveyard spiral.

I will return to these studies and their implications in a later post about anxiety and self-image. For now I will leave you to ponder Socrates’ claim that "No one knowingly errs." Especially as it might apply to persons who are anxious, panicky, stressed and make invalid assumptions, poor judgements and mistakes in their actions.

The Army Times yesterday posted an article about the Pentagon’s decision to withhold the Purple Heart from soldiers who are inflicted with Post-Traumatic Stress Disorder.

The article notes that about 20% of the soldiers in Iraq meet the criteria for PTSD.  The article cites Department of Veterans Affairs findings that nearly 76,000 soldiers were given a provisional diagnosis of Post-Traumatic Stress Disorder between 2003 and 2007.  Obviously, this is a prevalent problem for our soldiers.

The article repeats the Pentagon’s reasons for disqualifying PTSD as an injury meriting the Purple Heart.

To further explain the Pentagon’s decision, the article quotes Charles Figley, professor of disaster mental health at Tulane University.  Figley is quoted as saying “There’s no blood test…no neurological map that clearly identifies” PTSD.

That’s true enough. But Figley goes on to say that PTSD is:

“an anxiety disorder, and all anxiety disorders are extraordinarily subjective. They’re difficult to treat through medication for precisely that reason.” However, “ongoing research could someday lead to a blood test…for the disorder…Figley said.”

Now I must admit that I am lost in this tangled trail of thought.  Let’s pull out the highlights of this argument.

“There’s no blood test…”
“All anxiety disorders are extraordinarily subjective…”
Anxiety disorders are “difficult to treat” because they are “extraordinarily subjective.”
Some day there may be a blood test to diagnose PTSD and anxiety disorder.
And a Pentagon spokesperson added “predictable and quantifiable physiologic injuries associated with specific psychological injuries is less robust now than it may be in the future”

I take this to mean that PTSD is difficult to diagnose by standardized tests like a blood screening or a CAT scan or an MRI.

That point is granted. Like the disorders Major Depression, Schizophrenia, Bipolar and many more, diagnosis is made largely by evaluation of a patient’s reports of their symptoms and levels of functioning. There are no lab tests to confirm the diagnosis of these conditions.

But here comes the point where I become confused. “Anxiety disorders are extraordinarily subjective” which makes them “difficult to treat.”  But someday there may be blood tests to verify the diagnosis.  And at some point in the future we may be able to specify the physical injury behind the disorder.

Only three interpretations of these statements come to me.

I am going to assume this first possible interpretation is not what they meant. They could be saying that since there is no external lab test to confirm the diagnosis, then there is no way to tell if the soldier is lying about his/her injury.  The Purple Heart could then be mistakenly awarded to persons malingering and conjuring up the illness.  So, 20% of the returning soldiers from the current wars could be faking the illness and not deserving of the Purple Heart.

I also assume that this second possible interpretation is false.  They could be saying that since there is no objective lab test for PTSD, then it may not be a real “illness” at all.  That would also imply that nearly all psychiatric disorders are not true illnesses or disorders.

The last intepretation that I can come up with is that unless there is proof of physical injury (in this case damage to the organ of the brain), then the assumption is that there is no injury.

So, for a soldier suffering from PTSD, there would have to be physical, independently verifiable proof of physical injury.

Allow me to make an aside for a moment.  One of the most intelligent persons I have ever met is a neurologist.  Several years ago, he allowed me to follow him around on his morning hospital rounds for a year or so as a volunteer.  I was and remain fascinated by the brain and neurology and he was kind enough to share his time and knowledge.  One day I asked him a fairly detailed question about the neurological pathways and neurotransmitters involved in a particular task and the set of related emotions.  His candid answer to me was: “Mike, we are going to have to wait for Martians to land and have them explain the brain to us in that kind of detail.  So far, we humans haven’t been smart enough.”

Back to the point at hand: objective physical trauma to verify the diagnosis of PTSD.  PTSD is not traumatic brain injury, it is not a closed head injury, it is not a lesion in the frontal or any other lobe.  It is not something that you can identify in a brain scan, picture or even by autopsy. Post-traumatic stress disorder is a psychiatric disorder whose specific mechanisms are unknown to us at this time. Never mind figuring out a way to distinguish those mechanisms in a fashion that would be suitable for a blood test. Like it or not, there is no way to send off a blood sample or a biopsy specimen and confirm the diagnosis.

That certainly does not imply that the psychiatric disorders are not true illnesses.  It does say that we simply do not have a complete understanding of the brain at this point in time.

May I suggest that if Professor Charles Figley and the Pentagon are, in earnest, waiting for the “neurological map that clearly identifies (PTSD)”, then perhaps they are waiting for the martians to land as well.

In the meantime, it seems cruel to me to deny the Purple Heart to soldiers who are suffering from PTSD as a result of their service to their country.

Why deprive them of such recognition simply because our science has not advanced sufficiently to provide absolute diagnostic confirmation?

PSYOPS (psychological operations), according to Wikipedia, have “been used by military institutions throughout history.”

I am not declaring that PsyOps either does or does not calculate the quantity or quality of injuries and death inflicted on the enemy to maximize post-traumatic stress disorder casualties. I have no way of knowing if that is covered by their mission. Although there must have been some reason that the initial assault in the current war with Iraq was called Shock and Awe. Wikipedia’s entry for Shock and Awe reads, in part, as follows: “the use of overwhelming power, dominant battlefield awareness, dominant maneuvers, and spectacular displays of force to paralyze an adversary’s perception of the battlefield and destroy its will to fight (emphasis mine).”

Here is a link to psywarrior.com’s links to sites devoted to psychological operations and warfare. I present that as a reminder that psychological operations and the resultant damage inflicted on soldiers and civilians is a well-known and long-standing art of warfare (if such practices can be called an art).

What has this to do with anxiety? Let’s recall that post-traumatic stress disorder falls under the anxiety disorder classification.

In that vein, the Pentagon has determined that soldiers returning from battle with post-traumatic stress disorder do not qualify for Purple Hearts. Their reasoning, as reported by the Army Times, is that PTSD does not meet the criteria of a Purple Heart:

“The Purple Heart recognizes those individuals wounded to a degree that requires treatment by a medical officer, in action with the enemy or as the result of enemy action where the intended effect of a specific enemy action is to kill or injure the service member.”

If one side launches a fiercely violent and brutal assault, at least part of the casualities will be soldiers who have witnessed their fellow service personnel and friends die, get injured or maimed in ways that are highly likely to traumatize the witnesses. Any armed force, whether aggressor or victim, who failed to take that into their calculations would be foolish indeed.

In its wisdom the Pentagon, again according to the Army Times, goes further to say that “PTSD is an anxiety disorder caused by witnessing or experiencing a traumatic event.” It is not “a wound intentionally caused by the enemy from an outside force or agent…”

What possible line of reasoning could they be using? It would seem that they are ignoring their own PsyOps division.

So much for logic, reason and parity between “physical” and “mental” injury and illness.

And shame on the Pentagon.