PTSD – A Way Out.com A mindful way to heal

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FIGHT, FLIGHT—OR FREEZE

“What did it all mean? Unraveling the tangle of trauma, cortisol and PTSD has occupied me and many other researchers for the decades since. In the classic fight-or-flight response, identified in the 1920s, a threatening encounter triggers the release of stress hormones such as adrenaline and cortisol. The hormones prompt a cascade of changes, such as quickening the pulse and sharpening the senses to enable the threatened person or animal to focus on and react to the immediate danger. These acute effects were believed to dissipate once the danger receded.

In 1980, however, psychiatrists and other advocates for Vietnam War veterans won a prolonged struggle to get post-traumatic stress included in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). It was the first official recognition that trauma could have long-lasting effects. But the diagnosis was controversial. Many psychologists believed that its inclusion in the DSM-III had been politically, rather than scientifically, driven—in part because there were no scientific explanations for how a threat could continue to influence the body long after it was removed.

Complicating matters, studies of Vietnam veterans were generating perplexing results. In the mid-1980s neuroscientists John Mason, Earl Giller and Thomas Kosten of Yale University reported that veterans with PTSD had high levels of adrenaline but lower levels of cortisol than patients with other psychiatric diagnoses. Because stress usually causes stress hormones, including cortisol, to rise, many researchers, including myself, were skeptical of these observations. When I joined the Yale laboratory as a postdoctoral fellow a year later, I studied a different group of veterans using other methods for measuring cortisol. To my astonishment, I replicated the finding.

I still couldn’t believe that the low cortisol levels had anything to do with trauma. Surely the Holocaust was as terrible as the Vietnam War, I reasoned—and growing up as a rabbi’s daughter in a community full of Holocaust survivors, many of them my friends’ parents, I’d noticed nothing out of the ordinary about them. I was sure that they didn’t have either PTSD or low cortisol, I told my mentor, Giller. “That’s a testable hypothesis,” he responded. “Why don’t you study that, instead of conjecturing?”

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