of Research Come Together in a Book Explaining How Stress Affects
psychiatrist J. Douglas Bremner, M.D., has compiled more than ten years
of research, reflection, and observations as a clinical psychiatrist
in a book that explains how stress-induced changes in the brain may
account for some psychiatric disorders, including Post-traumatic Stress
Disorder (PTSD), dissociative disorders, borderline personality disorder,
adjustment disorder, depression, and anxiety.
The book "Does Stress
Damage the Brain? Understanding Trauma-Related Disorders from a Neurological
Perspective," outlines the theory that there is a biological basis
for trauma-related disorders which can be essential in diagnosing and
treating such disorders. This view of trauma spectrum disorders,
as Bremner calls them, is a departure from the widely held view in psychiatry
that psychiatric disorders are completely different from one another,
and have different causes.
The idea of trauma spectrum
disorders came out of research conducted by Bremner and colleagues
when he was a young psychiatry resident at West Haven, VA Hospital and
Yale University Hospital, During an experience in the wee hours of the
morning with a Vietnam War combat veteran who was trapped in the middle
of a post-traumatic "flashback," Dr. Bremner was struck by the seemingly
reflexive and uncontrollable nature of the symptoms, which were similar
to those of patients having seizures. Dr. Bremner wondered if the flashbacks
represented a neurological rather than a psychological condition, as
they were considered to be at that time.
"When patients are having
flashbacks, as my veteran was, they are unaware of what is going on
in the present," said Dr. Bremner. "Patients often describe flashbacks
as if a movie were playing in front of their eyes, complete with visual
images, sounds and smells." Dr. Bremner theorized that the flashbacks
could involve the same brain areas that are affected by seizures, most
importantly the hippocampus, which is affected in 80% of epilepsy cases.
Subsequent PET (positron emission tomography) studies with trauma victims
showed a significant and direct link between a reduction in the volume
of the hippocampus and PTSD.
Bremner emphasizes in his
book that all bodily functions are linked in one way or another to the
brain. In a stressful situation, the brain automatically sends signals
that release hormones, including cortisol and adrenaline. The heart
pumps faster; blood pressure goes up; and blood flow shifts to parts
of the body that need it the most such as the brain and muscles so we
can think fast and fight or run. If the brain overcharges for a prolonged
period of time in response to stressful stimuli, the body does not have
a chance to recuperate and the results can be deadly. "If stress has
effects on the brain and neurological function, then stress has effects
on all parts of the body including the heart, blood vessels, the immune
system, and the digestive system," says Bremner. "The long list of damaging
effects can include heart disease, memory impairment, depression, and
even increased susceptibility to stroke and cancer."
"Knowledge is power." Dr.
Bremner adds. "Our patients will benefit from a greater knowledge of
the potential effects of stress on mind, body and spirit. It is essential
that physicians talk to their patients and determine what is going on
in their lives before making a diagnosis."
Dr. Bremner's background
includes degrees in both psychiatry and neuroradiology, fueled by an
intense fascination with the link between trauma and its biological
effects. With the help of advanced PET technology, Bremner and his team
of Emory researchers continue to peer into the brains of individuals
with PTSD hoping to further determine the relationship between trauma
and functionality, so that future victims can be cured. At Emory, he
is director of the Center for Positron Emission Tomography and assistant
professor of psychiatry and behavioral sciences. He also serves as director
of mental health research at the Atlanta Veterans Administration Medical
"Understanding of the human
brain is more important now than ever " said Bremner. "One thing I can
say from my clinical experience is that people in our country will be
sorting out their response to the tragic events of September 11 for
many years to come. There are many patterns of response to that tragedy
that can be compared to other traumatic events from prior history. However,
in many respects this particular event was unprecedented. The constant
threat of terrorist activity is an anomaly."
Dr. Bremner's book is available
from W. W. Norton & Company, 1/800-433-2830.