(Part 1 is here if you need to catch up.)
Common Catalysts of Existential Crisis (cont’d)
Post-Traumatic Stress Disorder (PTSD)
Post-Traumatic Stress Disorder is characterized by a cluster of symptoms following exposure to death, threat of death, or sexual violence which include intrusive distressing memories of the traumatic event, related distressing dreams, flashbacks, and dissociative reactions (DSM-5, 2013). But it can also be the result of compound stressors that build up over time, or repeated exposure to traumatic events with little relief, as in the case of spousal abuse or child abuse. While the label of Post-Traumatic Stress Disorder was developed in 1980 in response to the Vietnam war veterans (it was called shell shock or combat fatigue prior), it was also the result of the feminist movement on behalf of rape and domestic violence survivors. Some people also develop PTSD from living through the trauma of natural disasters such as Hurricane Katrina.
Incidentally, about 25% of people exposed to severe trauma will also develop substance-related problems, and there are high rates of relapse among women with PTSD in substance abuse treatment upon release (Van Wormer & Davis, 2018).
With veterans, post-traumatic stress disorder is often the result of something going wrong in the post-war adjustment. Karl Schlotterbeck remarked that “our culture sends young people out to violate our basic moral values and then expects them to return home and adjust perfectly” (personal communication, April 17, 2012). There is insufficient reintegration into society, and often a lack of expressed spiritual values for them to fall back on. Young people returning from war have lost friends in sometimes gruesome ways, and it can be difficult to reconcile the act of war with religious beliefs or spiritual values. It can be difficult to find meaning in the death, destruction, and disregard for human life that is demonstrated in war. It should be noted here that meaning making can be destructive, and that negative meaning can be derived from traumatic experience as well. It is no wonder that so many soldiers return home with post-traumatic stress disorder, often as a direct result of traumatic bereavement. At least 1 in 6 veterans of the war in Iraq returned home with PTSD. Female soldiers, in addition to the trauma of war, sometimes seek help for rape trauma, having been attacked by fellow soldiers: 15%, according to Van Wormer & Davis (2018). Perhaps timely crisis intervention strategies and methods on the part of the armed services could prevent much post-war PTSD, as well as the utilization of integrated treatment specialists for co-occurring conditions such as PTSD and substance use disorder.
In any event, PTSD is a real outcome of war for many soldiers who have seen combat, people who have witnessed or experienced traumatic events like 9/11, or someone who has been repeatedly exposed to violence or abuse of any kind. Psychospiritual intervention may be very helpful in ameliorating symptoms in this population, with shamanic methods especially recommended for the dissociative reactions, detachment, intrusive dreams, and uncontrollable feelings common to PTSD.
Progressive therapists are starting to assert that depression is not a disease, but an indication that something is out of balance in one’s life. Depression may in fact be viewed as an existential crisis, a call to change one’s life circumstances. Depression is well-recognized as a condition that seems to be on the rise and can sometimes become chronic. In fact, James S. Gordon, MD observes that “depression is the defining disorder of our time” and “has become the most disabling of non-fatal conditions in the United States and around the world” (Gordon, 2008, p. 5). Indeed, “the prevalence of depression appears to have increased over the past three decades,” and Sarris, O’Neil, Coulson, Schweitzer, & Berk consider that certain factors of urban living are contributing to this rise, such as sedentary lifestyle, unhealthy diet, and chemical pollution, among other things (2014, p. 107).
While antidepressant medications, cognitive-behavioral therapy, and interpersonal therapy are at the forefront of the evidence-based methods of treatment, there is growing evidence that an integrated approach is far more effective and long-lasting, if not curative, for depression (2014). “The time has come for a more integrated approach for depression, and an acknowledgment of the potential applicability of lifestyle modification” (Sarris et al, 2014, p. 120).
There is some evidence that certain people are vulnerable to depression. If a child experiences insecure attachment, for instance, this may make them less resilient when risk factors (stressors) enter their lives. “Disruptions in early interactions with parents are indeed linked to a greater likelihood of experiencing depression” (Ingram, Atchley, & Segal, 2011, p. 103). That doesn’t mean it’s hopeless, however. Coping skills can be improved with training and effort, as well the development of a secure relationship later in life.
Depression can also be a complicating factor of post-traumatic stress disorder.
Current best practices for treatment of depression include antidepressant drugs, cognitive-behavioral therapy, and interpersonal therapy. Billions of dollars are spent for medically-prescribed antidepressants each year, which is understandable, as depression is a major cause for sick leave and work disability. And yet, it has been shown that medication isn’t the answer; more often, antidepressant drugs “seem to blunt emotions and to push people toward passivity” (Gordon, 2008, p. 20), rather than getting to the heart of the matter. It should be noted that in many studies, improvement was only partial, not complete, remission. Gordon goes on to say that the “actual benefits of antidepressant drugs are significantly less than is generally believed, and indeed, only slightly greater than placebo” (2008, p. 22). Evidence-based arguments have been made for a combination of antidepressants and cognitive-behavior therapy or interpersonal therapy; however, while cognitive-behavior therapy and interpersonal therapy have been positioned as first-line short-term treatments for depression, there is some criticism that these treatments are no more efficacious than any other therapeutic method (Parker & Fletcher, 2007, p. 352).
In fact, it is the therapeutic alliance (the relationship between therapist and client) that “is one of the most frequently cited non-specific therapeutic factors contributing to successful psychotherapy” (Parker & Fletcher, 2007, p. 355). It is the feeling of being more than oneself and having a significant connection outside of oneself that is most healing. A shamanic counselor can help the client recognize that s/he is part of a larger whole, and not as alone in the world as Western culture may have led him/her to believe.
(Next time: Making Meaning Through Spirituality)
(Excerpt from “A Transpersonal Approach to Existential Crisis: Shamanic Methods in Therapeutic Practice” (graduate paper)
© 2016 – Cindy L. McGinley. All rights reserved. )
American Psychiatric Association, (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association.
Gordon, J. S. (2008). Unstuck: your guide to the seven-stage journey out of depression. London, England: Penguin Books Ltd.
Ingram, R. E., Atchley, R. A., & Segal, Z. V. (2011). Vulnerability to depression: From cognitive neuroscience to prevention and treatment. New York, NY: The Guilford Press.
Parker, G. & Fletcher, K. (2007). Treating depression with the evidence-based psychotherapies: A critique of the evidence. ACTA Psychiatrica Scandinavica 2007;115:352-359. DOI: 10.1111/j.1600-0447.2007.01007.x
Sarris, J., O’Neil, A., Coulson, C. E., Schweitzer, I., & Berk, M. (2014). Lifestyle medicine for depression. MBC Psychiatry 2014, 14: 107. DOI: 10.1186/1471-244X-14-107
Van Wormer, K. & Davis, D. R. (2018). Addiction treatment: A strengths perspective (4th edition). Boston, MA: Cengage Learning.