All right, so you might have read “The Hobbit”
or “The Lord of the Rings,” you have probably
seen them, you’ve definitely heard of them.
But not everyone knows the story of their
author, J.R.R. Tolkien. Tolkien was an English
World War One veteran. A reluctant solider,
he joined up with a sense of duty and he lived
through the bloody battle of Somme suffering
tremendous shock, guilt, and loss during and
after the war.
It took Tolkien years to processes his experiences.
To help him do it he turned to writing fiction
and in time he constructed a world that helped
him and all of us better understand war, human
nature, loss, and growth. His novels were
the bi-product of trauma and they’re among
the more beautiful reminders of how it can
Most of us will experience some kind of traumatic
event in our lives and most of us will exhibit
some kind of stress related behavior because
of it, these symptoms usually fade but for
some those reactions can linger and start
of disrupt their lives or the lives of those
around them. These reactions can develop into
full blown psychological disorders including
post-traumatic stress disorder and, in an effort
to cope, sometimes addiction, but it doesn’t
always have to be that way.
Ultimately, Tolkien was able to harness the
effect of his trauma and shape them into something
important and to reclaim is own life because there
is such a thing as post-traumatic growth, too.
As it does with many other things psychology
approaches trauma related disorders with different
perspectives, but they all tend to ask the
How do you identify and diagnose these disorders?
And how do you treat them, so that the patients
can recover? — With the understanding that
they might never be the same as they were
before the trauma, but they can still be healthy
In a way, psychology helps patients ask themselves,
what Tolkien asks his readers, and what Frodo
asks when he is finally safe back in the shire:
“How do you pick up the threads of an old
life? How to go on, when in your heart, you
begin to understand that there is no going back.”
It could be September 11 or a serious car
accident or a natural disaster or a violent
crime that you survived but are still haunted
by. Trauma comes in many different forms and
sometimes it can stick with you.
When it manifests as nightmares, flashbacks,
avoidance, fear, guilt, anxiety, rage, insomnia,
and begins to interfere with your ability
to function it can come to be known as post-traumatic
stress disorder or PTSD.
It was once call “shell shock” a term used
to describe the condition of veterans, like
Tolkien in World War One but PTSD isn’t limited
to veterans. It’s defined as a psychological
disorder generated by either witnessing or
experiencing a traumatic event. Its symptoms
are classified into four major clusters in
the DSM V.
One of these clusters involves re-living the
event through intrusive memories, nightmares,
or flashbacks. The second involves avoiding
situations you associate with the event, while
the third generally describes excessive physiological
arousal like heart pounding, muscle tension,
anxiety or irritability, and major problems
sleeping or concentrating. And finally we
have the fourth major symptom cluster: pervasive
negative changes in emotions and belief, like
feelings in excessive guilt, fear, or shame — or no
longer getting enjoyment out of what you used to.
PTSD patients may also experience numbing,
or periods of feeling emotionless or emotionally
“flat” and dissociation, feeling as if situations
aren’t real or are surreal, feeling like time
has slowed down or sped up, or even blacking
We have been discussing how anxiety or mood
disorders can affect a person’s ability to
function and how that impairment itself leads
to more suffering and dysfunction.
When any of these disorders is left untreated
suffers may start to feel desperate to find
some way to cope and one way may be substance
abuse. Unfortunately, addiction and trauma
can go hand in hand and it can be hard to
recover from one without also dealing with
the other. According to the US department
of Veteran’s Affairs more than 2 in 10 veterans
with PTSD also struggle with substance abuse
problems and 1 in every 3 vets seeking
treatment for substance abuse also have PTSD.
And across many studies, between a third to
a half of women in treatment for substance
abuse have experienced rape or sexual assault.
For a long time most psychologists understood
PTSD through the lens of fear conditioning
or the unshakable memory of being in mortal
danger and the learned responses that stem
from that memory. But clinicians have also
begun to recognize that for some the disorder
can also be a kind of moral injury, widening
the focus to include hauntings not just of
violence done to a person but also what that
person did or did not do to others.
Brandon was a combat drone operator in the
air force he enlisted at 21 years old and
spent 6 years sitting in a bunker in the American
South-West watching Iraq and Afghanistan from
He watched soldiers die and people get executed.
He also watched kids play, people get married,
goats grazing — and when the time came he
ordered hell fire missiles to strike military
targets or people who had no idea they where
even being watched.
Although he was half a world away from combat,
he ultimately suffered the psychological trauma
felt by many on the ground soldiers. He was
diagnosed with PTSD. Brandon suffers no fears
for his own safety, but still experiences
the same intrusive memories, nightmares, depression,
anxiety, and substance abuse of many emotionally
traumatized combat soldiers. So do a lot of
other drone operators.
But why do some victims or trauma suffer from
PTSD while others seem able to move on?
Well, its psychology so the risk factors are
complicated. Some findings suggest that there
may be genetic predispositions making some
people more vulnerable than others. We also
know that context and environment matter,
for instance, someone who has experienced
childhood abuse might feel on the one hand
more ready to deal with difficult and traumatic
experiences. But on the other hand they might
be more likely to default to the suppression
and avoidance in which PTSD suffers frequently
engage, which as we’ve discussed in previous
episodes often makes psychiatric symptoms
worsen over time.
As far as whats going on in the brain, PTSD
shares some similarities with anxiety disorders.
For example the brains limbic system may flood
the body with waves of stress hormones like
cortisol every time images of the traumatic
event bubble up uninvited into consciousness.
And we’ve already talked a lot about how the
amygdala and hippocampus are involved in those
classic fight or flight reactions, which when
prolonged can be really rough on the body.
In fact, neuroimaging suggests that trauma
— or the chemical processes set into motion
by trauma — might actually damage and shrink
the hippocampus. Since this region is also
associated with how we consolidate memories,
this might explain how memories associated
with trauma could fail to be filed away as
long-term memories and instead remain vivid
and fresh through flashbacks and nightmares.
If there’s any silver lining to all of this,
it’s that some people may actually experience
positive change after a trauma. Treatment
and social support help some suffers achieve
post-traumatic growth, positive psychological
changes resulting from the struggle with challenging
circumstances and life crises.
That’s in part what Tolkien did. Though he
suffered great trauma and loss on the battlefield,
he was eventually able to use those experiences
to drive those powerful, allegorical stories. Stories
that helped not just himself, but many readers
of all ages around the world.
It seems that while whatever doesn’t kill
you might not necessarily make you stronger,
sometimes it really does.
But suffering can feed on itself. Many victims
of trauma try to cope through whats colloquially
called self-medicating and some can end up
with substance abuse or dependence issues.
Psychologists define addiction or dependence
as compulsive, excessive, and difficult-to-control
substance use, or other, initially pleasurable
behavior that beings to interfere with ordinary
life, work, health, or relationships.
This could mean over-consuming drugs or alcohol,
or compulsively gambling, eating, shopping,
exercising, or having sex. People with addictions
may not even realize that they have lost control
of their behavior for some time.
Addiction can refer to a physical dependence,
a physiological need for a drug, that reveals
itself through terrible withdrawal symptoms
if the use stops or reduces. Or psychological
dependence, the need to use that drug, or
complete that activity in order to relieve
People with addiction can sometimes be stigmatized
as pleasure-bound hedonists who have no self-control,
but people often compulsively use substances
or do things in reaction to stress and other
psychological problems. For various reasons
they have been prevented from coping in other
ways or maybe they just never learned how.
So in this way addiction itself is often secondary
to the more complicated matter of how a person
deals with stress and difficult emotions, or what
kinds of stressful situations they’ve survived.
Few will dispute that much of what makes addiction
possible is chemistry, but people are different
— from their life experiences to their biological
sensitivities. So people respond in different
way to different drugs and behaviors. Many
people can drink casually or gamble once in
a while without losing control. Others simply
People in recovery from addiction may also
have different needs. Some will need to be
completely sober and never again touch that
drug or do that thing. While others may in
time be able to regain enough control to use
again in moderation.
Likewise, some folks can kick the habit on
their own while others do better with or need
support from professionals or support groups.
Researchers and groups like Alcoholics Anonymous
debate whether addiction is a mental illness
— like a “software problem” related to thoughts, and
behaviors, and feelings — or a physical disease
— a “hard wire problem” related to biology
and genetics — or both, and even whether
addiction and dependence are the same thing.
Either way it can be hard to recover from
an addiction if you don’t get the underlying
problem treated. But some people believe that
you can’t treat the underlying problem without
first getting the addiction out of the way.
While this controversy too continues, many
are moving toward a model of treating both
at at the same time. The so-called Dual Diagnosis
Model of treatment.
Addiction that’s rooted in deeper psychological
issues — especially in emotional trauma like
PTSD — often require some version of dual
treatment to untangle both issues.
The good news is while PTSD and substance
dependence may be distressing and complex,
people can begin to heal given the chance
and the resources.
We’re amazingly resilient creatures. When nurtured with
the proper support and practice, we can overcome a lot.
Today we talked about the causes and symptoms
of PTSD and how trauma can affect the brain.
We also looked at addiction, physical and
psychological dependence, the relationship
between trauma and addiction, and why they
can require dual treatment, and we touched on
post-traumatic growth with the wisdom of Frodo
Thanks for watching, especially to all our
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This episode was written by Kathleen Yale,
edited by Blake de Pastino and our consultant
is Dr. Ranjit Bhagwat. Our director and editor
is Nicolas Jenkins. The script supervisor
and sound designer is Michael Aranda, and
the graphics team is Thought Cafe.