Biopsychosocial Psychiatry

Ian Goddard igoddard at
Tue Aug 20 21:53:34 EST 2002

 The following reviews a new book by Douglas Bremner, an Emory
 University psychiatrist who argues that many major psychiatric
 conditions are the result of environmental stressors. Modern
 psychiatry views such conditions as arising from organic brain
 disorders independent of environmental psycho-social insults. 
 In accord with that view, psychiatric treatment has shifted 
 since the 60s from psychotherapy to drugs and electroshock. 

 Bremner's contrary view matches the argument I've made:

 that a biological basis of psychiatric conditions does not 
 rule out psychosocial insults as possible causal mechanisms.
 In short, perhaps you can be "driven crazy" by the environment
 and such would manifest as distinct neurological malfunctions.
 However, such malfunctions would merely be the symptoms, not 
 the cause. Therapeutic interventions that merely treat the 
 symptoms would not constitute adequate genuine treatment.

Emory University Health Sciences Center

Emory researcher claims stress-induced changes in brain can create
psychiatric disorders

Years of research come together in a book explaining how stress
affects the brain

ATLANTA -- Emory University 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

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 Center.

"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."

Media Contacts: Kathi Ovnic Baker, 404/727-9371, kobaker at
Janet Christenbury, 404/727-8599, jmchris at

  Out-of-Body Explanation:


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