A belated realization on the media coverage of the MDMA/PTSD paper

July 24, 2010

The following is a more casual description of a stream of thought I had about these posts I’ve been writing on the MDMA/PTSD paper.

ok, so there’s this paper that has finally come out. I’ve been bashing away at the project itself on the blog since, oh, forever. I finally had a chance to get around to blogging the paper. no biggie.
takehome message, MDMA is good for treating PTSD if given in the therapy session.
one of the features of such a study is that it is going to get media attention. I was ignoring that all week so that I could blog the paper unmolested.
Trolling around the media coverage I started on a slow burn.
Going through Google hits, there was a great deal of emphasis on PTSD caused by combat stress. Angles on the story which suggested we have a big ol’ problem looming (true dat) and won’t it be great to have some new hope (true dat) and then doing a less than complete cockup of the facts of the paper.
Problem is that it is a small study as it is, 12 MDMA-treated, 8 placebo controls, but only ONE had combat trauma as the index trauma. ONE. The rest were mostly sexual assault, crime (not further specified) and childhood trauma (sexual assault and physical neglect). Me, I was happily bashing away at the overselling of the single combat PTSD case in my draft.
On the way home it hit me.

Belatedly I will admit. the overfocus on the single warfighter meant, you betcha, not much talk about the fact that most of the patients were women who had suffered some sort of sexual and/or (presumably) other physical criminal attack.
So now I’m going to have to comb through the coverage with an eye to that as well. any bets as to relative ratio focusing on the respective index traumas as opposed to a simple, and sterile, mention of PTSD?

Right? So here’s a scientific paper which give the opportunity to talk about a disorder which is distressing and harmful and debilitating to many people. The media gets this because they are linking it, on extreeeeeeemly thin grounds, to combat PTSD. A saleable media topic, given that our national attention is on the two wars that we are prosecuting.
Why is our national attention not on sexual violence against women? And sexual abuse and other violence against children?
That, after all, was what this Mithoefer 2010 study was about. The index trauma of the subject population was predominantly in these areas. Scientifically, you have to be seriously skeptical about whether anything was demonstrated in this trial at all about combat PTSD. There was only the single patient, assigned to the active MDMA-assisted psychotherapy group, in this study. (The group continues to recruit for a combat-focused sample though)
So why the heck does the media not jump all over the underlying lasting PTSD trauma associated with the real sample? Because we just aren’t that concerned about women who have been raped? About adults who were assaulted as children and have lasting and debilitating scars?
Come ON, media, pull your head out.
(yeah, me too)

8 Responses to “A belated realization on the media coverage of the MDMA/PTSD paper”

  1. Preston Says:

    I’m a vet and not a scientist so I’m speaking from anecdotes.
    For vets, PTSD looks like a failure to get better. Hypervigilance is an adaptation to close quarters combat. It really sucks to come home and be hypervigilant but most of us get over it. Ditto the 0-60 emotional reactions to things. You see a lot of emergencies downrange and over responding is not nearly as dangerous as under responding. You eventually stop screaming at people after you’ve been back a couple of months.
    Thing with PTSD is that some don’t get better. I have heard there may be some biochemical/physiological reasons for this. That would imply that there might someday be a fix. That would be pretty cool.
    In the mean time, talk therapy plus some kind of concurrent antidepressant helps. It certainly takes time, but it helps. This is a good option to the active duty guys who get time off to go do this.
    Reservists and National Guardsmen really get a raw deal as there civilian employers tend to not be supportive AND the nearest care provider might be a prohibitive distance away.
    The thing with a vet’s PTSD is that it is generally from a long term exposure and not a single incident. I do not believe this compares well with typical sexual assault. I think it’s two different kinds of psychological trauma.


  2. kevin. Says:

    This isn’t fair, but when I hear the term “PTSD,” I instantly assume post-combat PTSD. I imagine that journalists are the same. The term just isn’t used in/by the media to refer to non-combat PTSD. It’s been appropriated for combat PTSD.
    It’s also convenient because journalists don’t have to explain to the reader what specific events precipitated the PTSD. If you did, individual readers would decide whether a diagnosis of PTSD is appropriate for “lesser” stressors.


  3. DataGoddess Says:

    Preston, most sexual abuse survivors with PTSD were abused over days, months, and sometimes years, mostly as children. Yes, there are some who get it from a single incident, but when you have to be hypervigilant in your own home, usually from a young age, over a period of time, and being unable to tell anyone, or not believed when do tell, or in some cases not treated as a ‘real’ victim because your abuser is your spouse, then yes, the PTSD is similar.
    I think you might need to visit a women’s shelter, or talk to a group of adult survivors of sexual abuse to understand that a vet’s experience isn’t that different from sexual-or-abuse based PTSD. The majority of cases are women, and a lot of women’s experiences are dismissed as being over emotional, so it’s even a struggle to get it recognized sometimes.
    DrugMonkey, thank you for realizing how invisible those of us with trauma from abuse are.


  4. DuWayne Says:

    Preston –
    PTSD is a lot more than a failure to get better, it is also a lot more than a physiological problem. It is a physiological problem that is caused by traumatic incidents. Even for a combat vet, the stressor may well be a singular event – often times it is. It isn’t so much prolonged exposure, as it is reaching a breaking point.
    While there may well be some similarities, it is entirely plausible that PTSD isn’t the least bit similar to what most vets experience – only they don’t get over it. That the symptoms are the same is essentially meaningless. Especially as they aren’t always. It isn’t uncommon for symptoms to remain relatively innocuous for years. Sure, the person may seem a little more stressed than most people, but a lot of people are stressed. It may not be until another stressor happens that the symptoms emerge.
    That is extremely common with people who were victims of systemic childhood physical (including, but not limited to sexual) abuse. It is not uncommon for people with combat related PTSD to have such a delayed reaction as well. Nor are the triggering stressors at all predictable. One case study I read indicated that the triggering stressor for a Vietnam vet, was seeing a dog get hit by a car. It probably bore some minor relation to the initial stressor that put him over the edge twenty years before and set him off. A common trigger for people who experienced childhood abuse, is seeing children disciplined or even being the one disciplining a child. But it is just as likely to be something far more random, something that the person has related to the traumatic event.


  5. becca Says:

    On the ‘optimistic’ side, maybe journalists were just worried over what kind of message a headline of “ecstasy may help traumatized rape victims” would send…?
    Also, the media has a short attention span. Combat PTSD was JUST in their minds, due to the military changing rules about what qualifies for veterns benefits (and that sounded like a hella good thing, from the NPR story I heard about it).


  6. Preston Says:

    @DuWayne and DataGoddess Thank you for your expertise.


  7. David Dobbs Says:

    You’re onto something here, DrugMonkey. As I argued in my Scientific American piece about PTSD (see http://is.gd/zzpt), our culture seems heavily invested in seeing combat trauma as irretrievably toxic. In addition, of course, the PTSD Dx came out of the Vietnam War. So it’s little wonder that when people hear “PTSD,” they think of combat veterans.
    All in all, a highly problemmatic diagnosis bearing immense cultural baggage and riddled with diagnostic and treatment problems.


  8. Caro Says:

    Thank you for realising. Means a lot 🙂 I don’t suffer myself, but I know people who do, and it’s awful to watch – and they’re all sexual assault victims. I just want them to get better, but when their condition is mostly unrecognised by the public as relevant to their experiences… I dunno. It’s not a “glamorous” condition to treat.


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