Many people with PTSD refuse to admit that it can be a disability. But there is biological evidence indicating how it can be. Trauma affecting the brain that has experienced previous traumas undergo a change in brain structure. Namely, the hippocampus decreases in size. While researchers do not yet know why the hippocampus shrinks, there is evidence that its size is related to depression.1 Depression is a major symptom of PTSD. Studies have also shown that the size of the medial pre-frontal cortex and its response to emotional cognitive tasks is reduced as the severity of PTSD symptoms are greater.2 Conversely, activity in the amygdala, the part of the brain responsible for “fight or flight” is heightened when PTSD symptoms are greater. The function of the medial pre-frontal cortex is believed to have a role in decision-making and memory recall, and it “likely relies on the hippocampus to support rapid learning and memory consolidation.”3 The hippocampus is known to facilitate access to memory.
The changes to the brain are responsible for difficulties with verbal declarative memory, such as thinking of words, working memory, and executive decision-making. It might be partially responsible for dissociation and experiencing mental fogginess. There has not been enough research to ascertain the cause of many mental states.
The good news is that there is also evidence that the size of the hippocampus can increase with interventions “such as learning, environmental enrichment, exercise and chronic treatment with antidepressants.”4 Dr. Majid Fotuhi, a medical doctor and specialist in memory disorders, believes that ill-effects on the hippocampus can be reversed.5 He has been known to promote vigorous exercise as an intervention: exercise to the point of “huffing and puffing” as this supplies needed oxygen to the brain, which is essential for neurogenesis.
Personal observations of PTSD-related cognition and memory
While I don’t believe in chronic use of medication and especially not anti-depressants as an intervention to aid PTSD or any mental injury or disorder that is not psychotic in nature, I do believe that cognitive stimulation, exercise, and self-care can help improve changes in brain structure. Lately, I’ve been focused on learning.6
In early 2013, shortly after learning what PTSD meant for me, I was mentally disabled and could not work. I had become severely disabled after Hurricane Sandy came through Brooklyn, NY, and would sit in front of my computer screen at my job and stare into nothingness. My mind was disassociated and had trouble doing anything. Almost the entire floor at the office was laid off shortly after, and I missed an opportunity to apply for disability insurance.
It took several months and cognitive-behavioral therapy to return to work. The new job was my first full-time job in more than ten years, but it was the only thing I could do in a week. After work, I would return home completely mentally exhausted and was barely able to buy food at the grocery store. I was fortunate to have a friend bring me dinner. Otherwise, I might have had a daily diet of chips and pasta. The weekends enabled me to recuperate enough to return to the job. But the weekends were mostly mindless. Sometimes I rode my motorcycle, but I would not have the energy or cognitive ability to work on it if it had broken down. At the time, I rode a Kawasaki Ninja 500 with a poor clutch. I had changed the clutch plates before starting the job, but I still had problems losing second gear. The clutch basket needed to be replaced. Before I could get to it, I started working the new job. I sold the bike instead and bought a Triumph Street Triple.
I used to ride to the train station and take Caltrain to work. Time on the train was good for my brain as I could relax, read, do brain games, or do work if I were motivated enough. But when the office moved to a location harder to reach by public transit, I tried to ride my bike all the way, 30 miles on a crowded California freeway. This was exhausting. Though 30 miles isn’t that far for a motorcycle, for me with PTSD it was undoable. After work, sometimes I would be too exhausted to ride home. I sold the bike and got a car.
It took two years working full-time, a lot of weekend rest, some short-term medication for anxiety, and a lot of sensory identification of unconscious fears (aka TIPI) to be able to do more mental but fun activities on the weekends. Little by little I found my abilities improve: staying with a conversation, recalling vocabulary and memories, and making decisions. After three years at the job, I began to enjoy some of the activities I used to spend time on like environmental activism. (Yes, I enjoy explaining to people why using plastic bags is a bad idea.) At three and a half years, I began thinking about starting a new nonprofit and considering becoming a mental health professional. Then I was laid off and got a decent severance package.
Today, I am a full-time student of clinical mental health counseling in a graduate program at Antioch University New England and am building a nonprofit called Care Association with a project called Care For Us. After a few hours doing school work, my brain gets foggy, but the fog lifts with journaling. In the past, journaling didn’t help fogginess. I’m exercising more, making sure I get some huff and puff in the routine, and playing cognitive games. I spend as much time as I can on the nonprofit. One thing I’m still unmotivated to do is work on my motorcycles. Hopefully that will turn around and my brain will process enough dopamine whenever associating with them. It may take some cognitive-behavioral decision-making.
1 Khan, S. A., Ryali, V., Bhat, P. S., Prakash, J., Srivastava, K., & Khanam, S. (2015). The hippocampus and executive functions in depression. Industrial Psychiatry Journal, 24(1), 18-22. doi:10.4103/0972-6748.160920
2 Shin, L., Rauch, S., & Pitman, R. (2006). Amygdala, medial prefrontal cortex, and hippocampal function in PTSD. Annals of the New York Academy of Sciences, 1071(01), 67-79.
3 From the Abstract of Euston, D. R., Gruber, A. J., & McNaughton, B. L. (2012). The Role of Medial Prefrontal Cortex in Memory and Decision Making. Neuron, 76(6), 1057–1070. http://doi.org/10.1016/j.neuron.2012.12.002
4 From the Abstract of Sahay, A., Scobie, K., Hill, A., O’Carroll, C., Kheirbek, M., Burghardt, N., . . . Hen, R. (2011). Increasing adult hippocampal neurogenesis is sufficient to improve pattern separation. Nature, 472(7344), 466-470. doi:10.1038/nature09817
5 Fotuhi, M., Do, D., & Jack, C. (2013). Modifiable factors that alter the size of the hippocampus with ageing. Nature Reviews Neurology. Aug2013 Supplement, P29.
6 See Gould, E., Beylin, A., Tanapat, P., Reeves, A., & Shors, T.J. (1999). Learning enhances adult neurogenesis in the hippocampal formation. Nature Neuroscience, 2(3), 260-5.