Despite the devastating loss of life due to the pandemic, more than 6 million people world wide, as well as the chronic medical problems patients continue to suffer with after recovery from an acute infection, it is an agreed upon among researchers, educators, and the medical community that the number one health issue we will be dealing with after the end of masking and social distancing is post traumatic stress disorder. It is important for patients, their caregivers/family members, and their treating physicians to understand the difference between generalized anxiety and post traumatic stress disorder (PTSD) so as to best support and treat patients struggling with it.
PTSD is much more than simply feeling frightened. And it is not simply something you see in soldiers or disaster survivors. The first diagnostic criterion for PTSD is “Exposure to actual or threatened death, serious injury, or sexual violence in one or more of the following ways
- Directly experiencing the traumatic event
- Witnessing, in person the events as they happened to others
- Learning that the traumatic event occurred to a close family member or friend
- Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) ie.first responders, medical personnel
After this exposure, patients with PTSD experience intrusion symptoms associated with the event in the form of nightmares, flashbacks, intrusive memories or even dissociative reactions leading patients to believe they are back in the midst of the trauma. These intrusion symptoms are accompanied by intense and/or prolonged psychological and physiologic signs of distress that appear to others as overly intense and last an unexpectedly long amount of time. People with PTSD make extreme efforts to avoid these memories, and external reminders of their trauma–like people, places and things. They may be unable to remember many of the details of what happened, or find themselves blaming themselves, feeling guilty, or blaming others unfairly. They might have a negative world view, believing that they are surrounded by threats and will never know happiness or success. They often feel detached from others around them, and can be irritable or have angry outbursts. They might be hypervigilant, always scanning for the next threat, and have an exaggerated response when startled. They might experience sleep disturbance or difficulties with concentration.
People withPTSD describe how, once they are triggered, the symptoms are so overwhelming that they feel unable to reason beyond them–they feel smothered and choked by the intensity of what they are feeling emotionally and physically. And those around them often feel frustrated, wondering if the patients are “enjoying the drama” and purposefully acting out.
Cannabis is extremely effective in helping patients deal with PTSD symptoms. Obviously, its ability to lessen anxiety and other physical signs of tension like nausea, muscle spasms, and trembling is very useful. But there is another quality of cannabis that makes it uniquely helpful for PTSD patients. Cannabis has what we refer to in medicine as “dissociative qualities”. What that means is, instead of feeling smothered and choked by the PTSD symptoms, patients using cannabis to deal with them are able to “separate themselves” a bit from them. The symptoms don’t disappear, but the patient is able to experience a bit of distance from them. I compare it to peeling an octopus off of your face and placing it on the table beside you. You are then able to look at it from a different perspective, wonder about what you are seeing and if there are more layers to what you perceive, and engage your mind in thinking through what you are experiencing with non-judgmental curiosity. You might determine that your reaction is more related to past events than what is currently happening. You might come to believe that the things you thought to be true are not really accurate, but instead distorted in some way. You also may have the “space” to incorporate some of the coping mechanisms and skills you have developed to process and deal with stress or fear. You can engage your intellect to control your feelings and physical sensations. This is an important tool for patients, dramatically diminishing the degree to which getting triggered with PTSD symptoms might impact and impair your functioning in daily life.
Inhaled cannabis, through smoking or vaping, is the fastest way to get the effects. After taking a puff, one must wait only 90 seconds to 2 minutes to feel an effect, and therefore determine if you need another puff, or if you are okay. Compare that to taking a pill like Xanax where you must wait 45 minutes to an hour before you know if the dose was correct and/or the medication effective. Besides this, a medication like Xanax serves to end the attack by “knocking you out” or sedating you, and does nothing to help you learn improved coping mechanisms or change your distorted thoughts. Tinctures and oils taken sublingually (under the tongue) take a bit longer (10-15 minutes) to kick in, but are still much faster than medications. Edibles, which take quite a long time to kick in are of less help in dealing with the acute onset of symptoms, but can help hold the symptoms at bay for hours at a time once they kick in.
Optimal treatment for PTSD involves supportive or insight oriented psychotherapy as well as cannabis, but I certainly believe that cannabis is a much better place to begin treatment than the pharmaceutical alternatives available today.