A young man walks away from a beating by Kenyan police, who are responsible for many of the 1,000 deaths in the post-election violence there. Photo: AFP

Wounds of the mind and heart can be as life threatening as a blow to the head or a stab wound but often go unseen or misdiagnosed. Post traumatic stress disorder (PTSD) occurs in people following the experience or witnessing of horrific events such as disaster casualties or motor vehicle accident deaths, military combat, sexual assault, street and domestic violence.

PTSD is a true mind-body disturbance that produces both psychological and physiological symptoms. Unlike an injured knee or the scar of a bullet wound, PTSD is not always visible. Indeed, patients and their friends, family and coworkers may not be aware that PTSD is present. PTSD is further complicated by the occurrence of related disorders such as depression, substance abuse and severe anxiety.

Over 1,000 years before Christ, a famous Black Greek poet named Homer wrote one of the world's greatest and most enduring epic poems: "The Iliad." Ilium was the Greek name for Troy and an epic is a long poem that tells the story of heroic deeds. "The Iliad" is the marvelous tale of the ancient city of Troy, its 10-year siege by the Greeks and its final capture, downfall and destruction by the legendary Trojan horse. Troy was located in present day Turkey. It was thought to be only a legendary city until archeologists began excavating its actual ruins in 1870.

As well as being one of the greatest masterpieces of poetic literature ever written, "The Iliad" tells of 51 days in the 10th year of the Trojan War and of the quarrel between Agamemnon, leader of the Greeks against Troy, and Achilles, the greatest of the Greek warriors, who killed the Trojan leader Hector.

Jonathan Shay, M.D. Ph.D., in his book, "Achilles in Vietnam," offers evidence from "The Iliad" that Achilles suffered the classic symptoms of post traumatic stress disorder, including "berserk" rage, severe grief and psychotic depression following the death in combat of his beloved cousin and King Agamemnon's "theft" of a beautiful woman bestowed upon him as a prize for his heroism in combat.

Achilles became so reckless and emotionally disturbed that long before he was killed by Paris, son of King Priam of Troy, by an arrow shot through his heel, Homer writes, "the women mourned for Achilles as if he were already dead."

Achilles in ‘the hood' - rescuing the child soldier

Post traumatic stress disorder is evident in neighborhoods like Bayview Hunters Point, the Fillmore and the Mission, where children exposed to violent images on television and in films, fighting and violence they hear or see in their community and interpersonal violence at home and at school has cultivated a generation of urban combat war veterans, many of whom are "child soldiers" in need of rescue and assistance just like the combat veterans of Vietnam, Afghanistan and Iraq.

According to the Veterans Administration website, www.myhealth.va.gov, "PTSD is an anxiety disorder that can develop after exposure to a terrifying or life threatening experience - sometimes weeks or months after the event. Symptoms include one or more of the following: flashback episodes, nightmares, inability to sleep, hypervigilance, irritability and reduced frustration tolerance, angry outbursts and feelings of loneliness."

According to the National Institute of Mental Health, about 30 percent of men and women who have spent time in war zones experience PTSD. PTSD is not limited to those who have served in war zones. About 4 percent of adults aged 18 to 54 have experienced PTSD during the course of a given year following exposure to a traumatic event.

Firefighters, police officers, paramedics, emergency workers and trauma surgeons face a heightened occupational risk of PTSD and may manifest symptoms of chronic PTSD, including mood disorders, drug and alcohol "self medication," explosive rage and sleep disorders that are often accepted as "normal" behavior within the culture of the profession.

Joann is a 22-year-old Air Force veteran who was sexually assaulted while in Luxemburg serving with the Air Force in Germany. "After being assaulted and raped, I spent the next 25 years fighting demons and nightmares with psychiatric medications and numerous hospitalizations. I was afraid of everything. I moved every year thinking the next year would be better - but it never worked because wherever I went, there I was."

After residential treatment at the Women's Trauma Recovery Program of the Menlo Park Veterans Administration Hospital, Joann said, "If you had known me before the treatment at the WTRP, you wouldn't think I was the same person. When my former doctor saw me, she said, ‘You look great. This is he first time I've seen you look connected.'"

The great Greek poet Homer was Black and blind.

PTSD evidences itself in survivors of intense military combat, including torture and terrorist attacks, as sympathetic nervous system hyper arousal. The "fight, flight, freeze" division of the autonomic nervous system is "automatically" turned on and amplified when the survivor is faced with situations perceived as a threat. Simple non-threatening interactions with other people on a bus, in a crowded theatre or elevator can trigger intense anxiety and paranoia in a PTSD sufferer with an out-of-control sympathetic nervous system.

Treatment for PTSD includes the use of beta-blockers, small doses of a medicine that blocks the hyperactive sympathetic nervous system. Beta blockers may also benefit PTSD sufferers with high blood pressure, severe tremors of the hands and voice, exaggerated startle responses, rapid heart rate and breathing and GI upset from the amplified response to perceived threats.

Cognitive therapy or "stop your stinkin thinkin!" has been proven to benefit PTSD sufferers, as does "talk therapy," group therapy, transcendental mediation, yoga and other mind-body relaxation methods. Antidepressant therapy and sedatives may improve sleep and break the cycle of mood disturbance present in people with severe PTSD that interferes with normal day-to-day functioning at work or in social interactions.

The Stanford PTSD sleep study is currently underway. It has yielded remarkable insight into the role sleep disturbances play in chronic PTSD as well as the benefits of sleep to the general population. Sleep has been shown to have a "beautifying" effect. People who are well rested are more physically attractive and sexually responsive and they exhibit a more stable and appealing temperament.

In "How to Get a Good Night's Sleep," Dr. Norman Ford, a "somnologist" or sleep expert, writes, "26 million Americans suffer from sleep disorders. Sleep deprivation negatively impacts overall health and daytime functioning." He offers a sleep "prescription" of 75 natural ways to improve sleep other than taking a sleeping pill. They include exercise, avoiding caffeine, heavy meals and alcohol late at night, and solving environmental problems that disrupt sleep - from a snoring husband to an uncomfortable mattress or demanding pet.

Children exposed to chronic violence in their homes suffer from short- and long-term consequences, including changes in behavior, development delays and increased risk of violent or antisocial behavior in adulthood. Behavioral changes include fear of separation from parents and clingy, dependent or aggressive behavior. Difficulty falling asleep, waking at night and nightmares are seen as well as being withdrawn, looking sad, crying, whimpering, temper tantrums, poor frustration tolerance and hyperactive behavior with poor concentration.

According to Coutney Valdez Lin, Ph.D., "Multiple traumatic events that occur within the care giving system, the social environment that is supposed to be the source of safety and stability in a child's life, produces complex trauma in children and adolescents - a traumatized child who has difficulty regulating emotional states."
San Francisco's SafeStart Initiative is a partnership of the UCSF Child Trauma Research Project, the City's Department of Children, Youth and Families, the Department of Human Services and the Department of Public Health Community Mental Health Services. Its staff is located in the Bayview Hunters Point Family Resource Center.

SafeStart services for families with children exposed to violence include counseling and care management, advocacy, support groups, parenting education, childcare, shelter and food. Funded by the U.S. Office of Juvenile Justice and Delinquency Prevention, SafeStart's 24-hour support line is (415) 565-SAVE.

Gang violence cannot be effectively addressed through punitive means such as gang injunctions. Recently, Public Defender Jeff Adachi came under media ridicule and scrutiny for proposing that individuals named by the City Attorney's gang injunctions be eligible to receive restorative health, social and reentry services.

"Living in a Nonviolent Community" is a program of the UCSF National Center of Excellence in Women's Health. In its study of children exposed to violence, adolescents were found to demonstrate a sense of foreshortened future, increased risk-taking, including daredevil behaviors, drugs and alcohol and unsafe sex, self injurious or suicidal behavior, delinquency and gang involvement and an increased risk of involvement in dating violence.

Misdiagnosed, undiagnosed, criminalized and maltreated, these "child soldiers" crowd prison cells and Juvenile Hall for a disorder that can be treated for less than $150 a month.

Post traumatic stress disorder is a growing mental and physical health problem that must be competently identified and appropriately intervened upon to protect children from a certain future of violent perpetration. To get support for a child and family, call LINC at (415) 206-4444 or Women Inc. at (415) 864-4722.

Contact Bay View Health and Environmental Science Editor Dr. Ahimsa Porter Sumchai at (415) 835-4763 or This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

Children exposed to violence: Quick reference

Common effects include

• Post-traumatic stress disorder - hypervigilance, exaggerated startle response, nightmares, flashbacks, avoidance of triggering stimuli

• Depression - sadness, irritability, withdrawal, hopelessness, excessive guilt, suicidal or homicidal thoughts

• Anxiety - clinging behavior, separation anxiety, phobias, psychomotor agitation, fear of death or loss or compromised safety

• Aggression - fights with peers and family members, destructive rages, intractable temper tantrums, defiance, non-compliance

• Pseudomaturity, parentification, over-compliance

• Feelings of low self-esteem and feelings of incompetence

• Difficulties regulating emotions and affect

• Difficulties with attention and concentration

• Learning difficulties and school problems, problems with cognitive processing

• Somatic complaints, including headaches, stomach aches

• Enuresis or encopresis

• Increased risk of being domestic violence perpetrators or victims as adults
  

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