Ptsd and Intelligence

Author Note
Laurel K. Fauster, Department of Psychology, Sam Houston State University. Thesis Chair Dr. Jerry Bruce, Department of Psychology, Sam Houston State University. Correspondence concerning this paper should be addressed to Laurel K. Fauster, Department of Psychology, Sam Houston State University, Huntsville, Texas 77341-2447.

Abstract
This study sought to find an effect between intelligence level and post-traumatic stress disorder. A literature review was conducted to ascertain what researchers have discovered regarding the effect of intelligence level on post-traumatic stress disorder, as well as to provide a general overview on post-traumatic stress disorder, intelligence, and the possible link between these two variables. Face to face observation of post-traumatic stress disorder support groups, as well as informal interviews were also included to further support this study’s content. This study has implications for researchers in the areas of intelligence and post-traumatic stress disorder, clinicians, therapists, military operations, palliative care, research in victimology and abuse, as well as social science and other research interests.

Keywords: Post-traumatic stress disorder, Intelligence, PTSD, IQ, Risk factors.

Precis
This paper began years ago when, as a police officer, and later as an instructor in the private sector working with military special forces units, I came into contact with sufferers of Post Traumatic Stress Disorder, and began to wonder how best to help them. During independent study of the subject I sought to understand the signs and symptoms, as well as the risk factors for Post Traumatic Stress Disorder (PTSD). Being that police officers are frequent sufferers of this disorder, and that many more are also former military veterans, it was noticeable that those with higher intelligence levels did not avoid the disorder, but rather presented in a far different manner than their counterparts having more average or lower intelligence. Those with greater intellect may not have realized that they, in fact, did have Post Traumatic Stress Disorder, and this would most certainly have precluded a professional diagnosis and therefore beneficial treatment. However, late at night when the world is still and sleeping, the quiet conversations between trusted comrades revealed that these men and women suffer in silence, and that their personal hell is as real as any other sufferer, but that their wit and intellect prevent an accurate outside view to the internal cacophony that is Post Traumatic Stress Disorder.

This paper seeks through literature review to better understand Post Traumatic Stress Disorder, intelligence, and the link between the two. First I will consider Post Traumatic Stress Disorder, then intelligence. Next the science as to the correlation between the two will be studied. Then I shall recount personal observations related to Post Traumatic Stress Disorder and intelligence. Finally I will argue that lower intelligence is perhaps not so much a risk factor but rather an indicator of the presentation of the disorder, and that how intelligence is measured in sufferers if of interest. To this end I hope to provide a brief overview of the subject and lay the foundation for further academic study.

“…those who traffic in violence, regardless of the justice of their cause, risk their hearts and minds as much as their lives. And those who retain their integrity throughout the ordeal deserve our respect, for it is on our behalf that they fight.”

~Edward Conlon~

Post Traumatic Stress Disorder and Intelligence
Post Traumatic Stress Disorder
It is well known that trauma affects humans mentally and emotionally. The first credited, documented scientific formulation of the psychological effects of trauma occurred in 1678 by Johannes Hofer. Hofer was a medical student who used the term “Nostalgia” from the Latin meaning “home-pain” or “homesickness” to describe the malaise and melancholia of soldiers. Hofer (1688) noted in his dissertation that soldiers not only had mental health problems, but that Nostalgia also manifested in physical symptoms… (as cited in Rosen, 1975, p. 343).

The disease is due essentially to a disordered imagination, whereby  the part of the brain chiefly affected is that in which the images …  are located. This is the inner part of the brain where the vital spirits  constantly surge back and forth through the nerve fibers in which the impressions are stored. Once the vital spirits have made a path for  themselves and widened it they find it easier, as in sleep, to take the same path again and again. (Hofer, 1688)  Though Hofer studied the effects of trauma on soldiers over 300 years ago, even with the limited knowledge of the time, Hofer realized that the neural pathways of the brain and the effects of trauma upon them were directly linked to the malady he termed Nostalgia. This disorder is called Post Traumatic Stress Disorder (PTSD) in today’s medicine (Rosen, 1975). Referencing the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000) Post Traumatic Stress Disorder diagnostic criteria are as follows:

Diagnostic criteria for PTSD include; a history of exposure to a traumatic event meeting two criteria and symptoms from each of three symptom clusters: intrusive recollections, avoidant/numbing symptoms, and hyper-arousal symptoms. A fifth criterion concerns duration of symptoms and a sixth assesses functioning. (4th ed., text rev.; DSM–IV–TR; American Psychiatric Association, 2000)

While PTSD is most commonly thought of as a reaction to war, there are other unexpected traumas that can cause PTSD: Sexual assault, childhood trauma, kidnapping, being taken hostage, family violence, witnessing a traumatic event, even taking part in a rescue mission after a disaster can traumatize an individual and create an affirmative mental and emotional environment for developing PTSD (Javidi & Yadollahie, 2012, p. 2).

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) currently maintains that there be an initial event or “stressor criterion” consisting of a major, traumatic event that made the person feel helpless, fearful or horrified, and that this stressor was a threat to life, limb or safety of the individual or another within the scope of an individual’s experience (American Psychiatric Association, 2000). Though this is the accepted rubric for rendering a diagnosis of PTSD, further research has determined that these preceding events may not be the defining criteria for a diagnosis of PTSD. Schubert and Lee (2009) published a meta-analysis on PTSD.

During their study it was found that there is a call amongst researchers and clinicians that the DSM-V (the upcoming fifth edition of the DSM) not include a precursor event as a required criterion, but rather diagnose PTSD in the gestalt. Studies of late have found that smaller events, or events taking place over a period of time, as well as stressful life situations, can be just as traumatic as a major event, and therefore the diagnostic criterion needs to be changed (Schubert & Lee, 2009, p. 118).

As outlined by Matthew J. Friedman (1996) the symptoms of PTSD are varied. These symptoms may include intrusive recollections of the traumatic event, or a feeling as though one is reliving the trauma. Some sufferers experience flashbacks; dissociative episodes in which the person reenacts or relives the event as reality. Persons with PTSD may begin to display avoidant behaviors, shying away from things or places that remind them of the traumatic event. To illustrate: a person who suffered a violent attack whilst walking down the street at night may avoid walking anywhere, especially at night (Freidman, 1996, pp. 174-179).

Other symptoms include nightmares, memory lapses, especially memories associated with the trauma, such as blocking out all or part of the traumatic event. Some subjects experience a feeling of detachment, or become emotionally numb. They may even feel that they have no future, and cannot see anything positive in life. Many become hyper vigilant, have sleep disturbances, cannot concentrate, become very irritable or have uncontrollable anger or violent outbursts, and may exhibit an exaggerated startle response. For example: hearing fireworks or a vehicle backfiring a PTSD sufferer who experienced trauma in a war zone may be transported mentally, emotionally and physically back to the time of the trauma, feeling and re-living the war scene in real time (Freidman, 2006, pp. 174-179).

PTSD is categorized as acute, chronic or with delayed onset. Acute PTSD consists of symptoms that last less than three months, with chronic PTSD lasting three months or more. Delayed onset PTSD may be harder to diagnose, since the onset of symptoms in this category present at least six months after the traumatic event. Subjects may not be able to reconcile what they are feeling with an event so far in the past (Foa & Rothbaum, 1998, p.20; Freidman, 2006, pp.174-179).

Post Traumatic Stress Disorder and the accompanying symptoms causes suffering for those afflicted with the malady. This suffering can be physical as well as mental and emotional. PTSD can interfere severely with not only a person’s inner life, but with family relations, employment and even general day-to-day functioning.

Being considered for inclusion in the DSM-V is what is known as Complex PTSD (Herman, 1992). Complex PTSD differs from PTSD proper in several ways. Complex PTSD develops not from a single or grouped period of trauma, but more rather from a long, ongoing trauma, such as child abuse or neglect. It is related more to a lifestyle of abuse than to a single event, such as the difference between a lifetime of abject poverty and neglect rather than living through bombings during wartime. Complex PTSD also presents with the tendency for sufferers to be re-victimized (Herman, 1992, p. 377, 385). The symptoms of Complex PTSD are also more perceptual than physical, and include:

Impaired affect modulation, self-destructive and impulsive behavior, dissociative symptoms, somatic complaints, feelings of ineffectiveness, shame, despair, or hopelessness, feeling permanently damaged, a loss of previously sustained beliefs, hostility, social withdrawal, feeling constantly threatened, impaired relationships with others, or a change from the individual’s previous personality characteristics. (Herman, 1992, p. 377-391)

Physiological changes to the brain are also thought to accompany PTSD. J. Douglas Bremner (2006) writes of physical changes to the brain itself in sufferers of PTSD. Research finds that the size of the hippocampus is different in people who have PTSD and those who do not suffer from the disorder. The hippocampus is part of the limbic system, and controls such emotions as: anger, fear, emotional responses, as well as memory function, storage and retrieval of memories, and assists in decisions regarding fear reaction. Numerous studies show less hippocampal volume in persons with PTSD than in the normal population. Magnetic resonance images (MRI), “showed smaller volume of the hippocampus in PTSD; decreases in right hippocampal volume in the PTSD patients were associated with deficits in short-term memory (Bremner, 2006, pp. 80-86; Kitayama, Vaccarino, Kutner, Weiss & Bremner, 2005, pp. 79-86).

This in turn affects perceptions of memory and fear in PTSD sufferers, either contributing to being unable to recall a stressful event or, alternatively, being unable to stop reliving a stressful event. Research has also indicated that PTSD affects the medial prefrontal cortex of the brain, causing impairments to this area. The medial prefrontal cortex works closely with the hippocampus, and regulates the responses to fear and stressful situations in the form of emotions. These deficiencies in brain function can have resounding effects on memory, the ability to recall facts and figures, and can affect cognitive function as well as academic ability (Aupperle, Melrose, Stein & Paulus, 2011, pp. 686-694).

Many studies have been conducted to ascertain risk factors for developing PTSD. Brewin, Andrews and Valentine (2000) published a Meta-Analysis of Risk Factors for Posttraumatic Stress Disorder in Trauma-Exposed Adults. The article delineated what are considered to be the most commonly accepted risk factors in the scientific community. Some of these risk factors include: Gender of the individual, with women being at higher risk for developing PTSD than men. The subject’s age at the time of the trauma, with younger persons being more likely to develop PTSD than their older counterparts. Childhood trauma, lower socio-economic status, lack of education and general childhood adversity or abuse also places an individual at a higher risk for developing PTSD. A family history of psychological disturbances or a family history of PTSD is also noted. Lack of social support systems, the severity of the trauma experienced along with the duration of the trauma as well as stress factors in a sufferer’s life before the actual traumatic event may also make developing PTSD more likely. Lower intelligence is also thought to be a risk factor (Brewin, et al. 2000, p. 748-766). Intelligence

Intelligence is defined by the Merriam-Webster Dictionary as:
The ability to learn or understand or to deal with new or trying situations, the ability to apply knowledge to manipulate one’s environment or to think abstractly as measured by objective criteria (as in tests), and mental acuteness. Intelligence Quotient, or IQ, is defined as: a number used to express the apparent relative intelligence of a person. A: the ratio of the mental age (as reported on a standardized test) to the chronological age multiplied by 100. B: a score determined by one’s performance on a standardized intelligence test relative to the average performance of others of the same age. (Merriam-Webster’s Collegiate Dictionary, 2005)

In 1905 Alfred Binet and his doctoral student, Theodore Simon, were commissioned by the French government to study the education of mentally retarded children. Binet and his assistant developed a standardized intelligence test to help group the children by abilities and therefore ensure that the education provided to them would be commensurate with their abilities as well as therapeutic to the children. Binet expounds that intelligence should be separated from emotional or behavioral attributes (Binet, 2005). Binet also states:

Our purpose is to evaluate a level of intelligence. It is understood that we here separate natural intelligence and instruction. It is the intelligence alone that we seek to measure, by disregarding in so far as possible, the degree of instruction which the subject possesses. (Binet, 1905, pp. 191-244) Binet and Simon developed what is known as the Binet-Simon scale. This was the first standardized intelligence test, and the basis of today’s standardized IQ tests.  The debate on IQ often focuses on the ability of standardized testing to give a true and accurate portrayal of a subject’s intellect. Though these tests do offer an overview of a particular subject’s IQ, researchers have also been studying variances on intellect. Howard Gardner (1983) states that he believes there to be several forms of intelligence, including:

Linguistic Intelligence – the ability to use and understand words and verbal communications. Often found in writers and orators. Logical-Mathematical Intelligence – the ability to work with and understand well the maths and use of numbers and theorems. Einstein would be a classic example of this type of intelligence, as would Stephen Hawking.

Spatial Intelligence – the ability to understand space and the use of said space. Mechanics, construction workers and artists would possess this type of intelligence.
Musical Intelligence – the understanding and ability to produce music. Mozart and other composers would be among those with musical intelligence.
Intrapersonal Intelligence – the understanding of introspection, to see oneself clearly. Philosophers often possess intrapersonal intelligence.
Bodily-Kinesthetic intelligence – physical intelligence, such as that found in athletes and dancers.
Interpersonal Intelligence – the social intelligence that allows a subject to interact well with others or influence others, such as is found in politicians and popular teachers and those who excel in leadership positions. Former President Bill Clinton possessed this type of intelligence and charm.

Naturalistic Intelligence – An understanding of nature and the symbiosis of
nature are contained in this intelligence type. Botanists, hunters, and farmers use this type of intelligence in their activities (Gardner, 1983, 1999).

Gardner also further developed three distinct uses of the term “intelligence”: “A property of all human beings, a dimension on which human beings differ and the way in which one carries out a task in virtue of one’s goals” (Gardner, 2003, p.8).

Clinical Psychologist David Wechsler further mused that intelligence was not limited to performance and function, but was a broader attribute. Wechsler opined that; “Intelligence is the aggregate or global capacity of the individual to act purposefully, to think rationally and to deal effectively with his environment” (Wechsler, 1944, p. 3). Wechsler developed a test for intelligence that incorporated a wider range of abilities, a form of which is still used to test intelligence today (Edwards, 1994, pp. 1134-1136).

Brain volume and intelligence appear to be related. The differences between the brains in highly intelligent people versus those with average intelligence are most often related to increased grey matter. The more grey matter in the prefrontal region of the brain as well as the subcortical area of the brain, the higher the IQ (Reiss, Abrams, Singer, Ross & Denkla, 1996, p. 1771). There is also a connection between grey matter, which surrounds cell neurons, as well as white matter, which composes nerve axons and high IQ. It has been noted that those with higher intelligence have more of both types of matter than do persons with average intelligence Posthuma, et al., 2002, pp.83-84). Also of note was the discovery that older adults showed a stronger correlation between grey matter and intelligence in the frontal and parietal lobes while younger adults showed a stronger correlation between grey matter in the temporal lobes and limbic areas and intelligence.

Men also showed higher amounts of grey matter than did women (Haier, Jung, Yeo, Head & Alkire, 2004, p. 322). Neuroimaging studies show that people with higher IQ’s showed less brain activity for everyday tasks than did people with more average intelligence. Conversely, when presented with a challenging task, the high IQ brain shows a greater increase in activity as compared to the brains of those with normal intelligence. These results show that the brains of gifted individuals work differently, and may have developed more effective neural pathways (Hoppe & Stojanovic, 2008, para.4-6). Post Traumatic Stress Disorder and Intelligence

Though research has shown a correlation between intelligence level and PTSD, it has not proven that PTSD in and of itself lowers intelligence. Results have shown a correlation between pre-combat/trauma intelligence being lower and a heightened likelihood of developing PTSD, as well as a higher chance of that PTSD being more profound. In a study conducted by Michael Macklin and associates at the Veteran’s Affairs Medical Center Psychiatric Division combat veterans were studied as to their intelligence levels both prior to combat service and afterward. These veterans consisted of one group who reported PTSD disturbances and a group that did not report having any effects of PTSD. Between the two groups it was not shown that PTSD lowered intelligence levels, but rather that pre-combat intelligence levels were a predictor of developing PTSD as well as the severity of symptoms experienced by sufferers (Macklin, et al., 1998, pp. 323-326).

The type of trauma experienced is also a factor. Traumas of differing origin have been found to both positively impact intelligence as well as lowering IQ scores. Traumas that are classed as Personal Identity Traumas: rape, abject neglect, and sexual abuse show to have the greatest negative effects on intelligence, most notably in the areas of perceptual reasoning (problem solving) and working memory (Kira, Lewandowski, Somers, Yoon, & Chiodo, L. 2012, p. 134 ). Conversely, children of parents who experience trauma such as combat tend to have higher functioning in the areas of problem solving (perceptual reasoning), higher verbal acuity, process new information faster and have greater working memory (Kira, Lewandowski, Somers, Yoon, & Chiodo, L. 2012, p.132).

An understanding of the parts of the brain that are affected by PTSD and how these areas affect cognitive functioning is critical in order to study possible connections between the two. The three areas most affected by PTSD are the amygdala, the ventromedial prefrontal cortex (vmPFC) and the hippocampus (Liberzon & Martis, 2006, pp. 87-109).

The hippocampus, as stated earlier, is involved in memory. More particularly, the hippocampus helps form a cognitive mapping system. An example of this function is the ability to drive to and from work without conscious thought, or the ability to remember routes to familiar places. The hippocampus helps put memory and emotions into focus and order, what is normal and what is not, and forms contextual information (Williams, et al., 2001, pp. 1070-1079).

The amygdala expresses emotions, most notably: fear. It is the amygdala that sends the signal for fight or flight when we perceive a threat. The ventromedial prefrontal cortex is the part of the brain that conducts higher thinking and decision-making.

When a person sees or hears something that may or may not be threatening, the amygdala responds with the “fight or flight” impulse. The ventromedial prefrontal cortex decides whether or not the threat is real and the hippocampus puts the threat into context. An example would be going to a shooting range to practice target shooting. The person hears the crack of a gunshot, the amygdala sends a signal that there is a possible threat. The ventromedial prefrontal cortex states that the person is at a shooting range, and that this is a normal sound to hear and not a threat. The vmPFC then tells the amygdala to calm down. The hippocampus confirms that, yes, this is a shooting range, the subject knows what a shooting range looks like, sounds like and smells like and that there is, in fact, no threat (Liberzon & Martis, 2006, pp. 87-109, Williams, et al., 2001, pp. 1070-1079).

All of these signals are carried to and from the amygdala, the vmPFC and the hippocampus by neurons called pyramidal neurons. These are the primary excitation units of the corticospinal tract and the prefrontal cortex. These neurons have dendrites that project from the neural cell body, which is called the soma. These dendrites receive impulses, pass them along the soma and to the axon, which is the output portion of the neuron. These pyramidal neurons also feature in cognition. The complexity of these neurons is directly linked to the cognitive ability of a species. Because the prefrontal cortex of the brain receives input from the sensory areas of the brain, it processes these stimuli and plays an integral role in cognitive ability (Goldman-Rakic, 1987; Robbins, 1996; Stuss, 1994; Arnsten, AFT & Goldman-Rakic, 1998).

When a human being experiences stress or trauma, hormones are released. When a person feels threatened the endocrine system releases many hormones, amongst them norephinephrine and cortisol. Norephinephrine is a neurotransmitter that affects the anygdala, the hippocampus, the prefrontal cortex, as well as other fight-or-flight systems in the body. The cortisol releases glycogen and helps keep inflammation down. When a person experiences stressors of long duration or such terrific horror that the system does not return to normal but stays at a high cortisol and norephinephrine level, dendrites are damaged (Izquierdo, Wellman & Holmes, 2006, pp. 5733-5738).

In simplistic terms, the dendrites recede, and as a result have decreased glucocorticoid receptors. Fear extinction, or a lowering of a response to fear, is inhibited. This means that the sufferer of PTSD is prone to a state of heightened fear and anxiety, and exhibits an over reactive neural response to stress or perceived threat (Ledoux, 2003, pp. 727-738).

Personal Observations
The effects of greater self efficacy, impulse control and empathy in those with higher intelligence were noted in 23 years of personal observation of police officers, military special forces personnel as well as victims of violent crime. Other researchers have found the same types of examples; where PTSD is a hidden malady, and intelligence the veil it secretes itself behind. These observations led to the theory that; PTSD may not be prefaced by lower IQ, but more rather manifested differently according to a sufferer’s intelligence. Although not an exhaustive, scientific study, these observations provide a basis for further academic work.

Among police officers duty assignment as well as membership in sub-groups is often delineated by intelligence. So is it also with the military. As a natural occurrence the more intelligent operatives; those with the greatest decision-making abilities, impulse control and ability to immediately adapt to changing situations as well as skill in interpersonal communications are assigned to the more high-risk calls and details. They also belong to cliques, or sub-groups within their respective departments or units. Those operatives with more average intelligence are most usually assigned to less cerebral duties. This is not necessarily by design, but a type of interdepartmental natural selection, and the result of those at the command staff level possessing higher training, experience, intelligence and common sense necessary to promote to that level. Command staff assigns most duties to the operatives, and the sub-groups created amongst them further dictates which personnel are assigned to various duties.

Working for years with these men, and – to a lesser extent – women, there was a pattern that soon became rote. When personnel began to show signs of stress those with the higher intellects berated those with lower intelligence, and looked upon their sufferings as a sign of weakness or ineptitude. Interestingly, those who would be deemed as having higher IQs had symptoms themselves, but these were kept away from the public eye and the notice of superiors.

Lower level personnel had more overt symptoms: family violence, obvious substance abuse, personality changes, inability to mentally or physically function and numerous disciplinary infractions, as well as absenteeism and inappropriate emotional outbursts or affect. These symptoms often led to the resignation of the individual or to his being forcibly “resigned” or terminated from employ or assignments. In more progressive departments and units, these personnel were referred for psychological screening and care.

Higher-level personnel were most often those who had the highest scores on the Civil Service exam, ASVAB, or other entrance exams. It was also more apparent that those with higher impulse control were also the more intelligent operatives. They showed a greater numbing, often having a blunt affect in the face of horror or even non-social coping skills such as black humor. These men and women often chose to keep their problems within the sub group or stay silent altogether. Covert anger, isolation, and distrust of those outside the sufferer’s in-group were also obvious. Drinking was either kept to weekends or unit events known as “Choir Practice” (from Joseph Wambaugh’s 1975 novel entitled The Choirboys), which is group sanctioned binge drinking and emotional expression, often quite raucous and with shots being fired into the air, the occasional fist fight, driving at excessive speeds whilst intoxicated, and other risky behavior.

Drug use was restricted to prescription drugs, never taken when it might affect their ability to perform their assigned duties. By the time a higher functioning officer or unit member showed any outward signs of PTSD, it was usually very overt, violent, criminal or so obviously dysfunctional that the officer’s true mental and emotional state could no longer be ignored or rationalized away. Often they never have what would be considered a public “break”, but suffer quietly for years.

The lower level officers showed more avoidance of traumatic or high stress calls for service or situations whilst their higher functioning counterparts seemed inclined to actually search these situations out. This often led to accolades being heaped upon the operatives with above average intelligence and punishment meted out for perceived cowardice or dereliction of duty upon personnel with more average IQ’s.

When these elite units would speak of how they felt or thought about horrifying events, they described a sort of mental filing away of the event, rather akin to a mental accordion file or Rolodex. The traumas were mentally stretched out over time rather than processed in the present.

It was also interesting to see the physiological reactions of the two groups to situations involving extreme duress. The more average officer would often shake or cry after an event, sweat profusely and look to their cohorts or supervisors for guidance or comfort, and take a long time to return to stasis. Voice modulation became nearly impossible for them during a high stress event, and virtually all officers in this category experienced tunnel vision.

The higher functioning units sometimes showed little, if any, physiological upset. Voice modulation was excellent during traumatic and high stress events; tunnel vision was not as much of a problem, if at all. Higher functioning units were able to engage more of their senses appropriately and see situations in the gestalt rather than fixating on one element or one solution. They returned to stasis almost immediately after the event and sought no comfort from others, even cracking jokes about the event and downplaying the seriousness of the situation to make other officers feel more at ease.

Both groups of personnel spoke of nightmares, flashbacks, fear, depression and feeling detached or dissociated. The exaggerated startle reflex or hyper vigilance actually seemed more prevalent in the higher functioning officers. The reticence to seek treatment amongst sufferers with higher intellect was also very plain.

After teaching a class of Special Forces personnel, I was invited to speak to them after class in an informal forum. Out of 14 personnel, 12 stated that they knew they had PTSD. None of them sought treatment but either chose to “gut it out” or relied on members of their unit for support. When asked why they chose not to seek treatment, the resounding answer was, “You would have to be an idiot to tell them you have PTSD, it’s a career ender” (Personal Communication, February 2012, US Army Lieutenant). The following real life examples show how true this statement is.

In contrast, 23-year veteran Sergeant with a mid-sized metropolitan police department felt he had no one to turn to and nowhere to seek help. The police culture in this particular department prevented the seeking of mental health services. The Sergeant reported to this author that he had been suffering from intense stress for many, many years. Finally, he robbed the same bank at which he had worked a security detail for fifteen (15) years. He did not use a weapon in the robbery and wore the motorcycle helmet given to him by bank employees two Christmases before as his disguise. This Sergeant had no prior record for disciplinary infractions and was considered one of the brightest at the department. When the author asked him why, he wrote that he “needed a time out” (Personal written communication, 2012). His legal team petitioned for counseling for him, but the courts and police department chose to make an example of him. He was sentenced to 7.5 years in the Federal Penitentiary. It is a shame that he is now receiving the mental health counseling he needs from inside prison. He hopes that when he is released he can speak to police cadets regarding PTSD, and perhaps keep what happened to him from happening to another. In this case PTSD was most certainly a career ender.

Conversely, another veteran officer in the same department who had a more empathetic, observant supervisor received a visit in the dead of the night from that supervisor, in secret, at the officer’s home. He was treated kindly and told that his buddy had noticed that the officer was drinking alone quite often, at home, after duty. He was given the chance to speak about the intense PTSD he was suffering. His supervisor approved vacation time for this officer and sent him to rehab and then to a peer support group for police stress. Not only did this particular supervisor save the officer’s life, but also that officer is still serving honorably 20 years later. The important note? This had to be done without the knowledge of the higher administration of the police department to prevent reprisal. Discussion

Though many researchers and psychologists remain obdurate about the risk factors leading to PTSD, the connection between lower intelligence and the propensity toward PTSD should be examined further before it is affirmed as a precursor to developing the disorder. What is known is the connection between PTSD and the limbic system, to wit: the over activity of neurochemicals (catecholamines), the receding of dendrites, as well as the reduction of mass of the hippocampus and the over-activity of the amygdala amongst other changes (Goldman-Rakic, 1987; Robbins, 1996; Stuss, 1994; Arnsten & Goldman-Rakic, 1998).

History recounts that as long as there has been man and trauma, there has been PTSD. Though the disorder has been studied under differing names; Nostalgia, Shell-Shock, Battle Fatigue, and Post Traumatic Stress Disorder; the suffering and effects seem to be the same. Psychiatrist Viktor Frankel was a doctor in Austria during the Second World War. Dr. Frankel recognized the need for mental health care and established a clinic in the Theresienstadt Ghetto to help new prisoners deal with the trauma of being assigned to the camp. His mother, father, brother and wife all perished as a result of the Nazi occupation, and their time in the concentration camps. In his book Man’s Search for Meaning, Frankel sums the post-traumatic reaction most eloquently: “an abnormal reaction to an abnormal situation is normal behavior” (Frankel, 2006, p.38).

The body is a miraculous, amazing machine, and the stress responses that create the forum for developing Post Traumatic Stress Disorder appear to be another example of the wonderful, adaptive ability of the mind. Though the symptoms of this disorder are miserable for sufferers, one can see the biological, survival reasoning behind these changes. To see a lion from a distance evokes a fear response, true. To be up close and personal with a lion creates an indelible pathway in the mind: LION! DANGER! To have to survive for any amount of time in a den of lions the brain and body must adjust and go into survival mode. The hippocampal reduction as well as the over-activity of the amygdala denote that the more base instinct is to survive, and that higher thought, new information processing or short-term memory recall come a more distant second in the hierarchy of needs according to inherent biological programming. This would also be indicative of the avoidance of similar situations that evoke memories of the original trauma or traumas: to avoid lions, dens, and anything remotely similar in future.

Perhaps even flashbacks serve a survival purpose in the mind of a victim of PTSD. When a sufferer smells, sees, feels, hears or comes near a situation that even remotely resembles a lion’s den, the mind re-lives the trauma, ensuring even more avoidance of dangerous situations, whether real or imagined.

It was of interest that the children of trauma survivors had greater working memory, verbal acuity and processed new information faster. This lends to the Lion’s Den analogy: in order to ensure the survival of a PTSD sufferer’s offspring, that child needs to be even faster at danger perception to avoid the lion’s den altogether. Those who reacted by shutting down mentally, physically and emotionally would most likely not have produced issue, therefore realizing the key mechanisms of evolution (Kira, Lewandowski, Somers, Yoon, & Chiodo, 2012, pp. 128-139).

The same pathways used in the fear response are also used in cognitive activities. Therefore, the receding dendrites also affect the sufferer’s ability to learn new things. Short-term memory is blunted and verbal, declarative memory is also reduced. Spatial learning is also greatly impacted. This may account for the perceived reduction of IQ in sufferers of PTSD (Bremner et al., 1993; Bodnoff et al., 1995; Izquierdo, Wellman & Holmes, 2006).

In studies conducted on veterans of the Gulf War as well as the Vietnam War, it was concluded that those who reported suffering with PTSD symptoms had a smaller hippocampal volume, but that those who had PTSD that was remitted had normal hippocampal volume. Is a smaller hippocampus or lower IQ a risk factor for developing PTSD, or is the lowering of hippocampal volume and thus IQ an effect of the disease? Being that hippocampal volume can increase once PTSD has been remitted, as the hippocampus has regenerative capabilities, is IQ lowered over all, or does intelligence flow to other areas to compensate? (Apfel, et al., 2010; Thompson & Gottesman, 2008).

It is also important to consider that PTSD may manifest with differing symptomology in those with higher intelligence. Greater empathy and impulse control in those with higher intelligence may keep the outward symptoms of PTSD at bay, or make diagnosis more difficult. Several studies have been undertaken to ascertain the connection between lower intelligence and the propensity toward developing PTSD. These studies were not able to provide an actual pre-combat IQ for the participants, but rather had to rely on estimated pre-combat IQ (Heilbrun, 1982; Vasterling et al., 2002, Thompson & Gottesman, 2008).

PTSD should be studied further, and the range of symptoms expanded. Biologically, science knows the chemical and physiological effects of PTSD, but the personal experiences of PTSD are varied. Lower intelligence has not been solidly proven to be a risk factor for developing PTSD. The fluidity of intelligence and ability in the human mind, and how intelligence itself is measured is also a consideration. Perhaps intelligence level has nothing whatsoever to do with whether or not one suffers PTSD, but rather how one suffers PTSD.