While PTSD wasn't included in the Diagnostic and Statistical Manual of Mental Disorders until 1980, there are accounts of similar conditions dating to the Civil War, World War I and even to ancient times. PTSD -- though now defined by a term more accurate than "Vietnam syndrome," one of its earlier iterations -- is actually not a disorder. Nor is it an illness, not even a mental one. "PSTD is a normal reaction to abnormal events," says Beverly Donovan, a clinical psychologist at the Veterans Affairs Medical Center in Brecksville, Ohio, who runs an intensive treatment program for combat vets with PTSD.

Here's how trauma typically operates in the body: When you sense danger, your body automatically releases a massive blast of biochemicals, such as stress hormones (e.g., adrenaline), into your bloodstream. Then the "thinking" part of your brain asks: Am I in serious trouble, or just on a Tilt-A-Whirl? If the answer is the former, your hard-wired "fight or flight" action kicks in, sending your heart, lungs and liver into overdrive. Typically, then, you either fight or flee. All those chemicals, all that energy, gets discharged or burns off. Your parasympathetic nervous system then steps in to say "Show's over," decreasing blood pressure and heart rate, reactivating normal blood flow and organ function. You might be hungry or exhausted, even upset and shaken, but internally you're fine.

But some people get stuck. Even if they know the threat has passed, their neurons get jammed on orange alert. Remaining hypersensitive, the primitive, reactive part of the brain will pull the alarm at the slightest provocation: a loud noise, a footfall, a certain smell. Meanwhile, the constant state of alert leaves a waxy buildup of biochemicals and metabolic castoffs in muscle fibers and tissue. (This is why some people's fibromyalgia, cystitis, migraines and even irritable bowel syndrome may, at their root, be symptoms of PTSD. They may be a result of the truly unnatural amounts of both alarm-state and settling-down biochemicals that, without an efficient means of discharge, get lodged in the tissue.)

Researchers are still studying precisely why certain people are more susceptible than others to PTSD. Of two people in the same armed robbery, one may be fine while another remains traumatized. Someone who was blocks away from the World Trade Center towers on Sept. 11, 2001, may develop PTSD while someone who actually escaped a building may not. What we do know is that susceptibility to PTSD has nothing to do with, say, cowardice, or weakness of character.

So why doesn't traditional talk therapy usually help? Therapists have found that when PTSD patients seem resistant to talking about their traumas, it's not necessarily because they don't want to. That's because trauma memories are not stored where happy, or even ordinary, memories are. The sensations and experiences of trauma -- terror, struggling -- get packed away into the more primitive areas of the brain, to which the "rational" -- speaking, thinking -- parts do not have much access. The advanced areas can blab away all they want, but to the brain's nether region, they will -- at best -- be as unintelligible as Charlie Brown grown-ups. Says one of Naparstek's PTSD patients of an earlier experience with a psychoanalyst: "I kept asking my therapist, 'What is happening to me?' And, of course, in good psychoanalytic fashion, she asked, 'What do you think is happening?' Despite her good intentions, it was profoundly unhelpful." If anything, talking -- at least initially -- may do the opposite of "process"; rather, it can trip the lock on a Pandora's box. "In many psychotherapy practices this is still going on, out of sheer, well-meaning ignorance, just like mine," says Naparstek. "Too many of us have been defeated by trying the traditional tactic first, and extending and exacerbating our clients' suffering. It sucks."

Based on what's now known about how and where the residue of trauma lingers, many therapists are employing alternatives, or at least additions, to talk therapy -- such as guided imagery, eye movement desensitization and reprocessing, somatic experiencing and other methods -- that seem to offer more direct avenues to healing by seeking out trauma where it lives: not only in the mind but also in the body.

"When exposed to trauma, some people will have trouble letting go of the experience, but not because they want to dwell on it," says Steven Gold, Ph.D., director of the Trauma Resolution and Integration Program at Nova Southeastern University in Fort Lauderdale, Fla., and president of the International Society for the Study of Dissociation. "There are various techniques for helping people move beyond it, which may have as much to do with the body's reaction to the experience as with the mind's. A few years ago some of these therapies would have been considered 'alternative, but now the major specialists in treating trauma would consider them more mainstream."

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