Mental Health, the Brain,  and PTSD

by Carolyn McMakin, MA, DC

The most important things to keep in mind when considering mental health, the brain and PTSD is that in the brain: 

1. Everything is connected to everything else; 

2. The system is designed to help you survive trauma and threat in a primitive world; and, 

3. Nothing in the brain reacts well to inflammation.

Remember item 3. Nothing in the brain reacts well to inflammation. In general, inflammation slows conduction and interferes with neurotransmission. If the stress response and vagal function are not back to baseline in minutes, if the injury and infection are not repaired in eight weeks and the vagus remains suppressed, then the vagus is not suppressing the immune system or controlling the motility, the pH, and the microbiome in the gut; the gut leaks small peptides from ingested food, further activates the immune system, and inflammation increases. When inflammation increases, the nervous system becomes more dysregulated and slower. Corticotropin releasing factor (CRF) causes the cortex to focus on previous traumatic events to the exclusion of recent events that may be neutral or positive. If this goes on long enough, the amygdala, hippocampus, and prefrontal cortex eventually change in activity and even in size. 

What does that mean for mental health? Remember that every mental health definition includes some reference to cognitive ability, social integration, emotional balance, stress coping skills and work productivity. Inflammation, CRF and alterations in the prefrontal cortex (PFC) impair cognitive function, executive function, and decision making. Social integration and emotional balance depend on the specific neurotransmitters serotonin, dopamine, and oxytocin all of which depend on branch chain amino acids for their structure. When the gut wall thins and branch chain amino acid transport is inhibited, synthesis of neurotransmitters that depend on branch chain amino acids is delayed or reduced. Without serotonin, dopamine, and oxytocin, mental health is elusive or impossible. 

Stress coping skills depend on normal levels of stress hormones and the proper function of the prefrontal cortex and the limbic system (the amygdala and the hippocampus). In long-term stress, all of this delicate balance is disrupted. And the ability to do productive work will depend on the type of work that is considered productive for any specific individual. A concert pianist, an astrophysicist and a carpenter all have different demands on PFC, cortical function, and long- and short-term memory. The inevitable conclusion is that severe chronic stress is incompatible with mental health. 

How does this lead to PTSD?