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Trauma Revisited in Late Life

August 28, 2014

By Marc Agronin, MD
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The opinions expressed by Psychiatry & Behavioral Health Learning Network bloggers and those providing comments are theirs alone and are not meant to reflect the opinions of the publication.

In his book Prisoner of Her Past, Chicago Tribune jazz critic Howard Reich describes how his 69-year-old mother Sonia fled her suburban Chicago house one winter evening in 2001, convinced that someone was trying to kill her (Reich, 2006). Putting on his journalist’s cap, Reich investigated the seemingly sudden occurrence of this late-life psychopathology, tracing now only his mother’s known life history as a wife and mother, but also her lesser known history as a child survivor of the Holocaust. 

In a fascinating chronicle of his journey to Poland and Ukraine to find out what happened to his mother as a young teen during World War II, Reich encounters a family cousin with a similar history, and together they attempt to retrace Sonia’s steps hiding from the Nazis. The trip— featured in a film documentary—crystalizes Reich’s belief that his mother is suffering from late-life posttraumatic stress disorder (PTSD).

Although we often assume that the impact of trauma manifests right away, Reich’s account shows in vivid fashion how it can manifest decades later. Sometimes an emotional event can trigger the recurrence. For example, Reich later realized that the night his mother fled her home was the anniversary of her husband’s death. This phenomenon was commonly seen in many World War II veterans who first began to experience PTSD symptoms around the time of fiftieth anniversary commemorations of the war in the mid-1990s.

Emergent symptoms of late-life PTSD include the common suspects: hypervigilance, avoidance of triggers, autonomic arousal, and flashbacks. But these symptoms might be divorced from conscious traumatic memories, as with Sonia, who never spoke of them. Thus, the clinician might see the sudden manifestation of severe symptoms in a patient without clear links to past trauma. Some traumatic events, especially from childhood, are never related to anyone, and may remain either in distorted forms or totally repressed. For individuals with neurocognitive disorders, the memories themselves may be inaccessible but the bodily sensations often remain, resulting in severe reactions to physical deprivation and caregiving.

In all such cases, it is neither feasible nor advisable to work through the memories. Treatment has to be symptomatic, but informed by the trauma. Thus, Reich’s mother is allowed to maintain a very rigid, ritualistic routine in the nursing home where she now resides, since it serves to comfort her and reduce stress that might otherwise trigger her paranoid delusions and other symptoms.

Have you seen potential late-life PTSD symptoms in patients with known trauma earlier in life?

References

Reich H. Prisoner of Her Past. Chicago: Northwestern University Press, 2006.

For more information on Howard Reich’s book and the documentary film Prisoner of her Past, go to: http://prisonerofherpast.kartemquin.com/

Marc E. Agronin, MD is Medical Director for Mental Health and Clinical Research,Miami Jewish Health Systems, Miami,   FL. He also is Affiliate Associate Professor of Psychiatry and Neurology, University of Miami Miller School of Medicine, Miami, FL.

The views expressed on this blog are solely those of the blog post author and do not necessarily reflect the views of Psych Congress Network or other Psych Congress Network authors.

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