"If you are held up at gunpoint, your brain secretes a bunch of the stress neurotransmitter norepinephrine, akin to an adrenaline rush," he said. "This changes the electrical discharge pattern in specific circuits in your emotional brain, centered in the amygdala, which in turn transitions the brain to a state of heightened arousal that facilitates memory formation, fear memory, since it's scary. This is the same process, we think, that goes awry in PTSD and makes it so you cannot forget traumatic experiences."

if MDMA gains approval as a treatment for PTSD, psychiatrists could prescribe the drug for very different purposes.

Thalamus: Our Thalamus is like a cook.  It takes in info from all the senses and then blends it with our autobiographical memory. Breakdown of the thalamus explains why trauma is primarily remembered not as a story with a beginning, middle, or end, but as isolated sensory imprints: images, sounds, physical sensations that are accompanied by intense emotions usually terror and helplessness. In normal circumstances, the thalamus also acts as a filter or gatekeeper. This makes it a central component of attention, concentration, and new learning—all of which are compromised by trauma. People with PTSD have their floodgates wide open. Lacking a filter, they are on constant sensory overload. In order to cope, they try to shut themselves down and develop tunnel vision and hyperfocus. If they can’t shut down naturally, they may enlist drugs or alcohol to block out the world. The tragedy is that the price of closing down includes filtering out sources of pleasure and joy as well.

Social support is not the same as merely being in the presence of others. The critical issue is reciprocity: being truly heard and seen by the people around us, feeling that we are held in someone else’s mind and heart. For our physiology to calm down, heal, and grow we need a visceral feeling of safety. No doctor can write a prescription for friendship and love: These are complex and hard-earned capacities. You don’t need a history of trauma to feel self-conscious and even panicked at a party with strangers — but trauma can turn the whole world into a gathering of aliens.

In trauma survivors, Van der Kolk notes, the parts of the brain that have evolved to monitor for danger remain overactivated and even the slightest sign of danger, real or misperceived, can trigger an acute stress response accompanied by intense unpleasant emotions and overwhelming sensations. Such posttraumatic reactions make it difficult for survivors to connect with other people, since closeness often triggers the sense of danger. And yet the very thing we come to most dread after experiencing trauma — close contact with other people — is also the thing we most need in order to regain psychoemotional solidity and begin healing.

This, he points out, is why we’ve evolved a refined mechanism for detecting danger — we’re incredibly attuned to even the subtlest emotional shifts in those around us and, even if we don’t always heed these intuitive readings, we can read another person’s friendliness or hostility on the basis of such imperceptible cues as brow tension, lip curvature, and body angles.

“I would have liked to have done things like playing more with her PTSD, maybe having things like twisted versions of sequences of the first game that you have to replay, because she’s always replaying them in her head, and they end in different ways that you didn’t see in the first game, and trying to reflect aspects of PTSD,”

A common lament among educator-survivors is the way that personal boundaries shift within the school community. Abbey Clements, who taught second grade at Sandy Hook, says that after the shooting, she would take her entire class to the bathroom at the same time, so that no one would have to leave her sight. But as they drew their students close, she says, she and her colleagues distanced themselves from one another. “You’re afraid that if you start talking about your own trauma, you might trigger someone else’s,” she says. “You’re also afraid of looking weak or unstable, afraid you’ll be asked to leave or take leave if you admit how much you’re struggling.” As a result, many teachers bury their fear and anger and guilt, until it changes into something else entirely. The question of where to erect a memorial, or when to take one down, can create fierce divisions. So might similar questions about how long to allow comfort dogs on campus, or what to do with the mountain of gifts and condolences that pile up. Students may come close to blows over whether to discuss the shooting during class time. Teachers may feel close to doing the same. “It’s not all ‘Kumbaya,’ ” Clements says. “When the system is cracked by a trauma of this magnitude, a lot of stuff leaks out. It gets messy. And it can change relationships.”

Teachers are at the quiet center of this recurring national horror. They are victims and ad hoc emergency workers, often with close ties to both shooter and slain and with decades-long connections to the school itself. But they are also, almost by definition, anonymous public servants accustomed to placing their students’ needs above their own. And as a result, our picture of their suffering is incomplete. We know that the trauma that teachers experience after a school shooting can be both severe and enduring. “Their PTSD can be as serious as what you see in soldiers,” says Robert Pynoos, co-director of the federally funded National Center for Child Traumatic Stress, which helps schools coordinate their responses to traumatic events. “But unlike soldiers, none of them signed up for this, and none of them have been trained to cope with it.” We know that teachers who were least able to protect their students in the moment tend to be especially traumatized. “For teachers, the duty to educate students is primary,” Pynoos says. “But the urge to protect those students is deeper than that. It’s primal.” And we know that their symptoms can include major sleep disturbance, hair-trigger startle responses and trouble regulating emotions.

CONCLUSIONS: These findings suggest that higher standing BP is a biomarker that helps identify persons with combat PTSD who are likely to benefit from prazosin. These results also are consistent with α1AR activation contributing to PTSD pathophysiology in a subgroup of patients.