In her early works (2002–2011) A. Tadevosyan described traumatic stress under the name of APES – Antropogenic Psycho-Emotional Stress thus underlying its specificity already in the name. APES is specific for man and contains both emotional and cognitive components, the proportion of them varying depending on the memory peculiarities of a particular person, his personality, peculiarities of perception, content and duration of the state of grief. Resulting from the interaction between the stressor and the mental vulnerability of man, a state of deadaptation has a number of specific features relevant to man only, which mark its distinction from the emotional stress in general (A. Tadevosyan, 2002, 2003, 2011). An individual, having suffered a mentally traumatic situation himself or as its witness, experiences the emotional stress as an acute state. Actually, this first phase of stressor response as the first step of man’s response to a traumatic event can be easily modeled on animals. When the first emotional outbreak (shock) of traumatic experience somewhat calms down man begins to think over what had happened; memory, comprehension are turned on, the past, present (the cognitive component of the psyche) are assessed often from the standpoint of loss for the person himself. The trauma acquires the category of meaning for a particular man. “The meaningfulness” of injury, its sense results from processing the life entire past, present aimed at the search for “anchors” for the future. Sometimes it takes quite a long time to interpret what happened in detail; during this period “molecules” of emotions of various qualities, various intensities and duration are released. The variety of emotional experience of this period depends on what man remembers about stress, what the content of his traumatic memory is. The emotional palette when alone (stress outprice) can be very dynamic and manifold: from anger, wrath, to the sense of guilt, despondency. The flow of these conditions may be undulating: the emotional tension going up and down. Thus usually the emotional discharge proceeds gradually reducing the destructive activity of the injury – “time heals”. However, there are cases when deliberation of what happened may be accompanied by a growing emotional experience intensified by assuming a personal role in the loss, the rejection of a random set of circumstances, self-blame. This can result in self-generation of an affect with suicide or alcoholization, psychopathology or somatization of the injury. Thus, processing of the event may be accompanied by the second emotional wave, which in a number of cases is much stronger than when it really happened. This stage includes a new phenomenon of the evolution – consciousness and imagination.

The first mention about the cognitive aspect of mental stress is found in R. Lazarus work. He notes that only an interpretation of the fact or a situation makes the stimulus stressogenic. The evaluation attributed by the individual to a specific factor is the main intermediate variable between the stressor and the response. Defining stress as a situation whereby the requirements to a person are either a trial or something that exceeds his capabilities for adaptation, Lazarus concludes that even if a stimulus affects the individual through some sensorial or metabolic process, this process being stressogenic, the stressor response may fail to appear. A stimulus becomes a traumatic stressor only by virtue of the meaning ascribed to it by man. Therefore, an excessive stress can be initiated by the individual himself, by the one who ascribes sometimes the stressing characteristics even to the neutral stimulus.

This feature was already known to philosophers of the ancient world, who wrote: “People are frustrated not by an event, but rather by how they see it” (Epictetus). And Andre Gide wrote: “How wonderful life would be if we were content with some real disasters, not bowing to the ghosts and chimeras of our mind…”.

Usually three periods are distinguished after an injury:

The acute period can be considered up to 3 months.

Subacute period lasts up to 3–6 years.

Delayed or remote consequences can be extended for years, sometimes for the whole life.

Example from a husband’s story:

“I cannot understand why she did it now. We lost a child 3 years ago, she handled herself well. We have born a girl again. Life began to improve. And suddenly – she commits suicide, leaving a note: “I’m sorry. All this time, I tried to forget … every time embracing our second daughter, I see the face of my daughter, she looks reproachfully at me. I can no longer”… (from the suicider’s note).

Mental trauma is an act of the impact of mentally traumatizing event limited in space and time “there and then”. The traumatic event, having become the content of consciousness, in the course of time can be repeatedly manifested as unprompted flashbacks or initiated by the individual himself anywhere, anytime and in any situation. Its strength and meaningfulness can be amplified by the imagination, which manipulates the traumatic experience, moving it in time, expanding by connecting other people and events. Thus the state of traumatization develops, the core of which is the so-called in psychology and psychoanalysis “trauma body”. At the level of consciousness the “trauma body” (psychoanalytical term) or a traumatic constellation (neuro-physiological term) has a basic quality – the quality of attracting everything that can be tied up into a “single unity” and comprise a traumatic reality.

The latter does not already have clear space-time boundaries. Man “starts to live” not in the objective reality, but rather in the subjective post-traumatic one. Each time when activating that reality, man lives all through again with the whole complexity of the sensory perception of the traumatic injury, the somatovegetative symptomocomplex, supplemented with the affectivity of the moment and the behavior of the traumatized man during the traumatic injury. As a result, the act of “mental trauma” goes over into a “condition of mental traumatization” converting acute stress to chronic. The condition of chronic traumatization is manifested by anxiety, strain or asthenia.

Traumatization is a process, which starts from the sensory triggering factor (a psycho-traumatizing event) and going on when the system generates certain traumatic constellations based upon the A. Ukhtomsky’s dominant (A. Tadevosyan, 2000). The peculiarity of traumatic stress is its ability to retain stressful events in the form of a psychic echo – “echo-stressor” known as flashbacks. “Echo-stressors” can be of different types depending on the mechanism of origin and development (A. Tadevosyan, 2002). A common feature of all varieties of flashbacks is automatism, i.e. they can emerge from the memory anywhere, anytime and in any situation, regardless of the consciousness and desires of man. This category of mental phenomena is caused by the memory capacity to imprint individual sensory perceptions or entire situational events (gestalts).

This category of mental phenomena is conditioned by the activity of mirror neurons and the mechanism of eidethism of the SPA, the ability of memory to imprint individual perceptions or whole situational events, including the feelings, thoughts and behavior of the person himself.

We have singled out several variants of flashbacks – “echo-gestalts”:

• sensory;

• convulsive;

• somatic;

• painful;

• cognitive.

Sensory echo-stressor (sensory flashback). Traumatic dominant (constellation) occurs immediately, without a period of formation. A traumatic event is retained in memory in the form of pictures, situations or fragments of those situations that took place in reality. This phenomenon comes up unprompted. Considering the holographic concept of the memory and psyche, it is clear that “a fragment of man’s life” reflecting a traumatic event retains the spatial and temporal characteristics of the trauma moment and the whole complex of sensations and emotions. Most probably all this happens through the mechanisms of eidetic memory. Neuro-Linguistic Programming (NLP) makes it possible to determine which information channel is preferable for this or that person.

Based on NLP data it is possible to pre-determine the kinds of flashbacks that can develop in a particular individual in cases of traumatic stress. This “mould” (gestalt) of reality has a capacity to break into the current everyday life, pushing aside the current moment, and so a person starts to live, go through and act in accordance with the echo-reality. Having come up through the mechanism of association, this flashback possesses strength of the real event changing the clarity of consciousness into a psychogenic fuzzy consciousness, making a person lose his bearings in the real situation. This is the analog of hallucinatory illusory experience of epileptic twilight disorder of consciousness (mental equivalent). The individual can hear, see, smell the traumatic “echo-reality” in all variations of features, which is manifested in the common stressor response. As distinct from epileptic twilight, the content of traumatic twilight disorder of consciousness is stereotypic, it repeats in every detail the traumatic reality. The psychic equivalent involuntarily emerging from the memory, can change the mood, behavior that become inadequate to the reality, but adequate to the content of traumatic experience.

Examples.

1. Patient K. used to drop to the floor and crawl to a wall every time she heard a buzz of a flying plane. Squeezing herself in a corner or under a table she stayed there until the buzz ended. Her face showed fear; she was trembling, sometimes grappling her head and lamenting: “Again bombing, again bombing…”

These conditions emerged six months after the fears experienced during “Grad” bombings in Karabakh and moving to Yerevan.

2. Patient M., a survivor of the Spitak earthquake, each time during high wind used to run out of her apartment down the stairs screaming: “Earthquake!!!”. She lived on the 9^th floor. In this state no one could stop her or make her change her mind.

3. Patient T. lost his 9-yearold son in the earthquake. 12 months later he applied to the Center “Stress” on account of his condition that scared him and made him think he was going mad. He said that almost every day he heard his dead son talk to him. Walking along the street, “… clearly saw the son either walking or playing in the street or running to meet me”.

The described phenomenon is not merely a symptom. Its appearance makes it possible to understand the mechanism of transformation of the external signal into an act of consciousness, the mental phenomenon. Flashback is a reflection of the event or its fragment by mirror neurons. The parameter of a physical object – seen, heard, having become the content of consciousness, is transformed into a mental phenomenon. Echo-phenomenon is an intermediate link between the world of physical phenomena and mental world (between physics and psyche, matter and consciousness). It is a key to understanding the transformation of the external world energy into the internal one. Mirror neurons perform this first level.

Picture 1. Flashbacks as described by one of the patients.

Picture 2. Flashbacks as described by the patient.

Picture 3. Flashbacks as described by the patient.

Convulsive “flashback”. An epileptiform convulsive fit may occur in a psychotraumatic situation, especially if it is accompanied with oxygen deficit. Actually, the fit results from hypoxia. The state of “asphyxia” is accompanied with a characteristic facial expression and a specific pantomimic mask. A man who lacks air starts to “grab” air with hands, face is strained, neck reaches out, mouth opened, breathing outwardly reminds breathing of a fish thrown out on the shore and strenuously grabbing the air with the mouth open. Epileptoform “echo-stressor”, if it happens in situations with air deficiency, is accompanied by similar movements.

Examples:

4. Once the Epileptological Center sent a young man to the “Stress Center. He complained of epileptiform convulsive fits occurring once in 2–3 months for over 8 years. A careful examination in the Epileptological Center failed to yield any objective paraclinical data. Since the fits were rare and over time the tendency of their frequency was not observed, and the clinical picture did not change, the parents decided not to give the boy anticonvulsant drugs, for fear of their undesirable side effects. No epileptic symptoms were discovered. The father was a witness of fits and was able to describe in detail the onset of the fit, focusing my attention on the grasping movements of the hands, “as if lacking air” – added he. Some leading questions helped father to remember the occasion that happened with his son when he was taught swimming in the pool. On the second day of swimming lessons, not knowing how to swim, the child was dipped head and ears into water. The boy experienced strong fear and refused to attend the pool. Several months passed between that event and subsequent fits. The relatives forgot about it. The patient himself confirmed that the fit usually occurred in stuffy rooms. It happened twice in a vehicle packed with people, once it recurred when he saw the sea for the first time.

5. Three years after the earthquake, mother of a 12-year-old girl consulted the “Stress” Center on the occasion of convulsive fits in her daughter. Mother said that she and her daughter remained under the ruins for 10 hours. It was there that the first convulsive fit occurred to the girl. The subsequent examination revealed no data in favor of the organic origin of the fits. A fit starts with short breath, the girl grasps her throat, trying to catch her breath. The girl herself said she always felt short of breath before the fit.

Both examples mentioned are similar in their stereotype clinic, lack of dynamics and mechanisms of occurrence. In both cases, the parents decided not to give the anticonvulsants thus retaining their original form not burdening the clinic with side-effects of medications.

Somatic “flashback”. The memory retains not only “a piece of the objective-emotional world” in the form of a sensory “echo-stressor”, in the same way it can register any bodily symptom or syndrome accompanied by a strong emotional response – “somatic echo-stressor”.