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Post traumatic stress disorder

Trauma refers to the wounding of our will to live, our existential beliefs about the self and the world, our dignity, and sense of security or permanence as an organism. The assault on the psyche is so great that traditional ways of thinking, feeling and behaving are inadequate. Áine Tubridy explores how to deal with PTSD


The field of traumatology is relatively new. Until as recently as the 1980s, clients were treated for the many and varied after-effects of trauma largely as if they were separate problems, (anxiety, depression, insomnia, dissociation, concentration problems, low self-confidence and many others). Now, however, with a greater understanding of how trauma is processed by the psyche, therapy frameworks have developed which focus on steering the psyche back to a level of health and wellbeing — the essence of rehabilitation.

There is an ever-growing acknowledgment that we function as a mind-body-spirit organism, so it is not only our body which is battered and bruised by traumatic events, but our entire identity, at every level; emotional, mental, and spiritual. We are far more than the body whose bones were broken, or the brain which suffered concussion. We are a spiritual being, housed in this material body, both of which could have seen their last moments of life, a fact which has registered very forcefully in that part of our emotional brain dedicated to survival, our limbic system.

Trauma therefore refers to the wounding of our will to live, our existential beliefs about the self and the world, our dignity, and sense of security or permanence as an organism. The assault on the psyche is so great that traditional ways of thinking, feeling and behaving now prove inadequate.

 

Causes of PTSD
People are in a traumatic situation when they know or believe they may be injured or killed, or that others around them may be; natural disasters such as hurricanes, floods, fires, earthquakes, man-made catastrophies such as war, terrorism, concentration camps, physical, sexual or verbal assault such as occur during rape, incest or bullying, near-death or out-of-body experiences such as may occur during operations or accidents.

Two elements serve to clarify the definition of PTSD, distinguishing it from other monumentally distressing events such as bereavement, abortion or divorce — these are dehumanisation and entrapment.

At the moment of attack, if one feels like one’s life or right to health, dignity and safety counts for nothing, one feels as disempowered as a ‘thing’. This is easier understood in the face of natural disasters, but when it is at the hands of another human the defilement of the soul runs deep, and a mistrust in humanity as a whole is fostered.

In entrapment, one’s struggles to be free are ineffective or simply not an option, physically, morally, or econically. The element of ‘no choice’ where one’s survival may have been contingent on exposing others to risk, can prey on victim’s minds years later as survivor guilt, with the two warring polarities of not wanting to betray your own moral principles (such as having to leave wounded others behind, having to collude with the abuser, or keep silent in order to prevent worsening of the situation) while trying to secure one’s own survival.

 

Diagnosis criteria
The definition of PTSD is: a normal response to an extraordinary situation or event. The myriad of symptoms experienced reflect a nervous system stuck in alarm mode even though the event is now in the past, sometimes as far back as several years ago.

The psychiatric diagnostic manual gives these criteria:

The traumatic event was perceived as life-threatening, and was responded to with fear, helplessness or horror.

Re-experiencing phenomena are occurring; nightmares, flashbacks, intrusive thoughts about the incident.

Persistent avoidance of reminiscent situations, with numbing of emotions.

Physiological hyper-arousal; startle response, irritability, difficulty falling asleep, vigilance.
The above persist for at least one month.

Significant dysfunction in social, occuptional or family areas.

 

Symptoms
Sleep disturbances — insomnia, night sweats, nightmares.
Flashbacks, intrusive thoughts, kinaesthetic memories (of smells, tastes, touch, noises)
Anxiety — panic attacks, feelings of dread, catastrophising, fear of reccurence
Emotional numbing, naivete, distancing from others
Loss of interest in work or activities
Suicidal intentions
Revenge feelings, cynicism, paranoia, hypersensitive to injustice theme
Emotional roller-coaster; fits of rage followed by passivity, fear of losing others, survivor guilt
Phobic avoidance of activities which arouse memories
Dissociation; out-of-body states, trance states
Cognitive deficits; concentration problems
Psychosomatic disorders

 

Other phenomena
Polarities: Sometimes in family abuse survivors, some members can display a naivete, an ‘all will be well’ optimism, while others are cynical and paranoid.

The naivete and optimism reflect the survivor’s denial of the abuse and the wish that it didn’t exist. The cynicism and negative view of life reflect the survivor’s recognition of what happened and the over-generalisation of the cruelty and manipulativenss of the abuser to others and to life in general.

Another polarity is when feelings of extreme worthlessness (from being denigrated or treated as subhuman by their abuser) alternate with feelings of specialness (from being made feel important or special by their abuser).

Likewise, self-punitive may alternate with self-indulgent behaviours (because abusers can punish then indulge their victims, so that some are convinced they deserved the abuse) and intense dependency alternate with excessive care-taking (because many victims are in care-taking relationships with abusers, and in their isolation are dependant on them for both validation and company).
Secondary symptoms: These evolved as a coping mechanism after the trauma, but may become the central issue. Alcohol or drug misuse, eating disorders, compulsive disorders, delinquency or crimunality, depression, psychotic episodes, sleepwalking.

 

The process of healing
Recovery goes through three stages; the victim stage, the survivor stage and the thriver stage. The stages are far from clearcut, so a person could be at one stage at home but another at work, or vice versa. Progress in recovery may also occur haltingly, with a tendency for the least traumatic memories to emerge first, and the most traumatic later. As new layers emerge, someone who had begun thriving may seem to slide backwards for a time, to revisit a former stage such as that of the ‘victim’ which they thought they had left behind, with the thinking, feelings, and behaviours which accompany it.

There are also secondary victimising, or wounding experiences, in which the institutions, caregivers, and others to whom they turn to for help respond by disbelieving or trivialising their experiences, blame them for the event, negatively judge them for the trauma or their symptoms, or deny them the expected services. Many who are admitted to psychiatric hospitals following trauma testify to feeling retraumatised by the so-called ‘treatment’. Forcible injections, involuntary lock-up situations, or electro-shock applied to those in such vulnerable states can leave psychological scars which exceed the original trauma. Feeling isolated and misunderstood, many resort to suicide during this time, or harbour intense levels of anger towards their doctors for life.

It is important to state here that the term ‘victim’ by dictionary definition is ‘someone who has been harmed, made to suffer, or killed by another, by ruthless design or accidentally’. Some survivors have a difficult time accepting that this is so, because of society’s perception of victims as incompetent, inferior, or responsible for the trauma.

 

Victim stage: This includes three stages
Prediscovery — when PTSD symptoms are being experienced with little understanding of their origin or relationship to the trauma. Only an inner chaos is registered, with poor recall or the trauma. Seeking relief, they may abuse substances, or leave jobs or relationships frequently.
Early awareness — a vague sense of trauma having happened leads to increased anxiety, confusion, depression, irritability, and disatisfaction with life. As it emerges, disbelief and shock result, and PTSD symptoms increase.
Discovery — a stage where they are vulnerable to reabuse by others upon disclosure.

 

Survivor stage
A commitment is made to therapy or some healing effort where the trauma is confronted in whole or in part, the feelings find expression and validation, and the survivor begins to regain some control over their turbulent inner life. In this way, self-esteem is rebuilt, relationships renegotiated, and a new future envisioned.

Much of PTSD is ‘unexperienced experienced’. That is, being far too intense and overwhelming in nature, it was frozen, held in suspension, until such time as it could be recognised and released. In this process, it becomes integrated into the rest of the psyche for the first time.

However, in the same way that an extra jigsaw piece will displace other pieces in the overall picture, the entire psyche may find itself in a process of overhaul as the integration takes place. This can take time, sometimes years, and some elements of the former life may have to be weeded out, such as unsavoury relationships or contexts which do not support the healing venture.

 

Thriver stage
Personal goals, not the trauma, become life’s organising principle. There are fewer and fewer emotional upheavals, and increasing peace of mind. If PTSD symptoms persist, they are fewer and less intense or disruptive.

 

Treatment and symptom management
It is beyond the scope of this summary of PTSD to cover treatment in its entirety. Some sources which are useful are:
Waking the Tiger by Peter Levine, and also his CD set Healing Trauma. He has devoted his career to processing of trauma, with expert explanations of how symptoms come about and how they can be reversed.
Post Traumatic Stress Disorder: A Complete Treatment Guide by Aphrodite Matsakis. With a wealth of experience with veterans of Vietnam, this book will refer you on to many other sources of information also for survivors of incest, and domestic violence.
Focussing by Eugene Gendlin, with his CD set which can guide you through this invaluable somatic re-experiencing technique for processing trauma.

 

 

Dr Aine Tubridy was the author of When Panic Attacks.

(see Resources [book reviews] and Events)


More on PTSD


The PTSD first aid kit

Click the link to go to our PTSD first aid kit: PTSD arrowback

 

Links to

Eugene Gendlin

Peter Levine

Aphrodite Matsakis

 

See also links elsewhere on this site to other aspects of healing trauma such as anger management, bullying, panic attacks, depression and assertiveness