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Post Traumatic Stress Disorder

A disorder, in the past referred to as nerves, a mental break down or shell shock, that often went undiagnosed.  It is closely associated with obsessive compulsive disorder.   For 33 years, the American Psychiatric Association classified OCD as an anxiety disorder— but in May 2013 the A.P.A. redesignated it as an impulse disorder.

Most people exposed to traumatic events cope in an effective way, even though they may feel upset by it. A traumatic response, on the other hand, entails a collapse of the coping mechanism, when someone is flooded by anxiety. The most conspicuous outcome of this is post-traumatic stress disorder. People with PTSD experience continuous trauma. Despite the fact that the traumatic event is over – the war has finished and they have been reunited with their family – they still feel they are experiencing it.  You are left with a lifetime of horrific memories. The night terrors never go away and the slightest incident can trigger and revive repressed memories.

Symptoms include extreme anxiety, uncontrollable anger, depression resulting in obsessive compulsive disorders. Younger veterans tend to have intense surface anger and battling PTSD are more likely to be polydrug users, with alcohol abuse, marijuana and ecstasy all common.  Suicidal tendencies are common.

(PTSD) is common to rape victims, child abuse victims, and combat veterans, as among others. Carers such as medics, ambulance officers, police, doctors and even teachers are prone to it. 

Doug Brewer, the program co-ordinator of the PTSD program in Western Australia is just one source.

Causes:

Recurring memories that won’t go away resulting in flash-backs, nightmares and ineffable outrage regarding unspeakable horror memories challenging your most fundamental values.  David Adams refers to it as an idea that hijacked his brain. The “snowflake” of a single intrusive thought, as he puts it, becomes a “blizzard” that “blows the snow into every corner of my mind, and lays down a blanket that muffled every surface.”

Trauma is “like a wound that never heals”.   Freud describes trauma as resulting from any excitations from outside which are powerful enough to break through our protective shield  [and is] bound to provoke a disturbance on a large scale  and set in motion every possible defensive measure.  These defensive measures result in trauma standing outside of memory.  Trauma can be extremely debilitating, often called “nerves” or “shell shock” and is today called Post Traumatic Stress Disorder (Syndrome) PTSD.

Stress can trigger bad experiences from the past.  A sudden change in circumstances now can evoke long ago 'bad memories' so that a person is unable to function normally. Dr. Mark notes that a current event in our lives can trigger an old, unresolved fear and our bodies react with extreme stress – something that can greatly interfere with even vital remembering.4

Reviving painful repressed memories is what Robert Penn Warren calls “picking at the scab of our fate”.   Unless you can cauterise a traumatic experience it can resonate in a debilitating way.

Not necessarily fear of death, rather a feeling of inadequacy; a crippling or debilitating disease for anyone suffering under extreme or overwhelming stress.

Failure to do what you are expected to do – failure to do what you feel you should be able to do. You become deeply ashamed of yourself - a stigma of defeat; an inability to cope.

PTSD is often experienced when someone’s value system is tested.

However, the biggest moment of clarity is when the PTSD sufferer realises it wasn’t that their personal value system collapsed and they no longer care about things, but instead the reason they are so deeply affected is because their value system remains stronger than ever but it was other people's contrary value system.  They are reacting in horror to a situation they have no control over - they feel powerless.

They often push their family and loved ones away because they don’t want to hurt them — not because they don’t love them.  Avoidance is common.

Therapists, Dr. I. Lisa McCann and Dr. Laurie, first discovered the powerful phenomenon of vicarious traumatization well before the discovery of the mirror neurons that explain how it works. 

Ann Pearlman offer the original definition of vicarious traumatization as “the enduring psychological consequences for therapists of exposure to the traumatic experience of victim clients. Persons who work with victims may experience profound psychological effects, effects that can be disruptive and painful for the helper and persist for months or years after work with traumatized persons.”

PTSD is a brutal disorder not only for those suffering it, but for those closest to them.  Many family members, including children, suffer secondary trauma as a result of caring for them.

Moreover, just as fear can interfere with reason in the presence of an imminent threat, it can also exercise the same power over reason in the realms of memory. We mistakenly assume that memory is the exclusive province of reason, but in fact those regions of the brain that give us our capacity for fear have their own memory circuits. Over the course of our lives, we emotionally tag traumatic experiences as memories that are especially accessible to recall—either consciously or unconsciously—and they are constantly being retrieved to guide us in new situations, especially when a rapid response is required.

Normally, when an experience is translated into memory, it’s given a sort of “time tag,” a mechanism that gives us the ability when we recall those experiences to sense how long ago the events we recall occurred and a rough understanding of their temporal sequence. You can sense that the remembered experience was before this and after that. Or that it was ten weeks ago or eleven weeks ago.

However, when traumatic events—those involving anxiety or pain—are stored in memory, the process is different. All bets are off. The amygdala is activated, and that memory is coded and stored differently. In effect, the “time tag” is removed—so that when the traumatic experiences are later recalled, they feel “present.” And the memory has the ability to activate the fear response in the present moment—even though the trauma being remembered was a long time ago—because the intensity of the memory causes part of the brain to react as if the trauma is ever present.

Yet the fear center has incredible influence over the reasoning process and also over the way memories are shaped. As UCLA research psychologist Dr. Michael Fanselow describes, “The available evidence suggests the amygdala learns and stores information about fear-arousing events but also modulates storage of other types of information in different brain regions”

Historical PTSD

Recent research proves that the telling of traumatic stories to those who feel linked by identity  to the victims of trauma—whether the shared identity is ethnic, religious, historical, cultural, linguistic, tribal, or nationalistic—can actually produce emotional empathy.

Throughout the world, stories about past traumas and tragedies are passed down from one generation to the next. Long before television added new punch and power to the ability of storytellers to elicit emotional responses, vivid verbal descriptions of traumas physically suffered by others evoked extremely powerful reactions—even centuries after the original traumas occurred.

In the early summer of 2001, Tipper and Laurie went to Greece. While there, the pope made a historic visit to Greece, and was met with thousands of angry demonstrators holding signs, yelling epithets. They looked into what was going on. The Greeks were angry about something that had happened eight hundred years ago: The Fourth Crusade had stopped off in Constantinople, sacked the city, and weakened it for the later overthrow by the Turks. And they’re angry today, eight hundred years later.

To take a second example, Slobodan Milosoevic´, in the early summer of 1989, went to the plains of Kosovo on the six-hundredth anniversary of the battle that defeated the Serbian Empire  in its heyday. Government spokesmen said a million and a half people came. In his speech, Milosoevic´ revivified the battle of six hundred years earlier. And in the immediate aftermath of that collective retraumatization, a brutal campaign of violent expulsion began against the Croats and the Bosnians and the Kosovars at least in part because there was a vicarious experience of a trauma six centuries earlier that activated in the physical bodies of the individuals present, in this generation a response as if they were reliving that fear of so long ago.

Attempts to revive the trauma of early French Canadiens could be another example.

Remedies:

There are many theories on fixing the problems, some more simplistic than others - all attempt to reach closure

Initially the response was prescribed medicine, however, since the mid 1990’s the prevailing thinking is that drugs make things worse; they may be necessary to control surface anger, but patients who stayed on drugs did not recover.

Some insist the wounds can be cauterised simply by blocking or suppressing them; deal with it, get over it and move forward with your life.  They recommend gathering all relics; photos, documents – evidence, bundling it up and have a public bonfire to get rid of your demons.   In some cases this may work, in others, suppression can develop into cognitive disorders such as paranoia or Schizophrenia.

Mourning or grieving is essential.  You need time to deal with the issues and work through them.  Sharing your feeling with loved ones can be extremely helpful.  

Empathy or exposure therapy was found to be much more effective.  Talking and exposing the root cause to process the trauma does work. The trauma must be confronted and dealt with by exposing it in a rational, non-humiliating and safe environment.

Humour helps to detach you – For trauma carers, Black Humour can assist in dealing with horrific, tragic situations.

Writers vent by expressing their anguish, get it out into the open.  Severe sufferers refuse to talk about it and it festers.  Writing about it and empowering yourself to fight the cause can provide greater therapy than private quiet grieving and brooding.  

Coleridge addresses venting in the most famous poem in History; The Rime of the Ancient Mariner.  The Mariner seeks solace and closure through compulsively retelling his tale to any who will listen to gain relief or expiation.

Aristotle considered tragedy as therapy.  Pathos, arousing pity and fear and leading to Catharsis; a purgation of the soul, Aristotle asserted that Drama allowed the spectator or audience to participate in great events vicariously resulting in a Cathartic cleansing or purging of the soul/spirit.

Franz Kafka suggests  "Writing should be an axe for the frozen sea inside us".  

Confessional poets like Robert Lowell and Ted Hughes found venting their anxieties releasing;  Hughes' Private Letters indicate his motives and therapeutic effect:   ‘I’m not sure the effect of writing the poems isn’t just too raw’;   at the end of the Birthday Letters project: It was so great, I was sorry I hadn’t done it before. Writing released a bizarre dream life, and I realised how much had been locked up inside me.   I hope each of us owns the facts of her or his own life,” Hughes wrote, in despair, to London’s Independent newspaper in 1989 after someone had chiseled his name off Plath's gravestone.  This question is, who “owns” truth?

In Lady Lazarus and in  Daddy,  Silvia Plath uses her writing as therapy; by a frank and full admission of her pain she is hoping for some cathartic release of tension and an exorcism of the demons that haunt her. 

Emily Dickinson’s poems, intensely emotional, yet never dissolving into sentimentality, reveal a troubled soul searching for understanding and acceptance; a need for posterity to recognise her achievement. 

Another writer who used writing as an attempt to address inner turmoil is Zelda, wife of F. Scott Fitzgerald, commenting on the disintegration of their marriage: "To right myself, I write myself."   Writing is an escape into the depths of my imagination."  

Kathy Lette claims she writes because "it's cheaper than therapy".  Perhaps more effective?

PTSD can be treated if it is addressed at the appropriate time and done sensitively taking cognizance of individual situations and needs.


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