Post-traumatic stress disorder, or PTSD, is a new name for a very old condition. It is increasingly important that we have a clear understanding of the condition to be able to recognize it, and assist those suffering with it to access appropriate treatment.
My grandfather came home from World War 1 suffering from what was identified then as “shell shock” or “battle fatigue.” Before then, it had no name, even though the symptoms were described graphically as early as the 17th century. But even though it affected him for the rest of his life, it was something that was never talked about, a hidden family secret, as if it was something to be ashamed of.
Subsequent studies have shown that “shell shock” was actually PTSD, which research has indicated was not connected to pre-existing mental health issues or family instability, as had previously been assumed. The real reason was the degree of exposure to combat, and the amount of stress to which the soldier had been subjected.
In PTSD, a witness or victim of a terrible event or tragedy is so haunted by memories of the event that personal health and personality is affected.
The clinical diagnosis of PTSD depends on meeting the following criteria:
- You have been exposed to a traumatic event involving actual or threatened death or injury, during which you responded with panic, horror, and feelings of helplessness.
- You re-experience the trauma in the form of dreams, flashbacks intrusive memories, or unrest at being in situations that remind you of the original trauma.
- You show evidence of avoidance behaviour, such as a numbing of the emotions, and reduced interest in others and the outside world.
- You experience physiological arousal, as evidenced by insomnia, agitation, irritability or outbursts of anger.
- The symptoms have significantly affected your social or vocational abilities or other important areas of your life.
The kinds of events that can trigger PTSD were traditionally limited to the most violent and frightening situations, such as being involved in a plane crash, a shooting, or the collapse of a building after an earthquake or bomb. The main source of such trauma is war, and much of what we know about this syndrome comes from studies involving former soldiers. The largest category of PTSD sufferers is Vietnam War veterans, although participants in more recent conflicts of all nations are seriously affected by it.
More recently, however, the definition has broadened. People who suffer rape, physical or sexual abuse may react in much the same way as those who have witnessed carnage or been threatened by violent death. In this context, PTSD among children has become a major focus because they are particularly likely to develop the symptoms associated with this condition. Research suggests that as many as 10% of the population will be affected at one time in their life with PTSD.
- The most noticeable signs in a person suffering from PTSD are introversion and joylessness. People with this syndrome are unable to take pleasure from things they might have enjoyed in the past. They avoid the company of others and become generally more passive than before. They wish to avoid anything that will trigger memories of the traumatic event. A person with PTSD might drift out of a conversation and appear distant and withdrawn. This is a sign that unpleasant memories have returned to haunt them.
- Having trouble sleeping is almost inevitable in this syndrome. Nightmares are common, and as a result sleep is often disturbed, yet those dreams may not contain anything that’s obviously related to the original traumatic event.
- Psychiatrists speak of three symptoms that define PTSD, namely intrusion, avoidance and hyper arousal. Intrusion is the inability to keep memories of the event from returning. Avoidance is an attempt to avoid stimuli and triggers that may bring back those memories. Hyper arousal is similar to jumpiness. It may include insomnia (trouble sleeping), a tendency to be easily startled, a constant feeling that danger or disaster is nearby, an inability to concentrate, extreme irritability, or even violent behaviour.
- Depression is very likely to go hand in hand with PTSD, and in severe cases, suicide is a real danger. Some might say that suicide is the ultimate expression of unresolved PTSD.
As the initial shock subsides, reactions vary from one person to another. The following, however, are some typical responses to a traumatic event:
- Feelings become intense and sometimes are unpredictable. You may become more irritable than usual, impatient and restless, and your mood may change back and forth dramatically. You might be especially anxious or nervous, and feel depressed.
- Thoughts and behavior patterns are affected by the trauma. You might have repeated and vivid memories of the event. Even if you were not there, you IMAGINE what happened. These flashbacks may occur for no apparent reason and may lead to physical reactions such as rapid heartbeat or sweating. You may find it difficult to concentrate or make decisions, becoming easily confused. Sleep and eating patterns also may be disrupted.
- Recurring emotional reactions are common. Grief comes and goes. These “grief attacks” can be triggered by many different things. Anniversaries of the event, such as at one month or one year, can trigger upsetting memories of the traumatic experience. These “triggers” may be accompanied by fears that the stressful event will be repeated.
- Interpersonal relationships often become strained. Greater conflict, such as more frequent arguments with family members and co-workers, is common. On the other hand, you might become withdrawn and isolated and avoid your usual activities.
So, there is the problem. Part of the difficulty with the solution is that we live in somewhat of a macho culture that expects the strong to be strong, regarding an inability to cope with even the most horrific experiences as a sign of weakness. In our western culture, the “suck it up” factor still exists. Consider the following comments from soldiers with PTSD:
“I didn’t want colleagues looking at me and saying, ‘I came back and I’m OK. What’s wrong with him? He’s weak, or he’s crazy, or he’s just playing it up.’”
“One thing nobody mentions is the post-traumatic stress, but we all have it. It’s like luggage and we have it forever. The actual event was over in minutes but the effect was a hell of a lot longer than ten minutes long. It is like I am experiencing it over and over and over again.”
“I didn’t talk about it because I didn’t want to replay it. I lived it. I didn’t want to relive it.”
Sadly there is still a stigma for people who are dealing with coping difficulties after a trauma. The mantra seems to be “If you don’t see it, you don’t understand it”. If it is a physical injury, you can see it, but those who have “invisible wounds” … for them it can be even more difficult. Such injuries in their minds or in their inability to cope which we do not understand, sadly allow so many people suffering with them to fall through the cracks.
The only way we can determine whether the person is coping or is in crisis is to find out from them. They need to tell us. We then need to understand the reasons why this person has been overwhelmed by the event and help to restore and rebuild their coping mechanisms so the crisis can be resolved.
But therein lays the problem! The ordinary response to atrocities is to try to banish them from consciousness. Too often in the aftermath of such events, secrecy prevails. Some situations seem too terrible to mention or even utter aloud, and this is the meaning of the word “unspeakable”.
However, atrocities refuse to be buried. Almost as powerful as the desire to banish them from our thinking is the realization that denial does not work for long. Survivors challenge us to reconnect fragments, to reconstruct history, to make meaning of their present symptoms in the light of past events. This is about the power of “speaking the unspeakable”.
The main psychological treatment to treating PTSD is cognitive-behavioral therapy. This means examining the thought processes associated with the trauma, the way memories return, and how people react to them. PTSD sometimes fades over time, even without treatment, and the goal of therapy is to accelerate that natural healing or forgetting process. Because the horror may fade over time, being confronted with memories of the trauma when in a safe situation may help a person over time to become less frightened or depressed by those memories.
“As difficult as it is, a tragedy sometimes allows you to see that there is something incredible inside all of us. When, in the midst of pain, you reach down deep inside yourself, you become much more than you think you are. More than you could ever imagine possible. You survive.”