Post-Traumatic Stress Disorder

– by Lee Smith, Ph.D.

Take a deep breath…

The profoundly dirty secret came out recently that upwards of 1000 U.S. Veterans attempt suicide every month. Post-Traumatic Stress Disorder (PTSD) and inadequate help are frequently a part of their misery. This tidy label, PTSD, references the horrendous human burden and infinite complication caused by witnessing and suffering the worst depravities on the surface of our planet – not only in war but at home, school, work.

The forms of trauma are as varied as life itself, including natural disasters through to interpersonal assaults. Physical, sexual, emotional and verbal abuse, accidents and injury, sudden loss, bullying, harassment, betrayal, rape, genocide, terrorism, war – it’s quite a list. Age, severity, frequency, history and variety of traumatic exposure, and interpersonal complexities all matter. Falling down the stairs is far more traumatic if you were pushed. Some victims marinade in abuse.

And much more happens psychologically in the injury from trauma than some recording of the event itself. The fact is, trauma may lead to a whole range of adjustment problems affecting our behaviour, emotions, thinking, relationships, physical health and life-course. Because everything is always unique about trauma, in that each unique person with their own unique history experiences some unique trauma in their own unique way, the impacts are personal and highly variable. Nonetheless, there do exist general similarities across sufferers.

The tidy list of PTSD symptoms includes (a) unwanted memories of the trauma popping up anytime, (b) our bodies leaping into stress reactions and living lodged in emergency mode, and (c) avoiding anything that might cause (a) or (b) to happen, including our own memories. And life is clouded with uneasiness, all the time. Even when the mind is asleep traumatic memories commandeer our dreaming and physiology. Trauma can relocate your mind and body to a world of felt threat, emergency and despair.

Our recall of our life is most typically an uncomplicated thing. Watch as you answer this: What did you have for breakfast this morning? You’ll probably notice that you had a feeling of recalling, and that what you recalled included images and details about which you could talk for some time. These kinds of autobiographical memories are also tagged by the mind-brain with a sense of person, place and time. No one could convince you that that breakfast actually happened yesterday or at some other location.

In contrast, emotional or traumatic memories are felt and relived more than recalled.

Let’s imagine taking a veteran of, say, the Vietnam war with us for a summer hike in Algonquin Park. What might our friend experience and do? He might just freak out in response to the dense foliage, the lack of sight lines, the felt sense of mortal vulnerability from possible traps on the trail and threats in the greenery. The experienced threat doesn’t match the ‘real’ risks in the park, but instead reflect the emotional memories that flood in from another time and place, inappropriately.

Unhealed trauma means that the mental tags for place and time are unborn. The neurobiological underpinnings of healing ultimately place trauma in our past, to great relief.

Healing trauma is complicated in part because of the immediate bind between undesirable alternatives. It is our tendency to avoid unpleasant things, which include terrifying memories. I like the metaphor of dealing with slivers. Avoidance, just leaving the slivers (horrible memories) in your arm alone and wrapping them up in dressings (avoiding any reminders), perhaps with some nice local anaesthetic like xylocaine (beer, doobies), gives immediate relief. After a while of one-armed living, punctuated by explosions of pain should the slivers get bumped (reminded), life lectures us that the only wise course is to have the slivers out (to face the memories).

Our incredibly associative mind-brain is a medium for the subtlest of triggers for traumatic memories, jumpy-startle and threat-based anger. Every moment can be seen through a lens of dread, with the threat feeling as real as real can get. And it’s so subtle and so unconscious.

Trauma victims may be touched by literally hundreds of thoughts and things each day that prick a memory, sending the mind spinning, the body bolting and life to the crapper.

I was recently talking with a Veteran of many tours, including Bosnia, and his wife about PTSD and these qualities of emotional memory. His wife then connected how he was unduly upset by his present-day neighbour’s unkempt lawn with the once mentioned threat of hidden landmines on tour. Bingo! When our mind connects these dots, relief follows because the connections are now seen, their origins located in time and subject to management.

Unfortunately, we don’t have any anaesthetics for emotional pain. Skillful courage and skillful support and skillful help to face and open up to past trauma are the right ingredients to heal trauma’s injuries. Talk about easier said than done! But suicide and the many other forms of avoidance are not the way.