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PTSD: The pain of reliving trauma years after the event

126695042 300x246 PTSD: The pain of reliving trauma years after the eventOne of my first experiences of PTSD came as a psychologist working with African and Kurdish refugees.

Many had fled oppressive regimes and been referred to our service by their GP suffering severe anxiety, depression and stress. We discovered the root of the problem often lay in terrible personal experiences including rape, torture and witnessing the murder of loved ones.

These mental scars have a long and insidious reach in the shape of PTSD whose victims can repeatedly relive a traumatic event years after the original incident took place.

I remember my shock the first time I worked with a woman who, as she described what had happened to her, lost all sense of where she was. She verbally and physically tried to fend off an imaginary attacker as well as crying and shaking with fear as part of her episodic ‘flashbacks.’

The problem can be complicated by people having great feelings of shame and guilt about what happened as if they were somehow to blame. PTSD’s victims can also include perpetrators of violence who, on reflection, feel enormous regret for their actions.

Soldiers are the most high profile casualties of PTSD but it is even more prevalent among the civilian population.

It can affect anyone involved in a near death experience and includes ‘single incident’ traumas, such as a car crash, earthquake or tsunami.

The recent sinking of an Italian passenger ship that made headline news is another example as were the terrorist bombings on London’s transport network.

It’s important to recognise that PTSD symptoms are a perfectly normal part of the healing process when they occur immediately after a trauma. Our mind is often too pre-occupied with survival to process what happened at the time so revisits the experience helping us make sense and gain perspective on what happened. In the normal process of producing memories the mind knits the various strands of an experience together based on our senses, such as sight, sound, touch and taste as well as other aspects of what we were experiencing at that time.

It also puts a ‘date stamp’ on the memory so we know when and where something has happened. When a trauma is occurring the mind is using all of its energy to keep us alive so memories often don’t get properly formed.

In the hours, days and weeks following the trauma bits of the semi-formed memory will ‘pop’ into consciousness. This can be upsetting but gives the mind the opportunity to link the various fragments together to form a normal memory.

In cases of PTSD, the healing process effectively gets stuck and, like a scratched CD, the mind repeatedly replays the trauma.

This produces a vicious circle in which the distress generated by the memories continues to stop the brain’s ability to process the memories to a level that they cause less discomfort. As a result, patients find themselves vividly reliving the experience over and over with the same intense feeling of fear they experienced during the original incident. These ‘flashbacks’ can be triggered by something that the victim associates with the original trauma, such as a sound, colour or smell.

Sensory triggers can create powerful positive and negative anchors in our minds. You could be having a bad day at work when an old friend rings and your mood switches in an instant because the sound of their voice triggers a past association of feeling good. Likewise, hearing a favourite song on the radio often makes you feel better because you associate it with a previous experience of wellbeing.

This is also true of traumatic experiences, particularly when the ‘date stamp’ has not been associated with the memory so rather than being reminded of the events it can feel exactly as if they are happening again.

A refugee suffering PTSD may link the sound of footsteps echoing down a corridor with those of events years before when their protagonist came to torture them. The smell of burning rubber and smoke may bring back the experience of watching the family home burnt to the ground by soldiers or a family member killed in front of you.

PTSD creates a vicious circle in which the distress caused by the partially formed memories stops the brain from processing them to a level where they are less intrusive. This round-robin can lead to a number of associated conditions including anxiety, depression and stress as well as ‘avoidance’ where someone will increasingly isolate themselves to avoid triggering a flashback.

Flashbacks or vividly ‘re-living’ aspects of past events are one upsetting response to trauma. Another is ‘disassociation’ where the victim’s mind psychologically removes them from an experience. This can be emotionally protective at the time but if this dissociation happens when memories of the trauma are triggered it can be hugely upsetting and disruptive to normal day-to-day life. People experiencing this can often ‘lose’ pieces of time from their day and have no recollection of what happened to them unless someone tells them.

In our clinical work we tend to see this type of response in people who have gone through repeated trauma as a child, such as prolonged periods of sexual or physical abuse.

You can imagine that to ‘remove’ themselves mentally may be the only way that a child is able to escape what is being done to them. It serves to protect the child when nothing else can but also leads to problems later in life.

Medication can help reduce stress in some patients but the main treatment for PTSD is a ‘talking therapy’ in which the patient works with the therapist to help their mind find a way process the bits of trauma memory in a more complete way.

A number of question marks remain. Why are some of us more resilient to the effects of PTSD than others? And what role do the corrosive effects of guilt, grief and shame have on recovery?

It is an often distressing area to work in as a therapist but also incredibly rewarding in helping patients first understand what is happening to them and then interrupt the cycle of PTSD symptoms.

It is, for some, the start of the long journey back to more ‘normal’ day-to-day life helping them regain control over aspects of their lives they thought they may have had lost forever.

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  • ScrapPaper

     This is interesting, though it assumes one can remember the trauma. Many can’t, for various reasons.

  • http://www.facebook.com/thetroubledtroubador Gary Ukulele-Rudd

    I agree with ScarPaper. This article – which uses the term ‘brain’ and not ‘mind’ – is entirely theoretical. To experience PTSD from the inside, and not as an observer, is to relive physical experiences – such as hyper-acuity, such as that experienced in the near-death experience; elongation of time and profound sensory experience – but triggered by un-related stimuli – such as stressful moments, conflict, and actual threats of a non-existential type.
    The result is that one’s entire organism returns to a fully-stressed condition, appropriate perhaps to the former life-threatening incident, but maybe not to the bullying, hectoring colleague, or the indifference of a call centre advisor who refuses to listen.
    The body’s responses are unable to differentiate the level of danger and so simply revert to red-alert!
    In my experience, the error that psychologists – and this article – make is in their failure to differentiate the causes, unknown though some of them may be. One cannot compare the trauma of watching, or experiencing, torture to a high-speed head-on car collision. Unless of course they would offer the same therapy for someone with erectile dysfunction with another’s arachnophobia.
    Yes, the brain is the organ within which the psychological complex is contained, but the program is fundamentally different.
    The writer seems also to ignore the potential differences experienced in terms of gender and race, which we all know are tremendously different programs.
    I despair when I read articles such as this which are dumbed-down to encourage people to believe a ‘cure’ is possible, It isn’t. One simply has to accept the fact, rather like an amputated limb, and adapt to the terrain of one’s mind, not brain!

  • http://www.facebook.com/thetroubledtroubador Gary Ukulele-Rudd

    It may be easy, but that doesn’t mean it is plausible. Believe it if you want but as someone who has lived with PTSD for over 20 years I suggest a reality check. It’s nonsense.

  • http://www.facebook.com/thetroubledtroubador Gary Ukulele-Rudd

    There is no ‘normalcy’ of PTSD, which is why this analysis is so deeply flawed. You clearly have no ‘experience’ of PTSD. Watching is not experiencing.

  • nerdic

    ScrapPaper ,

    Yes. The NHS is/has-been introducing a fair few options for the treatment of PTSD. I received most excellent assistance in this regard from the NHS for the treatment of PTSD. 

    I’m very grateful for the cognitive behavioural therapy (and some others too) that I received from the NHS (they rock in fact). The treatment has given me more ways of dealing with the, frankly, annoying hard presence of some moments of caring for my then wife, before she passed on from complications due to a 4 year leukaemia fight in our early twenties.

    I wish I’d sought help out at an earlier stage, but I was too wrapped in a seemingly cosy agony blanket at the time. So it goes.

    As this article correctly portrays, I felt enormous guilt, irrationally blamed myself for her death and relived scores of not-so-nice moments watching her erode in anguish. Those moments inserted themselves at irregular but frequent moments. I could not get past it (and felt like I didn’t want at the time either). I most especially blamed myself for surviving her & had classic survivor guilt to be sure.

    I would hallucinate the sounds of telephones, lots of different smells, my wife holding my hand and see ‘numbers’ at totally rational and lucid moments (those moments made me rationally curious about them & I could easily describe them to others at the time). I still dislike classic telephone noises to this day, but they no longer slide me into depressive sink-holes like they used to. Thank god for MP3 ringtones say I.

    Normal everyday things (reflections on windows, particular brands of shoes, episodes on television – literally anything) could trigger those moments. I spent a long time thinking I’d just avoid those things, but there’s too many and any human cannot know them all in advance.

    In dreams, I’ve been visited by the dead, shown the afterlife, scolded by my dead wife, been repeatedly shown where I went wrong etc… My atheism has never wavered though. How many people do you know that are staunch atheists who can, hand on their heart, draw an afterlife that truly doesn’t exist, whilst laughing about it? Go chat to some soldiers perhaps…. I’m guessing they’ll have similar thoughts.   { btw, If you’re interested in an afterlife that doesn’t exist : I’m afraid to tell you that we all have to go and do chores as gardeners, on our own, for all eternity, on alien planets that catch our shooting star escaping comet-souls. Tough luck. Chin up. Don’t let the little ones know.}  lol!. PTSD is a funky, vivid, beast. Like William Blake without the cuddles.

    When compared to soldiers or the recipients of violence at the hands of others, either sustained or at ‘the wrong age to deal with it at all’, I feel I have not had that severe a time with handling PTSD. My heart seriously goes out to those folks (I’ve had PTSD ‘lite’, if you will).  If you know any of them, tell them it’s not their fault and that they’re reacting as anybody in that situation would – even if you don’t believe that.

    Though be careful, I *hated* being aware that someone else was aware that I was hurt or hurting. And I mean *really* hated it. I could fuel my sad, melancholic or angry reactions with the fuel of grief and would often ‘lens’ it upon those who were getting too close for my comfort at the time.

    PTSD costs its owner in terms of socialising in no uncertain terms.

    I was ‘extremely’ prone to avoidance and wishing I wasn’t present frequently, in terms of conciousness. I’d use any instant distraction available. Self medication figured highly, though alcohol made my moods much worse, I still consumed it (along with a shed load of pot). I no longer self medicate more than my friends (far less in fact) & that’s due to receiving professional help.

    One of the worst thing about it for me was I saw death, misery and destruction in *everything* I looked at. A pleasant walk in the park would be about spotting how many homeless looked hungry. New parents’ jubilations were ‘naive’. Listening to politicians would be to try & equate how many people they just got killed. Life was suffering and existentially pointless and my PTSD helped me revel in that. 

    There’s an upside to PTSD though (for me anyways)…. One of the benefits was that I’d lock onto non-destructive behaviours that I enjoyed and not do much else. One was to study and practice at my chosen profession until I was much better at it than I ever would have been otherwise… I’ve also learned more about myself than most my age seem to be aware of the need for. It’s an odd privilege I wish upon nobody. Die naive if you’re lucky, but don’t be proud of naivety either.

    I don’t feel sorry for myself about experiencing PTSD in the grand scheme of things – it’s just one of those things. Some people hurt others, or die trying to help, for example (both of which would be much more complicated to get past)…. Though I’m saying that with more hindsight than in the past of course (^_^). At the peaks “itwereshite”.

    With help, you can actually start to actually feel lucky that you both survived those terrible moments and are present and lucid enough to help others at key moments thereafter, having learned more about yourself and the baselines of existence than you would have otherwise.  You can enjoy more and more moments in the ways you perceive others to. Groovy.

    I’m also aware that the term PTSD is just a name for a model that people smarter than myself have created. The map is not the mountains that it represents and all that, yet the NHS’s therapy has helped me as much as I allowed it to, which luckily for me was ‘quite a bit’. 

    I said to my therapist on day one, “I’m not depressed, I depress others….” It turns out, I was wrong at the time on both counts, despite believing that for 14 years. So it goes.

    The NHS is the finest concept Brits have ever devised, please elect people who respect that next time. Thank you.

  • nerdic

    Hola Gary,

    I respectfully disagree good sir. Please read my (overly blooming long) post above & if you feel like it, might you care to explain why you think the article was deeply flawed? or was it Rebecca’s response you’re referring to?

    AS somebody who had lived with PTSD for over 12, untreated, years (and 5 massively improved years, post treatment), I think this is an excellent article with regards to explaining i) how common it is and ii) what it involves.

    PTSD is normal in my opinion. Anyone can get it and it’s very common.

    I suspect you’re deriving a different meaning to the word ‘normalcy’ than Rebecca’s use of it? Which is absolutely fine. I’m genuinely, non-judgementally, interested in hearing why you think Rebecca and the article are wide of the mark. 

    I have a shameful pride in enjoying different perspectives, so don’t think I want to debate you about it, I don’t. I’m simply and respectfully curious.
    :)

  • nerdic

    Simon,

    Those are extremely naive things to write. They are also insensitive and rude. 

    So ner.

  • nerdic

    Gary,

    Respectfully. I’ve had it too for a long time. Your, frankly, angry replies remind me of me when I perversely enjoyed wrapping myself up in the ‘agony blanket’ of reliving the cause. ie when I was suffering the peaks and troughs of PTSD.

    I tried to get help twice. The first time I wasn’t ready for it. I had a support network that I relied on (to their cost and mine). The second time I was by myself and desperate for something to help me… so when I went along to the exact same treatment and (bravely) opened myself to it (instead of fighting it off), amazingly it helped. It helped because I helped myself.

    During the years (and I believe it gets worse over time, not better) I revelled in it I was like Kilgore Trout from Kurt Vonnegut’s novels. If anybody tried to pry inside too close for comfort, I’d react like Kilgore… I’d shout ‘Get the fuck out of my body bag’.

    I’m not suggesting you’re in the same boat (most PTSD sufferer’s seem to have had far worse experiences than I, so I’ve only limited empathy and a crap load of sympathy), yet hostility to others who talk about one’s PTSD is all too common – it certainly was for me (and still is sometimes of course).

  • nerdic

    Sounds interesting for sure (though hypnotic states are pure myth. Feeling relaxed perhaps??).

    May I suggest folks seek Cognitive Behavioural Therapy as a course of treatment. It’s one of the few therapies that actually exposes itself to independent scientific measuring processes and regularly alters course based on collective studies. Science is everything when being treated for something.

    C.B.T. helped me with PTSD in no uncertain terms, though only the second time. The first time I went I wasn’t really wanting to let go of the familiarity of it all, so the therapy didn’t help. You’ve got to want to change and all that…

  • milesinnz

     

    This explanation is simplistic and
    deals primarily with the very “traditional” view of PTSD.
    Trauma is often much more complex than this. Therapists often have a
    view that the patient needs to “revisit” the trauma to
    “re-associate”… If you read the research done on Rwandan
    refugees, the evidence is that re-telling the traumatic event makes
    the trauma worse. One needs to consider how malleable “memory”
    is and the re-attachment of emotions to events. It is a reality that
    there is a real danger that those emotions in the process of
    re-attachment can become overwhelming, even to the extent that those
    newly attached emotions are out of context to the actual event. Also
    the context of the trauma is important – is the traumatised person
    part of a group of similarly traumatised people? Is the trauma a
    repeated event over many years? There is a social dynamic involved.
    There are also social consequences to trauma in earlier years that
    then compromises later years. A patients realisation of losses as a
    result of traumatic events in which they were very much the victim
    can lead to grief of what has been lost and anger at what has been
    done to them. Most often the best therapy is to create a new and
    meaningful life whilst acknowledging how your reactions to current
    events have been impacted by your past experiences.


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