PTSD and You: 5 Considerations
by Peter Goetz, MFT
PTSD as an acronym has come into common usage to name the experience of strong emotional, memory and bodily responses to stressful life experiences. I've heard people say 'my PTSD is active' and as an organizing principle, this can help explain a complex interlocking set of strong reactions. It can help contextualize experience rather than having no framework to hold their intensity and immediacy. But what does it mean? To say that PTSD is active might help name experience but it gives scant clue to the unique form and shape of it, the organization of this syndrome so keenly felt.
Backtracking, PTSD is an acronym for Posttraumatic Stress Disorder, a psychiatric diagnostic category originally developed to describe and name the debilitating and life altering changes that returning Vietnam veterans routinely exhibited. As time went on, it was broadened to include trauma stemming from sexual abuse and then expanded again to include individuals who had experienced severe stress or trauma to the degree that a pronounced residue of memory, strong emotion, or distorted self beliefs remained. These residuals have become the symptoms of PTSD. These symptoms are not felt so much as they take over an individual.
PTSD is event based; something has been perceived, seen or directly felt that is gauged to be life threatening or profoundly impacting to the individual involved. Symptom clusters of PTSD generally fall into 3 groups.
- Traumatic events are re-experienced in the form of recurring, intrusive recollections or dreams leaving the individual sensing or feeling like the traumatic event was recurring. There may be intense distress or activation to cues resembling aspects of the traumatic event.
- Avoidance of anything such as feelings, thoughts, activities, or places associated with the traumatic event along with diminished interest in significant activities and relationships. Restricted emotional responsiveness including numbing is often present.
- Increased arousal whereby people sense an on-going vigilance, with difficulty concentrating, irritability, anger outbursts or difficulties with sleep.
As diagnostic criteria these provide a window into the full bodied experience of the dysregulation, the time, reality and identity distortions arising from the after-effects of trauma especially through its chronic and repeated forms. PTSD is more pronounced and longer lasting when the traumatic incident is of an interpersonal nature. The imprint of something done to you by another person is more impactful than, say, a natural disaster or chance accident.
Not all emotional or mental distress, of course, is trauma based. There are many routes of how we come to form mental models for ourselves that are restrictive, pained or deluded. The usefulness of naming PTSD as an organizing principle lies in the formation of a cognitive map of after-effects of traumatic events. As such, it can help name and shape experiences that up to now have felt formless, wordless but palpably real. Below are 5 areas of experience, both internally felt and externally seen. They may help in seeing how PTSD as an organizing marker might be relevant to you.
1) "You should be over that by now!' When people recount painful, confusing life experiences they usually respond self critically for not having gotten over it but such a dismissal also effectively shuts us up (and shuts us down) by keeping memories sequestered to themselves. Listeners dismissing concerns with 'are you still upset about that?" are signaling they don't grasp the full-on impact of an event. If an individual isn't over something in their past, there's probably good reason; neurologic, cognitive and emotional systems are at play in keeping it all alive. Trauma persists because our nervous system doesn't come to a natural resolution of the activation waves that come when we feel we're under threat.
2) Vigilance. As mammals we're wired to detect danger in subtle, overt and hidden ways. Outside of awareness, we strategize escapes to life threatening situations and to carry on - along with our brood - with the continuity of normal life. Survival above all! When we're always looking for danger, there may be more going on than being 'wired a little tightly' or being 'on edge' a lot. Our nervous systems are wired to be on the lookout and as such they're providing a protective function for us. We may not know just what we're feeling under threat from but our bodies keep the score*. Residual trauma which we know as PTSD can function outside the realm of thought and awareness. Somatic sensations are unformed feelings and as such function as a communicating language unto themselves.
3) Overwhelm. PTSD overwhelms our ability to adapt to changing life conditions. When we encounter stressful, challenging demands, we optimally adapt as needed, making micro adjustments here, there and naturally return to a homeostatic state after a stressful situation has waned. This internal self regulation system is disrupted by PTSD where we are flooded by thoughts and feelings that are not merely something that occurs to us but can feel like we're being taken over by them. The anxiety and panic that can come with this speaks to the first cluster grouping of PTSD diagnostics listed above but with an add-on. When overwhelmed, we may re-experience painful events from our past. In that preoccupied state, we have restricted ability to respond to life fully now - in present time - with its constant changing conditions.
4) Reactivity. When people are in the grip of PTSD, they react, they don't respond. Reactivity is impulsive, a knee jerk, something that often requires correction or revision, be that vast or subtle. Reactive mode often comes with a low level of irritability. What, this again? may be the mode of mental operation. Reactivity can be seen as a compass that has been shaken; PTSD throws off our ability to flexibly right our responses to life. PTSD also sensitizes us; smaller stimuli will elicit larger responses. Reactivity functions defensively; to the extent that we're overwrought against pain or the unfamiliar, we're restricted from sensing what's in front of us now.
5) Hunkering down, drawing into oneself. This is self protective. Trauma restricts our field of consciousness. The pull of the mental preoccupation of unresolved trauma is in and of itself restrictive. This hunkering down may appear to observers to be a state of stillness, of quiet with not much (visibly) going on. Internally, however, it's a different story. There can be intense activation, with elevated blood pressure and heart rate, a sense of heat and racing or looping thoughts. This is in essence a mode of conservation, whereby energy is being stored, perhaps frozen, but certainly not available in present time. There may be a stubbornness to hunkering down, of unwillingness to move from some given position. Or not. If this is driven by PTSD, hunkering down comes when initiating any action simply doesn't work or is deemed too dangerous to try.
Most of us come by our life problems honestly. We live with and are shaped by what we've experienced. PTSD is by nature and definition a syndrome that arises after (as in post) a stressful or traumatic event occurs. Its myriad forms of presentation can mask its source, can make our experiences seem derivative of something else. For people living with PTSD symptoms, life can be confusing, with personal problems seen as character flaws or the response of just being crazy vs. understandable responses to the body-mind reactions that point back to traumatic experiences from our past. With a widened perspective can come new understandings and the options stemming from them of choice, for ourselves and others.
*Thanks to Bessel van der Kolk for coining this phrase as the title of his article 'The Body Keeps The Score' (1994).
Peter Goetz (c) 2013
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