WHAT ARE POST-TRAUMATIC STRESS REACTIONS?
Post-Traumatic Stress reactions start with a traumatic stressor "outside the range of usual human experience and that would be markedly distressing to almost anyone," according to the American Psychiatric Association's Diagnostic and Statistical Manual, III-R. Since it is almost impossible for a non-survivor or a numb survivor to understand or imagine what the survivor experiences at the time of the trauma, and therefore to identify what is traumatic, the DSM III-R offered four categories of traumatic stressor for diagnosticians and therapists:
(1)-threat of death or loss of physical integrity to the survivor (combat, rape, incest, earthquake, etc.)
(2)-death, threat of death or loss of physical integrity to family or close friends (survivor does not have to be present)
(3)-sudden loss of home or community, and
(4)-seeing another person who has recently been seriously injured or killed.
These were derived from reality: real nurses and body-baggers had terrible PTSD just like combat vets, rape and incest survivors, and people who lost their homes in fires or floods, or lost their kids on Flight 103 over Lockerbie.
As a person is traumatized, at least for the first time, (Many trauma survivors have multiple traumas.) the sense of personal safety is shattered. Two things start to happen immediately. The person will strive to survive using three available systems: fight, flight or freeze. What they called the reptile brain in high school biology seems to take over and choose. Military training is designed to get soldiers to always choose fight, but they wouldn't have to train us to do that if we were natural born killers. Culture and religion often train women to freeze, to take it and endure. In nature, flight is most common.
Simultaneously, while survival is at stake, feelings will shut down and information taken in and processed will become very focused so the person can do whatever it takes to survive.
Whatever it takes! This is not a polite, well-behaved part of us. It p*sses and sh*ts in its fear. It scratches and bites and goes berserk, beating people to death with the rifle-butt when the bullets are gone. It kicks and gouges. It runs out on its friends, trampling whoever gets in its way. It cowers, unable to get up or to fight, unable to protect those it loves. It may freeze or follow orders that are against all the survivor personally believes in. Survivors may feel shock or shame over what this part of them did.
Let me emphasize something: this ability to do whatever it takes to survive is God-given or evolution-given, depending on your point of view, but we all have it, and in traumatic enough situations, it will come out or we die. Extreme situations which trigger this reaction again and again may cause survivors to do things in order to survive which can be hard to look back on later.
This survivor part of us is not able to listen to "reason" either. It is going to be looking for danger from now on whether or not others think it is reasonable.
Real physiological changes occur in the brains of survivors which make them quick to react. In order to live through the trauma, survivors may develop the capacity to go from fine into a killing rage in seconds. That helps them live. They may stop sleeping soundly. Sleep can get you killed. Survivors may be uncannily able to read the moods of those around them because the moods of their abusers defined their lives. They also become hypervigilant, searching for physical danger all around and all the time. Due to hypervigilance and lack of sleep, it is hard for them to concentrate on everyday things. They may do poorly in school and believe they are stupid when what they have is a symptom of PTSD. Survivors react faster and more completely to sudden noises. These are lifesaving skills as long as the survivor is still at risk, still in combat, still living with the batterer or the molester, still living in the bad neighborhood, the bombed city. These are reality based, effective survival skills. They keep you alive.
They don't go away by themselves.
Similarly shutting down feelings in order to do whatever it takes to survive, or do your job and help others survive, is a reality based survival skill. If you sit down and cry in combat you will get killed. If you keep screaming while Daddy hurts you, he may kill you. If you cry in the aid station or emergency room, you won't be able to save as many lives. Numbness is the answer. It is effective. It will help you live. It will help you keep others alive.
It doesn't go away by itself either.
Unfortunately when survivors numb fear, despair and anger, all their feelings, even good ones, are numbed. Numbness is comfortable. Thinking about what they have been through is so painful survivors wind up avoiding thinking about, feeling, or doing anything that reminds them of the trauma. For example, if they feel the trauma was their fault they may spend the rest of their life having to be right so they won't ever be at fault again. If they were happy when the trauma hit, they may avoid happiness forever. If they lost those close to them, they may give up closeness.
Most trauma survivors do not know anything about PTSD, so instead of seeking help, they will turn to whatever is available, self medicating to maintain numbness. Addictions and compulsive behaviors often are rooted in attempts to numb the thoughts and feelings associated with trauma. Until recently, a diagnosis of alcoholism or drug abuse made the effects of trauma invisible: because he's (or she's) an alcoholic, alcoholism is the cause of all these problems so he (or she) can't have PTSD
"Inability to recall important aspects of the trauma," is another of the ways avoidance and numbing may work. This means the person cannot remember exactly what happened. Many trauma survivors forget in order to survive. This is well documented in the scientific literature for combat veterans, torture survivors, battered women, child sexual abuse survivors, natural disaster survivors and others, as well as in personal narratives. The current attack on traumatic amnesia by the parents of incest survivors, involving memory experts who know nothing about trauma and therapists who were trained back in psychiatry's denial and delusion period (from Freud to 1980), will be the subject of a future issue.
Survivors may also feel that no one can understand what they've been through, (which is reality-based). Another form of numbing and avoidance is that they may feel like they're not going to have a long life. This is realistic if the survivor has seen a lot of people killed. Survivors may also lose interest in what they once liked to do. What is the point? Small children are likely to go back to baby talk or forget their toilet training. Survivors may also feel like they have no emotions or be told by their loved ones that they have none. They may even be so numb to the damage that was done to them that they become perpetrators and cannot understand what the fuss is all about. "What are you crying for? I'm pulling my punches."
Survivors may also have learned to dissociate, to literally not be there, to survive. Automatically checking out of stressful situations will make it hard to have relationships or to work in therapy.
Numbness will make it hard for survivors to take care of themselves. Feelings are there to tell us how to do that. If you can't tell what you feel, you can't choose healthy behaviors for yourself.
I've just described two of the symptom categories psychiatrists use to diagnose PTSD: hypervigilance and numbing. I've described them in this way because I think it is important for survivors, families and therapists to understand that this is not some random collection of weird behaviors, but appropriate and effective biologically based reactions to extreme stress. They have a purpose: survival. These reactions develop under conditions that most of us cannot imagine or comprehend, although such conditions are common in our society.
A person has to have two hypervigilant symptoms and three numbing symptoms, not present before the trauma, to be diagnosed with Post-Traumatic Stress Disorder. That means if the survivor already had PTSD from a previous trauma which the therapist doesn't know about and is already numb, the survivor may be misdiagnosed.
Most trauma survivors turn out to have multiple traumas, but the diagnosis of PTSD was formulated as if trauma was rare and only happened in isolation from the rest of life.
It is normal to be affected by trauma, but not every one who is traumatized gets diagnosable Post Traumatic Stress Disorder. There is a great range of post traumatic reactions because people are different, have had different life experiences, and have different capacities and skills. Some people do okay during the trauma, others crack. Some people have no reaction till another trauma, years later. Most people will find that post-traumatic reactions come back when there is subsequent trauma. Some people seem to alternate periods of extensive numbing with periods of explosive hypervigilant behavior or intrusive reexperiencing (the third category of PTSD symptoms). If the alternation is severe enough, they will never be diagnosed with PTSD because the symptoms won't be present at the same time, but their lives will be scarred by the trauma nonetheless.
