Post-Traumatic Stress Disorder

In the course of my career I worked with many people who had experienced significant trauma. Something I heard from many of them was along the lines, “What’s wrong with me? I think I’m going crazy! I can’t stop crying (worrying/ having panic attacks/having nightmares/having flashbacks/losing my temper/thinking about suicide, etc.) I didn’t used to be like this!” Once I was confident in my diagnosis, I’d respond in this manner: “You’re not going crazy. You’re having a normal reaction to an abnormal, traumatic life event. Your symptoms are consistent with something called post-traumatic stress disorder (PTSD) – the same thing that affects some soldiers who’ve been in combat. In World War I it was called shellshock and in World War II it was called combat fatigue, but it doesn’t only happen to soldiers.”

I’d go on to explain what happens in the brains of some people who’ve had traumatic experiences. The amygdala – which helps us to process emotions and is linked to the fear response – can be activated by trauma and sensitized to react to triggers: things that the brain has come to associate with the original traumatic event. A sudden loud noise might trigger an instant fear response in a combat veteran. Seeing a depiction of an assault on a cop show on TV might trigger a flashback in an assault victim. Sights, sounds and sensations reminiscent of the trauma can re-stimulate the amygdala and trigger symptoms. Thoughts can also be triggers.

Two people might experience the same traumatic event, only one of whom will develop PTSD; and science can’t predict which one. You can’t put a timetable on recovery from trauma, but all too often people suffering from PTSD are blamed for the persistent changes in their behavior. Many get told things like “Just get over it!” and “What’s wrong with you?” – as an accusatory statement in the form of a question.

PTSD can be caused by a single event or by serial traumas, such as ongoing child abuse. It can result from physical or sexual assault, surviving a terrible accident, or witnessing bloodshed and/or death. It can be caused by weeks or months spent in combat zones, even if there was no single major traumatic event. Soldiers are often reluctant to admit to symptoms of PTSD, as the military culture tends to stigmatize the diagnosis as a sign of weakness. But it isn’t; it’s a brain disorder.

My wife Maria and I served as Red Cross Disaster Mental Health Volunteers at a Red Cross Family Service Center near Ground Zero after 9-11. Although we were both licensed mental health professionals, as disaster mental health workers we weren’t there to do therapy. We were there mostly to listen, and to help people understand and process  what they’d gone through on the day when the twin towers fell. We also provided referral information to those we met who might need therapy from local practitioners. One thing I remember saying to a number of trauma victims I encountered was, “You’re not going crazy. You’re a civilian who suddenly found yourself in a war zone. Nothing in your life has prepared you for that. Your (symptom/symptoms) is/are a normal reaction to an abnormal circumstance.”

Hundreds, perhaps thousands, of Manhattanites were traumatized to a greater or lesser degree by the events of 9-11. You didn’t have to be near Ground Zero to be affected, and it seemed that the whole city was on edge, anxious about the possibility of another attack. I met a woman who had watched the falling bodies of people who’d jumped from the burning towers, transfixed by the horror of what she was witnessing. I spoke to a young man who’d ridden the subway his whole life,  ashamed because he was terrified to do it again. I heard story after story from people who wondered if their lives would ever be the same again. Another thing I said to several people I encountered was, “Nobody’s qualified to tell you when you ‘should’ get over this. It may get better as time goes by, or it may not. There’s no guarantee that you’ll completely recover, but don’t give up on the likelihood that you will, in your own time. You may need professional help.”

There are highly effective treatments for trauma victims. Just as physical wounds can heal over time, so can the “invisible wound” of PTSD.

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