copyright 2010, Patience Mason.
I just listened to some idiot (didn't catch his name) on The Diane Rhem Show (a show I love, by the way) tell the usual lies about how only 10 % of vets get PTSD, and a new and amazing lie, that DSM II came out in the forties, and after that until 1982, I think he said, no one could get help for PTSD because of DSM II.
DSM I came out in 1952. It was an attempt to standardize diagnoses. It contained "Gross Stress Reaction" for survivors of traumas like combat or a concentration camp.
Contrary to what that idiot said, in 1968, DSM II was published during the Vietnam War: it actually went on sale during the TET Offensive. It dropped all stress reactions except for "transient situational disturbance" which could only last up to 6 months... Otherwise you were screwed up before you went to the war and got a diagnosis of personality disorder and no help from the VA since Personality Disorders were pre-existing conditions.... Was this aimed at Vietnam vets? I can't say, but it is quite a coincidence.
People who work for the VA often do not know the history... They don't know the facts... They speak for the VA, not for veterans.
It is the same problem when you get military psychiatrists. They speak for the military, not for the soldiers. They usually don't know the facts, either. Their job is to keep people going back to the war, so they have a conflict of interest with their patients.
They all say they can fix or prevent PTSD.
Maybe they can but there is no proof of that. NO PROOF.
A four year follow up on some 12 week or 12 month treatment is not proof that a lifetime condition has been fixed. (We'll give you insulin for a 12 week course and then you won't be diabetic. No one would say that.) And that's at a VA that uses "evidence based therapy," or some sort of therapy or treatment. Some of them just give drugs, and let me tell you, if the drugs make the vet feel weird, he or she won't take them and won't tell the doctor either.
Each VA is a feifdom. The doctors do what they believe in, and none of them use all the therapies and techniques which are available today and each of which helps some people... It 's like if you want help, fit into our theory. This is wrong. Vets need a variety of therapies because people are different and need different things. Some people need long term help. The government took them long term, perhaps for the rest of their life, and they should be willing to help them long term.
Statistics can always be manipulated so only 10 or 12 or 17 % of people get PTSD. In the National Vietnam Veterans Readjustment Study, of people who had had "high war zone stress" (multiple traumatic incidents) 66% of them had diagnosable PTSD at some time after the war and 33% still did, twenty years after. That means it is a normal reaction to multiple tours and multiple traumatic stressors. The guy today said 10%. The technical term for that is bullsh*t.
It is enough to make me tear out my hair.
I want to help people understand their PTSD.
I want them to know it is normal.
I want them to know there are four basic causes of PTSD, only one of which is the traumatic stress you have endured. The traumatic stressors you may have endured include serious threat to your life or physical integrity, serious threat or harm to spouse, kids, close relatives or friends (i.e. your buddies to whom you are probably closer than anyone), sudden destruction of home or community, and seeing anyone who is or has been recently seriously injured or killed. Traumatic stress is cumulative, it is worse when it is caused by human cruelty, neglect, error or betrayal, worse when you are young, and worse when part of the cause is a person or institution which is supposed to take care of you.
If you have PTSD think about how many of these traumatic stressors did you have? One a day? Ten a day?
The other three causes are that your brain is designed to keep you alive so all the symptoms of PTSD start out as brain based survivor-skills, that you care about other people no matter how numb you feel now, and third, that you lived. Dead people don't get PTSD...
Having lived means you are fast, smart, courageous, ingenious, and lucky. PTSD is proof of survival. It is not weak or weird. Normal people are affected by what they live through. Some psychiatrists know so little about human nature as to deny this. They seem to write the diagnostic criteria as some sort of numbing ritual entirely divorced from the reality of trauma. One of my friends is a lawyer and he says this is good, but I think it makes it easier for them to avoid the reality of war and other traumatic events and think, "I wouldn't be affected."
To psychiatrists, PTSD is a problem. To me the problem is war (or rape, incest, battering, industrial accidents, fires, etc,). PTSD symptoms are a wonderful solution to surviving war (or any other trauma) physically and mentally. They are evidence of courage, initiative, endurance, speed, luck, and caring. You wouldn't have to get numb if you didn't care. The same things that get you through the trauma alive can also become your biggest problem over time.
Post means it can happen any time after the war, right after or sixty years later. Most people have all the symptoms right after a traumatic event (Critical Stress Response, what guys who break down in combat have, not PTSD, although it probably does become PTSD) and some people seem to heal, we don't know why, so it is a disorder of healing.
Some people also appear to heal, but in fact they are using behaviors (work, sex, gambling, tv watching) and/or substances (alcohol, drugs, food, adrenaline) to hide their problems. This is as bad for their families as living with the PTSD would be, but it looks better to the outside world. "My dad never talked about WW II" is actually evidence of PTSD, not that it didn't bother him...
I want every one to know that the symptoms of PTSD begin as evolution-based or god-given survival skills, built into our brains. The symptoms come in three clusters which often overlap and reinforce each other.
The diagnosis of PTSD in DSM, whatever edition, always begins with re-experiencing. This is because psychiatrists had to stop denying PTSD's existence when vets were having flashbacks in the halls of the VA. That is when they noticed PTSD, so they describe it as weird re-experiencing disorder with associated problems.
I look at it differently: what would keep you alive when someone is trying to kill you?
Your brain is designed to keep you alive and a big part of this is paying attention to threats. Moreover, your body is provided with abilities that get you moving long before you actually think I should move out of the way of that bullet. DUCK! Move fast. Action. Action before thought. That is why some of us think somatic therapy should be offered along with talk therapy. Your body retains hyperarousal, and it does not speak English, nor can it tell time in the sense that your fore brain can. It does not know it is over.
The basic built in capacities of your body are usually described as fight or flight, but freeze is also an option the body can take, even against your will, if it thinks that is the only way to survive. Your body will do, is designed to do, whatever it takes to survive. Your brain also has a tremendous need to be in control of things, so it keeps repeating what works.
These reactions, once triggered lead to constant wariness (hypervigilance) one of the PTSD hyperarousal symptoms. Another symptom which the shrinks call "exaggerated startle response," I call effective startle response (You're alive!). Inability to concentrate is actually the inability to concentrate on everyday stuff, because you are concentrating on survival information, who is in the room, how will you get out, where the ambush or IED might be, etc. Irritability or outbursts of anger? Maybe it is normal to get pissed when people are trying to kill you and have killed your buddies. Plus people are so rude (Did you kill anyone? Aren't you over it yet?) and so full of dumb problems (Who cares what color the curtains are?)... Maybe anger makes you feel powerful so you can fight for your life or endure the privations of war and the need to kill people. Inability to fall or stay asleep keeps you alert at all times, keeps you from being killed in your sleep. They all make sense when viewed like this.
Numbing and avoidance probably develop at the same time as the hyperarousal symptoms. Your brain has an incredible capacity to rapidly adapt to situations. Rapid adaptation means that something that is horrifying quickly becomes everyday: emotional numbing. After that it takes a lot of adrenaline to get an emotion out of you. This means you may only feel alive when angry, doing something dangerous, or screwing around, because your emotions have been buried by the need to be in control combined with the need to do whatever it takes to survive and do your job and help others survive. People can do things under these conditions which are hard to look back on later. Feeling detached and estranged from others is reality. War changes you. People can't understand what you have been through, no matter how understanding they want to be. I realized this when my husband Bob and I came out of the movie Platoon, and I was upset by one of the wounded guys, the one with the shredded arm. Bob looked at me like I was nuts and said, "It's worse when it's real." I was starting to think I understood war because of all the interviews I was doing for Recovering from the War, but when he said that it hit me. I will never understand the reality. It is a separate reality. This is also self protective because of the stupid things people say to vets and trauma survivors. Having a sense of a foreshortened future is also realistic and self protective. You see other people dying all around you: why get your hopes up? Live for today because you may be dead tomorrow. (This can be annoying to your spouse...) Inability to recall parts of the trauma is a brain based protective device. The actual events are not recorded in narrative memory (and then, and then...) because it happened too fast and was too overwhelming for you to take it all in. This ties in with the reexperiencing because these unprocessed bits of memory seem to intrude and they are upsetting, so you begin the process of avoidance. You may avoid thoughts, feelings, situations, places, people, and activities that remind you of the trauma. If you were happy with your buddies and got ambushed you may decide never to be happy again. It is not conscious, and often is is done by staying drunk, or drugged, or high on adrenaline. Maybe you feel a mistake on your part got someone killed, so you are never going to be wrong again. Most of these are unconscious decisions, and you may not know you have made them. Avoidance is self protective and helps you avoid triggers, but it also perpetuates PTSD. Being really numb can lead to depression and to outbursts when your emotions erupt and scare every one around you. You may also lose interest in significant activities which helps you avoid triggers. What activities? Sex (losing control), hunting (no more killing), parties (crowds), family gatherings (people who wonder why you're not over it yet), cookouts (burning flesh) among other things.
Finally we get to reexperiencing, where the psychiatrists start the diagnosis. I think your brain keeps you alive by doing better safe than sorry. Primitive parts of the brain can't speak English and can't tell time, so they don't know it is over and you are home. Bits of experience, sights, sounds, smells, emotions, physical feelings like a thump on the head, all bring back the trauma in full living color. These are non-verbal memories, like your dog has when it sees a ball, only they are painful and upsetting. You may have the opposite of avoidance, and be constantly tormented with intrusive recollections of the war or trauma. You may also have nightmares about it, symbolic or actual repetitions of some awful events. You may suddenly act or feel like you are back in the war (flashbacks). You get upset by stuff that resembles or symbolizes the trauma. This includes anniversaries of holidays and of personal events including ones you don't remember! And you can have a physiologial reaction to things that remind you of the trauma. (Heart rate goes sky high when you see a car parked by the road, or hear a helicopter, etc.) You can also have second and third generation triggers. You get triggered by a car backfiring while you are eating a hot dog and watching children play, and after a while you can't stand hot dogs or the sound of kids playing... and you think you are nuts or a bad person, instead of realizing this is from the war.
Reexperiencing symptoms are probably what brings most people in for help, because they feel pretty nuts.
It appears that moving your non-verbal memories from what they called the reptile brain into your fore brain and encoding them as narrative memories is probably the most important healing device. This is called therapy when done with a therapist, writing when done with a typewriter (like Bob in Chickenhawk) or a pen in your journal or your fourth step in a 12 step program. It is the basis of cognitive therapy and narrative therapy and talk therapy, of EMDR, TIR, and other alphabet therapies.
If remembering is too upsetting, you need something like the skills you learn in Dialectical Behavioral Therapy, Acceptance and Commitment Therapy, meditation, or the HEALS technique developed by Steven Stosny, Ph. D., compassionpower.com so you can tolerate painful feelings in order to heal them.
Whatever you have done or not done, witnessed or ignored, you did not deserve to be traumatized, even if everyone says you deserve what you got. You do deserve to recover, and I hope looking at PTSD through my eyes will help you find the courage to get help. It is not fair that it hurts to recover. It is just reality. And since you made it through your war or traumas, you can probably make it through the work it takes to recover.
I also have seen people recycle PTSD symptoms when a new war starts or another traumatic event happens, and I think this is probably normal too. That's why I don't like the term "cured." "In remission," seems more realistic and more accurate to me. If your symptoms do come back, what worked before will work again. Don't give up. Get more help. You deserve to recover.