Last part of What Are Post Traumatic Stress Reactions? from the first issue of the PT Gazette.

Here is the last section of of first article in The Post-Traumatic Gazette #1, copyright Patience Mason 1995, 2005,
What are Post Traumatic Stress Reactions?
Denial and discounting are the skills society has developed to deal with trauma, as expressed in “It wasn’t that bad,” and “Aren’t you over that yet?” Statements like these cause secondary wounding in trauma survivors. They reinforce the mistrust trauma evokes in all survivors who no longer can believe that the universe is fair and just. Secondary wounding by the medical community has been a serious problem, from the incest survivor, revealing her rape by her father and being told by the male psychiatrist (trained to believe this), “You know you wanted it,” to the thousands of misdiagnosed, mistreated Vietnam veterans of the seventies,( many of whom are now dead).
It is a problem that still persists.
In DSM IV, published in 1995, the APA has dropped the list of what is traumatic, and the all important sentence which points out that if it would be upsetting to almost anyone and it isn’t to this person then maybe that’s one of the symptoms of PTSD, and added the peculiar phrase that the person has to have felt “fear horror or helplessness” at the time.
Most trauma survivors that I know can’t feel. The diagnostician or therapist is the one who may be able to call up appropriate feelings (eg. grief, rage) about the incident. The survivor shouldn’t have to and probably can’t without a lot of healing. What this really says is that if bad things happen to you and you don’t feel the authorized feelings, they weren’t bad. This is neither logical nor scientific. It will create a class of good survivors who get diagnosis and treatment, and another (bad) class who due to numbing get misdiagnosed and mistreated, just as veterans were after Vietnam. If the APA really needs to list feelings, a more realistic and more diagnostic set would include disbelief, betrayal, feeling nothing, and feeling comfortable. The latter two would signal to any experienced therapist that this person already had PTSD before this latest stressor. Many people have multiple stressors over the course of a lifetime, and have already developed PTSD long before they see a professional. Most trauma survivors never do see a professional.
Adding the words “fear, horror, or helplessness,” to the diagnosis has made it more inclusive in one important sense. It keeps therapists from “pooh-pooh-ing” experiences that terrified individual survivors. The words fear horror or helplessness were added to the diagnosis because trauma turned out to be far more prevalent than the APA expected. (Yes, I am laughing!) The whole diagnosis of PTSD reflects the upper middle class idea that trauma itself is rare. It ain’t!
Rather than redefining trauma as evoking particular emotions, I’d like to see us open our eyes to the invisible effects of trauma.
We must become aware of the costs to survivors, society and families of all forms of numbing and hyperarousal including socially acceptable dysfunctional behavior. By ignoring it, we often simply put off to the next generation the cost and effort of recovering from trauma, and the effects of trauma increase geometrically. This is particularly true because something which might be mildly traumatic to a grownup, particularly one who is numb, is terrifyingly traumatic to a small child. As Beverly James points out, the well known phenomena of the “good” hospitalized child who “misbehaves” when the parent shows up is actually a terrified traumatized child displaying learned helplessness and the freeze response who becomes brave enough to voice his or her terror when the parents are around.
What else can’t we see?
One of the facts we need to face is that PTSD is an epidemic. For every incest survivor, every battered woman, every combat veteran, every holocaust survivor, every survivor of a fire, plane wreck, night club fire, rape, torture, mugging, hurricane, tornado, earthquake, every cop, nurse, firefighter, EMT, for everyone whose pain is not listened to and felt and accepted and healed, the effects of the trauma spread geometrically. Drug abuse, AIDS, heart disease, obesity, all related to the epidemic of PTSD through the compulsive behaviors people use to numb their pain and the inability to take care of one’s self which numbing causes.
If 17% of the teenagers in Detroit had tuberculosis, it would be a national emergency. Because they have PTSD, and PTSD is not acknowledged nor well understood, no one is talking about it. But we can.
New notes: Because it is so distressing for many professionals to know about trauma, there is a historical record of a period of acknowledgement followed by a period of denial and forgetting. Right now there are conflicting currents. The American Psychiatric Association has transformed the description of traumatic stressors in DSM III into a numbing ritual in which big Latin-rooted words alternate with the word “or” until the person reading it is practically asleep. This makes it hard to comprehend when someone has been traumatized
There are even academics who are once again doubting the diagnosis, saying it is overused. This is quite popular with those who don’t like paying the entire costs of war.
In addition soldiers resent the term PTSD. It feels like a stigma, and is treated as one in some commands. In Canada they use the term Occupational Stress Injury and include anxiety and depression as well as PTSD. Here some military psychiatrists are using CSI, Combat Stress Injury, which service members find less stigmatizing. I suggest Stress Injury with subtypes: Occupational for first responders, peacekeepers, etc; Combat for soldiers; Crime for survivors of rape, incest, interpersonal violence; Disaster; Betrayal; Neglect, etc.
Service members, unlike previous wars, are being sent back into harm’s way on medications with PTSD. This illustrates the ethical problems inherent in military psychiatry, which focuses on getting people back into action. Is it safe? Probably not. People with PTSD can be hypervigilant and overreact, instead of being vigilant and react with appropriate force.
Will it make them worse to go back with PTSD? Yes it will. But that is their job, and many of them want to go.

Fifth section of What Are Post-Traumtic Stress Reactions?

I am publishing this on my personal page, on my author page and on my book page, Recovering from the War.
Here is the fifth section of of The Post-Traumatic Gazette #1, copyright Patience Mason 1995, 2005,
What are Post Truamatic Stress Reactions?
A healing perspective on reexperiencing is that this is an appropriate and effective message from the survivor’s inner self that he or she has been through something that is too much to deal with alone. We are human, a species that is interdependent, that forms families, bands, tribes, communities, and talks about stuff. Survivors were not meant to face this alone as if they were polar bears or some other solitary non-verbal species (although they may wish they were).
The brain is a “better-safe-than-sorry” system. It would rather you get a million false alarms than be surprised by danger once. Part of reexperiencing may be the brain going haywire, triggering full alerts in an attempt to keep you safe.
Reexperiencing is circumstantial evidence that a person has been through too much to handle alone. Reexperiencing can also be seen as appropriate and effective because it sends more people to get help than anything else. Finally, human beings are communicators. Turning the flashes of memory in the reptile brain into a narrative memory in the frontal lobes seems to stop most reexperiencing.
Although this is not part of the current diagnostic criteria, I believe the message from the inner self can come as a physical symptom. Somatization (the development of physical symptoms) has disappeared from studies about PTSD although it was the primary symptom in soldiers’ heart, hysteria, railway hysteria, shell shock and combat fatigue. People who will not listen to their own need for healing often experience a lot of physical symptoms. The body is trying to tell the story that can’t be told. In light of George Vaillant’s recent findings that 56% of WWII Harvard-educated combat vets without “diagnosable” PTSD were chronically ill or dead by age 65, this looks like a field ripe for study.
Many trauma survivors also appear to reenact their traumas, self-mutilating, getting themselves into the same type of trouble over and over, or doing to others what was done to them. These behaviors probably serve the same unconscious purpose of speaking the unspeakable. Although such behaviors have been observed, they are not enumerated in the diagnosis yet, and may never be. That doesn’t mean we can’t keep them in mind in our search for healing.
For a survivor to be diagnosed with PTSD, three numbing, two hypervigilant and one reexperiencing symptom have to last a month. If you have seventeen numbing symptoms, one hypervigilant and are not reexperiencing this month you won’t be diagnosed with PTSD, but traumatic events will be ruling your life.
Symptoms may come on soon after the trauma or fifty years later. That is the post in PTSD. It is normal for symptoms to come up again in the face of further trauma and in times of high stress. It is normal to be affected by trauma. 17 % of the teenagers in Detroit have diagnosible PTSD according to one study. Another study showed that 69% of the surviving spouses of police officers killed in the line of duty have diagnosible PTSD. 66% of Vietnam veterans exposed to high war zone stress have had diagnosible PTSD at some time since the war and 33% still do today. Several studies of WWII combat/pow veterans in the hospital for other problems have shown that at least 50% of them have had PTSD and about 30 % still do.
Israeli studies show that people who have been traumatized react faster and more deeply to each subsequent trauma.
In addition, the effects of a traumatic stressor are worse when the cause is human neglect, betrayal, or human cruelty.
There are other post traumatic reactions which have not been studied including workaholism which might be invisible to workaholic doctors. Family system effects are just beginning to be studied, but many survivors manage to look good at great expense to their families. A child playing the role of family hero is not seen as a sign of family dysfunction, but as proof of good psychosocial adjustment. As a community of survivors, family, friends, and therapists, we need to look at our experiences, examining everything to see how it relates to trauma because what happens to people affects them.

The second section of What Are Post-Traumatic Stress Reactions which apparently I forgot to put on Blogspot.

Here are a few more paragraphs of The Post-Traumatic Gazette #1, copyright Patience Mason 1995, 2005.

What are Post Traumatic Stress Reactions?

...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 does not speak English, nor can it tell time. 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 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, although they are concentrating on survival information. 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 (startle response). 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-out 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. And your brain’s inborn capacity to rapidly adapt means that what horrifies you the first time becomes nothing much by the third time it happens. But, if you didn’t care, you wouldn’t have to get numb. Being numb is evidence that you do care.

From The Post-Traumatic Gazette #1, copyright Patience Mason 1995, 2005, What are Post Truamatic Stress Reactions? You can see more of this issue on my author page or book page, Recovering from the War

Here is the fourth section of of The Post-Traumatic Gazette #1, copyright Patience Mason 1995, 2005, What are Post Traumatic Stress Reactions?

It is normal to be affected by trauma, butt 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.
These PTSD survival skills tend to become less appropriate and less effective with time and can wind up being really crippling ineffective behaviors. For a healing perspective, we need to keep in mind that the behaviors of trauma survivors are direct evidence, sometimes the best evidence, of what they have survived, of their experience. They are also evidence of ingenuity, creativity and courage. Reframing the behaviors in this light can be an enlightening experience for the survivor, families, friends, and therapists. Instead of being bad behaviors, they become useful evidence about the nature of the trauma or traumas and the guts and brains of the survivor, who, after all, survived.
Along with three numbing symptoms and two hypervigilant symptoms, to be diagnosed with PTSD, survivors must also reexperience the trauma in some form. The most dramatic of these reexperiencing phenomena, the flashback, forced the recognition of PTSD by psychiatrists.
Psychiatrists were trained to deny that traumatic events did affect people despite evidence from concentration camp survivors and World War II veterans. When Vietnam veterans were having flashbacks in the halls of the VA hospitals, some professionals were able to break this denial and see real people really suffering. They had to acknowledge the flashbacks, so they created a diagnosis centered around reexperiencing reactions. Psychiatrists tend to think of it as a wierd reexperiencing disorder instead of a natural-but-now-not-so-useful survival-skill disorder. I think a more healing perspective focuses on the effectiveness of the skills the person developed to survive, (hyperalertness and numbing). The other approach makes it easy to stigmatize survivors for the very behaviors which helped them survive.
Apparently sharing about traumatic experiences is also necessary for human beings because people who can’t, for whatever reason, develop reexperiencing symptoms. Survivors are reexperiencing when they cannot stop thinking (or talking) about the trauma, when they are dreaming about it, or flashing back to the experience, feeling like it is happening again, even if they are drunk or on drugs. Reexperiencing also includes being upset on anniversaries of the trauma or by things that remind the survivor of the trauma. New wars, highly publicized rape, murder, battering and incest trials all affect survivors. Having a physiological reaction to something that reminds the survivor of the trauma is also a form of reexperiencing. The sound of a helicopter overhead sends a rush of adrenaline through many veterans. Someone raped in a stairwell may find herself sick and dizzy in any stairwell.

Here is the third section of of The Post-Traumatic Gazette #1, copyright Patience Mason 1995, 2005, What are Post Truamatic Stress Reactions?

Here is the third section of of The Post-Traumatic Gazette #1, copyright Patience Mason 1995, 2005, What are Post Truamatic Stress Reactions?

This 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 usually also feel that no one can understand what they’ve been through, which is reality. 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.

What are Post-Traumatic Stress Reactions? Part 1 (from Vol. 1, No. 1, The Post Traumatic Gazette, Revised © 2002 Patience H. C. Mason May-June 1995)

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 a 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, people who lost their homes in fires or floods, or lost their kids on Flight 103 over Lockerbie or in the World Trade Center. Interestingly enough, DSM IV basically contains a legalese mumbo-jumbo numbing ritual which enables professionals to not think about the reality.
As a person is traumatized, at least for the first time,* 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 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 pisses and shits 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 does not speak English, nor can it tell time. 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 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, although they are concentrating on survival information. 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 (startle response). 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-out 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. And your brain’s inborn capacity to rapidly adapt means that what horrifies you the first time becomes nothing much by the third time it happens. But, if you didn’t care, you wouldn’t have to get numb. Being numb is evidence that you do care.

From The Post-Traumatic Gazette #1, copyright Patience Mason 1995, 2005, What are Post Truamatic Stress Reactions?