November 6, 2008

Post-Traumatic Stress Disorder (PTSD) is especially relevant at holiday times, birthdays and anniversaries, because those days are difficult for people with ambivalent feelings about their family, their lives, or  the way they were raised.

For people who grew up in abusive, negligent, addicted, or uncaring homes, the holidays can trigger crippling symptoms of PTSD that can last for months.

People from toxic families that trigger them should consider spending the holidays with supportive friends, and maybe dropping in on the family celebration just for dessert.

Spouses, children, and extended families s often need as much help as actual  sufferers do.  Ask the 20-something child of a Vietnam vet with PTSD.

As it happens, I deal with PTSD myself, follow a well-known plan for staying on track and getting back on track, and teach that plan to people learning to deal with their traumatic pasts.

I have a list of wellness tools (coping skills) that make me well and keep me well – the same things everybody does to deal with stress, and lists of things that can trigger my symptoms, and early warning signs that I might be getting off track – plus plans to respond to triggers and early warning signs right way. Quick reaction with a plan can limit the severity of the problem, or in many cases avoid it completely.

That’s why you have to make your plans in advance, when you’re feeling OK.  When you’re starting to slide, it’s too late to make a plan.

Everybody’s triggers and early warning signs are different, and so is the list of wellness tools that help them.  Household chores are a trigger for some people, and a coping skill for others.  Craft projects help a lot of people, but they drive me crazy.

Some people kill themselves to escape the emotional pain right away; many more commit suicide “on the installment plan,” one day at a time through alcohol and substance abuse.  The addictions often grow from attempts to numb the pain of PTSD.

You do not just “get over it and move on.”  You can’t “cure” PTSD.  You have to deal with it, to minimize its control your life in the present.  Not everyone who experiences trauma develops PTSD.  Our natural resiliency, plus some supportive counseling after the event, are all most people need.

But for some others, the traumatic event enbeds itself in the centers or our brain that control emotions, “fight or flight” responses, immune systems, and other systems that evolved to protect us long before we developed speech and logical thinking.

When PTSD takes over those centers and starts controlling them, you need a plan to keep it from controlling your life in the present.

Most important, I’ve adjusted my attitude about myself and my past traumas.  When horrible things happen to you, it’s not your fault, but it’s your choice what you do next.

It took me decades to stop playing the “blame game” and take responsibility for what I did next, because the horrible things and horrible people really happened and were really horrible.  But the blame game freezes you. It’s easier to blame your unsatisfying life on abuse you suffered years ago than it is to take responsibility for your life and attitude in the present.

Here’s a recent example of how PTSD works sometimes.  It was uncomfortable for me, but it did no harm: The thinking part of my brain forgot the anniversary of my father’s death this year.  But my normally feisty, expressive personality went flat.

It often took me three hours to wake up and start the day.  I was starting to wonder why this was happening, and how long will it last?  As soon as my sister mentioned the anniversary had just passed, I could give the problem a name and get over it.  From now on, I’ll write that anniversary into my calendar every year.

The other manifestation of my PTSD is rage.  It’s rare, and only lasts s few seconds, like a thunder clap. It’s never violent or dangerous, but it’s scary to anyone who does not know me.

It’s the only part of myself I hate, and I struggle to keep it in control.  But I sometimes fail when I’m tired or under strain.  Even if those explosions are not completely my fault, they are my complete responsibility.

Often, when a person with PTSD is triggered, all the feelings connected with all previous traumas come baqk as if they’re happening now.  That’s when I blow my top, and,unfortunately, it’s sometimes a pretty minimal trigger.

My plan, which is offered in our peer support centers, is called the Wellness and Recovery Action Plan (WRAP), pioneered by a survivor of trauma and mental illness named Mary Ellen Copeland.

Our community mental health centers offer a program called Dialectical Behavioral Therapy (“DBT”), developed by psychologist Marcia Linnehan.  Both plans are used around the world, and there is plenty of evidence that they help a lot of people..

PTSD is listed as an official psychiatric diagnosis, but it is not a biological disorder like schizophrenia, bipolar disorder, or major depression. PTSD is a normal human reaction to an abnormal event that really happened, like combat, natural disaster, violent crime, domestic violence, sexual abuse, or abuse and neglect by a caregiver. It often looks just like a severe mental illness.

It often looks enough like a biologically-based mental illness to have a mistaken diagnosis and treatment.  It can look like rage, suicidality, depression and withdrawal, self-harming behavior, irritability, mood swings like bipolar disorder, and flashbacks and hallucinations like schizophrenia.

It affects public spending on police, courts, corrections, psychiatric hospitals, community mental health centers, and the quality of life in all corners of society; it breeds homelessness, public drunkenness and drug abuse, damaged children and families.

It’s about to become a major public health issue as growing numbers of war veterans come home with it.  We’d better be ready.

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