PTSD and More

I sat for hours last night fighting that horrible feeling of emptiness. Then, I gave up and just allowed myself to feel it. It always seems particularly difficult at the close of a weekend. Maybe, it is because I have to put that mask firmly in place to get through another week? Maybe, it is because night had arrived and with the night comes the quiet internal fear of the unknown. I will not pretend I have any answers, therapist/counselor/whatever I am called, does not make me invincible to emotions. I feel them. I hate to feel them.

I have all these daily readers, counselor websites, mental health and addiction websites that come onto my news' feed everyday. I pick out what is useful for my patients. Most days I ignore their messages. Today, there was an article on PTSD and three specific symptoms; intrusive thoughts, hypervigilance and avoidance behaviors. What really stuck out to me was the avoidance behaviors, especially the one where the sufferer avoids emotional connections with those they love. They pull away from those they love as to not feel any pain. I am very familiar with the intrusive thoughts, nightmares and anxiety associated with the disorder, but the avoidance behaviors, I paid very little attention. It is so textbook and so damn true.

It is wanting to be accepted, but wanting to be alone at the same time. It is wanting a normal everyday existence, perhaps the existence, one previously had, or it brings out the hidden deep dark fear that has been there all one's life, but never recognized, acknowledged or was aware. The feeling is a huge gap, a hole, a void, an emptiness that the outside world cannot fill. How, when, why or where it started does not really matter. What matters is the feeling. The here and now feeling of emptiness, loneliness, sorrow, a pain so deep, one would do most anything to avoid.

I wonder if this is the true source of addiction and/or the development of mental health disorders, which are often miss-understood.

Snap out of it! Get over it! It could be worse! You never go to anything! You avoid us! Knock it off!

OMG, if only they understood the pain.

This kind of pain leads to suicide, drug/alcohol addiction, impulsive behaviors, anger, One does not want to really die or self-medicate or even fight, one just wants the pain to end.

One pushes those closest away though one needs them more than ever. One reacts in miss-directed anger though the anger is really about the person in pain. Those around them become frustrated, aggravated and judgmental, though that is the worse possible way to address this person in pain. The person in pain needs love, understanding, compassion and patience. The person in pain needs to be pulled back into the fold not abandoned even though that person resists. Remember, someone in that much emotional pain uses resistance as a defense mechanism. What person in pain wants to set themselves up for more pain in the form of rejection?

If you know such a person, please be understanding. Time takes time or that is what they say.

Part VII Depression Bipolar Suicide

Becoming One's Own: The Powerful Words of Virginia Woolf

Virginia Woolf, born in England in 1882, is considered one of the greatest modernist and early feminist writers of the 20th century.
Her most famous works include Mrs. Dalloway (1925), To the Lighthouse (1927), Orlando (1928) and A Room of One’s Own (1929).
Woolf also struggled with bipolar disorder and died from suicide in 1941.
She experienced her first depressive episode at age 15, after the death of her mother and then her half-sister two years later. In 1904, after her father died, she experienced her second episode of depression and was briefly hospitalized. Sexual abuse from half-brothers also contributed to her mental illness.
Throughout Woolf’s life, mood swings often resulted in periods of convalescence that compromised her creativity. Episodes would begin with migraine headaches and sleeplessness and eventually lead to her hearing voices and experiencing visual hallucinations. In 1932 she wrote in a letter: “My own brain is to me the most unaccountable of machinery—always buzzing, humming, soaring, diving and then buried in mud. And why? What’s this passion for?”
Woolf’s passion was for modernism in the arts—reaction to industrialization, urbanization and the horrors of World War I. It rejected traditional (realist) art forms in favor of radical reassessments and innovations, not only in style but also in considering the human condition and value of technological progress. Woolf experimented with stream-of consciousness narratives in her novels which revealed psychological and emotional motives of characters and other untraditional forms. In Flush: A Biography, for example, a semi-fictional biography of the poet Elizabeth Barrett Browning, the narrator is Browning’s cocker spaniel, Flush.
Ironically, the play Who’s Afraid of Virginia Wolf (1962) by Edward Albee, has nothing to do with Woolf the writer—except for the title. It reflects Woolf’s modernist perspective and is intended to ask “Who is afraid to live without illusion?” (i.e., peeling back social pretensions until raw motives and emotions are exposed).
Woolf’s greatest novel, Mrs. Dalloway, includes criticism of the medical establishment of the 1920s in its treatment of mental illness. One level, it is about a woman in London on a single day, preparing to host a party that night. But parallel chapters told from the perspective of a “shell-shocked” World War I veteran, who today would be referred to as living with posttraumatic stress disorder. Like Woolf, in her own experience with bipolar disorder, the character isolates himself, hears birds singing in Greek and ultimately dies from suicide.
In 1941 after finishing her last novel, Between the Acts, Woolf fell again into depression, which also coincided with the onset of World War II and destruction of her London home by a German bomb. In a note she left for her husband before she died, she wrote: “I feel certain that I am going mad again. I feel we can’t go through another of those terrible times. And I shan’t recover this time. I don’t think two people could have been happier ‘til this terrible disease came.” (NAMI)

Part V PTSD Depression

Audie Murphy: Branded by War, but Not Defeated by It

Audie Murphy is the most decorated soldier in American history. He received the Medal of Honor in World War II and many other awards for valor— including three Purple Hearts.
After the war, he built a successful career as a Hollywood actor and country and western songwriter.
He also lived with posttraumatic stress disorder (PTSD) and became an advocate for veterans, speaking openly about his ”battle fatigue” and calling for greater mental health care.
Born into poverty in Texas in 1924, he enlisted in the Army after the attack on Pearl Harbor. With the 3rd Infantry Division, he fought in Italy, France, Belgium and Germany—at one point winning a battlefield promotion to second lieutenant.
On Jan. 26, 1945, he fought the battle in France that earned him the Medal of Honor.

He then single-handedly fought the enemy advance.

Twenty-four inches of snow were on the ground and the temperature was 16 degrees below freezing. In the face of an armored attack from three sides, he ordered his company to retreat to a more protected position. He then single-handedly fought the enemy advance. He used his rifle until it ran out of ammunition, then a machine gun from on top of a burning tank destroyer and finally a land-line telephone to call in artillery strikes.
He then rallied his men into a counterattack. The official citation for his Medal of Honor declared that “his refusal to give an inch” of ground saved his company from encirclement and destruction” and held a vital position the enemy desperately sought to gain.
But heroism came with a price.
For the rest of his life, Murphy lived with insomnia, nightmares, paranoia and depression. He once claimed that the only way he could sleep was with a loaded pistol under his pillow.

When I was a child, I was told that men were branded by war. Has the brand been put on me?

In his autobiography, To Hell and Back (1949) he described the emotional conflict that haunted him:
"Like a horror film running backwards images of war flicker through my brain… I cannot sleep. My mind still whirls. When I was a child, I was told that men were branded by war. Has the brand been put on me? Have the years of blood stripped me of all decency?"
But he expressed hope and faith.
"I believe in men who stood up against the enemy, taking their beatings without whimper and their triumphs without boasting. The men who went and would go again to hell and back to preserve what our country thinks right and decent.
My country. America! We have been so intent on death that we have forgotten life. And now suddenly life faces us. I swear to myself that I will measure up to it. I may be branded by war, but I will not be defeated by it."

Even while struggling with PTSD, Murphy launched a movie career starring in over 40 films.

Even while struggling with PTSD, Murphy launched a movie career starring in over 40 films. He played himself in the film version of To Hell and Back (1955), which became Universal Studios’ biggest hit—ever— until 20 years later when Stephen Spielberg’s Jaws surpassed it.
He served as a major in the Texas National Guard and then the Army Reserve.
He died in a private plane crash in 1971. He was buried with full military honors in Arlington Cemetery, not far from the Tomb of the Unknown Solider. (NAMI)

PTSD

How is PTSD treated?

The main treatments for people with PTSD are psychotherapy (“talk” therapy), medications, or both. Everyone is different, so a treatment that works for one person may not work for another. It is important for anyone with PTSD to be treated by a mental health care provider who is experienced with PTSD. Some people with PTSD need to try different treatments to find what works for their symptoms.
If someone with PTSD is going through an ongoing trauma, such as being in an abusive relationship, both of the problems need to be treated. Other ongoing problems can include panic disorder, depression, substance abuse, and feeling suicidal.

Psychotherapy

Psychotherapy is “talk” therapy. It involves talking with a mental health professional to treat a mental illness. Psychotherapy can occur one-on-one or in a group. Talk therapy treatment for PTSD usually lasts 6 to 12 weeks, but can take more time. Research shows that support from family and friends can be an important part of therapy.
Many types of psychotherapy can help people with PTSD. Some types target the symptoms of PTSD directly. Other therapies focus on social, family, or job-related problems. The doctor or therapist may combine different therapies depending on each person’s needs.
One helpful therapy is called cognitive behavioral therapy, or CBT. There are several parts to CBT, including:

• Exposure therapy. This therapy helps people face and control their fear. It exposes them to the trauma they experienced in a safe way. It uses mental imagery, writing, or visits to the place where the event happened. The therapist uses these tools to help people with PTSD cope with their feelings.
• Cognitive restructuring. This therapy helps people make sense of the bad memories. Sometimes people remember the event differently than how it happened. They may feel guilt or shame about what is not their fault. The therapist helps people with PTSD look at what happened in a realistic way.
• Stress inoculation training. This therapy tries to reduce PTSD symptoms by teaching a person how to reduce anxiety. Like cognitive restructuring, this treatment helps people look at their memories in a healthy way.

How can I help a friend or relative who has PTSD?

If you know someone who has PTSD, it affects you too. The first and most important thing you can do to help a friend or relative is to help him or her get the right diagnosis and treatment. You may need to make an appointment for your friend or relative and go with him or her to see the doctor. Encourage him or her to stay in treatment, or to seek different treatment if his or her symptoms don’t get better after 6 to 8 weeks.
To help a friend or relative, you can:

• Offer emotional support, understanding, patience, and encouragement.
• Learn about PTSD so you can understand what your friend or relative is experiencing.
• Talk to your friend or relative, and listen carefully.
• Listen to feelings your friend or relative expresses and be understanding of situations that may trigger PTSD symptoms.
• Invite your friend or relative out for positive distractions such as walks, outings, and other activities.
• Remind your friend or relative that, with time and treatment, he or she can get better.

Never ignore comments about your friend or relative harming him or herself, and report such comments to your friend’s or relative’s therapist or doctor.

How can I help myself?

It may be very hard to take that first step to help yourself. It is important to realize that although it may take some time, with treatment, you can get better.
To help yourself:

• Talk to your doctor about treatment options.
• Engage in mild activity or exercise to help reduce stress.
• Set realistic goals for yourself.
• Break up large tasks into small ones, set some priorities, and do what you can as you can.
• Try to spend time with other people and confide in a trusted friend or relative. Tell others about things that may trigger symptoms.
• Expect your symptoms to improve gradually, not immediately.
• Identify and seek out comforting situations, places, and people.

NIMH

PTSD

Why do some people get PTSD and other people do not?

It is important to remember that not everyone who lives through a dangerous event gets PTSD. In fact, most will not get the disorder.
Many factors play a part in whether a person will get PTSD. Some of these are risk factors that make a person more likely to get PTSD. Other factors, called resilience factors, can help reduce the risk of the disorder. Some of these risk and resilience factors are present before the trauma and others become important during and after a traumatic event.
Risk factors for PTSD include:

• Living through dangerous events and traumas
• Having a history of mental illness
• Getting hurt
• Seeing people hurt or killed
• Feeling horror, helplessness, or extreme fear
• Having little or no social support after the event
• Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home.

Resilience factors that may reduce the risk of PTSD include:

• Seeking out support from other people, such as friends and family
• Finding a support group after a traumatic event
• Feeling good about one’s own actions in the face of danger
• Having a coping strategy, or a way of getting through the bad event and learning from it
• Being able to act and respond effectively despite feeling fear.

Researchers are studying the importance of various risk and resilience factors. With more study, it may be possible someday to predict who is likely to get PTSD and prevent it.

NIMH

My own comments in regards to PTSD as it has come to light as a result of the military men returning from war. When we think of PTSD, we think of war. However, most people who develop PTSD have never been to war, but have experienced a trauma in their everyday life.

When a trauma occurs, the first reaction is known as ASD (Acute Stress Disorder) and this is the time, one should seek help because ASD can lead to PTSD. Though, it should be known that everyone with ASD does not develop PTSD. There are several factors such as how long the trauma is prolonged, resilience factors and potential fall out from the trauma, especially if one loses the support of people or a loved one.

Despite my best efforts of avoiding PTSD, I have it. After 20 months of pushing ahead through ASD, throwing myself into work and school, taking over responsibilities of others, I found myself in the mist of all the symptoms associated with PTSD. I recognized them and tried to work through them until I was unable to do so on my own. I am not ashamed to admit the therapist has a therapist and for me talk therapy is best. Zoloft was replaced with Cymbalta. I will not take any other drug whether used on or off label. Since I worked with patients, I took a few weeks off to do some self care. The would haves, should haves, could haves will not change the course of my future or get back what I have lost. I know this now. All the responsibility I felt was not my responsibility at all. I learned this. There are emotional boundaries I need to set, but it will come with baby steps. I am now aware. One of my strengths is research and writing and this is the reason why my focus is on PTSD. It shows its ugly face through depression, angry, nightmares, feelings of self-doubt and extreme periods of anxiety. I am more fortunate than others as I have a very strong support system. I also know that I am not alone.  

PTSD

What are the symptoms of PTSD?

PTSD can cause many symptoms. These symptoms can be grouped into three categories:
1. Re-experiencing symptoms:

• Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating
• Bad dreams
• Frightening thoughts.

Re-experiencing symptoms may cause problems in a person’s everyday routine. They can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing.
2. Avoidance symptoms:

• Staying away from places, events, or objects that are reminders of the experience
• Feeling emotionally numb
• Feeling strong guilt, depression, or worry
• Losing interest in activities that were enjoyable in the past
• Having trouble remembering the dangerous event.

Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car.
3. Hyperarousal symptoms:

• Being easily startled
• Feeling tense or “on edge”
• Having difficulty sleeping, and/or having angry outbursts.

Hyperarousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic event. They can make the person feel stressed and angry. These symptoms may make it hard to do daily tasks, such as sleeping, eating, or concentrating.
It’s natural to have some of these symptoms after a dangerous event. Sometimes people have very serious symptoms that go away after a few weeks. This is called acute stress disorder, or ASD. When the symptoms last more than a few weeks and become an ongoing problem, they might be PTSD. Some people with PTSD don’t show any symptoms for weeks or months.

NIMH