Nancy Poitou, M.A., M.F.T., C.T.S.
In the field of trauma therapy trauma is defined as an event that threatens life or bodily integrity. One may be traumatized directly, through a close relationship with someone who has been traumatized or through witnessing such an event. Because a person survived a trauma physically intact does not mean that they are not injured. Just as too much stress on a bone will break it, too much stress on the psyche will cause a breakdown of normal functioning. Post Traumatic Stress Disorder is a psychological injury and not a mental illness.
The symptoms in the aftermath of a trauma are sometimes so extreme that individuals often feel as though they are going crazy. Indeed the mood swings, anxiety, lack of sleep, inability to concentrate and think clearly, changes in appetite, flashbacks, nightmares and depression may feel crazy but are symptoms of psychological injury. Flashbacks and nightmares can be so extreme that it feels as though the traumatic event is recurring. Relationships and self confidence can suffer as a result. The first 30 days after a traumatic event with symptoms is called Acute Stress Disorder. If the symptoms persist beyond 30 days it then is Post Traumatic Stress Disorder.
There are three groupings of symptoms of Post Traumatic Stress Disorder. “Avoidance” is a common reaction to a trauma, attempting to repress it by denying its effects, focusing only on the positive, avoidance of any discussion or reminder of the event. Although avoidance may in the moment feel better, it also delays the victim in getting the help needed to completely recover from the trauma symptoms. The sooner the victim gets help, the better the prognosis. The second grouping of symptoms is the “re-experiencing symptoms;” flashbacks, nightmares, and mood swings fall into this category. The third grouping of symptoms is “hyperarousal symptoms” of anxiety, insomnia, feeling jumpy and fearful. All of these symptoms are normal reactions to an abnormal event. One thing you need to know is often in dealing with trauma, when you get help and and a lot of time has passed since the trauma you can feel worse before you start to feel better. When that happens often is people want to quit because they think the therapy is not working, but it is a very bad time to end therapy once once you have opened up an old wound.
Trauma symptoms are not understood by non-professionals who have not been traumatized. Comments by others in the wake of trauma can often compound the effects of the trauma. Well meaning friends and family often tell the victim, "put it behind you", "let it go ", "don't think about it", etc. The traumatized person wants to do that more than anything but changes in the brain will not allow the person to "let it go". Flashbacks and nightmares are one of the psyche's ways of attempting to process the traumatic experience. No one wants them, nor are they making them happen.
In the immediate aftermath of the traumatic event, affect and mood can swing widely, people can fluctuate between feeling numb and hysterical and everything in between. All of these fluctuations are normal reactions to the traumatic event. Immediate reactions to a traumatic event are as unique as the individuals who have them, and because the variety of reactions is not what others expect, the victim is sometimes not believed, his or her distress is invalidated and the victim may, as a result, question his or her sanity all the more. Terrorism , abuse, crime are interpersonal traumas caused by one or more human perpetrators. Interpersonal trauma often means that the ability to trust and feel safe often affect one’s ability to have and sustain relationships that are intimate, satisfying and nurturing.
Any type of trauma can include a spiritual crisis where one’s beliefs about the universe are shattered, a sense of power and safety are torn away, and one is left with the additional loss of faith and belief that the universe is friendly and good and that there is a purpose and place for him or her within the grand design. Through a holistic approach, treatment is not limited to symptom elimination, but includes emotional and relationship healing as well as addressing the spiritual and existential dimensions of the trauma. Post Traumatic Stress Disorder is highly treatable and real healing is possible.
What often happens to veterans is that while in country survival mechanisms kick in. They are on guard 24/7. They don’t have symptoms usually because the psyche usually protects they as long as they are in danger. There is a delayed onset PTSD that is common in veterans. What often happens when they return to civilian life they are grateful they survived and happy to be home. The first 2–3 months is like a honeymoon. Eventually they start feeling anxious, angry, reactive they over react to any perceived threat. The flashbacks and nightmares start. Noise and crowds activate anxiety and hyperarousal.
Relationships start to be affected because it is difficult to have and express loving feelings. They grow distant from relationships. They anger easily. Especially men who are not used to and feel vulnerable expressing sadness and fear which they turn into anger. They avoid talking about their feelings and don’t understand why they are feeling this way. They survived. They didn’t have any symptoms. Even when they were screened for PTSD in Germany or wherever they were screened for it they didn’t have symptoms. It is difficult for them to connect what is going on within because they felt fine when they first got home.
They may also develop depression and panic disorder. I call the three disorders the Trauma Trifecta. Panic disorder develops after a prolonged period of stress. It is not in response to anything currently in their life. Being in a war zone is stressful. Depression because they feel out of control and can’t feel any positive feelings. A restricted range of affect results. They may make an appointment for psychological help but get anxious as the time approaches and cancel or no show. Then they feel a sense of relief which sets up a cycle of avoidance that impedes them getting the help they need.
If the PTSD goes untreated it can morph into other diagnoses including substance abuse. Using substances can eliminate the symptoms but destroy their life, including marriage and family, work life and friendships. That is what has happened to veterans who are homeless. My advice is get into psychotherapy ASAP even if you don’t think you need it. It is much easier to treat and the prognosis is better the sooner you get help. If you don’t have PTSD it can help the veteran to readjust to civilian life. Not everyone gets PTSD. It is not about weakness or anything wrong with the veteran, what they experienced was wrong. War is not healthy. Seeing violence and violent death is not normal and is bad for the psyche and the soul. PTSD is not about the veteran it is about what they experienced. I have told veterans I would be more concerned after hearing what you went through if you did not have a reaction to it.
Is medication a substitute for therapy?
No. But it can help people get through and make the most of psychotherapy for PTSD. So in some cases a combination of medication and therapy is the right course of action. For some there will be no improvement without medication. Working with your medical doctor or psychiatrist you can determine what's best for you. It is well established that the long-term solution to mental and emotional problems and the pain they cause cannot be solved solely by medication. Instead of just treating the symptom, therapy addresses the cause of our distress and the behavior patterns that curb our progress. You can best achieve sustainable growth and a greater sense of well-being with an integrative approach to wellness. I do not require that you take medication but if therapy alone is not getting the results you would like or you are not able to function, it may be time to consider medication.