Stages and Manifestations of Recovery in Post Traumatic Stress Disorder (PTSD)
"As the survivor summons her memories, the need to preserve safety must be balanced against the need to face pain" - Judith Lewis Herman, M.D.
Judith Lewis Herman (1942) is a psychiatrist, researcher, teacher, and author who has focused on the understanding of traumatic stress. She has published several books and articles about traumatic stress. One of which, the book Trauma and Recovery, provided distinctive contribution to the understanding of trauma and its victims. (Wikipedia).
According to Judith Lewis Herman, M.D. there are three fundamental stages to recovery from post traumatic stress disorder (PTSD). These are:
1. establishing safety
2. reconstructing the traumatic story
3. restoring the connection between the survivor and the community
For people with post traumatic stress disorder (PTSD) especially those that are due to a life threatening or grave traumatic experience, establishing safety is the first and foremost concern. He has difficulty gaining the confidence with his surrounding because his stress is coming from being threatened once, was rendered helpless and was not able to resist or escape from it. This overly cautious and always on guard behavior is becoming unhealthy because he always feels a threat within his immediate environment.
Anything related to the trauma incident or reconstructing the traumatic story is something trauma victims avoid. In extreme cases, a detrimental effect of this reconstruction would put the person in a dangerous situation because they would find themselves reenacting some aspects and the situation taking a life of its own. A healthy reconstruction would be that the person will be able to summon his memories,simultaneously reexperience the feeling in all their intensity while holding on to the sense of safe connection that was destroyed in the traumatic moment (Herman, Trauma and Recovery)
Restoring the connection between him and the community is crucial for him not to succumb to detachment and disconnection. This disconnection or alienation is usually a response to a perception that "trust" has been broken and him being helpless at the moment of trauma. Thereby he looses his self esteem, detach themselves from people, unstable at relationships and deprive themselves of new opportunities.
How is recovery manifested in these stages for a person with PTSD?
According to Dr. Mary Harvey's (colleague of Judith Herman) recovery is manifested as symptoms being manageable, recall of the traumatic memory is bearable for the survivor, the survivor has control over the traumatic memories, retelling or recount of the memory is coherent, the survivor has gained or improved his self-esteem and relationships and connections are restored.
For more detailed explanation, read Judith Lewis Herman, M.D's article here, Trauma and Recovery.
Going through these stages transform and incorporate the traumatic experience into the person's life story. With these resolutions evident, the survivor can then turn to the task of living his usual life.