Truama and PTSD
Trauma and PTSD……how, what, when and why do some people affected by trauma seem to heal, grow and move on; while others seem to get stuck and develop Posttraumatic Stress Disorder (PTSD)? We know war, vehicle accidents, rape, fights, abuse, surgery, etc. affects us all differently; what one person feels as traumatic and life altering another may find it as a momentary halt followed by growth and getting on with their life. What or who maybe the cause of this development of a stuck point leading to PTSD?
As humans develop from birth to death, our physical body along with our mental capacity develop on average around the same rate. Granted, there are both internal and external events that occur that can speed up, change, slow or stop some developments in people. These events can range from physical to mental illness, physical to mental trauma, unhealthy or healthy diet, lack or abundance of education, intake of illicit narcotics or alcohol, increase or decrease of responsibility, etc. Everything we do or do not do affects our body and mind, experiences good and bad drive us to who we become and how we deal with both positive and negative stimuli.
So what causes one person to recover and another person to develop PTSD? Is it a biological aspect? Too much energy pent-up in the body after the event has ceased and past, only needing an outlet? Is it a lack of mental development dealing with change or trauma? Could it be the people we surround ourselves with not giving us the time to process and heal? Could it be the medical field both physical and mental doctors causing us to relive and re traumatizing the survivor? As a current student of Counseling, what I once thought about mental health treatment has now been placed into question and has made my quest for further knowledge and understanding a higher calling. My need to understand is not some holy quest though; but a better understanding of what has happened to me and why after being affected by so many traumatic events in my life, one event has stopped me in my tracks and keeps me behind closed doors looking for the next negative event to occur.
To have a better understanding of what is occurring when someone is placed into a situation that they, their physical body or mind, feels is traumatic at the time a need to understand what occurs internally to the individual is just as important to understand as the event itself. To start with I’m going to be making references from On Combat written by Lt. Col. Dave Grossman with Loren W. Christensen. Though this book is written from the aspect of first responders and armed forces, it breaks down the basic concept of what is occurring to the body and mind during a stressful event that has kicked in to push us, as humans, into a fight, flight or freeze thought process. The basic aspect is this, as the body perceives a threat it will start to process what is occurring; blood flow increases and begins to be pushed into the parts of the body that are needed for action. These parts are basically the muscles and brain, since they are the parts of the body needed to take action to preserve the person’s life. As your blood pressure increases, so does the amount of cortisol a stress hormone produced in the adrenal cortex of the brain. This hormone is needed to help keep your blood sugar and blood pressure high to aid in your response to the situation and the chance for survival. It will stay that way until the perceived threat no longer exist. Due to this change in the body, a person may find themselves with tunnel vision or acute vision, hearing dulling or acute hearing, lack of pain response, memory loss, etc. as blood is rerouted to the areas needed to survive. Once the person finds themselves in a safe location or situation, the amount of cortisol being sent to the brain should decrease along with the amount of blood sugar and pressure. For some people their body will recover from the event and the individual is able to move on with life. For others this process may not fully return to normal due to physical and mental injuries that occurred during the period of stress. If the body does not return to normal, then the higher levels of cortisol can lead to physical and mental harm to the survivor of the event.
This aspect maybe difficult for some people to understand if they have never actually felt it or remember feeling it. The best way I have learned to date to understand this process and to better understand the fight, flight or freeze response, is through reading Waking the Tigger, Healing Trauma by Peter Levine with Ann Frederick. Though we as humans think we have little in common with our four legged counterparts, there are still some aspects we share. One of these areas is our response to a perceived threat to our life or others. So now I want you to imagine you are a rabbit or any other prey type animal. As you graze on grass with other rabbits, something startles you from nearby brush. Your senses go on high alert trying to determine what has startled you, the amount of cortisol has already started to increase to the brain allowing for your ability to hear and see to become finer. Suddenly a wolf breaks from nearby brush, it is at this point every rabbit runs for safety and blood flow is quickly pushed into the leg muscles to help with escape. At some point one rabbit realizes the wolf is going to catch it, so it freezes in place. The thought process is if the rabbit freezes it will take on a dead appearance by the wolf; since not only does it stop moving and goes stiff, the heart and breathing goes down to a level that is not noticeable by the wolf. If the rabbit is lucky the wolf will take it back to its cubs, where it may find another chance to escape once it unfreezes. If the rabbit is unlucky then this freeze will help the rabbit as it dies to feel little to no pain as the wolf tears into its body. So basically everything that has occurred is biological, with only the mental stimulus to increase or decrease the body’s response to the threat. Is it possible that the freezing aspect can cause an increase chance of not recovering from the event?
Now that the harm is done, the next question is how do you treat a survivor of a traumatic event that has developed PTSD? There are many theories out there on how to treat a person with this disorder and others. Some believe by returning the individual to the traumatic event through Narrative Therapy is the best way to go. Others believe it is best to work on the symptoms that have developed due to the traumatic event through Prolonged Exposure Therapy. The key thing in both of these treatments is to change the survivor’s cognitive and behavioral problems that have arisen. There are a ton of theories and therapies out there for dealing with just about any disorder developed due to the traumatic event. But what type of treatment is best to help those with PTSD? Do you focus on a more biological aspect of recovery? Chance the possibility of re-traumatizing the survivor through the use of Narrative Therapy. Leaving the survivor in a worst position then they were prior to the treatment.
Example: A military member is sexually assault and does not report the incident due to shame and lack of memory of what actually occurred during the event. The survivor goes years without dealing with what occurred and finally finds themselves intoxicated all the time and in an abusive relationship. Finally, the survivor is hospitalized for alcohol poisoning and during treatment for this and the abuse, it comes out that while on active duty the member was sexually assaulted. Counselors make the assumption the reason for the alcoholism is due to the sexual assault and has nothing to do with the current domestic abuse. The counselors determine the best treatment to utilize is Narrative Therapy, basically writing down the event and reading it out loud over and over again. As the survivor is going through treatment, on multiple occasions has made comments of feeling worst, re-traumatized, helpless, depress, high anxiety, etc. Were the counselors right to choose to treat the trauma for the sexual assault or should they have stuck with the domestic and substance abuse treatment?
It is at this point the individual will either begin their process of recovering or start down the road to problems such as PTSD. It is also at this point where controversy starts to occur on where to go from here for the survivors. Some counselors have told me that staying amerced in your life that was prior to the event will help in healing, basically keeping the victim in a familiar location and people. Others have told me that it is more important to remove the survivor from the location and people they were with or around prior and at the time of the event. Now I can agree with the second aspect when it comes to child abuse, rape victims, domestic abuse victims, etc.; however, I only agree to the point where the victim is no longer in danger. When it comes to first responders or military personnel that keeping them with trusted people in a safe location is important and that removing the person all together can actually cause more harm. This is especially true when it comes to a person who understands what they are going through and feels they will do better in a familiar place and people. I also believe that going against, within reason, what the survivor wants can be very harmful; especially, when the survivor is not ignoring the fact that they have been affected by this event.
Example: A military police (MP) officer involved in an active shooter situation, where the victims of the shooter are close friends and co-workers. This MP has been through bad situation before and with help from friends and other co-workers, plus a stable environment that was still in the same location was able to recover from the trauma and carry on with life and the job. However, following this last event the MP is removed from everyone who is considered a trusted friend and co-worker, plus sent to a location that the counselor believes is best for recovery and treatment. This goes against everything the MP believes when it comes to how to recover from such an event. This MP becomes stuck in this event, nightmares continue for four plus years and is now unable to conduct normal daily life events such as grocery shopping, working outside the home, etc. Basically, this MP now has PTSD and is unable to do the things she use to enjoy in general. The new stress causes anxiety, anger and severe headaches. Things that did not happen prior to the final traumatic event. In this case was it the counselor telling her that she didn’t know what was best for her, making her feel like a victim or was it this final traumatic event that caused the pain to follow? Since the development of PTSD it is unsure what actually pushed this veteran into the state of PTSD that may last for the rest of her life. It is due to this unknown factor that is making it difficult for current counselors to help the veteran.
Due to my two examples and multiple of other stories I have heard from survivors suffers of PTSD and different educational papers and books written I have started to call into question the different aspects of how people are treated for trauma. Should all the focus be placed on the mind or should some of the focus be placed on different ways to expel the pent-up energy from the traumatic event. I know the jury is still out for me as I continue to search for information and medical treatments for those affected by the after effects of trauma. Though some may not wish to change or to add some physical aspects to the treatment plan of those who suffer from PTSD, it seems as if we should look even more at how other mammals are able to recover as the answer for how to help mankind with its recovery.