PTSD: A Few Thoughts...

My mentor/supervisor is a wonderful lecturer. At the start of each lecture he reminds the students that no question is ever stupid and that you should ask questions, because there is probably another person in the room who also wanted to know that answer, but was too scared to ask.

A few days ago, I had a wonderful experience. Someone had enjoyed my poetry on Hello Poetry (awesome site by the way) and had followed up by taking a look at my website. Guess what? They asked a question! 

They asked about my thoughts on post traumatic stress disorder (PTSD). While I wouldn't call myself an expert in the field, I have had some experience of this disorder during my internship at Rape Crisis, Cape Town. Of course, I also love the history of mental health and adore feminist theory, so the resultant answer was quite interesting. Here goes...

 

One of the central problems with PTSD is fear and avoidance behaviours, which are common to all anxiety disorders. The main difference between PTSD and other anxiety disorders is that we have a direct cause - the traumatic event.

I find the history and development of PTSD very interesting. I am fascinated by how society affects the treatment and recognition of mental disorders, as the lack of a physical cause seems to really irk them. Of course, I believe that the brain is an organ that works in ways that we don't quite understand yet and that something caused by any organ (brain included) can be classified as a bodily disorder. 

The human brain has amazing capabilities, but, in terms of mental disorders, sometimes these work against us. One such capability is the capacity to remember events and experiences (sometimes called episodic memory) extremely well. This is great when we remember getting our first bicycle or have fond memories of grandparents, but works against the anxious mind terribly. One of my favourite quotes from Mark Twain is, “I've lived through some terrible things in my life, some of which actually happened.” The awful thing about PTSD is that the terrible things did happen, but our amazing capabilities for remembering the event means that we can relive it whenever we “choose”, such as in dreams or flashbacks. Choose is not really the correct word for PTSD sufferers, as it implies that they have control over these thoughts and thus can easily be blamed for their disorder. 

Often triggers of the memory cause the replaying of the event, whether they choose it or not. In therapy it is important that the person understands that they can regain control of their thoughts. The memory will still exist, but it can be pushed aside. One exercise to achieve this is mindfulness. Mindfulness means that you situate yourself in the "now". A way to do this is to focus on your breathing and on slowing it to a calm pace. The next step is to use all of your senses to place you here and now. What do you hear? What do you feel on your skin? What do you smell?, etc. 

Moving back to the history of PTSD, it is interesting that PTSD was only included in the DSM-3 in 1980 (before that it was not considered a real disorder).

The feminist movement of 1970, was largely influenced by the treatment of war veterans of the Vietnam War. As the war was not won by the Americans, these veterans were not treated as they should have been, especially in the treatment of their PTSD and re-introduction to everyday life.What is very interesting is that feminism is not just about female rights and equality to males in society, but has now extended to fight for the equal treatment of all people.

Smokey the War Dog

 One of the most tragic PTSD stories, is how it was overlooked during WW1 and WW2. The idea of “shell-shock” was created as a poor stand in. The main reason for this oversight was the predetermined roles of men and women at the time. It was unseemly and unmanly to be traumatised by war. War, after all, was how you showed the world how brave you were. To come back scarred physically was fine, but mental wounds were seen as cowardly and weak. By the way, animals can have great therapeutic effects for many disorders. Smoky the war dog (right) gave comfort and inspiration to many soldiers in WW2.

Feminist theory comes up a lot around PTSD, mainly because of the link between the feminist movement and its recognition as a disorder, but also because many of the ideas of semantics (word choice) are central to the movement. The choice of politically correct terms is very important in the treatment and recognition of PTSD. 

Always remember, if you have been diagnosed with PTSD, it is not a sign of weakness; rather, it is proof of your strength, because you have survived!
— Michel Templet

For instance, sexual assault is a common cause of PTSD. Calling a person subjected to sexual abuse a rape victim or rape survivor may seem trivial to those of us spared from the heinous crime. However, in therapy it is crucial for that person to, not only know, but fully engage with the idea that to cope with what happened to you and to empower yourself to continue living the life you wish, despite the trauma, makes you a survivor. While I used rape here (my experience with PTSD was during my internship at Rape Crisis Cape Town), this applies to any trauma that may have induced PTSD.

While PTSD is now fully recognised as a mental disorder, I think there is still a stigma attached to trauma and how one copes with it. Think of how society often calls people brave for coping well and weak for needing help. This is especially applied to men.

My father is a war veteran and to this day he hates movies with excessive violence and never talks about his war experiences (other than humorous anecdotes, few as they may be). Although this is a far cry from PTSD, I still think that a little post-war debriefing may have done his generation a world of good. Unfortunately, that would have been seen as weak and unmanly.

To see a great comparison of the DSM-4-TR and DSM-5 criteria for PTSD read this article  http://www.jaapl.org/content/42/2/146.full.pdf