Important article about PTSD

I get a lot of people searching this blog for information on PTSD. It’s one of the top search terms that leads people here. I don’t write about it much but have once in a while. That shows you the paucity of information out there if this obscure blog is one of the Google hits in the first few pages of listings. There is a notion that Buddhist practice can be of assistance to those suffering PTSD. That can be true but there are a lot of caveats I’d add.

PTSD doesn’t just affect the person who experienced trauma. It affects everybody around them as well. Here is an excellent new article on that.

Is PTSD Contagious? from Mother Jones magazine. Read it before you continue here. I’ll wait.

Those who are around people suffering from PTSD will recognize themselves immediately. From the experience of having been the partner of someone with severe PTSD for 12 years I acknowledge the veracity of this article. It is contagious. It conditions you to view life in a completely different way. It is stressful and can become debilitating. It takes a very long time and a lot of work to recognize how that conditioning happens because it is very insidious. [No we didn’t get divorced because of PTSD but because he wanted children, which he now has with his second wife, and I didn’t. People ask that when I mention how come I am familiar with the topic so I’ll save someone the trouble.]

The effects on those around PTSD sufferers is something that we all need to become aware of because PTSD is far more common that many people realize. It’s not something that just happens to military personnel but also to police, doctors, nurses, rape victims, accident victims, prisoners of any sort, refugees, children who are bullied or otherwise abused, victims of assault and other crime…in general people who have experienced trauma.

In any social matrix (family, club, work place, school class, sangha, etc) if one or more people are experiencing PTSD symptoms, and in any large group there is a likelihood that there will be at least one or two people, this will to some extent begin to generalize to the group. That is one of the reasons we all need to get more education on the subject.

From the National Institute of Mental Health:

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.

Additionally from Casa Palmera Mental Health facility:

TOP SIGNS OF C-PTSD

Prolonged exposure to traumatic events can result in C-PTSD, or complex post-traumatic stress disorder. Survivors of prolonged physical and sexual abuse, hostage situations, religious cults and prisoners of war are all examples of people susceptible to C-PTSD.

The symptoms of C-PTSD are similar to PTSD, but also include:
* Persistent feelings of depression
* Problems controlling feelings
* Preoccupation with suicidal thoughts
* Self-injury or self-mutilation
* Explosive or inhibited anger
* Compulsive or inhibited sexuality
* Amnesia or hyperamnesia regarding the traumatic events
* Episodes of dissociative behavior
* Preoccupation with the perpetrator
* Seeing the perpetrator as all-powerful

TOP SIGNS OF PTSD IN CHILDREN

Following the traumatic event, children may exhibit signs of confusion or agitation and show intense fear, helplessness, anger, sadness, horror or denial. Children who experience repeated trauma will dissociate, or numb their emotions to deaden the pain.

Children will exhibit many of the same symptoms of PTSD as adults do, but with the following exceptions:
* Worrying about dying at an early age/anxiety about death
* Acting younger than their age (e.g.; clingy or whiny behavior, thumbsucking, etc.)
* Repeating behavior that reminds them of the trauma. For example, repeatedly playing in a way that re-enacts the trauma.
* Regressive symptoms (e.g.; bed-wetting or losing speech or motor skills)
* Freezing (sudden immobility)
* Separation anxiety

Other sources of information:

• Mayo Clinic Post-traumatic Stress Disorder
• Helpguide.org Post-traumatic Stress Disorder (PTSD):Symptoms, Treatment and Self-Help
• PTSD Forum
• Family of a Vet Secondary Traumatic Stress Disorder [with additional links to resources]

I mentioned conditioning at the beginning of this piece. For those with STSD (Secondary Traumatic Stress Disorder) conditioning is how the symptoms begin to manifest, through the daily rituals and reactions that accompany PTSD symptoms in one’s loved one. When one becomes used to their partner waking up from nightmares, sleep becomes fragmented and lighter. When one becomes used to checking someone else’s psychological status in case a hospital visit may be needed, one starts reading everyone from that perspective. When one is in the company of another who sees the entire world as a threat one starts to examine the world through a similar lens. When one becomes used to checking their own emotional and psychological status in order to thwart an inappropriate reaction to someone else’s fear, introspection can become almost obsessive. When one is frequently and abruptly alarmed by a loved ones erratic behavior, hyper-vigilance, startle reactions and anxiety become constant.

The reasons for the manifestation of symptoms are different between PTSD and STSD. One has not experienced the same trauma as the loved one. But one becomes very defensive and protective of that loved one. When you see their pain daily you want to prevent anything more from hurting them. You feel the need to intervene in all their interactions. You feel the need to stand against any criticism of them. And if they ever act out in a violent way due to their fear then one has some trauma of their own to deal with. This can cause a lot of internal conflict, both wanting to protect someone and feeling the after effects of personal trauma. It can get very complicated.

One other thing I notice among those I know with PTSD is the tendency towards denial. Denial is an attempt to regain control of the situation and of the person’s thoughts and emotions. It is a poor coping strategy because it does not address the problems which then continue. Confrontation of this denial though is not only pointless because it only causes the person to distance themselves further from those who would support them but can also further traumatize the person. As a loved one, if the situation is stress inducing for you, take counseling for yourself and reach out to community support groups (for military personnel veterans departments may have some suggestions), do research and modify your own reactions to their behavior. If you can remain calm and open during a time your loved one is experiencing symptoms, this may assist the person in feeling more secure and comfortable in talking about their issues. If you react with agitation, excitation and stress-based reactivity the situation will escalate and not be resolved. This is part of the PTSD syndrome. It tends to reinforce itself in ever larger circles.

These situations can be very complicated to resolve. Some kinds of mindfulness training can be beneficial if it is supported by counseling. I am not an advocate of pharmaceutical approaches to mental health issues generally but if someone is feeling really out of control initial use of some drugs may be helpful as long as it is supported by counseling, self-help techniques to relieve stress, learning further coping skills, community/family support and education on the causes and available treatments. Unfortunately a lot of people only go to their doctor, get a wrong diagnosis from a 10 minute interview (ie social anxiety disorder, depression, bipolar, etc) and get a prescription for something which doesn’t help much.

One important thing I want to point out is the difference between mindfulness and hyper-vigilance. I’ve seen some suggestions that mindfulness is similar to hyper-vigilance. It is not. They are very different modes of attention. Mindfulness is fully attending to the present situation. It is reality based and unmediated by out of control emotions, projections of threat or re-emergent memories of past trauma. Hyper-vigilance does not attend to the present situation realistically. Instead hyper-vigilance attends to fear and potential psychologically manufactured threats in the environment whether the environment is safe or not. Hyper-vigilance is seeing every situation, through a filter of fear and anxiety, as a threat. The hyper-vigilant person does not relax enough to be able to attend to the present and accurately assess the situation. The ability to reality-test does not fully function. Sometimes cognitive behavioral techniques can help with that and sometimes mindfulness training can help with that provided the instructor is aware of the situation of hyper-vigilance and is knowledgeable about PTSD. That is the biggest caveat to undertaking any sort of Buddhist technique to help with PTSD symptoms.

Other caveats include:

• denial. “You are Buddha already.” therefore you can’t have those problems. This “Buddha already” is problematic in far more ways than just denial of psychological issues but that is beyond the scope of this post. [I’m trying to curb my tendency to go off on tangents so maybe I’ll address it in a future post]
• positivity. Not really a Buddhist approach but one that does occasionally creep in, the positivity approach simply exhorts people to “banish the negative”, “be positive” and shies away from dealing with any actual problems. It often gets mixed in with “The Secret” type notions. The “what you think manifests” or just by believing something it shall come to be. Also known as wishful thinking or Magical Thinking which has as much of a history in the West as elsewhere—see Magic (paranormal)—theories of adherents for more. You cannot wish PTSD away.
• dismissal. of trauma based hallucinations, flashbacks, etc as “delusion”, “a dream”, “makyo” etc. A person’s subjective reality is their reality and has to be deal with as such.
• catharsis. I have read some Buddhist teachers advocating meditation as a way to face trauma and be present with the feelings that arise. This is dangerous if there is no psychological support in place to deal with the fall out.
• breaking through. This is an extreme form of catharsis. A few seem to think that prolonged retreats or intense sessions of meditation “through the pain” will somehow break the hold of PTSD or other psychological distress. This is also dangerous. For example a brilliant young man recently took his own life—Aaron Swartz held to the idea of “leaning into the pain” in order to overcome it. He suffered from bouts of depression in his life. [He wrote about it here Lean into the pain-if you read it notice that some of the impetus for “self-help” and “self-improvement” is very similar to what some Buddhist teachers put out, particularly those who do large group training and related sorts of seminars. People like Arianna Huffington are even praising the approach on her Google plus profile after his death.] While Swartz was not a Buddhist, nor did he have PTSD, as far as I know, this type of approach to any sort of psychological difficulty is problematic and has appeared intermittently in some Buddhist circles.

There’s likely a few more I could come up with but I’m sure you get the idea. The point is using Buddhist techniques as assisting in healing PTSD has to be done knowledgeably, carefully and that this is not the same as simple self-improvement or self-help.

So if you know anyone struggling with PTSD first educate yourself on the topic and then advocate on their behalf. That’s the two best things you can do for them. It will help you too, especially if you are close to them and beginning to experience some of the same issues.