wpe1.jpg (12422 bytes)

transitions-counseling.com Where Your Help Begins Online   

PTSD - The Normal Reaction to Real Life Horror - Part II -

            Nighttime is falling across the once-stormy sea and the handful of survivors cling onto their tiny boat with a mixture of relief and desperation.  Relief, because they survived the ravenous monsters on a tiny island that nobody knew existed; desperation, because rescue has yet to come in response to the SOS signal Muldoon had transmitted two days ago as his last act in this world.  

            Nobody sees the dark shadow pass under the boat, fully three times its length, slowly circling back to the horror of no one.  Everyone is staring at the skies – the skies from which they await their rescue, and not one of them wants to consider whether the water could hide anything as terrifying as what stalked them across the confines of that God-forsaken island.  Especially not Nora and Glenn, who had witnessed their children eaten from the very shelter they had placed them in for safety. 

            Perhaps their memory serves them to their advantage, as they wedge themselves tightly into the bottom of the bow of the boat, staring up into the darkening sky.  They are spared seeing the last moment of horror as the rippling shadow rises up under the stern of the boat, crashing through the aft hull-framing like cannon-shot. Only Nora and Glenn are spared as the cries of the remaining survivors are swallowed up in a cacophony of splintering wood and surging bloody water swirling behind the shadow they did not see. 

            As suddenly as it happened, the silence behind this last catastrophe now hangs over them more heavily than their weight on the half-sunken bow, seeming to pull them deeper with each swell of the darkening seas.  Terror is their first reaction to the sudden appearance of the light, just above the horizon, gradually followed by the crescendo of rotor-beats whopping in their direction . . .   

            And so it goes, like the ending of a scary Halloween movie.  But how would life continue for Glenn and Nora if they were real people returning to “normal” life after an ordeal like the one described?  Even if they had not lost their children, the likelihood of their contracting Post Traumatic Stress Disorder would be very high.  Likewise, if the “monsters” had been stalking pot-growers and the sea-monster had been a coral reef. It’s largely a matter of intensity and duration of exposure, helplessness or lack of control, and isolation.  

Real Symptoms – Not Halloween Thrills 

            Nora is distressed continually after her return.  She becomes overwhelmed by panic attacks that increase in frequency.  She has a close circle of friends who support her and maintain availability for when she needs to talk – which is often, because she cannot get the horrible visions of what happened out of her mind.  She develops physical symptoms, including constant gastrointestinal upset and pains throughout her body.  Six months after her return, her friends take her out for a day on the lake and she panics upon entering the boat.  After she collapses in tears, her closest friend stays behind with her and Nora opens up about her growing rage toward Glenn, who seems not to care about anything anymore.  She is thinking of leaving him. 

            Glenn immerses himself in his work, staying on the job long hours.  He has little to say when he returns home and Nora feels increasingly alienated.  She wonders how he can be so heartless and distant – especially under the circumstances.  He is short-tempered, especially when she insists upon talking about their ordeal.  Little does she know that he has no memory of the actual incident involving the loss of their children. Yet, the flashbacks of those last moments on the ocean overwhelm him.  

She has no awareness of how “numbed out” he is, as opposed to not caring, nor of how close to tears he feels all the time.  All she sees is his anger – and finally, he starts coming home drunk.  He sleeps less and less, presumably because he often has nightmares that wake him up. When Nora confronts him with her thoughts of separation, he walks out of the room, consumed with his overwhelming sense of guilt at not being able to protect his family. He just wants to get out into the cool night air – away from her, away from people, away from anything that will remind him of what has become of his life. He doesn’t see the critter that plays a part in the events that turn things around. 

Beneath him, under the deck, a raccoon rustles through the bushes and succeeds in knocking over the wood-splitter.  Glenn suddenly feels overwhelmed with a sense of dread and panic. Stumbling back inside, he sits, head in hands, with his heart racing.  He is startled to find Nora beside him, gently stroking his back and looking into his eyes with concern.  She now knows she is not alone. She now knows he also is being stalked from the inside by the same monsters that raid her dreams at night and paralyze her with foreboding by day.  At her touch, Glenn is both ashamed and relieved to find himself wracked by sobs that seem to have no end, as they finally begin to talk. 

Since I am a counselor and I am writing this story, I’ll say that Glenn and Nora seek counseling for what is diagnosed as PTSD.  And, instead of deepening their tragedy through losing their relationship, they begin to recover and learn to support each other according to each partner’s unique needs. 

The experiences of this couple illustrate the unique ways PTSD can manifest itself in individuals. 

Living with PTSD  

PTSD can come about as a result of various kinds of traumas, including war, physical assault, rape, domestic abuse, fire, natural disasters, and catastrophic accidents.  It seems that human-induced trauma is more likely to result in PTSD than natural disaster.  Also, the further the departure of events from everyday reality (sometimes referred to as the “Oz-factor”), the greater the chances of developing PTSD.  

People living with PTSD experience symptoms of anxiety which fall into three categories.  First, they tend to re-experience the event(s) through dreams and nightmares, through vivid memories or flashbacks, through experiences of anxiety in response to reminders of the trauma, sometimes through hallucinations, and through intrusive thoughts reminding them of the traumatic events.  

These can lead to the second category: avoidance.  People with PTSD may avoid people and places that can remind them of traumatic experience; may avoid close emotional contact with family and friends – to reduce the impact of future loss, should it occur. Total or partial loss of memory for the event(s) can occur, as well as emotional numbing, feelings of detachment or a sense of unreality. 

The third cluster of symptoms center around hyper-arousal. This includes a tendency for hypervigilance, including being easily startled, difficulty concentrating, anger and irritability.  Difficulty falling or staying asleep is common.  

Other common symptoms include survivor guilt, shame at not having resolved or prevented the incident, crying uncontrollably, feelings of being overwhelmed by ordinary tasks, or losing interest in previously interesting activities. It is not uncommon for people to “self-medicate” with alcohol or other drugs in their attempts to feel normal.  Getting lost in work (“workaholism”), hyper-religiosity and other addictive behaviors also fall into this category.  

Some symptoms are unique to the specifics of the trauma.  For example, Vietnam veterans tend to feel suspicious of authority as a result of their having been betrayed by their superiors at a vulnerable period in their lives; women survivors of sexual abuse tend to be suspicious of men in general.  I have treated car accident victims who avoided the site of the accident – or avoided driving altogether. 

Physical symptoms may accompany PTSD, including gastrointestinal problems, headaches, dizziness and chest pain. Recent research implicates evidence of PTSD history in chronic fatigue syndrome. 

Psychologist Mark Dombeck describes PTSD as a condition, “that could happen to anyone. It is not a sign of weakness or moral failure.”  He describes such traumatized people as, “. . .stuck people, forever needing to avoid what no one could legitimately face without going ‘mad’.”  Yet, we are doomed to a lifetime of symptoms if we do not confront the demons of our PTSD.  Like many therapists who treat PTSD, Dombeck explains, “You can’t really avoid fears and expect that they’ll go away, however.  In general, the safest way out is usually through.” 

Treatment 

            For those who experience less intense trauma, over a shorter duration, with immediate treatment, significant progress can be made to alleviate all or most of the symptoms of PTSD.   

For those who experience more significant trauma, in terms such as intensity, duration, repetition – especially under circumstances of helplessness or loss of control and lack of social support – research is increasingly identifying this condition as a process that results in permanent neurological damage for which there is no permanent cure. However, there are a number of therapies that can help relieve symptoms and make PTSD easier to live with. 

Cognitive behavior therapy approaches help change thinking patterns to relieve symptoms, while various exposure therapy approaches allow a person to re-experience the trauma in a controlled environment to assist in reducing fear and gaining control over anxiety.  Group therapy with other trauma-survivors is a powerful approach and proper use of medication can help alleviate symptoms, but not effect a cure. I have found helping people find personal meaning in their suffering can make trauma bearable. 

Prevention 

For those of us who experience trauma, the most important response is to seek immediate help. We must recognize our vulnerability.  As they say at the VA, “Don’t try to be the tough guy.” A process known as stress debriefing can help prevent the emergence of PTSD by allowing victims of trauma to talk about their reactions, thoughts and feelings in a safe environment.  Also, I cannot emphasize enough the importance of an effective social support system – which should include family, friends and community support. 

None of these things were in place when I and so many other veterans returned from Vietnam so many years ago.  As a result, my personal struggles, with treatment and training, became my professional standards.  The desire to help prevent or minimize the emergence of PTSD was behind my journey to Ground Zero, WTC, after 9/11 and the Mississippi Gulf Coast after Katrina.  In doing so, I met many courageous individuals who were struggling with the effects of their trauma.  More than they knew, I understood the challenges they faced. 

Many years ago, I played the “tough guy” because the role was the only option for soldiers returning to a world that neither accepted the sacrifices, nor offered the support for those who made them.  Now, things have changed.  It’s okay to “get real” about the things that happen to you.  I wish I could say I have gotten over the shame over having the condition, but I am working on it.  I know it has made me a better therapist and a more compassionate person for having gone through all these things.  Maybe, after all, that is what life is all about. 

Granville Angell   © 10/2006 

Granville Angell, EdS, LPC, NCC, invites you to submit questions for his column. (Your identity will be kept confidential.) Email him:  angell(at)transitions-counseling.com, call his private practice, TRANSITIONS Personal & Family Counseling Services at 704-276-1164; visit his web site: www.transitions-counseling.com, where you can read prior articles.