a little rant on Post Traumatic Stress Disorder – in honour of mental health awareness week

This week is mental health awareness week in Australia. It’s about promoting awareness of mental health and wellbeing and equipping people with the right information – about making a move towards better mental health.

Last Friday was odd socks day – it was about stomping out the stigma around mental health. It had 5 tips:

• Be a friend – be there, for the ordinary and extraordinary moments
• Be brave – don’t tolerate stigma and discrimination
• Be open – share your experiences
• Be informed – know the truths and dispel the myths
• Be good to yourself – recognise the need to look after your own mental wellbeing

So in the spirit of being brave and open and having extensively informed myself since realising its affects on me – I am going to share a little about Post Traumatic Stress Disorder. Whilst eating chocolate of course in observation of point 5. I am a big believer in dispelling the stigma but that begins with me & I’m in a place where although this makes me a little vulnerable and not super comfortable – I am ok with sharing.

I took me a long time after witnessing a traumatic event to realise that maybe I wasn’t coping. It took even longer after reading my symptoms in a social work text book to actually go to the doctor. Although a few friends had suffered with mental illnesses and (I hope) I didn’t stigmatise it in the least for them – believing that it was better to have it out in the open so I could support them through it – for some reason when I saw the symptoms in myself the same didn’t apply. I was shamed, I didn’t want my extended family to know, I didn’t even tell my parents. In fact I think I only told 1 or 2 people at the very start, months after reading about my symptoms in the text book – hoping it would push me to actually make that doctor appointment. It was stigmatised – there was something wrong with me, I wasn’t coping, something small and trivial that shouldn’t have been affecting me was, so I ignored it and I didn’t want anyone to know in case they thought I was weak.

When I was sitting in a lecture and the lecturer began telling a confronting true history story about slaves and black America with photos and I began shaking and wanting to throw up in class because what I was seeing was too close to the traumatic event. My senses were reliving ‘that moment’, but I wasn’t hundreds of kms away, where it happened, I was in class. I somehow managed to just focus the rest of the class on calming down from my panic attack. I realised that afternoon – I wasn’t ok and I wasn’t going to get better by myself. Angry emails to the lecturer about graphic images wasn’t going to stop the possibility of it happening again.

So I worked up the courage to see a Doctor. We did the mental health assessment and it was clear that I needed to see a psychologist to help me work through it, I had been suffering mild depression and anxiety for months – all related to a memory. Several months after the doctor appointment I had worked up enough courage to see the psychologist. It took several sessions and Eye Movement Desensitisation and Reprocessing (EMDR) – the most weird and fascinating technique for dealing with trauma (more info later) for me to finally be ok with the memory. For the shakes, wanting to throw up, smells, fear, turmoil of emotion that I used to live every time I would remember that moment, to stop.

Since then I have been fine. Amazingly, something so simple (EMDR) in my case worked so effectively. It also helped that I happened to take off to Europe for 8 months of extended holiday (4 months exchange studying – but hardly as stressful due to the uprooting all previous responsibilities). 8 months of learning not be stressed, relaxing, exploring, getting out in nature more and remembering how to have fun without a heavy cloud overhead, 8 months of recovery that happily coincided with my traveling.

So that is my story. What I experienced is nothing compared with some many others that have PTSD, I haven’t come from a war torn country, I haven’t been abused – however that doesn’t change that the traumatic event I witnessed affected me hugely & I needed help in resolving it.

What was the trauma you might be thinking – actually you have no idea what a pet peeve that question is for me about people suffering with PTSD! No actually it makes me REALLY ANGRY – it’s noseyness and unless you have the skills to help someone come to terms with the trauma let me explain the consequences of asking the question! (in detailed information about how PTSD works)

To rip some lines out of my PTSD essay I wrote earlier this year – the brain stores traumatic memories differently from other types of experiences, with traumatic memory being stored more as senses and emotions than cognitions. In PTSD the hyper-arousal in the body’s nervous system caused by traumatic stress becomes stuck with the memory being stored in the amygdala (sensory memory).(Jenkins, 2004)

Basically this means that the memory is stuck in the senses, thus when I saw an image of something similar, or had to retell the event, or even thought about what I had witnessed I relived all the senses I felt when I experienced the traumatic event. Basically the memory gets stuck in the fight / flight / fight mode.

This is one of several of the list of symptoms of PTSD which includes: recurrent intrusive distressing recollections of event; acting or feeling as if the event were recurring; intense psychological distress at exposure to internal or external cues that symbolise event; avoidance of stimuli associated with trauma or numbing general responsiveness; duration of symptoms is more than 1 month. I should also mention that PTSD often develops quite some time after the event. The memory isn’t resolved and so you believe you can ignore it to avoid it, however, the longer it is ignored and not resolved the more it becomes an issue – the greater the fear of the memory and inability to deal with it when it arises.

The interesting thing about PTSD however is not all people who witness traumatic events get it (thank goodness!). So how come? Well it is because some people are able to resolve those horrid memories (as I now have with the help of EMDR [description after my rant]). The memory is resolved from the amygdala (sensory memory / stress response) to the hippocampus (long term memory). This can be due to a number of reasons however a contributing factors include how seriously they took the original trauma – the feedback they received when they told another person about the event and then being able to come to terms with it (all of these help process the memory to long term memory instead of unprocessed and stuck in sensory).

For me, the first person I told / that was there with me proceeded to tell me numerous other highly traumatic stories with disturbing graphics explicitly described. It definitely was not helpful for me and made me feel that what I had just witnessed was nothing, because it wasn’t, not compared to what my my friend had witnessed. I also didn’t want to burden anyone else with such a disturbing story – as a visual thinker I put myself in others shoes, not wanting to burden them with something so heavily burdening me. I held onto the trauma, ignoring it, saying it was nothing and that I should get over it, that I was being weak (that went on for 2 years till a fun text book life realisation interaction).

So why do I hate the question of what happened? What was the traumatic event? Because for 4 years of my life telling that story made me want to throw up, caused me huge anxiety, made me relive that experience for someone else’s curiosity or the worlds disgusting obsession with violence and gore! (clearly I have personal issues with this and its a whole other kettle of fish – get me started I dare you!)

What is more, I gauged what my response should have been to that trauma off those people’s responses. If they could brush it off so should I.

So please, stop asking someone what they have been through, whether you genuinely care, want to help or are just curious. It feels rude to say actually I don’t want to say, it feels weak to keep / hold that information back. And even when it has been resolved, it’s still a horrible memory! It’s none of your business unless you want to support someone through their recovery and feel its imperative to know. And if it is someone close, let them know you care – ask them if they think something is affecting them – talk / ask about how they feel not the gorey details of what happened – because that doesn’t matter (unless you are working out how to resolve the memory) but the person sitting with you and how they feel does.

And if someone ever discloses a traumatic event to you – DO NOT MINIMISE IT! I don’t care if it makes you uncomfortable; if you don’t know what to say (Just say ‘I don’t know what to say’ – being willing to sit in the uncomfortable can be the best support in the world because it shows you take it seriously & you don’t know what to say but you’re going to be there anyway!); if it makes you feel sick (if someone is offloading on you and you don’t think you can cope then stop them nicely, but tell them you think it is important that they tell someone but that maybe you aren’t the right person to tell, but you want to support them with how they are coping – vicarious PTSD is a thing). You ask that person how it makes them feel and if they say crap then impress on them the importance of dealing with that. That regardless of what it is, that they shouldn’t minimise its effects but acknowledge them so they can begin to come to terms with them. Be there to support them through it if they need, recommend professional help if they want it or could do with it (help them make the appointment if they know it is good but its hard to get there). There is free access to mental health professionals through medicare rebates (6 sessions a year) through a GP (its called the better access scheme).

So like that list at the start:

• Be a friend – be there, for the ordinary and extraordinary moments
• Be brave – don’t tolerate stigma and discrimination
• Be open – share your experiences
• Be informed – know the truths and dispel the myths
• Be good to yourself – recognise the need to look after your own mental wellbeing

Obviously PTSD is a bit of a topic of interest for me, as is trauma in general – so if you have any questions feel free to send them my way & I will attempt to answer / help if I can.

I am so glad that I am beyond the stage where I feel stigmatised for having had PTSD. And as much as I am sad of my sense of stigmatisation when I realised, not telling people so I could get through it was important – it minimised that ‘what happened’ question. It was my journey and that was the way it needed to happen for me to come to terms with it. What I am super proud of and so so so grateful for is all my friends that I did disclose too and were such amazing supports to me whilst I did come to terms with it. Depression, Anxiety – PTSD doesn’t have fun side effects – I was gloomy and difficult to be around at times especially around those where I knew loved me regardless. I would be so stressed about what to make for dinner that it came with a ridiculous stress drama dance from the cupboard to the fridge with my hands pulling my hair repeating what can I even eat?! But those people that stuck with me through my ugly self – through my struggling not coping – body screaming for help in so many ways – have now helped see me through to my much happier life giving self. And for that – and all those who didn’t know but have been supports anyway – I’m eternally grateful!

EMDR description : “EMDR is a relatively new and contentious clinical treatment that has been scientifically evaluated predominantly with trauma survivors and persons stricken with anxiety.  The premise of EMDR is that traumatic, panic, and anxiety experiences are processed differently by the brain than pleasant or neutral experiences.  EMDR maintains that the amygdala (part of the temporal lobe responsible for moderating emotions) provisionally shuts down the hippocampus (complex region in the temporal lobe responsible for long-term memories) resulting in a heightened reaction to the specific event.  Theoretically the memory of the disturbing experience is trapped beyond the domain of usual brain-processing abilities.  EMDR grants the patient admission to the experience so that he/she can convert it into a tolerable or neutral memory.  The neuro-physiological concept behind EMDR is that the hippocampus is not entirely shut down by the emotions evoked from the induced experience. Therefore, the patient is able to endure the procedure.  Distraction by bilateral stimulation catalyzes rapid eye movements (REM) similar to that produced during sleep.   In theory the REM induced in an EMDR session triggers an accelerated processing system in which the patient is able to rapidly absolve upsetting experiences creating an adaptive learning experience.  In simpler terms, the patient learns to draw out what is necessary and useful from the upsetting incident.”

stolen from: http://healthpsych.psy.vanderbilt.edu/EMDR.htm