PTSD & Resilience

What makes one soldier suffer from PTSD and another one not have symptoms? Why do some people never recover from catastrophic grief while others do?

In the movie “What Dreams May Come” with the late Robin Williams, a physician dies in a car crash and ascends into heaven, his distraught wife commits suicide and descends into hell or Hades. The physician embarks on an epic journey to save his wife.  He descends into hell.  This is based on the presumption that we create our own hells and heaven with our own thoughts and memories (a theme in the Tibetan Book of the Dead as well). The couple had lost both of their children in a tragic car accident-the father was able to carry on through focusing on work, but the mother had much difficulty moving forward.  When she looses the love of her life, she commits suicide.

Why is it that some can carry on through immeasurable grief and others break down and can no longer function? How can one be resilient?

An article called Trauma, PTSD and Reliance by Christine E Agaibi,  http://tva.sagepub.com , states that “Theoretical models of  PTSD have established that there is a wide range of outcomes in how persons cope with traumatic experiences.”

Children cope more effectively with adversity if they receive nurturing and love, even those children exposed to chronic stress such as war trauma, refugee status, civil violence and extreme poverty. Self-esteem and self-confidence help protect against traumatic experiences.

A study of former prisoners of war and veterans, examined PTSD symptoms and they found that the greater the torture and weight loss experienced while imprisoned, the greater the PTSD symptoms. They noted that pre-military trauma, personality, age, and post-military social support determined the severity of the PTSD symptoms.

“To understand the plasticity of behavior in response to traumatic life events, it is necessary to recognize the multidimensional nature of traumatic experiences. Traumas are not equal in their impact to the psyche and vary greatly in their stressor dimensions. “

Support of others, childhood, pre-existing conditions, self-esteem, assertiveness, personality, intelligence, use of left brain and right brain and other cognitive styles, all play parts in how one survives and reacts to grief and trauma and whether they are vulnerable to PTSD or pathological disorders such as dissociative disorder.

Robin Williams retrieves his wife from hell through his love. She in the end decides to no longer blame herself for the death of her children, the hell she created, and to let go. She loves herself enough now and she loves her husband. She chooses to join her husband in heaven.

What is truly ironic about this film, is the late Robin Williams, who tragically committed suicide in real life. Perhaps his risk factors where far too high even for his magnificent creative mind to transcend, for he was battling both Parkinson’s and Alzheimer’s.

Chance

I am a bit confused and disappointed when I see how mental issues are portrayed on television. There is a new series out on Hulu which offers hope, however. Hugh Laurie who once played the despicable Dr. House is now playing one quite different, a compassionate if not perplexed neuropsychiatrist. Chance is plagued by an attractive patient with “multiple personality” or dissociative disorder. I wonder how it is going to play out. In other series, I have come to feel that perhaps society is afraid of mental illness- to portray it accurately.

In the series Homeland for instance, Brody one of the main characters, definitely has PTSD, yet there is hardly a mention of it nor any therapy given to him when he arrives home from being a POW in Iraq. He has in fact what doctors call PTSD with DID or Dissociative Identity Disorder. As a soldier he was taken prisoner, suffered repeated beatings and unspeakable torture. He takes on a terrorist persona in order to survive the ordeal but he never relinquished the persona even when he comes home, and is celebrated as a hero in the United States. The results are devastating for the country and himself.

In Mr. Robot, Elliot struggles with his persona of his late father who tried to kill him as a young man. He is a vigilante hacker starting a revolution against corporate America. His “father” tells him how to do it. In a talk show after the 1st episode, Elliot is described as having an overactive imagination and anti-social. Really? On twitter it was tweeted about the potential  surprise you get when you figure out all of the characters are dissociative personalities of Elliott! In this case, the audience may know best!

Drama and comedy have been a way that society talks to itself about difficult issues. The Wire, Archie Bunker in the 60s, Roots are some that come to mind. Why can’t we be real about mental health issues? Dr. Chance’s philosophy is that in every situation there is hope. I say let’s give Chance, a chance.

Fugue

People often ask me what is a fugue, when they see the title of my novel. What is dissociation disorder?

A fugue can be a piece of music split apart from the whole symphony, similar but different. The Greek definition means “flight.” To take flight. Dissociation Disorder is a broken off piece from the whole. There are many types of Dissociation Disorder. There is Dissociative Fugue which is short -lived, Dissociative PTSD and the most famous type, Multiple Personality. Dissociation was once seen as quite rare, but today therapists are saying it occurs more frequently. Martha Stout, author of “The Myth of Sanity” writes that “moderate dissociation is a normal mental reaction to pain and fear and that even the most extreme dissociative reaction-multiple personality is more common than we think.” We all dissociate when we daydream.

The mind is a wondrous living computer. The cerebral cortex filters enormous amounts of stimuli that bombard us everyday from inside and out. The living human brain is also hell- bent on survival.

A traumatic event can be overwhelming for a child. The child has no life experience nor perspective to draw from. If a small child for instance is left accidentally by his/her mother, they may actually believe she is never coming back, he/she may eventually curl up in a fetal position, helpless.

In the case of a small child who witnesses a horrific event, the mind filters the event, puts the memory deep within the subconscious, so he/she does not have to feel the pain again as a recurring memory.

In dissociation disorder, this has happened a number of times due to many events. The response happens again in the adult due to triggers that relate to an actual excruciating memory. It can simply be a sound, or a smell or even a picture paired with the frightening experience.

Take Elaine, for instance, a beautiful young woman, who did a stint as a model and even started a business selling handbags. But she is continuously plagued by severe episodes of depression. It affects all her important relationships. When asked what is wrong, she doesn’t know. Her misery finally forces her to seek therapy. She undergoes hypnotherapy where she uncovers horrific memories of her childhood, living under the roof of a sadistic father. A sadistic father who threatened her with horrible things such as making a stew out of her pet white rabbit if she disobeyed him. Uncovering these memories is painful, but the truth of why she is the way she is, is revealed and that is priceless.

Many patients, decide that it is too painful to uncover memories. But Elaine decides she is going to make it worth all the struggle. She is going to make her life COUNT. She makes the effort to fill her life with passion and joy after having come out on the other side. This is the stance that many with severe Disassociation take, of appreciating life much more than the average person, perhaps freaking out over their iphone breaking. They have a clarity about them and know themselves well.

Dissociative Disorder is how the mind survives the unimaginable. It is adaptation.

Warrior Heroines

Mother always said I’d be a late bloomer. Little did she know just how late. I chuckled to myself as I walked down the lane on a winter’s day.

Summer is just a memory now. The fragrances, the bright colors, the abundance of growth are gone. Snow flurries dance in the wind as I pass one by one the neatly bricked houses that were once surrounded by colorful impatiens in shades of red, pink and purple. Horticulturists call these flowers “busy Lizzies” or “impatient Lucys.” Much like the women who lived inside these houses, I thought. Busy with career, children, impatient with their lives. Busy having it all.

There are now naked brown vines where “heavenly blue” morning glories once bloomed. These flowers are often tied to fences and mailboxes. They need lots of support to show their charms. Unlike wild, carefree black-eyed Susans that spring up unexpectedly in ditches and rock piles.

Women historically have been the caretakers in birth and in death. As midwives, they brought new life into the world, and as caretakers they ease the passage through this world. Many folktales from Europe, from countries such as Hungary and Germany, are actually a kind of map of the psyche handed down to us by ancient grandmothers. Full of archetypes, the fairy tales tell how to take care of the feminine soul.

They speak of renewal, of recovering that which was once sacred, and making time to replenish the self. They speak of growth and attaining knowledge and wisdom. They tell of the green apple which is young and tart like a young woman; it slowly matures on the tree and in time it becomes luscious red, ripe with sweetness.

Once must learn how to be kind. How to cultivate long-lasting relationships. How to spot a crisis. How to be firm but gentle.

There are women who are not necessarily doctors, lawyers or CPAs. They are the warrior heroines who do battle every day with fate, and identify oppressors inside and out. Often it is a silent one. Their adversaries are ominous: AIDS, cancer, poverty, depression, grief, abuse and trauma. Sometimes they confront more than one of these challenges at a time.

They continue to fight the good fight for they have discovered on their journey that even “the devil works for God.” Confronting the shadow within, they look fear in the eye. Carol S. Pearson, author of The Hero Within, writes of the wicked old woman who asks questions of her mirror. Because she is honest with the mirror, she becomes free from all her fears except one.

“I fear death. I fear change,” said the old woman to the mirror.

“Yes, they are frightening. Death is a closed door, and change is a door hanging open.”

“Yes, but fear is the key,” laughed the wicked old woman, “and we still have our fears.”

There exists, also within, a Gardener who overturns the soil periodically. She plants and cultivates for new growth according to the rhythms of life. Pruning, making beds, preparing. My nasturtiums were bedraggled from the hot summer sun. They forced a bloom or two, bright orange and red, in desert-like soil. Nevertheless, they did bloom.

A bitter unforgiving wind kicks up suddenly. The busy Lizzies and impatient Lucys are but a summer memory. “Be prepared,” the swift bit of wind announces. Beauty alone does not sustain one through the icy snows of winter. One must be strong from within, from long summer growth.

Be prepared, my friend, be prepared.

June Sitler
Published “Nashville Eye” March 21, 1996.

PTSD

When one hears Post-traumatic Stress Disorder, the image of a Vietnam Vet comes to mind. However, many people from all walks of life may suffer from this disorder. They are the survivors. They can be people who live in the inner city, those who have suffered the loss of a loved one, survivors of childhood trauma in adulthood, or a man or woman after a divorce. Or they can be witnesses, rescuers or survivors of catastrophic events. They can have reactive depression and even a dissociative disorder.

Can we heal from PSTD? Not completely. I have figured out my triggers and I still have occasional night terrors but the uncontrollable shaking, reactive depression and chronic anxiety have dissipated. Learning to ride your dragon, can open portals to a new life.

I cried in grocery stores. At unexpected moments. Hiding my tears. There are times I felt that if I ever start crying I would never stop. As a child, it was demanded of me to endure incomprehensible suffering without shedding a tear. I began to understand how tragic my childhood was in my middle aged years when depression became overwhelming after the birth of my first child.

Trauma comes from the Greek word meaning “wound.” Among professionals it is defined as “an emotional state of discomfort and stress resulting from memories of an extraordinary, catastrophic experience which shattered the survivor’s sense of invulnerability to harm.”

One way, the only way to survive these traumas is to numb yourself. By pushing painful memories and feelings down and away, we can cope. However, as time passes by, if we do not deal with these original feelings, they may begin to affect our conscious behavior. We may numb ourselves to a point where we are no longer responsive to our own family, we avoid friends and finally in severe cases we avoid all human contact. In the case of dissociative disorder, the person takes on a whole new persona. It can be a whole new personality lasting years or of short duration called a fugue state.

Usually, the person appears to be coping, well even. They may be going to work every day as if nothing is wrong, but on the inside, they may be feel they are falling apart.

In this society where expression of feeling is often viewed as a weakness on the part of the individual, one must not hesitate to seek help. Help is out there and you need not “tough” it out alone.

Psychotherapy is not a luxury, nor should one be stigmatized for it. Finding someone you can really talk to about your trauma without judgement, is the most important thing you can do for yourself. Professionals can help you re-experience the trauma little by little so you can remember it as a whole in the here and now and not feel wounded by it. You can begin healing. There are many ptsd stories to be told.

Common coping mechanisms that are counterproductive are such things as living in denial, blaming yourself or others for the catastrophe, overprotection and avoidance. When people are living in denial they refuse to talk about what happened to them. “Naming and talking about our experience, no matter how tragic, take much of their control and power away”, writes Robert Hicks in his book, Failure to Scream.

Sometimes we become numb to our feelings because we grew up in a dysfunctional family. (50% of all families have been described as dysfunctional) In these cases, it is not considered a disorder, but an ineffective mode of dealing with feelings.

Pain, Fear, Anger. Invite them in for tea. Use your best china. Give them space. Recognize them for what they are. We feel the bad so we can feel the good once more. Cry the river of tears. Tears are the salve for wounds of the heart. Take hold of your fears, trace them down into your subconscious. Make the subconscious, conscious. Trace your fears to the root, whether it be in your past, in your family, in your self, in the culture, both or all. You will also find your broken dreams, your creativity and much more. Archetypes abound in the collective unconscious, Magnificent discoveries await you.

Joseph Campbell told the story of Igjugarjuk, the shaman or priest of a Caribou Eskimo tribe in northern Canada, in his book, The Power of Myth. Igjugarjuk told European visitors that the only true wisdom “lives far from mankind, out in the great loneliness, and can be reached only through suffering. Privation and suffering alone open the mind to all that is hidden to others.”