One in Ten
YESTERDAY WAS National PTSD Awareness Day, but we can still be aware today. This day is, in large part, designated to encourage learning about what PTSD is, what can cause it, who can get it, how to get help—and for that information, I’ll direct you to the science portion of my website (http://www.aprylpooley.com/science.html) and to this surprisingly informative pamphlet (http://www.ptsd.va.gov/public/understanding_ptsd/booklet.pdf). I’m so pleased to see that the VA is recognizing PTSD as a civilian problem in addition to a military issue. The misconception that PTSD only evolves out of combat experience has prevented millions of people from getting the help they need. As many as 1 in 10 women experience PTSD in their lifetime, which is mostly due to sexual abuse and assault.
PTSD is not a new disorder, and it is not just a military issue. The effects of traumatic experiences on individuals and societies have been observed throughout history in descriptions of war, torture, physical and sexual assault, natural disasters, and accidents. In fact, accurate and detailed descriptions of the constellation of PTSD symptoms can be traced back more than 400 years to Shakesphere’s Henry IV, part 11, or even thousands of years ago to Homer’s Iliad 2. The earliest clinical references to the effects of trauma were described in the 1800s when chronic symptoms were observed in railway employees and passengers who had experienced railroad crashes. Significant hypotheses regarding the effects of trauma stem from psychological studies of “hysteria” in the nineteenth century, in which the majority of “hysterical women” were found to have experienced some traumatic event (usually childhood sexual abuse) and whose dissociative states were thought to be caused by their inability to integrate painful memories and the associated emotions into a narrative in their episodic memory. Other responses to trauma were associated with war, including American Civil War soldiers who exhibited “soldiers’ heart” and World War I soldiers with “shell shock.” But it wasn’t until 1980 that PTSD was officially recognized as a psychiatric diagnosis in the third edition of the Diagnostic and Statistical Manual of Mental Disorders, which was fueled by the psychological problems of returning Vietnam Veterans. The recognition of PTSD was monumental in advancing research in the field because it acknowledged that the disorder was caused by an external agent (i.e. a traumatic event) rather than an individual’s weakness, overreaction, or failure to just “get over it,” which are misconceptions that still stigmatize PTSD.
But reading about the history of PTSD or reading a list of PTSD symptoms on Wikipedia is very different from actually experiencing the disorder. My first experience with PTSD was with my father who had been involved in a fatal car accident ten years before I was born, and more than 35 years later, he still has daily nightmares and flashbacks and panic attacks. Instead of bedtime stories, my dad would tell me about the car accident that spared only himself, detailing the screaming and the blood and the limp childrens’ bodies (my reaction to this is now termed “secondary traumatic stress”). My dad never drove again after that accident, he never slept soundly, and his body fell apart, and after experiencing my own trauma as a seventeen-year-old, my life was looking more and more like my father’s life each day. After hearing a friend talk about her veteran husband’s PTSD, I did an internet search for PTSD because I knew nothing about it. After hours of reading over its symptoms and causes, I realized my dad was suffering from PTSD. I was surprised to learn that a person could get PTSD from anything other than military combat, and when I read that rape commonly lead to the development of PTSD, I was floored.
With my own life in mind, I re-read all of the PTSD symptoms again, and realized that I had experienced daily almost every single one of the 20 symptoms listed, including persistent intrusive memories of the traumatic event, nightmares, emotional numbing, avoiding reminders of the trauma, increased startle, and hypervigilance. I always felt like something horrible was going to happen any minute, so I was constantly in this state of hyper-alertness and always on guard. The smallest noises or movements would startle me immensely, and it wasn’t just a momentary jolt. When I got startled, my heart would pound and my skin tingle sometimes for hours afterward. I had trouble sleeping for more than thirty minutes or an hour at a time because I kept waking up to check my surroundings. What’s happening? Where am I? What day is it? What time is it? If somebody would awake me from my sleep, I would scream and throw punches at them. If I did sleep for an extended period of time, I would wake up terrified because I didn’t know what had happened in the last couple hours. During those eight years, I lived many days thinking they’d be my last, and I certainly could never envision my life more than a few months into the future. This—the often overlooked “foreshortened sense of future” symptom of PTSD—caused me so many problems. It was hard to stay motivated at school or work, saving money didn’t make sense, and investing in any new relationships seemed pointless. I would often ask myself, “Is this really what I would be doing on my last day alive?” Sometimes I would just leave in the middle of a lecture or my shift at work because I couldn’t believe that I was spending my last hours alive doing something so meaningless. My feelings of imminent death may have seemed irrational—I didn’t have a terminal illness—but experiencing rape is like having your soul murdered and knowing there is always a chance that it could happen again at any moment did make death seem imminent for me.
I couldn’t believe I had been suffering from PTSD for the past eight years and had been completely oblivious to it. I felt comforted by the fact that all of my problems could be explained by a four-letter acronym and that maybe I wasn’t really just a crazy mess. However, I became completely dejected when I learned that there was no effective treatment for PTSD, that suicide rates among PTSD patients were among the highest of any demographic group, and that PTSD symptoms can persist and continue to worsen over the course of a lifetime. When I became more aware of what having PTSD really meant, I felt like I had been diagnosed with some terminal illness that I was going to have to fight every day for the rest of my life until if finally killed me. I feared I was going to end up just like my father, and I could not live another year like that. Over the next three months, I entered my most severe downward spiral of drinking and lost all hope that I would ever recover, until an extremely unfortunate circumstance led to my life-saving connection with health professionals who could help me (See my blog The Sobering Truth for that story).
The loss of hope is what will really destroy a person, but I know first-handedly that people can recover from even the most horrific situations. With a combination of therapy, medication, sobriety, and social support, I can confidently say that I have recovered from PTSD. I still have the occasional bad day or nightmare, and I still have the memories, but these things are no longer completely debilitating. The goal in recovery from PTSD is not to forget the trauma, but to be able to remember it without being flooded with fear, guilt, pain, horror, and helplessness. There is life after trauma, and it’s so, so worth it to put in the time, effort, and money to get all the help you need.
(1) For a fascinating line-by-line analysis of how the Shakespearean passage depicts PTSD symptoms, see: https://www.publicinsightnetwork.org/2013/05/28/a-shakespearean-view-of-ptsd/
(2) Shay, J. (1991). Learning about combat stress from Homer’s Iliad. Journal of Traumatic Stress, 4(4): 561-579.