Back in October 17, 1989, I was working in San Francisco at a construction company located on the 21st floor of a downtown high-rise. Just after 5:00 PM, the Loma Prieta earthquake hit, and shocking me with its suddenness and impact. The skyscraper began to sway, the lights went off, and then all the telephones.
For many years, I had wondered when the Big One would come. Perhaps this was it. I was fortunate to get a ride across the Golden Gate Bridge, passing the Marina where an apartment building caught fire. Only when I got home and played the TV did I grasp the full scope of what had happened. For example, my stereo had slid across the carpet several feet. Outside, the San Francisco Bay Bridge had undergone considerable damage.
Although this earthquake wasn’t the end of the world, I developed a strange reaction over the next several days and months. I kept watching movies on earthquakes, hoarding emergency supplies and obsessing over the news. I kept expecting more earthquakes to come. I got smart and decided it was no longer safe to drive across the Golden Gate Bridge. I would now take the Ferry.
It took me nearly half-a-year to get over it. While this wasn’t a full-scale trauma, it was a memorable foretaste.
Due to growing uncertainty throughout our world, capped by religious wars and terrorism, Post-Traumatic Stress Disorder has become a fact of life, no longer limited to Vietnam, Gulf War or Afghan vets. With climate change increasing hurricanes, floods and fires, anything can happen at any time. If the situation is drastic and dangerous, it can provoke severe psychological reactions.
PTSD entails sustained stress well over and beyond the initial traumatizing event, which can be as intense as attempted murder, torture or child abuse, or can be more along the lines of a sudden loss of job or career, a marital disruption or flunking a final exam.
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The stress manifests as nightmares, unwanted flashbacks, obtrusive memories or exaggerated emotional reactions to anything that reminds you of the initial event. For example, when someone broke into my car and stole my laptop in a well-lit spot in a prominent private university, I felt violated. I called security, and drove home almost crying. Later, I took out home insurance. Does it mean I am now paranoid or traumatized?
Symptoms of severe trauma can result in panic attacks around anything that reminds you of the painful event, such as someone who resembles a rapist, riding in a plane after a crash or facing heavy winds after suffering a major hurricane or tsunami. This can involve a pounding heart, sweating, trembling, shortness of breath, nausea, dizziness and even chills.
Traumatized individuals can develop severe avoidance behavior, withdrawing from public interaction and becoming homebound. You go out only when accompanied by others. Your basic trust in humanity has been shaken to the core, and it may take a great deal of time for it to ever come back.
PTSD can also lead to suicidal thoughts amidst deep depression, especially in rape victims. These thoughts are compounded if you don’t feel free to discuss them with anyone. For relief, people may reflexively turn to alcohol or drugs to deaden the pain. You might feel betrayed by the world, and even God, following acts of terrorism.
It is important not to confuse PTSD with shock, which is a dangerous medical condition after an accident resulting in a fall of blood pressure and loss of blood, marked by cold skin, irregular breathing, rapid pulse and dilated pupils. First-Aid is demanded. Unattended, shock can rapidly lead to death.
If one survives the initial shock, however, perhaps through being taken to a nearby hospital, trauma can develop over the incident that caused it, which might be warfare, inner city violence, flood or fire. As the physical danger is removed, the persistent dreams and memories can make the stress continue months, even years.
One need only think of the holocaust survivors who came close to the ultimate degradation. If they escaped, they were haunted for the rest of their lives as to why they were spared, while their family and friends died in the most degrading circumstances imaginable.
Rape victims often suffer from a brutalizing stigma, that they did something to be raped, or that the incident wasn’t really rape if they were on a date. Here we see a violation of trust on one of the deepest possible levels, with the possible exception of child abuse.
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This can severely set back a woman’s ability to ever open up again to another man, even if she loves him or wants to demonstrate affection. Women have to heal from the initial trauma and beginning to narrow their association of the rapists with other men. Even the slightest resemblance can trigger a powerful reaction.
Exceptional women have been known to forgive and forget in these circumstances, but only through the aid of a powerful spiritual force within them. There is good reason for etiquette with women, and a basic code of honor, empathy and tenderness. Women carry humanity forward. Without them, we would all perish in a single generation.
Less well-known is vicarious trauma, where family, friends, colleagues and healthcare professionals can experience distressing feelings entailing upset, overwhelm, shock and grief over the condition of their loved ones. Professionals include doctors and nurses, law enforcement officers, therapists and counselors, even religious leaders.
No one is exempt from feeling overwhelmed over the severity of another’s misfortunes. It is interesting that, in the Gospel account, Jesus Christ, Himself, wept over the death of his dear friend, Lazarus.
Vicarious trauma can show up in therapists having difficulty discussing their own feelings, losing sleep over clients or actually dreaming about their clients’ traumatic experiences. This can further manifest in overwork, exhaustion, withdrawal and isolation from colleagues, apathy or even profound existential doubts about the validity of their own worldview.
Psychiatry has the highest suicide rate of any profession, and this can closely relate to overload, feelings of burnout, getting to the point where you can’t take it any more, but are unable to admit this to your colleagues. These problems are finally being recognized and programs are emerging to address them.
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Several different approaches to PTSD have been developed in therapy, including anxiety management, cognitive therapy and exposure therapy.
Anxiety management entails learning to relax, start breathing consciously, replace negative thinking with positive self-talk, be more assertive and stop the flow of distressing thoughts.
In cognitive therapy, trauma victims are guided to a more rational approach with their past experience. For example, soldiers may blame themselves as to why their buddy was shot and killed, and not them. You are encouraged to identify your upsetting thoughts and assess the rational evidence for and against them.
It becomes easier and easier to accept that what happened, happened, that it is time to move on.
In exposure therapy, you are supported in confronting actual situations, people, objects, memories or emotions that evoke intense aversion and fear. You may retell the traumatic memories in a safe environment. If you stay with the situation, and repeat this process enough times, your intense fear may go away, much like learning to handle a live snake.
In the face of severe trauma, it may be desirable to seek additional assistance beyond therapeutic intervention. Medication may be prescribed by an MD over several months, even as long as a year Each medication may have unwanted side-effects, which sometimes decrease with usage.
Common serotonin reuptake inhibitor (SSRI) antidepressant medications include Zoloft, Paxil and Prozac.
Mood stabilizers include Depakote (divalproex). These are typically recommended for being with combined bipolar disorder and PTSD.
Anti-anxiety medications are typically prescribed for shorter periods of time, such as Valium, Xanax and Klonopin.
Medication is most typically used to counter depression, especially when it leans towards suicide.
What must be avoided is thinking that the chemicals, all by themselves, can do it. They should be considered only temporary adjuncts to therapy to see yourself through an extremely stressful period.
Most important of all in dealing with PTSD is to reach out to others, family, friends and concerned professionals, either health or spiritual in orientation. Support groups and peer counseling have made a powerful difference to patients and clients in clinical settings.
What has opened up for us in the Internet era is powerful online support, where you can educate yourself on trauma and phobias and actually receive expert assistance from highly experienced professionals, skillful in dealing with real-life problems. You can maintain your own privacy and confidence, while discovering new options and relevant resources.
Steve King offers a helpful course on PTSD for both clinicians and clients that explores the condition in great depth with both video and audio, as well as substantial resources. His is a good-natured, no-nonsense style that developed out of helping thousands of people through very challenging conditions. You may want to take a closer look at his offering to see how it fits your current needs.
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