It was in the news again recently here, in the Great White North. The Canadian military redeployed soldiers with PTSD back to the places that made them sick. At least, that’s how the headlines ran, the truth was slightly different but hey, who doesn’t want to sensationalise how stupid it is to give a gun to someone who’s unwell?
This set me to thinking how cross I get whenever an episode of Criminal Minds or some such leads us to believe that PTSD turns people into killers, running amuck reliving their trauma from Afghanistan on the streets of Niceville. Trauma, PTSD, Post-Traumatic Stress Disorder is another one of those misunderstood dramatic devices that really, no really, upsets those who know when writers get it wrong.
True PTSD is so much more likely to cause suicide than murder you see. Yes, sometimes there will be rages, lashing out in terror at a situation that looks innocuous from the outside, but it’s not usual. Withdrawal is usual. And self-medication with anything that brings dreamless sleep. It takes guts to face the symptoms, and extreme bravery to seek treatment, most people don’t. Which is why ineffective ways to escape trauma drive a lot of lives and can propel characters into all manner of situations that they don’t fully understand at the time.
It’s also remarkably common. Studies which document the full occurrence of PTSD in the population are rare, due to the diagnostic requirement of a triggering traumatic event. Recent research has shown that this doesn’t always happen, but even given a misleading diagnostic, most epidemiology studies come to a figure of between six and seven percent of a normal adult population.
The symptoms of PTSD are fairly well known, flashbacks, nightmares, hyperarousal, avoidance behaviours etc but the causes are frequently misunderstood. At the deepest level, trauma is a characteristic of being human. It is a byproduct of the normal, healthy responses to fear that we have inherited from our history as predators and prey…combined with the expectations of self which socialisation has imposed.
We are taught about the flight or fight response, that surge of adrenalin that equips us with the strength to deal with a crisis, but these are not our only reflexes. There is a third, which has its roots in survival, and that is to freeze. Its evolutionary purpose is obvious, many predators have peripheral vision which depends on movement (humans among them) but we have developed a society in which freezing in response to danger is frowned upon. This creates two internal crises. Firstly, the adrenalin surge is still there and needs release, and secondly, we feel shame as well as fear.
Any inability to act, perceived helplessness, whether self-imposed or forced from outside can create a trauma trigger. The incident will be replayed in flashbacks and/or nightmares until that adrenalin is expended. This can be compounded by any shattering of assumptions about yourself and the world. In a crisis, anything that leads you to believe that your response was ‘wrong’ can be relentlessly replayed, even if you had no choice. Either way, your reptile brain, the bit of you that deals with fear, will not let you off the hook until you get it right.
Consider a woman who has been raped. Her response to the terror was to freeze. It was probably the best survival tactic at the time but it wasn’t a conscious choice. Then the criticism begins. Why didn’t she fight? The perfect PTSD setup. This incident will replay until she relives it while smacking someone (or something) extremely hard, but she won’t. She will withdraw, avoid triggers, people, men especially, do whatever it takes to get some peace.
Many people with PTSD weren’t aware that anything particularly traumatising was happening to them at the time. A friend of mine couldn’t get back into a car after a relatively minor road accident. She beat herself up because, ‘It wasn’t that bad, other people get badly injured and they’re not terrified like this.’ I asked her, ‘Was there a moment when you couldn’t move?’ She thought about it. ‘Yes, when we first crashed I couldn’t get the seatbelt undone. I thought there would be a fire and I couldn’t get out.’ Imposed freezing…that would do it. Studies* on the Israeli army found that rates of PTSD were significantly higher among prisoners of war when compared to other combatants.
Severity varies, sometimes the terrifying reruns are relentless, sometimes they will only play with the sort of trigger you can avoid. In the latter case, it depends a how easy the avoidance is, and how much it diminishes your life, how debilitating the symptoms become. I once counselled a chap whose flashbacks only recurred if he attempted CPR. (He thought he’d killed his brother, but of course, he hadn’t.) He’d solved the problem neatly by refraining from keeping up his first aid qualification. This worked fine until requalifying became compulsory at work, whereupon we had to address the trauma.
Treatment can be simple. Something as basic as replaying the incident while out for a run, on an exercise bike or kickboxing a pile of cushions can often do it, and modern treatments such as EMDR (eye movement desensitisation and reprocessing) seem to mimic the effect such physicality has on the brain.
Talking cures and ‘reframing’ can work too, especially if the trauma includes an element of shattered assumption, but the terror generated by each ‘replaying’ is so overwhelming that most of us would choose trigger avoidance over treatment.
This could get long. There’s so much more to say, and research to be done…on long-term-stress trauma, vicarious trauma and traumatic overlays on grieving and depression…but the ingredients for PTSD as a driver of behaviour are within all of us, and no more shameful than the ability to think and feel at the same time.
*I know this isn’t an academic treatise but this Google Scholar link brings ups some fascinating studies.
Wow very interesting. Makes me want to help/question my husband when he was in the military because I am not sure if it is PTSD or something else that causes him to have nightmares about it occasionally, or if there was something else in his life that causes them. Thanks Carolyn. Something to think about when we are writing stories that involved characters that may or may not have suffered from this.
Fantastic post, Carolyn! I thank you and the many folks who experience PTSD thank you.
We dealt with a lot of war vets at the college where I worked, and I was able to attend workshops on PTSD and traumatic brain injury. Fascinating and heartbreaking at the same time. I especially appreciate that you mentioned victims other than soldiers who have it. I’ve met several people through the years who didn’t think it was possible because they hadn’t been to war.
Wow, Carolyn. This is an amazing explanation of PTSD. As someone who has been diagnosed with PTSD from relentless, repeated childhood trauma, I can attest to the accuracy of what you say. For me, the initial moment of freezing is often followed by over-reaction. The response to a lesser, non-dangerous trigger sends me into defense mode where I feel the need to make sure my ‘attacker’ (not really, but that’s how it feels) MUST be made to understand how I feel. Many years of various therapies have enabled me to recognise triggers and stop the reactions in most cases. Some still slip by, something I know will never completely go away.
Thank you. You have done many, including me, a great service today. I now understand myself better.
What a great post, Carolyn! I’m reading “Quiet,” which is about introverts, and she mentions the amygdala — your “lizard brain”. And I’ve got a character in “Tapped” who may suffer from PTSD, so this is very timely.
I am very pleased it’s been useful, I did wonder if it was a post-too-serious. Resisting the temptation to answer individually this week, since I’d be slipping helplessly into inappropriate analysis mode. 😉
I love your post. I have 2 kids with PTSD from something that happened early in childhood. It amazes me how many people misunderstand PTSD. They are both functioning adults, who went through much therapy as children, but still have triggers. It annoys me when PTSD is used as a plot device in books or shows because it is very rarely done right.
I found some of your treatments interesting. At the time my kids went through therapy, those weren’t mentioned. Of course, they may not have been appropriate for kids.
Thank you for this, Carolyn. I hope now more people will understand.
Hear, hear. Saw Laurie’s heads-up on this post and knew you’d do it justice, Carolyn. I even wonder if writing itself could be a partial cure, or at least might alleviate the symptoms. My own seem to be far less debilitating when I write a cathartic horror story, strangely enough. Plus, I’ve heard they sometimes use MDMA. Hmmmm. Gotta get me some ecstasy! 😉
Great article. As a vet married to a vet with severe PTSD and TBI, I know how it all goes. Admittedly, it’s been good for my writing- especially my military thriller series. Having first hand experience has allowed me to bring my characters to a new level of human nature. Sometimes it’s really tough to be married to a vet with so many problems, but I’m at least in the position to understand a bit better than the average person.
This was a very thorough explanation of PTSD and quite fascinating. I didn’t realize that freezing in place was a self-protective response.
Thanks for the information.
Excellent article! Thank you for such a thorough post about PTSD.