30 April 2012

PTSD (post-traumatic stress disorder)

This is a special submission to Our Duty by Gerry.  Since this is such an important issue, I am re-porting it here.


Post-Traumatic Stress Disorder (PTSD)
March 8 2012
Gerry Fostaty

I have been travelling around lately, speaking to groups about post-traumatic stress disorder.

At the start of my talks about PTSD to folks, I tell a story about a neighbour, a toad and me.  The story isn’t important. The important thing is that it illustrates that we sometimes make assumptions, when we don’t have all the facts. That’s the way it is with post-traumatic stress disorder. People make all kinds of assumption about PTSD. It used to be known by many descriptions: shell-shock, battle fatigue, the thousand-yard stare, and of course, cowardice, among others. (Unfortunately, it still is in some circles.) But in the 1980s, some smart people realized that what the sufferers were experiencing wasn’t behavioural, it was neurological. They discovered that you can’t just snap out of it, man up, grow up, or get over it. In the 1980s it became a recognized clinical disorder. Although we most frequently associate PTSD with the military, PTSD can affect anyone. It doesn’t discriminate by gender, age or occupation. It is an equal-opportunity disorder.  There are some occupations that may be more exposed to the stimulus that create a host for PTSD.  The military, emergency first responders like police, firefighters, paramedics, emergency room nurses and doctors are all obvious candidates, but victims of violent accidents, crime, assault, terrorism, abduction, and rape are also at risk.

So what brings it on? Here is my simplified version.

When our minds experience trauma, that is, when we feel that our lives are in danger, or the lives (or well being of those we are responsible for) are in danger, or we feel utter helplessness in a perilous situation, our brains, not surprisingly, become most interested in our survival. The brain triggers a response that immediately has our bodies create a massive amount of adrenaline that floods through us, giving us a rapid and intense burst of energy.  This energy is channelled to our gross motor limbs, our arms and legs, to help us either defend ourselves, or escape the danger. That is commonly called the “fight or flight” response.  Most times brains are able to reset after the trauma is past, but if the trauma is particularly profound, or prolonged, or is repeated, something else occurs. A deep neural pathway is created in the brain. The brain feels that it will need the memory of the trauma again soon, so it hangs on to the info, and it has its hand ready on the adrenaline switch . . . just in case we’ll need to fight or flee again. In most cases, we won’t need that adrenaline again in the short term. But, the brain hangs on to the info.

So what can happen?

The problem is that our brains don’t understand that we don’t need the adrenaline, but it stays at the ready for a long time. In most cases, the brain relaxes and “resets” within thirty days, but in some cases it will hang on to that trauma, even for years. The brain may begin to look for opportunities to pull the switch. Things that are only barely associated with the old trauma, may present the brain with what it thinks are triggers. Sights, sounds and smells are very powerful triggers. When the brain feels that you are in danger again it flips the switch and the body is again flooded with adrenaline to help us escape or defend ourselves. After that happens a few times we begin to see a pattern and try to avoid the things that triggered the adrenaline. Being on guard and being watchful, trying to avoid the triggers is exhausting and can cause sleep disorders. The lack of sleep causes daytime fatigue and irritability, which can make us less able to recognise and avoid a trigger situation, causing another PTSD episode, like nightmares, flashbacks or an outburst of anger, or can lead to depression. This continues as a cycle, spiralling downward.  Once the switch has been pulled a few times as false alarms, the sufferer will become more aware of the triggers and try to keep away from them. Not only does the hyper-vigilance and hyper-awareness exhaust them, they may begin to retreat from what they used to enjoy; friends, family, sports and the other diversions that usually enrich their lives.  For them, however, they present unwelcome opportunities to trigger the PTSD. So the PTSD sufferer begins to withdraw from their former life, shunning their former normal life and further isolating themselves.

So what now?

The difficult thing is for the sufferer to recognise PTSD in themselves.  Many times the symptoms don’t seem to bind together in a way that easily lets them know they are affected. Everyone is different, and PTSD manifests itself in each person differently.  Once they suspect that they may have PTSD, the easiest thing is to let their family doctor know that they would like to be assessed. They’ll most likely be referred to a specialist who understands the disorder, and then will begin a journey toward health. There are treatments for PTSD, and they are effective. The treatments don’t remove the memory of the trauma; it just moves the memory from a place in the brain where it creates urgency and panic, to a place where it becomes benign.  Getting back to making assumptions when not having all the information: If you are suffering with PTSD, sadly it’s not just about you. An important thing to remember about treatment for PTSD, is that the sufferer is not only getting treatment for himself or herself. Their family and friends and co-workers are also affected by their PTSD.  Their family also experiences the effects of the flashbacks, nightmares, hyper-vigilance, depression, substance abuse and all the other baggage that chains the sufferer to this disorder. PTSD adversely affects the community which surrounds the sufferer. In the same way, treatment also benefits all those around the person suffering from PTSD.  Treatment is important and available.


Gerry Fostaty is the author of As You Were: The Tragedy at Valcartier published by Goose Lane Editions in 2011.

1 comment:

  1. NOTE: This comment came in from a veteran who wishes to remain anonymous, so I am sharing it for her - JRM


    I have had PTSD since 1994. I had my first full blown reactivation in 2008. I have dealt with the questions of which you speak and the reluctance of others to even attempt to understand. I even was banned from another facebook page by a doctor no less for saying how I felt and it was not the happy statements that he desires. It was the truth but I answered the question that he had asked. He said that I was angry. Duhhh...and you are a doctor who treats PTSD??? Talk about not understanding. I volunteer in the fire and EMS field but it is a far cry from my "day" job. It brings me joy, takes me away from my PTSD and all that goes with it. I have come to realize that not all mental health "professionals" are equipped nor do they wish to hear horror stories by those of us who suffer from this disorder. As a critical incident stress debriefer and being in the medical field, I find their behavior unacceptable. I do not get to chose what the next ambulance call is going to be and these people who create these pages should understand that PTSD comes with many different emotions and some of them come all at once. You do. Thank you. Your article hit home and I do not feel like an outsider after being tossed from another site for speaking what was in my soul. I am medically trained and it is extremely hard for me in that I can help others because it helps me to forget about me but there is that part of me that screams PTSD and all of its problems. I was scared to "like" this page for the fear of being hurt down to my soul again because I am not hopping around like a happy bunny and touting some success story. I printed out the article because I am somewhat new with PTSD symptoms, reactions, and how to deal with them. Again, thank you for the article. I found some hope today.