During this PTSD Awareness Month, I’m reminded of my early work with people experiencing extreme trauma. I’ll never forget meeting survivors from the Gulf Coast area after Hurricane Katrina and bearing witness to the rawness of having lived through such an extremely overwhelming experience. Unless one has experienced a traumatic event, it’s hard to fathom the intensity of the nervous system response to mobilize or immobilize a body for survival. It’s truly an amazing process built into us, but sometimes the impact lingers long after the traumatic event has subsided.
It’s estimated that over 70% of the population will experience a traumatic event. I personally suspect the percentage is actually higher, as it’s hard to make it through a lifetime without terrible things happening. These events will shake and even change a person, but most people who experience a traumatic event will resume mostly normal functioning after a few weeks. However, about 6% of the population will go on to develop Post-Traumatic Stress Disorder (PTSD).
What is PTSD?
The name Post-Traumatic Stress Disorder pretty well explains what happens with someone experiencing PTSD. Post, so after a Traumatic event, Stress can overwhelm and Disorder life, creating difficulties in daily functioning. It is truly a great storm, disrupting life deeply, much like Hurricane Katrina did nearly 2 decades ago.
Trauma is the experiencing or witnessing of something overwhelming that threatens life or bodily integrity. One actually doesn’t have to directly experience an event for it to be traumatic, for even hearing about it happening to someone else can actually be a trauma. The stress part of PTSD can involve an intense and comprehensive emotional, physical, and cognitive disruption.
There are 4 categories of difficulties people with PTSD typically deal with: Re-experiencing, Avoidance, Negative Changes in Cognition and Mood, and Arousal and Reactivity.
Re-experiencing
Re-experiencing is the first category, which represents what it sounds like, reliving the traumatic event even though it’s not happening anymore. This can happen in flashbacks, which is a body and mind takeover where one feels like they’re back in trauma time. One might also experience nightmares and intrusive thoughts about reliving the traumatic event. This is a very scary experience, which can be activated by trauma reminders, or triggers.
For instance, a strong thunderstorm with gusty winds and heavy rain would sometimes trigger re-experiencing for some of the people I worked with after Katrina. The threat system of the nervous system would get activated and people would feel like they were back at the time the hurricane happened.
But some triggers aren’t so obvious. Anything associated with a trauma memory can be a trigger: a smell, a sound, a look, a feel, a time of year, etc.. And this generally occurs without conscious thought. So gaining more conscious awareness about things that trigger trauma reminders is an important part of recovery, as well as learning to ground oneself in the present moment.
Avoidance
Avoidance is the second category of symptoms of PTSD. Because of the extreme difficulty of the experience, it’s common to make efforts to avoid talking about it, thinking about it, or anything that might remind one of the traumatic experience. Makes sense. But, strong efforts of avoidance complicate the healing process.
And even in the midst of talking about something one can still be in a state of avoidance. Meeting with Katrina survivors, it wasn’t unusual to hear a horrific story being recited as though it was just a grocery list. Our brains have the capacity to avoid thoughts and feelings of difficult things even in the midst of talking about it.
Gradually and gently addressing avoidance is another important aspect of healing from PTSD. Avoidance actually involves much energy and effort, so people on the PTSD healing journey learn they’ve actually got the capacity to let these difficult experiences have more space when they lessen avoidance.
Negative Changes in Cognitions and Mood
Negative Changes in Cognitions and Mood is the third cluster of symptoms experienced by someone dealing with PTSD. Trauma is something that often intrudes on spaces that are considered safe or at least neutral. Author Salman Rushdie, who was stabbed multiple times while giving a talk at a tranquil education center, spoke of this experience in an interview with Ezra Klein. He explained, “We all have a sense of how things are, and that sense of how things are is our reality…And the explosion of violence into that picture destroys that reality. And then you literally don’t know the shape of the world.” He adds, “How do you act in a moment when the thing that’s happened isn’t a part of the narrative you think you’re in?”
So this is one hallmark of experiencing trauma, a major disruption of how one makes sense of the world. With the internal system being so overwhelmed, it can make it difficult to experience positive emotions. And often people blame themselves for what happened, possibly feeling a deep sense of shame and guilt. And, of course, there’s very often fear.
I’ll never forget an elderly woman I met with in her new apartment after she had to relocate to central Mississippi from her lifelong Gulf Coast home. She lost everything except her life in the storm and shared how she didn’t want to own anything again because she was afraid of ever losing anything else. She walked into her kitchen and pulled out a plastic spatula and, as she held it up, said she didn’t even want to own something as simple as that because it could be taken away from her. I’m still sad that she experienced such tremendous loss in her last years and totally understand why she was afraid to lose anything ever again.
Another significant part of PTSD recovery is working with these sticky and difficult thoughts and feelings and learning to navigate this major disruption in worldview.
Arousal and Reactivity
The fourth category of symptoms of PTSD is called Arousal and Reactivity, which is exemplified by being on edge and keyed up. This manifests in various ways such as being easily startled, feeling very tense and on-guard, having difficulty concentrating, and difficulty sleeping. This is what happens when the fight/flight system is activated, which is what’s happening with PTSD. It wouldn’t make sense to be able to chill out if there is an imminent threat looming. But with PTSD, though the threat is in the past, the brain and nervous system have difficulty differentiating between the traumatic past and the present day.
Think of what it feels like when something awful almost happens. Like maybe you’re almost in a wreck or almost attacked by an animal. There’s typically a period of time of hyper-arousal, being very keyed up and overloaded, but this usually subsides after a short amount of time once the stress hormones are metabolized.
I was once almost in a head on collision with a driver going the wrong way on an interstate. I had to run off the road to avoid what would have been a devastating accident. When I was finally able to get back on the road I realized soon thereafter I needed to stop somewhere for a while because I was so hyper-vigilant and angry about what almost happened. After a short period of time off the road (and some ice cream), I was able to get back in my vehicle and leave that experience mostly behind me.
But with PTSD, the experience is so overloading and overwhelming that it can’t be left behind. Stress hormones remain activated and don’t get fully metabolized, so a person is existing in a perpetual fight/flight activation. That is another important part of healing from PTSD, learning ways to calm the nervous system and increase present moment awareness.
Complex Trauma
One thing that stood out to me in my work with Hurricane Katrina survivors was how the trauma many experienced in that storm activated other traumas they had experienced in their earlier lives that remained unresolved. The fact is, many people don’t experience just one trauma in a lifetime. Many experience several different traumas or years of ongoing traumatic experiences, not just a one-time event. This is known as complex trauma. Many complex trauma experiences started in childhood and lasted a long time, so as the name implies, it’s more complicated.
Several of the survivors I met needed to address their older traumatic experiences before we could ever begin to focus on their Katrina experience. And those older traumatic experiences impacted their Katrina experience too. That taught me a lot about how trauma in post-traumatic stress experiences remains stored and will continue to reactivate until it is more fully processed.
Effective Trauma Treatments Exist
Processing is like digestion. When terrible things happen, we need to digest it so that it can ultimately be stored in our brains as being in the past. A knowing that the terrible thing is something one survived and it’s now in the past. PTSD and Complex Trauma disrupt this digestion process so that terrible experiences feel present and ongoing. Thankfully there are many effective treatments to support healing from PTSD, and they all work with facilitating this processing, this digesting, experience.
Traumatic events often become a way of marking time. Working with Katrina survivors I would often hear references to life “before the storm.” If you’ve ever been through a traumatic experience, you probably understand this. My hope is that all trauma survivors will learn there is also life after the storm.
If you or someone you love is dealing with PTSD or Complex Trauma, there is help available. It takes time, but healing is possible. Visit the National Center for PTSD and EMDRIA for more information. For child and adolescent trauma-focused information, visit the National Child Traumatic Stress Network.