Post Traumatic Stress Disorder, or PTSD is a medical term for a psychiatric condition suffered by people exposed to deeply shocking events. In our everyday lives, any of us can have an experience that is overwhelming, frightening, and beyond our control. We could find ourselves in a car crash, the victim of an assault, or see an accident. Soldiers-Veterans, police, fire brigade, or ambulance workers are more likely to have such experiences as they often have to deal with horrifying scenes. Soldiers may be shot or experience a blast and see friends killed or injured. The average person is able to cope with these situations in a way that is productive. In some cases, however, traumatic experiences set off a reaction that can last for many months or years. This is called Post-Traumatic Stress Disorder (PTSD).
Causes of PTSD
PTSD can start after any traumatic event. A traumatic event is one where a person can see that they are in danger, their life is threatened, or where an individual sees other people dying or being injured. Some typical traumatic events would be:
- Serious road accidents
- Military combat
- Violent personal assault (sexual assault, physical attack, abuse, robbery, mugging)
- Being taken hostage
- Terrorist attack
- Being a prisoner-of-war
- Natural or man-made disasters
- Being diagnosed with a life-threatening illness.
Even hearing about an the unexpected injury or violent death of a family member or close friend can trigger symptoms of PTSD. The symptoms of PTSD can start after a delay of weeks, months, or years.
Symptoms of PTSD
Many people feel grief-stricken, depressed, anxious, guilty and angry after a traumatic experience. As well as these understandable emotional reactions, there are three main types of symptoms produced by such an experience:
1. Flashbacks & Nightmares
The sufferer finds themselves re-living the event. This can happen both as a flashback while awake, and as nightmares while asleep. These can be so realistic that it feels as though the person is living through the experience again. The person can see it in their mind, but may also feel the emotions and physical sensations of what happened - fear, sweating, smells, sounds, pain. Ordinary things can trigger off flashbacks. For instance, if the sufferer had a car crash in the rain, a rainy day might start a flashback.
2. Avoidance & Numbing
It can be just too upsetting to re-live your experience over and over again, so the sufferer distracts him or her self. The person will keep their mind busy by losing themselves in a hobby, working very hard, or spending time absorbed in crossword or jigsaw puzzles. They avoid places and people that remind them of the trauma, and try not to talk about it. They may deal with the pain of their feelings by trying to feel nothing at all - by becoming emotionally numb. The person communicate less with other people, who then find it hard to live or work with the sufferer.
3. Being "On Guard"
The sufferer finds that they stay alert all the time, as if they are looking out for danger. They can't relax. This is called "hyper vigilance" and the sufferer feel anxious and find it hard to sleep. Other people will notice that they are jumpy and irritable.
Emotional reactions to stress are often accompanied by physical reactions such as:
Why are Traumatic Events so Shocking?
They undermine our sense that life is fair, reasonably safe, and that we are secure. A traumatic experience makes it seem very clear that we can die or be hurt at any time. Not everyone gets PTSD after a traumatic event, but nearly everyone will have the symptoms of post traumatic stress for the first month or so. This is because they help to keep you going, and help you to understand the experience you have been through. This is an "acute stress reaction". Over a few weeks, most people slowly come to terms with what has happened, and their stress symptoms start to disappear. Not everyone is so lucky. About 1 in 3 people will find that their symptoms just carry on and that they can't come to terms with what has happened; it is as though the process has got stuck. The symptoms of post traumatic stress, although normal in themselves, become a problem - or Post Traumatic Stress Disorder - when they go on for too long.
What makes PTSD worse?
The more disturbing the experience, the more likely individuals are to develop PTSD. Traumatic events:
- Are sudden and unexpected
- Go on for a long time
- Trap the individual, who is unable to get away
- Are man-made
- Cause many deaths
- Cause mutilation and loss of arms or legs
- Involve children.
Everybody feels stressed from time to time. Unfortunately, the word "stress" is used to mean two rather different things: Feeling burdened by problems or an inner sense of worry. This could be work, relationships, maybe just trying to get by without much money. Unlike PTSD, these things are with us, day in and day out. They are part of normal, everyday life, but can produce anxiety, depression, tiredness, and headaches. Stress can also make some physical problems worse, such as stomach ulcers and skin problems. These are certainly troublesome, but they are not the same as PTSD.
Psychopathology of PTSD
There are a several possible explanations for why PTSD occurs.
When humans are frightened, they remember things very clearly. Although it can be distressing to remember these things, it can help to understand what happened and, in the long run, help us to survive. The flashbacks, or replays, force the sufferer to think about what has happened. The individual can decide what to do if it happens again. After a while, he or she learns to think about it without becoming upset. It is tiring and distressing to remember a trauma. Avoidance and numbing keep the number of replays down to a manageable level. Being "on guard" means that the sufferer can react quickly if another crisis happens. It can also give individuals the energy for the work that's needed after an accident or crisis. But the sufferer doesn't want to spend the rest of their life going over it. They only want to think about it when they have to, such as if the sufferer finds themselves in a similar situation.
Adrenaline is a hormone our bodies produce when we are under stress. When the stress disappears, the level of adrenaline should go back to normal. In PTSD, it may be that the vivid memories of the trauma keep the levels of adrenaline high. This will make a person tense, irritable, and unable to relax or sleep well. The hippocampus is a part of the brain that processes memories. High levels of adrenaline can stop it from working properly. This means that flashbacks and nightmares continue because the memories of the trauma can't be processed. If the stress goes away and the adrenaline levels get back to normal, the brain is able to repair the damage itself, like other natural healing processes in the body. The disturbing memories can then be processed and the flashbacks and nightmares will slowly disappear.
Evidence of recovery from a traumatic experience
Individuals can recognise that they have overcome PTSD when they:
- Think about it without becoming distressed
- Don't feel constantly under threat
- Don't think about it at inappropriate times
Why is PTSD Difficult to Diagnose?
The sufferer may not want to admit to having symptoms, because he or she doesn't want to be thought of as weak or mentally unstable, which they are convinced will result in social ostracism (rejection, contempt, isolation), being helplessly victimized or attacked (bullying), involuntary hospitalization, and/or a damaging permanent loss of confident self-respect. Doctors and other professionals may feel uncomfortable if the sufferer tries to talk about gruesome or horrifying events. People with PTSD often find it easier to talk about the other problems that go along with it - headache, sleep problems, irritability, depression, tension, substance abuse, family or work-related problems.
The signs and symptoms of post-traumatic stress disorder have been tragically mistaken for signs of demonic possession. The possibility of demonic possession or oppression is almost non-existent, and should be the last suspicion. If anyone is observed experiencing any conditions suggestive of possession, experienced pastoral care counsellors, mental health and medical professionals, and experts in paranormal phenomena and research, all strongly advise immediately contacting a physician for further evaluation. A medical consultation should always be the first step.
Children and PTSD
PTSD can develop at any age. Younger children may have upsetting dreams of the actual trauma, which then change into nightmares of monsters. They often re-live the trauma in their play. For example, a child involved in a serious road traffic accident might re-enact the crash with toy cars, over and over again. They may lose interest in things they used to enjoy. They may find it hard to believe that they will live long enough to grow up. They often complain of stomach aches and headaches.
PTSD and WWII
Colonel Dave Grossman and Bruce K. Siddle wrote in their work the "Psychological Effects of Combat" which was published in the Encyclopedia of Violence, Peace and Conflict:
|“|| During World War II, 504,000 men were lost from America's combat forces due to psychiatric collapse--enough to man 50 divisions. The United States suffered this loss despite efforts to weed out those mentally and emotionally unfit for combat by classifying more than 800,000 men 4-F (unfit for military service) due to psychiatric reasons. At one point in World War II, psychiatric casualties were being discharged from the U.S. Army faster than new recruits were being drafted in.
Swank and Marchand's World War II study of US Army combatants on the beaches of Normandy found that after 60 days of continuous combat, 98% of the surviving soldiers had become psychiatric casualties. And the remaining 2% were identified as "aggressive psychopathic personalities." Thus it is not too far from the mark to observe that there is something about continuous, inescapable combat which will drive 98% of all men insane, and the other 2% were crazy when they got there...
It must be understood that the kind of continuous, protracted combat that produces such high psychiatric casualty rates is largely a product of 20th-century warfare. The Battle of Waterloo lasted only a day. Gettysburg lasted only three days--and they took the nights off. It was only in World War I that armies began to experience months of 24-hour combat, and it is in World War I that vast numbers of psychiatric casualties were first observed.
- "Psychological Effects of Combat" By Dave Grossman and Bruce K. Siddle, Encyclopedia of Violence, Peace and Conflict, Academic Press, 2000.