It’s complex, that’s what. How to boil it down into some simple statements of fact? The symptoms of post-traumatic stress disorder (PTSD), which I’ve learned from Dr. Louis Tinnin, Dr. Robert Scaer, and Dr. Judith Herman, are classified in a three-fold way: intrusion, constriction, and hyperarrousal. Here’s my own spin or synthesis of their material.
Intrusions are flashbacks, nightmares, body sensations, obsessive-compulsive rituals, automatic obedience, tics, stuttering, a voice telling you to harm yourself. These responses seep into or burst in on one’s life and interrupt the normal flow; for example, you see a stranger in a mall wearing a red shirt similar to the shirt of the man who raped you years ago and for a moment, you are overwhelmed by frightening body sensations. Your heart races, you feel paralyzed. Life is interrupted.
Constriction or numbing can be expressed as a diminished visual field; an increased pain threshold; self-injury as in cutting, burning, hair-pulling; numbness of emotional attachment to others (estrangement, divorce, social withdrawal); loss of conscious connection to emotions; and depression. Consider, as an example of numbing, a young boy putting cigarettes out on the heel of his foot, claiming it doesn’t hurt.
Hyperarrousal can be expressed as a sleep disturbance or a state of vigilance. For example, the body may be tensed, always braced for a blow. “Forever vigilant” is one way of describing it. Being easily startled and/or irritated by small things are also characteristic of hyperarrousal. Outbursts of rage may occur. One’s fight/flight response gone haywire, so that the sound of a friend slamming a car door terrifies you, for it reminds you of the car door slamming years before as your spouse drove away after beating you.
As you can see, the categories are not so cut and dry. An example of hyperarrousal might also be a good example of intrusion, but you get the general idea.
So what is PTSD anyway? Without resorting to the words of the doctors mentioned above, I’m going to wing it and see how I do. It’s a response of the brain, body, and mind to helplessness one experiences in the face of a life-threatening event, or an event that one perceives as such. A key word is helplessness; the fact that one wasn’t able to escape sets the fight/flight brain chemistry going, which initiates certain stress responses of the body and mind. The trauma response becomes hyper-sensitized. So even though a life-threatening event is long past, when one is restimulated by a nightmare or a sound, one’s trauma response kicks in physically, mentally, emotionally, and it’s as if the life-threatening event is happening in the present.
Anyway, that’s what post-traumatic stress disorder is in my view. Forgive any oversimplifications or overgeneralizations. Just like you, I’m trying to grasp a complex phenomenon, one that affects me every day as a survivor of infant surgery.
(National PTSD Awareness Day is Thursday, June 27th.)