Life after Trauma

My year of becoming a woman and learning about loss - when life events are PTSD triggers

 The temple bell stops, but the sound keeps coming out of the flowers.

Basho

 

Happy graduate (photo: Rik Ruff, flickr creative commons)

  Many people consider 18 to be the age at which someone becomes an adult. If so, then the year I became an adult was a doozy. I experienced the Rites of passage of graduation, and beginning university that are often associated with adulthood, and, then, for good measure, I also experienced the birth of my first child, the loss of my first child, and the loss of my first love. It was a tumultuous year. 

My high school graduation (personal collection)

Even though I was pregnant during my senior year, I focused on the goal of graduation with a tenacity that I find hard to believe when I look back. I was eight months pregnant when I graduated, a shocking thing in my small town. Thankfully, no matter how shocked people were neither parents nor the local school board could do anything about my presence at school. Michigan was ahead of the rest of the country in this regard. While the passage of Title IX in 1972, allowed pregnant teens to attend school in most states, Michigan began allowing pregnant teens to attend school in late 1970. So, yes, graduation day was a happy one. I felt proud and then about a month later the other shoe dropped.

 

Teen mother (photo: Harbor Life, flickr creative commons)

 

Our daughter was born on July 25th and no one had told us anything about what to expect: not that it would have mattered. I was drugged against my will, not allowed to hold my baby, and my boyfriend and I were both treated as less than human. I can't remember anyone acknowledging our presence or offering the least crumb of comfort. We were deeply grieving and no one acknowledged that either, they simply told us, "you'll get over it." I started university in the fall, which went fairly well under the circumstances and, then, about a year later my boyfriend and I broke up. By August 1972, I resembled the survivor of a shipwreck who had barely made it to shore, more than I did a normal young woman embarked on adulthood. 

My son and his girlfriend at the prom (photo: Angela Wheelock)

My son turned 18 this year and, as he headed toward graduation, I realized that this event could be a big trigger. (I already wrote about his birthday and new girlfriend on an earlier post.) In some ways, it was. I had some very bad days and it wasn't always easy to attend the many events associated with graduation: which is a big deal in Vancouver. However, today was the last day of school for my son and I managed better than I thought I would. Self-awareness and self-care made the difference. I treated myself with tenderness and it worked. I got through the approximate month of events and participated in most of them with the kind of happiness you would expect a "normal" parents to show. There was the prom (June 3), the pre-graduation brunch, the graduation ceremony, the after-grad dinner/dance (June 20), the beach party/potluck (June 27), and - finally - today the last day of school. Whew!  

In my life, pregnancy has been another matter altogether. The loss of my first child was such a wrenching one, that when I became pregnant again ten years later, I experienced intense emotional flashbacks, had a miscarriage, and nearly lost my marriage. Things were very tough. At that time, my husband and I were living in a remote community with no access to counseling, neither of us had heard of PTSD or had any idea why I was so profoundly upset or what the intense emotional outbursts were about. After that, I went on to have two other pregnancy losses. By then, I'd begun to understand more about the connection between my earlier loss and my problems maintaining a pregnancy. I began practicing tai chi and other relaxation techniques to get through the hard times. Pregnancy was still a potent trigger for me, but over time the strength of my emotional flashbacks relented enough to allow me to give birth to a beautiful boy in 1994. 

I have other triggers: anniversaries, music, feelings, people, but life events have been the largest triggers for me and have triggered the largest and most painful PTSD flashbacks. (The exception might be people. More on that in a future post.) Music, as I mentioned, has been a powerful trigger. I can't remember why now, but when I came home from the hospital after my daughter was born, I stayed in bed for about a week, crying and listening to Cat Stevens Tea for the Tillerman. Why that album? I can't say. All I know is that today, the thought of listening to Cat Stevens feels dangerous. Several years ago I thought I had come far enough to be able to finally listen to the album again. I even bought a copy. It's still in its wrapper. However, I think I'm brave enough to download a video below of one of the songs that conjures up that dark moment in my life. Why bother, you might say. According to most of the things I've read about PTSD, avoidance is an impediment to healing. So, here goes. 

  

Wow, after downloading Wild World, I can see what a good song it would be to listen to while grieving. It's not as hard as I though it would be to listen to, but I don't plan to open the CD anytime soon and listen to the whole album. Baby steps. 

What are your triggers? I'd love to hear your story. 

 

 

 

 

What are PTSD flashbacks & what triggers them?

A trigger is anything that sets you off emotionally and activates memories of your trauma.

Jasmin Lee Cori, Healing from Trauma 

   

Helicopter (photo: Sarah Macmillan, flickr creative commons)

Triggers, as Jasmin Lee Cori notes above, can be anything from the sound of a helicopter to a beautiful September morning, like the morning of the 9/11 attacks in New York City. Triggers are sights, sounds, smells, and feelings that you may have encountered during whatever traumatic experience(s) you've been through. Listed below are some examples of triggers.

 

• Visual reminders
• People, either the same person, or a type of person who was with you at the time of the trauma. Eg. a nurse or doctor if you've experienced a medical trauma.
• Places
• Sounds
• Smells
• Thoughts
• Music, movies, or other things that trigger memories
• Life events, such as weddings, funerals, birthdays (more on this in next post)
• Anniversary dates of the original trauma(s)
• Feeling abandoned, trapped, or alone

There are as many triggers as there are traumas. Perhaps, you had just eaten a meal of spaghetti before being sexually assaulted and so spaghetti could become a trigger for you. Perhaps, you hear a song playing that brings back memories of a time in your life when you experienced trauma(s). Sometimes, you're aware of these triggers and sometimes you're not. And, as with many things in life, just when you think you've "figured out" what triggers to watch out for, new ones arise. Besides, some things cannot be avoided without changing your life dramatically. My doctor told me about one of her patients who is triggered by white vans because they remind him of being in a war zone. Imagine trying to avoid all white vans. The only way to do that would be to stay inside and, even then, you might see a white van in a movie or a white van might pull up to your house to deliver something. The article, How to identify PTSD triggers, does a great job of describing internal triggers - such as feelings and memories - and external triggers - such as sights, sounds or other external stimulus. We'll get to how to cope with flashbacks later, but go ahead and read that part of the article now if it interests you.

Flashback (photo: Paul Williams, flickr creative commons)

 

What happens when you have a flashback?

As you might imagine from the word trigger, encountering a trigger sets off a process that causes your frozen traumatic memories to become activated. Depending upon the trigger, the activation might be small or large and intrusive. Perhaps, you just feel somewhat unsettled. Something's wrong, but you can't put your finger on it. Or maybe you wake up from a terrifying nightmare, sure that the traumatic event is recurring. Flashbacks symptoms can run the gamut from mild to extreme. The severity and frequency of flashbacks will depend upon how many traumas you've experienced, how extreme they were, how long they lasted, and how far along you are in processing your trauma. 

Take a look at How PTSD Flashbacks Feel for one man's experience with PTSD. Of course, flashbacks feel different for everyone. In my case, I feel dread, but I also feel emotional pain that isn't always easy to pinpoint. All I know is that if I'm having a full blown flashback, I need to be alone. Sometimes my flashbacks last an hour or so, sometimes more than a day. It all depends. You could say that it's like checking into "the memory motel," but not being able to check out again. 

Memory motel (photo: Jeff Weston, flickr creative commons)

 

 More flashback symptoms

• Panic attacks
• Nightmares
• Anger
• Sense of dread
• Seeing the "movie from hell" play on a continuous feedback loop in your head
• Intrusive memories and thoughts that you can't quiet 
• Shame
• Self-hatred
• Depression
• Frustration 

I'm sure you get the picture. Flashbacks are no fun!! Check out the video below for one man's experience with PTSD. Robert is a Vietnam veteran who was in the U.S. Airforce and he is eloquent in his description of the impact PTSD has had on his life. Of course, as you'll see in the next post, you don't have to be a war veteran to have PTSD and experience flashbacks. 

  

 

 

How are traumatic memories different from other memories?

It is as if time stops at the moment of trauma. The traumatic moment becomes encoded in an abnormal form of memory, which breaks spontaneously into consciousness, both as flashbacks . . . and as traumatic nightmares. . . 

Judith Herman, Trauma and Recovery 

 

Former child soldier, Uganda, 2008 (photo: Gary Moore, Trocaire, flickr creative commons)

 

Memories are very important to making sense of our lives. That's why people with any sort of brain damage or dementia often struggle because when they lose their memories, they lose much of their ability to function in the world. Traumatic memories are created at the moment of trauma. In this moment, the person - and the person's brain - is overwhelmed. Indeed, as Judith Herman says about trauma, "traumatic reactions occur when action is of no avail." Often the person freezes, helpless to act either because they will be killed if they do so or because they have been overpowered by someone or something stronger than themselves. Some trauma survivors were drugged against their will or told family members would be killed if they tried to escape. We can only imagine the sort of traumatic memories the young man above is struggling with and the courage he must have to get on with his life.

Ice bubbles (flickr creative commons)

Characteristics of Traumatic Memory

Frozen 

Exist outside of normal time

 Non-verbal

Possess heightened reality

Tremendously persistent

Stored differently in the brain

Difficult to fit into the "story" of one's life

Go to Traumatic memory for more on the characteristics of traumatic memory. 

 

 

 What's the Amygdala Got to do With It?

 

 

The human brain's limbic system (photo: Zachary Veach, flickr creative commons)

 

Okay, what is the amygdala and what does it have to do with traumatic memories? The amygdala is an almond-shaped set of neurons located deep within the brain's limbic system. During traumatic events, the amygdala may become damaged and, after the event, continue to function differently than the amygdala of people who have not experienced trauma. The science of exactly how this works is somewhat lost on me. The important take-away point is that after trauma our brains, and the way in which we process memory and emotions, are changed in a profound and long-lasting way. I think that this understanding not only normalizes certain aspects of PTSD, it helps us understand how the process of recovery works and the key role that memory plays in healing. For more on this fascinating topic, see Memory, the Amygdala, and PTSD. 

Below, Dr. Frank Ochberg does an excellent job of explaining the nature of trauma memories.

 

 

Why is understanding Traumatic Memory important to the PTSD recovery process?

Knowledge is power. Understanding, if only in a limited way, how traumatic memory functions allows someone with PTSD to understand more about what is happening in their mind and why PTSD can be so resistant to change. Dr. Ochberg does a good job of explaining this in the video above when he describes the difference between verbal memory and non-verbal memory, which he terms VAM and SAM. Trauma memory is a deeply rooted memory that was created under extraordinary conditions. Understanding the power of this special kind of memory is the first step to understanding and coping with PTSD triggers. Next time, more about flashbacks and how they are triggered. 

 

PTSD Flashbacks - A Series

. . . it's as if we are wandering lost in a desert, famished, delirious

set upon by wild lions, our minds blank with fear,

starving for a crumb, any morsel of light.

Barbara Hamby, "Thinking of Galileo"

 

 

Bereft (photo: flickr creative commons)

I am going to start a new series here on PTSD Flashbacks. Several readers have written about this and I know from my own experience that flashbacks and intrusive emotions can be one of the hardest parts of PTSD to cope with. However, it would be impossible to tackle this huge subject in one post. I'm not exactly sure yet how many posts the series will include, but 5 or 6 is my best guess. Below are some of the topics I plan to explore. Please let me know if you think of other topics that should be covered and I'll add them to the list. Partly, I'm doing the series now because of reader interest and partly I'm doing it because I am in the middle of dealing with some potent triggers myself. More about that in a future post. 

 

1. How are traumatic memories stored in our brain?
2. What are flashbacks and what triggers them?
3. My own experiences with flashbacks - recent and in the past. 
4. What are the different types of flashbacks people with PTSD may experience?
5. How can you cope with flashbacks?
6. Will flashbacks ever completely go away?

 

 Traumatic Memories and the Brain

The limbic system of the brain (photo: Zachary Veach)

 

As you can see from the list above, the first topic I plan to tackle is a look at how traumatic memories are stored in the brain. In fact, traumatic memories are stored quite differently than "normal" memories and this fact has a large influence on both the power and unpredictability of PTSD flashbacks. Despite the fact that flashbacks can be unpredictable, trauma survivors can anticipate circumstances, stimuli, and anniversary dates that may trigger flashbacks and plan accordingly. When it comes to PTSD flashbacks, ignorance is certainly not bliss!  

 

Stay tuned for more.

Some of you may have noticed that I've changed the title of my blog. It used to be Sitting With Sorrow. However, as I've begun healing and feeling stronger, I felt that Life After Trauma was a more appropriate title. Of course, the URL remains the same.  

On a lighter note here's a fun video. 

 

Trauma and Recovery - a Book Review

Traumatic events are extraordinary, not because they occur rarely, but rather because they overwhelm the ordinary human adaptations to life.

Judith Lewis Herman 

   

Distressed woman (photo: Alex Thompson, flickr creative commons)

  Judith Lewis Herman's book, Trauma and Recovery, is a landmark book. I don't use this term lightly. A woman who calls herself SwedishJewfish has written a lengthy review of Trauma and Recovery on The Daily Kos, describing it as a "life-changing" book. I definitely agree.  I first picked up Trauma and Recovery several years after I'd been diagnosed with PTSD. I'm not sure how I had overlooked it before, but I think it was because I wasn't ready to read something theoretical yet. I was too caught up in my own head. The genius of Herman's book is that it operates on so many levels. The book is not only a history of the study of trauma and recovery, as the title suggests, it also deals with many topics that few have written about in quite the same way. I'll go through the book's sections below - hopefully briefly. If you're interested, you should get your hands on a copy because Herman's book is so filled with insights into trauma that it is impossible to share them all in a brief review. 

Introduction

In most books, you can skip the introduction. However, I suggest that you read Herman's introduction. It's brief and clear about why we should be interested in trauma. Herman argues that, "Remembering and telling the truth about terrible events are prerequisites both for the restoration of the social order and for the healing of individual victims." (p. 1) She then goes on to describe the conflict that is at the heart of Post-Traumatic Stress Disorder: "the conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma." And that's just on page one! 

A Forgotten History

Memorial to those soldiers who were executed in World War I for shell-shock (combat trauma) (photo: flickr creative commons)

 

In the first section of the book, Herman discusses the history of the treatment of trauma. She begins with Freud and shows how he suppressed the evidence that sexual abuse was more widespread in the well-to-do population of Vienna than anyone suspected. Controversy is still raging on this subject, so I'll leave it to you to decide who's right. Right or wrong about Freud, Herman raises many important points about the study of trauma. She argues that it has been hard for psychologists to get "respect" for studying something that most people would rather deny. "To study psychological trauma," Herman says, "means bearing witness to horrible events." (p. 7) 

The next section of the book, discusses the work of W.H.R. Rivers with shell-shocked soldiers in World War I. I've written about this work at length on an earlier post and Man Booker Award winning author, Pat Barker, has written about it in Regeneration. Barker's book - part of a trilogy on the subject - beautifully evokes the shift from punishing combat trauma to treating it humanely. That wasn't necessarily because people became more empathetic, Herman suggests, but simply because there were so many shell-shocked men in World War I, that if they had all been executed - as many were - there would have been no one left to fight the war. 

Next, Herman goes on to discuss the treatment of combat trauma in the Vietnam War, when PTSD first came into usage as an official diagnosis. As Vietnam Vets returned home, they increased awareness of this issue and, in the 1970s, the Women's Movement took up the issue of rape and what they called "the rape trauma syndrome."  It's amazing to realize today that it was only in 1971 that the first rape crisis center was opened in the United States. Before that, women kept quiet or were silenced about sexual violence, unless - and this is a big unless - the perpetrator came from a group that was discriminated against by society, eg. African-American men in the U.S. 

Describing PTSD

In this section of the book, Herman does a splendid job of describing the hallmark symptoms of PTSD.

• Hyperarousal
• Intrusion
• Constriction
• Disconnection - with family and community

Unfortunately, I don't have room here to share her many insights. 

A New Diagnosis

Herman makes a strong case for a new diagnosis: complex PTSD and outlines why she believes that people who have experienced repeated/chronic PTSD, particularly at a young age, will need different treatments and approaches to recovery. 

 

Man crying at the Vietnam War Memorial (flickr creative commons)

Stages of Recovery

As important as the first part of Herman's book is, the part that glued me to the page was the stages that trauma survivors must pass through in order to successfully recover from PTSD. (Caveat: to recover doesn't mean that people who have experienced significant trauma will return to their pre-trauma state. It means, rather, that the survivor will be able to reconnect with others both on the individual level and on the community level.) 

Safety

The first, and most important stage, is that the survivor must be safe. Some survivors, tragically, cannot leave unsafe conditions and may not have the luxury of a safe recovery. Most people, however, can begin to understand that the trauma is over and they are safe now. First, comes physical safety, then the establishment of a "safe" therapeutic relationship. Both facilitate healing.

Remembrance and Mourning

Beatrice Mauwa, Survivor of Sexual Violence in the Congo, telling her story (The Advocacy Project, flickr creative commons)

This is a very difficult, although vital, stage for recovery. It may be a long stage, if my own experience is any indication. Much depends upon how many traumas you've experienced and whether or not others are receptive to hearing about them. Telling your story of trauma in this stage is essential. Ideally, you can do this through a combination of therapy and writing, voicing your story to a wider audience. Be aware, however, that this story is not something most people want to hear, so choose your audience carefully. This is what sets Herman's book above many others on trauma; she recognizes the essential role that the community and the political climate have on trauma survivors' ability to recover. 

Reconnection with (Ordinary) Life

Women protest violence against prostitutes and others, Columbia, 2009 (The Advocacy Project, flickr creative commons)

The first person the survivor must come to trust is the self. Indeed, it is only recently that I have come to trust myself in ways I hadn't done since the initial traumas in my life occurred. Herman urges survivors to connect with a larger community and become involved in action to expose or end the trauma of others. This can only be done, however, when the survivor is strong enough. This step, however, can be a powerful one. Herman suggests that survivors can, "transform the meaning of their personal tragedy by making it the basis for social action. While there is no way to compensate for an atrocity, there is a way to transcend it, by making it a gift to others" (p. 207). Herman has more to say about the connection between trauma survivors and communities. However, I've run out of both space and energy. In the final analysis, Herman's book is not just informative, it's courageous. Herman is not afraid to speak out about the so-called "unspeakable" and to bring traumas that are hidden out into the open. It's only there, Herman suggests, that true healing can occur. 

 And what about Judith Herman the person? She was born in 1942 and grew up in New York City. She's a medical doctor and a professor of psychiatry. Those of you interested in Herman and her work will enjoy the lengthy interview below. It gets off to a bit of a slow start, but stick with it or fast forward to about minute 12. Herman shares wonderful stories about her work with trauma survivors and insight into how trauma is connected to our larger society. 

 

Finally, a video by Solomon Burke. Herman worked in the Civil Rights movement and much of her work has been motivated by a sense of justice. I think she would like this song; it makes me think of her.

 

How will you know when you're healing from trauma and grief?

You have power over your mind - not outside events. Realize this, and you will find strength.

Marcus Aurelius

                Balancing (photo: Olivia, flickr creative commons)
   
A funny thing has been happening to me lately. When I feel emotionally overwhelmed by events, angry emails, and worries, at first I focus on the external stimulus, like I have for much of my life. Then, it's as if a switch goes off in my brain and I say to myself, "You know what, I can't do anything about  _____ (fill in the blank with your stressor of choice). But I can do something about myself." Then I ask myself, "what do you want to do?" This may not seem like rocket science; however, it is a revelation for people who have been grappling with PTSD and grief. It's huge. A quote from Madeleine L'Engle (author of A Wrinkle in Time) does a perfect job of describing what this feels like, "That's the way things come clear. All of a sudden. And then you realize how obvious they've been all along." And that's so true. I find myself thinking, "Gee, why couldn't I do this before," and wondering if all those times that my therapist said, "you can only control yourself," finally trickled down into my brain. Whatever happened, I can feel myself healing and it feels good. Scary too. 

                                            Beans sprouting (photo: Flora Cyclam, flickr creative commons)

How will you know if you're healing? Your first sign may be a similar desire to turn towards yourself instead of turning towards the other, turning inward, rather than outward; being able to focus on yourself the way the woman above is focusing on balancing that egg. Before I began to heal, I was easily derailed by the needs of others, my desire to control the uncontrollable, and my desire to make my emotional pain go away. These days, I find that I can listen to myself, where before listening to myself was too frightening to do. These signs of healing are still new, however, and I am protective of them the way my husband is protective of the seedlings that are hardening off on the patio before he puts them in the garden. My healing still needs to "harden off." It's fragile, but not so fragile that it can't stand a few knocks. It feels miraculous, the way seedlings always seem to me when they first burst out of the seed. I know it's going to happen, but it's a miracle just the same. 

Another man with complex PTSD discusses his own signs of healing here. 

                                    Self-heal (photo: Jerry Oldenettel, flickr creative commons)

For me the strongest sign of true healing has been my newfound ability to trust myself. This self-trust has been coming for a long time, like a seed planted in the fall, that sprouts in the spring. My singing, writing this blog, therapy, reading, and spending quiet time alone, have all contributed to my healing. Self-compassion and self-kindness have also been essential. And, more and more often, I trust myself. Just saying those words, "I trust myself," bring tears to my eyes. Maybe that sounds maudlin, but I survived so many traumas, beginning at age 17, that trusting myself has not been part of my life. When I was looking for images of healing, I came across a flower called self-heal. I didn't even know there was a plant named self-heal, but I think it is a lovely name and, while I realize that I haven't healed alone - I've had lots of help and support - self-heal(ing) has a beautiful ring to it. The flower of the self-heal plant has a simple beauty, as you can see from the photograph above. 

If you haven't detected signs of healing in your own life, don't beat up on yourself. It may not be time yet; you may still be struggling with the necessary stage of allowing yourself to feel your pain and grieve the losses you've experienced. Don't give up. For most of us, things will get better. Healing may be slow and quiet, but I believe that if we do the work it will come. To end, here's a quote from St. Bartholomew and a song from Ruthie Foster.

Many of us spend our whole lives running from feeling with the mistaken belief that you cannot bear the pain. But you have already borne the pain. What you have not done is feel all you are beyond the pain.

St. Bartholomew 

 

What signs of healing have you experienced? I'd love to hear your story.