When I was five years old, I had St. Louis encephalitis (SLVE). SLVE is a virus that can cause serious illness that affects the central nervous system. For those of us that had a severe case, symptoms often include fever, headache, stiff neck, disorientation, and altered level of consciousness. Coma, convulsions, and paralysis may also occur sometimes leading to death, or a permanent vegetative state. Those were the days before antibiotics and anti-virals; to this day there is no known medication that kills the SLVE virus.
I did not comprehend, or understand my experience in the children’s hospital. Those were the days when hospital personnel explained nothing to children. I would fall asleep then wake up in the morning unable to recall where I was. Since I was in a university teaching/research hospital, their primary concern was on drawing large tubes of blood daily; a process that was true torture. My first memory of the hospital is floating above myself and looking down at my body; I had feeding tubes in my nose. My second memory was waking up in isolation alone with people standing on the other side of the window glass staring at me.
From the time I was five until far into my adult years I had nearly daily thoughts that the encephalitis would return and either leave me in a vegetative state, or kill me. Any thoughts that triggered me would cause panic symptoms. At times I would believe I had conquered my fears. But the fears would sneak back in at unexpected moments. It had been forty years since my traumatic hospital experiences. Once I decided to see a neurologist about my proprioceptive issues. The neurologist, who had an intern with him, had had me put on a hospital gown. When he started the cursory reflex testing using the little hammer on my knees, I began sobbing and hyperventilating. I was again the five-year old child unable to communicate to the doctor who was demanding that I conform to the needs of his day. I felt his judgmental attitude and I felt all the guilt I had as a child for fighting against them as they drew my blood.
Again I thought I had conquered all of these irrational fears (are such fears truly irrational?) until I was faced with needing breast cancer treatment. I made it through the treatments I chose. However, I realized I had developed a set of anxiety, panic and migraine behaviors that were adversely affecting my daily life. Life had become joyless, and hyper-vigilant. I had no emotional reserves to deal with increased work stress.
I had taken a class on the diagnosis of mental disorders as part of the requirements for becoming a licensed professional counselor. I realized that my childhood experiences did meet the criteria for post-traumatic stress. I also realized that left over guilt and irrational beliefs were keeping me from accepting the truth that I had a right and deserved to feel better. (I often would think of the other children in the ward—are they alive are they dead? Sick, or well—to me they are still children suffering.)
I had gone to a psychologist to deal with work stress four years previous. I decided I needed to go back to the psychologist and try to heal this PTSD issue and quit pretending it doesn’t exist. I needed to stop being a hypocrite with myself if I intend to be an effective counselor.
It is natural to feel afraid when we are in danger. Fear triggers many split-second changes in the body to prepare to defend against the danger or to avoid it. The “fight-or-flight” response is a healthy reaction meant to protect us from harm. But in PTSD, this reaction is changed or damaged. We may feel stressed or frightened even when we are no longer in danger.
Anyone can get PTSD at any age. The person has been exposed to a traumatic event in which both of the following have been present: 1. The person has experienced, witnessed, or been confronted with an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others. 2. The person's response involved intense fear, helplessness, or horror. Note: in children, it may be expressed instead by disorganized or agitated behavior.
PTSD can cause many symptoms. These symptoms can be grouped into three categories:
1. Re-experiencing symptoms:
• Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating
• Bad dreams
• Frightening thoughts.
Re-experiencing symptoms may cause problems in a person’s everyday routine. They can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing.
2. Avoidance symptoms:
• Staying away from places, events, or objects that are reminders of the experience
• Feeling emotionally numb
• Feeling strong guilt, depression, or worry
• Losing interest in activities that were enjoyable in the past
• Having trouble remembering the dangerous event.
Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car.
3. Hyperarousal symptoms:
• Being easily startled
• Feeling tense or “on edge”
• Having difficulty sleeping, and/or having angry outbursts.
Hyperarousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic event. They can make the person feel stressed and angry. These symptoms may make it hard to do daily tasks, such as sleeping, eating, or concentrating. It’s natural to have some of these symptoms after a dangerous event. Sometimes people have very serious symptoms that go away after a few weeks. This is called acute stress disorder, or ASD. When the symptoms last more than a few weeks and become an ongoing problem, they might be PTSD. Some people with PTSD don’t show any symptoms for weeks or months.
Children and teens can have extreme reactions to trauma, but their symptoms may not be the same as adults.1 In very young children, these symptoms can include:
• Bedwetting, when they’d learned how to use the toilet before
• Forgetting how or being unable to talk
• Acting out the scary event during playtime
• Being unusually clingy with a parent or other adult.
Older children and teens usually show symptoms more like those seen in adults. They may also develop disruptive, disrespectful, or destructive behaviors. Older children and teens may feel guilty for not preventing injury or deaths. They may also have thoughts of revenge. For more information, see the NIMH booklets on helping children cope with violence and disasters.
Many factors play a part in whether a person will get PTSD. Some of these are risk factors that make a person more likely to get PTSD. Other factors, called resilience factors, can help reduce the risk of the disorder. Some of these risk and resilience factors are present before the trauma and others become important during and after a traumatic event.
Risk factors for PTSD include:
• Living through dangerous events and traumas
• Having a history of mental illness
• Getting hurt
• Seeing people hurt or killed
• Feeling horror, helplessness, or extreme fear
• Having little or no social support after the event
• Dealing with extra stress after the event: pain/injury, loss of a loved one, a job or home.
Resilience factors that may reduce the risk of PTSD include:
• Seeking out support from other people, such as friends and family
• Finding a support group after a traumatic event
• Feeling good about one’s own actions in the face of danger
• Having a coping strategy, or a way of getting through the bad event learning from it
• Being able to act and respond effectively despite feeling fear.
Psychotherapy is “talk” therapy. It involves talking with a mental health professional to treat a mental illness. Psychotherapy can occur one-on-one or in a group. Talk therapy treatment for PTSD usually lasts 6 to 12 weeks, but can take more time. Research shows that support from family and friends can be an important part of therapy.
Many types of psychotherapy can help people with PTSD. Some types target the symptoms of PTSD directly. Other therapies focus on social, family, or job-related problems.
One helpful therapy is called cognitive behavioral therapy, or CBT. There are several parts to CBT, including:
• Exposure therapy. This therapy helps people face and control their fear. It exposes them to the trauma they experienced in a safe way. It uses mental imagery, writing, or visits to the place where the event happened. The therapist uses these tools to help people with PTSD cope with their feelings.
• Cognitive restructuring. This therapy helps people make sense of the bad memories. Sometimes people remember the event differently than how it happened. They may feel guilt or shame about what is not their fault. The therapist helps people with PTSD look at what happened in a realistic way.
• Stress inoculation training. This therapy tries to reduce PTSD symptoms by teaching a person how to reduce anxiety. Like cognitive restructuring, this treatment helps people look at their memories in a healthy way.
Other types of treatment can also help people with PTSD. People with PTSD should talk about all treatment options with their therapist.
Talk therapies teach people helpful ways to react to frightening events that trigger their PTSD symptoms. Based on this general goal, different types of therapy may:
• Teach about trauma and its effects.
• Use relaxation and anger control skills.
• Provide tips for better sleep, diet, and exercise habits.
• Help people identify and deal with guilt, shame, and other feelings about the event.
Focus on changing how people react to their PTSD symptoms. For example, therapy helps people visit places and people that are reminders of the trauma.
If you know someone who has PTSD, it affects you too. The first and most important thing you can do to help a friend or relative is to help him or her get the right diagnosis and treatment. You may need to make an appointment for your friend or relative and go with him or her to see the doctor. Encourage him or her to stay in treatment, or to seek different treatment if his or her symptoms don’t get better after 6 to 8 weeks.
To help a friend or relative, you can:
• Offer emotional support, understanding, patience, and encouragement.
• Learn about PTSD so you can understand what your friend or relative is experiencing.
• Talk to your friend or relative, and listen carefully.
• Listen to feelings your friend or relative expresses and be understanding of situations that may trigger PTSD symptoms.
• Invite your friend or relative out for positive distractions such as walks, outings, and other activities.
• Remind your friend or relative that, with time and treatment, he or she can get better.
Never ignore comments about your friend or relative harming him or herself, and report such comments to your friends or relative’s therapist or doctor.
If you are unsure where to go for help, ask your family doctor. You can also check the phone book under “mental health,” “health,” “social services,” “hotlines,” or “physicians” for phone numbers and addresses. An emergency room doctor can also provide temporary help and can tell you where and how to get further help.
If you are thinking about harming yourself, or know someone who is, tell someone who can help immediately:
• Call your doctor.
• Call 911 or go to a hospital emergency room to get immediate help or ask a friend or family member to help you do these things.
• Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1–800–273–TALK (1–800–273–8255); TTY: 1–800–799–4TTY (4889) to talk to a trained counselor.
http://www.ptsdsupport.net/Spiritual_Alienation.html
http://www.nimh.nih.gov/health/publications/post-traumatic-stress-disorder-ptsd/complete-index.shtml
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