PTSD

5 people are driving in a car and there is an accident. Only person (not the driver) develops PTSD in the wake of the event. Why?

Diagnosis ---> Resolution:

Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat

This quote from NIMH's website is followed by a link for treatment, but it links to a page on treatment for anxiety disorders, broadly speaking. This, I assure you, is not the way to treat PTSD. At least not for me. No amount of Xanax could touch this 'anxiety'. I've been anxious before, I've had panic attacks before, and this was different.

There are four main symptoms of PTSD:
1. Reliving the event, in flashbacks, nightmares, etc.
2. Chronic avoidance of situations that bear some relation to the traumatic event
3. Numbing of emotions, forgetfulness
4. Hyper-vigilance/hyper-arousal

In the program I have found that has finally be successful in treating what I now can comfortably identify as PTSD, the illness is treated differently than a typical anxiety disorder (although copious benzos are always helpful). Rather, it is treated as, to some extent or another depending on the person, a dissociative disorder, like dissociative identity disorder, formerly known as multiple personality (with which PTSD is often comorbid especially in children). Trauma, for some people, is treated as a fundamentally a dis-integrating experience, and PTSD as a disintegrated worldview. The trick then is not to teach yourself how to stop being afraid -- although that is a goal -- but rather to figure out, slowly but surely, how the trauma and its concurrent reaction can be fit into the rest of your life (or reintegrated). Whether you need talk therapy, cognitive behavioral restructuring, hyponosis, or just paper and pens and a lot of time, the goal is to come to an understanding of Why You. But not why the trauma occurred to you, because that is often (as in my case) the malice of others and shit luck. Rather, why the PTSD did.

Now, in some ways, this requires working ahead of the medical community, whose members know very little about the Whys of PTSD. What they do know is often focused on and limited to war veterans, no doubt an group in need of help but perhaps not a representative sample. But they do not really know much about why that fifth person in the car is predisposed to PTSD. What you can bring to the table, though, is your knowledge of yourself. It may not provide any medical exactitude, but let's be honest, how often do psychiatrists offer that? So in my case, while underlying mood disorder tendencies are no doubt a component, there are other environmental factors, and factors in my personal history, that I realize now made it unlikely that I would find a way to healthily cope with what happened. So I sort of forgot, sort of panicked, sort of dissociated, was always hyper-vigilant, and was too numb to really be any of those things fully. I was textbook.

I'll explain all this more clearly. I've had some revelations. More to come.



P.S. For those in other circumstances, watch out for something called Complex PTSD, possibly to be included in the next DSM. It's what some victims of routine child abuse and other long-term childhood trauma experience, and has distinct symptoms.