Stigma…we hear this word a lot these days. “Break the Stigma” is now a battle cry for substance abuse, mental illness, and both domestic and sexual violence. A stigma is defined as “a mark of disgrace associated with a particular circumstance, quality, or person.” (Webster’s) I prefer to describe it as an ignorance or misunderstanding of a condition or situation. We judge what we do not understand. Addiction is a perfect example…I’m not an addict so why are you? I make the decision to not use drugs and I don’t struggle with that, why can’t you do the same? It is easy to judge a person if you do not understand the disease, in this case the disease of addiction. It can lead to criminal behavior, destroy families, and can even result in death. This makes it easier to stigmatize. People suffering from addiction are assumed to be “bad” people, when in fact, they are usually great people who are suffering. Stigmas are common in the misunderstanding of abuse and mental health as well. “Why doesn’t she just leave?” is a common thought in domestic abuse. “What was she wearing?” is often said in cases of sexual violence. And what about mental health? Depression is seen as a choice. Anxiety as just thinking too much. PTSD? Oh you must be unstable…
One of the first misconceptions of PTSD is that it is a mental illness; it is not. PTSD (Post Traumatic Stress Disorder) is actually a brain injury. It is caused by a traumatic event that changes the neurological processes of the brain. PTSD actually CHANGES the brain! The hippocampus (located in the medial temporal lobe of the brain, almost the center) actually shrinks. This area of the brain helps us to distinguish between past and present memories. The ventromedial prefrontal cortex (located in the lower front of the brain) also shrinks. This region of the brain regulates negative emotions that occur when confronted with a specific stimuli. Are you starting to see a correlation? The amygdala (located deep and medially in the brain, also part of what is called the reptilian brain) sees increased activity with PTSD. This is what helps us to process emotions and is linked to fear responses. The reptilian brain is the area of the brain first developed in humans. It is in charge of our “fight or flight” response. This is the part of the brain that takes over when we are in danger. Let’s connect the dots. Traumatic event occurs. Brain injury (PTSD) develops. Changes are happening in the brain with the shrinkage of the areas that differentiate past and present memories and regulation of emotions. Our reptilian brain is becoming more active. What comes of this?
Hypervigilance – This is an exhausting state of constant high awareness. The world is potentially unsafe and a constant threat. This causes increased paranoia as well as an exaggerated startle response. An example from my own experiences are locks. I am adamant about locked doors, both at home and in my vehicle. If someone else in my household leaves a door unlocked, I WILL overreact and feel immediate panic. This reaction is known as a trigger.
Triggers – This is where the brain changes really come together. A trigger is “anything that sets you off emotionally and activates memories of a trauma.” (Healing from Trauma) An event causes a trigger. The brain that differentiates past and present memories has shrunk so it processes this as though the past trauma is currently happening. We begin to respond out of fear or anger; the part of our brain that regulates our negative reactions has shrunk as well. We are unable to react appropriately. Now we must fight! The amygdala is already in overdrive so it takes over and we are now in “fight or flight.” Once our reptilian brain has been put in charge, all of our reasoning ability that occurs in the front of our brain is no longer available. The amygdala is in charge and it HAS to save us! Our reactions will often take us back to the time of our actual trauma. My therapist has described it as a ditch that the trauma has “dug” into our brains. Once we are triggered, that is the pathway that our brain takes to react. Our reaction will be based on our trauma and the age or circumstance in which it happened. I may be in my late 40’s but I may react as an immature adult in my early 20’s or show the emotional control of a young child.
Exhaustion – Because our reptilian brain is overactive and the world seems to be a constant threat, we grow weary. Exhaustion is a common symptom of those of us who live with PTSD. We’re not lazy, we are exhausted from the battle that rages within ourselves.
These changes are not just theory, they actually DO show up on a brain scan.
This is your brain. This is your brain on PTSD. Any questions?
You may or may not have gotten that reference.
Now that we have talked about the science-y stuff and I got to use a lot of big brain words, what does PTSD look like in everyday life? That’s not an easy question to answer because, in reality, it varies individually and is based on severity. It can also vary based on the type of trauma. Some people have developed PTSD due to witnessing a violent crime or homicide or were the victim of an attempted homicide with a firearm while others have PTSD through their combat experience. Many of these individuals may have difficulty with loud, sudden noises or fireworks. I have no issues whatsoever with either as those experiences were not the case with me. I am obsessive with locks, because the world is not safe. I have had several traumas occur over a lifetime beginning with childhood sexual abuse, rape in my young adulthood, and severe mental abuse in relationships. I remember thinking that nothing else horrible can happen to me because I’ve had my tragedy already. I was wrong, so I lock my doors…religiously. If I am walking by myself anywhere, a store or parking lot, for exercise through my neighborhood or on the track; I am uneasy if a man is behind me. I do not want to keep looking over my shoulder so I will do so occasionally and listen constantly. You just never know, right? Things that will throw me into a tailspin are leering, sexually explicit and unwelcome comments, condescension, angry confrontation, personal criticism, and being cornered (literally or figuratively). I react differently depending on the trigger. If a man leers at me in a sexually deviant manner or says something to me that is sexually explicit and inappropriate, I will react internally with fear and panic. That is also how I feel when walking by myself with an unknown male behind me. Terror. When I face the other triggers mentioned, that is when I will feel rage. It will take days, weeks, or longer for me to get past it. Sometimes I never do. It will haunt me with intrusive thoughts and brewing hostility. Because of this, I tend to change jobs frequently. If the clientele become difficult to get along with or the work environment is toxic, I get out. I have to for I am afraid the rage will show itself and then everyone will know. I keep to myself a lot. It just seems easier that way. I am a heterosexual woman suspicious, fearful and resentful of the male gender which can make me hard to love and marriage difficult. I find joy in my children. I have never felt triggered by them. They make me feel whole and safe. With them, I feel normal.
Much of these things happen internally. On the outside I do not walk around with a scowl on my face nor am I anti-social. I consider myself easy to like and rather funny. People laugh often when they are around me; I’m hoping it’s my jokes and not my face or that my fly is unzipped. If you are that person who takes up an entire aisle at Kroger trying to decide which Chips Ahoy cookie you are going to bring home this week, I may be internally punching you, but externally I will wait for you to decide and hate you in silence. I stand outside and talk to my neighbors. I laugh loudly and without reservation. I clap and give standing ovations at my kids’ various performances. I have ups and downs just like everybody else and I deal with problems the best I can…much like everybody else. But I see things differently and I feel things differently. I often wonder what it looks like from the outside; how people might perceive me. This morning I was letting Rex, our dog, out. A gentleman had been in the backyard reading the meter about a half hour before. As soon as Rex stepped out he began sniffing the air. He walked toward the meter taking in the scent. He just knew that something was different. I wonder if people feel that too, that everything seems ok but there is just something different…about me.
I wish I could describe what I was like before my injury, but I know no other way. It has been surmised that I have been dealing with this condition in one way, shape or form, since I was four years old. I don’t remember much before that. Would I have married differently? Have a successful career? But also, would I appreciate the genuineness of an individual like I do now? Would a sunrise or sunset still move me to tears? Would I have the same passion to fight social injustice? It’s hard to say. What I can say is that having PTSD is not a scarlet letter on my chest or a cross I must bear. It is a scar and a harsh reminder of a tragedy, the ugly threads sewn into a tapestry that is my life. But even with the ugly threads, mixed with the beauty of the whole of my experiences, I am still quite a work of art.
Sources: Healing from Trauma: A survivor’s guide to understanding your symptoms and reclaiming your life.
YaleNews: New PTSD study identifies potential path to treatment.