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PTSD Questions & Answers
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Joyce Boaz & Dr. Frank Ochberg, M.D.

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Managing PTSD After Partner Pushes Too Hard

Q: Dear Joyce,

A veteran wrote to me recently and agreed to have his letter, edited to remove certain issues, and my response, serve as a GFW "Q & A." With gratitude to this young man for his candor and for his willingness to share this exchange with our GFW community, here goes:

Dear Frank,

My name is Gene (not really). I watched a talk of yours on Youtube today. I spent a few years as a soldier. I've seen people killed in action, been to many funerals, I don't know how many people I know who have died, my parents lost two kids before I was born, etc.. I've always been more of the dissociated type of person, especially with regard to my own trauma.

Recently I was involved with a girl and she begged me to open up and talk - I resisted, warning her it was not a good idea, but finally did after months of her requests - and I did, crying, for the first time in 20 years, for four nights in a row. It was too much for her and she walked out a week later. I had never opened old wounds and the PTSD is now ever present. I am searching for guidance and help, if you can offer me some.

If you can help me, thank you.

A: Dear Gene,

Thank you for writing and offering to share our correspondence with others who may benefit. As you know, I've edited out some details that might "trigger" GFW readers, since they, too, seek PTSD information but have to be very careful about taking in too many images and setting off their own internal injuries.

My field, traumatic stress, has come a long way in three and a half decades. We have pioneers who recognized elements of post-traumatic emotion long ago, but this current era began in the 1970's during the Vietnam war, during the rise of feminism and attention to the impact of rape, battering and incest, and during certain catastrophic events which were well-studied by social scientists and medical experts. We learned that some people were more likely than others to become deeply wounded and to carry those wounds inside, with episodes of painful, unwanted, almost explosive memory.

You may be a bit more vulnerable because of "dissociation." (Those who move into trance-like states to contend with harsh reality do seem more likely to develop PTSD). And when dissociation does not work to protect against a break-through of painful episodes from the past, that onslaught of memory can be severe. I've come to think of this as similar to epilepsy - a convulsion of memory with vivid recollection and various terrible feelings. Sometimes those feelings are full of fear. Sometimes rage. Sometimes shame.

Thanks to a handful of scholars who understand classical history, poetry, philosophy and drama, and who also understand the modern combat warrior, a feeling of "moral injury" has been added to that list of post-traumatic emotion. Moral injury means that one's sense of honor has been assaulted. But it is more subtle and complicated than just that. We all have a sense of "that which is right" based on the teaching of good parents, of role models, of those elders and peers we respect and trust. Psychopaths never develop that moral sense, but normal people do. And when we encounter trauma - the type of trauma likely to result in epileptic, explosive memory- and, at the same time, we find ourselves in a world turned upside-down by moral injury, we have an existential problem as well as a memory problem. The existential problem is usually impossible to explain to a person who wasn't there. Of course you can say that a commander screwed up. Or that you had to choose between a direct order and saving a civilian life in a military operation. In a totally different situation, an incest victim can stay silent so that she and her mother survive the assault of a brutal step-father. But she knows in her gut that she is being "morally injured." How can she possibly explain that to a teacher or a classmate?

I'm assuming, Gene, that you know very well what I'm expressing here. You have been injured by exposure to many traumatic and tragic events. You succeeded, for a while, in keeping these experiences out of mind (out of conscious mind). And now they are all too conscious. They come when you don't want them to come. They make you cry - and that happens to be healthy and reasonable, but painful and, unfortunately, shameful in our macho culture. And, I'll bet, there is also this moral injury component. Your sense of a just world has been injured, too. So what can you do?

Well, you did write to me. That shows initiative, curiosity and willingness to seek help. Good! You did open up and look at your invisible wounds. That is courageous and useful in the long run, but painful and lonely right now. I'm so sorry that your girlfriend couldn't take it. Not all partners can. You deserve "peer support." That means a friend who will not walk out on you. GFW does try to link "support pals" but you'd be best off if an existing pal is willing to share some of the issues you shared with me. You don't need to pour it all out at once. But if a pal "gets it" - sometimes that means knowing what you are experiencing in general terms without all the detail- that can be good enough.

Veteran groups often work well, providing peer support, but not all the time. A veteran of a foreign fighting force might not be comfortable in one of the US veteran communities. I know Marines who will only confide in Marines. Peer support is tricky business. The peer has to be trustworthy and often has to come from a similar set of experiences and alliances.

You can read more about PTSD, avoiding the pop psychology quick fix stuff that is out there, but getting a good sense of the science of trauma studies and developing a feel for the types of therapies that you can afford and tolerate. You do deserve a trained trauma specialist. Here are some links to help with that.

http://www.goodtherapy.org/therapy-for-ptsd.html
http://www.giftfromwithin.org/html/FAQ-Therapy-Inadequate-Therapy.html

Gene, there are "tools of the trade" once you are in recovery from post-traumatic injury. I like the ones I've developed: the Color Wheel; the Board of Directors; the Counting Method. Some can be learned on your own. Some need a trained pro to help you along. A few more links:

http://www.giftfromwithin.org/html/FAQ-Frank-Ochberg-Color-Wheel-of-Positive-Emotion.html

https://www.youtube.com/watch?v=3eiAt_22js4

http://countingmethod.com


Exposure therapy is such a critical part of PTSD care. Counting is one form, but many others are well researched and well respected:

http://www.giftfromwithin.org/html/FAQ-Recovery-Exposure-Therapy.html

This is particularly relevant to you, Gene, since you experienced the opposite of exposure therapy. You were exposed to the full impact of your own stored-up experience without a trained guide to help you re-experience in small doses, paired with forms of relaxation and reassurance. Your well-meaning girl friend was no expert in PTSD and she naively thought she was doing you a favor when she was, in all likelihood, over her head and out of her league. (I don't mean any disrespect for her; I just want to signal others that it isn't always therapeutic to encourage a person to let it all out).

Many, many non-traditional, non-medical forms of assistance are available. Consider the role of service dogs:

http://www.giftfromwithin.org/html/FAQ-Therapy-Service-Dogs-and-PTSD.html

Gene, the bottom line is this: PTSD is real and it is painful-- but it gets better. Even if it becomes chronic, you can manage it. Many, many others share the condition although every individual is unique. Don't be self-critical for having the human response to trauma and tragedy. You are starting a tough recovery from the wounds of reality. Pace yourself, taking time to relax between periods of remembering and learning how to reduce your "triggers" and your negative emotions. Do learn how to expose yourself, gradually and comfortably, to sources of stress. Learn the relaxation technique that suits you. Pair relaxation with exposure.

You are joining a group of millions who share this condition and who will overcome fear, guilt, rage and other consequences of trauma. You will, eventually, mentor others who join with us. Welcome aboard.

Frank

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Page created on 12 October 2014
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