Wednesday, March 09, 2005

When Johnny Comes Marching Home

Part 2: PTS - More Common Than You Think

Remember I said that Post Traumatic Stress is common? If you are a civilian standing in the grocery check out line, the lady checking out her groceries in front of you may have or have had PTS. Last week or last month, she may have been in a serious car accident where she suffered a few minor injuries, but was able to walk away. Or, maybe she was hospitalized for a few days or weeks and is finally out and able to regain her normal life. Unbeknown to you, she may have nightmares at night about the accident or, hearing a loud crash, she may jump. She may even have gone several days or weeks without getting into a car because she was afraid. Even now, when she gets into her car and prepares to leave the parking lot, she may break into a cold sweat or be extra alert to the cars around her.

This is post traumatic stress at its simplest.

Most of us probably know someone that was in a bad accident, fell from some height, broke a bone, had a panicked moment in the water when they thought they might drown, etc. Directly after the incident, they may seem quiet and withdrawn, but, within a few hours or days, they are telling you and a lot of other people all about it. They may even laugh at some detail that they hadn’t thought of before. This is the way that most of us deal with a stressful or traumatic event. In this manner, we’re able to give it distance and get perspective on how it relates to our normal lives. Eventually, while we may always remember that incident, it may fade dramatically in significance.

If you’re a soldier, the guy standing next to you in the chow line might have or have had it, too. Soldiers do the same thing that civilians do. They may sit around with their compatriots and share stories about the day’s events, even laugh about a few things that, we in the civilian world can’t relate to, but, they are doing the same thing, the natural and instinctive thing: getting distance and perspective. Maybe even celebrating the fact that it all turned out okay in the end and they are happy to be sitting there with their friends to talk about it.

This stands true for policemen, firemen, emergency and healthcare workers as well. Sometimes it presents itself in what many call “gallows humor” when someone might tell a joke or make a deadly situation humorous. People who have never experienced it may not relate, may possibly even find it a little repugnant, but it is the way that they deal with the stress. It’s also the reason many prefer to share their experiences with a group of their peers. They are more likely to get understanding and empathy, not sympathy necessarily, from their compatriots.

Other ways of dealing with it can be writing, or art, or playing games, or even simply “chilling” (relaxing for we older folks) with some music, books or videos.

Like I said, there is no cookie cutter program. Everyone is different.

Just because someone doesn’t necessarily share the details with others doesn’t mean that they aren’t or haven’t dealt with it in their own fashion, either.

However, it is important that we don’t ignore some of the signs like moodiness, excessive anger, sadness, sleeplessness (in a war zone, this may be pretty common as part of that ancient “fight or flight” instinct to be aware of potential enemies/predators in the surroundings), nightmares, paranoia or hyper-vigilance and, yes, even violence.

Aside from the violent aspect, anyone can have these symptoms for a short period of time. What’s important is to note whether it goes on for weeks or even months. This is usually a sign that some sort of professional or at least simple therapeutic treatment is necessary. I can't stress enough that stressing over whether there is something "terribly wrong" can add to the over all effects and if there is some question, it is better to seek professional advice and know for certain than to stress over the issue.

You may notice that we build things up in our minds and put them off because we are afraid what we will find out. Then, when we actually take care of this looming problem it is a relief and, often, we find that the situation is much more easily resolved than we originally presumed.

Aside from the social connotations that people often put on these episodes, there is a great fear among professionals (soldiers, doctors, nurses, law enforcement and emergency workers) that any report by themselves or someone else on the matter may result in a loss of their career.

Most professional institutes now recognize the problem and have taken steps to minimize it amongst their own. Police, fire and emergency response departments now offer counseling either free of charge (as part of the department’s program) or through a designated counseling program paid for by their insurance. Health professionals still lag behind a bit on this, but do offer employee assistance programs that can be anonymous, including hotlines.

Still, many people hesitate to take advantage of these programs voluntarily. After significant events, like plane crashes or other incidents resulting in significant stress, or wounded and dying victims, many departments, just like the military, insist on mandatory counseling for their members. And, just like in the military, there are plenty of professionals that roll their eyes at the orders to attend. Some because of the fear of being labeled or damaging their careers. This is also personal. These professionals rely on each other in the field or in stressful situations, no one wants to be the person that is deemed a “risk” to their situation, no one wants to be the person that others think will let them down in a tight spot.

The fear of showing weakness is a big motivator when it comes to people declining counseling, or minimizing it, or giving it little attention when they do go. This has led to the continuing struggle to develop effective programs and dealing effectively with potential sufferers.

One of the ways that we can minimize these feelings of insecurity regarding this subject is to talk about it, openly and without fear. It’s something that many programs and professions have been attempting to do, but they can’t do it alone. It is only by making this subject a part of our normal everyday discourse that the fear of weakness or failure becomes less the bogeyman and more of something that just needs to be dealt with. People need to understand that Post Traumatic Stress is normal, it can be minimized and it’s important to do so now.

Those that have suffered from PTSD will tell you that one of the reasons that it became such a problem was that, when the first symptoms of PTS appeared, they did not seek assistance, they didn’t talk about it, they thought that no one would understand or worse, think they were "crazy". Often, the people they were trying to protect, whether themselves or their loved ones, ended up being victims of their disorders more than they would have had the process of sharing, distance and perspective, been experienced in a normal and timely fashion.

This doesn't mean that the memories of the event or events go away. Unless it is so traumatic that it induces trauma related short term loss of memory. The mind has a funny way of protecting itself. Sometimes events are so terrible that the mind shuts the memory off. This can be physical or emotional trauma. A recent study has shown that people who suffer from head injuries often experience short term memory loss, not necessarily from damage to the brain tissue, but because head injuries are so traumatic to remember.

For instance, someone who falls off a scaffold may remember what they were doing just prior to their fall, remember losing their balance and beginning the fall to the ground, but they often do not remember hitting the ground, even if they never actually lose consciousness.

This is the mind protecting itself. People with emotional trauma experience much the same "short term memory loss".

So, what about the nightmares people have? Professional studies of sleep have long determined that the mind uses dreams to process information. Our dreams and nightmares are acting like the night processing on a main frame or the defragmentation process of a PC. The files, our memories, need to be processed and put in proper order and perspective in our memory banks. Recurring nightmares or dreams are like corrupted files that the system (the mind) cannot re-align.

Professionals will also tell you that the order and content of your dreams or nightmares are not usually exact replicas of memories, but rather the mind's interpretation. Recurring nightmares around a similar subject, even if it is not the exact nightmare every time, means that the mind is having a hard time processing the information.

Sometimes, other worries have a way of infiltrating these episodes.

A fire fighter friend of mine said, after a very bad fire at a house where he fell through the roof and had to be rescued, he had a recurring dream about falling through the roof. Sometimes, when he fell through the roof, the house in his dream was his own house or his parents' house. Sometimes he kept falling and would wake up in a cold sweat because he never hit the floor. Sometimes, he didn't fall all the way through the roof, but was stuck in the middle while flames roared around him and, while other fire fighters were around him on the roof, no one appeared to notice him, even though he was yelling at them to come and help.

Another fire fighter friend had been at the site of a house fire where they rescued a young boy who suffered from smoke inhalation and second degree burns over 30% of his body. He would have repeated nightmares about the episode, but, sometimes, instead of the little boy, the person he was helping was his own daughter or other member of his family. To compensate for his concern he had insisted that his five year old daughter learn how to dial 911, learn about fire detectors and he was extra vigilant about not leaving flamables, accelerants or fire starting devices (like matches or lighters) lying around. Not necessarily a bad thing when you have a five year old, but his super vigilance often caused very tense moments in his house. He would yell at his five year old daughter if she even came into the kitchen while the stove was being used which made her cry which made his wife very upset since it appeared he was angry with the little girl for no reason.

His instinct was to be hyper vigilant and hyper-protective which his daughter couldn't understand and, although his wife tried to, she couldn't relate either. After his wife brought the problem to his attention, he tried to control it. When I visited with them, I noted that he didn't yell at the little girl as much, but he was still very vigilant about watching where she was and what she was doing. The nightmares still visited him occasionally, but, eventually, they were less intense and further between episodes.

I'm not sure that today he still doesn't have the nightmare every once in awhile.

A police officer friend talked about a terrible accident where he was first on the scene. It was a fatality accident. When he arrived, the driver was dead the passenger died before firemen could extract him. Later, when he had nightmares about the incident, he would sometimes dream that, when he approached the car, it was a family member in the driver's seat. Sometimes, he saw himself there. This made him very nervous about driving over the speed limit or riding with anyone who was driving over the speed limit even if that was only one or two miles per hour. There were multiple episodes where he became very distressed if not down right angry with his wife while she was driving. They both knew that the terrible accident had affected him and his wife was as understanding as she could be, but, eventually, it was so tense that she refused to drive or ride with him in the car until he "got over it".

I'm not sure if they aren't riding in separate cars to the same place even today.

In summation

  • Post Traumatic Stress is very common.
  • Nightmares about the episode(s) in question are also very common.
  • Having some repeat nightmares or dreams about the episode(s) is also common.
  • Having repeat nightmares or dreams about the episode(s) for several months may point to a larger problem.
  • Not remembering every detail about the incident is the minds way of protecting itself.
  • Hyper vigilance or hyper-protectiveness is a common response.
  • Hyper vigilance or hyper-protectiveness can lead to problems in personal or professional relationships.
  • A traumatic episode can lead directly to full blown Post Traumatic Stress Disorder (long term and chronic)
  • A traumatic episode can lead to simple Post Traumatic Stress (short term)
  • Undiagnosed and untreated Post Traumatic Stress can lead to full blown Post Traumatic Stress Disorder.
  • Fear of appearing weak, losing the respect of loved ones or peers can cause someone to ignore the symptoms and refuse to seek assistance..
  • Fear of being labeld "crazy", a risk or other damage to a career can cause someone to ignore the symptoms and refuse to seek assistance
  • This fear may inflate the problem beyond its real level.
  • It is better to address the problem in the beginning and, after resolution, the problem may be less dramatic than first surmised.
  • Never self diagnos. Even if some of these symptoms may resonate, it is better to seek professional advice and know for sure.

  • Next post: How the family reacts.

    Soldier's Stories

    365 Days In Iraq: Nightmares
    365 Days In Iraq: Counseling
    Questing Cat: Returning
    Doc In the Box: Twilight of Deployment
    Blackfive: The Mad Ghosts Return Home
    Mudville: Rounding it up
    Mudville: We are the war


    Copshock: Surviving Post Truamatic Stress Disorder
    About Trauma
    National Centers for Post Traumatic Stress Disorder
    NCPTSD: General Facts on Treatment
    NCPTSD: For Veterans - FAQs, PTSD Treatment Programs, & Managing Stress


    Cigarette Smoking Man from the X-Files said...

    Just a one-week spate of combat gave me some very very mild symptoms of PTS.

    1) I flinch at sudden loud noises.

    2) If anyone runs toward me I mentally prepare to kill them with my bare hands if necessary. Mosh pits are not a problem, but jogging tracks by the lake sometimes get me nervous (total stranger running headlong at me--even though I know consciously what he's doing, a part of me goes into defensive mode).

    No nightmares, that I know of. If my one week had been an 18 month stretch, then yes, I'd probably have to sit down with somebody and talk a few things through. Hopefully these hardcore veterans coming back, will be doing that.

    Sean from DocintheBox said...

    Good write up, I'm sure it's going to be years before that little part of my mind will stop ducking whenever there's a loud boom. Most of my PTSD is from rock climbing and being set on fire. Ewww (shiver) Thanks for the ping!

    Kat said...

    Sean, thanks for dropping by. I know what you mean about PTS from other things. I had a car accident and for weeks, if someone in a car even acted like they were getting too close to me in the other lane, I felt like I was having a little panic attack and almost over reacted a couple of times.

    Good of you to stop by. I was happy to hear about your write up in the Army Times