Tuesday, August 7, 2012


Okay, so what is it we do with Post Traumatic Stress?

Well, we are going to take a look at the criteria listed in the book.  The book?  Yes, the  DSM-IV-TR)(1) which lists all the mental disorders for which a mental health professional can bill your insurance, including picking your nose while driving the car.  (Just kidding!).

Now, the criteria listed for Post Traumatic Stress in this book are very helpful in identifying how Post Traumatic Stress comes about as well as identifying the many symptoms of Post Traumatic Stress.  However, listing Post Traumatic Stress in this book classifies it as a disorder.  And that, I think, is a misnomer.  To read more about my take on Post Traumatic Stress as a gift rather than a disorder, check out The Gift of Post Traumatic PART ONE and PART TWO .

So the first thing one does with Post Traumatic Stress is to acknowledge Criteria A.

CRITERIA A (taken from DSM-IV-TR)(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.

*The person's response involved intense fear, helplessness, or horror. Note: in children, it may be expressed instead by disorganized or agitated behavior.

So let yourself say out loud.


As described in our other blogs, our brain blocks the full impact of a trauma so we can survive it without going completely bonkers.  And as time goes on, we tend to hold on to that “blocked” or minimized version of what occurred.  For example, when someone is sexually abused, a person will often say, but there wasn’t any penetration, when in reality, any kind of sexual abuse is penetrating.  Men, in particular, when they experience trauma, will reassure me, “it was no big deal....part of the job....I knew when I joined up....other people had it a lot worse.....”

 “It only happened once,” is a classic minimizer.  Of course, it doesn’t matter if an over-the-top event occurred only once.  It’s still over-the-top and traumatizing.  Even once is more than a person’s brain can take in.  It’s like a little bit pregnant!

AND it’s okay that our brain blocks the trauma, and we subsequently minimize.  It really is.  It’s the brain’s way of protecting us from a head-on collision with the horror of the event.  And now, that the trauma is over, it is also okay to let yourself become aware of the minimizing.  Let yourself slowly drop the filtering screens and say out loud what actually occurred.

I had to shoot the man....the woman.  I didn’t think I had a choice....I tried to resuscitate the child, but I couldn’t....when I walked in the house on a welfare check, the woman had been dead for days....when I assisted the coroner in lifting up the body, I thought I was going to throw up and I can’t get the smell out of my nose.  That was last week....I thought I was helping the person by risking my own life and crawling out there with them, but as soon as I did they jumped....I remember the dog’s teeth and the pain was unbearable for a second, and then I guess I just went somewhere else because I helplessly watched the dog chew on my leg....I know he was a ruthless asshole and deserved to die, but I can’t get it out of my mind watching my bullet enter his brain....I remember the awful feeling when they informed us we had fired on our own buddies....I remember arriving at the bank and the bullets flying everywhere....I remember hearing the squeel of tires from behind me and the next thing I knew....I just can’t make myself get into a car....I have operated on, you know, zillions of patients, and I can’t stop wondering why I couldn’t save this one....I can never quite figure out why my own father would do that to me....why my mother would do that to me....why the priest would do that to me....why my doctor would even think of doing that to me....I guess I knew it was my job to take him out, but when I did, the look on his face, the blood....keeps haunting me....I was so close, and if I would have been willing to risk crawling a tad farther into the flames, I think I would have saved him, but instead, my best friend’s hand disappeared into the fire....I mean, the driver didn’t have a head, and I can get silly about it, but, well, I hope I never see that again, but I probably will....I could not believe she was picking up the knife and running toward me....I could not believe he was trying to suffocate me....I heard the plane’s engines and before I knew it, it was crashing all around me....I thought I would not live to tell this story.....

There are endless stories of over-the-top events, some obvious headline stories, others secrets, and still others stories that are probably not even thought of as being traumatic, but each of them is.  And again, it’s not about how strong you are or how seasoned or experienced you are.  The bottom line is you are not a robot, but a living human being, and you are going to respond to over-the-top events in the same way that every other human being does.

Some over-the-top events are so disguised as “ordinary” that we miss it all together.  Jack told me that he couldn’t stand watching his “Pa” pick up a chicken and wring its neck and then chop off its head with a hatchet.  Jack would run and hide, and his Pa would chase him with the chicken’s head in hand and shout, “I’m going to find you, you pussy.”  When Jack was about twelve, his Pa forced him to wring the chicken’s neck and chop off its head himself.

Jack never realized the impact of those experiences until he got sober and his wife told him that every time he got drunk and the kids would get upset, he would scream at them, “If you don’t quit your whining, I’m going to wring your necks.”  The kids would scream and Jack would laugh his drunken laugh.

It was very unsettling for Jack to confront  this sadistic side of himself that came out not only with his kids but with friends and enemies.  It was very challenging for Jack to reach a place where he could be at home with the parts of himself that were scared shitless of so many things.  Jack was so bound and determined not be a pussy that he became sadistic instead, just like Pa.  This is a good example of not recognizing and acknowledging and not debriefing a traumatic event and how it then impacts our life without us even knowing it.

And, it can be even subtler than that.  Bob told me that, that as a kid, he laid awake night after night listening to his parents fight.  He said he was torn apart inside by his love for his parents and his simultaneous hate for them.  He was not sure he wanted them to stay together but became absolutely terrified any time they talked about divorce.

When Bob got off the phone talking to his former wife, his new girlfriend said to him, “I hope you never talk to me like that.”  Bob was stunned.  He had no awareness of talking loud to or being over bearing with his ex-wife.  He thought he was simply standing his ground and not letting her push him around one more time.

Years of tuning out, successfully or unsuccesfully, Mom and Dad’s constant arguing and splitting off from his own wide range of mixed emotions, left Bob almost completely disconnected and unaware of how he sounded or how he looked whenever he was triggered.  Ah, triggered!  And Bob caught himself that night from destroying one more relationship as he was about to tell his new girlfriend that she didn’t know what the f she was talking about.

Do you get a sense that I am implying that just about everything can be traumatic?  Well, no, not everything is.  Not at all.  But when we catch ourselves becoming triggered when others are looking puzzled, so they see no connection with reality and our triggered behavior, that is a clue to us.  There is something in our life, similar to this moment, that WAS or still IS traumatic, but because our brain works the way it does, we have no awareness what that event is or was. But it is time to pay attention and to identify the event, to acknoweldge it.  

For many of us, we, ourselves, may not experience an over-the-top event, but we may witness someone else experiencing a trauma.  AND HERE TOO.  Let yourself say out loud.


We forget or perhaps don’t even know that witnessing someone else going through an over-the-top event impacts us equally profoundly and traumatically.

So a first responder may experience daily events that involve actual or threatened death or serious injury, or a threat to the physical integrity of...OTHERS.  The Combat soldier obviously experiences daily events that he or she may miraculously survive, but others, including buddies and innocent bystanders, do not survive.

You, as an “ordinary” person may witness your child or a close friend or even a stranger being hit by a car, falling off a cliff, being pulled out to sea by a rip tide, being attacked by dogs, being shot in a bank robbery, in a movie theatre or a fast food restaurant even.  You may walk into the garage to find your grandfather hanging from the rafters.  You may be traveling in a car with grandfather when he has a massive heart attack or stroke.  You may witness a parent or a child having a psychotic episode.  As a therapist, you may listen to your client talk about their own or a family member’s abuse or describe a psychotic episode they witnessed of a parent when they were little.

I remember one client telling me that she felt safe in her room when she heard Mom and Dad fighting.  She never knew for sure what Dad was doing, but she figured the repeated thumps had to be Mom’s head hitting each stair as Dad dragged her down the stairs into the kitchen to force her to cook him something to eat.  She never thought of the experience as traumatizing till she found herself in the identical scenario one evening with her own husband.

Well, the scenarios are endless, and it doesn’t matter that none of it happened to you.  Over-the-top events are traumatizing to the observer or listener as well.

Being traumatized as an observer or listener is a BIG CLUE as to how our brain works.  So let’s take a moment to talk about MIRROR NEURONS.

Yes, there are neurons in our brain called MIRROR neurons.  You may have figured out already what mirror neurons do.

These mirror neurons make it possible for us, from the very beginning, to learn new behavior by observing the “Giants.”  These mirror neurons also account for other interesting phenomenon.  For example, when you are kind to another person, endorphins are triggered in both your brain and the brain of the person receiving your kindness.  NOW, here is the real phenomenon.  The same endorphins get triggered in the brain of a person who is simply watching your act of kindness.  How incredible is that?  So yes, these mirror neurons are the building blocks for our developing compassion and empathy.  These same mirror neurons come into play when we are observing another person confronting trauma.

So, it is pointless to say, “But it didn’t happen to me, I was just there watching it happen to someone else.”  Well, guess what?  Because of our mirror neurons, it happened to you neurologically just as it did to the person you were observing.  And it is going to be equally traumatizing to you as well. 

To acknowledge any piece of Criteria A does not mean your are constitutionally weak.  Nor does saying out loud that the event scared the shit out of you, terrorized you, or left you feeling helpless qualify you for whimp or wuss status.  Acknowledging Criteria A simply indicates you are a normal human being and not a robot.

Now many of you experience Criteria A every day on your job.  Or if you are a combat soldier, you experience Criteria A every day for the duration of your tour of duty. 

Listen up!  That the experience is all in a day’s work or it’s just what we do every day, makes it no less traumatic or over-the-top or life threatening.  The fact that it is our job is not the same as a “pass” for our brain.  Our brain, like everyone else’s brain, will see these events as traumatic and will respond accordingly.

Yes, as a seasoned policeman, fireman, EMT, soldier, surgeon, with years of experience and training, we may have a more extensive and more effective array of survival behaviors than the man on the street, but the adrenalin still flows and flows in great quantities.

In fact, it is the excitement and the adrenalin that keeps drawing us back to our job.  But it is also the adrenalin that continues to disconnect us from our thinking and feeling brains, and it is the adrenalin that ultimately keeps us from having emotionally meaningful relationships with the people, big and small, whom we love and who love us.  It keeps us from being as close to them as THEY want us to be.

And again, it is NOT about how strong you are, how seasoned you are.  Traumatic events are traumatic for you, and require you taking the time to debrief.  And if we do not, again, when it comes to those important relationships, our most valuable and life-giving resources, like empathy and compassion, will not be available to us.  When the brain stem takes over, it shuts down our capacity for compassion and empathy.  It zeros in on one thing only.  SURVIVAL.  In fact, we will tend to resent anyone who complains about anything that hurts because obviously they don’t know what hurt really is.  Yes, you’ve thought or said those very words, haven’t you?

You know, interestingly enough, what we are describing thoughout here also applies to the person who either by choice or circumstance continues to live in a potentially life-threatening situation which, in a sense, becomes that person’s “normal.”  So, for example, a prisoner of war, perhaps a prisoner or inmate of any kind, the person in chronic pain, the person in an abusive relationship, an abusive job, the person who lives in a war-torn country, gang members. So any situation where HOPELESSNESS begins to reign supreme, and a person puts all of his or her energies into SURVIVING.  But they have stopped LIVING.  And for those of us who voluntarily choose to take on trauma as part of our work or life, we are at risk, very high risk, for “burn-out” and reaching that same place of hopelessness.

So when we are experiencing Criteria A, either once or on a daily basis, our brain works the way we described in The Gift Of Post Traumatic Stress, Part One  and PART TWO.  We go into survival mode, and we remain there till we take the time to rebalance our brain chemistry and our brain functioning.  Until then, we are disconnected both emotionally and thoughtfully.  We basically are not emotionally present or emotionally available to the people who love us and want to live with us.  We will tend to spend most of our hours feeling anxious, very anxious and rageful.  Rage, not anger.  If it were anger, we'd have half a chance (check out Real Men Get Angry).  We will tend to spend a great deal of our energy either repressing that rage or expressing it in self destructive and sometimes other destructive ways.  We will do just about anything to settle the anxiety, including a wide range of addictive behaviors.

Well, to start, how about saying it out loud to wonderful You, TO YOURSELF?   So, in the privacy of your car, your room, your office, say it out loud. I EXPERIENCED, WITNESSED, OR WAS CONFRONTED WITH AN OVER-THE-TOP LIFE-THREATENING EVENT AND YES, I WAS SCARED SHITLESS, TERRIFIED, FELT HELPLESS, AND THOUGHT I WAS GOING TO DIE OR WISHED I WOULD DIE   If you are by yourself in an empty church, say it out loud to your God.  If you have a support group, say it out loud in a support group meeting, not once, but over and over again.  Find safe loved ones and safe friends to whom you can tell "your story" over and over and over again out loud.

So you are going to begin shifting from simply saying out loud that you experienced an over-the-top event...., to telling a story about the event.  Each time you retell the story, you may find the story changing, embellishing, becoming more dramatic, becoming more painful in content, perhaps even more painful to tell.  These are good signs because the story is coming alive and taking on a life of its own, which means it's becoming your story.

The point of your story is not how factual it is, but how well it describes the metaphorical or the full meaning of your story.  So it is not just that on Monday morning, I shot a suspected murderer.  Those are the facts.  The full meaning of the story includes all of your feelings, including guilt, shame, seconds thoughts, fear of reprisal, a whole gamut of emotions and thoughts.  Perhaps you even feel proud and justified.  Perhaps you even have a since that you finally proved yourself or you fear that some smart ass is going to remind you that you hesitated before pulling the trigger.  So not just the facts, but the whole story with all your fears, your laughter, your tears, your anger, your resentment, the whole nine yards.

What if no one wants to hear my story or folks say they have heard it enough?  Well, then these folks are not safe folks.  You haven't found the safe folks, yet.  They are out there.  I know from first hand experience.

Several years ago, I was working with a group of foster parents and grandparents when the topic of war came up.  Every one began sharing their battle experiences until a Viet Nam Veteran said that the last time he shared his experience with a group that everyone moved away from him and stopped talking with him.  So each person in the group told him that they wanted to hear his story and promised him they would not only listen but would continue sitting with him and talking to him throughout the rest of the workshop.  So he took a chance and began telling us how he had to "liquidate" women and children.  The group kept their promise.  And it was the beginning of healing for this Veteran.

Once we can say out loud that I EXPERIENCED, WITNESSED, OR WAS CONFRONTED WITH AN OVER-THE-TOP LIFE-THREATENING EVENT AND YES, I WAS SCARED SHITLESS, TERRIFIED, FELT HELPLESS, AND THOUGHT I WAS GOING TO DIE OR WISHED I WOULD DIE, I can begin addressing all the other symptoms I display or act out rather than looking at them and saying “I don’t know why I am doing those things” OR "I don't know why these things are happening."  And it is here where we will begin in PART TWO.

So what if I don't remember the over-the-top event or don't remember even enough of it to say that I experienced....Well, the reality is that with all the adrenalin pumping in our system at the time the event occurs, it makes it next to impossible to remember, as indicated in in a previous blog.  So let yourself say whatever it is you know, and say it out loud.  We will talk about this further in Part Two.

NOW BE A LIVE PART OF THIS BLOG AND SHARE WITH US.  Share with us those events in your life that you have accepted as being traumatic.  But also tell us about those events that you minimized, for a long time, and denied as being traumatic.  And share with us the events that you still think are or were not traumatic, but other people keep insinuating to you that they were.


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