Tuesday, August 14, 2012


So in PART ONE, we began to define Post Traumatic Stress by citing Criteria A.

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.

Criteria A, is the first of six criteria listed under Post Traumatic Stress Disorder in  DSM-IV-TR)(1).  And remember, we are taking issue with the use of the term disorder.

Secondly, in PART ONE, we acknowledged out loud that we did experience a trauma. 

We concluded PART ONE noting that, sometimes, I might not remember enough of the traumatic event to say out loud what happened.  In the blog, The Gift of Post Traumatic Stress, Part Two, we talked about why this is.  So the excess adrenalin pumping through our body and our brain tends to neutralize the brain chemicals necessary for conscious or explicit memory processing in our hippocampus.  Consequently, the facts of an over-the-top event may “disappear” the way the content of a dream fades away very quickly after we wake up.

So sometimes, we will want to retrieve the facts of the events from another source other than our own memory, and it may require some courage and even some effort or work on our part, but  this retrieval can be an important part of what we do with our Post Traumatic Stress.

Why not just drop it and let sleeping dogs lie?  Well, what our brain does “remember” implicitly or unconsciously are the emotions surrounding the event.  These emotions sit in our amygdala waiting to be triggered by any event that even remotely reminds the brain of the traumatic event.  These emotions hanging around in the background, out of consciousness, leave us with a pervasive sense of impending doom, or leave us with heightened vigilance, or low grade fear, anxiety and or depression, along with a sense of helplessness.  So we live our life with a very limited range of emotion.  What emotions we do feel, we do not know why.  And at times, we feel nothing, a kind of numbness, but even that has an overlay of there’s something out of whack.  If we just drop it, we are left to live like this, and what this is, is survival mode.  The worst part of survival mode is the isolation because healthy relationships are next to impossible for us to nurture and grow while in survival mode.

These issues surrounding memory processing are what set up the symptoms we will be talking about here in Part Two.

So what are those symptoms?  The symptoms are outlined in Criteria B through D.

intrusive recollection....Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions....Recurrent distressing dreams of the event.... Acting or feeling as if the traumatic event were recurring....Intense psychological and physiological distress and reactivity at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

The intrusive recollections, the dreams, the reactivity let us know that those emotions we talked about above, the emotions that are dangling about like loose threads, are looking for a storyline with which they can weave together and make a complete story of the trauma. 

What do we mean by a complete story?  A complete story weaves together both the facts of the events with the emotions of the event which will then help us make sense of our post traumatic stress.  Once we make a complete story of the trauma, we can then weave the trauma into the fabric of our life and finally lay it to rest in our history or past. The trauma can then become a part of our life instead of dominating our life as it does now.

Okay, so concretely, what do I do now?

Again, you want to surround yourself with safe people.  Safe people, friends and loved ones, maybe even professional folks, like a good therapist, or a support group.  Safe people who will not become bored, tired, or irritated listening to you talk about your symptoms--your intrusive recollections, your flash backs, your dreams, and nightmares.  Safe friends will not become bored, tired, or irritated listening to you talk about it over and over and over and over and over and over and over.  If you are an adult, be sure your safe folks are your peers.  As an adult, leaning on a child for support, as you work through a trauma, can be traumatizing to the child.

OH YES, there are safe people for you.  If you convince yourself that they do not exist, you will never see them even when they are right smack in front of you.  THEY ARE THERE.  I know they are.  I have seen them.  They have walked me through my own traumas.  They are alive.  But we can convince ourselves that they do not exist, and when we do that, no one does want to walk with us because then we have chosen pity pot land and we tend to drive people away, not by the story of our trauma, but by our unwillingness to receive the support people have for us.

Many folks fear that telling about their symptoms is like making their friends live through the trauma themselves.  Probably not, but even if it means that, remember, you experienced the trauma and lived through it, and your safe friends will be happy to experience the trauma with you if it means you becoming again the friend they know.   And the reality is telling the horrors of the trauma to safe friends makes it possible for you to experience the trauma perhaps for the first time.  You know, full blown, from inside your skin, from inside your consciousness.  And experiencing it for the first time, will make it possible for the trauma to be processed into our hippocampus, into our past, our history.

Keep a notepad next to your bed and when you wake up from a dream or nightmare, jot down immediately what you remember.  When looking at a dream, perhaps what is most significant are the emotions experienced in the dream.  When you have recurrent dreams where you feel powerless and helpless, begin rewriting the “script.”  You will be surprised how the dream, itself, when you dream it again, begins to change.  In the dream, you will begin to feel more powerful, less helpless, and the outcome of the dream will gradually change.

When something reminds you of the trauma, begin paying attention to your breathing.  Breathe a little more deeply than usual.  Definitely avoid breathing shallow.  That will only create a felt sense that the trauma is happening again at this moment.

After you breathe for a few seconds, allow yourself to feel the emotions.  If you need to scream and you’re somewhere private, then scream.  If tears come, do not choke them back.  Breathe into them.  They will come like a wave and then leave again.

Surround yourself again with safe people, so, at a moment like this, you can have someone hold you.  You can call someone on the cellphone.  Yes, guys, have someone hold you, a man or a woman, preferably a man.  As men, we need men to support us through trauma.

When you begin to feel the feelings associated with the trauma, speak them out loud, even if only to yourself.  So, I feel scared, terrified, lonely, helpless, overpowered, defeated, hopeless, angry, sad, depressed, anxious, scared to death.  I think I am going to throw up, and let yourself throw up.  Giving voice to an emotion, literally discharges the energy of the emotion and the energy of the emotion literally dissipates.

Begin journaling each day, journaling off the top of your head with no agenda, just writing whatever comes out on to the paper.  If you do not like to write, get some kind of recording device and just talk into the recorder randomly, off the top of your head for five minutes.  Don’t censor anything.  Let me repeat that. Don’t censor anything.  You may want to be very careful not to leave your journal around or make it possible for anyone to hear your recording unless you consider them a safe person.  When I journal off the top of my head, I write almost illegibly so I don’t have to worry about anyone reading it.
Check out the book, THE ARTIST'S WAY.  Julia Cameron present a process called morning pages and morning pages would be very helpful in indirectly but directly processing trauma.   Again, if writing is an issue, use a recording device.

With the internet literally at our fingertips, you can blog about your trauma, post photographs related to your trauma.  You can create You Tube videos, featuring the one and only (yourself, silly!) talking about your trauma.

If you are an artist of any kind, you can write fictional accounts of the trauma, write poems about the trauma, compose music or choreograph a dance depicting the trauma, or give expression to the over-the-top experience on canvass, in stained glass, in sculpture and pottery, and in any other artform of your choice or talent.

You can increase your exercise routine and bring the trauma into your consciousness as you exercise.  This is an important piece.  By bringing the trauma into your consciousness while you exercise, you will exhaust the energy of the trauma.  If you simply exercise without bringing the trauma into consciousness, you will benefit from the exercise, your body will get the workout, but the trauma will remain as powerful as ever.

All of these above suggestions are ways of weaving or integrating the trauma into both our right and left brain hemispheres.  This left-right brain integration supports creating a complete story about our over-the-top event.  It also defuses the emotions associated with the trauma as these emotions become less vulnerable to being triggered.  The left-right brain integration also places the trauma into our past so we know the trauma happened and is over.  We don’t keep waking up, as in the movie Ground Hog Day, experiencing this day as the day of the trauma.

There is also a therapeutic intervention called EMDR, which directly attempts to integrate the right and left brain hemispheres by a simple therapeutic procedure involving eye tracking or tapping alternate sides of the body while one is focusing on the emotions associated with the trauma, and I think EMDR can be and has been effective in resolving trauma issues.

Catch yourself and stop yourself from saying.  When are the dreams going to stop?  What is wrong with me?  When am I going to be able to do this right?  I should have been stronger.  It couldn’t have been this bad.  Lots of people go through what I went through and don’t have all these symptoms.  Oh yes they do!  What you are experiencing is very very normal in response to a traumatic event.

Let your self-talk shift.  Wow, my dreams keep coming, but they are changing.  There is nothing wrong with me.  I am experiencing what normal people experience when they go through an over-the-top event.  I was as strong as ever and yes, what happened was really awful, really terrifying, really debilitating, really over-the-top.  It could have killed me if my brain didn’t work so wonder fully.  I am just like everyone else who experiences trauma.  We all have these symptoms.

So now, let us look at Criteria C and D

Avoidant/numbing....Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following:
   * Efforts to avoid thoughts, feelings, or conversations associated with the trauma
   * Efforts to avoid activities, places, or people that arouse recollections of the trauma
   * Inability to recall an important aspect of the trauma
   * Markedly diminished interest or participation in significant activities
   * Feeling of detachment or estrangement from others
   * Restricted range of affect (e.g., unable to have loving feelings)
   *Sense of foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

hyper-arousal....Persistent symptoms of increasing arousal (not present before the trauma), indicated by at least two of the following:
   * Difficulty falling or staying asleep
   * Irritability or outbursts of anger
   * Difficulty concentrating
   * Hyper-vigilance
   * Exaggerated startle response

So, NOTICE, all the above symptoms are pretty normal responses to a trauma.

Of course, I am not going to want to talk about something traumatic or over-the-top as if it was a Super Bowl game.

Of course, I am going to want to avoid activities or places associated with the trauma.  Do you think the folks in the movie theatre in Aurora Colorado were back in line the next day to see Spiderman?  Probably not.

Of course, one is going to think they have little time to live after experiencing a trauma.  I survived this, but tomorrow I will probably get run over by a kid on a tricycle or killed in a drive by.

Of course, I will have difficulty falling asleep and of course, I am going to be angry, irritable, and have little if any patience.

And, of course, I will have trouble remembering important aspects of the trauma.  We have already talked about that a great deal.  It has nothing to do with our memory, but, of course, everything to do with our memory.  Adrenalin flooded our brain and literally neutralized the brain chemicals required for memory processing.  No, I am not losing my memory or my mind.

Do you notice that most of what is recommended prior to our looking at Criteria C and D flies in the face of Criteria C and D? So are the symptoms listed in Criteria C and D going to make it impossible to “tackle” the recommendations?

Well, it could work that way if you let it.  Again, a key are your safe people.  Make a commitment to your safe people that you are going to follow the recommendations and suggestions above.  Have them check on you daily or hourly.  Be accountable to your safe people, and allow them to HOLD you accountable.

Again, experiencing the various symptoms listed in Criteria C and D lets you know beyond a shadow of a doubt that what you experienced was, in fact, over-the-top.  As we noted in PART ONE, be wary of anyone, even yourself, saying things like, “Hey, it was no big deal....all in a day’s work....it’s what we do as a policeman, soldier....”  Of course, it IS what you do and what you do is to face trauma every day of your life and sometimes, several times a day and that is the point of this article.

Be wary too of anyone who says something like, “When will you face reality?  Why do you think you are so special?  This kind of shit has been going on in our family (or in our church, or in business, or in politics, or in our country, or in the world) for generations. Buck up and get over it!”

It doesn’t matter how “normal” trauma has become in our lives.  It is trauma, and if we do not do something with trauma, our brain and our soul and our relationships are going to pay a high price.

So has this been helpful?  Let me know.  I will use these FIVE BLOGS as a reference point for current news that is in any way related to Post Traumatic Stress.

I do not see Post Traumatic Stress as a disorder even if one experiences the stress for an extended duration.  Over-the-top events, trauma, is given that name because by definition, it is something that one will not get over in a day.  And yes, it will create impairment for us socially and occupationally, especially if the trauma occurred on the job or as part and parcel of our social life.

What I am willing to go out on a limb and guarantee for you is that if you follow the recommendations in this blog, and if you digest the information in the other four blogs the best you can, you will not get stuck in your Post Traumatic Stress and, in fact, you will want to move on, and you will.


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