Friday, March 6, 2009

Post Traumatic Stress Disorder

Years ago I happened to be at the school yard in the morning on the first day of school in September. The bell had rung about 5 minutes before...the excitement of the first day of school that had the hard top vibrating only a short time ago was now in the school. However, the fire alarm rang. Suddenly the playground was unexpectedly flooded with people again. Not being a teacher or involved directly at the school, I pulled off to the side to get out of the way. On one end of the school yard was utter chaos...the children in the lower grades were, well, to put it politely, chaotic. Actually, many were completely losing it.

I'm not sure if it was grief that the school would burn down before they had a chance to even experience 1st grade, or if it was terror from what that very loud sound was, and wondering about their personal safety. The first grade teachers--well, they weren't doing so well either...they couldn't line the children up to do a head count, and there was this sense of hopelessness that the class lists in their hand were virtually useless because there hadn't even been an opportunity for the teachers to learn the students' names--if someone was missing, how would they ever figure out who?

The other side of the school yard, where the bigger children were, was completely different. They were more or less organized--they knew about fire alarms and knew that every alarm they had ever known was a false alarm. They were more or less in line, cuz they literally, "knew the drill". Of course, they saw this as an opportunity for an extra 15 minutes of summer vacation--they were laughing and joking--quite content to visit for as long as they could before they filed past.

Post traumatic stress disorder is a condition that follows the experiencing of something that is traumatic to a person. We are all unique, and so 2 people could be in the same car accident, with one person experiencing the event as traumatic and the other being nonplussed by the event.

Usually within 3 months, but sometimes much (even decades) later the symptoms of PTSD begin to appear...there is an intrusive reexperiencing of the event. This might be in nightmares, or with uninvited thoughts during the day. It might be when the situation is similar (e.g. walking down a sidewalk when robbed while walking home from work), or during an anniversary (e.g. having trouble at a certain time of year, or day, or time of day similar to the original trauma). This is disturbing, even alarming--and can be so distressing that a person can begin to avoid certain situations that might trigger that reexperiencing. At times, the reaction can appear out of proportion to the trigger. For example, a person who has been choked with rope may get agitated even seeing someone with a scarf around the neck. There is sometimes a "hypervigilance" where the sufferer becomes a detective waiting and watching and expecting the trauma to reoccur. Often a PSTD sufferer will say that their head knows it's safe, but their body doesn't get the message (e.g. a person who was assaulted in a high risk country with significant security issues still anticipates being "jumped" while walking down a Winnipeg street)

The person can become disengaged with people around them, as the inner feelings of fear are hugely distracting and managing them takes an enormous amount of energy. They may "put up a wall" to avoid being affected by triggers. They may pull away so as not to have others affected by their symptoms which feel so overwhelming.

Sleep is often affected. A person can have difficulty focusing, or concentrating. Other reactions can happen as well...increased irritability, impulsiveness, guilt, altered appetite, accompanying depression.

Therapy can be helpful to help work through the trauma of the experience and work to have a client understand their body's reactions and what they can do about it. Over time, the traumatic reexperiencing and other symptoms of PTSD can diminish. Part of this process is understanding bodily sensations of PTSD and knowing how to handle them...

In essence, one of the goals of treatment for PTSD is to help a person handle the re-experiencing like a grade 6 kid, and not a grade 1 kid at an unexpected fire drill. In both cases, there is an automatic complete response--filing out and waiting on the school yard, but the older kids are able to understand what it means and what to do with it in such a way that they can handle the reaction much more effectively.

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