Tuesday, December 18, 2018

PTSD and the Family

If you already know a bit about PTSD, scroll down. The first part of this entry sketches the syndrome and its symptoms.

The term "post-traumatic stress disorder" dates from the early 70's, Vietnam War era. It had previously been called combat fatigue, combat stress, combat stress reaction, and others. The sheer numbers of returning veterans who had difficulty adapting back to civilian life brought much more attention to the syndrome. Since then, PTSD has been recognized as stemming from any traumatic event, one in which life is threatened or thought to be threatened. This could be a car accident, rape, plane crash, assault, etc.

The official text of psychiatric disorders is the Diagnostic and Statistical Manual of Mental Disorders and is currently in its 5th edition. In a sense, a disorder doesn't exist until it's defined in the DSM. Doctors, insurance companies, hospitals, and so on use the DSM to categorize mental illness.

There are several notable symptoms of PTSD. One is hypervigilance, the concern that something terrible might happen at any moment. The individual is thus always on guard, sits with his/her back to the wall, watching the door......turning lights off at home so as not to be seen....cautioning against noise. The heightened adrenaline has effects on the body, of course.

Another symptom is flashbacks. Most of us have memories that can be triggered by a smell or song, With PTSD the flashbacks can be triggered by a sight--trees that seem like the jungle. Or a smell of diesel fuel--the heavy equipment ran on diesel fuel. The sound of a car backfiring or fireworks can also trigger a flashback. An individual can feel as if he/she is reexperiencing the original traumatic event.

Additional symptoms include difficulty concentrating and/or sleeping; loss of interest in formerly enjoyable activities; detachment and difficulty showing positive emotions; aggressive behavior; and avoidance of anything that might be reminiscent of the original trauma.

Survivors of traumatic events also commonly experience survivor guilt--why did I survive and not someone else? Feelings of being unworthy and blaming oneself for having survived are part of the picture.

Additionally, there can be loss of memory about details surrounding the original trauma; consistent negative view of the self, others, the environment; and engaging in self-destructive behavior, including alcohol and drug use.

Treatment for PTSD frequently includes or is based on SSRIs, Selective Serotonin Uptake Inhibiters like Prozac, Effexor, Celexa, Zoloft. Talk therapy and/or Cognitive Behavioral Therapy help as well.
Plenty of other therapies are suggested, including getting more exercise, spending time in nature, music, art, and more.

But the issue I really want to address is how one individual with PTSD can affect the entire family (meaning that only treating the individual isn't enough).  It seems logical to me that one individual with PTSD symptoms would influence other family members and the family system as a whole.

Imagine a combat soldier returning home with PTSD and being hyper-vigilant. It could be mom or dad, but let's say dad just to make the point. Dad doesn't sleep well at night because night is when the enemy struck....he makes sure all the lights are off and the curtains are closed. He sits in the living room listening for any sounds of danger.  His heart rate is elevated, adrenaline is flowing, and he's tense and still. His wife or kids know he is doing this and know that the loss of sleep will cause problems the next day. His kids, furthermore, are learning that the world is a dangerous place and not to be trusted. They'll have trouble forming relationships and attachments.

 That soldier might also avoid any situations that might trigger flashbacks. No parades--the diesel fuel reminds him of war. No fireworks. No place where he can't sit with his back to the wall. Wide open spaces like parks make him uncomfortable. He avoids crowds, avoids places where he might see people who look Asian. His world has become small and limited. And because of his own fears, he may attempt to protect his children by not allowing them to go to fireworks, parades, parks, busy places.....so their world, too, is small. And as they grow older and marry and have children, they repeat some of these patterns because after all, that is what they know.  So the effects of just one or two PTSDS symptoms can carry on for generations.

Lots of WWII vets likely had PTSD but they didn't talk about it.  War became a taboo subject. Thus their kids, seeking to be like dad, signed up for Vietnam.

Holocaust survivors--imagine the trauma. Many (not all, of course) also tried to put the past behind them and move on. Their children might know little about their family history--grandparents, aunts and uncles, and so on. So they have a sense that the past is simply not there, they don't have the grounding of a family history. And the survivors may exhibit symptoms of PTSD as well.

The Columbine shootings. The Murrah Federal Building. 9/11. Wars in Afghanistan and Iraq. The legacy of PTSD continues....the cycle needs to be broken.

No comments:

Post a Comment