Feminist Therapy

Post Traumatic Stress Disorder

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There has been a great deal of disagreement about what constitutes trauma and how to categorize the symptoms that result from it. Posttraumatic Stress Disorder is in the anxiety disorders section of the DSM-IV TR,  but PTSD appears to be much more diffuse than just anxiety. People also exhibit symptoms of dissociation and depression, for example. We will list the criteria for PTSD below and then move into the existential realm to explain some of the forces operating. We will talk about the experience of finding a trauma counselor as a great opportunity for mindfulness and a powerful therapy in and of itself.

Diagnostic criteria for 309.81 Posttraumatic Stress Disorder

A. The person has been exposed to a traumatic event in which both of the following were present:
(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
(2) the person’s response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior

B. The traumatic event is persistently reexperienced in one (or more) of the following ways:
(1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the same trauma are expressed.
(2) recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.
(3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). note: In young children, trauma-specific reenactment may occur.
(4) Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
(5) Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:
(1) efforts to avoid thoughts, feelings, or conversations associated with the trauma
(2) efforts to avoid activities, places, or people that arouse recollections of the trauma
(3) inability to recall an important aspect of the trauma
(4) markedly diminished interest or participation in significant activities
(5) feeling of detachment or estrangement from others
(6) restricted range of affect (e.g., unable to have loving feelings)
(7) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:
(1) difficulty falling or staying asleep
(2) irritability or outbursts of anger
(3) difficulty concentrating
(4) hypervigilance
(5) exaggerated startle response

E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month

F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

One of the huge mistakes laypeople and practitioners make upon hearing that only 20% of people exposed to a trauma develop PTSD is to assume that the other 80% are fine. The bottom line is that if you are exposed to trauma there will be repercussions. These might be of an existential nature like experiencing grief and loss or coming to terms with the capricious nature of fate and life. Or the experience might manifest itself as an increased feeling of detachment from others. The point is that you can’t go through a traumatic event or a series of traumatic events without having the experience shake you to the core of your being in one way or another.

This is why we don’t like ‘Post Traumatic Stress Disorder’ and prefer ‘Post Traumatic Stress’. It seems to be a universal human response to a trauma, not a disorder, and has been a documented phenomena in many different cultures throughout history. More recently it has been called ‘shell shock’ or ‘flashbacks’. To us, especially in cases where a person continues to be in a situation that is spiritually, emotionally, or physically dangerous after the trauma has passed, it makes perfect sense that PTSD will arise and the trauma will be replayed until closure is found. Your body and unconscious, which speak in symbols, don’t know the difference between the danger situation then and your danger situation now, only that you remain unsafe. This is the height of existential crisis. Until you can complete your relationship to the gaping wound of the trauma and towards all of the other areas in your life where you are unsafe, your symptoms will probably remain.

People who were exposed to a trauma, especially in childhood, tend to unconsciously place themselves in situations that repeat the original trauma. This creates a vicious cycle that has to be interrupted. Safety is water to the fire of trauma. When you experience a trauma, you experience yourself and the world as completely unsafe. This feeling of helplessness is actually the best argument for calling PTSD an anxiety disorder, especially if we are talking about existential anxiety. Think of existential anxiety as the source from which all other types of anxiety flow. Without the source, there could be none of the various rivers. Existential anxiety is the threat of nothingness. We are all unsafe from the always looming threat of nothingness in the form of death, and we all know this but usually bury our awareness of it in our unconscious because it’s so painful. Nothingness can also be symbolic. It can be the way you are made to feel about yourself in an abusive relationship, or the barely perceived doubt that you are not living the life you want for yourself.

A trauma shines the light on all of this difficult subject matter and much more, so it makes a lot of sense that you will have mental health symptoms if the roots of them are not confronted openly, honestly, and mindfully.

We said that safety is water to the fire of trauma. The two cannot coexist. This reminds me of a dog training tool that is quite effective called training an incompatible behavior. Let’s say your dog is super anxious and barks every time you leave the house. If we can teach him by association with petting, treats, and a peaceful environment to be calm and lay on his mat quietly every time you leave, then the problem is solved without dealing directly with the barking or anxiety. He can’t be calm and anxious at the same time, and since he is calm the problem is solved.

One meaningful action you can take to increase the safety in your life is to carefully pick out a mental health professional who is good at trauma work. Creating a safe space for yourself to honestly talk about what you are going through with the intention of improving your life and relationships is a mindful decision to increase the level of safety in your life. This act alone directly contradicts the feelings of unsafety that are so central to PTSD.

The experiential realm is usually more powerful for people than the theoretical realm and you can use the entire process of picking your counselor as a chance to mindfully consider the ways in which you strike up new relationships, how long they usually last, if and when they tend to fizzle out, and which you consider to be safe or unsafe. You can write down a list of questions to ask a counselor before deciding to start treatment. What would be the answers you would want to hear and why?

Having a trauma counselor who is trustworthy and authentic is essential, because going to a supposedly safe space to work on an event or events filled with unsafety, only to experience another trauma in that supposedly safe space, would be incredibly difficult for your psyche to bear. How will you decide that the person you are going to work with is trustworthy? How do you decide when people are trustworthy in the rest of you life? Does what your gut tells you about them usually tend to prove right or wrong? What role do you play in the ruptures or conflict in your relationships?

You have a chance in the therapeutic relationship to form a healthy bond with someone, and this experience can shed light upon the relationships in your life that are not healthy. Whatever your trauma, until you can reach equilibrium with your environment where you feel safe emotionally, spiritually, and physically, making your symptoms go away is going to be a difficult task. Once you do feel safe, the rewarding work can commence where true growth is possible.

My advice is to look for someone trained in trauma counseling who is also skilled in mindfulness. Mindfulness training can be a powerful ally for you to learn to accept the thoughts, feelings, and emotions you are having for what they are rather than running away from them. With deeper understanding and insight into the roots of your PTSD you will gain a better ability to start to transform what you are feeling into energy for healing and growth.