In my last (and first) diary, I tried to tell the story of my father's life with Post-traumatic stress disorder (PTSD). Because people who read and comment on Daily Kos are so well informed on just about every topic, it was second nature to just tell the story without providing any background on the disorder.
It has been a few years since I've had to take a literature class, but I do remember that knowing your audience is one of the most important parts of discourse, written or spoken. That first diary seemed to resonate with people who have PTSD, people who know PTSD sufferers, and professionals who have treated the disorder. That diary received one comment complaining about my use of the acronym "PTSD." I was sharing a personal experience, and my intention was never to provide information on the disorder, but that comment made me realize that PTSD isn't understood by everybody.
Just what the hell is post-traumatic stress disorder?
The fabulous
ilona has done an amazing job collecting
information,
personal stories, and even a
timeline dealing with PTSD. While some diaries include some of the symptoms of PTSD, there is no comprehensive explanation of the disorder. Will you understand our returning soldiers?
Overview
As you can tell by parsing the phrase "post-traumatic stress disorder," PTSD can develop after someone has witnessed or experienced a traumatic event. The Iraq debacle has heightened the discussion of PTSD. War is perhaps the most effective method of increasing the number of people with PTSD, but it can happen through any traumatic experience:
Posttraumatic Stress Disorder, or PTSD, is a psychiatric disorder that can occur following the experience or witnessing of life-threatening events such as military combat, natural disasters, terrorist incidents, serious accidents, or violent personal assaults like rape.
The disorder is not new, and is probably as old as war itself. In fact, the term post-traumatic stress disorder was not established until the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, printed its third edition in 1980. Prior to that, stress disorders were called various things throughout history. In the 1800s, the term used was "exhaustion." "Soldier's heart" was used during the Civil War. Some of the more recent terms include "combat fatigue" and "shell shock." (Information found in Chapter 1, section II of the Military Veterans PTSD reference manual)
Studying PTSD picked up steam after the Vietnam War:
Careful research and documentation of PTSD began in earnest after the Vietnam War. The National Vietnam Veterans Readjustment Study estimated in 1988 that the prevalence of PTSD in that group was 15.2% at that time and that 30% had experienced the disorder at some point since returning from Vietnam.
Who will it affect?
One of the most difficult things to understand about this disorder is the seemingly random way people are affected. Not everyone who experiences a traumatic event will develop PTSD. This is true for any traumatic event; not all rape victims, hurricane survivors, or combat veterans will be affected:
How serious the symptoms and problems are depends on many things including a person's life experiences before the trauma, a person's own natural ability to cope with stress, how serious the trauma was, and what kind of help and support a person gets from family, friends, and professionals immediately following the trauma.
In the general population, women and men do not suffer in equal numbers
The estimated lifetime prevalence of PTSD among adult Americans is 7.8%, with women (10.4%) twice as likely as men (5%) to have PTSD at some point in their lives. This represents a small portion of those who have experienced at least one traumatic event; 60.7% of men and 51.2% of women reported at least one traumatic event.
Women are more likely to suffer from personal violence, which is one of the reasons for the disparity. Personally, I feel that it is also due to gender bias. Men are not supposed to be "weak," and it is more socially acceptable for a woman to admit she may be suffering from PTSD. My father had a difficult time accepting that he had an actual illness, as opposed to simply being cowardly or feeble. I'll admit that every time I hear someone say he (or any other man suffering from PTSD) should "get over it" or "quit being a pussy" I feel a little violent.
Symptoms
Obviously, in order to fully understand the illness, one must understand the symptoms. PTSD symptoms can be divided into clusters, or groupings of various symptoms:
Re-living the event through recurring nightmares or other intrusive images that occur at any time. People who suffer from PTSD also have extreme emotional or physical reactions such as chills, heart palpitations or panic when faced with reminders of the event.
Avoiding reminders of the event, including places, people, thoughts or other activities associated with the trauma. PTSD sufferers may feel emotionally detached, withdraw from friends and family, and lose interest in everyday activities.
Being on guard or being hyper-aroused at all times, including feeling irritability or sudden anger, having difficulty sleeping or concentrating, or being overly alert or easily startled.
PTSD can also lead to other illnesses and problems, which make the illness that much more terrible.
PTSD is marked by clear biological changes as well as psychological symptoms. PTSD is complicated by the fact that it frequently occurs in conjunction with related disorders such as depression, substance abuse, problems of memory and cognition, and other problems of physical and mental health. The disorder is also associated with impairment of the person's ability to function in social or family life, including occupational instability, marital problems and divorces, family discord, and difficulties in parenting.
PTSD is just the gift that keeps on giving.
Family and PTSD
Family members are affected by PTSD:
It's no wonder that family members react to the fact that their loved one has gone through a trauma. It's upsetting when someone you care about goes through a terrible ordeal. And it's no wonder that people react to the way a traumatized family member feels and acts. Trauma symptoms can make a family member hard to get along with or cause him or her to withdraw from the rest of the family. It can be very difficult for everyone when these changes occur. Just as people have different reactions to traumatic experiences, families also react differently when a loved one is traumatized.
Family members can experience a gamut of emotions like guilt, anger, or shame. Often, family members can be consumed by worry and try to avoid dealing with the illness. They may even develop drug or alcohol problems of their own. Spouses of people who suffer from PTSD can also develop sleeping problems as a result of restlessness or nightmares that the person with PTSD suffers from. My mother would often have difficulty sleeping because my father needed to sleep with the television on. She would also wake up in response to my father's thrashing during his nightmares (Dad is over six feet tall, and mom is under five). Once, I was passing their bedroom after they went to bed. The door was open, and my dad was having a nightmare. He smacked her in his sleep, and they both sat up. My mother glared at him for a moment, said "You son of a bitch," slapped him, and they both promptly fell back asleep. It was actually quite amusing.
Children develop their own set of problems:
Researchers also have noticed patterns in the ways children respond to the parent's overall presentation of PTSD. Harkness (1991) described three typical ways these children respond: (1) the over-identified child: the child experiences secondary traumatization and comes to experience many of the symptoms the parent with PTSD is having; (2) the rescuer: the child takes on parental roles and responsibilities to compensate for the parents difficulties; and (3) the emotionally uninvolved child: this child receives little emotional support, which results in problems at school, depression and anxiety, and relational problems later in life.
Personally, I'm pretty well adjusted, but I obviously exhibit some of the symptoms of secondary PTSD. I've developed a bit of social anxiety. I have to sit at the end of the row at a movie theatre, for example, just in case I need to "escape." Escape from what you ask? I haven't a clue. I also have a noticeable startle effect.
Treatment
It is impossible to detail all of the types of treatment available, so I'll simply provide some links.
My Dad is currently going to group and individual psychotherapy sessions, and that seems to be working well.
Understanding PTSD is so important. It doesn't occur only during wartime, but now society will have to face an influx of people who wouldn't be ill if it weren't for experiences in the damnable war. I'll close with a quote from ilona, because she said it best:
It's not just a military problem. It's not just a military family problem. It's our problem. Our veterans are returning to all of us.