Tag Archives: PTSD

Facing a trigger

There is a world of difference between causing anxiety, and triggering. Anxiety is unpleasant, no two ways about it, but a trigger will give a person a flashback to a situation of trauma. It is possible to tackle anxiety by facing up to the sources of fear – and of course the less well founded the fear is, the more effective this is. Sometimes we end up scared of things for no good reason and we have to retrain ourselves to deal with stuff. I’ve done some of this along the way, I’ve found CBT approaches really useful.

The worst thing to do to someone who suffers PTSD is to make them revisit the trauma. Untreated trauma, and trauma revisited can build up layers of additional triggers and problems. Been there too. I don’t have a PTSD diagnosis because the doctor I was seeing when that would have been most useful didn’t want to send me for tests – not because he thought there was no issue, he just didn’t want to send me for tests, and I didn’t have the energy to fight him. Every single professional person I encountered over a period of years – doctors, police, solicitors, social workers and the like, every last one of them required me to retell what had happened. That’s a lot of deep retriggering, often in situations where being distressed put me at a significant disadvantage. I have no idea if being able to name a diagnosis would have helped.

Triggering happens because something is too associated with the original trauma, and brings it all back. This is why trigger warnings matter – on obvious things like child abuse, torture, extreme cruelty and rape it is worth warning people because anyone who has experienced that will suffer enormously if they come upon it unprepared. This isn’t like pushing past fear of going outside to go outside – because in that example, you go outside and you probably don’t face a terrible thing. Being triggered means facing a terrible thing. So on the whole, facing down a trigger is not the ideal way to deal with it.

The further removed the trigger is from the trauma, the more chance you have of taking it out. You need to stack up a lot of time feeling safe and secure first. There is no real scope for dealing with triggers while you’re still in a dangerous situation. I’ve written before about how I have overcome being panicked by post. I’ve got that down to just a bit anxious, now. The reason I had become so panicked by post, was that terrifying things came in envelopes for some years. Many of those terrifying things came from my solicitors, and every envelope represented a bill that would cripple me financially for good measure. Between this and the deliberate retriggering described above, I’ve been totally unable to deal with most people in a professional capacity for some years now.

Yesterday I went to see a solicitor about making a will. The same family solicitors company responsible for all that letter sending. I let a professional person ask questions about my life. But, because it was a will, we didn’t get into the stuff I never want to have to talk about again. And I knew upfront what it would cost. The appointment letter, when it came in the post, made me feel bodily sick, but I weathered it. I’ve kept reminding myself that I’m in charge of this process. Perhaps next year I will find the means to go and talk to a doctor – and it will be a different doctor – about things that are wrong with me.

It has taken me years to get to the point where I feel like I can do this. Years of kindness and support on the domestic front. Years of rebuilding my sense of self. It is possible to challenge a trigger, but it is not something to rush towards. Only the person dealing with the trigger can say when it might be worth having a go.

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Lessons from the PTSD cat

I’ve been living with this cat for about six months now, and she’s taught me a lot about fear, and about healing. She’s a long haired kitty, and when she first came to us, the sight of a pair of scissors made her panic. She gets tufts and knots, and she sheds a lot of fur so sometimes a little cutting out is in order. At first she fought us, clearly really distressed by any attempt at tidying her up. Even in the first few weeks we saw a lot of changes, as she became less fearful. We weren’t hurting her, and that knowledge started to replace the evident fear that she would be hurt. We used cat treats and fuss to reinforce the idea that she’s safe, and all is well, and she’s responded to this.

She’s evidently anxious about being left. Early on we had frantic responses to absence – and we’re talking a few hours here. She’s usually waiting by the door when we come in, although she’s calmer about it than she used to be. We never leave her unattended for long enough to cause her physical problems, but even without knowing her history, I could easily infer that she has abandonment issues.

At the moment, we’re working on going outside. She’s been indoors for six months, and I know before I got her she’d lived outside for months. She’s clearly afraid of going out – she seems anxious either that she won’t be able to get back in, or that she’s being kicked out. I take her to the front door, and open it. The first few times she just ran away. She’s now venturing to stand there and look outside. Treats and cuddles for positive reinforcement always follow, and I think by the summer she might be ready to sit out in the sun.

I can’t reason with her or tell her she should feel differently – she’s a cat. The only way to overcome her fear and help her live a fuller cat life, is to help her feel safe and secure and in control. She doesn’t have to go out, she can come back at any time, she won’t be hurt with scissors, she won’t be left for extended periods. The only way to have her feel this is to keep presenting her with a safe, supportive environment and wait for her to learn to trust this.

I think about my own patterns of damage and healing and the parallels are obvious. No one has ever helped me by telling me my reactions are wrong, or that I am silly. I’ve not coped when new situations seem to mirror old ones. It has taken time, patience and learning to trust a new environment to get me not to panic as much. With me it isn’t scissors and the front door, but the patterns are the same.

When fear becomes your state of being, it isn’t a consciously held thing, and it can’t readily be reasoned with. Learned fear is a body thing, an issue of the animal self, and if we want to heal ourselves or other people who are damaged by fear, then we have to heal them as creatures first and foremost. A safe space and the time to relearn how to feel safe is essential. Damaged people need the same patience that rescue dogs do. The only way to break the conditioned responses to the past (cowering before the dangerous scissors) is to replace it with a different reality (after the pain-free scissors, the treats). Recovery is so much easier when someone is holding that safe space for you, and healing is so much more viable when it isn’t a solo project.


Triggering and justice

I do not have any kind of formal PTSD diagnosis, although it’s been suggested a few times by people qualified to say, that it might be an issue for me. To get a diagnosis, I’ve have to show up and answer questions, and I have resisted this strenuously. This week really required me to look hard at what’s happening there.

I’ve just had a wholly different situation in which professional scrutiny was an option. It went fairly painlessly, and well on the day, but the level of anxiety, panic attacks and flashbacks beforehand were startling. I haven’t been like that over anything in a while. If you suffer from PTSD, then you will have triggers that give flashbacks and really bad reactions. I do seem to have these symptoms, and it would appear that professional scrutiny is a trigger for me. This makes it nigh on impossible to bear the prospect of asking for proper help.

How I might have got here is no great mystery. People who experience trauma and who are not helped are more vulnerable to being further traumatised. There is nothing worse for a trauma victim than being made to revisit the memories, but for several years, I was repeatedly forced into contact with professional people who demanded I did just that. Every new professional in the equation wanted a retelling of the worst things that have happened to me, so they could come to their own decision about whether or not I was telling the truth.

What that adds up to is ten different occasions when I had to talk in detail about traumatic experiences. There was also one hideous physical examination. Most of the professional people I had to deal with were not professionals when it came to dealing with my issues – they had other roles, and no training in how to minimise the damage for me. Several of them were disbelieving and hostile, putting me in situations of having to revisit trauma whilst being told off, blamed, humiliated and otherwise made to feel awful and responsible. Several were keen to minimise both the physical and psychological impact of what I’d experienced. Perhaps because they did not understand and were unable to imagine. The one additional round of talking to a professional who was in the mix just to help me – a counsellor – resulted in being taken seriously, but by then I was so damaged and demoralised by how I’d been treated by other professionals, that I found it difficult to make good use of her time.

In any compassionate situation, what happens to a trauma victim post-trauma is that support is given to make sure they do not carry a sense of blame or responsibility for what happened. This is key to recovery. However, we have an adversarial court system, and what I’ve been put through is the exact opposite. I had years of a process of being blamed, held accountable and told it was my fault and my failing, or that I was lying. The idea of professional scrutiny has become unbearable to me, and there is now no way I could now bear to submit to letting anyone try and help me with this.

What troubles me most about this is the certainty that it won’t just be me. All victims of crime are vulnerable to feelings of distress and trauma. Victims of violent and sexual crimes are likely to be traumatised by their experiences, and to need professional support to overcome this. What we have instead is this adversarial justice system that exposes victims to hostile questioning, requires them to repeat, in great detail the worst things that have happened to them, thus increasing the trauma, and where attempts to humiliate and discredit are pretty much a given. This is not justice. Even if you win, having to endure the process is not justice. Given our increasing levels of understanding about human psychology, this whole process needs a radical rethink. I do not have any answers, but I feel strongly that we need to be asking questions.


Living with fear

One-off traumas are awful to experience, but generally, if it seems like a singular event, people get over it fairly well. It’s the experience of living with fear, and having the unthinkable become normal that does the longer term damage. This is what underpins shell shock, as experienced by soldiers. Post traumatic stress disorder is just as likely for civilians after wars. However, being crippled by fear is not an experience unique to this level of hostile experience. People who experience much lower levels of bullying, abuse, persecution or difficulty over a long period can end up just as scarred. It’s not a very well understood problem, nor is it much talked about outside support groups for the afflicted.

People coming out of long term bullying, or abuse can be just as psychologically damaged as people coming out of war zones and can display all the same kinds of symptoms as shell shock. This is not because victims of these apparently lesser problems are somehow being weak or pathetic. This is a biological process that has everything to do with how fear acts on the body. It is a very bodily condition. Once you can get your head in on the process, you’re actually moving towards healing. Prolonged fear causes physical sickness and needs treating more like an ailment of the body and less like some kind of character failing.
There are a number of things that can happen to a person. If you are constantly victimised and nothing you do will protect you, you will come to believe that the whole world is hostile and threatening. You may be unable to respond to even mild setbacks, and feel overwhelming despair in face of even the smallest problems. You may build fear associations such that leaving the house becomes unbearable. For me, it was postmen. I still break into a cold sweat if I see a postman, or post van. I know why, but that doesn’t stop me. When you have lost power and control in your life, the idea of being able to solve problems, or being able to cope barely exists in your head. Each new scenario is there to punish you further, to take you apart, to kick you again. The loss of hope is a consequence of living with fear.

You may develop superstitious beliefs about actions or behaviours that will keep you safe. This can lead to obsessive and compulsive disorders. People only feel safe when they have performed rituals that, from the outside, look crazy and irrelevant. The desire to be safe may also lead to passivity, acquiescence. The abused woman may make no sound when she is beaten if acknowledging pain makes it worse. She may become unable to vocalise any kind of pain at all. The abused child may learn to do anything at all to please adults, in the hopes of avoiding further torment and thus become even more vulnerable.

Once your body has learned fear as normality, things go a bit crazy. The fear responses happen when there’s almost nothing to trigger them. That can mean heart racing, stomach heaving panic attacks that leaving you weeping and fighting for breath, and not even knowing why. The experience of this kind of bodily panic suggests that there must be something terrible going on, you just don’t know what it is yet. When terrible has become normal, that’s not irrational at all.

There was a cure for shell shock. All you had to do was get the soldiers out of the war zone, give them total rest and tranquillity, gentle physical activity and time outdoors. With peace and the right support, many would heal. The only way to break the cycles of physical terror, is to bodily remove the sufferer from the source of their fear, support them to feel safe, keep their environment unthreatening and gradually rebuild their sense of what ‘normal’ ought to look like.

This is one of the reasons why those apparently lesser forms of harm can turn out to be the most damaging. Short of going into a hospital, your chances of getting a few gentle, stress free weeks in order to heal are slim. The longer you are trapped in a fearful situation, the more normal it becomes. A few weeks might enable you to recover from a few months in a war zone, but what if you’ve been a victim for a decade? Making a new ‘normal’ so that you are not afraid all the time, is not going to be so quick. A good doctor can do a lot to help a person, but a careless one may feed paranoia and reinforce feelings of powerlessness and hopelessness. Add in the social stigma of mental illness, the fear of having your children taken away, or losing your job, and the fear itself becomes self perpetuating.

Fear does not always show on the outside. Panic attacks, and expressions of a terror that is rooted in your body like a parasitic plant, are humiliating. Most sufferers go to a lot of effort to hide it.
What would you do if you saw someone succumb to what appeared to be irrational panic? Tell them to pull themselves together? Mock them? Pity them? Avoid them? And if it happened to you, who could you go to for support? Who could you tell? Who would hold your hand and help you rebuild your life?

There but for the grace of… what? Go any of us. The going is easy and there are plenty of people who will happily take you there. The coming back is very, very hard.