Being is Bewildering by Portia

Cross-posted with permission from Portia Smart

My name is Portia Smart and I have Post Traumatic Stress Disorder (PTSD). *TUMBLEWEED*.

What would you say to that?! “I’m sorry….erm…wow that sounds tough”? Would you change the subject? Would you say nothing? You’d not be alone. I tend not to share my experience of PTSD with people outside of those I trust. Because it isn’t the type of thing you drop into a conversation and because I manage it well most days.

This purpose of this post is twofold – a chance to introduce what PTSD is and how it affects people, and secondly, it gives me the chance to share my experience. My hope is that it will help people to better understand and empathise with people experiencing PTSD. I also hope that maybe others will recognise symptoms/experiences that mirror their own, and can access support. My post is dedicated to everyone who has experienced trauma.

What is PTSD?

PTSD is a condition that can affect anyone who experiences, witnesses or hears about events where there is a threat to life.

NICE guidelines state that: “Post-traumatic stress disorder is the name given to the psychological and physical problems that can sometimes follow particular threatening or distressing events…. The trauma can be a single event or a series of events taking place over many months or even years.”

My story.

After experiencing a range of trauma caused by male violence, I was diagnosed with PTSD by a clinical supervisor and trauma psychotherapist in my early twenties.

What causes PTSD?

As previously mentioned, many events can trigger PTSD. The following list is by no means exhaustive:

• a major disaster
• war
• rape or sexual, physical or emotional abuse
• witnessing violence
• a serious accident
• traumatic childbirth
• experiencing trauma by proxy (hearing about a traumatic experience, for example)

Personally, I find these lists quite off-putting. Sometimes, I have developed traumatic reactions to events not often associated with PTSD. The key to understanding what can cause PTSD is to understand that it can occur when a person experiences acute fear, horror or helplessness in a situation that is traumatic.

My causes

For me, it is difficult to identify when it started as I have had significant traumatic experiences since early childhood. It is believed that it may have been triggered as a baby/toddler living in a household with domestic violence. Subsequent traumas include rape and sexual abuse in childhood, physical assault in childhood, rape and sexual abuse as an adult, domestic abuse as an adult, bereavement and witnessing events where people were killed. I have “layered trauma” or complex PTSD – meaning that I am managing many traumas.

Symptoms of PTSD.

As with all conditions, PTSD affects people in different ways. However there are some *symptoms which are often experienced (*this list is by no means exhaustive):

• Flashbacks to the event/reliving the trauma
• Intrusive thoughts/memories
• Anger/distress
• Dissociation
• Sleep problems
• Hyper vigilance
• Numbness/emptiness
• Acute anxiety
• Avoidance (to minimise triggers)
• Nightmares
• Survivor guilt
• Fight or flight responses
• Suicidal ideation

(please note – people experience a variety of symptoms with PTSD – you may experience only a few of those listed above, or some which haven’t been included)

The symptoms listed above will be in play for the first few weeks after the traumatic event – this is seen as a natural, if frightening, experience to trauma. PTSD develops if these symptoms last longer than 4 weeks.

How PTSD affects me

In all honesty, although I seem to manage my PTSD quite well, I do adjust my living to accommodate it. I startle easily at loud noises, raised voices. I sometimes have flashbacks and/or dissociate when triggered by images/language/media relating to male violence. I disengage/cut people out of my life if they exhibit abusive behaviour (although this may have happened without my experience of PTSD). Trigger is a word often associated with PTSD. It means that something or someone “triggers” a distressing memory and that triggers off some of the symptoms listed above. Smells, sounds, places, faces, media…. Some directly linked – the same aftershave – some more tenuous – a song that reminds me of my childhood. It is hard to know what may or may not trigger me. Thankfully, my triggers seem to happen less frequently these days. My sleeping pattern is problematic and distorted. I don’t experience nightmares or sleep paralysis as much as I used to, but because of my hyper-vigilance, I startle easily. I also experienceVicarious Trauma – which I believe is connected to my experience of PTSD. This seems a lot more prevalent for me at present.

How to manage

It is recommended by mental health services that you seek professional support via your GP. If this is not possible, contact your local Mind  – they can provide information about a suitable service. People manage their experience of PTSD via many different ways.

Coping strategies

Before seeking professional support, many people self-manage using a variety of coping strategies: sometimes these strategies can cause harm as well as alleviating distress.

Drugs and alcohol may be used to manage symptoms and numb the distress. People may engage in risk-taking behaviour – such as driving dangerously or gambling. Some people suppress feelings/memories in order to “cope” better. This works short-term but over time can cause deeper distress. Self-harming may provide a release, a grounding, a connection to emotions or a dissociation for people with PTSD. Some people may consciously or subconsciously seek to actively re-traumatise themselves in order to “face their fear”. Some coping strategies can help more than harm – meditation, relaxation, self-help via books or online websites. This list is by no means exhaustive – you may be able to share a dozen more examples of your own.

Medication

Anti-depressants, sleeping tablets and anti-anxiety medication such as beta blockers can be prescribed to people with PTSD but should never be the first option. Medication should be prescribed alongside therapy and should not replace therapy, unless the person with PTSD specifically requests medication alone or has to wait a long time for therapy.

Talking therapies

Talking about your experience to someone you feel safe with can help. However, it is VITAL that you only talk about your experience when you are ready. Any forced discussion of your experience can actually re-traumatise you and cause deeper distress. The following therapies for PTSD are available via the National Health Service:

• Trauma – focussed Cognitive Behaviour Therapy

CBT is a therapy that looks at your thoughts, feelings and behaviours and how they influence one another. The idea with CBT is to challenge your thinking so that your feelings and behaviour may become less negative and or/restrictive to your life.

• Eye movement desensitisation and reprocessing (EMDR)

This is a therapy where you become less sensitive to your trauma by making a repeated movement of your eyes whilst remembering the trauma that you experienced.

Other therapies that may help, although are not necessarily available for PTSD via the NHS include:

• Person Centred Counselling
• Psychodynamic Psychotherapy/Counselling
• Gestalt therapy

My experience of managing PTSD

In my younger years, I avoided spending time alone with men and boys as much as possible (I still do!). As a teen I used coping strategies to manage the symptoms – some helpful (keeping a journal, self-help), some unhealthy (eating distress, alcohol). I experienced sleep problems for so many years. Nightmares and sleep paralysis were very debilitating for me. When I started to journal my nightmares, I could identify the “theme” and I started to work through a particular part of the trauma. I also tried to connect to the younger me – to reassure her that she is safe now and that she survived. This process helped me immensely.

I also started volunteering at Rape Crisis. I needed to understand what I was feeling and why. Thankfully, I was self-aware enough to not work with clients until I was well enough to be boundaried. Rape Crisis not only changed my life, but saved it as well. The more I learned about PTSD and sexual violence, the more I realised that I was not abnormal, but responding naturally to trauma.

In terms of talking therapies, although the woman who diagnosed me was an excellent therapist – and specialised in trauma from sexual abuse in childhood, I don’t engage well in therapy. I decided to self-help by working through the causes of my own PTSD (domestic abuse in childhood, child sexual abuse, rape, bereavement). I used incredible books (listed at the end of the post) to work through my feelings and memories, as and when I could. I was successful by working really hard at processing the trauma that I could remember. However, a significant portion of the trauma in childhood is inaccessible. Until I feel safe enough to remember those memories, I am unable to process them. The biggest discovery for my experience of PTSD is that I need to be patient. I am so determined and forceful in all aspects of my life – fixing and micro managing…..yet this is one area that I have to allow to unfold of its own accord. It is not always easy but I recognise that memories will be released when I feel safe enough to process them. And so I wait…

Recovery

It’s possible! That’s why I am able to write about PTSD – because I am in recovery. I can’t envisage a time when I won’t have PTSD but I know it is possible. I worked with people experiencing mental ill health for many years, some of which experienced PTSD and some of whom were in recovery. Recovery is not the same as cure – for some people it means living with PTSD for others it is living without PTSD symptoms. Recovery will mean something different for every person with mental ill health. And recovery is fluid – some people may become symptom-free only to have symptoms return… That is OK – mental health is on a continuum – it is fluid. Not too many years ago there was the widely held belief that mental ill health was fixed and permanent. Thankfully today, we know that is something that we can live with and recover from. And that is exactly what I intend to do!

Note: the picture at the top of the post is from The Princess and The Pea – it’s what my beautiful Nanna used to call me when I struggled sleeping as a bairn xxx

Helpful resources:

Websites

• Mind – PTSD – Fantastic resource from Mind explaining PTSD & recovery
• NICE Guidelines – PTSD – A guide providing information about the condition aimed at people experiencing PTSD, their carers and family.
• Mind – talking therapies Guide on how to access talking therapies

Blogposts

• “Trigger” via The Fementalists – Great post by @FunnyGrrrlexplaining rape culture and what “trigger” means.
• PTSD resources PTSD resources shared by @TheFementalists

Twitter accounts

• @TheFementalists –  Twitter account which is for feminists with mental health problems.

Books (if your trauma is based in sexual violence and abuse)

• Breaking Free: Help for Survivors of Child Sexual Abuse  – The first of two books that changed my adult life. A resource helping survivors of child sexual abuse to understand their experience, and to work through their distress.
• The Courage To Heal: A Guide For Women Survivors Of Child Sexual Abuse  – A book I discovered only a few years ago but has proved invaluable in understanding my experiences of sexual abuse in childhood.