Public Service Announcement About PTSD
Hiya folks, this came up recently at a 4th-of-July-weekend celebration I went to where a soldier had a flashback triggered by fireworks. Several friends expressed awkwardness and confusion about how to help, so I wanted to mention here what to do if someone near you has a post-traumatic stress disorder breakdown. While my PTSD is pretty well under control nowadays, I can still say with confidence what helps and what doesn't. These points hold true for a lot of other kinds of breakdowns too, including but not limited to panic attacks, asthma attacks, and cataplexy attacks. I've had all of these (often I'll have more than one kind of attack at once), and I know that there are some differences, but this is what helps me and what has helped me help others:
1) Say the person's name
It's kind of like a password: the reaction where you look up automatically if someone says your name works on a very deep level, and sometimes that's all it takes for the person to notice their actual surroundings.
2) Say your name.
Even if the person doesn't know you, identification is comforting. We're trained from a very early age to respond in certain ways during an introduction, so again, this works on a very deep level.
3) If that doesn't work, slowly and gently reinforce concrete details.
Start with telling the person where he or she is, what day and year it is, what state and country they're in, what they're wearing, etc. Keep it very basic, but try not to sound judgmental. The idea is to mention things that they were perfectly aware of before the episode was triggered, basic things that they can look around and notice without having to take your word for it.
4) Limit the amount of input they receive
Concrete details help when they come from one person who is calm, but it definitely doesn't help when multiple people are asking questions and being worried, and it takes energy to deal with energy. Get the anxious people out of the way, and if possible, get the victim somewhere where he or she doesn't have to process any extraneous information. TV, radio, overheard conversations, and frequent noises are also input that should be avoided.
5) Avoid asking questions.
If you absolutely need to know the answer to a question, try to phrase it as a gentle statement instead. For example, "What is your name?" becomes "Tell me your name," etc. Questions are very, very hard to answer when you're having an attack of any kind because you have to decide what the question means, think about an answer, filter your answers, deal with your emotional response to the person's choice of question, and deal with your resentment that someone is adding to your confusion, all the while dealing with what was already happening in your head. That feeling of confusion and panic grows with every different question and every different person asking. It is much, much easier to follow an order than to do anything requiring abstract thought.
6) Listen to what they need.
a. If the victim tells you to get away, don't take it personally (and do get away). Yes, they should probably be monitored by someone, but it doesn't have to be you. See if you can find someone else to help, someone who will be calm, comforting, and firm. If there's no one else, you can also keep a pretty good eye on the victim without being too close. Try as much as possible to honor the victim's wishes and be sensitive to the fact that he or she is the person who needs care, not you.
b. If the victim tells you that they need something/someone, do your best to grant whatever it is. If the request is unclear or impossible, remain calm. It is imperative that you make the effort without complicating matters for the victim.
7) Avoid physical contact until they have a handle on where they are and who you are.
You could trigger response that they can't control, which can be dangerous to say the least.
8) Sometimes the person seems like they're having a flashback when they're really just experiencing an automated physical response that they can't control.
The difference is usually evident in what they say - in a flashback, the person talks like they're still in the traumatic situation, so it is comforting for them to have concrete facts and proof of where they really are. In an automated response they know where they are and what they're doing, and they just can't control it. In that case, the victim should be left alone until he or she regains control because it is embarrassing to have people see, and very hard to reconcile within a normal social context. If it seems like someone should still stay with them, it's okay to ask them who they want, or if that person isn't available leave them with whoever is the most calm and least likely to interfere.
9) Don't pretend to be someone else while talking to someone experiencing a flashback.
That would make you a douche. I shouldn't have to say this, but don't take advantage of the victim in any way, because if you do the tooth fairies from Hellboy II will wreak their karmic vengeance upon your tasty, tasty calcium. I think you need your calcium.
Love you all. I know you know this, but I'm not fishing for anything here -- I tell you what I've been through so you know that you can trust the information as it may apply to other people, not because I want you to think anything different about me.
Carry on.
-turtle
:::Edited for clarity on 7/5/10, and to add the shiny links:::
http://healthguide.howstuffworks.com/post-traumatic-stress-disorder-dictionary.htm
https://health.google.com/health/ref/Post-traumatic+stress+disorder
1) Say the person's name
It's kind of like a password: the reaction where you look up automatically if someone says your name works on a very deep level, and sometimes that's all it takes for the person to notice their actual surroundings.
2) Say your name.
Even if the person doesn't know you, identification is comforting. We're trained from a very early age to respond in certain ways during an introduction, so again, this works on a very deep level.
3) If that doesn't work, slowly and gently reinforce concrete details.
Start with telling the person where he or she is, what day and year it is, what state and country they're in, what they're wearing, etc. Keep it very basic, but try not to sound judgmental. The idea is to mention things that they were perfectly aware of before the episode was triggered, basic things that they can look around and notice without having to take your word for it.
4) Limit the amount of input they receive
Concrete details help when they come from one person who is calm, but it definitely doesn't help when multiple people are asking questions and being worried, and it takes energy to deal with energy. Get the anxious people out of the way, and if possible, get the victim somewhere where he or she doesn't have to process any extraneous information. TV, radio, overheard conversations, and frequent noises are also input that should be avoided.
5) Avoid asking questions.
If you absolutely need to know the answer to a question, try to phrase it as a gentle statement instead. For example, "What is your name?" becomes "Tell me your name," etc. Questions are very, very hard to answer when you're having an attack of any kind because you have to decide what the question means, think about an answer, filter your answers, deal with your emotional response to the person's choice of question, and deal with your resentment that someone is adding to your confusion, all the while dealing with what was already happening in your head. That feeling of confusion and panic grows with every different question and every different person asking. It is much, much easier to follow an order than to do anything requiring abstract thought.
6) Listen to what they need.
a. If the victim tells you to get away, don't take it personally (and do get away). Yes, they should probably be monitored by someone, but it doesn't have to be you. See if you can find someone else to help, someone who will be calm, comforting, and firm. If there's no one else, you can also keep a pretty good eye on the victim without being too close. Try as much as possible to honor the victim's wishes and be sensitive to the fact that he or she is the person who needs care, not you.
b. If the victim tells you that they need something/someone, do your best to grant whatever it is. If the request is unclear or impossible, remain calm. It is imperative that you make the effort without complicating matters for the victim.
7) Avoid physical contact until they have a handle on where they are and who you are.
You could trigger response that they can't control, which can be dangerous to say the least.
8) Sometimes the person seems like they're having a flashback when they're really just experiencing an automated physical response that they can't control.
The difference is usually evident in what they say - in a flashback, the person talks like they're still in the traumatic situation, so it is comforting for them to have concrete facts and proof of where they really are. In an automated response they know where they are and what they're doing, and they just can't control it. In that case, the victim should be left alone until he or she regains control because it is embarrassing to have people see, and very hard to reconcile within a normal social context. If it seems like someone should still stay with them, it's okay to ask them who they want, or if that person isn't available leave them with whoever is the most calm and least likely to interfere.
9) Don't pretend to be someone else while talking to someone experiencing a flashback.
That would make you a douche. I shouldn't have to say this, but don't take advantage of the victim in any way, because if you do the tooth fairies from Hellboy II will wreak their karmic vengeance upon your tasty, tasty calcium. I think you need your calcium.
Love you all. I know you know this, but I'm not fishing for anything here -- I tell you what I've been through so you know that you can trust the information as it may apply to other people, not because I want you to think anything different about me.
Carry on.
-turtle
:::Edited for clarity on 7/5/10, and to add the shiny links:::
http://healthguide.howstuffworks.com/post-traumatic-stress-disorder-dictionary.htm
https://health.google.com/health/ref/Post-traumatic+stress+disorder