A User's Guide to PTSD, Part III: I Don't Have To Do That Any More
This is Part III of a three-part essay on Post-Traumatic Stress Disorder: understanding it, having it, writing it.
Part I: What I Did In The War. (Introduction; background; what happens during trauma; what happened to me.)
Part II: What Does A Flashback Feel Like? (My history with PTSD, what it felt like to me, and dealing with other people who have it.)
Part III: I Don't Have To Do That Any More. (On recovery; lingering effects; book, film, and TV recommendations.)
ETA: Several years later, I added Part IV: Postscript.
After all that, I have never been either formally diagnosed with or treated for PTSD.
Unusual Circumstances May Cause Unusual Problems
rosefox commented that the median length of time between onset and treatment is twelve years. I suspect that long delays in treatment are common in mental illness, due to denial, fear of being stigmatized as a crazy person, romanticized ideas about mental illness (especially pernicious in artsy circles), fear of treatment, the shame of having put it off for so long, lack of knowledge of what's going on, the illness itself making it difficult or impossible for you to make rational decisions about dealing with it or to take action on those decisions, the conviction that treatment won't help because you are broken beyond repair, and, in America and other countries without universal health insurance, lack of access to affordable medical care.
I am still angry at the woman whom I confided in, and who proceeded to tell me a bunch of scare stories about friends of hers who had gone on Prozac, lost their creativity, and turned into zombies. That, sadly, is typical. At least in the circles I traveled in during my late teens to early twenties, nobody was in therapy or taking psychiatric medications, and nobody ever suggested it to me. Nor, though several friends did notice that I was profoundly unhappy and frequently acted quite strange, did anyone in those days ever suggest that I had a mental illness or that anything could be done about it.
I strongly recommend that if you think someone you know well has a mental illness or addiction, you sound them out to find out if they already know this and are doing something about it. ie, "I know someone who has post-traumatic stress disorder... Have you heard of that?" (You do know someone. Me.) If they don't know or have never discussed it with anyone, I suggest that you tactfully tell them what you think. Whether you're right or wrong, they may be relieved, or they may be furious. However, you may save their life-- maybe years down the road, when they remember what you said. It's not all about you. Do the right thing.
The people who finally did notice and tell me were two of my co-workers when I was a disaster relief worker. One was Tracey, the same one who got the fright of her life walking into my bedroom years later. They'd both studied psychology, and helpfully left a book on my desk: I Can't Get Over It: A Handbook For Trauma Survivors. I had mixed feelings about this--I am not a crazy person! being one. But I did read it, and it was one of the things which did propel me into treatment.
If you count from when I was eighteen and had the legal right to make my own medical choices, it took me eight years to get into treatment. It was one of the hardest-- and best-- decisions I ever made.
Previously, I had made a couple of half-assed attempts at getting treated, but fled after one or two sessions because I detested my therapist. (They were irritating and smarmy!) I had consistent problems getting decent treatment due to my unusual history. Even many therapists tend to think of child abuse as either being sexual, or if physical, perpetrated by the parents. Mine was neither. At one point I tried to get into group therapy for victims of child abuse, but was turned down because mine wasn’t sexual… and there was no group for victims of non-sexual abuse. People I went to for help tended to get caught up in the bizarre circumstances and forget about the actual person, me, who was looking for help. (Something else to keep in mind for your characters.)
If you are having trouble finding help because your case is also weird or in some way doesn’t fit the mold, I am really sorry. I understand how exhausting and discouraging it is to slog around looking for help and, if you’re unfortunate enough to be American, fighting insurance companies all the way. I did eventually find an excellent psychiatrist and therapist, but it took a lot of looking. You might try what I did, which was to pick the hospital in your area with the best reputation in general, and go to their psychiatric department.
If you're having trouble getting yourself to pick up the phone to get help, do whatever you have to do to break that logjam. Get a friend to make the call for you, then walk you to your appointment. Go to a free clinic. Anything. Remember, wherever you go, they are used to people who don't want to be there, cry, act odd, or are utterly ashamed to walk in the door. If everyone was totally normal and happy to be there, it would not be a mental health facility.
Recovery: Traditional Methods
When I showed up at Cedars-Sinai, I told them "depression," and proceeded to sob non-stop through my initial interview with a psychiatrist. He ran through the check-list for major depression, and didn't inquire further. I don't blame him for that, as he otherwise was quite astute, and managed to get a good idea of my personality and use that to treat me, which is incredible to me as I was almost entirely incoherent. (Not mentally disorganized, I was crying so hard I couldn't get many words out.)
He prescribed Prozac, telling me that it might make me a little jittery, "but I get the feeling you'd be more comfortable being a little edgy rather than a little sedated, right?"
Me (sniffle): "Yeah."
This was an excellent judgement call, because if I had taken anything that made me feel sedated, I probably would have panicked and ran. This may sound odd, given that I had an anxiety disorder, but some level of anxiety felt normal and natural to me. Feeling sleepy or apathetic would have given me the creeps-- especially because of all the "anti-depressants turn you into a zombie!" scare tactics going around.
His other personality-based assessment, which I again cannot fathom how he managed to figure out based on my behavior when he met me, was his selection of a therapist for me: "She's a bit confrontational. I think you'll like her."
As it happens, I am a bit confrontational myself, and I responded well to that therapist's blunt, take-no-prisoners approach. She sure as hell was not smarmy. I think a good personality match between therapist and client is essential, whether you need someone to be very gentle with you or someone whose unadorned honesty you respect.
I did cognitive-behavioral therapy, plus Prozac, for six months. Then my therapist cheerfully informed me that I was now perfectly capable of continuing on my own and it was time to leave the nest, suggested that I continue taking Prozac and using cognitive-behavioral techniques on my own, and that I could call her at any time. And that was it.
I was, indeed, enormously improved. Cognitive-behavioral therapy is very effective in treating both PTSD and depression. It tends to focus more on the present than on the past, which was paradoxically good for me, as I had been so locked into the past that I had not been paying nearly enough attention to what was going on right now. It takes the approach that you can re-program your irrational, depressive thought processes into more logical and healthy thoughts. I would highly recommend it, with the caveat that it will probably sound absolutely nutty and vaguely New Agey when you first encounter it. You have to trust that it does work and go with it. There are books on it, but it is much easier to do it with a therapist at the beginning. Later on you can carry on by yourself. I still use these techniques, all the time.
SSRIs are also a standard and often extremely helpful treatment for both PTSD and depression. (I later found out that one of my uncles had also successfully used Prozac to treat depression and agoraphobia. I don't know if any research has been done to see if an SSRI which has helped one family member may be more likely to help another-- does anyone know?) The Prozac helped a lot. Two weeks after I started taking it, I woke up one morning and, for the first time in months, felt... fine. It did make me a little jittery, and I had to start drinking half-and-half caffeinated coffee and decaf, or else I'd get really wired.
There is still the idea going around that psychiatric medication (and/or therapy) will destroy your creativity. I can only say that while my creativity was unaffected one way or another, my productivity was way better during and after treatment than before, because I was able to actually sit down and write. As opposed to writing three lines, then giving up because they sucked, which proved that I sucked, which meant that I would spend the next three hours sobbing on the floor rather than doing any more writing.
There are other treatments for PTSD. One of them, EMDR, apparently involves recounting traumatic memories while a therapist wiggles her fingers in front of your eyes. (Seriously! Or twirls taps a baton.) Has anyone tried this? It sounds bizarre, but hey, if it works...
You may also be given anti-anxiety medications. That sounds sensible but I've never taken any myself. And if you are being treated concurrently for some other disorder or addiction, you'll need to do whatever's usual for that. There's also group therapy. I always wanted to get in a group, but I never did, as they are typically closely tailored to some particular population. As a non-addict, non-veteran, victim of non-sexual, non-parental child abuse in an ashram in India, I am pretty much a population of one.
SSRIs are often prescribed for PTSD. Another medication you might want to look into, though I've never taken it myself, is prazosin. It's intended for high blood pressure, but has been used in PTSD patients to reduce nightmares. Please comment to let me know if you've tried it - if it works, it's worth its weight in gold.
I was lucky in that the first SSRI I tried worked beautifully and had no intolerable side effects. It's more common that you have to try a couple (or, if you're unlucky, a lot) until one works. I was also unusually lucky in that I did not get depressed again when, against medical recommendation, I stopped taking it. I figured I'd never know if I would or not unless I tried it out, so I tried. I was OK. It's been eight years now. I'm still OK.
The curious thing is that this was all for my depression. My PTSD was not directly addressed. But medication is medication, and the CBT techniques, once I learned them, could easily be applied to any sort of dysfunctional thoughts. So though I went in to fix one problem, I came out with both fixed. Mostly. The depression went away, leaving hardly a trace behind. The PTSD was alleviated to the point that it was no longer ruining my life, but it wasn't exactly gone...
Recovery: Non-Traditional Methods
At that point, the only symptoms I had left were the ones from the increased arousal set, hyper-vigilance and an exaggerated startle reflex. Especially the latter, which was frustrating because I basically felt OK, but I still had trouble walking down a busy, noisy street (and so forth.) I tried various relaxation techniques, meditation, and so forth, to calm my body by calming my mind. Wow, did none of that work! Like, not at all!
Then I got an idea. I figured that being traumatized had programmed my mind and body. At this point, I had successfully re-programmed my mind, but had failed to re-program my physical reactions. I had unsuccessfully tried to re-program my body via my mind, with meditation and cognitive techniques and so forth. But maybe what would work better would be if I tried to re-program my body directly.
It occurred to me that a way I might be able to do that would be to take up some intensive physical activity, which would require intense concentration and physical precision, and which I had never tried before. (The latter was partly so it wouldn't have bad associations, but more to emphasize the intense, ground-up, new learning process I wanted to put my body through.) I hoped that the study alone, with the mindset of "I am reprogramming and remaking myself with these moves," would have at least some effect in getting my physical reactions to either calm down or come under conscious control or both.
I should mention here that this was an idea I came up with entirely on my own, and up until I wrote this essay, I'd never heard of anyone doing it before. I would be very interested to hear if any of you have tried anything similar, or know of anyone doing it in a professional therapuetic setting.
There were a lot of things I could have tried-- ballet, rock-climbing, yoga-- but I had always wanted to study a martial art. I settled on Shotokan karate, because I liked the dojo. I did not tell anyone what I hoped to get out it. I thought that would make me stand out in a bad way when I wanted to blend in, make them treat me like I was made of glass, and possibly even make them deny me entry for fear of liability should I either have a nervous breakdown or hurt someone else. I did have some worries about being triggered, but Shotokan is so stylized that I thought it would probably be OK.
I hate to say it because I love them and I know for a fact that they can be used effectively in real situations, but traditional martial arts really are not very much like street fighting or other actual violence, and may not trigger you even if you've been exposed to a lot of violence. They don't trigger me, anyway.
Two weeks after I started training, I could walk down a busy, noisy street with barely a flinch. Maybe it was the placebo effect. But if so, it was the first time it kicked in. Also, it has been working for the past eight years, including this last year when I haven't trained at all due to (not karate-related) injuries.
After writing these essays, a couple people mentioned in comments that they derived similar benefits from martial arts. Here a veteran suggests horseback riding or martial arts in a group geared toward veterans. I suspect that any intensive, precise form of physical training would be effective, if the entire concept works for you at all. If you already do martial arts, you probably would want to use something entirely different, for the "new to you" effect.
I don't think this method is likely to work unless you've already addressed or are concurrently addressing the more mental issues as well, via therapy and/or medication. But if you've already made some progress and are trying to make more, particularly if you want to address physically-rooted reactions, it might help. If anyone gives it a try, do let me know how it works out for you.
I still sometimes sleep with a flashlight in my hand. I still jump at loud startling noises. A couple times a year, I have a week or so when I become convined that the apocalypse is going to happen any minute now, and then I update my disaster kits and play Leonard Cohen's "Everybody Knows" over and over on my car CD player. Due to writing this essay, I have woken up at 4:00 AM these past two mornings and been unable to get back to sleep. (I go to bed around midnight.) But overall, I am about a million times better than I was before I reprogrammed myself.
But though I don't regret doing it, I wish I could have done so with more precision. I am not sure now if I can still shift in an instant from sound asleep to on my feet fighting, or even wake up if a real intruder was to walk in while I slept. I am not sure if my reaction speed when awake is as fast as it used to be, or if my senses are as sensitive, or if my fighting instincts are as good. (Yeah, my technique's better, but technique can only take you so far.) I don't know because nothing's come up recently where I've needed any of that stuff. If I've lost those symptoms, those abilities, I would feel it as a loss. (Especially since I still have the anxiety that makes them seem useful and valuable.)
I used to worry that I was only brave enough to risk my life because I was hoping to lose it. But even now, when I want very much to keep my life, I know that I can still crawl inside a burning car filled with black oily smoke and search it for trapped survivors. And I know that I can get out fast when I don't find any! As a firefighter who taught an emergency response class pointed out, "So what if you're not as strong as the other guy? So what if it takes you fifteen minutes to drag one person out of the building when that other guy could carry them in three? That's great! That other guy wasn't there, and you just saved that person's life!"
So I hope and believe that even if I'm no longer optimally geared toward operating in a crisis, my painstakingly un-optimized, ordinary self will get the job done anyway.
Which brings me to my next point:
Don't fall in love with your own beautiful suffering.
There is a tendency among people who have had a mental illness for a long time to fall in love with their own suffering. There is a tendency among people who have suffered to think that their scars make them beautiful.
Be careful of this. There is a fine line between healthy pride and joy in survival, and the arrogance and self-righteousness of feeling, as Naruto's Sasuke might say, "more special than you." There is a fine line between taking a clear-eyed look at your illness and how it relates to your self, and luxuriating in the sense of being too broken and sensitive for this cold cruel world.
You will not want to get better if you think that your illness is what makes you special. You will not be able to fully appreciate the present if you think that your dark past is the most interesting thing about you. You will never get rid of your symptoms if you're too thrilled by their drama. This is something I have to watch carefully in myself.
And, yes, there's another fine line between deglamorizing suffering and disrespecting it. I'm just saying: be cautious around those lines. Leave the beautiful suffering to the characters you write and read and watch. It's a lot prettier onscreen than inside you.
Recommended Media: Nonfiction
I Can't Get over It: A Handbook for Trauma Survivors
, by Aphrodite Matsakis. This was the single best book I read on PTSD, written for people who have it in a clear and accessible style. She gets into specific issues that go with specific traumas, and has a good bibliography with recommendations of books for both general and specific populations (ie, Latinas dealing with domestic violence.)
The Courage to Heal 4e: A Guide for Women Survivors of Child Sexual Abuse 20th Anniversary Edition
, by Ellen Bass and Laura Davis. This is not specifically on PTSD, but on recovery from childhood sexual abuse. It's a bit of a mixed bag and has a New Agey slant, but if you're willing to ignore the parts that aren't useful,* it has some fantastic, specific advice that's widely applicable even if you weren't sexually abused. It too has an excellent bibliography.
*I still laugh when I think of the part where a woman tries to stop fantasizing about unhealthy S&M sex (um, yeah-- I did say "ignore the parts that aren't useful") by fantasizing about her clitoris being caressed by... lying under a waterfall! I can't say that her gentle stream of water will be starring in my sexual fantasies any time soon.
Feeling Good: The New Mood Therapy Revised and Updated
, by David Burns. The classic self-help book on cognitive therapy. I suggest that you buy it after seeing a therapist, not instead of.
Wasted: A Memoir of Anorexia and Bulimia (P.S.)
, by Marya Hornbacher. A memoir about anorexia and bulimia, not PTSD, but a lot of the issues that attend any mental illness and its effects on your life are roughly similar, and it's just fantastically well-written. She is particularly perceptive and unsentimental about the ways in which one tends to collude with one's own illness.
Trauma and Recovery: The Aftermath of Violence--from Domestic Abuse to Political Terror
, by Judith Herman. A more academic work on trauma and PTSD.
Achilles in Vietnam: Combat Trauma and the Undoing of Character
, by Jonathan Shay. Shay relates Homer to the American soldier's experience in Vietnam, and provides a good overview of the history of PTSD in soldiers.
Home Before Morning: The Story of an Army Nurse in Vietnam
, by Lynda Van Devanter. The vivid memoir of an American Army nurse in Vietnam, with lots of good material on coping (and failing to cope) with trauma and PTSD.
Le Ly Hayslip, Tim O'Brien, and Joe Haldeman have also written good fiction and nonfiction on the Vietnam war experience, and I recommend their work in general.
There are a number of excellent depression memoirs, of which my favorite is Tracy Thompson's The Beast: A Journey Through Depression
.
Recommended Media: Fiction, TV, and Movies
I could write a really long list here, but I will try to restrain myself. I've got a lot of fantasy here because I like fantasy.
Spooks/MI-5 season five. Fantastically suspenseful British spy show. The fifth season (and debatably the fourth) has one of the more realistic portrayals of PTSD I've seen onscreen. We shall pretend the sex-after-nightmare scene did not happen...
Fearless. A movie about the survivors of a plane crash. I especially like the non-reductive approach to Jeff Bridges' character's condition: maybe it's a mental illness, maybe it's something else.
A lot of anime and manga deal nicely with wartime insanity and PTSD, or childhood trauma and PTSD, or just trauma and recovery in general. In this regard, I am particularly fond of the anime Fullmetal Alchemist: Season One Box Set
and Mobile Suit Gundam Wing - Complete Collection 1
(pure crack!), Samurai Champloo, and X/1999, and the manga Fruits Basket, Saiyuki, Wild Adapter, ES (Eternal Sabbath), and Naruto.
The Kestrel
, by Lloyd Alexander. My favorite war novel of all time. Read the first book, Westmark
, first. It gets darker.
Mirror Dance
, by Lois McMaster Bujold. The entire Vorkosigan saga does an excellent job of portraying various and sundry mental illnesses. This is probably my single favorite fictional portrayal of PTSD (with complications.) Note that is well into a series, and probably not the place to start.
Deerskin
and The Hero and the Crown
, by Robin McKinley. Not on PTSD, but very good fantasy novels which deal with trauma and recovery in general.
Flying in Place
, by Susan Palwick. An intense and ultimately uplifting novel about an abused child.
Between Mountains
, by Maggie Helwig. The complicated love affair of a war correspondent with PTSD and an interpreter at a war crimes tribunal; intelligent, politically sophisticated, beautifully written.
Kitchen
, by Banana Yoshimoto. Grief, violence, food, love, and recovery; one of the most joyous books I've ever read. Lizard is also excellent.
The Rising
, an album by Bruce Springsteen. One of the very few pieces of good art to come out of 9/11.
The West Wing episode "Noel" is a very well-done episode focusing on a character's PTSD after being shot; his performance is underplayed, totally lacking in melodrama, and stellar.
Pat Barker's WWI trilogy, beginning with Regeneration
, is about soldiers being treated for what was then known as shellshock. It's thoughtful, meticulously historically accurate, and extraordinarily well-written.
I hope this was helpful, useful, or enlightening. It was hard to write, and not just because of its extreme length. Some of it was stuff I've never told anybody before. There was even a point when I considered not posting it at all.
I was tremendously pleased and flattered when so many of you, when nominating the anime character I most resemble, thought that sanity and stability were among my most notable traits. I briefly had the woeful thought that after writing a three-part essay detailing my suicide attempts and blackouts and flashbacks and sleeping with a weapon in my hand and so forth, if I ever asked that question again, you would all say, "You are crazy suicidal teenage terrorist Heero Yuy from Gundam Wing!"
On the other hand, most of that craziness is in the past. Regarding what remains, I believe that while I may have more total crazy than the average person, I am also much better than average at dealing with and controlling it. Not to mention the advantage I gain from not pretending that I have no crazy. In equation form:
More crazy + more anti-crazy skills - denial = less insanity.
Less crazy + fewer anti-crazy skills + denial = more insanity.
Or so I hope. Actually, so I believe, considering that the total amount of time I spent considering not posting this was approximately thirty seconds. Surely Heero would have deleted the entire series without posting, in the unlikely event that he had the self-awareness to compose it in the first place.
As always, please feel free to link, ask questions, comment, share your own experiences, correct my science and statistics, or recommend media on the subject. And anyone is always free to friend this LJ. (Though I mostly write about manga, anime, and books, not mental health issues.)
ETA: I do still read and am grateful to receive comments on these posts, even many years later. I can't guarantee to respond to every one because it can be a bit overwhelming, but I do read them.
Part I: What I Did In The War. (Introduction; background; what happens during trauma; what happened to me.)
Part II: What Does A Flashback Feel Like? (My history with PTSD, what it felt like to me, and dealing with other people who have it.)
Part III: I Don't Have To Do That Any More. (On recovery; lingering effects; book, film, and TV recommendations.)
ETA: Several years later, I added Part IV: Postscript.
After all that, I have never been either formally diagnosed with or treated for PTSD.
Unusual Circumstances May Cause Unusual Problems
rosefox commented that the median length of time between onset and treatment is twelve years. I suspect that long delays in treatment are common in mental illness, due to denial, fear of being stigmatized as a crazy person, romanticized ideas about mental illness (especially pernicious in artsy circles), fear of treatment, the shame of having put it off for so long, lack of knowledge of what's going on, the illness itself making it difficult or impossible for you to make rational decisions about dealing with it or to take action on those decisions, the conviction that treatment won't help because you are broken beyond repair, and, in America and other countries without universal health insurance, lack of access to affordable medical care.
I am still angry at the woman whom I confided in, and who proceeded to tell me a bunch of scare stories about friends of hers who had gone on Prozac, lost their creativity, and turned into zombies. That, sadly, is typical. At least in the circles I traveled in during my late teens to early twenties, nobody was in therapy or taking psychiatric medications, and nobody ever suggested it to me. Nor, though several friends did notice that I was profoundly unhappy and frequently acted quite strange, did anyone in those days ever suggest that I had a mental illness or that anything could be done about it.
I strongly recommend that if you think someone you know well has a mental illness or addiction, you sound them out to find out if they already know this and are doing something about it. ie, "I know someone who has post-traumatic stress disorder... Have you heard of that?" (You do know someone. Me.) If they don't know or have never discussed it with anyone, I suggest that you tactfully tell them what you think. Whether you're right or wrong, they may be relieved, or they may be furious. However, you may save their life-- maybe years down the road, when they remember what you said. It's not all about you. Do the right thing.
The people who finally did notice and tell me were two of my co-workers when I was a disaster relief worker. One was Tracey, the same one who got the fright of her life walking into my bedroom years later. They'd both studied psychology, and helpfully left a book on my desk: I Can't Get Over It: A Handbook For Trauma Survivors. I had mixed feelings about this--I am not a crazy person! being one. But I did read it, and it was one of the things which did propel me into treatment.
If you count from when I was eighteen and had the legal right to make my own medical choices, it took me eight years to get into treatment. It was one of the hardest-- and best-- decisions I ever made.
Previously, I had made a couple of half-assed attempts at getting treated, but fled after one or two sessions because I detested my therapist. (They were irritating and smarmy!) I had consistent problems getting decent treatment due to my unusual history. Even many therapists tend to think of child abuse as either being sexual, or if physical, perpetrated by the parents. Mine was neither. At one point I tried to get into group therapy for victims of child abuse, but was turned down because mine wasn’t sexual… and there was no group for victims of non-sexual abuse. People I went to for help tended to get caught up in the bizarre circumstances and forget about the actual person, me, who was looking for help. (Something else to keep in mind for your characters.)
If you are having trouble finding help because your case is also weird or in some way doesn’t fit the mold, I am really sorry. I understand how exhausting and discouraging it is to slog around looking for help and, if you’re unfortunate enough to be American, fighting insurance companies all the way. I did eventually find an excellent psychiatrist and therapist, but it took a lot of looking. You might try what I did, which was to pick the hospital in your area with the best reputation in general, and go to their psychiatric department.
If you're having trouble getting yourself to pick up the phone to get help, do whatever you have to do to break that logjam. Get a friend to make the call for you, then walk you to your appointment. Go to a free clinic. Anything. Remember, wherever you go, they are used to people who don't want to be there, cry, act odd, or are utterly ashamed to walk in the door. If everyone was totally normal and happy to be there, it would not be a mental health facility.
Recovery: Traditional Methods
When I showed up at Cedars-Sinai, I told them "depression," and proceeded to sob non-stop through my initial interview with a psychiatrist. He ran through the check-list for major depression, and didn't inquire further. I don't blame him for that, as he otherwise was quite astute, and managed to get a good idea of my personality and use that to treat me, which is incredible to me as I was almost entirely incoherent. (Not mentally disorganized, I was crying so hard I couldn't get many words out.)
He prescribed Prozac, telling me that it might make me a little jittery, "but I get the feeling you'd be more comfortable being a little edgy rather than a little sedated, right?"
Me (sniffle): "Yeah."
This was an excellent judgement call, because if I had taken anything that made me feel sedated, I probably would have panicked and ran. This may sound odd, given that I had an anxiety disorder, but some level of anxiety felt normal and natural to me. Feeling sleepy or apathetic would have given me the creeps-- especially because of all the "anti-depressants turn you into a zombie!" scare tactics going around.
His other personality-based assessment, which I again cannot fathom how he managed to figure out based on my behavior when he met me, was his selection of a therapist for me: "She's a bit confrontational. I think you'll like her."
As it happens, I am a bit confrontational myself, and I responded well to that therapist's blunt, take-no-prisoners approach. She sure as hell was not smarmy. I think a good personality match between therapist and client is essential, whether you need someone to be very gentle with you or someone whose unadorned honesty you respect.
I did cognitive-behavioral therapy, plus Prozac, for six months. Then my therapist cheerfully informed me that I was now perfectly capable of continuing on my own and it was time to leave the nest, suggested that I continue taking Prozac and using cognitive-behavioral techniques on my own, and that I could call her at any time. And that was it.
I was, indeed, enormously improved. Cognitive-behavioral therapy is very effective in treating both PTSD and depression. It tends to focus more on the present than on the past, which was paradoxically good for me, as I had been so locked into the past that I had not been paying nearly enough attention to what was going on right now. It takes the approach that you can re-program your irrational, depressive thought processes into more logical and healthy thoughts. I would highly recommend it, with the caveat that it will probably sound absolutely nutty and vaguely New Agey when you first encounter it. You have to trust that it does work and go with it. There are books on it, but it is much easier to do it with a therapist at the beginning. Later on you can carry on by yourself. I still use these techniques, all the time.
SSRIs are also a standard and often extremely helpful treatment for both PTSD and depression. (I later found out that one of my uncles had also successfully used Prozac to treat depression and agoraphobia. I don't know if any research has been done to see if an SSRI which has helped one family member may be more likely to help another-- does anyone know?) The Prozac helped a lot. Two weeks after I started taking it, I woke up one morning and, for the first time in months, felt... fine. It did make me a little jittery, and I had to start drinking half-and-half caffeinated coffee and decaf, or else I'd get really wired.
There is still the idea going around that psychiatric medication (and/or therapy) will destroy your creativity. I can only say that while my creativity was unaffected one way or another, my productivity was way better during and after treatment than before, because I was able to actually sit down and write. As opposed to writing three lines, then giving up because they sucked, which proved that I sucked, which meant that I would spend the next three hours sobbing on the floor rather than doing any more writing.
There are other treatments for PTSD. One of them, EMDR, apparently involves recounting traumatic memories while a therapist wiggles her fingers in front of your eyes. (Seriously! Or twirls taps a baton.) Has anyone tried this? It sounds bizarre, but hey, if it works...
You may also be given anti-anxiety medications. That sounds sensible but I've never taken any myself. And if you are being treated concurrently for some other disorder or addiction, you'll need to do whatever's usual for that. There's also group therapy. I always wanted to get in a group, but I never did, as they are typically closely tailored to some particular population. As a non-addict, non-veteran, victim of non-sexual, non-parental child abuse in an ashram in India, I am pretty much a population of one.
SSRIs are often prescribed for PTSD. Another medication you might want to look into, though I've never taken it myself, is prazosin. It's intended for high blood pressure, but has been used in PTSD patients to reduce nightmares. Please comment to let me know if you've tried it - if it works, it's worth its weight in gold.
I was lucky in that the first SSRI I tried worked beautifully and had no intolerable side effects. It's more common that you have to try a couple (or, if you're unlucky, a lot) until one works. I was also unusually lucky in that I did not get depressed again when, against medical recommendation, I stopped taking it. I figured I'd never know if I would or not unless I tried it out, so I tried. I was OK. It's been eight years now. I'm still OK.
The curious thing is that this was all for my depression. My PTSD was not directly addressed. But medication is medication, and the CBT techniques, once I learned them, could easily be applied to any sort of dysfunctional thoughts. So though I went in to fix one problem, I came out with both fixed. Mostly. The depression went away, leaving hardly a trace behind. The PTSD was alleviated to the point that it was no longer ruining my life, but it wasn't exactly gone...
Recovery: Non-Traditional Methods
At that point, the only symptoms I had left were the ones from the increased arousal set, hyper-vigilance and an exaggerated startle reflex. Especially the latter, which was frustrating because I basically felt OK, but I still had trouble walking down a busy, noisy street (and so forth.) I tried various relaxation techniques, meditation, and so forth, to calm my body by calming my mind. Wow, did none of that work! Like, not at all!
Then I got an idea. I figured that being traumatized had programmed my mind and body. At this point, I had successfully re-programmed my mind, but had failed to re-program my physical reactions. I had unsuccessfully tried to re-program my body via my mind, with meditation and cognitive techniques and so forth. But maybe what would work better would be if I tried to re-program my body directly.
It occurred to me that a way I might be able to do that would be to take up some intensive physical activity, which would require intense concentration and physical precision, and which I had never tried before. (The latter was partly so it wouldn't have bad associations, but more to emphasize the intense, ground-up, new learning process I wanted to put my body through.) I hoped that the study alone, with the mindset of "I am reprogramming and remaking myself with these moves," would have at least some effect in getting my physical reactions to either calm down or come under conscious control or both.
I should mention here that this was an idea I came up with entirely on my own, and up until I wrote this essay, I'd never heard of anyone doing it before. I would be very interested to hear if any of you have tried anything similar, or know of anyone doing it in a professional therapuetic setting.
There were a lot of things I could have tried-- ballet, rock-climbing, yoga-- but I had always wanted to study a martial art. I settled on Shotokan karate, because I liked the dojo. I did not tell anyone what I hoped to get out it. I thought that would make me stand out in a bad way when I wanted to blend in, make them treat me like I was made of glass, and possibly even make them deny me entry for fear of liability should I either have a nervous breakdown or hurt someone else. I did have some worries about being triggered, but Shotokan is so stylized that I thought it would probably be OK.
I hate to say it because I love them and I know for a fact that they can be used effectively in real situations, but traditional martial arts really are not very much like street fighting or other actual violence, and may not trigger you even if you've been exposed to a lot of violence. They don't trigger me, anyway.
Two weeks after I started training, I could walk down a busy, noisy street with barely a flinch. Maybe it was the placebo effect. But if so, it was the first time it kicked in. Also, it has been working for the past eight years, including this last year when I haven't trained at all due to (not karate-related) injuries.
After writing these essays, a couple people mentioned in comments that they derived similar benefits from martial arts. Here a veteran suggests horseback riding or martial arts in a group geared toward veterans. I suspect that any intensive, precise form of physical training would be effective, if the entire concept works for you at all. If you already do martial arts, you probably would want to use something entirely different, for the "new to you" effect.
I don't think this method is likely to work unless you've already addressed or are concurrently addressing the more mental issues as well, via therapy and/or medication. But if you've already made some progress and are trying to make more, particularly if you want to address physically-rooted reactions, it might help. If anyone gives it a try, do let me know how it works out for you.
I still sometimes sleep with a flashlight in my hand. I still jump at loud startling noises. A couple times a year, I have a week or so when I become convined that the apocalypse is going to happen any minute now, and then I update my disaster kits and play Leonard Cohen's "Everybody Knows" over and over on my car CD player. Due to writing this essay, I have woken up at 4:00 AM these past two mornings and been unable to get back to sleep. (I go to bed around midnight.) But overall, I am about a million times better than I was before I reprogrammed myself.
But though I don't regret doing it, I wish I could have done so with more precision. I am not sure now if I can still shift in an instant from sound asleep to on my feet fighting, or even wake up if a real intruder was to walk in while I slept. I am not sure if my reaction speed when awake is as fast as it used to be, or if my senses are as sensitive, or if my fighting instincts are as good. (Yeah, my technique's better, but technique can only take you so far.) I don't know because nothing's come up recently where I've needed any of that stuff. If I've lost those symptoms, those abilities, I would feel it as a loss. (Especially since I still have the anxiety that makes them seem useful and valuable.)
I used to worry that I was only brave enough to risk my life because I was hoping to lose it. But even now, when I want very much to keep my life, I know that I can still crawl inside a burning car filled with black oily smoke and search it for trapped survivors. And I know that I can get out fast when I don't find any! As a firefighter who taught an emergency response class pointed out, "So what if you're not as strong as the other guy? So what if it takes you fifteen minutes to drag one person out of the building when that other guy could carry them in three? That's great! That other guy wasn't there, and you just saved that person's life!"
So I hope and believe that even if I'm no longer optimally geared toward operating in a crisis, my painstakingly un-optimized, ordinary self will get the job done anyway.
Which brings me to my next point:
Don't fall in love with your own beautiful suffering.
There is a tendency among people who have had a mental illness for a long time to fall in love with their own suffering. There is a tendency among people who have suffered to think that their scars make them beautiful.
Be careful of this. There is a fine line between healthy pride and joy in survival, and the arrogance and self-righteousness of feeling, as Naruto's Sasuke might say, "more special than you." There is a fine line between taking a clear-eyed look at your illness and how it relates to your self, and luxuriating in the sense of being too broken and sensitive for this cold cruel world.
You will not want to get better if you think that your illness is what makes you special. You will not be able to fully appreciate the present if you think that your dark past is the most interesting thing about you. You will never get rid of your symptoms if you're too thrilled by their drama. This is something I have to watch carefully in myself.
And, yes, there's another fine line between deglamorizing suffering and disrespecting it. I'm just saying: be cautious around those lines. Leave the beautiful suffering to the characters you write and read and watch. It's a lot prettier onscreen than inside you.
Recommended Media: Nonfiction
I Can't Get over It: A Handbook for Trauma Survivors
, by Aphrodite Matsakis. This was the single best book I read on PTSD, written for people who have it in a clear and accessible style. She gets into specific issues that go with specific traumas, and has a good bibliography with recommendations of books for both general and specific populations (ie, Latinas dealing with domestic violence.)
The Courage to Heal 4e: A Guide for Women Survivors of Child Sexual Abuse 20th Anniversary Edition
, by Ellen Bass and Laura Davis. This is not specifically on PTSD, but on recovery from childhood sexual abuse. It's a bit of a mixed bag and has a New Agey slant, but if you're willing to ignore the parts that aren't useful,* it has some fantastic, specific advice that's widely applicable even if you weren't sexually abused. It too has an excellent bibliography.
*I still laugh when I think of the part where a woman tries to stop fantasizing about unhealthy S&M sex (um, yeah-- I did say "ignore the parts that aren't useful") by fantasizing about her clitoris being caressed by... lying under a waterfall! I can't say that her gentle stream of water will be starring in my sexual fantasies any time soon.
Feeling Good: The New Mood Therapy Revised and Updated
, by David Burns. The classic self-help book on cognitive therapy. I suggest that you buy it after seeing a therapist, not instead of.
Wasted: A Memoir of Anorexia and Bulimia (P.S.)
, by Marya Hornbacher. A memoir about anorexia and bulimia, not PTSD, but a lot of the issues that attend any mental illness and its effects on your life are roughly similar, and it's just fantastically well-written. She is particularly perceptive and unsentimental about the ways in which one tends to collude with one's own illness.
Trauma and Recovery: The Aftermath of Violence--from Domestic Abuse to Political Terror
, by Judith Herman. A more academic work on trauma and PTSD.
Achilles in Vietnam: Combat Trauma and the Undoing of Character
, by Jonathan Shay. Shay relates Homer to the American soldier's experience in Vietnam, and provides a good overview of the history of PTSD in soldiers.
Home Before Morning: The Story of an Army Nurse in Vietnam
, by Lynda Van Devanter. The vivid memoir of an American Army nurse in Vietnam, with lots of good material on coping (and failing to cope) with trauma and PTSD.
Le Ly Hayslip, Tim O'Brien, and Joe Haldeman have also written good fiction and nonfiction on the Vietnam war experience, and I recommend their work in general.
There are a number of excellent depression memoirs, of which my favorite is Tracy Thompson's The Beast: A Journey Through Depression
.
Recommended Media: Fiction, TV, and Movies
I could write a really long list here, but I will try to restrain myself. I've got a lot of fantasy here because I like fantasy.
Spooks/MI-5 season five. Fantastically suspenseful British spy show. The fifth season (and debatably the fourth) has one of the more realistic portrayals of PTSD I've seen onscreen. We shall pretend the sex-after-nightmare scene did not happen...
Fearless. A movie about the survivors of a plane crash. I especially like the non-reductive approach to Jeff Bridges' character's condition: maybe it's a mental illness, maybe it's something else.
A lot of anime and manga deal nicely with wartime insanity and PTSD, or childhood trauma and PTSD, or just trauma and recovery in general. In this regard, I am particularly fond of the anime Fullmetal Alchemist: Season One Box Set
and Mobile Suit Gundam Wing - Complete Collection 1
(pure crack!), Samurai Champloo, and X/1999, and the manga Fruits Basket, Saiyuki, Wild Adapter, ES (Eternal Sabbath), and Naruto.
The Kestrel
, by Lloyd Alexander. My favorite war novel of all time. Read the first book, Westmark
, first. It gets darker.
Mirror Dance
, by Lois McMaster Bujold. The entire Vorkosigan saga does an excellent job of portraying various and sundry mental illnesses. This is probably my single favorite fictional portrayal of PTSD (with complications.) Note that is well into a series, and probably not the place to start.
Deerskin
and The Hero and the Crown
, by Robin McKinley. Not on PTSD, but very good fantasy novels which deal with trauma and recovery in general.
Flying in Place
, by Susan Palwick. An intense and ultimately uplifting novel about an abused child.
Between Mountains
, by Maggie Helwig. The complicated love affair of a war correspondent with PTSD and an interpreter at a war crimes tribunal; intelligent, politically sophisticated, beautifully written.
Kitchen
, by Banana Yoshimoto. Grief, violence, food, love, and recovery; one of the most joyous books I've ever read. Lizard is also excellent.
The Rising
, an album by Bruce Springsteen. One of the very few pieces of good art to come out of 9/11.
The West Wing episode "Noel" is a very well-done episode focusing on a character's PTSD after being shot; his performance is underplayed, totally lacking in melodrama, and stellar.
Pat Barker's WWI trilogy, beginning with Regeneration
, is about soldiers being treated for what was then known as shellshock. It's thoughtful, meticulously historically accurate, and extraordinarily well-written.
I hope this was helpful, useful, or enlightening. It was hard to write, and not just because of its extreme length. Some of it was stuff I've never told anybody before. There was even a point when I considered not posting it at all.
I was tremendously pleased and flattered when so many of you, when nominating the anime character I most resemble, thought that sanity and stability were among my most notable traits. I briefly had the woeful thought that after writing a three-part essay detailing my suicide attempts and blackouts and flashbacks and sleeping with a weapon in my hand and so forth, if I ever asked that question again, you would all say, "You are crazy suicidal teenage terrorist Heero Yuy from Gundam Wing!"
On the other hand, most of that craziness is in the past. Regarding what remains, I believe that while I may have more total crazy than the average person, I am also much better than average at dealing with and controlling it. Not to mention the advantage I gain from not pretending that I have no crazy. In equation form:
More crazy + more anti-crazy skills - denial = less insanity.
Less crazy + fewer anti-crazy skills + denial = more insanity.
Or so I hope. Actually, so I believe, considering that the total amount of time I spent considering not posting this was approximately thirty seconds. Surely Heero would have deleted the entire series without posting, in the unlikely event that he had the self-awareness to compose it in the first place.
As always, please feel free to link, ask questions, comment, share your own experiences, correct my science and statistics, or recommend media on the subject. And anyone is always free to friend this LJ. (Though I mostly write about manga, anime, and books, not mental health issues.)
ETA: I do still read and am grateful to receive comments on these posts, even many years later. I can't guarantee to respond to every one because it can be a bit overwhelming, but I do read them.