Living With PTSD – Not Like The Movies

I managed to go to service this morning, for the first time in a long long while. Last week I couldn’t go because I had managed to give myself a concussion, before then it was down to running a temperature, and before then – for many many weeks – it has been due to simply not being up to it; too depressed, too submerged in my life/death battle. And then there’s the PTSD. Post-traumatic stress disorder. The bane of my life. A big reason for previously mentioned life/death battle.

I feel that a lot of people don’t really understand what post-traumatic stress disorder is. Or, more accurately, they may not be aware of how it affects people. I think that, at least in part, media is responsible for this. People have generally heard of flashbacks as being one of the symptoms of PTSD, and you often come across storylines in which characters suffer from this disorder, and the viewers are treated to an insight into the flashbacks that they experience in a variety of ways. Only, there’s an issue with this: having a flashback isn’t like watching something happening on a film screen. It’s about feelings. About re-experiencing the traumatic event, as if it is happening all over again, and having an emotional response to it. Again and again and again and again.

In the most recent episode of BBC’s Silent Witness, the storyline followed a former soldier suffering from PTSD. It was explained that certain sounds and situation could trigger flashbacks for him. So far so good; this is all true for many people suffering from PTSD. Later on in the program we got to ‘experience’ a flashback alongside the character: he saw a person on the street, it morphed into a flashback person – someone who wasn’t actually there – someone who had been part of the trauma. All of this is fairly accurate, I think, for a lot of people: flashbacks can very well be triggered by someone who looks like someone who was part of the traumatic event, and flashbacks can absolutely cause a person to see someone who isn’t really there. Happens to me all the time.

But then the character talked to someone about his experience of having flashbacks, and when the person listening to him said something along the lines of “That must be really horrible” the character’s reply was “No, it’s OK. It’s actually quite nice.”

And this, to me, is a huge departure from what PTSD sufferers truly deal with. I have yet to meet a single person suffering from PTSD who would describe having flashbacks as ‘nice’. Because the disorder is caused by traumatic experiences, often very extreme ones, you are not likely to have an emotional response which could in any way, shape or form be described as ‘nice’. Having a traumatic experience is not nice, thus, the emotional response will probably not include positive feelings.

Let me illustrate: say your previously wonderful and perfect partner rapes you. Very traumatic, very hard to deal with, extremely emotionally damaging. Let’s say the effects of the experience go so far as to cause you to develop PTSD. You now have flashbacks of the event. This is hardly going to trigger emotions related to the rosy honey-moon period of your relationship. Whilst you may still – in your conscious mind – remember that time when your partner brought home a dozen roses and your favourite chocolates, and the lovely feelings that gave you, those feelings will not be triggered by a flashback to the rape. They just won’t. Those lovely feelings weren’t associated with the rape, and so can’t be triggered by flashbacks to the trauma.

When you have PTSD [as I understand it, and put in layman’s terms] the memories of the trauma are stored in a different part of the brain to where other, ‘normal’, memories are stored, and the response flashbacks produce completely bypass the part of the brain that is responsible for rational thought. Thus, even though some part of you may be aware that the trauma isn’t really happening right now, and most of the time you are able to remember both positive and negative aspects of a relationship [assuming there have been both], because rational thought is taken out of the equation, your emotional response to a flashback will be as if it the trauma had only just happened, and will involve the feelings you either had at the time, or the feelings you may have had to repress at the time in order to survive. It won’t involve feelings related to an entirely different situation.

I mentioned earlier that flashbacks are often caused by triggers. But there is more to it. While a majority of people with PTSD have flashbacks caused by external triggers [sounds, smells etc – things that in one way or another remind them of the trauma], some people – myself included – have flashbacks that are caused primarily by internal triggers. Internal triggers are tricky, because they are difficult to identify. And if you can’t identify triggers, it is almost impossible to avoid them.

For me, personally, it is often a case of one flashback triggering the next, in a continuous chain, and I am just as likely to have flashbacks if I am out having an absolutely fantabulous time ice-skating with my friends, as I am sitting with someone talking about really deep and difficult things. In short, if I’m going to have a flashback, it will happen, regardless of what I am doing, where I am or who I am with.

One of the first things people [professionals in particular, actually] tend to ask is “What do you do to stop the flashbacks from happening?” to which I answer “Nothing”. They will then in one way or another convey to me that I have a very negative and defeatist attitude which isn’t helpful. Or they will suggest that I do something nice and relaxing – light candles, have a bath, listen to music, and so on. So, I tell them, oh, I do all of those things. Because they are very nice things to do. But I will still have the flashback, only I will have it in the bathtub, with the music playing and the candles all around me. I then say “You know when you go to sleep..?” adding a pause to allow the person I am talking to to nod, since this is something everyone has an experience of, before continuing “Well, you know once you are asleep, yeah?” Another nod. “At what point do you choose not to have a nightmare?”  You see, I can’t choose to not have a flashback any more than you can choose not to have a nightmare. No amount of positive thinking or relaxation is going to change it. If it’s going to happen, it’s going to happen, and it simply isn’t caused by a defeatist or negative attitude. I know a million different grounding techniques to help me come out of a flashback, all of which I employ on a daily basis, and I am working very hard at finding ways to cope with the emotions the flashbacks bring out, but there is no way I can stop the flashback from happening in the first place.

I have somewhere between 30 and 40 flashbacks on an average day. On a particularly bad day, when it seems like one flashback triggers the next, I can have over a hundred. That means re-experiencing, re-living – the abuse over a hundred times in a day. It means dealing with the emotional impact a hundred times in a day. To me, the fact that I am still here, in spite of this, is proof that I absolutely do not have a defeatist attitude.

If you would like to know what it is like [for me] to have flashbacks, there is a drawing (What Words Can’t Express – A Visual Representation Of Sexual Abuse Flashbacks) that I posted a number of years ago, trying to visually explain that sense of being in two places at once – the past and the present, simultaneously. I feel pushed to warn, though, that it is somewhat graphic, and could be potentially triggering.

I want to make it clear that I am in no way an expert on PTSD, and what I have written here is based on my own experience of living with flashbacks, and on what others with PTSD have told me. Of course, as with anything, different people react in different ways, and there may very well be PTSD sufferers out there who disagree entirely with my take on what PTSD is like. And that’s OK. I just wanted to offer my view of what it’s like.

 

All the very best,

xx

 

PS. In case you happen to know me, I’ve recently added a little section on the right, appropriately called “For People Who Know Me”. You may want to check that out. Not in any way saying that you can’t check it out even if you don’t know me, it just won’t be all that relevant to you. :)

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Long-Term Psychoanalytic Therapy & Short-Term Trauma Focused Counselling

I have been meaning to update my blog for a long time now, but blogging has had to take a step back in the midst of coping with what has felt like an ever-increasing onslaught of flashbacks. Still, here I am now, neatly posed in front [well, technically, behind] my computer and though I will more than likely have to make many stops to work my way out of flashbacks, I still wanted to write a little, just to keep you all in the loop as it were.

Firstly, I would like to apologise – or perhaps not so much apologise as acknowledge that my previous post was of a rather difficult-to-read nature. I know that some people found it a little too hard to cope with. And, at the same time, I have also had emails from people saying that they found it helpful in one way or another, and I suppose, at the end of the day, this blog, it is – as it states on the tin – an honesty focused blog, and does come with an explicit warning that it sometimes deals with difficult issues.

Now, moving on from that, you will be pleased to know that this post will be perhaps a little less difficult to stomach. I can’t guarantee that it will necessarily be joyful, but it won’t be leaving you with any particularly nasty mental images, I shouldn’t think.

So, what’s been going on in my life? Well, as mentioned above, there have been the flashbacks, and sometimes it really feels like that is ALL that there is, but, really, that’s not true, and I am hoping that – eventually, with plenty of hard work – I will get to a place where those will take a back seat.

As regular readers will know I am currently in twice weekly psychoanalytic therapy, and have been for nearly four years [thrice weekly, a lot of the time]. In fact, A.’s and my four year anniversary is coming up later this month. Perhaps time to crack open the champagne, or share a celebratory cigar ála Freud? But more than anything, I think, time to reflect.

People often ask me if my therapy helps, and what does A. say about all these flashbacks that I’m having, about self-harm, about feeling suicidal? And I find myself forever explaining that it’s not that type of therapy. It’s not the type of therapy in which A. and I sit and practice grounding techniques or where she advices me on what I should and shouldn’t do. It just isn’t. Psychoanalytic therapy isn’t a short term crisis action plan. But that is not the same as saying that my therapy isn’t helping. No, it doesn’t immediately offer relief from flashbacks or other psychological ills, but it helps in different ways. It helps me see things from different perspectives, it helps me develop self-awareness, it helps me understand why I sometimes react very differently to other people, it helps me see patterns in both my behaviour and in my way of thinking and relating. It helps me in a very broad way. This is not trauma focused therapy. We look at a lot more than ‘just’ the sexual abuse I experienced, we look at all different aspects of my life. It’s colour photography, as opposed to black and white, and I feel that it offers a bigger and more stable platform to stand on, when looking at all the various angles of being alive and being human. So, yes, therapy absolutely does help. It’s just that it is rather more complex than a plaster cast on a broken arm.

That said, the one thing that impacts my day-to-day life more than anything else is without a shadow of a doubt the flashbacks, the horrible experience of being made to relive the abuse again and again without warning. It’s a painful and uncontrollable mental bombardment which severely alters the way I live my life. Apart from, of course, being extremely emotionally exhausting (both the actual flashbacks and the aftermath of them – it’s simply not a case of OK, I’m out of the flashback, everything is fine now..) they also impact on a very practical level. Firstly, the unpredictability of when they [the flashbacks] are going to happen, means that it is very hard to relax. I don’t have easily identifiable triggers which give me warning that I might soon have a flashback, so, even when things are good, when I’m only having perhaps six or ten flashbacks in a day, I don’t know when they are going to happen, and so have to always be on the ready to deal with them. Secondly, when things are bad – like at the moment when I’m having anything between sixty and eighty flashbacks in a day – it leaves little time or energy to spare for doing other things. I can’t read, I can’t watch telly, because I’m constantly being interrupted by these flashbacks, and by the time I’ve come out of them and calmed down, I’ve forgotten what I was reading or what the storyline was. Also, having so many flashbacks makes venturing outside something to be avoided. It’s simply too hazardous, as I won’t notice traffic lights changing, I’ll keep walking while having them ending up getting lost, I’ll miss my stop on the tube etc etc. Even something so simple as making myself a cup of tea can become quite dangerous, as I discovered the other week; I was pouring out the water, had a flashback but kept pouring.. as a consequence the boiling water spilled onto my lap, and I got a burn on my thigh. So, even though the flashbacks are not psychotic; I do know where I am, it is like being in two places at once, it’s an altered state of awareness which affects daily life a lot more than people realise. I have to do a million different work-arounds just to get by, like being on the phone with someone whenever I’m out walking (so the person can help me notice if I have a flashback and tell me to stop walking), ask bus drivers and tube staff to make sure I get off at the right stop, meet friends in places that are easy for me to get to and generally meet at the station rather than at the cafe or restaurant we’re going to, to minimise the potential for getting lost on the way. Etc etc etc.

Because of this, I have decided that on top of my normal therapy with A. I am going to do some short-term specialised trauma-focused counselling, aimed at trying to reduce the number of flashbacks I have. I’ve talked to A. about it, and although it’s not the norm to see more than one therapist at any one time, it is something I really want to do. And I think that doing it this way, while I am still seeing A. will help me cope better with what can’t be anything but very painful trauma work. It’s one of those I don’t think it is meant to be easy, I think it’s meant to be WORTH it sort of things. Because, if it helped reduce the frequency of the flashbacks even just a little, it would improve my life enormously.

So, although there is much to discuss, not least of all the reasons why I am chosing to do this work with someone other than A. [is it to protect her? is it to protect me? maybe fear of ruining our relationship? etc etc], for now, I am waiting with some trepidation to start this new (additional) type of counselling. So do stay tuned. Updates will be forthcoming once I actually start.

All the very best,

xx