Episode 2. Welcome to episode two of the PTSD Academy podcast. I'm your host, Dr. Diam. Today's title is "Normal Post-traumatic Symptoms".
Feeling "crazy" after a trauma?
Many people wonder, "Am I crazy?" Or, "Should I expect this after a trauma, a loss, a grief or severely upsetting episode?" Sometimes people will get into self doubt questioning because emotions have a way of being sort of a wet blanket on us. It feels like, "The sadness I feel now is worse than any sadness I have ever had before. It also feels like it's never going to stop," because it's an out of control sensation.
Emotions are just that, of course. They are emotions but, when you're in the middle of it, there's nothing else that seems comparable to it. So it's a pretty normal question to say, "What would be a normal response to stress? What would be expected? And is there anything I should look out for?"
What is "normal" anyway?
First of all, let's talk about what does it mean to be "normal?" Normal is also a trashcan word. Something like anxiety is a useless sort of concept because it's hard to say what normal is. The alcoholic that drinks with the winos on the street thinks that's normal because that's what they surround themselves with. So, normal is a very relative phrase. It's helpful to think of what's healthy, what's not healthy.
In the wake of a traumatic episode, a wide open gamut of symptoms is experienced by mankind. Who am I to say what is normal for someone to go through? I think the biggest mistake we make is when we tell someone else they should get over something by now. Or arbitrarily make up like one year or after a year you should be over it. Losses of children or loved ones or traumatic events.
How long does it take PTSD to improve?
My point is that there are no specific cutoffs and time-frames for how long things happen, how long wounds hurt and heal. Everyone grows and learns and develops in different order. Different people have different emotional needs met and different relationships. Some people expect to be able to go to work and earn a living and come home. But when that workplace has an industrial accident and that doesn't happen and you lose your friends, your coworkers, your job or your finances and then your house and then no one will talk to you and you have to move away. I mean, you can lose everything.
I have been a psychiatrist specializing in PTSD for a little while now and have a background in writing and research before that. Did some emergency medicine and I'm a military veteran as well. And so, I've thought about this and studied it a lot. Written books, protocols and I wanted to steal a page out of a book I wrote on it. A book called The Warrior Class, called, 'Normal Reactions to Trauma' and essentially just share that with you today so you'd have an idea of what normal post-traumatic symptoms really are.
"You're never the same after being run over by a truck."
There's a saying I like involved early on in my training for PTSD treatment and that is, "You're never the same after being run over by a truck." And I think about that. I know a therapist that literally was hit by a car. She likes to run and marathon and ride bikes. And one day while on her bike she was hit by a car. Fractured her pelvis and some other injuries. Multiple surgeries, physical therapy. She healed up for the most part but do you think she runs and bikes exactly the same as she did before? No. She's not the same after she's been run over by a truck. So you can't expect that someone's going to return to a pre-trauma life perfectly well.
That doesn't mean that they stay disordered. It doesn't mean that they can't move on with goals in their life and even heal and grow from it though. Only about 80% of people that get exposed to the exact same trauma go on functioning somewhat normal. It's the 20% that struggle to function. And modern medicine, in it's infinite intelligence, tends to say, "Oh that's PTSD. That's Post-traumatic Stress Disorder." And they label it disorder.
And there are those fighting that PTSD becomes a serious mental illness on par with schizophrenia and major depression and bipolar disorder. But so far, it's really not winning that battle, though it may eventually.
It's important to label things for research and funding for insurance to pay. And while that's all well and good, you do not have to have PTSD to be severely emotionally wounded by a traumatic event. There are many walking wounded around us that look okay from the outside, will never ask for help, but they've got wounds that they're not talking about. And Western society tends to minimize those things. So we put everything in a tight box, stuff it way down deep and keep moving. I mean, you've got to pay your bills, right? Who else are you going to talk to about the stress? I understand that, I see that a lot in my treatment of patients. I do outpatient work now but I've done inpatient work and started a PTSD program, an intensive outpatient program, in Texas. And so, I've seen that before in a variety of presentations.
Asking for help is a very American thing to do
All that is to say, that when you go through something traumatic, you can't always hold it in. And very often, particularly men will think that showing any kind of vulnerability, showing emotional pain or even irritability from lost sleep and nightmares is a sign of weakness. And I want to stop here before I read you this list on normal reactions to trauma to tell you that this fear that asking for help is a sign of weakness is really an un-American idea. The Pilgrims built each others farms and they all took time out for each other to survive in the wilderness. And Andrew Carnegie, one of the steel magnates that really was responsible for the industrialization and the railroad steel industry, et cetera, that helped build America into the empire it was and get it ready for the World Wars, said himself that, "Never do anything for yourself that you can get someone else to do better than you can."
We're supposed to use the brain, brawn of other people and in a cooperative team so that we can get the best product. And Napoleon Hill's outstanding audio program called 'The Science of Personal Achievement,' he says, "No one ever grows above the level of mediocrity without using the brains, know-how, expertise and sometimes even the money of other people to achieve their goals. Assuming that you take care of your team members, cooperate in active harmony and processes, mastermind groups are very effective."
So on with the subject here. Normal reactions to trauma. I'm going to read a list to you and then discuss two harbingers to watch out for. So, obviously after a trauma, people will have some anxiety and inner tension. Fear that something could happen again. Shock and upset and emotional numbness, personal or social disconnection. Some people like to get alone. Other people just want to cry. Some people want to pretend like there's nothing else going on.
If you look at the mantra that I used at the PTSD Academy in the training programs there, you will hear often about capacity, opportunity and motivation as being the three domains for any kind of state of being. Doesn't matter what you're talking about. Someone's ability to improve, their opportunity to get good information or have bad experience with a therapist for example. Or their motivation, whether they're sort of beat down or they're just disgruntled and have a bad attitude that they think the world owes them something because they have gone through traumas and abuses. These things, either plus or minus, will affect your ability to get better.
Insomnia and PTSD
Same is true for sleep disturbance. So, some people will sleep too much after a trauma and want to avoid. And they're under-reactive. And they won't get off the couch, they won't get out of bed. Other people can't sleep. The depression wakes them up at 3:00 am. Or they're intermittently awoken by every sound all night, et cetera. So that can really change you. You might be exhausted.
If you're having trouble sleeping a lot and you have a lot of turmoil going on, focus on this for me. Ask yourself, "When I'm lying awake at night thinking about my problems, once in a while at least, am I able to get a new idea related to this? Am I able to think my way forward and figure out one little thing I should do? Or am I just stuck on a mouse wheel that's going around and around and I'm not making any progress mentally or cognitively at all?" So, if you're making any kind of progress with your thoughts and, once in a while, while you're up in the night, you are thinking about a new idea towards solving your problem, then you're really just processing. You don't want to not process. That would cause anxiety. If you're going to lose sleep over something big, it's not necessarily a bad thing. You're figuring out, you're adapting, you're reorienting to a new reality. I'd encourage you to do so at least in moderation. Only use sleep aids temporarily for extreme cases.
Some people can hear the voices of death. People will think they see them in a crowd even in hallucinations or illusions like that can be considered normal and not uncommon globally as we study post-traumatic stress.
The Two Biggest Dangers after Trauma
You've got to watch for things like inability to function. But specifically, there are two harbingers that we should really watch out for. That if you have these present, I would ask you to get help right away.
The first one is persistent feelings of worthlessness. The second one is suicidal ideations. If you have any of that going on, or know someone that does, get professional help. Those are shown through many research studies to be independent risk factors for suicide attempts and it's just not worth the risk. Some people can struggle a lot on their own and eventually make it through it. But when you have some of these symptoms and you're concerned about someone's safety, remember, safety first.
This podcast is dedicated to honoring the trauma survivors of the pipe bomb explosion at the subway station near Times Square in New York on December 11th, 2017.
We here that the PTSD Academy believe that people are not intended to merely survive but to overcome. If you or someone you love would like to know how, I invite you to take the complimentary nine line PTSD test at ptsdacademy.com/podcast.