When the Alarm Goes Off:
Posttraumatic Stress Disorder and its Power
by Natasha J. Thomas, MD
“I felt exposed, vulnerable. I was outside and there was nothing but open spaces.
I felt my anxiety go up, up, up. The dark made me feel like I was in a coma again.”
- Actual quote from someone recovering from medical trauma.
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Posttraumatic Stress Disorder (PTSD), for its manifestations, phenomena and potential for chronicity, is one of the most fascinating mental health challenges I ever encounter as a psychiatrist. Though we won’t all meet criteria for PTSD, almost all of us have experienced trauma. Trauma is part of the human experience.
I often think traumas, great and small, are the origins from which many mental illnesses arise, and have been known to say, “Unresolved trauma is THE only mental illness.” That may be a bit of exaggeration but unresolved trauma is directly linked to the onset of a host of mental disorders. On the other hand, well-integrated trauma has the potential to motivate a person to their highest potential. Sometimes, that’s in pursuit of justice – correcting wrongs we’ve personally endured. Sometimes, it’s fighting for all people living within a consistently traumatic environment (as in the case of the fight against child abuse, human trafficking, and for victims of war).
And sometimes, trauma breaks the heart open. The healing that occurs afterward creates clarity, strength, resolve and power that seems almost unnatural. That phenomenon is dubbed “Posttraumatic Growth.” Think Oprah Winfrey. Though she has never reported being diagnosed with PTSD, she has been quite open about the sexual trauma she endured early in life. Think Maya Angelou – the same can be said for her. Just those two women alone show us the undeniable force that a trauma resolved through resilience can create.
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Healing from our scary, shocking, devastating experiences as humans – it's our task and our birthright. Let’s see how it’s done.
THE STATS
Researchers affiliated with the National Center for PTSD have released helpful statistics for the study of trauma and its impact. They have determined the majority of adults in America have experienced some sort of traumatic event. Some figures report the number impacted is as high as 70%, with about 1 in 5 of those people going on to develop PTSD. But in those who have experienced a severe trauma, up to 80% will develop PTSD. Like many disorders, more women than men are affected. PTSD also appears to be higher in so-called minority groups in the US, including African-Americans, Hispanics and Native Americans.
Studies also show 1 in 5 deployed military personnel will return with PTSD. It is reported that 70% of female military personnel develop PTSD from sexual harassment or assault during their service. That number surprises even me.
And our children appear to be even more vulnerable, with up to 100% of children in at-risk samples being impacted by PTSD, based on figures reported by the National Center for PTSD. That number includes children who have been sexually abused, sexually assaulted, witnessed the homicide of a parent, have been part of a school shooting or have grown up in an urban environment.
THE SCIENCE
Did you know that when a person develops PTSD, it’s the result of both chemical and physical changes in the brain? A neuroscientist named Paul D. McLean developed a theory of overall brain structure that essentially breaks the brain down into three parts (the Triune Model). He called the part responsible for our survival instincts and autonomic processes (like breathing) the reptilian brain. This is the part we normally call the brainstem, and it is the innermost section. It is topped by the part he called the mammalian brain (our limbic system), which processes everything we feel – both emotions and sensory information from the environment. The third section he called the neomammalian brain. We call it the cortex. The outermost and most developed part, where our thinking, learning, language, memory, decision-making and personality reside.
It is thought that in people who develop symptoms of PTSD, the reptilian and mammalian parts of the brain take over and put a person persistently in survival mode. The body thinks it is in danger long after a traumatic experience has ended. A structure called the amygdala, deep in the brain signals fear in danger, and in PTSD. I think of it like a malfunctioning smoke alarm – blaring constantly, once smoke has completely cleared away. In this state, when basic and automatic drives are the whole focus, parts of the brain responsible for thinking, learning, and memory begin to physically shut down. Stress hormones stay elevated in response to the alarm. But inappropriately elevated stress hormones course through the hippocampus, causing it and the frontal part of the brain to wither away. Normally, the hippocampus and frontal lobe helps us with learning by promoting memory, the understanding of context, and the ability to complete high levels of thinking.
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The goal in PTSD treatment is to get the alarm system to shut off, stress hormones to go back to their normal levels, and to make the thinking/processing parts of the brain regenerate. This is completely possible. And this is the reason those who are living in traumatic environments must get out in order to heal.
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THE SYMPTOMS
Even though I am known for being a reproductive psychiatrist focusing on women’s mental health issues, I actually became a psychiatrist because of the work I did with military veterans with PTSD while a medical student at the University of Miami. They were young people, truly handicapped by anxieties, sleep disturbances, explosive tempers, social withdrawal, depression, suicidal thinking and substance issues. The US military had not given them adequate mental preparation for how the reality of war would impact them. They would return home and forever be aliens. They would struggle to relate to their spouses and children for years and years to come. My Vietnam Vets, 70 years old or more, were still just as traumatized as they were in 1975. I found it all unjust. And I found that the look in their eyes was the same broken heart seen in all traumatized people, in all our iterations. It was devastating and beautifully alluring at the same time. I wanted to see them heal.
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Over time and practice, I learned the formal diagnostic criteria for PTSD. It is a confluence of symptomatology lasting more than one month after a traumatic event. It can become chronic, lasting months, years, decades. It begins to set in after witnessing, experiencing, or gaining knowledge of a traumatic event in which there is risk of or actual loss of life to the self, family/friends, or even strangers. After the event, memories of it invade the mind, nightmares may form, and full-on flashbacks may develop. A flashback isn’t just a memory. A flashback is true reexperiencing of the event – and it can be deeply disturbing because it is a sudden interloper in the mind. Other forms of dissociation can be present, too.
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There are thinking and mood changes. At times memory for the event is impaired. At times one feels angry, depressed, unnecessarily “on guard,” or even guilty for the trauma – somehow rationalizing it was their fault. Some begin to feel they are worthless and maybe they won’t live much longer. And these changes are only highlighted, and maybe even worsened, by feelings of isolation. Sometimes isolation is voluntary, as being around people results in reminders of the traumatizing event. And so, life starts to feel lonely, it becomes a struggle to enjoy things – everything seems dull and happiness becomes a distant memory.
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There is anger and outbursts. Most of my Vets from the Gulf War were fathers of school-aged children at the time we started working together. And despite their attempts to be involved dads, they often found themselves in shouting matches at school sporting events. They were kicked out of basically everywhere for fighting. They couldn’t think. They couldn’t calm down at night to sleep.
Obviously, these symptoms caused them a great deal of distress and dysfunction.
THE SOLUTIONS
There are multiple strategies for addressing PTSD, including medication and various types of therapy. Currently popular is somatic experiencing therapy and Eye Movement Desensitization and Reprocessing (EMDR), but therapists also use Cognitive Behavior Therapy, working through the “trauma narrative,” group therapy, etc. I find a place for all our treatment modalities in PTSD and know they’ve helped my patients tremendously. Today, I’d like to share my favorite approach - because it is something a patient can do on their own between sessions, without the risk of becoming retraumatized, and because it has been proven to return the brain to normal functioning and structure.
Basically, I want to shut the alarm off. The part of the brain McLean referenced as the reptilian brain – I want it to go back into a normally responsive state. And the mammalian brain, that picks up all the sensations and feelings, I want it to relax. When these two events happen, the thinking brain can grow and thrive again. The work of Bessel van der Kolk, a Boston-based psychiatrist and researcher, has revolutionized the way I see and treat PTSD. He’s been working in this field nearly 40 years and in 2014 released the book, "The Body Keeps the Score" which, among other things, explains how we can “rewire” the brain after trauma.
Say what you want to say
So, when I am working with a patient that has PTSD, I don’t have them focus on the trauma repeatedly – unless they intuitively feel they need to talk it out. When I have patients that lost their ability to speak during an assault or medical trauma (usually due to being intubated for an extended time), I allow them to talk about trauma, and anything else that comes to mind, as much as they desire. It is them reclaiming their power and agency – a strong signal to the brain alarm that they are in control again.
Let’s move
In nearly every case of trauma I see, people were immobilized or paralyzed by fear, or physically trapped or restrained by an assailant or circumstance. For them, a key component to recovery is movement. Rhythmic movement in dance, Yoga, and running are my favorites. They show the brain the person is in control of, and can feel safe in, their body again. In therapy, if I have a patient that wants to talk about their traumatic experiences in detail, I ask them to take a walk with me and tell me about it. I don’t allow them to ever sit in trauma again. I also tell them to avoid sitting in one place thinking of the trauma between sessions. If memories come, that’s ok, but when they notice them, I want them to get up and move.
Where do you THINK you’re going?
Going through a traumatic experience is not only frightening, it’s confusing. It’s disorienting. After the event, or even during, your brain tries to think up an explanation for what’s going on. But since the brain alarm system has turned on, thinking becomes difficult. And it may get more difficult over time. This understanding is one of the reasons I began to change my therapeutic style for people with PTSD.
Some patients try to use their intellectual abilities to process or rationalize the events that led to the development of their PTSD. As an initial approach, it may not work. What begins to happen instead is people become stuck in a memory surge. Trauma feels like it’s happening in the present. And talking about it can become retraumatizing – or reinforce feelings of powerlessness, anger and disgust.
The Amazing Healing Woman: How a Woman’s Intuition Saved her Life
Many years ago, I worked with someone that had experienced a trauma so shocking, she was unable to speak about it. I don’t mean she’d talk about it and get upset or cry or just shut down. I mean her mouth would literally not form the words to talk about it. When talking about everyday topics, her speech was completely fluent. And when she’d try to tell me about the trauma, thoughts about the trauma, or even how she was feeling as a result of the trauma, her eyes would widen. She would stare, unconsciously tap on my desk, and would stutter to the point that I would often interrupt her to save her from the distress. She became paranoid of others’ intentions and became extremely angry with herself. She fell into a depression. She tried medicines. For many people they work, but didn’t help her much. She remained depressed.
As part of the depression, she would neglect most things she needed to do – cleaning, paying bills, showering. Instead, she would bake. Repeatedly. She baked 8 hours a day for over 3 months. She did not really talk to anyone, leave her house for much, enjoy anything, or even eat the food she baked. She would see me for office visits – and we’d talk about baking. We talked about baking through an entire summer - and then one day, she stopped.
She moved on to a new project. For a year, she continued to do this - intense focus on learning a new skill for several months at a time, and then would abruptly stop and switch to something else. Everything she did required her brain to be able to follow multiple steps in order. Everything required rhythmic movement. And everything was time-limited.
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Over time, she started to look differently – stunningly beautiful. It was like watching a flower blossom. Her desire to care for herself returned. Her sense of safety was being restored. Her ability to speak came back, and she could sit down and talk with general ease about her trauma. It happened without my interrogation, she just started talking. It took about one year of these projects, but she did it. She followed her intuition, and her natural ability to release trauma from her brain and body. Her approach worked better than any other modality that had been tried to that point – I was not her first therapist.
Essentially, what she did was to shut the alarm system off in her brain. All of her projects required the integration of her whole brain, that’s why they worked. Healing from trauma is integrating and releasing it. The repetitive movement and rhythm soothed the reptilian brain. The use of texture, flavor, scent, color, and beauty soothed the mammalian brain. Her need to focus brought her into the present moment. And doing multistep processes that required both memory and decision-making actually rebuilt the neomammalian thinking brain.
Over time, I saw her PTSD resolve by at least 85% and this is all without having to talk about her traumatic experiences at all. Later, she was able to use her rational mind to free herself from some lingering feelings of guilt, but there would have been no way for her to do that in the beginning. I do think medication eventually helped her improve somewhat and am not suggesting one shouldn’t seek psychiatric care and counseling for PTSD. This case illustrates at-home healing practices one can do in addition to therapy and medicines. It also supports the newly emerging data on what it really takes to heal your brain from the symptoms of PTSD.
Try it at home
So, for those of you reading this article and wanting to heal from PTSD, try to do what my patient did. Try to engage your entire brain in activities that have the potential to heal you. No, you don’t have to neglect all else. But, you should definitely make use of rhythmic or focused movement, things that you can manipulate with your hands that appeal to your senses, and seek time-limited activities or projects. Time-limited activities help the brain remember that everything comes to an end – and that even though your traumatic experience happened, it is now over. You can talk about the trauma if you’d like, but if you do, move your body – show it who it belongs to and who is in charge.
Some things my patients have tried:
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Trauma Sensitive Yoga (one of the most effective strategies researched)
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African Drumming and Dance
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Belly dance
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Rearranging closets, home offices, and pantries
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Redecorating rooms in their homes, or changing furniture arrangement
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Playing piano, guitar, or drums
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Growing a garden
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Listening to their heartbeats with a disposable or inexpensive stethoscope
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Learning a new language
Whatever you use to integrate and release trauma from your mind and body, just know that it can work, and you can heal. Beyond that, because of lived experience, you can become wiser and stronger. I’m not suggesting you glorify or seek trauma. And I don’t believe that if you struggle to heal you’re weak. But I know that for far too long, the traumatized have been viewed as unfortunate, broken, “crazy” victims. But oh, to the contrary! When we find our way back, we are victors!
Tell me your thoughts. How would you go about turning the brain alarm off?
I want us all to heal. So, for more information, check out these websites – and if you know of other helpful sites, send me a link!
African Drumming and Dance Links:
http://allafrica.com/stories/201702200062.html
https://www.youtube.com/watch?v=kZHfmgIb4mc
Trauma Sensitive Yoga Links:
http://www.traumacenter.org/products/pdf_files/Yoga_Chronic_PTSD_LTFU_Study_R0003.pdf
http://www.socialworktoday.com/archive/111714p8.shtml
Other Music and Dance options for treating trauma:
https://www.hsrd.research.va.gov/news/research_news/music-010614.cfm
https://bellydanceu.net/teachers-lounge/ptsd-what-a-belly-dance-teacher-should-know/
My Resource Articles:
https://psychcentral.com/blog/the-science-behind-ptsd-symptoms-how-trauma-changes-the-brain/
http://www.healmyptsd.com/education/post-traumatic-stress-disorder-statistics
http://www.traumacenter.org/about/about_bessel.php
http://www.traumacenter.org/products/pdf_files/Yoga_Chronic_PTSD_LTFU_Study_R0003.pdf
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* If you or a loved one is in a mental health crisis, please call 911, go to the nearest emergency room or reach out to 1.800.273.TALK or other national crisis hotlines.
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*This article is for informational purposes only, is not intended to diagnose or treat any condition, and does not take the place of a medical assessment or treatment by a licensed professional.