A User's Guide to PTSD, Part II: What Does A Flashback Feel Like?

[rachelmanija]

This is Part II 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.)

I Don't Have To Do This Any More. (On recovery; lingering effects; book, film, TV, and music recommendations.)



It is generally a bad sign when you lose six months of your life.

PTSD can begin right away, or it can have a delayed onset. Or it may be hard to tell, as in my case.

I left Ahmednagar, India soon before I turned thirteen, and moved to Santa Barbara, a town in southern California, USA. Hello, culture shock. It's hard to say, for the first few years, whether I was unhappy because high school sucks and I had no friends, or whether it was because I was depressed. I'm sure I was depressed by the time I was sixteen, though; I began to notice that I could go to the movies or read a book and I'd feel OK at the time, but the instant the distraction was over, a heavy gray blanket of misery dropped over my head and covered me.

But before that, when I was fourteen or fifteen, I was walking home from school when I remembered having rocks thrown at me. This wasn't a flashback, just a normal memory. But when I had it, it occurred to me that I hadn't thought about my years over there-- at all-- for at least six months. Literally, not once.

Then I thought, "Wait a moment... What have I been doing for the last six months?"

There is nothing quite like the realization that you have apparently been sleepwalking for months and months. It was not a total blank, but I could not recall very much at all, and what I remembered of it was that I'd been on autopilot, moving through life in a daze without really thinking of anything at all. And then I'd suddenly woken to full consciousness, on my feet and walking down the sidewalk. I believe that this is called a fugue state.

This is one reason why repressing memories is bad. Apparently, in order to not remember the trauma, I had to suppress just about everything else as well. When I realized this, I had the horrible sense that something was disastrously wrong with me-- that the damage had already been done. It was like a much more frightening and awful version of the moment, many years later, when I lost control of my car, hit the curb, and flipped off the freeway at 65 or 70 mph. In mid-air, I thought, "This is really happening. I can't stop it because it's already happened."

That is an example of the DSM-IV's criterions C-1 and C-2, in the "avoidant/numbing section."

"1. Efforts to avoid thoughts, feelings, or conversations associated with the trauma

3. Inability to recall an important aspect of the trauma" (As in, the whole thing!)

Turning into a zombie is not one of the criteria, but I bet I'm not the only person that ever happened to.

I wish I could say that I'm surprised that no one noticed that I was an automaton for quite some time, but... I'm not surprised.

Many years later, my parents mentioned that when I'd first come back to the US, they were considering moving to Ojai, but when they took me there, I burst into tears and started screaming hysterically that the hills looked like Ahmednagar and I wouldn't live there and they couldn't make me. (The hills have roughly similar vegetation and topography, so there is some resemblance.)

One might think this would be the cue to take me to a therapist, but if my parents did stuff like that, they would have been totally different people and I would not have been traumatized in the first place. They did nothing, other than not moving to Ojai. I vaguely remembered this when my parents reminded me years later, but I hadn't until then.

This is criterion 4B from the DSM-IV, "intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event."




You don't have to eat the eggplant.

These cues are often known as triggers. It can be helpful to know what your triggers are, so you can avoid them, desensitize yourself to them, or at least prepare yourself for the impact they're going to have on you. The trouble is, they can be nearly infinite in number, and you generally don't know what they are until they trip you. I would not, for instance, have thought of "topographical resemblance to countryside' as a trigger for me until it happened-- and then I promptly forgot about it, thus losing the possibility of dealing with that one.

A trigger can be just about anything-- a smell, a sound, an emotion, a situation-- and does not have to be traumatic in itself, but merely remind you in some way of the trauma. (I actually liked the hills in Ahmednagar.) Say you were raped by a blue-eyed man who got out of a white car. You could end up being triggered by blue-eyed men, white cars, or the brand of cigarettes which happened to have an empty packet on the ground in the alley that your eyes happened to fix on while you were being raped. When you come across one of those triggers, you could have a panic attack, a flashback, go into a state of hyper-arousal for the next few hours or days or weeks, or just feel uncomfortable and nervous and maybe not even know why.

Some triggers will probably bother you a lot more than others. If you are unlucky enough to find yourself in a situation which really does strongly resemble one from your trauma, it could push you into a far more severe reaction than is usual for you-- as I will detail in the section on flashbacks.

Avoiding triggers is also considered a symptom, and if you are triggered by something like wide open spaces or red cars, avoidance can be its own problem. However, if any given trigger is easily avoidable without limiting your life, my feeling is, why not avoid it? I don't like eggplant, so I don't eat it just to prove that I can; a loud bang will set me off, so when I see someone blowing up a balloon, I ask them to step away so they won't be near me if it pops. Think of it this way: if you weren't tough, you wouldn't have made it this far. You're allowed to not eat the eggplant.




If you have PTSD, odds are good that it is not your only problem.

When I went to college, I crashed harder than my car did off the 405 freeway.

PTSD frequently occurs in tandem with other mental illnesses, most frequently depression and/or addiction. The same trauma that caused the PTSD can also cause or trigger other mental and behavioral problems. Also, people often get addicted to drugs or alcohol or other substances or behaviors in an effort to numb or distract themselves from whatever pain and anxiety they're feeling. PTSD causes pain and anxiety, so it is entirely unsurprising that it frequently co-exists with addiction.

What I had to go with my PTSD was major depression. Keep that in mind as you read, because some of the symptoms of that and PTSD overlap with and feed into each other.

If I didn’t have enormous issues about control and some fluke of biology or temperament that causes drugs and heavy drinking to be neither effective nor addictive, numbing the pain via substances would have been very, very tempting. That’s not to say that I didn’t resort to other self-destructive behaviors, just that mine were different.

I developed insomnia in my late teens, and by the time I'd been at college for a while, I was lying awake for hours each night, and eventually half the night. I sometimes had vivid and detailed nightmares, in which I would dream that my entire life up until that point had been the dream, and I was still a kid in Ahmednagar.

(Nightmares are common in PTSD, sometimes of the trauma, sometimes seemingly unrelated or metaphoric. When I was still in Ahmednagar, I used to dream that I was entombed in solid rock. I believe that my subconscious was shrieking, "I feel trapped and buried alive!" Some people with PTSD yell and thrash around when they dream, but I didn't.)

I'd wake up with every muscle rigid, my jaw clenched tight, my heart pounding, sometimes drenched in sweat. Then I'd lie there and loosen my muscles one by one, telling myself that it was just a dream. Since I was also prone to dreaming that I had woken up when I actually hadn't, it could be hard to convince myself.

The next morning, my body would ache like I'd been beaten, I'd feel hungover and exhausted, and I'd jump out of my skin every time a twig snapped or I saw some sudden movement in my peripheral vision.

Add that particular dream to the "zombie for six months" incident and my other issues with memory, and I had enough legitimate doubts about my grip on reality that while I didn't literally believe while I was awake that my nightmare might actually be the truth, and that when I fell asleep I might wake up back over there, I can't say that I disbelieved it one hundred percent either. Anyway, just the prospect of having that dream made me less than eager to go to sleep. But the biggest issue was that hyperarousal symptoms were beginning to kick in, and it was psychologically and physiologically difficult for me to relax enough to fall asleep.

I tried various relaxation techniques and exercise, but the only thing that worked reliably was to stay up all night and let exhaustion take over the next night. This is fine if you do it occasionally, but if you do it a lot, you will be chronically sleep-deprived, which can make you irrational and depressed all by itself.

Insomnia is a symptom of both PTSD and depression, by the way.




Attempting suicide via sleep-deprivation will make you even crazier than you were when you got the crazy idea to try it.

I was suicidally depressed, but didn't want to inflict the guilt of my suicide on others, so I had obsessive thoughts of killing myself in a way which would look like an accident. Then some other student was hospitalized with pneumonia, which was attributed to her having worked too hard and not slept and eaten enough, leading to a depressed immune system. So I decided that since I was hardly sleeping anyway, if I added hardly eating to the mix, with any luck I'd drop dead and it wouldn't be my fault or at least not traceably so. If I didn't, and I did realize that it was unlikely, even non-fatal self-destruction had its own appeal, given the bottomless depths of my self-hatred, survivor's guilt, and free-floating shame.

I said I was irrational.

I was also hoping that someone would notice. Remember, I had been programmed with "don't tell," so that was off the table. Unfortunately, this was college, everyone was preoccupied with their own problems (often equally serious-- which God knows I didn't notice), and when people did figure out that something was wrong, they didn't know what or how to deal with it.

This is very difficult for me to relate to now. I don't have issues with food or weight and never have, so starving myself, though technically an eating disorder, was really more a convenient means of passive self-destruction. As I am now an enthusiastic foodie, it feels quite strange and alien that for several years, I would go for weeks or months on end only eating when other people around me were, or when I got so dizzy and lightheaded that it seriously affected my ability to work and study. (I was a workaholic stage manager, if that's not redundant.) But then I had no appetite, and nothing tasted good because I'd largely lost the ability to feel pleasure. (Those are both symptoms of depression.)

In retrospect, I think this was an unconscious strategy to force my focus away from my past and my self, and on to anything else. Any task becomes challenging and requires singleminded concentration when you haven't eaten or slept in two days. I do also enjoy pushing my physical limits, which I now do in a more healthy and socially acceptable manner, via exercise. So my no-eating, no-sleeping campaign was totally crazy, but it wasn't random. Again, not eating and sleeping makes you irrational, which makes all sorts of craziness seem quite logical.

At some point either I got bored, or eating regained some appeal and sleeping wasn't quite so hard, so I stopped.




What does a flashback feel like?

Flashbacks are probably the single best-known aspect of PTSD. I am not sure whether this is because they are inherently dramatic, or whether I can lay that at the feet of 1970s movies about crazed Vietnam vets. Flashbacks often turn up in fanfic and somewhat less commonly in published fiction.

The common dramatic presentation has the person completely lose touch with reality, and speak and act as if they are really living in their memory. This generally involves a lot of screaming and enough dialogue that onlookers can not only figure out what’s going on, but can follow the story of the memory like a radio play. And they go on for hours. Sometimes followed by comforting sex.

I hesitated to say that this never happens, because anything that’s physically possible has probably happened to someone at some point, but I'd never met anyone who'd had that experience, even without the comfort sex. In my anecdotal experience, any sort of flashback is fairly rare-- some people never have them at all, others have them maybe once or twice ever. So I asked a therapist:

"Do flashbacks in PTSD ever manifest in the way they are sometimes depicted in fiction, as episodes in which you replay the traumatic event in real-time (ie, possibly hours on end) while being totally unaware that it is not actually happening, and in which you say and do everything you actually said and did, so any watchers can figure out exactly what happened?

I am a bit dubious about this, as I did have a flashback once where I did completely lose touch with reality, but it lasted three minutes maximum and I basically just froze in place. And from what I've heard from other people, one more commonly has more of a double sense that the memory feels real, but you do know that you're still in your living room (or whatever.)

But I don't know! Does the movie/fic-type flashback really happen? Is it common (in the PTSD population)? If you're reverting to childhood for hours every night, would you still be capable of piloting a Gundam in the morning?"

[A Gundam is a giant flying fighting robot. Duo in my icon pilots one. Their pilots are notoriously mentally unstable, so much so that "Gundam pilot" may be both a job description and a diagnosis.]

gaudior wrote, "Huh. I don't want to say that never happens, because you're almost always wrong when you say that about people. But I haven't heard of it.

Then again, my experience is limited, so let me try to think of some things that could happen thus (am I guessing that this would be helpful for essay-writing?). I think that most of the time, when you're flashing back, you've got similar mechanisms going on as when you're dreaming, that keep you from moving, speaking, etc. But of course, there are exceptions to that. One thing could be that your trauma, in addition to whatever else you've got going on, has pushed you over into psychosis, so you're having delusions at the same time as the flashbacks (ouch). It's true that trauma does a good job of predisposing you to whatever mental illness you might have been set up for by your genes, so if you have psychotic depression or schizophrenia or some such, it could manifest like that. I think. In which case, you're really not gonna be flying your Gundam in the morning. Or if you do, you have more problems than this.

One thing that might be more likely for Gundam pilots would be the really intense nightmares that go with PTSD, which are much more like "flashing back for hours at a time"-- each dream doesn't last hours, but you could have a lot of them. And each one could trigger some of the more aware-of-where-you-are-but-still kinds of flashbacks. In which case, in the morning-- well, you're going to be really irritable, and have a hypersensitive startle reflex, and want to avoid anything like that, and possibly have some panic attacks, and so on. So it depends a lot on what you're doing in your Gundam-- you might actually do quite well in combat, as long as you can avoid curling up into a little ball.

(Have I mentioned that when I picture myself in the Gundam universe, I don't fantasize about being a pilot, a pacifist, or a commander-- I fantasize about being a rogue therapist for pilots?)"

As I said above, what other people have told me about flashbacks is that while they know that they’re not literally re-living the past, it feels as if they are, and to a certain extent they react as if they are. The memory is extremely vivid, might include sound and sight, and you might have some physical responses (like sweating or crying) but it co-exists with reality. I hope someone will elaborate on this in comments, because I haven’t experienced it myself.

I have only once had a flashback, and it was a case of an unusual set of circumstances conspiring to hit all my buttons at once, thus pushing me into a much worse reaction than I normally would have had.

I volunteer at a mentoring program/summer camp for kids. I was walking past two of the adult men volunteers, who were playing catch, when one of them unexpectedly tossed the ball at me. Because of my history with people throwing rocks at me, I reacted as if it was a rock—I momentarily thought that it was a rock—and dove to the side. Then I realized what had happened. Even before anyone said anything, I’d had a ton of adrenaline dumped into my system, which does not feel good under those circumstances; I was angry at the guys for causing that reaction; and I felt humiliated that I’d acted weird in front of them. (They had no idea of my situation, of course.)

One of them remarked, “Just like a girl, ducks instead of catches!”

Then I was furious at him for being a sexist asshole, for laughing at me when I had a serious problem, and for looking down on me for being weak and incompetent when, I was pretty sure, I’d survived worse things than he’d ever been exposed. I thought, “When I was eleven, I disarmed a boy who was threatening me with a switchblade. What have you ever done that gives you the right to laugh at me?” So I was not only going into emotional and adrenaline overload, I’d also had two different bad memories of about the same time period tripped.

However, I’m sure it wouldn’t have gone any farther, except for what happened next.

I picked up the ball and threw it back at him as hard as I could. I aimed it so he could catch it, but I did intend to sting his hands a bit. My focus had narrowed down to those guys, and I was paying no attention to anything else around me. Just as the ball left my hand, one of the kids we were mentoring, an eleven-year-old girl, stepped right between us. The ball hit her smack in the eye and knocked her down.

I would have been pretty upset at this under any circumstances, but the fact that she was the age I’d been at the time of the memories that had just been triggered, plus everything else that had just happened—and that all this took about two minutes, which is not a lot of time to calm down— I lost it.

The guys ran to see if the girl was all right. I said, to no one in particular, “I... I didn’t mean...” I stumbled one step backward—

--and I was back in Ahmednagar, on the grounds of the evil abusive school I attended, surrounded by a gang of kids throwing rocks at me and yelling insults. This was not the sort of flashback I mentioned above, in which you do know that it’s not real and don’t lose track of where you really are. Not only did I not know that it wasn’t real, I didn’t even have the sense of my present-day self being transported into a nightmare. I wasn’t adult Rachel on the playground, I was child Rachel who had never been anywhere else. I could feel the heat of the sun on my hair, and taste the grit and dust in my mouth.

--And then I was back in the present. A crowd of adults, other volunteers, who I don’t think had been within my line of sight before, were standing around me, calling my name and looking really worried. I was still on my feet, but a couple steps backward from where I’d been before. The girl who I’d hit with the ball was doubled over crying and clutching her eye, and there were only one or two people with her.

To this day, I wonder what I did that made them all ignore her and cluster around me! I didn’t have the nerve to ask at the time, and now it’s been so many years that I don’t remember who was there. (And am not so curious as to make me want to bring it up now.) I am pretty sure that I didn’t say anything, because I had a sort of kinesthetic sense that I hadn’t. My best guess is that I went white and staggered a few steps backward, thus catching at least one person’s attention, and was completely nonresponsive when they spoke to me. It couldn’t have been more than a couple minutes, because the girl was being led away when I came out of it, and she hadn’t gotten very far. But I think two or three minutes of catatonia would have been sufficient to gather a crowd.

I think someone in the group told me the girl was OK. (She had a black eye, I think, but no serious injuries.) I don’t think I said anything. I burst into tears, then shoved aside whoever was in my way and took off like a rocket. I ran until I found an open and vacant room, then I curled up in the corner and sobbed for hours. I don’t think I even had any coherent thoughts. I’d just gone to pieces.

Eventually, I had to come out and face the music. I felt much like Gaudior wrote about how one might feel after eight hours of nightmares and the less extreme sort of flashbacks, only more so. Unfortunately, I did not have the option of getting in a Gundam and blowing stuff up, but instead had to slink into the camp cafeteria. I had no idea how I was going to explain my reaction, but since this was a camp devoted to volunteering for kids, I think everyone assumed I’d just flipped out because I thought I’d injured a child.

I think this sort of flashback is much more likely than the “radio drama” type, and probably much less likely than the type where you don’t forget who and where you are. As a writer, I suggest that you not have your characters have sex afterward, no matter what type you choose! A warm body to hold on to might be very comforting (I imagine, she says bitterly) but sex is likely to be unappealing, too much effort, or too physically or emotionally difficult. Especially if the original trauma was sexual. A man might not be able to get an erection. (I know sex does not have to involve an erection—I’m just saying.) Also, the “curled up in a ball for several hours” reaction is pretty likely, and if my partner was doing that, the last thing I’d do would be try to have sex with him.

From the outside, I don’t think it would be easy to tell that someone else is having a flashback unless they told you. It might be obvious that something is going on, but not what. Despite the other irritating literary trope of “we had to hold him down for hours while he re-enacted the battle of Gettysburg,” it is probably not a good idea to touch someone who’s having a psychiatric crisis of an unknown nature. Calling their name would be better. If someone had touched me, I probably would have punched them.

As a dramatic device, flashbacks are best used in moderation. Each one will be much more of a shock to your character, and have more impact on the readers, if they’re infrequent or one-time-only thing than if they happen every day.

Finally, with all of these unpleasant experiences I've detailed above, I want to note for writers that the aftermath, for me, has never included vomiting. Not once! I am not sure how throwing up has gotten to be a fictional signifier of extreme emotional distress, but it seems like every other movie and novel and fanfic I read has someone having a nightmare and then vomiting, or a flashback and then vomiting, or hearing bad news and then vomiting. People do sometimes vomit from stress, but generally they have a touchy stomach and that is natural to them. If they are not prone to that in general, it probably won't happen, unless there are other factors like heavy drinking, bulimia, concussion, or food poisoning. Otherwise, it's cliched, unnecessary, and gross. Enough with the vomit.




Don't go to sleep with a gun in your hand.

PTSD is an anxiety disorder. Probably its most common features (remember that not everyone will have all the symptoms, or at least not all at once) are hyper-arousal and hyper-vigilance, which both involve abnormal levels of anxiety.

Hyper-vigilance can manifest in a lot of ways, but it's basically worrying intensely about your own safety or the safety of others, and taking a lot of precautions to ensure it. This is a fine line, since plenty of people without PTSD are interested in, say, disaster preparedness, and certain occupations, like firefighting or police work, will make you a bit preoccupied with safety. I spent a year doing disaster relief and disaster preparedness for the Red Cross and periodically take refresher courses in search and rescue and so forth. That gives me concrete things to do (like update survival kits) which make me feel less anxious, and I've used my training in real-life situations to help others, so that's been a productive way to channel those impulses.

A lot of people in America own weapons for protection. But if you're sleeping with a loaded gun under your pillow, that is hyper-vigilance. Other common manifestations include checking rooms for danger before walking in, noting where the exits are and where you could take cover, and not sitting with your back to a door-- or being very uncomfortable if you have to. If you know that someone has PTSD, let them choose the table or take the first seat at the restaurant. Not all of us have issues about doors and exits, and that sort of thing tends to ebb and flow with those of us who do, but at worst it will be polite and at best it will make your friend much more comfortable.

If you tend toward hyper-vigilance anyway, and then something happens to encourage it, that can push you into more extreme behavior. For example, I usually slept with a Maglite within hand's reach of my bed, because of earthquakes. Mostly because of earthquakes. (That's a huge, heavy flashlight like a policeman's baton.) After my apartment was burglarized when I was out of town, I got anxious about a burglar breaking in while I was home, and for a couple weeks I slept with the Maglite in my hand. And for a few nights I slept with a big knife like a machete in my hand. I wouldn't do that again. I hope.

Any sort of stress can also cause flare-ups of hyper-vigilance and other symptoms. I still occasionally keep the Maglite in my hand when I sleep, if I'm feeling especially anxious. I realize that as the actual likelihood of someone breaking in is constant, this is purely for comfort and I might as well clutch a teddy bear. But it works. I sleep. If I was doing that all the time, I might try to stop, but at the current rate of a couple days a year, I figure it's easier and less stressful to not fight it. ("Don't eat the eggplant.") Plus, if an earthquake hits while I'm asleep, I will be set.

And I keep a fire extinguisher in my car. However, that is because I have twice now needed one to put out a car fire and not had one on hand, so that is totally not crazy.




NEVER EVER hug a stranger from behind.

Hyper-arousal is more or less the physical equivalent of hyper-vigilance. In my experience, it's the single most common PTSD symptom, at least in people whose trauma involved violence.

Imagine you're watching a horror movie, and the music builds and builds, and oh no! She's going to the basement! She's walking down the stairs... feeling for the light switch... The moment of your highest tension, right before the jump-cut to the monster that makes you scream, is what hyper-arousal feels like. Only more intense, and all the time. Usually including in your sleep. If you can get to sleep.

Sudden noises make you jump. Sudden motion makes you jump. Touch makes you jump. You're taut as a guitar string. Walking down a busy street, with all those cars moving fast and making noise, is like running a gauntlet. You sweat. Your heart pounds. You breathe fast. You always want to look over your shoulder.

Once when I was in a really bad state, someone admired the necklace I was wearing, then reached out to touch it. Normally that would have been fine, since I had warning, but I was so edgy that I jumped back, without meaning to.

"Er... may I touch your necklace?" she asked.

"Sure," I said, figuring that it would be fine since I knew it was coming and vowing to stay still, like a normal person. She reached out her hand toward me. Just like it had the first time, it felt as if someone had suddenly and without warning lunged toward me in a threatening manner. Entirely without volition, I jumped backward.

That is what I meant earlier about some PTSD symptoms making you feel and act as if you are losing your mind. A few days later, I called the psychiatric department of Cedars-Sinai, a local hospital, and made an appointment.

If something would be startling to anyone, rather than only startling if you have PTSD, a person with hyper-arousal may react very dramatically. I have rolled under a desk because a car backfired. (This is probably not because it sounded like a gunshot-- I was never exposed to gunfire-- but because even non-traumatized people are startled by short, sharp, percussive noises.) A waitress once reached over my shoulder with a cup of coffee, and I knocked it out of her hand.

These reactions are impossible to control because they're faster than thought. You don't realize what you're doing until you've already done it. And then, typically, not only are your nerves even more jangled by the adrenaline that the stimulus dumped into your bloodstream, you probably feel very embarrassed by your reaction, and will frantically try to figure out how the hell you can explain it. Especially if you reacted violently.

This is why you should NEVER EVER sneak up behind anyone and glomp them or touch them, or even suddenly and without warning tackle-hug them from the front, unless you KNOW they are OK with it. I have never actually injured anyone who's done that to me, but people have gotten banged heads or my elbow in their ribs when they tried it, and odds are good that someday someone will really startle me, and I will break their nose or worse.

Please don't make me break your nose.




Or shake a sleeping soldier.

This goes double for touching people who are sleeping. It's a really common issue in veterans, for obvious reasons, even if they don't have PTSD and have no other symptoms. I know a woman whose father is a Vietnam vet, and a really sweet, gentle person. But she always knew that she wasn't supposed to touch him when he was asleep. When she was a teenager, she spaced out and grabbed his shoulder when he was snoozing in a chair in the living room. He had her all the way across the room and up against a wall before she could scream or he could wake up. No harm was done, but it was scary for her and I imagine scarier for him.

Don't shake people awake unless you know they're OK with it. If you happen to know they're not OK with it, stand on the other side of the room, so you're not looming over them, and call their name until they wake up. If you're sharing the bed, you probably don't need to worry about it. Personally, that's never been a problem for me, as I have a kinesthetic memory that they're present and not a threat. Same if I'm sleeping in public (like on a plane) or sharing a hotel room. It's the unexpected presence that's a problem.

Given that, if you happen to know that someone has PTSD or is a veteran, try to avoid walking into a room where they're sleeping unless it's a public place or you're sharing the room with them. If you have to, call their name from outside to wake them up. (Again, unless you know this isn't an issue for them.)

I once had a friend stay over at my apartment and sleep on my sofa in the living room. Unlike my old apartment, it was a one-bedroom and you had to walk through the bedroom to get into the bathroom. Ironically, Tracey was studing to be a therapist and not only knew all about my PTSD (and had been the first person to diagnose it, years earlier) but even thought that maybe she shouldn't walk in. But in a massive lapse of judgement caused by being half-asleep herself, she decided that rather than knock to wake me up, she could tip-toe through and get to the toilet without waking me up.

From my perspective, what followed went like this, but in less time than it takes to read it:

Is that a noise...?

Eyes open: INTRUDER!!!!

Reach for weapon, not there, never mind, use fists--

Wait, that's Tracey, Tracey's here--

--I freeze halfway across the room, the sound of my own battle-cry echoing in my ears.

--And this all went so fast that I had already stopped when Tracey hurled herself backward, and slammed into the opposite wall with her hands over her head, yelling, "It's me, it's me!"

"Tracey," I said, reminding myself. "...Sorry about that."

"I thought you were going to throw a knife at me," she said. I guess she saw me reaching for my Maglite, which had not been in its usual place because I'd used it as a flashlight and left it somewhere else.

"I don't have any throwing knives," I said. I don't think she found this reassuring.

I also once woke up under the bed, where I had dived-and-rolled when a moderate earthquake hit in the middle of the night. I woke up when it was still going on; I had moved before I was fully awake.

If I have reason to expect that someone might walk into the room while I'm asleep, though, it's not a problem (as some of you know from experience) so you don't have to worry about sharing a hotel room with me or anything like that. I was even OK with someone climbing into my bed in the middle of the night, because it was a shared room in a con and I had reminded myself before going to sleep that someone might. The human mind is a wonderfully flexible and adaptible instrument, all things considered.



At this point, you may be wondering how in the world I was managing to lead anything remotely resembling a normal life. Writing this essay, I wonder the same thing. And yet I did get an undergraduate degree, then a graduate degree, have friends, and hold various jobs, all of which I managed to perform with at least some degree of competency.

But, remember that I didn't have all the symptoms all at once. They come and go. I wasn't diving under desks 24-7, just if my level of overall stress, my level of symptomaticness (is that a word?), and outside triggers combined to produce a visible reaction. And even then, a lot of what was going on was not visible to others, because I was highly invested in and skilled at putting up a front of normalcy.

It’s absolutely possible to be completely disabled by PTSD, but it’s also possible to have fairly severe symptoms and still hold down a job and seem more-or-less normal to a cursory inspection. This will be affected by a lot of factors, such as how much money you have and so how much it will affect your life overall if you forget to pay a bill or miss a few days of work, whether you hold a job which requires a lot of concentration and skill to achieve even minimal competency (like brain surgery) or one with more room for error, how invested you are in keeping up appearances, whether and so forth. This is similar to depression, anorexia, or alcoholism: some people hit bottom fairly quickly, and some people never really do.

In literary terms, I’d be surprised if a person’s work life is entirely unaffected, but I’d buy that they could continue working with reasonable or even excellent competence. However, some area of their life is bound to be falling apart, because that’s the nature of the beast. Typically even if your work isn’t much affected, your social, love, or creative life is. Or any variant on that.

Tomorrow or the day after, I will post the final part of this essay, on recovery.

Feel free to link, ask questions, comment, share your own experiences, correct my science and statistics, or recommend media on the subject. Also, anyone is always welcome to friend this LJ.

Comments

[tekalynn.livejournal.com]

Word on don't hug a stranger from behind. I'll kick like a mule.

[singsonggirl.livejournal.com]

I gave my girlfriend a black eye when she decided to grab me from behind. At least she thought it was funny.

[mac-stone.livejournal.com]

Excellent series, I look forward to the conclusion.

Here via Sartorias (http://sartorias.livejournal.com/profile) - friending you, if that's alright.

And thanks.

[chomiji]

Interesting. I tend to automatically try to strike (with some type of hand blow) or elbow anyone who grabs me unexpectedly, and I have no idea where this behavior comes from. I do have one actual traumatic memory of being held down - when I was to have some teeth removed for orthodonture at age 8, they didn't warn me before they put the breathing mask over my face, and my last conscious memory is of kicking out while they attempted to restrain me. But I am not sure that is the reason for my reactions even now.

I'm not at all surprised that major depression and insomnia set in when you went to college. The change in environment and withdrawal of my usual social connections had me on the ropes with insomnia in the first two weeks, and that cascaded to major depression by the next month. It would not surprise me if this were extremely common in introverted but social people. On top of everything else, this must have been devastating for you.

[rachelmanija.livejournal.com]

From other comments here, it sounds like people can have that sort of reaction just because of normal human variation. Also, you train, which probably ingrained your natural tendencies.

I recall that a number of other students had some sort of nervous breakdown soon after going away to college. One of my roommates was suicidal and had to be shipped back home.

[ruffwriter.livejournal.com]

(Oh man, it is such a bad idea to grab people from behind. Even without PTSD, my natural instinct is to evade it and protect myself... and I'm a really tactile person, too!)

I'll be adding all three parts of this to my memories... it's an amazingly thorough resource for anyone who wants to write about it, and I think it'll be really valuable. Thank you so much for sharing your experience! It's really, really admirable how well-adjusted you are despite everything.

[arielstarshadow.livejournal.com]

A wonderful and engrossing second parter - and I'll be re-reading it because I got a few ideas for possible scenes in the book from it.

Thanks again for taking the time to write this.

[matociquala.livejournal.com]

My own flashbacks are kinesthetic, and brief. They often come with a massive wall of rage, however.

They have gotten less frequent over the years.

I used to get them in the shower a lot. I'm not really sure why, unless it's because my guard would drop.

I also will hit people who trigger my startle reflex. I feel very bad about it afterwards.

[kate_nepveu]

Minor suggestion: it might be helpful to put the cut-tag text in the body of the post itself as headers, such as:

***

<lj-cut text="It is generally a bad sign when you lose six months of your life.">

<b>It is generally a bad sign when you lose six months of your life.</b>

PTSD can begin right away, or it can have a delayed onset. Or it may be hard to tell, as in my case.

***

I'm looking forward to part three. My only experience with PTSD is a case where the litigant claimed to be suffering from it and sought compensation, which is obviously a very different perspective.

[rachelmanija.livejournal.com]

Thanks, I'll do that.

[clodia-risa.livejournal.com]

On inappropriate touching - when very stressed out right before my wedding, I had someone hug me unexpectedly and without my permission. My stress level immediately shot up by ten degrees and I went and cried for thirty minutes. People should be careful of touching anyone without knowing what that person's boundaries are.

[gnarlycranium.livejournal.com]

Definitely, regardless of who the person is. I was out on Pier 39 watching the Blue Angels a few weeks ago and some old guy in the crowd suddenly prods me from behind to complain that I was standing in front of him (I'm tall). If he'd simply asked politely I'd apologize and move, as it is I was wrestling with the adrenaline of wanting to smack him for the next hour, feeling violated, cussing loudly and demanding of nobody in particular "Who the fuck told him he could TOUCH me?!" Then I dropped my soda and started to cry, with like a hundred people right there, rather embarassing.

[http://users.livejournal.com/_swallow/]

(Thank you so much for writing about this.)

[yhlee.livejournal.com]

Thank you for writing this.

[comrade-cat.livejournal.com]

Hi, it's me again. I was going to thank you for posting again, it is so fascinating, & I was agreeing about the hyperarousal (I have a couple mental problems too) - when I realised that I actually did get PTSD from a car crash & never realised it. But I remember walking a 15-minute walk by the side of the road with no sidewalk to get to my psychologist's office, & being hyperaroused the whole time, being sure the cars were coming at me, but knowing they were not. I ended up not being able to speak for a bit when I arrived at my therapist's.

I was in kind of an extreme accident, because my mom had a heart condition & was totally in denial & was driving me home from college when she started losing the battle & falling unconscious for various periods of time. She passed out for an hour or more in a sitting position in a restaurant at a rest stop & only woke up when I came in to check on her after I'd finished my book & realised she wasn't there. She completely denied that it was more than an hour & said it was only a few minutes. This was completely messing with my sense of reality, along with her insistences that she wasn't sick, because I was severely depressed at the time & was prone to having these odd panic attacks where I hit myself & screamed & couldn't control myself. They don't fit classic panic attack symptoms, but that's what I called them.

So it was night & we were driving home & she kept falling asleep/unconscious & then waking up & yelling at me for not keeping her up & then it got worse & we kept going off the road into the ditch & coming back onto the road & going off the road & coming back onto the road, &c. (The car was completely trashed by the time we got back to New York state, about 24 hours later.) I managed to get her to pull off the highway, on the assumption that we could find a hotel, but we couldn't. What was going on in her mind, I think, was she was running on pure stubbornness & emotions, & she kept saying how she had to get back home or she'd be a bad mother. Since she wasn't thinking, this became urgent, & didn't involve stopping to sleep (which she probably wouldn't have woken up from anyway). So we were lost somewhere in rural Pennsylvania sometime after dark, & then at 4am, & it kept going on, & I was very tired too, & finally I figured I couldn't keep her awake, & if I was going to die I couldn't do anything about it, so I went to sleep (I was in the back seat, which probably helped). I woke up in daylight in the car on some highway on the edge of a mountain (& boy was the other car alarmed when we came around the bend in the other lane - but we swerved just in time - I could see the other driver's face, it was pretty funny), & when I asked Mom where we were she said she didn't know. She was a lot easier to deal with exhausted into compliance. She actually let me take charge of the navigating, & I got us to my best friend's college town, & she agreed to stop in a hotel, then I snuck out of the hotel room & called my best friend from a payphone so my mom wouldn't know I was disagreeing with her version of reality. He came with his parents & drove us back home. (Then my mom decided to lie on the stairs in the house & not move 'just for now because I'm tired' & I had to convince her to let me call 911, &c, which is a whole other story, but not traumatic.)

But after that whole thing, I had problems watching car crash scenes in movie previews, which I figured was normal, but I thought the panic attack thing by the road was a bit excessive. But if I look at the incident by the road as hyperarousal - it was exactly as you described it - then I notice that when I closed my eyes during car crash scenes, it felt exactly the same way, just less intense.

Oh, & I agree with you completely about non-fatal self-destruction! I was very into that when I was depressed (mainly college & some years after). I would write more, but my post exceeded lj's length limit (sorry!)

Again, thank you for posting!

[comrade-cat.livejournal.com]

And, no, I didn't know how to drive. I thought I was saving my mom money on her car insurance, & trying to punish myself in some way.

[chipmunk-planet.livejournal.com]

I will second the few minutes-flashback experience.

Thank you so much for posting this.

[vom-marlowe.livejournal.com]

Reading this post made me uncomfortable. I spent most of it thinking, 'oh, hey, I've done that/been like that'.

I've never had an intense flashback like you describe, but much of the rest of it, oh yeah. I'm a lot better these days, and I can be touched (if I know the person and am expecting it), but huh. I'm going to have to think about this.

[scribblemoose]

Thank you so much for posting these. It's really helpful, and a great resource to signpost people too when they reveal distressing levels of ignorance.

Otherwise, it's cliched, unnecessary, and gross. Enough with the vomit.

That really resonates with me - it's got to be a kind of trope and I hate it. (I have emetophobia, which doesn't help, but even so. *shudder*)

And I wish more people would take note of the hugging thing. There's one colleague who comes into our office and seems to think any woman is free game to poke in the ribs or sneak up on from behind. One day I'm going to fucking lay in wait for him just for the satisfaction of breaking some part of his stupid body!

[tekalynn.livejournal.com]

Oh god, attack pranksters. There ought to be a law, or at least a retaliation clause.

I've had a few people think it tremendous fun to sneak up behind me and clasp their hands around my leg. So far, I've been able to suppress the instinct to kick back--hard (and it really is an instinct, not a "damn, I'd like to get 'em back" response), and have been able to quietly and firmly explain that I do not like to be touched unexpectedly, I'll excuse it this time but please do not do this again. Ever. The usual response is a wide-eyed "Wow, I've never seen anyone jump that high before!" and a subdued apology.

[green-knight.livejournal.com]

it’s also possible to have fairly severe symptoms and still hold down a job and seem more-or-less normal to a cursory inspection.

As someone who has been a functioning depressive for a long time, I don't find that difficult to accept at all. People are good at compartmentalising, and often concentrating on one thing helps to push out everything else. I find that there is only a limited amount of time you _can_ do that in a day - but trying to hide how bad you're feeling is a mammalian instinct: look too vulnerable, and you're prey.

[wishwords.livejournal.com]

I keep nodding my head in agreement as I read. This is one of the best descriptions I've seen.

[veejane.livejournal.com]

My best guess is that I went white and staggered a few steps backward, thus catching at least one person’s attention, and was completely nonresponsive when they spoke to me.

It's very likely it looked like a petit-mal seizure, from the outside. IME, witnessing a seizure or a flashback is a fairly distressing situation, and I'm not surprised people would notice. There's something uncanny and frightening about watching the eyes go glassy and the consciousness absent itself, without an obvious cause; the automatic impulse is to reach out and catch that person in case her next step is to fall. (Probably, as you say, an unhelpful impulse, when applied to people sensitive about their physical integrity.)

In re that sensitivity, I've long been surprised that SFF people at cons, who seem primed in general to bend over backwards in accommodating the odd, atypical, and unique, are not more physically standoffish as a rule. When I remarked on a total stranger having asked to rub my shoulders (I said no), the common response I got was to be grateful that I'd been asked first. Which...? I am told that many people arrive at-con and treat the space as if it were a UN safe area, and so relax their inhibitions; but assuming that everyone else has similarly relaxed is just cruising for a tragic judo accident, I should think.

[kate_nepveu]

re: personal-space-invasion at cons: No-one has ever done this to me. Possibly they were just hitting on you?

Edit: not that it's okay! Just that I'm not sure about the not-more-physically-standoffish being a general thing.

[casacorona.livejournal.com]

This is excellently well done. And let me second the emphatic prohibition on hugging people from behind. A. Don't hug strangers. period. B. Don't hug me from behind even if you're my best friend. Actually, my best friends know this. If I don't react violently, the adrenaline dump will still leave me incoherant for minutes.

Of course, the hypervigilence means that it's really hard for anyone to come up behind me without me being aware of it, and even of who it is.....

[tekalynn.livejournal.com]

I'm aware enough of my husband's presence, even in a crowded place among strangers, that he can touch me gently from behind without triggering a startle. I certainly wouldn't let anyone else do that to me in the bookstore.

Sudden headpats from him, even when we're alone, can still trigger (small) jumps. That's something we've resigned ourselves to.

[cluegirl.livejournal.com]

Thank you for a very succinct guide to the disorder. I've pimped this in my own journal, on the notion that more people should probably understand about how it works, to help sufferers to heal.

I know I've had a hard time explaining my twitches to bystanders, all my life.

[copperwise.livejournal.com]

Hypervigilance and the aftereffects of it are one reason I accept the label of "bitchy". I will exist for hours in a state of hypervigilance, getting edgier and edgier and more and more exhausted, and then someone will say or do something that puts me over the edge and I snap at them or otherwise become obviously cranky. It's gotten me called "oversensitive" on many occasions. What it actually is, is my trying *not* to show I'm freaking out for long periods, and then finally showing it.

The Tanuki, at least, has come to understand my need to get out of situations that are triggering me. I don't deal well with crowds. I can be fine in a crowded situation and then suddenly it's too much and I have got to get out. We have a code word, now, that basically means "we're leaving NOW" and he knows what to do when I say it.

[glinda-w.livejournal.com]

I will exist for hours in a state of hypervigilance, getting edgier and edgier and more and more exhausted, and then someone will say or do something that puts me over the edge and I snap at them or otherwise become obviously cranky. It's gotten me called "oversensitive" on many occasions. What it actually is, is my trying *not* to show I'm freaking out for long periods, and then finally showing it.

Oh ghods, yes, that.

Re: the crowds thing, I'm fine at the opera or symphony, and did OK at the Hawking/Greene lectures this year (same venue as opera). Not fine with crowds out shopping, can't even think about things like festivals, flea markets, etc. I think it's partly the nature of the people involved, partly having gone to concerts/recitals since my early teens and feeling that they're just a safe place.

[panjianlien.livejournal.com]

Oh, the joy of hyperreactivity & other favorites from PTSD's Greatest Hits!

I still think guiltily of the guy I briefly dated, whose nose I broke because he playfully reached around my neck/shoulder from behind. Poor guy never knew what hit him until after he was flat on the floor with his nose bleeding like a fountain and I was apologizing like there was no tomorrow.

I also have never really had trauma flashbacks. Acid flashbacks, yes. But not trauma ones. Weird, that.

[miintikwa.livejournal.com]

My one "complete" flashback experience was a very odd one.

I could still see the room that I was standing in, yet I could also "see" and "hear" and "feel" everything as though I was a 5 year old child again, going through what I went through that night, as my father molested me.

It answered a lot of questions, including why I had chronic insomnia, could never sleep if a roommate or person who was supposed to be in the house was not, and why I was more comfortable sleeping during the day-- night time was not "safe."

I have had one other flashback, that one was more a sensory memory than a visual one-- I "felt" another night of molestation, enough to know that the original memory's experiences were not an isolated case.

But yeah-- the vomiting thing? Totally bogus in my estimation as well. I *do* have a twitchy stomach, and I didn't vomit after either flashback, nor have I ever vomited after a particularly bad startle reaction, or any bad news. Feh.

I also wanted to comment on the fugue state-- I literally could not recall my childhood. The entirety of it became a fugue state for me after about age 14. My mother and I moved to Virginia when I was 12, and I spent the entire summer after the move living in the basement of my Uncle's house, daydreaming, reading, and sleeping the summer away, and then I got mono my freshman year of highschool.

I "woke up" my sophomore year, which is when my memories of life are clearest. I have a very hard time recalling anything from my childhood and preteen years, still.

[oyceter]

*big hugs*

Also, I will vouch for your being totally sane when I am camping over and sneak off to use the bathroom in the middle of the night.

Also also, thank you so much for writing this. And let me know if you feel like a call some time!

[morgan-dhu.livejournal.com]

I really don't know how to label the thing that happens to me. It's not a flashback, becasue I do know where I am, sort of, and I don't lose memory, not completely. It's not dissociation, because I experience it as myself.

It's kind of doubled consciousness experience, in which I'm simultaneously being here and now in the situation that's triggering, but I'm also fully aware of what it was like when the origial trauma was occurring, and I feel emotionally, and react like, myself at the age of the original trauma and not myself today.

Because it's doubled and overlaid, my memories of what's really going on are usually kind of blurred and fuzzy once the triggering situation is no longer an issue and the overall resonse is over, but if my memories of what it's like are reasonably accurate, it's as if I'm projecting what the original abuser did onto the person who has performed the triggering acts, and reacting now as I did then, without really being able to influence my current actions and responses directly and immediately - it's like working through waldoes with a long lag to try and get myself to calm down, relax, recognise that while I've been triggered, I'm not in the same kind of danger and therefore don't have to respond as I did way back when.

I really don't know if this makes any sense at all.

Sounds Familiar....

[kistha.livejournal.com]

In the usual college period, a girl on campus was being raped, and she picked me as the person to help her go through her reliving the horror, and keep her from scrubbing her skin off. I'd comfort her, then I'd have flashbacks. I quickly taught myself to get to a safe distance, get a "minder" and then lie down. Since when I fell over the first couple of times I nearly beat the crap out of the people who "caught me" in an effort to be helpful. Since she wouldn't go to the law (and I couldn't blame her, really) I did what I could.

My flashbacks are similar to what you describe, only I have (apparently) repressed whatever it was that happened to myself and my brother (he remembers and refuses to share) so that I don't actually know what I flashed-back to. Which is eerie all in its self. I do know that they cold last for up to fifteen minutes, and that I'd mumble, violently twitch and cry. For some reason, I preferred men to women (still do during any traumatic event) for support during this which is odd, since I'm as close to positive I'll ever get that it was a boy, and perhaps a man who did the abusing.

I've never sought professional help for personal reasons (and serious distrust issues) so I'm very interested in seeing part 3.

[ldybastet.livejournal.com]

Here via cluegirl's link. It was very interesting to read someone else's experiences with this condition. Thank you for writing it.

About flashbacks: since I have completely repressed/lost the memory of my actual trauma which took place when I was 6, my flashbacks have always been in the form of emotions, not memories. Nothing visual at all, only very strong emotions that really have little to do with what's going on around me. They have most likely been triggered though, but for about 30 years this was severely confusing and unsettling because I didn't know where the emotions came from or what triggered them. So, even though I react as if it was happening all over, it's hard even for me to see it, much less for people around me. I just look overemotional or over-anxious, etc. Not so much with the complete dialogue. ;-)

Oh, and never any vomiting for me either. *g*

[ungemmed]

You don't know me, but I get that too. It's... validating, kinda, to hear that I'm not the only one, because for years I've wondered if they were "real" flashbacks or not.