Reading for one of my trauma classes. I’m not summarizing the whole thing, just bits I found especially interesting.

Chapter One: Clinical Features of PTSD. Nothing new here.

Chapter Two: Cognitive and Behavioral Features of PTSD.

Amnesia. People rarely have global amnesia for traumatic events (not even knowing it happened or having no memories of any of it), unless they also had a head injury or other physical damage (ETA: or are children, or there were a whole series of similar events, of which only some are remembered. What doesn't happen often: a sober adult has something horrible happen to them, and later does not even recall that it ever happened.) But partial amnesia is extremely common. A typical example is “weapon focus,” in which a person might recall every detail of the gun but nothing about the attacker’s face.

Taylor suggests that this is caused by “attentional narrowing,” which is a common result of extreme arousal. The apparent amnesia is caused by hyperfocus on certain details and total ignoring of others, so the ignored details were never encoded into memory at all. (As opposed to being forgotten or being present but inaccessible.)

My note: be upfront with people about this – they may never be able to recall everything, and that’s okay. Total recall is not necessary to healing.

Guilt. Trauma survivors tend to have a number of incorrect beliefs about the trauma which cause them a lot of pain and suffering. Helping them identify and argue with these beliefs can be very helpful. Great breakdown of common false beliefs on p. 34-35. I’ll just list a few.

- Hindsight bias. “I should have (magically) known the drink was roofied.”

- Justification distortion. “What I did/did not do during the trauma was unjustified.”

- Responsibility distortion. “It was entirely my fault.”

- Wrongdoing distortion. “What I did during the trauma went against my morals and ethics.”

These come about for the following reasons (I only excerpt a few); unraveling them and making them explicit may be very helpful.

- Judging your actions not based on the reality of the situation, but against an ideal or fantasy that didn’t actually exist. “I should have disarmed and kicked the asses of the men who were holding me at gunpoint.”

- Blaming yourself for not acting on ideas you didn’t get until after the fact. “I should have memorized the license plate.”

- Overlooking actual benefits of actual actions. (ie, you got out alive, possibly because of what you actually did.)

- Focusing only on imaginary good outcomes of actions you didn’t take. “If I’d tried to disarm him, I definitely would have succeeded.”

- Not taking into account that when all options are bad, selecting the least bad is a highly moral choice.

- Not taking time and emotional factors into consideration – what you’d do if you had an hour to contemplate it in the peace of your own living room is different from what you do when you have seconds and a gun to your head.

Beliefs about Symptoms

- People with PTSD often think their symptoms mean they’re “going crazy.”

- They tend to interpret emotions or physiological responses as objective truth. “My heart is pounding and I’m frightened, therefore the situation is dangerous.”

- Physical/emotional arousal has become so entwined with negative feelings that they may avoid all arousal, including that caused by exercise or positive feelings. (Anxiety sensitivity.) Interoceptive exposure (inducing arousal in a safe, controlled manner) is good for this.

Clinician's Guide to PTSD: A Cognitive-Behavioral Approach
I am once again having a failure of imagination. Please pitch in by suggesting a trauma which would plausibly make a character willing to go on a suicide mission. For story purposes, I want this character to be motivated by externally-caused depression rather than solely by idealism.

1. No rape or child abuse. No "terminally ill" or "suicidal because biochemically depressed." I'd prefer to not do "My entire family/significant other/child was killed," but would consider it if the circumstances were interesting.

2. I'm not mentioning the exact setting to avoid giving you all preconceived notions, but it's steampunk in an area where access to steam tech varies widely. Tragedies that could only occur in very rural, pre-modern areas are fine. Tragedies that could only occur in a steampunk context, like tragic zeppelin accidents, are fine. Bullying via Facebook will not work.
My paper for one of my trauma classes is copied below, on the question of including CPTSD (complex PTSD) in the DSM-V . It's 4 pages long, and as per the assignment, summarizes the arguments in a set of papers I read, then describes my own proposal. Quote marks used here as LJ doesn't support block quotes. Also, apologies for the alphabet soup.

Read more... )
This is the third book in a loosely connected series. It doesn't have to be read in order, and requires no more background than what I'm about to tell you. In the first book, Graceling, some people have special abilities, called Graces, which may be magical or may be enhanced versions of real talents, such as acting or fighting. In Fire , set in a different part of the world, some people and animals, called monsters, are overwhelmingly, dangerously attractive and charismatic.

The link between the three, apart from the shared world, is a sadistic, psychopathic serial killer named Leck, Graced with mind control, who takes over a kingdom and rules it for 35 years in the manner you would expect, until he's defeated in Graceling. His ten-year-old daughter, Bitterblue, is installed as queen with a council of advisers to rule as regents until she's old enough to take over. In Bitterblue, she's about eighteen, and starts investigating what really happened to the kingdom during Leck's rule (unsurprisingly, no one wants to talk about it.) The book as a whole seems inspired by things like the Truth and Reconciliation Commission, post-revolution Romania, etc.

This is hugely and admirably ambitious. As an allegory of personal and political trauma and recovery, it's largely successful. As a fantasy, and especially as a fantasy set in the same world as the other two books, it doesn't make a whole lot of sense. It doesn't read like a fantasy. It doesn't feel like a fantasy. The concepts and language are extremely modern, as in America right now, and don't match the Renaissance-ish time period. There is nothing Leck does with magic mind control that couldn't have been accomplished in non-magical ways. With minimal rewriting, the book could have been set in either an imaginary country in our world, or a completely different and more contemporary fantasy world.

I liked this the best of the three novels, but, as a much more ambitious work, it also had more glaring flaws. I didn't like the romance at all, though thankfully that's a relatively minor part of the plot. There was a lot of repetition of ideas, revelations, and plot points, making the book feel over-long and in need of editing. Bitterblue comes to essentially the same realizations repeatedly, when she only needs to do so once. There's no humor whatsoever - at one point a man turns up with the Grace of turning his head inside out. I laughed and laughed, and then realized that it was actually supposed to be horrifying, not funny. And the names continue to be terrible, such as "Gracelingian" as the name of the language and a man named Thigpen, which I can never not read as Pigpen.

Still, the strengths are quite strong. Bitterblue is a very sympathetic character. I rarely encounter novels on this subject at all, and considering how hard the subject is, it's pretty well-done. Oh, and there are several important gay and lesbian characters in the supporting cast. Warning for disturbing material appropriate to the subject matter, including sexual violence, child harm, and mass murder.

Spoilers are enciphered )

Bitterblue

My favorite novel on the subject of personal and political trauma and healing is this: Where She Was Standing, by Maggie Helwig. It's not fantasy.
The compassionate Maisie Dobbs, once a nurse in WWI, becomes a private investigator ten years later, relying on her understanding of psychology to crack cases. Her first one, naturally, involves the damage done by the war, both to the people who served and the ones they left behind.

This well-written, thoughtful book works better as a novel than it does as a mystery; the sleuthing is very basic and the villain barely concealed. Some of the details of Maisie's history are a bit much - she began life as a servant but was lifted into a higher class because her employers were just that bowled over by how amazingly smart she was, and her thoughts about psychology sometimes sound more New Age than period - but all the parts dealing with the war and the wreckage it left in its wake are perceptive and moving. I'd read more in this series.

Maisie Dobbs
I'm writing a paper on PTSD and combat-related berserk states as depicted in pre-1650 sources and comparing it to the current understanding of both. Ideally, I will be able to reference substance/alcohol use and abuse in relation to this.

Can you recommend me some sources to check out? I am definitely going to be using Shakespeare's Henry V, Part I. I have already thought of Macbeth (possible PTSD), and The Iliad and The Mahabharata (berserk states). Nonfiction is also fine.

NOTE: No Civil War memoirs! I'm trying to find sources from before PTSD was really conceptualized as such, and it had been conceptualized as "soldier's heart" by then.
rachelmanija: (Book Fix)
( May. 20th, 2012 12:52 pm)
What would I like to do today? Curl up with any one of the delicious-looking books which have just arrived in my home!

Code Name Verity, by Elizabeth Wein. WWII girl pilots and spies, female friendship, and did I mention that they're WWII girl pilots and spies? This is by one of my favorite authors, and people are saying it's amazing. Please do not spoil. I am sure it has many twists.

Everybody Sees the Ants, by A. S. King. I have no idea what this is other than Sherwood highly recommends it, it was nominated for the Andre Norton Award, and she said that it is very psychological and the less you know before reading, the better. Please do not spoil!

Shadow Ops: Control Point, by Myke Cole. Contemporary military fantasy by an author who did three tours in Iraq. I expect the military details are all very accurate. This looks very enjoyable. Bonus: black protagonist is actually on the cover.

Hiding the Elephant: How Magicians Invented the Impossible and Learned to Disappear. Fun-looking nonfiction.

Unstrange Minds: Remapping the World of Autism. Written by a man with an autistic daughter, it promises to pull in personal accounts, science, history, and culture to explore the increase in or increased awareness of autism.


What do I actually need to do?

Complete an online course in Trauma-Focused CBT. By the way, the course seems very comprehensive, as far as comparatively brief online courses go, and it is free if you register. If you complete it, you get a certificate. It's intended for children who have gone through a traumatic event, but could be adjusted to work with adults. I have to complete the course, produce the certificate, and demo a section in front of the class.

ETA: Also, the therapist and the child can play a game where different names of emotions are written on individual pieces of paper. The therapist and the client take turns picking out one of the pieces of paper out of a box (without showing the other) acting out the emotion and having the other person try to guess the feeling.

My emotions upon imagining myself doing this exercise: horror, embarrassment, anxiety, panic, hysteria, inappropriate laughter, denial, disbelief, doom. Well... I know which section I WON'T be demonstrating to the class!

Please taunt me by discussing the books I have mentioned. No spoilers, please. I will select one to reward myself with when I'm done.
rachelmanija: (Gundam Wing: Sane against the odds)
( Feb. 14th, 2012 11:27 am)
This is about triggers in the technical sense, of the "cues" mentioned by the DSM-IV in its criteria for PTSD: "intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event."

I have a much more detailed explanation of triggers here. (Warning: uh, triggery in that it contains descriptions of PTSD and abuse.)

In LJ/DW culture, people often use "trigger" in a much more colloquial sense, to mean "a thing which is upsetting/disturbing/unpleasant." But in the technical, trauma-related sense, this is what a trigger is:

Triggers are not merely upsetting in general. They are things which bring back memories or feelings associated with trauma.

Triggers are highly, highly idiosyncratic. (There are exceptions to this, which I'll get into in a moment.) They don't have to directly relate to the general nature of the trauma. In fact, they are at least as likely to relate to some random thing associated with the trauma, not with the nature of the trauma itself.

For instance, a person who was raped in a car would be at least as likely to be triggered by hearing the song which happened to be playing on the radio during the rape, or by the feel of a vinyl car seat, as she would be by fictional depictions of rape, discussions of rape, or the word "rape." (Some people, of course, do end up triggered by all fictional depictions of rape, etc. I'm just saying, not all people, not always.)

I suspect that the reason for this is that "rape" is a very general thing. But a specific trauma is specific. A fictional rape may bear very little resemblance to one's real rape, and so not touch off any specific memories. But the song, the vinyl seats, the smell of the man's cologne, and so forth, are real things which get burned into the very cells of one's brain, and the fibers of one's nervous system. They may bring up reactions which happen before you even know why you're reacting.

ETA: Forgot about the exceptions to the "idiosyncratic" thing. There's two big categories of those:

1. Most people whose traumatic reactions reach the level of diagnosable PTSD will be physically triggered by sudden loud noises and unexpected touch. It has to do with how our nervous systems are wired. Those things are inherently startling, and if your startle reflex is cranked up past a certain point, inherently startling things will provoke the same level of physiological/emotional reaction people normally have when, say, someone suddenly leaps out of a dark alley and sticks a gun in their face.

2. When similar sorts of traumatic things happened at the same time, in the same space, to large groups of people, you can take a pretty good guess at what triggers will affect many or most of them simply by looking at notable features of the trauma or the area in which it took place. For instance, some insensitive landscape designer stuck a bamboo grove on the grounds of the Veteran's Administration. Unsurprisingly, you can tell who the Vietnam vets are by which ones are taking a very wide path around the bamboo. In the unlikely event that burning papers start fluttering down from the sky, the people who have very strong reactions are probably the ones who were present in New York during 9/11.

End ETA.

People often warn me about fictional depictions of child abuse. I am not triggered by that, or by fictional anything. I was tied up and abused. I'm not bothered by rope bondage in fiction. (Feel free to rec me rope bondage in fiction!) But I did have something trigger me yesterday, and I'm writing it up because it was such a great example of how triggers actually work - and can be dealt with.

Cut for length; also, kind of navel-gazey. )
If I get through all this tonight, I will go eat dinner and watch some Flashpoint. Really dense material below - but interesting.

Summary:

- PTSD is largely a matter of conditioned physiological changes, which are very hard to change via insight and introspection alone.

- Many people face trauma, but not all develop PTSD. People are wired to respond to fear with action (fight/flight.) If they are immobilized and helpless, literally or metaphorically, during a trauma, they are likely to develop PTSD. This may have a biological basis. If they could take action - complete the fight/flight response - they may be able to decondition some of their PTSD reflexes.

- Traumatized people often freak out when meditating due to its internal focus's tendency to send them straight into traumatic memories. But meditation or mindfulness would probably be helpful if they could manage it. Wonder if movement-based meditative practices are less likely to cause freak-outs? If so, that would explain why so many survivors find movement practices helpful. Maybe the movement provides a balance between interior feelings (scary/bad) and external focus (move left arm to block), thus decreasing interior focus and making it more tolerable.

If the trauma is partly caused by the interruption of the fight/flight response and people being forced, physically or by circumstance, into helplessness or inaction, then maybe movement lets them work through the fight/flight (action) response they needed, thus rewiring conditioned responses.

Lots of detail below cut.

Read more... )
Two years ago I wrote a set of posts called “A User’s Guide to PTSD.” They attracted a lot of attention, and several people friended this LJ in the hope that I would write more in the same vein. I pointed out that I write about mental illness approximately once every two years, so it could be a long wait. If any of them are still reading, I hope they enjoy this follow-up. If you missed the first set, I've linked them below.

Part I: What I Did In The War. (Introduction; background; what happens during trauma; what happened to me.)

Part II: What Does A Flashback Feel Like? (My history with PTSD, what it felt like to me, and dealing with other people who have it.)

Part III: I Don't Have To Do That Any More. (On recovery; lingering effects; book, film, and TV recommendations.)

I recently underwent training to join a team which counsels people in crisis situations. A crisis situation could be finding the body of a loved one who died of natural causes. It could be witnessing a car crash. It could be surviving a brutal mass murder. (All calls are absolutely confidential, so while I discuss the training a bit below, you will never hear any counseling anecdotes on this blog.) Since the team is run by psychiatrists, they’re very concerned with the psychological effects on the volunteers. During the training, I and the other prospective team members were repeatedly asked to consider what triggers we might have and what situations we might find especially disturbing, so we’d either be able to prepare ourselves or bow out of situations involving those triggers.

Since I was abused as a child, had a family member murdered in a domestic violence situation, had other family members die slowly and painfully of natural causes, was in a serious car accident, and have done several suicide interventions not to mention attempting suicide myself, I was confounded by the idea of avoiding crisis situations with possible triggers. What crisis situation wouldn’t have one?

“I think I’d be upset by dead children,” I hazarded. “That’s one I haven’t encountered yet.”

Statistically speaking, a prior history of PTSD puts you at risk of recurrence should you again be exposed to trauma. We are not strong at the broken places. The broken places remain fragile. We build up our strength around them to compensate. If we’re lucky, that’s sufficient.

I do not expect to have any kind of catastrophic meltdown. If I did, I wouldn’t have volunteered. I do expect that, if I come across a particularly disturbing situation, it will exact some sort of price – some sleepless nights, some nightmares, some hyper-vigilance – the sort of thing I’m subject to anyway if there’s a lot of stress in my life. Basically, the same sort of thing the counselors are subject to regardless of personal history, should they encounter something sufficiently unsettling.

One can’t avoid all stress, but it’s easy to avoid work which puts you into direct contact with other people’s traumas. But avoiding it also exacts a price. I sometimes get a feeling as if a fire alarm went off in my head, a sudden sense of urgency and the conviction that something terrible is happening somewhere and I ought to be doing something about it. This sense can keep going at a low level for weeks on end, periodically startling me with an especially intrusive feeling that I should go! Go now! Run!

I used to identify this as a peculiarly specific anxiety attack, though what it really feels like is the world's most useless psychic power. I cope mostly by consciously acknowledging it for what it is - a habitual firing of neurons that were overused for too many years, and never got used to peace. It's not meaningful. It's annoying background noise. It doesn't mean I have to actually do anything, though if it gets especially "loud" stocking up on earthquake supplies or activities of that nature sometimes helps.

But in fact, terrible things really are happening somewhere at any given time, and I really ought to be doing something about them. I don’t expect that being a volunteer crisis counselor will make the alarm turn itself off permanently. But at least I will be doing something.

(I could elaborate, but I had to write three separate essays over the course of ten weeks on “Why I Want to Join the Crisis Response Team (please detail your strengths and weaknesses,)” and I’m a bit sick of the subject. No, I didn’t say anything about fire alarms in my head. I figure that sort of thing can wait till they know I’m not a raving axe maniac me a bit better. Though I think that if most and maybe all people were to disclose absolutely everything that goes on in their heads, they'd all sound at least as strange as I do.)

A year ago I was involved in several (unrelated) extremely stressful situations. I would lie awake at night thinking, “What if right now [something terrible] is happening?” I should note that this wasn’t my internal fire alarm. There really was a reasonable chance that [terrible thing] might, in fact, be happening at any given moment. That being said, my insomniac obsessing was helping neither the situation nor me. I wanted to see a therapist, but my insurance only covers therapy in cases of “major mental illness” as defined by the insurance company.

I went to a psychiatrist and asked for a diagnosis, only to be informed that in her opinion, I was under a lot of stress and would benefit from therapy, but did not have a mental illness, major or otherwise. “Actually, especially given your history with mental illness and what’s going on in your life right now, I think you’re pretty emotionally healthy.”

You can probably imagine my mixed feelings about that statement. (When I explained the situation with my insurance, she kindly wrote down for their behalf that I met the DSM-IV criteria for an adjustment disorder. “Technically speaking,” she added to me. An adjustment disorder is psychiatrist-speak for “temporarily unhinged by the sort of stressors that occur under normal life circumstances (death of a loved one, job loss, divorce, etc), as opposed to the extraordinary stressors that can cause PTSD (rape, combat, natural disaster, etc).” And yes, the therapy was very helpful. I'm now much better at walking away, letting go, and otherwise not pouring all of myself into a futile attempt to fix someone else's life.)

It wasn’t only that, after so many years of trying to fix my mental illness, the fact that I had largely succeeded was now preventing me from getting needed mental health care. It was also that PTSD, even before I knew what it was, had shaped so much of my identity that I felt strange without it, or even contemplating the idea of being without it. And yet she was only telling me what I already knew. It was as if, after many years of debating with myself over whether I was willing to lay down my armor and weapons in order to get out of the war zone, I found that I had already dropped them. And that I’d known I had, but rather than either pick them up or kick some more mud over them, I’d taken mental note of where they lay, just in case, and tried not to think too much about the lack of weight at my belt and back.

I thought of finding a different metaphor, because PTSD is not actually helpful protective armor but rather a set of massively counterproductive and painful reflexes that can feel like they’re all that stands between you and your own destruction. I also realize that my choice of imagery does not exactly shout out “emotional health.” But the metaphor I used is the one which feels true.

I can sleep through the night. I can eat without having to consciously make myself swallow each bite. I can let people touch me. I can walk down a busy street without flinching. I can sit with my back to a window or door. I can sleep while people walk into my room, if I know in advance that they might. I can let people walk up behind me and not turn around. I do notice when people walk up behind me. I guess I kept a pocket knife.

This is not PTSD as defined by psychiatrists and as recorded by history. I no longer meet a single one of the criteria. By that standard, I don’t have that illness any more. What I have now, technically speaking, is a sub-clinical set of reflexes, attitudes, and sensitive areas that were shaped by the experience of having PTSD.

(By the way, it’s still totally fine to say, “Rachel has PTSD.” I’m not particularly attached to the DSM-IV criteria, nor to the concept of having it now vs. having had it in the past.)

To return to the crisis counseling, I’ve considered the possibility that I’m attracted to it because it offers me the chance or excuse to pick my weapons back up, so to speak. But I don’t want to automatically assume that my subconscious is trying to kill me. Sometimes it’s best to operate under the assumption that your instincts are sound. That nothing bad is happening right now. That you’re not in denial. That, however unlikely it may seem, you really are all right.

Any sort of crisis-related field draws people who have been shaped by trauma. Those fields also draw people who haven’t, but are there for other reasons. I know why I’m there – and that it’s fine that that’s why, but it doesn’t make me a better counselor, let alone a better or cooler or stronger or more compassionate person, than those other guys. It’s just the road I happened to drive in on.

Like my first set of posts, this one is intended solely to reflect my own experience, not anyone else’s. That being said, having gone through all of this, I’ve learned some things:

That trauma is influential, but doesn’t define us or our lives or our choices.

That trauma isn’t what makes us special or interesting or ourselves, though how we choose to deal with it may be one of the things that does.

That we all live with our own private battles and own private pain, even those of us who don't have horrific stories to tell.

That ongoing pain and struggle doesn't mean we're not leading quite happy lives anyway.

That we can get much, much better.

That it isn’t our fault if we haven’t yet.

That change is possible, always, at any time, regardless of what we’ve done or haven’t done or for how long.

That it isn’t hopeless unless we’re already dead.

And that, courtesy of one of our more entertaining training sessions, you’re not dead till the coroner says you’re dead.
rachelmanija: (Default)
( Feb. 16th, 2010 10:38 am)
Have gotten sucked in. Spent entire weekend watching first 4 discs of season 1. Am a little bit in love with entire male cast, except for Jason Gideon whom I enjoy watching but who sort of scares me with his resemblance to various men in mentoring positions I've known who got off a little too much on their own wisdom, compassion, and influence over others. Possibly that's just me projecting my own issues. Send help before I mainline the entire series and get no work done in the meantime!

This is the show about the FBI profiling team that catches serial killers via psychology, and the inspiration for "Shadow Unit." I can't help watching it with the Malcolm Gladwell article that says that profiling doesn't actually work in mind (and I am pretty sure that they see more serial killers in a month than the world really gets in a year), but as fiction, it's quite compelling. Note that it is about serial killers and so is extremely violent, disturbing, and gross. (But has no onscreen puking, so I find it much more watchable than Farscape.)

I saw an episode or two a while back and wasn't impressed. No one seemed to have any personality, and I have pretty much zero interest in serial killers. Then I idly started watching a marathon that was running on TV while doing way-overdue housecleaning, and noticed that actually, the detectives do have personality, it's just extremely underplayed. Underplayed in the way that makes you hang upon every brief insight into their psyches. One episode had an exchange which seemed to sum up the show's theme:

Hotch, the icy, controlled, literally and metaphorically buttoned-down team leader whom of course I adore, and look forward to him breaking down spectacularly, which I am sure will happen eventually (quote from memory): "Some abused kids grow up to be monsters. Some of us grow up to catch monsters."

So this a show about how people are shaped by trauma, respond to trauma, and are further chewed up and spit out by their job. The portrayal of PTSD and related issues is very good, for the most part, though I'd like to have some of the hypervigilance and other stuff be shown rather than told. (We hear that Gideon won't sit with his back to a door and avoids windows, but so far we haven't seen this in action.)

In other issues, the victims are given an unusual amount of autonomy (I mean by the writers) and character development, which I like. Considering that it's about serial killers, it's less trashily exploitative and sexist than one would expect, which isn't to say that it's not at all. And, while it can be a little PSA-like, the portrayal of mental illness is reasonably sensitive, again considering that this is a show about serial killers, some of whom are mentally ill.

Negatives: Only one major character of color (Morgan, one of the agents, unless Garcia's name is meant to signal that she's Latina.) Except for Garcia, I don't find the female characters as interesting as the men - JJ has so far had little of interest to do, and I'm failing to be intrigued by Elle, though that may be my problem. Gay people mostly don't exist. And the device by which episodes are bracketed by quotes utterly fails to work for me.

Something else which I don't think is a negative per se - it's part of the tone of the show - but which I think is a little unrealistic is the total lack of gallows humor. I guess it would come across as too insensitive, but seriously, in real life those guys would be breaking up on the plane now and then.

To return to the agents and their traumatic pasts, Reid has mentioned being a victim of bullying, and the way he spoke to the schizophrenic train guy did suggest some level of personal experience. The way Reid speaks reminds me of the way some people with Asperger's do, and his body language is a little odd. I think he has some kind of autism spectrum disorder.(I don't actually buy that he could ever get into the FBI in real life, but whatever.)

Because of the TV marathon, I already saw the episode about Morgan and the youth center. (On a side note, how heartbreaking was Reid's "He talks about me?") I think Elle has some kind of sexual trauma on her past. Gideon we already know has been traumatized on the job. I also wonder if his wife was murdered. Hotch I am very curious about. I had been thinking childhood abuse by his father, but he and his brother didn't speak of their father in a way that implied that. Abuse by someone else? Family habits of total denial?

Please don't spoil further developments, but if there's any spectacularly terrible episodes you think I should avoid, feel free to tell me so I can skip them.
This is Part III of a three-part essay on Post-Traumatic Stress Disorder: understanding it, having it, writing it.

Part I: What I Did In The War. (Introduction; background; what happens during trauma; what happened to me.)

Part II: What Does A Flashback Feel Like? (My history with PTSD, what it felt like to me, and dealing with other people who have it.)

Part III: I Don't Have To Do That Any More. (On recovery; lingering effects; book, film, and TV recommendations.)

ETA: Several years later, I added Part IV: Postscript.

After all that, I have never been either formally diagnosed with or treated for PTSD.

Unusual Circumstances May Cause Unusual Problems )

Recovery: Traditional Methods )

Recovery: Non-traditional Methods )

Don't fall in love with your own beautiful suffering. )

Recommended Media: Nonfiction )

Recommended Media: Fiction, TV, and Movies )

I hope this was helpful, useful, or enlightening. It was hard to write, and not just because of its extreme length. Some of it was stuff I've never told anybody before. There was even a point when I considered not posting it at all.

I was tremendously pleased and flattered when so many of you, when nominating the anime character I most resemble, thought that sanity and stability were among my most notable traits. I briefly had the woeful thought that after writing a three-part essay detailing my suicide attempts and blackouts and flashbacks and sleeping with a weapon in my hand and so forth, if I ever asked that question again, you would all say, "You are crazy suicidal teenage terrorist Heero Yuy from Gundam Wing!"

On the other hand, most of that craziness is in the past. Regarding what remains, I believe that while I may have more total crazy than the average person, I am also much better than average at dealing with and controlling it. Not to mention the advantage I gain from not pretending that I have no crazy. In equation form:

More crazy + more anti-crazy skills - denial = less insanity.

Less crazy + fewer anti-crazy skills + denial = more insanity.

Or so I hope. Actually, so I believe, considering that the total amount of time I spent considering not posting this was approximately thirty seconds. Surely Heero would have deleted the entire series without posting, in the unlikely event that he had the self-awareness to compose it in the first place.

As always, please feel free to link, ask questions, comment, share your own experiences, correct my science and statistics, or recommend media on the subject. And anyone is always free to friend this LJ. (Though I mostly write about manga, anime, and books, not mental health issues.)

ETA: I do still read and am grateful to receive comments on these posts, even many years later. I can't guarantee to respond to every one because it can be a bit overwhelming, but I do read them.
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.)

ETA: Several years later, I added Part IV: Postscript.

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

You don't have to eat the eggplant. )

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

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

What does a flashback feel like? )

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

NEVER EVER hug a stranger from behind. )

Or shake a sleeping soldier. )

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.

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.

ETA: I do still read and am grateful to receive comments on these posts, even many years later. I can't guarantee to respond to every one because it can be a bit overwhelming, but I do read them.
This is Part I 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, and what it felt like to me.)

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

ETA: Several years later, I added Part IV: Postscript.

You probably all know what PTSD is, in general terms: a mental illness resulting from trauma, often occurring in combat veterans but not limited to them, best-known for causing flashbacks, nightmares, and acute anxiety states. But people who have it often don't realize what's going on or don't seek help, and much of the fiction which deals with it reads as if the authors referred to a checklist of symptoms rather than finding sources from the point of view of someone who actually has it.

That would be my point of view.

Have you ever wondered what it feels like to have a flashback? I can tell you. (It does not typically involve acting out the entire trauma in real time, complete with dialogue and screaming. Vomiting is also not essential, nor even, as far as I know, likely.)

Also, the method I used to recover, more or less, and one of the issues I'm dealing with now, are both things which I have literally never seen addressed anywhere. I shall be very curious to hear if anyone else has had similar experiences.

I'm not a psychologist, and so can only speak from my own idiosyncratic perspective, plus a bit of research and discussion. But if you’re writing a story about someone who has cancer or know someone who does, it’s fine to look up cancer on Wikipedia, but you’ll learn more by going on to talk to a person who’s doing chemotherapy right now. And if you've ever done any interviewing, you know that the shortest route to an interesting response is "What did it feel like?" So I will tell you how it feels: how it feels to me.

Keeping that in mind, I mean this as a public service announcement— if nothing else, I hope that it will improve the depiction of PTSD in fiction, fan- and otherwise, for my own reading enjoyment, and reduce the incidence of gratuitous vomiting— so feel free to link far and wide.

Here's the DSM-IV criteria for PTSD. The DSM-IV is the American manual on diagnosing mental illness. I don’t think it's the be-all and end-all of existence, but it’s more familiar to me than other countries’ criteria, so that's what I'm using.

You don't have to have been in a war. )

Two people, same trauma; why only one case of PTSD? )

How I got into this mess-- skip to the next cut if you've read my book, know me well, or have been on my friends list for a while. )

What I did at the time, and some theory on how that relates to what happened later. )

This is trauma: You are walking along the path you always take, when suddenly the ground cracks under your feet like rotten ice, and you fall. You're shocked and terrified and you think you're going to die. Then you slam into the bottom. Maybe you break some bones, maybe you're just shook up and bruised.

This is normal recovery: You climb out of the pit. You go to a hospital. Depending on the extent of your injuries, recovery may be long or short, but after some length of time, the casts come off and you get on with your life. Maybe you're a little more cautious about where you put your feet, but it doesn't interfere with your life.

This is PTSD: You break bones at the bottom of the pit. You move to get out, and the bottom of the pit crumbles just like the path did, and you're falling again, stuck in that same moment of terror and shock and pain. And you keep on falling, and you will fall forever unless you grab a rope.

Grab that rope.


Feel free to ask questions, comment, share your own experiences, correct my science and statistics, or recommend media on the subject.

I am a fan and I read and write fic, so I will not feel in the least that you are being voyeuristic or trivializing if you want to ask me a question about how to make your Spooks/MI-5 or Magneto/Professor X or 3x4 story more realistic. In fact, I would probably request that you send me the link when you're done.

ETA: I do still read and am grateful to receive comments on these posts, even many years later. I can't guarantee to respond to every one because it can be a bit overwhelming, but I do read them.
.

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