Managing Traumatic Stress and Combat PTSD Through The R-E-C-O-V-E-R Approach*
TRAUMA AND THE BODY
Decoding The Body's Internal "Logic": I am often asked why I enjoy working in the field of trauma, despite the fact that it is stressful and very emotionally intense. For me, it is work that adds great meaning to life. For one thing, it allows me to work in a field in which I am able to connect my love of psychology with my love of biology. Because I view the trauma survivor's symptoms and behaviors through both a psychological and a medical lens, I am able to always keep in mind that the root cause of the illness is biological. As a result, I am not tempted to become judgmental towards the survivors under my care. I am always able to place their situation in perspective, because I know very well what part of the illness they can manage, and what part they simply cannot control. Ensuring that this knowledge is shared with survivors' families almost always helps ease the tension and frustration that exists in households impacted by PTSD. It's often a great shock to a spouse when he or she learns for the first time that PTSD is truly a medical problem, and not one that can be overcome by simply getting an "attitude adjustment."
Every trauma survivor I know or work with is someone whom I see as a whole person, in the total context of his or her life experience. They are all deserving of respect. I take great pleasure in offering them that respect, in the hope that ultimately, they will be able to follow my lead and offer respect to themselves.
In working with survivors, I am almost always called upon to also work with their families, helping them so see PTSD through a biological perspective. People's behaviors may not necessarily be healthy, but they almost always make more sense if you know enough about the life they have led. With PTSD, this involves understanding survivors' behaviors as the outgrowth of the body's natural biological agenda for survival. Behaviors, which are admittedly frustrating and difficult for both patients and families, become more understandable and manageable, when viewed through the lens of the body's internal drive for safety and control. In short, to understand PTSD, one must recognize that the mind, brain and body adhere to an internal logic all their own.
It's Time To Put Down The Burden Of Shame: Instead of living with a compassionate understanding of their disorder and its underlying biological cause, the lives of people with PTSD are often shaped by shame. Society at large often sees them as "guilty" of noncompliant, dysfunctional or antisocial behavior. The operative word in the previous sentence is "guilty". It reflects a general, mistaken assumption that the PTSD sufferer's symptomatic behaviors are freely chosen, and therefore intentional. In fact, this is generally not the case. As any PTSD sufferer will tell you, flashbacks are not chosen. Nightmares are not chosen. Hyperarousal and hypervigilence are not chosen. Terror is not chosen.
Unfortunately, however, PTSD sufferers often internalize society's mistaken assumptions, and incorporate them into their own self-concept. As a result, PTSD sufferers themselves often assume that they are antisocial misfits who can no longer integrate into the fabric of society, in the way they once did. These stereotypes and assumptions exist largely because patients do not understand, and are simply not educated about, the biophysical roots of their disorder. If society understood more about PTSD as a medical problem, it would treat its sufferers in much the same way it treats people with other kinds of illnesses, such as diabetes or cardiovascular disease Society would recognize that what they need is help to manage their conditions responsibly, rather than being on the receiving end of shame, blame or judgment.
Beyond The Imaginary: My greatest pleasure as a trauma therapist occurs when I am able to help patients to understand that their stereotyped beliefs about PTSD, and about themselves, are largely false. I am able to explain to them, simply and understandably, that the behaviors that are so disruptive to their lives are the secondary results of a real primary medical cause. That cause involves the brain/mind, the central nervous system, the endocrine and immune systems. This is why Dr. Croft and I refer to PTSD as a psycho-neuro-endocrine (PNE) disorder, even though the DSMIV classifies it as a disorder of anxiety. In fact, psycho-neuro-endocrine processes are the "stuff" of which anxiety is made. The moment at which a person's eyes suddenly open to this fact is usually the moment that their life begins to change.
Understanding that their illness is real, that it has a medical cause which medical science has long known about, and that it is not merely a subjective occurrence that is "all in their head", allows people to put down their burden of shame. They learn that their illness exists because nature has operated to take a good thing too far in helping them to survive the traumatic events they could not control. Although emotional, psychological and even spiritual adjustment are essential elements of healing from PTSD, these things may take time and cannot be pushed too quickly. Frustration can easily result. While the long term emotional work is ongoing, it is helpful for patients to know that in the short term, they can ordinarily take steps to begin immediately managing the root medical cause of their condition with the help of their health care provider. Obtaining medical control of PTSD symptoms can often be the most rapid part of treatment, if approached properly and with the correct medication. PTSD suffers can often experience in relatively swift and significant "shift" in their quality of life - for the BETTER. (We discuss the treatment and management of symptoms in other sections of our book and this site.) To achieve this however, requires a more thorough understanding of PTSD than either Mom or the military ever gave you. We hope to provide you with that knowledge.
Making Peace With Your Life: Yes, once again, the Beatles got it right. Help!... you need some body… and that body is YOURS. When your life was on the line, you needed the body's internal processes to help save you. Understanding the way in which these processes work is the first step to achieving full awareness of what PTSD is… and ISN'T. It isn't a death sentence. It isn't something that needs to destroy your life, unless you yourself decide not to approach and manage it responsibly. By understanding the biological roots of PTSD, you can remove the disorder from the realm of the "imaginary", and come to peace with your family, your community and, most of all, yourself.
Begin With The Basics: In Chapter 3 of "I Always Sit With My Back To The Wall", Dr. Croft and I provide our readers with a very thorough, yet simple, explanation of the biological processes which are at the root of PTSD. We also explain how your biology and your psychology intersect. We strongly encourage you to read this chapter, because the knowledge it conveys is likely to change how you think and feel about yourself and your illness. The book offers far more complete information than we can provide in a single blog, so we suggest that you slowly read and digest both types of information.
To provide you with the information you need, in small doses , and without the subject becoming overwhelming, we will deal with this important subject in a series of articles. This will simply be the first, and will give you a very brief overview of PTSD's mind-brain-body connection. Greater detail will be furnished in articles to follow.
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