Tag: ptsd

Trauma impels people both to withdraw from close relationships and to seek them desperately. The profound disruption in basic trust, the common feelings of shame, guilt, and inferiority, and the need to avoid reminders of the trauma that might be found in social life, all foster withdrawal from close relationships. But the terror of the traumatic event intensifies the need for protective attachments. The traumatized person therefore frequently alternates between isolation and anxious clinging to others. […] It results in the formation of intense, unstable relationships that fluctuate between extremes.

Judith Herman in Trauma and Recovery (via psychologicalsnippets-blog)
Source: psychologicalsnippets-blog

descriptions of dissociation

themostradicalthing:

theneurotypicals:

Depersonalisation

Common: ‘I felt strange / weird’, ‘I felt as if I was floating away’, ‘I felt disembodied / disconnected / detached / far away from myself’, ‘apart from everything’, ‘in a place of my own / alone’, ‘like I was there but not there’, ’I could see and hear everything but couldn’t respond’

Less Common: ‘puppet-like’, ‘robot-like’, ‘acting a part’, ‘I couldn’t feel any pain’ ‘like I was made of cardboard’,  ‘I felt like I was just a head stuck on a body’, ‘like a spectator looking at myself on TV’, ‘an out of body experience’, ‘my hands or feet felt smaller / bigger’. ‘when I touched things it didn’t feel like me touching them’

Derealisation

‘My surroundings seemed unreal / far away’, ‘I felt spaced out’, ‘It was like looking at the world through a veil or glass’, ‘I felt cut off or distant from the immediate surroundings’, ‘objects appeared diminished in size /  flat / dream-like / cartoon like / artificial / unsolid’

Other dissociative symptoms 

Memory: “I drove the car home/got dressed/had dinner but can’t remember
anything about it”, “I don’t know who I am or how I got here” (fugue state), “I
remember things but it doesn’t feel like it was me that was there”. 

Identity: “I feel like I’m two separate people/someone else”. 

Other: “I felt like time was passing incredibly slowly/quickly”, “I get so absorbed
in fantasy/a TV programme that it seems real”, “I felt an emptiness in my head
as if I was not having any thoughts at all”. 

Source: Jon Ston. Dissociation: What Is It and Why Is It Important? Practical Neurology, 2006; 6: 308-313.

This is seriously something all psychiatric students/professionals/diagnosticians need to read.

There are not enough dissociation-specific “layman’s” words and phrases to highlight what folks with dissociative disorders (or other conditions with marked dissociation) go through.

All we have are these vague sounding terms like the above. So often they’re ignored/belittled, when instead they should be taken seriously and taken as indications to investigate the possibility of dissociation further.

If I had this sort of vocabulary I wouldn’t have spent 8 mystified years referring to how I spent a huge chunk of my waking life as “that feeling that there isn’t a word for” or  “the water running out of the bathtub feeling”

I miss waking up back in the Pacific NW, where each morning I could stroke the soft gold of his hair. His deep, untroubled sleep was brilliant; an alien entity to me. How can he slip back into the comfort of that soft release—pulling me, fidgeting and anxious, back into his arms without ever truly stirring? My main gripe, I suppose, is my incapacity to register wonder in this world, what Nathan called my chronic weariness…But the word “wonder” is no hyperbole for the borrowed realization I found in his arms—that there are bodies in this world so innocent, so undamaged, that they are not yet startled by contact, by affection. There are bodies that still believe that they belong entirely to themselves. I think that’s why I liked walking with him, through the woods and the plains, better than anything. Each step he took was decisive, unburdened, as though he had never doubted the contract between himself and the world. All this to say that I miss him and the dog and the joy he took in simply being, though I railed against him at times, accused him of dwelling in fantasy, of indulging in the luxury of withdrawing from the oppression and pain that others had no choice but to acknowledge. Perhaps some of that sentiment came from a place of actualized politics, but most of it was born of envy and of the fear that accompanies my sense of exile from the bright world he inhabits still. I miss him. I want him to breathe his settled manner back into my mouth.

From The Body Bears the Burden: Trauma, Dissociation, and Disease by Robert C Scaer

When people develop PTSD, the replaying of the trauma leads to sensitization: with every replay of the trauma there is an increasing level of distress. In those individuals, the traumatic event, which started out as a social and interpersonal process, develops secondary biological consequences that are hard to reverse once they become entrenched. Because these patients have intolerable sensations and feelings, their tendency is to actively avoid them. Mentally, they split off or “dissociate” these feelings; physically, their bodies tighten and brace against them. They seem to live under the assumption that if they feel those sensations and feelings, they will overwhelm them forever. These are patients who rely on medications, drugs, and alcohol  to make these feelings go away, because they have lost confidence that they can learn to tolerate them without outside help. The fear of being consumed by these “terrible” feelings leads them to believe that only not feeling them will make them go away. 

After all eight participants completed the procedure, Scott Rauch went to work with his mathematicians and statisticians to create composite images that compared the arousal created by a flashback with the brain in neutral. After a few weeks he sent me the results, which you see above. I taped the scans up on the refrigerator in my kitchen, and for the next few months I stared at them every evening. It occurred to me that this was how early astronomers must have felt when they peered through a telescope at a new constellation.
There were some puzzling dots and colors on the scan, but the biggest area of brain activation—a large red spot in the right lower center of the brain, which is the limbic area, or emotional brain—came as no surprise. It was already well known that intense emotions activate the limbic system, in particular an area within it called the amygdala. We depend on the amygdala to warn us of impending danger and to activate the body’s stress response. Our study clearly showed that when traumatized people are presented with images, sounds, or thoughts related to their particular experience, the amygdala reacts with alarm—even as in Marsha’s case, thirteen years after the event. Activation of this fear center triggers the cascade of stress hormones and nerve impulses that drive up blood pressure, heart rate, and oxygen intake—preparing the body for fight or flight.1 The monitors attached to Marsha’s arms recorded this physiological state of frantic arousal, even though she never totally lost track of the fact that she was resting quietly in the scanner.

SPEECHLESS HORROR

Our most surprising finding was a white spot in the left frontal lobe of the cortex, in a region called Broca’s area. In this case the change in color meant that there was a significant decrease in that part of the brain. Broca’s area is one of the speech centers of the brain, which is often affected in stroke patients when the blood supply to that region is cut off. Without a functioning Broca’s area, you cannot put your thoughts and feelings into words. Our scans showed that Broca’s area went offline whenever a flashback was triggered. In other words, we had visual proof that the effects of trauma are not necessarily different from—and can overlap with—the effects of physical lesions like strokes. All trauma is preverbal. Shakespeare captures this state of speechless terror in Macbeth, after the murdered king’s body is discovered: “Oh horror! horror! horror! Tongue nor heart cannot conceive nor name thee! Confusion now hath made his masterpiece!” Under extreme conditions people may scream obscenities, call for their mothers, howl in terror, or simply shut down. Victims of assaults and accidents sit mute and frozen in emergency rooms; traumatized children “lose their tongues” and refuse to speak. Photographs of combat soldiers show hollow-eyed men staring mutely into a void.

Even years later traumatized people often have enormous difficulty telling other people what has happened to them. Their bodies reexperience terror, rage, and helplessness, as well as the impulse to fight or flee, but these feelings are almost impossible to articulate. Trauma by nature drives us to the edge of comprehension, cutting us off from language based on common experience or an imaginable past.

This doesn’t mean that people can’t talk about a tragedy that has befallen them. Sooner or later most survivors, like the veterans in chapter 1, come up with what many of them call their “cover story” that offers some explanation for their symptoms and behavior for public consumption. These stories, however, rarely capture the inner truth of the experience. It is enormously difficult to organize one’s traumatic experiences into a coherent account—a narrative with a beginning, a middle, and an end. Even a seasoned reporter like the famed CBS correspondent Ed Murrow struggled to convey the atrocities he saw when the Nazi concentration camp Buchenwald was liberated in 1945: “I pray you believe what I have said. I reported what I saw and heard, but only part of it. For most of it I have no words.

When words fail, haunting images capture the experience and return as nightmares and flashbacks. In contrast to the deactivation of Broca’s area, another region, Brodmann’s area 19, lit up in our participants. This is a region in the visual cortex that registers images when they first enter the brain. We were surprised to see brain activation in this area so long after the original experience of the trauma. Under ordinary conditions raw images registered in area 19 are rapidly diffused to other brain areas that interpret the meaning of what has been seen. Once again, we were witnessing a brain region rekindled as if the trauma were actually occurring.

—From: Bessel van der Kolk MD. “The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma.”