With the recent news about the high prevalence of Post Traumatic Stress Disorder (PTSD) in military veterans returning from Iraq and Afghanistan, I decided to interview Revolution Health’s expert psychiatrist, Dr. Ned Hallowell, to find out more about PTSD and what to do about it.
Dr. Val: What is post traumatic stress disorder (PTSD)?
Dr. Hallowell: As the name implies, it is the response a person has to any traumatic experience or event. The brain really changes in response to trauma, and people can be quite crippled by it. Some will actively avoid people and situations that remind them of the event, others experience “triggers” that set them off into a panicky or dissociated state. PTSD can cause “flashbacks” where people feel as if they’re right back at the scene of the incident, they may also have nightmares or problems with relationships, job function, substance abuse, major anxiety or depression and even suicide.
PTSD exists on a spectrum. You can get fired from your job and experience mild trauma, but if the firing was really unfair and unexpected it can change you fundamentally for years to come. It isn’t the actual event that determines whether or not a person develops PTSD, it’s how you –given your particular neurochemistry and genetics – are able or not able to assimilate, accommodate, and deal with the traumatic event.
Dr. Val: How does a person know if they have PTSD?
Dr. Hallowell: If something terrible has happened to you and you’re not able to calm down, put things into perspective or get back to your old self – then you may have PTSD. Instead of getting your equilibrium back you’re rattled, anxious, and sleeping poorly. Fear builds on fear and you can even become afraid of life itself and begin withdrawing, avoiding, and shutting down, and self-medicating.
What you want to do is “name it” – in other words allow yourself to consider that you may have PTSD, and then get professional help. A mental health professional who specializes in PTSD is ideal. Dr. Bessel van der Kolk has written several excellent books on the subject.
It’s also worth noting that people can get vicarious PTSD. There have been cases where practitioners have developed PTSD simply by listening to accounts of trauma.
Dr. Val: Is early intervention important?
Dr. Hallowell: This is controversial. Some people believe that it’s important to talk about the event right away, but I’m of the belief that people should remain connected to others but not be required to talk about it until they’re ready. I could see someone after a mugging or car accident and never talk about the event – my role is just to create a “safe place” for them to be. Later on we might talk about it, or we might not. Discussing the details of a traumatic event can retraumatize you – and in a funny way you can develop a habit of reliving the trauma, almost the way that people become addicted to worry. However if the patient wants to talk about the trauma, that suggests to me that they need to – and I let them be the guide.
Dr. Val: What happens if PTSD is not treated?
Dr. Hallowell: It can wreak havoc on people. “Avoidance” as a lifestyle is very incapacitating. If you can’t go places and do things, you’re feeling anxious all the time, and having nightmares and flashbacks, you can’t enjoy life.
Dr. Val: Can PTSD be prevented? In the case of soldiers, for example, who are likely to experience horrible things in times of war – can they be mentally prepared for this kind of thing?
Dr. Hallowell: Part of what makes trauma traumatizing is that it’s unexpected. So it makes intuitive sense to me that if you’re prepared for what you’re going to see or experience that you will find it less traumatic when it happens. The surprise and lack of control are what’s overpowering about trauma. Having a plan (knowing what to do in case of a traumatic event) and knowing what to expect afterwards (and how to get help) will go a long way in reducing the damage of trauma. You can still be traumatized, however, even if you’re “ready” for it.
Dr. Val: Tell me a little bit about kids and PTSD. Do they express PTSD differently?
Dr. Hallowell: In children, the dissociative state is pretty common – they become vacant and unreachable. Sometimes the opposite happens and they are inconsolable, experiencing night terrors, crying, and temper tantrums. However, kids are remarkably resilient and I’ve seen play therapy work wonders for them after traumatic events.
For example, four-year-olds might sit on the floor and not talk to me at all about the trauma they’ve been through, and the next thing you know they’re reenacting the scene with their toys and dolls. They have no idea that they’re replaying the event this way (a form of “displacement”) – and may do it over and over again for a period of six weeks… and the next thing you know they’re over it. It’s remarkable. They use their imagination to heal themselves. It’s the greatest therapy in the world. No medication is used, and it’s a permanent fix. It’s almost like doing psychoanalysis at the point of the childhood trauma. When you’re 40 you try to relive these experiences in analysis to resolve the conflict – but as a child you’re actually doing the work near the time of the incident.
Dr. Val: What’s the most important thing for families to do for loved ones who have PTSD?
Dr. Hallowell: Connect with them. Understand them, listen to them, and don’t let them get isolated. Take their concerns seriously, and don’t judge them. Then find out what they need and get them to a mental health professional who understands PTSD.