Monday, January 13, 2014

Still Recovering, Chronically Ill, Steps to Take After a PTSD Episode

Those who follow my blog know that I have had a serious PTSD episode. My recovery from this episode has been extremely slow.

When I finally was able to see my therapist, he asked me what I did the last time I was like this.

"Checked into the looney bin," was my exasperated reply. After all, if I could figure out how to cope, I wouldn't need to see him, now would I?

If you take my emotional, mental trauma and place my chronic illness on top of it, you basically have one hot mess. My emotional upheaval has caused my immune system to waiver and that has lead me to have to get my chest x-rayed. I had been doing so much better physically and my physical distress adds to my emotional stress.

I will say that I find that I am clearer now on a lot of different things.

Resilience is more than my personal opinion.

For years I have wondered at my ability to cope with my past trauma versus other person’s ability to cope. I am able to speak out and others are not. Why is that? I have come to attribute this coping with two things - a seemingly innate ability that I have always had that what was being done to me was wrong and my unwavering focus on functionality.

My life now and in the most recent past has been about how highly functioning I am. What do I accomplish on any given day despite whether or not I want to do something or feel well enough to accomplish anything? My therapy sessions are always about relieving some of the daily stress everyone accumulates and if it intersects with some past trauma it is because that trauma helps to explain or describe behavior. With that explanation a plan of treatment can be created to avoid the behavior that started the discussion in the first place. My treatment isn't about desensitization. It is about function, today, here, now, in this moment.

With my discovery of George Bonanno’s research, I am finding out that I was on the right track all along and that makes me feel better about many of the decisions I have made in regards to my past. For example, spiritually divorcing my parents is a fairly controversial decision. One I made not out of anger, a need to punish or an inability on my part to forgive. I based this decision on the fact that relationships with my biological family inhibited my functionality. I was not as sane or functional when I tried to maintain a relationship with them. The fact is, I have been mentally, emotionally and spiritually healthier without them in my life than with them in my life. Further, I have never met someone who would suggest a relationship between a rape victim and the stranger rapists. I fail to see why there should be an expectation of relationship between a rapist and his victim just because the act was incestuous.

Some of the reactions that I think are because of my past trauma, are actually a result of healing.

I am attempting to buy new clothes these days. This desire is driven by the fact that I can choose my own clothes without censor. There is no one in my life to tell me I am ugly, fat, slutty or not something that I should be to wear the clothes I love. This means I am telling my t-shirts goodbye. I am buying more dresses. Pretty, sexy dresses that show off my breasts and my figure to best advantage. I am wearing good make up and pretty jewelry.
For the first time in my life, I am doing these things because I want to reflect who I am now. There is no other reason. I am seeing myself clearly and I want others to see me clearly as well. When I look in the mirror, what I wear makes a statement about who I really am and recently I have realized that what I wear doesn’t reflect the statement in my head. So I am driven to change this. It isn’t a reaction to being suppressed. This is an action that comes with getting comfortable in ones skin. 

I do not have to do this alone.

For years I have hide just how monumentally tough it is some days to simply get up and get dressed. When you are no longer being victimized, the default feelings tend to be, “Just let me stop fighting and rest.”  There is an overwhelming sense of exhaustion. That is often coupled with the feeling that there is so much I want to do that I am not doing and that adds to the feeling of complete guilt and tiredness.

This past episode has taught me that if I talk to others about things that would assist my functionality, then I have stopped carrying the burden of thriving alone. I confessed to my husband that when I said, “Yes Sir,” to him what I was really saying is:
“I fill trapped. I can’t figure out how to appropriately respond. I don’t think I am being listened to. I am afraid if I object violence will follow. So I am going to say ‘Yes, Sir,’ and try to divert your attention.”

I told him to not let me get away with this anymore. I asked him to take me by the shoulder and tell me, “I am not your father. You can object to me. Do not say that to me.”

It is amazing the difference him doing this has had on my functionality. I have finally managed to stop myself from giving this boxed reaction and started reacting more from a “me” place, not a place from some past abuse.

I also think that having a family member, Nate, who has known me and not understood or seen the devastating effects that my past has upon my present, as been a break through all its own. Nate still loves me. He is still affectionate and loving. He is still funny and supportive. It gives me confidence that someone can see my life fall apart temporarily and love me even when I am falling apart, even when I am temporarily fragile.

I have determined to keep writing about this episode and how I have worked through it because I do no think enough surivovrs talk about how they meet these challenges and over come them. Below is a list of other things I have done since my episode to try to put myself back on track:

  1. I listed the stressors in my life and then set realistic goals about addressing them. For me it was booking  a flight for a trip next month, purchasing the conference tickets, planning a trip later this month, talking over some money issues with my husband and cutting my hours at my part time job so I can focus specific days of the week on writing. 
  2.  I stopped utilizing my phone as my calendar. I have found that writing things down does something to reduce my stress. I bought the We’Moon Calendar and am utilizing it to do weekly planning. Sitting down on Sunday nights and reviewing what events are upcoming for the week, writing them in the planner and then meditating on meeting each event positively.
  3. Time Off. I took some time off of most things and focused only on what I absolutely had to do. I took naps.
  4. Medication. I have anti-anxiety medication and I have been using it. I am tapering off the further out I am from the event and I am not hesitant to use them when needed.
  5. Owning my prickliness. I have been short tempered and easy to cry. When these happen, I turn to whomever I am with and say, “I have had a bad shock to my system. I am getting over it and in the meantime I am short tempered and easy to cry. IT isn’t you. It’s me. Please understand I am just trying to cope as best as I can.”
  6. Being honest about where I am coming from. Several friends have asked if I was mad at them or upset because I have seemed distant and “odd energy.” When this has occurred I have lovingly told the truth. I am distant and I do have odd energy right now because I am going through something tough. I have asked friends to bear with me while I work it out.
  7. I have made a daily effort to think about someone else’s life and do something for someone else. It is easy when trauma surfaces to get lost in the pain and ungrounded, living in the past. I have found that by deliberately reaching out to others and asking about their lives, their struggles and encouraging them can help bring a sense of peace and well-being that nothing else will. A note on Facebook, a phone text or call, dropping a friend off a token of love and affection are all things that drag a person out of the past and into a future where they are contributing successfully to society.
  8. Stayed busy. It is easy to fall into the watch tv, YouTube or play video games mode of coping. This is not coping though, this is procrastination. Eventually, you will have to cope and it is far more productive to stay busy doing things than to wallow in self-pity.

C-PTSD, Resilience Theory and A Look at Recovery after a Major Episode

Since my major PTSD episode, I have been trying to cope as best I can. My therapist a trauma specialist, has cancelled on me a few times which has hindered by bi-weekly stress release I receive when I see him. 

Yesterday, I finally got in to see my therapist and discuss what happened when I ran, unexpectedly into a cousin I had not seen in years. This was the first biological family member I had run into since divorcing my biological family. (You can read the entire excerpt, here. You can read about divorcing my biological family here.)

Since my discussion with him I began to quantify some states of being that I commonly associate with these period of extreme stress brought upon me by a PTSD episode. This was promoted by my therapist who insisted on creating a plan of action to deal with my current state of complete undoing.
Before I move forward, allow me to explain something to my reader. There are several schools of thought regarding therapy and recovery of trauma. I like to classify them by things they remind me of; however, they have real psychological terms to. 

Let’s Dissect Your Trauma – Eye Movement Desensitization and Reprograming (EMDR)
“EMDR psychotherapy is an information processing therapy and uses an eight phase approach to address the experiential contributors of a wide range of pathologies. It attends to the past experiences that have set the groundwork for pathology, the current situations that trigger dysfunctional emotions, beliefs and sensations, and the positive experience needed to enhance future adaptive behaviors and mental health.”[i]

This approach to me centers on the world desensitization. This is a systematic exposure to something in order to help a client have that thing bother them less and less. Desensitization is used often when confronting phobias. For example, you have a problem with bugs? Then they might bring you into a room with a bug in it and utilizing some exercise of meditation to slow your physical response to bugs, they will bring you closer and closer, over time, to the bug.  Eventually, the goal would be that your fear of bugs will not interrupt your ability to function. 

I tried this approach with disastrous results. I was told to write down the top ten most horrifying abuses in great detail to give to my therapists. Then we were going to use these things to desensitize my physical reactions over a period of time to these stressors. Once I realized what was going to happen, I literally walked out of the second session. My life is not about the past, it is about how I am able to function today.[ii]

Take this Pill, It Will Help for A Little While – Medication[iii]
This therapy is one that I do utilize. Still, I object on different levels. I am a holistic kind of woman who is trying to get away from GMOs, different chemicals, antibiotics and medications of all types. So popping a pill, for me, means I am introducing outside, unnatural things into a natural system. I am very sensitive to side affects from all types of medications so that taking “safe” drugs can be unsafe for me. I have to take drugs that are formulated under name-brands, instead of generic because the fillers used have an adverse reaction to my body which struggles with dysautonomia.
Father, this is not a permanent solution. Eventually, I have to switch medications or take breaks from taking certain medications. None of which helps me to LEARN how to better function after living a life overflowing with dysfunction. I am not the only person who has issues with taking long term medications.
Tell Them About Your Trauma - Family Therapy
Utilizing the intimate persons in your immediate life to deal with the trauma of your past can be extremely helpful. However, not if it means reliving your trauma for your family. My husband has been involved in sessions over the years when I find it difficult to communicate what is happening. Taking him into the controlled environment of a session so that I can use the mediation of a therapist to explain what is happening with my body, soul, mind or emotions is helpful. Teaching family members about the normal reactions and thought process of the person afflicted by torture can often help them better deal with these reactions when they arise in day to day settings. One thing my husband has always been clear about in these sessions is that I do not need to give some detailed accounting of the abuse I suffered. He had come to realized that I had a much harder time functioning when forced to make these accounting. Consequently he has very few “stories” of my abuse. Mostly it is through my writing that he has come to know these things. He is absolutely correct. Being forced, as part of therapy, to re-hash events I had no control over then and have no control over now is not a type of therapy I find beneficial.
Tell me About Your Trauma in Great Detail - Trauma-Focused Cognitive-Behavioral Therapy.
Although readers of this blog know that I utilize cognitive -behavioral therapy, what separate this focus of therapy with trauma-focused cognitive-behavioral therapy is “trauma-focused.” This is includes a recounting of past traumatic events.
Because none of these therapies seem to really appeal to me, I developed a set of guidelines that I give to potential therapists. When I am forced to find a new therapist because of a move or a therapist closes, I set interviews with potential therapists and go and see them. I set down the following guidelines.
  •  I am not a Christian so talking about the Bible or the Judeo-Christian God is not the way to make me feel better. I am Wiccan. If you don’t know what that is, I will provide you with a book about Wicca for you to read so you can understand my faith based perceptions. I need a therapist who is at least familiar with my spiritual choice.
  • I am a thinking and accepting liberal. If you are going to find my handling of my life which permits that gays have equal rights to marry, my son can be gay, straight or bi-sexual and I am equally attracted to women and men as morally reprehensible, then I need to move on.
  • I believe in rights and wrongs. Don’t tell me that my biological father had some dharma he needed to live through by raping me which in turn should prompt me to forgive him and continue a relationship with him. Bullshit. He was fucked up and should be in jail. If I was raped by a stranger no one would dare to suggest a close relationship with my attacker. I see no reason why the relationship to my attacker should change that opinion. Can’t live with that view point, then I need to move along.
  • I have no plans to spend the first four or five sessions giving my new therapist a detail accounting of the torture and trauma I suffered at the hands of my biological family. I am happy to give one session to a brief over view of my trauma with my biological family and my trauma during my first marriage; however, I am not going to spend a month trying to give a counselor a full and complete accounting. As things come up in therapy, certain specific incidences will also rise and I may give an accounting at that time. It is likely to be general and not detailed. I share as much as I need in order to explain or quantify why I think there is a relationship between a particular issue in my present life and some violation of my past.
  • I have spiritually, mentally and emotionally divorced my biological family. I do not forgive or forget my biological father, my paternal grandmother or grandfather or my biological mother. Although I may release my past as a way to ensure that it doesn’t have continued adverse effects on my present functionality, I will not be lulled into a false sense of security in trusting people who spent a lifetime destroying that trust. I know that pedophiles and rapists only stop doing those things because of age. Their testosterone decreases and they stop offending. My offender raped multiple girls who found me when they were adults and confronted me over my biological father’s behavior. My mother, despite having been given an opportunity to hear the truth, has rejected that truth as my biological siblings have. I do not deny their right to do this and my divorcing of them is to ensure that some objection registers. I do not want future victims to find me and continue to accuse me of doing nothing to stop a monster. So I took a stand and divorced them. If, as a therapist, you can’t or won’t understand why this is a good therapeutic choice, then I cannot work with that therapist.
  • I see therapy as a two prong approaching to keeping the level of my ability to function in an acceptable range. First it is to relieve normal stressors in a safe environment. I want to bitch moan, groan and explore the stress I experience daily. Often, I am not looking for direction regarding these stressors, just a place to release them so that some of the internal pressure is also released. Second I am looking to use cognitive-behavioral therapy to change poor thinking patterns and behavioral habits in order to keep from repeating behavior that lowers my ability to function.
I cannot recount to you the number of therapists who have rejected me as a patient after hearing the above requirements. Unfortunately, most survivors do not know what works best for them in therapeutic situations and will spend years in negative therapy that doesn’t improve their functionality within real world circumstances. 
This inability to find positive therapeutic situations for myself has baffled me for years. When I started my research into the cycle of recovery from a major post traumatic event, I came across two theories that I am currently trying to learn about and understand. Both have left me hopeful that I am not completely out of my mind.
Complex Post-Traumatic Stress Disorder (C-PTSD)

“Complex Post-Traumatic Stress Disorder (C-PTSD) - Complex Post-Traumatic Stress Disorder is a proposed psychological injury that results from prolonged exposure to social or interpersonal trauma, disempowerment, captivity or entrapment, with lack or loss of a viable escape route for the victim.[iv]
The biggest differences between C-PTSD and PTSD is around the length of exposure is separated. PTSD victims may have had one or two encounters where C-PTSD victims have had prolonged exposure that lasts years. Another difference involves disempowerment, captivity and inability to escape. PTSD include members of the military who have suffered trauma fighting in war. This trauma was born of a place of empowerment (with the notable exception of some Vietnam veterans who were drafted). Even if drafted, however, some training was given before the trauma occurred. In the case of C-PTSD sufferers, the victims are children born into the trauma without any warning or training to prepare them for the coming torture they will experience. Further, although war veterans may have felt the military had physical trapped them, there are still options available to them (medical discharge, dishonorable discharge, not accepting an extension in a commission). Children born to torture and rape have no viable mechanism available to them to leave. Their torture continues under the bounds of complete captivity.[v]
Having been part of group therapy sessions that include veterans with PTSD and victims of PTSD who suffered one incidence of trauma, I can tell you that the patients being treated do not see many similarities between the PTSD of veterans and onetime sufferers or the class of PTSD sufferers who came from years of captive abuse. This distinction also helps surviors of proglonged captive suffering to understand that there was no alternative of escape available to them. This may seem obvious to some and is not obvious to the sufferers of abuse. After going to a battered women’s shelter at 18, I remember clearly my complete shock when the director said, “Obviously, you can’t go live with your parents anymore.”
“You aren’t going to send me home?” I had said in shock and bewilderment.

“No! You can’t live with people who allow these things to happen or do them,” she replied.

“Oh Good. I haven’t wanted to live with them for so long and thought I didn’t have a choice,” I said.

This exchange is a common mind set of persons who have suffered long term abuse. There comes a point when they expect the abuse to continue and expect that there is no option of not suffering the abuse. C-PTSD is the an attempt at a clinical explanation of this phenomena particular to children who have suffered prolonged suffering without the ability to leave.

Resilience - George Bonanno

The research being conducted by George Bonanno is overturning previous ideas around the stages of grief. Bonanno asserts that psychological resilience, the ability of a person to cope with trauma and stress, is at the center of trauma and grief reactions.

He is utilized scientific method to prove his theories and further them and hasn't readily accepted that the Five Stages of Grief nor the ways in which persons of severe psychological trauma are currently being treated is the best or even the most efficent treatment.

Bonanno has demonstrated that there are four trajectories related to grief and trauma reactions.
Resilence, Recovery, Chronic Dysfunction and Delayed Grief or Trauma. What intrigues me at first blush with Bonanno and his research is his focus on functionality, the ability of a survivor to cope long term after a traumatic event or death.

Functionality is what I have, inadvertently focused my personal counseling on. I have focused on cognitive behavioral therapy that only looks at trauma in relations to the light it can shed on my functionality today. If issues come up during my coping with C-PTSD, the default question is, "How can I take this experience from my past and mimize it's impact on my now?"

"How can I change how I think or do something now, despite my learned behavior from my past trying to mold my thoughts or actions in a different and less desirable way?"

Further reading on this issue is going to be needed for me to fully understand what Bonanno is suggesting. However, these new views of trauma and loss, are for me extremely hopeful.

[i] "EMDR Institute, Inc. - EMDR Institute." EMDR Institute, Inc. EMDR Insistute, Inc., n.d. Web. 10 Jan. 2014. <>.
[ii] This is my personal experience and I am aware that this type of therapy MAY work for some people. Although my resent research has uncovered the Resilience Theory by George Bonanno which suggest through the scientific method and research that these types of therapy may cause more harm than good.
[iii] Symptoms, Treatment and Self-Help., Dec. 2013. Web. 08 Jan. 2014. <>.
[iv] "Out of the FOG - Complex Post Traumatic Stress Disorder (C-PTSD)." Out of the FOG - Complex Post Traumatic Stress Disorder (C-PTSD). Out of the Fog - Support, Information regarding Personality Disorders, 2011. Web. 10 Jan. 2014. <>.
[v] Author's Note: C-PTSD would be considered a viable diagnosis for miltary personnel held as prisoners of war, any persons kidnapped and held against their will, women and children kidnapped and tortured by a perpetrator over significant periods of time. Age is not the most important quality for C-PTSD. The inability to escape the abuse is paramount.