"The following is an essay I wrote in the spring of 2006, depicting my personal struggle with Post-Traumatic Stress Disorder at that time. Please know that you are not alone. Know that, as I have, you too can fully recover."
~ Jane Doe
According to the National Center for PTSD, Post-Traumatic Stress Disorder, or PTSD for short, is a psychiatric disorder that can occur following the experience or witnessing of life-threatening events such as military combat, natural disasters, terrorist incidents, serious accidents, or violent personal assaults like rape. Most survivors of trauma return to normal given a little time. However, some people will have stress reactions that do not go away on their own, or may even get worse over time. These individuals may develop PTSD. People who suffer from post-traumatic stress disorder often relive the experience through nightmares and flashbacks, have difficulty sleeping, and feel detached or estranged, and these symptoms can be severe enough and last long enough to significantly impair the person's daily life.
Available data suggest that about 8% of men and 20% of women go on to develop PTSD, and roughly 30% of these individuals develop a chronic form that persists throughout their lifetimes. An estimated 7.8 percent of Americans will experience PTSD at some point in their lives, with women (10.4%) twice as likely as men (5%) to develop PTSD. About 3.6 percent of U.S. adults aged 18 to 54 (5.2 million people) have PTSD during the course of a given year. This represents a small portion of those who have experienced at least one traumatic event; 60.7% of men and 51.2% of women reported at least one traumatic event. The traumatic events most often associated with PTSD for men are rape, combat exposure, childhood neglect, and childhood physical abuse. The most traumatic events for women are rape, sexual molestation, physical attack, being threatened with a weapon, and childhood physical abuse.
The NCS (National Communications System) report has concluded that "PTSD is a highly prevalent lifetime disorder that often persists for years. The qualifying events for PTSD are also common, with many respondents reporting the occurrence of quite a few such events during their lifetimes."
However, none of these events invariably produce PTSD in those exposed to it, and a particular type of traumatic event does not necessarily affect different sectors of the population in the same way
Source: National Center for PTSD (2007)
How do I explain this to myself? How do I explain that sometimes I live in a world that isn't real anymore?
I turn the lights on - all of them. In every room of my apartment. Preparing to take a shower that I'm afraid to take. I lock our front door, and turn on the light that leads down the staircase from our front door to the downstairs, bottom door. This way, if someone knocks, the light will be on. If I open the door I'll be able to immediately see who they are.
"What, are you inviting them in?" It starts, "How freaking stupid are you?"
"Shut the hell up," I respond.
I'm in the shower in our bathroom, with the bathroom door open. The bathroom door, itself, is directly eye to eye with the front door of my apartment- both doors stand maybe 15 - 20 feet apart. If the front door knob jiggles, I'll hear it. If someone knocks, I'll hear it over the water spewing out from the shower head above me. I take turns between washing my hair and staring out of my shower curtain at the door, making sure nothing looks or sounds suspicious.
"What the hell is wrong with you?"
It sounds like a man who once asked me that same question. Though I can't be sure of the circumstances. It sounds like I'm standing outside the door, and listening to him scold me from a distance from a room we once were in. I don't know for what exactly he was scolding me for. I never know, I just hear it like a record that won't shut off in my head.
I do what they told me to do at the hospital. I tell myself its not real. I know its not. But that doesn't keep me from getting shaky inside. My hands tremble like I have Parkinson's. I get out of the shower, and dry off, still staring at our front door. Listening. When I'm like this everything is so much louder. I can hear the slightest sound, and if I get like this in front of people it takes all I have not to cover my ears and curl up into a ball. With each word spoken seeming so loud, it makes me want to scream, myself. I do what the doctors tell me and remind myself that I'm listening for something that's not really there anymore. For footsteps that used to be.
Source: National Center for PTSD (2007)
I get dressed and go get my medicine ready for later on in the night. Its important. I have to make sure I take the right pill at the right dosage, and don't get any of it confused. The trileptal is used to treat epilepsy, but they've also found its a good mood stabilizer as well. The dosage changed this month. I have to make sure that I take the 600 mg pill tonight and not the 300 mg pill I'll need to take when I get up tomorrow morning. Trileptal was initially, and still is, used to treat epilepsy, but they also use it to treat mania in patients who are bipolar. I'm neither epileptic, or bipolar. But I can see how it would be similar in treating mania and treating this post-traumatic stress that plagues me.
In mania the brain chemistry is imbalance causing elevated mood, over-reacting to stimuli, distractibility, racing thoughts, excessive energy, lack of sleep - sometimes only a few hours a night. I'll never forget a bipolar gentlemen I met in the local adult unit of our cities mental hospital, who'd gone two weeks without sleep by he time they brought him in. With post traumatic stress - what I experience - its a reliving of trauma, they say.
According to The National Center for PTSD(2007), symptoms are associated with a number of distinctive neurobiological and physiological changes. PTSD may be associated with alterations in the nervous system, such as altered brainwave activity, and abnormal activation of the amygdala, which is a part of the brain that is involved in the processing and integration of memory, and that has also been found to be involved in coordinating the body's fear response.
Symptoms associated with PTSD include hyper-arousal of the sympathetic nervous system, increased sensitivity of the startle reflex, and sleep abnormalities. People with PTSD tend to have abnormal levels of key hormones involved in the body's response to stress. They also continue to produce higher than normal levels of natural opiates after the trauma has passed - trauma being the primary cause of the disorder. An important finding is that the neurohormonal changes seen in PTSD are distinct from, and actually opposite to, those seen in major depression. Mania, in bipolar individuals is the opposite of the depression they also suffer from. So, using medication that treats mania for also treating PTSD makes sense.
Now, I'm bent over our end table sorting through bottles with pills and labels, searching for my seroquel. This month the dosage has changed also - from the 300mg to 200mg. Seroquel was originally used to treat only schizophrenia, and is considered to be an antipsychotic. But, again, they've found it works in treating acute mania in bipolar patients. So, again, its also now being used to treat post-traumatic stress disorder. Its mainly for the unbearable insomnia associated with both mania and post traumatic stress disorder.
Sometimes the old recordings in my head get so loud I can't think, or sleep. But, sometimes I'm too scared to sleep. Sleep brings the nightmares of the things that happened. Replaying, replaying. But, at the same time, being awake isn't much easier. 50 mg of seroquel usually knocks someone out within 10 to 15 minutes. It took 400 mg to finally get me to sleep at night, knocking me out - past the noise in my head, and the feeling that I was about to be attacked at any moment...by someone who was no longer there to hurt me. That was over a year ago, during my last and what I wish to be my final hospitalization. Now I'm at 200 mg.
Then there is the klonopin - two pills that equal 1 mg. - that doesn't really do anything, but I take it anyway. Klonopin is used to treat anxiety, and PTSD is still considered to be a type of anxiety disorder. I take them for good measure, though when I run out that will be it. So, I need to start weening myself off of them, because some strange, tiny part of my brain will miss them once they're gone and that could keep me up for an hour more than I can't afford to spend, on another night, doing all I can to fall asleep. Another night spent feeling alone, though I'm not.
Again, the National Center for PTSD (2007) notes that it is not a new disorder. There are written accounts of similar symptoms that go back to ancient times, and there is clear documentation in the historical medical literature starting with the Civil War, when a PTSD-like disorder was known as "Da Costa's Syndrome." There are particularly good descriptions of post-traumatic stress symptoms in the medical literature on combat veterans of World War II and on Holocaust survivors.
Source: National Center for PTSD (2007)
So I know I'm not alone. I never have been and never will be. I'm one out the millions here in the United States, that develop this, from one given point to another. But, looking at the statistics it just really only makes me feel a bit worse sometimes. There's so many different pains in the world that have no cure. From this, you can heal. You can get better. But it's a life long process...a life long commitment for me, I've been told. But, It's not so for everyone. It's not so for most. All I can do is the best I can, which is all that any of us can do. On night's like this its just harder to remind myself that I'm doing the best that I can, and even harder to fathom that where I'm at, and that what I'm experiencing is actually okay. That, for one reason or another, this is where I'm supposed to be? That this won't last?
It never does. Nothing is permanent. Life guarantees change to us, if nothing else. And that gives me comfort. And I remember how far I've come. I remember what a gift it is to want to wake up in the morning and keep going, because everything will be okay. To really know that. So I explain to myself that maybe its not so much that sometimes I live in a world that isn't real anymore, but more of one where time simply moves a bit differently for me. Where there is a place in my mind that is still trying to understand what happened. So sometimes, it repeats things to try to process it. To try to come to terms with it. To try to bridge the gap between betrayal and trust, between danger and safety, that is so vital to having peace of mind, and that eventually I'll unwind from the depths of what once was suffering, back into a place that is here, right now.
Its in this room with me. I'm here now. I am 24 years old, and I focus to feel my fingers moving effortlessly over the keyboard, and feel each key slip down from the weight of my fingertips. Next to my computer lays a bottle of my favorite tea of raspberries and sugar that I can never get enough of, as I reach over, taking a sip, appreciating it's flavor. I can hear the passing of cars on the busy State Route, just outside my quaint apartment.
I rise up and light the same candle I do every night, and this time I pray for strength. I try to relax in its flames language of its own cinnamon-apple aroma and warm flickering. It can be breath taking how much serenity comes in concentrating on living in this place they call "the here and now".
I explain to myself that the key to wellness is to concentrate on living in this moment, because these moments are all that any of us really have. I explain to myself that, it's not that I sometimes live in a world that isn't real anymore, but in one that is very real, if I can manage to reaching hard enough beyond the clutter of pain that plays over in my mind...all the muffled yelling, and fear of being found. Because, beyond it I'm right here. Even during the times that I can't reach past the madness, I can at least remember the calm, close my eyes, and imagine myself there instead.
National Center for PTSD. (2007). PTSD Overview. U.S. Department of Veterans Affairs. retrieved from: http://www.ptsd.va.gov