PTSD is not (exactly) an illness

Flashbacks.  Avoiding public places.  Hiding in the closet.  Jumping at sounds.  Nightmares.  Waking up shaking or screaming.  Yelling at loved ones for no reason.  Feelings of fear, anxiety, shame, rage.  These are some common symptoms of PTSD.  (Childhood trauma can manifest itself a bit differently.) There may also be depression, numbness, lack of ability to focus or concentrate and many similar symptoms.  People feel unreal, the world feels unreal.  But still, I’ll say that PTSD is not exactly an illness.  It’s not quite that simple.

How can anyone say that, especially when PTSD sometimes requires hospitalization?  Well, let me explain.  It starts with an understanding.  We are creatures with bodies and our brains are part of our bodies.  When bodies are injured, they immediately do several things.  First, they marshal protective resources.  If you are cut, the blood begins to clot.  The body may withdraw bloodflow back to your core (this is the physical reaction called shock).  Next comes inflammation—the body sends white blood cells to the site to fight any infection that may have intruded.  Finally, over the next few days or weeks, many restorative healing processes reconstitute the skin, the flesh and the blood vessels in the injured area.  Protection, then healing.  It’s what bodies do.

Protection

Traumatic stress occurs when our brains are overwhelmed with events that threaten us or those we are close to in some way.  The first thing we do under threat is fight or run.  If either of those works, then we’re usually pretty much ok afterwards.  But sometimes they don’t work.  Something is too much for our defenses.  The beating happens, the person is ejected from the car, the dog tears at the face.  When this happens, our brains protect us.  We dissociate, that is, we check out in some way.  Numbness, freezing, shutting down, forgetting, out-of-body experiences—these are the realm of the body’s defenses.  These are examples of defenses against threats that overwhelm our fight and flight responses.  If we can successfully fight, flee, or get help, we don’t need them. But when those strategies don’t work, our brains protect us from the too-intense experience of harm.

And as long as the threat remains active, the body (the brain) is in protection mode.  We do whatever it takes to survive.  But eventually the threat is gone (in cases of child abuse, domestic violence or imprisonment, this may take years).  Once we are safer, it’s time for the body to heal.  It’s time for the broken bone to mend, for the slashed skin and flesh to knit itself back together again.   So what does it look like when the brain is healing trauma?

Healing

In the last 50 years, we’ve begun to discover some answers to this.  We know, for example, that unhealed traumatic memory is very different from normal memory.  So the healing process must involve the brain constructing a normal memory of a situation that was unbearable at the time.  We also know that there is some kind of “charge” held in the body.  The body must somehow “ramp down” from its protective state back to a resting state.   This involves changes in physiology, in muscle tension, in the levels of stress hormones in the blood and many other things.

In the vast majority of people, the brain heals itself.  Some people are even stronger after the traumatic experience.  But some people do not quite heal on their own.  We don’t know completely why, but there are probably many reasons.  One is unresolved trauma from childhood.  Another is that the trauma might have been so massively overwhelming that the brain can’t heal just by itself.  There are other reasons and often we don’t know why.

So what then is PTSD?  A modern view is that it is nothing but a situation the brain’s attempts to heal that are stuck in one place–the brain is still trying to protect us, even though the event is over.  If you look at the PTSD symptoms, they are all about protection.  (The two major modes of protection involve being more agitated in some way, or checking out in some way.)  So there is nothing “crazy” or even wrong with a person who is suffering from PTSD, except for the fact that somehow, things are not healing (yet).  Like a scab that is constantly picked, like an unbandaged wound that keeps getting torn open, there is something that keeps the PTSD sufferer from healing naturally.  Some part of the brain doesn’t know that it’s over.

Supporting a natural process

The goal of trauma therapy is not fixing people who are broken.  It’s more like putting casts on broken bones, bandaging bad cuts, supporting immune responses with antibiotics.  We create a space for healing and facilitate the process.  Therapy puts a container around the wound and protects it.  Then we often jump-start the process, but then it unfolds of its own accord.  We try to keep from re-injuring it while that happens.

So in some important sense, PTSD isn’t quite an illness–it’s more like and unhealed wound–the body’s attempts at healing are stuck for some reason.   There are many things that can help—arts as simple as massage or as complex as acupuncture have been shown to be helpful.  And there are a number of therapies that can be very helpful in getting the process going.  But let’s be clear:  The therapy doesn’t completely heal the trauma, any more than the cast heals the bone.  The body heals, the brain heals, the person heals.

But sometimes, I have the privilege of helping.

I appreciate any comments. :)