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Last Updated Thursday November 30 2017 11:11 AM IST

Heal Thy Self | Shaken, not seared

Nirmala Ferrao
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Heal Thy Self Now and then, life throws us a particularly vicious googly. Here’s how to field it – and bounce back. Photo: Getty Images

What do India’s acid attack survivors have in common with the 20,000-odd teens and adults who ran, screaming and terrified, from the smoke and embers and carnage of the Manchester terror attack? And what do they all have in common with a last-generation Holocaust survivor who says he doesn’t remember what he had for breakfast, but he will never forget anything that happened to him in the four concentration camps that he endured?

Also read: Heal Thy Self | Helicopter parenting

The common denominator in their lives is that they are all Extreme Survivors – each of them was exposed to an experience that completely overwhelmed his or her ability to cope, and left their psyches marked with a forever-scar.

Fifty to 60 per cent of people will experience at least one traumatizing event in their lives. In some regions today (e.g., Syria, Iraq, Turkey) and in some kinds of situations (refugees fleeing from ethnic strife; abductees; hostages), the proportion of trauma-affected persons can go right up to 90 per cent. And, on a different plane, Nature – mercurial and merciless – continues to unleash her sudden, inexorable cruelties. Whether the trauma is a fallout of a natural disaster or a violent attack, there has been a rising graph of such events in recent times.

A life forever changed

But, more than the power and fury of Nature, more than the menace of the gun or the chilling terrors of a concentration camp, what is stupendous and awesome is the sheer resilience of the human spirit, the grit of most survivors. Although many, if not most, people exposed to trauma will temporarily experience symptoms of stress – disrupted sleep, anxiety, irritability, anger, numbness, difficulty in concentration, flashbacks of the experience, nightmares, crying spells that come on without warning – most will also recover with the support of trusted and compassionate family and friends. They get better essentially on their own, without any professional intervention.  In general, the intense physical and emotional responses start to lessen within two weeks and often disappear within four to six weeks as the survivor integrates the loss, works to cope with the challenges, and begins to re-build a new life.

Heal Thy Self In general, the intense physical and emotional responses start to lessen within two weeks and often disappear within four to six weeks. Photo: Getty Images

Also check: Heal Thy Self | Want respect?

But there is a significant minority of people in whom these stress reactions don’t resolve, and they go on to develop conditions like major depression, or anxiety disorders including Post Traumatic Stress Disorder (PTSD).  Those at risk for PTSD include not only those who are directly affected by a horrific event, but also witnesses, perpetrators and those who help PTSD sufferers (“vicarious traumatisation”).

Unfortunately, “PTSD” has increasingly become a catch-all label among media persons who haul the term into their reportage of any kind of crisis, trauma or disaster. Even more unfortunately, mental-health professionals are also guilty of sticking this label where it does not belong. Thus, victims of a traumatic experience have been “diagnosed” by healthcare volunteers as suffering from PTSD in on-the-spot appraisals in the immediate aftermath of a tragedy. But PTSD, by definition, is not diagnosed – or diagnosable – until a specific syndrome of symptoms has persisted beyond a month. That cut-off criterion is important because some who would have recovered on their own might instead conceivably be “assessed” as suffering from PTSD. The symptoms that survivors show in the immediate aftermath of a trauma may be diagnosed as “acute stress reaction”. But if they persist beyond a month, and if certain other criteria are met, the diagnosis might change to “Post-traumatic Stress Disorder”, which is quite a different can of worms. In PTSD, the fight-or-flight response that is triggered in the body when a person feels under threat, is changed or damaged. People who have PTSD may feel stressed or frightened even when they are no longer in danger.

The three main criteria for diagnosing PTSD are:

1. Re-experiencing the trauma in your mind:

» Having unwanted images of the trauma (called flashbacks) coming into your mind

» Having upsetting dreams about the trauma, or dreams about other things that frighten you

» Feeling that the trauma is happening again – strong sensations of re-living the trauma for minutes or even days at a time

Heal Thy Self Having unwanted images of the trauma (called flashbacks) coming into your mind. Photo: Getty Images

» Feeling very distressed at coming across situations or feelings that remind you of the trauma

» Experiencing distressing physical reactions, e.g. heart beating faster, dizziness, sweating, when you are faced with memories of the trauma, or situations or even words that remind you of it

For instance, you may hear a car backfire and be flooded with the same sensations that you experienced in the war-zone – sweating, heart pounding, chills and shakes. Or you may see a news report about a rape and feel overcome by memories of your own assault.

2. Avoidance of triggers related to the trauma, and emotional numbing:

» Avoiding activities, places or people that remind you of the trauma (external reminders)

E.g., after experiencing a close call in a plane mishap, you might decide to avoid air travel.

» Trying to avoid thoughts, feelings or physical sensations that remind you of the trauma (internal reminders)

» Feeling emotionally numb, feeling detached from others or having difficulty maintaining close relationships

» Losing interest in activities that were enjoyable in the past

» Hopelessness about the future

» Memory problems

3. A heightened state of arousal:

Heal Thy Self Hyper-arousal symptoms are usually constant, instead of being triggered by things that remind you of the trauma. Photo: Getty Images

» Irritability or anger

» Overwhelming guilt or shame

» Reckless, self-destructive behaviour, such as drinking too much

» Being easily startled or frightened

» Hyper-vigilance (as though continually on guard against a repetition of the terror)

» Trouble falling or staying asleep, or having restless sleep

» Problems with concentration

Hyper-arousal symptoms are usually constant, instead of being triggered by things that remind you of the trauma. They may make it hard to carry on with daily routines such as sleeping, eating or concentrating.

To be diagnosed with PTSD, a person must have all of the following for at least 1 month: 

» At least 1 re-experiencing symptom

» At least 3 avoidance / numbing symptoms

» At least 2 hyper-arousal symptoms

If you have been experiencing the disturbing thoughts and feelings of PTSD for more than a month, if they are causing significant distress in your life or interfering with your ability to go about your normal daily tasks, talk to your doctor. You may be referred to a psychiatrist or other mental-health professional. Getting treatment as soon as possible can help prevent PTSD symptoms from getting worse.

Important: In some cases, PTSD symptoms may be so severe that you need emergency help, especially if you’re thinking about harming yourself or someone else. If this happens, get in touch immediately with a doctor, or ask a supportive family member or friend for help, or call a suicide prevention helpline.

The road to recovery

PTSD is the sentinel disorder of anxiety. What seems to happen is that a sweeping alteration takes place in the chemistry of the brain. The hyper arousal that occurs at the time of the original trauma – prompting the body to fight, flee or freeze – does not abate with time in people with PTSD. They literally become “frozen in time”, their neural circuitry becomes stuck in a state of hyper arousal, keeping their bodies fixed in a readiness to react – to dangers that are no longer present.

Heal Thy Self Recovery from PTSD thus becomes a matter of reversing this hijacked neural circuitry, which can happen only by a process of re-learning in the brain. Photo: Getty Images

Recovery from PTSD thus becomes a matter of reversing this hijacked neural circuitry, which can happen only by a process of re-learning in the brain. Research continues into how people form memories, and how they can create “safety” memories to replace the alarming ones that form after a trauma. In the meantime, we do have therapies that have proven their worth in re-educating the emotional circuitry.

» Reaching a place of emotional safety. The first step is for the person with PTSD to be helped to regain a sense of safety, which translates into calming the too-fearful, too easily triggered emotional circuits enough to allow re-learning. Often, this begins with helping him understand that his flashbacks and his nightmares, his jumpiness and his vigilance are all normal responses to an abnormal event, that he is not “going crazy” or “losing it”. Knowing this itself makes the symptoms less frightening and overwhelming, and helps the person regain some sense of control over what is happening to him.

» Medications. While there is no clear drug treatment for PTSD specifically, a clutch of medications is used to relieve symptoms. These include anti-depressants; anti-anxiety drugs; anti-psychotics (can help with mood issues and aggression); and Prazosin, a drug that was developed to treat high blood pressure, but which has also proved useful in reducing the nightmares and other sleep disturbances that are common in PTSD.

Heal Thy Self While there is no clear drug treatment for PTSD specifically, a clutch of medications is used to relieve symptoms. Photo: Getty Images

By controlling symptoms such as sadness, emotional outbursts and anxiety, these drugs create a physiological calm that may make it easier to go through psychotherapy.

Be sure to tell your healthcare professional about any side-effects or problems you may have with the medications, as you may be able to try something different.

With many medications, residual symptoms of PTSD are the rule, rather than the exception (which has led to stepped-up research in the aggressive treatment of PTSD symptoms).

» Psychotherapy. Also called “talk therapy”, it involves just that – talking with a mental health professional. Therapy usually lasts 6 to 12 months, but can take longer. There are many different types of psychotherapy that can help. Working with the therapist, you may try only one, or combine therapies before finding the right fit for you.

The goal of therapy is to help the trauma victim to understand rather than to avoid feelings, to tolerate negative emotions such as anger or fear, to communicate such emotions rather than suppressing them until they explode in an uncontrollable outburst, and thereby to enhance communication with others and re-build trust.

How you can help yourself

As you continue with treatment for PTSD, you can take actions to help yourself cope:

» Follow your health professional’s instructions. Although it may take a while to feel benefits from therapy or medications, most people do recover. Remind yourself that it takes time.

Heal Thy Self Working with the therapist, you may try only one, or combine therapies before finding the right fit for you. Photo: Getty Images

» Exercise. The U.S. National Center for PTSD, which is a centre of excellence for cutting-edge research into PTSD, recommends moderate exercise as a way to distract from disturbing emotions and increase feelings of being in control again.

» Take care of yourself.  Eat a balanced diet, stay physically active, but give yourself permission to rest, relax and engage in non-threatening activity. Read, listen to music, take up a new hobby, treat yourself to a massage by a professional. Avoid caffeine and nicotine, which can worsen anxiety.

» Don’t self-medicate. Turning to alcohol or drugs to numb your feelings isn’t a good idea, even though it may be a tempting way to cope. It can lead to more problems down the road.

» Talk to someone. Stay connected with supportive and caring family, friends or a spiritual guide. You don’t have to talk about what happened if you don’t want to. Just sharing time with loved ones can bring solace and healing.

» Consider a support group. Ask your healthcare professional for help finding one.

» Religious practices — especially those that emphasize altruism, community and having a purpose in life — have been found to help trauma victims to overcome PTSD.

The message of hope for today is that we have a variety of effective treatments for PTSD. Although they are not perfect, if you stick with the therapy and team up with your healthcare provider to find the mix that works for you, you can expect a considerable degree of relief. 

Slowly, survivors start to live again. In time, they begin to believe that life is worth living and that, most of all, despite tragedy...life goes on.

(The author is a former editor of 'Health & Nutrition' magazine, and now works as a counseling therapist)

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