Psychoanalyze Your Characters 4: PTSD

Onto our fourth installment of Psychoanalyze Your Characters, my attempt to share some psychological knowledge to help you flesh out your characters' psyches. Today I'll shift from Axis II to Axis I, focusing on the clinical syndrome of Post-Traumatic Stress Disorder (PTSD).

PTSD is a normal reaction to an abnormal event. It's an anxiety disorder that some people develop after seeing or living through a threatening event. Most experience a "fight or flight" syndrome in response to a dangerous situation, but in PTSD this reaction is damaged and individuals feel threatened long after the danger subsides. Potential traumas include:

* Abuse (physical, sexual, emotional)

* Sudden, unexpected death

* Natural or human-caused disasters

* Personal assaults

* Military combat

* Accidents

I've seen PTSD develop after individuals have experienced sexual abuse, motor vehicle accidents, childhood bullying, domestic violence, and suicide of a loved one, to name a few. What's interesting is that a group of people might all experience trauma but only selected few develop PTSD. Some factors that increase the likelihood of PTSD include a history of anxiety, past losses, and lack of coping resources. Abuse survivors are more likely to experience PTSD when that abuse occurred at a young age, was frequent and intense, and was perpetrated by someone close to them charged with their care.

There are three groupings of symptoms in PTSD: distress, numbness, and avoidance.

Individuals typically alternate between states of high distress (reliving the traumatic event through flashbacks and nightmares, feeling on edge or "hypervigilant") and numbness (emotionally flat, exhausted). The distress taxes our systems so much that the body shuts down and goes into a dull state of fatigue at times.

The third symptom is avoidance of the trauma. For example, an individual who was sexually abused might avoid romantic relationships, because intimate situations remind her of the trauma. Or, a car accident survivor might not want to get into a car.

One of the best movies I've seen about PTSD is Fearless. The movie features Jeff Bridges and explores the aftermath of a horrific plane crash. If you watch it, keep the tissues handy.

Another good PTSD movie is The Prince of Tides (except for the part about the psychiatrist sleeping with her client's brother--why does the media always have to portray therapists sleeping with their clients? *winks*). At its most severe, abuse can result in a splitting off of oneself in order to cope with the trauma, resulting in dissociative disorders like Dissociative Identity Disorder (formerly Multiple Personality Disorder). Primal Fear and Sybil showcase this disorder.

Why do individuals with PTSD behave like they're in danger when they're not? A colleague explained it using a screen door metaphor which I thought was brilliant. Picture a screen door in your brain. When a stressful event happens to you, chemicals like adrenaline flow through the screen door and prepare you to handle the stress. However, when a trauma occurs, sometimes the chemicals scream through so fast that they bust a hole in the screen door. Now individuals are left with a hole in their screen door. The next time they experience something resembling a trauma (a "trigger"), the adrenaline rushes through the hole and they feel like they are re-living the trauma. Their heart races, they can't get air, they tremble, they freeze.

Treatment can be very effective for PTSD. Since the brain is living in the past, one strategy is to bring the brain to the present through using grounding skills. Individuals should use their five senses to anchor themselves in the present: "I see the painting on the wall. I hear the clock ticking. I feel the surface of the sofa beneath me." Deep breathing is essential. When we are very anxious our breathing becomes shallow and fast, and deep breaths help quell the cascade of the stress response.

Treatment also involves correcting dysfunctional beliefs that might have developed. The most common seems to be the belief "It was my fault" for abuse survivors. Because children are egocentric, they believe they alone are the cause of good and bad things that happen to them. As adults they need to learn that they are not to blame for the actions perpetrated by others. Therapy, specifically a technique called EMDR, might help individuals adopt a more functional belief like "I did the best I could."

We all experience stressful events and life is also full of trauma, so this disorder can provide a realistic and dramatic backdrop to your characters. Good luck!

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