A close acquaintance of mine has had post-traumatic stress syndrome (PTSD) for the better part of a decade. Recently, this person referred to their condition to a relative, only to receive the reply, “Aren’t you over that yet?”
The response highlights one of the many misunderstandings of this condition. In fact, from its origins to its symptoms, treatment, and long term prospects, probably no other mental condition is so misunderstood. Nor is understanding encouraged by the fact that the words “trauma” and “stress” are bandied about by people to refer to normal reactions to daily events or merely mild upsets.
So what is PTSD? Contrary to popular perceptions, it is almost never the anxiety caused by financial or romantic concerns, or by grief. All these circumstances can be stressful, but do not result in PTSD unless other factors are at play as well.
Nor is PTSD simply a reaction to physical trauma, such as combat or rape. Many people go through both and do not develop PTSD, while some people develop it because of psychological sufferings, such as interactions with unsympathetic authorities or the suicide or random deaths of people around them.
Just as importantly, there is no way of predicting what will cause PTSD. What triggers the condition in one person may seem trivial to another, and some cases of PTSD are caused by a single episode while others are caused by a continuing sequence of events. Contrary to the way that “shell-shock” was once regarded, it is not a matter of cowardice, but of being overwhelmed and rendered powerless by events.
Similarly, while some studies suggest a genetic predisposition to PTSD, what matters is whether a person ever encounters circumstances that will cause the condition in them.
Another reason to downplay any genetic tendency is that the cause of PTSD seems primarily psychological. What all cases of PTSD seem to have in common is a loss of world-view – in particular, an individuals’ ability to control their own life.
Faced with a loss of meaning and control, those with PTSD develop what psychologists refer to as “hypervigilance” — a more or less continual condition of extreme alertness. This condition generally includes permanent physiological changes to the body, including an exaggerated startle response, and permanently higher pulse rates, and higher blood pressure. A PTSD sufferer is always far closer to fight or flight than the average person, or than what they were when they were healthy.
These physiological changes explain the images of PTSD in popular culture, in which the crazed war veteran goes berserk, or the badly stressed resort to alcoholism or drug addiction. And, in fact, sometimes those with PTSD do act in this way. However, more common symptoms are depression, loss of purpose and direction, nightmares, and a distancing from social contacts. Perhaps the most common symptom is a sense of existential angst (in fact, it may not be a coincidence that existentialist philosophy emerged out of France around the end of World War 2).
All of these symptoms may be reinforced by a person’s reluctance to disclose their problem for fear of appearing vulnerable – after all, to the hypervigilant, to appear weak means that they are risking attack.
Contrary to the response my friend received, PTSD is not something you “get over.” It makes permanent changes to the body, and probably the mind as well. It can flare up at any time, even after many years. In this respect, PTSD is similar to malaria – it is something that you learn to live with, but never move beyond.
Treatment of PTSD is two-fold. In the short term, those who suffer from it can minimize its effects by reducing the stress in their lives. Eating a balanced diet, staying physically fit, and getting rest all help. Even more importantly, those with PTSD need to develop a routine that minimizes the stress in their lives. They may need to find less stressful work, or have more flexible hours, or even work from home.
For example, the poet and novelist Robert Graves, who suffered shell-shock in World War I, eventually fled to the quiet of Majorca after over a decade of unsettled life in England. When people congratulated him on his apparent recovery, he explained that all he had done was to organize his life to deal with his problems.
In the longer term, the most successful coping mechanism seems to be to find a way to reaffirm the world view and values that PTSD have shattered. A classic example is the Canadian general Romeo D’Allaire, who suffered PTSD from what he perceived as his failure to do his duty as a soldier and stop the genocide in Ruanda while he commanded United Nation forces there. After a period of adjustment in which he was often drunk, D’Allaire managed to re-assert his ethics by becoming a strong advocate for peacekeeping by both Canada and the United Nations. He has also spoken frequently about PTSD and become something of an advocate for Canadian soldiers who suffer from his condition.
This sort of compensation can mean that, despite their condition, many people with PTSD can lead highly purposeful and accomplished lives. The catch is that they generally have to continue their accomplishments in order to reassert their world view against the trauma that has physically and mentally transformed them.
Finally, perhaps the most important point to make is that PTSD is not a mental illness in the sense that schizophrenia is. Instead, it is more accurate to compare it to an injury such as breaking a leg that permanently changes regular functioning. A person with PTSD is sane by any legal or common sense definition, but, like someone in whom an injury has left one leg shorter than the other, they have some troubles with ordinary functioning.
The next time you see someone with PTSD, try to keep these points in mind. And remember – the only reason that you haven’t suffered from the same condition may be that you have been lucky.
Off the Wall 
I would like to thank you for such a thoughtful essay. I have been dealing with PTSD for many years, and often a couple of family members have remarked I should ‘think positive’ (ironically, they are a portion of the reason why I have it…from physical abusive violence inflicted on me) and my initial reaction inside is always “How can I if so much of my experiences are Negative?!” To me it is in alignment with what I have experienced from other human beings (rape, stalking me, car accident injuries, assault in broad daylight) that tell me “anything can happen and I must constantly monitor for red flags in behavior” to keep myself ‘safe’. I wish more people would understand it is not based on imaginary fears, it is based on REAL HISTORIC EXPERIENCES. If I had been like this before, I think I could have prevented half of the trauma by running in the other direction. Instead I was ‘nice’, forgiving, and tried to ‘see the good’ in someone. Some people will never cross the line with you, some people will ruin your life in an instant and feel nothing about the damage they caused, and then the police do nothing, tell you that you can do nothing. Basically, there is no justice and the only measure of ‘control’ I have is to try and ‘prevent’ anything from happening by assessing people’s behavior. The flashbacks (triggered by any form of boundary crossing or cruel behavior in others), nightmares sometimes, and inclinations to become fearful are like one’s instinct on full throttle, because there is SO MUCH UNPREDICTABILITY IN THE ENVIRONMENT with regard to what people can do to you and get away with it, even if you file a police report. Is it really paranoid, or just smart these days?
Contrary to the response my friend received, PTSD is not something you “get over.” It makes permanent changes to the body, and probably the mind as well. It can flare up at any time, even after many years. In this respect, PTSD is similar to malaria – it is something that you learn to live with, but never move beyond.
Whoa, Nellie! Have you heard about/tried EMDR? As a survivor of childhood abuse I thought this was a burden that would twist my relationships forever, yet after a summer of treatment sessions, I left the weight of that transgression somewhere in Dean Funabiki’s office and walked out free of the psychological cancer that had spread into so many aspects of my (then) semi-functional life.
Inspired, I went back to grad school, got my MA in counseling and am finishing my training to be an EMDR provider. The changes are not permanent, they just seem that way. The body heals, the brain moves on just as you do.
Remember a splinter you once had? Leave it there and it gets infected, get worse and hurts every time you bump it. Remove the splinter and treat the wound and after it heals you almost forget where the splinter was. Really.
I’m glad that you are over your own trauma. Unfortunately, EMDR is still an unproven treatment that gives mixed results. In many cases, it does not work at all.
Perhaps EMDR will one day be solidly established. However, until that day, I will continue to say that PTSD is incurable.
lately i’ve been having panic attacks, and I’m going to the doctor soon about it. But I want to know what is the difference between Panic attacks and anxiety attacks. Also when i do go to the doctor. what will they do actually, like how will I be test and what do I tell them..
i gave ptsd for30 years and im still haveing nightmares,depresion foggy memory,i get into so much trouble.everytime i see a plane i think they are droping a bomb.when ever my son gets a cut i think hes been shot.i freek out all the time.i know ill never get over it. ive been through treatments,they dint work very long. so i hung my self.and dam if that didnt work eather.then the only thing i consintrate on is my children,this keeps me togeather.and i wont to give thanks to god above.and his son jesus.ided be dead by now.
From what I have read, researched, experienced and applied to PTSD in my psychology Bachelors, eight years experience in the field of psychology and entry into a masters in psych, PTSD does not have to be a permanent affect or disorder. It can be reduced to the point that a PTSD pt is no longer diagnosed with it. No one can accurately claim cure on any disorder of he mind, which is unseen and therefore difficult or impossible to completely determine. For the same reason, no one can completely determine that there is not a cure, plz excuse the base word. This is what I have read and what more accomplished professionals have explained to me. I discontinued my career in psych at 8 years to enter another field of study, which had nothing to do with this subject.
Opinion is divided on the subject, perhaps because PTSD can vary so much between people. My statements are based on that of practioners who have dealt with PTSD over a number of years.
I’ve spent fifty three year of my life reliving a paternal conflict without ceasing, for an event that was seared into my mind like molten metal. I was a deans list honor student in a fine arts college for five years. I presented my portfolio to my parent to show my accomplishment and was told to destroy it and ” make a real man out of yourself and do something worthwhile”. Being the dutiful German son that I was reared as I unquestionably followed his demands. To this very day whenever I attempt any art form I get almost catatonic, lock up and must force myself with terrible angst to produce any results that even come close to the work I loved more than anything I’ve ever done before or since. You are unquestionably right about your observations of PTSD. Thank you.
My husband is in a severely anxious state all the time, (for 2.5 years now) and has given up any hope of improvement. We have had psychology counselling, drugs, psychiatric help, hospital admissions, and his life is hell. I have read your article with interest and I think PTSD in part fits his problems. As his carer I am always looking for new angles to try, and think he was psychologically damaged in his early childhood by a bullying older brother who is now dead. It destroys me that I can’t help – we’ve been together 38 years – he longs to be dead so he doesn’t have to endure it any more. He won’t see any more doctors as he has had enough. He is exhausted mentally. I am glad to have read your article, I do think that some people are just lucky.
shelly i really feel for u and your husband because that could be you describing my situation ,if i didn’t have a family and gf would’ve given up a lot time ago iv had mine for 5 years tried various therapies over 30 different meds and just can’t seem to see any light its constant anxiety that hasn’t left for one second in 5 years , the thing that keeps me half going is what you said about finding different angles there’s not much else you can do but to keep trying and trust me i know how hard that is especially after every time another therapy or med doesn’t work it destroys you…..i really feel for your husband and hope you can both find the answer soon just hang in there …billy
I don’t see how any honest decent person can avoid getting PTSD in this world – its lies piled upon lies. All of society is deceived and brutality is the operative model of nature. Its an abomination that should be destroyed – the entire scheme of mortal life in a physical universe is evil. The sheeple seem to do fine. The evil seem to do great.