Taking That First Step

You don’t want to go in there. You know something’s waiting for you in those woods, but you’d rather not find out what. The trailhead is always there. But you walk right by it, again and again. And again. You don’t want to go in there. You don’t know if there’s even another side for you to come out of.

PTSD is hard. The journey to recovery, at least at first, is even harder.

But treatment has helped me realize exactly how hard PTSD has made my entire life. I’ve had PTSD since I was 12. And it’s never been treated or diagnosed, until now.

I’ve had therapists before. And they were fine. They were competent. I came in because I was having a specific issue. Once, I dashed away from a handsome cashier who said hello. Another time, I went in because my migraines were shifting from episodic to chronic, and I was resisting the self-care prescribed by medical providers. Still another time, I tried to set a boundary with my brother who blew up at me and cut me off. I felt shame and panic and a constant, low thrum of fear. And it was often disabling.

Therapists addressed each issue with talk therapy. I was never given specific tools or a diagnosis, and my reactions were not explored as indicators of anything deeper than “This experience must have echoed an older experience for you; let’s talk about that.”

At 25 I’d discovered, while reading Judith Butler’s Trauma and Recovery, that I have PTSD. But I’d had no money for any kind of treatment. I didn’t have health insurance. I was working three jobs. And I could barely pay my living expenses. I never brought up PTSD to care providers. I just assumed that therapists and physicians knew what they were doing, and—just as my abusers had socialized me to do—I accepted other people’s judgments as more authoritative than my own.

And that was back in 2006. The most effective treatments for PTSD—and the research that proved their efficacy—were either still in the works or not yet common practice among the majority of therapists.

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Things are different now. A lot of what I need is accessible for free or a minimal charge. And during the pandemic, I have found other ways to access the guidance I need from my own home.

I’m going to track my journey on this blog, and I’m going to share the tools I’ve used with you.* The more people know what’s out there, the more we can take control of our mental health and exercise agency in our recovery process—both factors that can speed along healing from PTSD—the better our chances of total recovery. And even if you don’t have PTSD, knowing as much as possible about it can help you recognize it in others and know how to support loved ones suffering from it.

The first step in recovery is to learn everything you can about the disorder, from who gets it to why, from what the symptoms are and what treatments are effective.

People suffering from PTSD are unlikely to have great concentration, so while reading a book can be helpful, it’s probably not realistic. The free app PTSD Coach, developed by the Department of Veterans Affairs as well as the Department of Defense, is a fantastic place to start (click the “Learn” tab from the home screen). The information is authoritative and concise, and it’s compatible with both Android and iOS.

Here was the information that stuck for me:

• Around 90% of us will experience trauma at some point in our lives, but only 7% will develop PTSD.
• Trauma is defined, according to Tull, Gratz, and Chapman (2016) as exposure “to actual or threatened death, serious injury, or sexual violence.” It includes car crashes, floods, war zones, being attacked or beaten, unexpected and sudden violent death, sexual assault in all forms, kidnapping, being locked up against your will or held captive, and even the act of inflicting violence on others.
• In the first month or so after exposure to trauma, most people experience PTSD symptoms. These symptoms are adaptive and can help keep you safe in the aftermath of terror and violence. However, for most individuals, these symptoms will subside after a month or so.
• For that 7% who continue to experience symptoms, there are usually factors in play outside their control. Factors that increase the likelihood you will develop PTSD after a traumatic event include: repeated traumas, certain types of trauma (sexual assault overwhelmingly leads to worse outcomes than being in a car accident or even being beaten), and the support available to you in the aftermath (namely, how family and friends respond, how society judges you, neighborhood resources, and whether you can afford a quality therapist trained in PTSD treatments).
• The American Psychiatric Association initially misclassified PTSD as an anxiety disorder, but in 2013, its classification was altered to reflect that it is in fact a “trauma-related disorder” (Tull, Gratz, and Chapman, 2016).
• PTSD symptoms are listed in four categories: intrusion, avoidance, negative thoughts and mood, and hyperarousal (being ever watchful, on guard, irritable, aggressive, and easily startled).
• Untreated, PTSD often worsens over time and can even damage the body because it is a form of chronic stress.
• PTSD treatments, such as cognitive processing therapy and exposure therapy, have been proven to be incredibly effective in helping people successfully reduce and manage symptoms, returning to us a sense of control over our own lives and bodies.

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I’ve had PTSD a long time. And as I’ve started to learn more about it, I’ve come to understand why my therapists never spotted it. I had 20 years between the onset of my first symptoms and my first visit to a therapist’s office. So I had learned how to manage the disorder on my own.

Unsurprisingly, I developed some not-so-helpful methods to disguise my symptoms. For one, when I’m in a state of hyperarousal around anyone but those closest to me, I simply get very quiet and very still. Outsiders to my life call this mode “quiet and peaceful.” I call it “I’M TRYING TO STOP MYSELF FROM SCRATCHING OUT YOUR EYES, BITCH, AND MURDERING EVERYONE IN THIS ROOM.” I call it, “YOU WILL NEVER KNOW HOW MUCH I WANT US ALL TO DIE.”

To cope with my father’s constant physical threats to my safety when I was a child, I learned to smile lots. I speak softly. (Have you noticed Ivanka Trump does the same?) This leads people to see me as wallpaper, as unthreatening, and they make disastrous assumptions about me.

Survival, under childhood trauma, shapes everything. From sleep patterns to long-term health outcomes, to what I say and how I say it, to whether I believe people are worth the effort of asserting myself and revealing who I am. In my own life, the necessity of living with untreated PTSD has ensured that no one has ever really known me at all.

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So I learned a bunch about PTSD. Great. My symptoms remained difficult to manage as the pandemic dragged on and police violence has gone unchecked.

It was time to move to the next step. Which is to recognize and track the symptoms that are most prevalent, then to identify what events or thoughts trigger those symptoms. Finally, you start to build some tools to cope with triggers once you identify them. These include mindfulness and grounding yourself in your senses (holding an ice cube in your hand, taking a hot shower, listening to music, inhaling a strong scent). Deep breathing exercises work well for me. Some people swear by distractions, like playing a video game for a few minutes or reading a fun book.

Whatever you do, remember this is only Step Two. It’s just the beginning. In fact, my symptoms worsened during this step. That’s common. Paying attention to any disorder often makes it more noticeable.

Every time I started to panic (I’ll never get through this, my life ended a long time ago, what’s the point), I told myself this is only temporary. Take a deep breath. And let’s move on to the next step where things will actually get better.

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I’ve been at this 18 weeks and counting. My PTSD symptom score has dropped from 50 (in the high range) to the low 20s (on a scale of 80). One tool that has been indispensable on this journey is this book, available for $21.95 on Amazon as a paperback or $13 on Kindle (and no, I don’t get any benefit of any kind from sending you to it).

It covers a range of treatments that have been clinically proven to reduce PTSD symptoms, and it’s written by licensed, trained professionals who believe in making these treatments accessible. It’s a resource I’ll be referring to a lot as I track my healing journey over this blog.

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I don’t really know where I’m going. I have no idea what I’m doing. But I know it’s got to be better than where I’ve been. If you are suffering, too, remember there’s hope. There are treatments. And more and more professionals are committed to making these treatments accessible, regardless of geography, social class, gender, race, disability, or any other factor. For me, it’s going to be a lot of work. And I’m not going to come out the other end as the same person I was when I entered this forest. But I’m here, and I’m pushing forward. And I’m making progress.

At this point in my life, I’m wise enough to know: this is what victory looks like. It’s not an arrival. It’s a journey.

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Featured image from Francesco Ungaro

*I am not a therapist or treatment provider and am only recounting my personal experience of the disorder. This blog is not intended to be a substitute for professional advice, diagnosis, or treatment. Always seek the advice of a physician, licensed therapist, or other qualified health provider with any questions you may have regarding PTSD.