Sunday, August 22, 2010

PTSD under a directed microscope

I haven't written here for a long time because life has been overwhelming, so much so that the thought of trying to write about everything--or anything!--is too much and I can't sit down and choose one thing and just type. But I am going to try, now, because I think I have learned something.

A little over a month ago, I finally left Hanover. Hanover...Dartmouth...I still do not know what my final thoughts on it are, what is left when I subtract my pain from my joys. I made friends, but I lost friends. I learned to be social, then had my trust in people painfully punished. I do not know if I can trust anyone from that era of my life. But that was not the subject of this post.

What I wanted to talk about was the biggest change I am experiencing now. As part of a study, I am undergoing a couples-based cognitive behavioral therapy program designed for PTSD. I am not sure how much I can go into the details of it, since it is still a study, so instead of the mechanics, I will talk about what I have learned. Namely, I have learned that PTSD is not just a collection of symptoms like nightmares, flashbacks, emotional numbness, and hyperarousal. It is a damaging way of thought and of living life that results from trauma. I have been told, and am still trying to accept, that PTSD is not me. I am not my pain, and my pain is not me. My therapist likes to call PTSD a gremlin that invaded my life, something that can be eradicated that isn't part of myself. That is a stuck point for many people with PTSD, she says-- thinking that your suffering is part of you and so it becomes much more difficult and terrifying to fight it.

Fear. Fear is what PTSD thrives on. I have learned that my particular PTSD gremlin delights in constantly making me worry about the worst thing that could happen at any moment. I am filled with the dread and conviction that I am always in danger, or at the brink of losing what is dearest to me because bad things can and do happen at a moment's notice. Every time D* leaves, I am scared sick that I will never see him again. I live in a state of hyperarousal, jumping at the slightest noise, terrified that my door rattling means someone is going to break in, always watching, always looking.

Fear wants control. I have to be in control of what happens both around me and in me so I can be prepared for when something bad inevitably happens. The way I subconsciously try to control my emotions and prepare myself for the worst that can happen is what was destroying my ability to lead a happy and healthy life. For example, because of the lack of validation that I received from others each time after I was raped, I rely on my pain as evidence that something terrible did in fact happen. I control my displays of distress until I know they are happening for a reason (such as after a stimulus that I consciously recognize as a trigger-- e.g. a mention of rape, seeing someone who looks like him, realizing it's Friday night or the 25th/26th of each month), and then I allow myself to feel distressed and show visible pain. That is the only way I found to believe that what happened to me was legitimately bad. This is another stuck point for PTSD: believing that you have to keep your pain around as proof that something bad really happened.

Lack of control is severely distressing and leads to a spiral of negative thoughts. For example, after one evaluative session, I was feeling tense and a little numb but otherwise okay. I met up with D* and, after a little while, ventured up the courage to ask for a hug. As I was trying to relax, I very suddenly started sobbing. I had no idea that I was about to cry, and the feeling of being startled and totally helpless was terrifying. I could not stop sobbing no matter how hard I tried. Don't get me wrong-- I cry all the time. It wasn't the fact that I was crying that terrified me. It was the fact that I was crying and didn't know why and hadn't found a trigger or reason to allow myself to.

Control becomes an issue in other ways too. Remember what I mentioned earlier about fear? When you put together fear and control, you get fear that you won't be in control of a situation, fear that something bad will happen and you won't be prepared. What that leads to for me is extreme black and white thinking and thinking the worst. This is where my therapist's bumper sticker comes in.

After our first session, I was having trouble calming down and I couldn't stop crying, so D* and I went back to her office (interrupting her lunch :( ) and she spent another hour kindly and patiently explaining the pitfalls of my own mind. Then she gave me a bumper stick that said:

Don't believe everything you think.

It didn't make sense to me at the time, but I am starting to see its significance now. We have just started the stage of bubble sheets in therapy. What I'm supposed to do is notice a PTSD-fueled thought, write it down, brainstorm alternative thoughts, and evaluate which is the more balanced thought. In short, it is an exercise to literally replace my harmful PTSD thoughts with more balanced, less black-and-white thoughts. As you might be able to imagine, my mind is barely submitting to this, kicking and screaming all the way.

The first time we tried it, the thought we challenged was "If D* leaves, I will be all alone." (This was made all the more poignant by the fact that D* actually had to leave immediately after our therapy session to go to his first day at a new job, and I was crying the whole way through the session because I was thinking about being left all alone right afterwards.) While we were working on this in the session together, I just couldn't come up with any alternatives. My mind simply did not understand that there was any alternative to that thought; it could not conceive of the possibility that there was a more balanced way to think about him leaving. D* and my therapist made a great list of alternatives; for example, "Even though I want to be with D* the most, I am not totally alone when he leaves"; "When D* leaves, I can still reach him by phone"; and "Even if D* leaves, he still cares about me." All my mind could think of was these alternatives are all lies and I don't believe them because I really do think I will be all alone and I will be terrified and despondent and I may never see him again and I just can't do this. To make the rest of the long story short, that day I almost ended up hospitalized. My mind really was not liking this exercise at all.

I tried doing some more bubble sheets with D* again this afternoon. I ended up sobbing hysterically again, but I realized something important: the reason they affect me so is that I am terrified that I could delude myself into thinking that things are better than they are and so I would be caught defenseless and unprepared when it is all revealed that it was a lie. I feel safest believing the worst because that way, I will at least not be caught unprepared (whether The Bad Thing will happen or not is not even up for consideration). The way my therapist puts it, PTSD has given me fear-colored goggles that only see danger everywhere I look. This translates into a desperate need for control and a crippling lack of trust in everyone, even D*. Even though part of me knows he cares about me, I still can't bring myself to fully believe that he does. I don't fully trust that his affections won't stray, or trust that he means what he says. It's an awful barrier between us that he has done nothing to bring on. He is the sweetest, most wonderful boyfriend that I can imagine, who has done everything he can to help me through my PTSD spells and who is sacrificing so much to come with me to therapy even though it means he has to drive down to Boston at least once a week. I am trying to plant in my mind the conviction and determination to go through with this therapy program to beat the PTSD gremlin that is building all kinds of barriers between us.

We're almost halfway through the treatment program. The trauma focus is about to begin, where I will have to challenge my beliefs about blame, trust, and control regarding the rape and the aftermath. I will try to be less intimidated about writing about it and blog more regularly.


  1. I swear I commented on this post but the comment isn't here. Oh well.
    I said something like------
    I'm happy therapy is making a difference for you, and soon you'll be a stronger person looking back on this.

  2. This comment has been removed by a blog administrator.