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.

Choice and Blame

You've probably seen it: "that exam totally raped me," "this monster in (video game) is raping me," ad nauseum. Such careless use of rape as a metaphor for something unpleasant is absolutely acceptable; throwing around the word so blithely demeans survivors of a terrible crime and desensitizes people to an issue already commonly misunderstood or ignored.

I just read this article on how Kristin Stewart, star of that terrible movie Twilight, compared the intrusive nature of the paparazzi to being raped. I of course still think that metaphor is unacceptable, for many reasons, but the article brings up an interesting point. One argument commonly made is that celebrities choose to seek out publicity, so therefore they have a choice, while rape is a violation in which the victim has no choice. However, the end of the article states:

"There are choices when it comes to being an actor, yes, but much less choice when it comes to celebrity, and making that distinction comes really frakking close to blaming rape victims because of what they wear or how they behave."

(Then the article goes on to say that Kristen Stewart took on an "indie movie" and is simply "living up to her contract and suffering through the consequences of a film's publicity, not her own," which I think is a bit of a ridiculous statement, but let's ignore that and return to the original debate about the nature of choice.)

What do you think? Does the above quote make sense? I have to admit that I am still unsure of my own opinion, so I'd love to hear your thoughts.

Song: "Nightminds" -- Missy Higgins

A touching song about supporting someone through dark times.



Just lay it all down
Put your face into my neck and let it fall out
I know, I know, I know
I knew before you got home
This world you're in now
It doesn't have to be alone
I'll get there somehow, 'cause
I know, I know, I know
When even springtime feels cold

But I will learn to breathe this ugliness you see
So we can both be there
And we can both share the dark
And in our honesty, together we will rise
Out of our nightminds, and into the light
At the end of the fight
...
And in our honesty, together we will rise
Out of our nightminds
And into the light at the end of the fight 

Site: National Center for PTSD

http://www.ptsd.va.gov/

The National Center for Posttraumatic Stress Disorder (NCPTSD) is sponsored by the United States Department of Veteran Affairs, but its work (as well as its website) is a good resource for all trauma survivors, not just military veterans. On the website you can find fact sheets about PTSD and its various causes as well as links to other good resources and information on how to find a mental health care provider for yourself, a family member, or a friend. 

What I think stands out about the NCPTSD's work is the PILOTS database-- Published International Literature On Traumatic Stress. The goal of the project is to index every academic work published on PTSD, no matter what language or journal it is published in. If you might benefit from reading academic studies on trauma, this is definitely a great resource.

Also, this summer I will actually be working on PILOTS with Dr. Fred Lerner and his team. Best volunteer job ever! I am thrilled to have this opportunity. :D

Anniversary

The two-year anniversary of my rape was last weekend. I couldn't find the words to write a blog post. I cried the moment I realized the weekend's significance, and sunk into a depression until my D* held me and helped me out of it. Then I spent that Weekend with him and was mostly fine. On Saturday night, when my mind was filled with intrusive memories and fear and misery, he held me and the storm eventually passed.

But now I am back to being alone, and the thoughts have settled in again. This morning I could not bring myself to get out of bed. I do not remember having bad dreams last night, but I woke up feeling numb, miserable, afraid, closed-down. I passed the morning under the covers with my laptop, doing everything I could just to pass the time. Finally I willed myself to eat something, and my numbness loosened up just enough for me to accept that the memories and emotions are back.

I have been reading survivor stories and allowing myself to cry. Some of the stories echo my sentiments and sometimes even my very own words. I cry because of the reminders; I cry because some wounds are still fresh; I cry because to this day I still grasp for validation even though the pain is there right before my very eyes. Even though I saw my symptoms, I still feel inferior, ashamed, to call myself a rape victim when so many others have experienced trauma worse than mine.

Right after it happened it was too easy to convince people-- no one argued with me, and everyone just accepted that it happened, because he was a jerk and he was gone, never to return anyway, so it required little effort to throw support behind some words. Words, but few actions. Words drift away. Words fade away. Two years later, all I know is that I feel alone because I do not, cannot, tell my friends when it hurts. I tell D* sometimes, but then I feel awful because it just becomes another weight for him to bear. I tell my therapist when I see her, but somehow nothing really helps these moments-- they have to come and go on their own.

It is lonely. My covers are warm and my laptop is a decent connection to the outside world, but I am lonely. Perhaps I will return to Pandora's Aquarium again, to seek out a group of people who might understand. Still, though, the pain, the exhaustion, the tears-- they are mine to bear. I don't know how to reach out to people when most everyone thinks, or wants to think, I am healed. I don't know what anyone can do to help me. Somewhere in my mind I know that I have a good future and that my life is not solely made up of the Event, but right now it is a distant thought shrouded by the fog. I have at least been able to stay safe and not harm myself-- that is one relief. But how do I escape this fog? And more importantly, can I let myself, or will my ability to move on deny me the validation I still yearn for?

When I am happy, I feel guilty. I feel as though I have lied. Because if my experience really had been that bad, I would still be suffering. The more I suffer, the easier it is to accept that my pain is legitimate and okay and real. But then another voice whispers that it has been two years, and maybe it is finally possible to reconcile those two things, that the event could still be intrinsically and truly awful, yet it is okay to heal.

I still struggle to convince myself that being able to walk away from pain doesn't lessen the severity and true, legitimate horror of the event. For some reason, I cannot simply accept that it is okay to fully heal, or even to want to heal. Instead, I fight my body's desire to seek relief and happiness. Sometimes I seek exposure to triggering media in order to immerse myself in the familiar numbness and pain. I would try to explain that behavior by calling it an attempt at mastery, but that's not it, either-- if I were trying to re-expose myself to traumatic thoughts to prove to myself that I am stronger, I would not be so hesitant to break the spell and return to my happy, carefree self. Instead, I sink. Am I waiting for someone to rescue me? God, I hope not, because I don't know who could, or would. What am I waiting for? Why do I do this? Two years later, I still don't have good answers. The memories of the Event do not burn as brightly as before, but dull pain is not much better than fresh pain. Dull pain brings with it the worry that I will never heal.

It is 6pm and my entire day has been lost in the fog of my mind. The solution is not as simple as taking a bubble bath or treating myself to some soothing tea or music or books. Crawling out of the fog has never been that simple. Do I talk to someone, or do I hide? Do I stare at mindless things on the internet, or do I bury myself under the covers and will everything to go away? Do I ask sleep to overtake me in the chance that all will reset, or do I struggle to stay awake because I am afraid the next day will just be more of the same? What should I do?

I don't know. I just don't know.

Another Hiatus

Dear Blogland,

I am terribly sorry for not having posted as much these past few weeks as I had wanted to. I stressed out a lot over application essays and ate chocolate. All my applications are finally done (huzzah!) as of this afternoon but alas, I will shortly be leaving for Thailand. I have arranged to volunteer and shadow doctors at three hospitals there while I am also visiting family for the first time in almost ten years, so that'll be a blast.

I do not think I will have the time or the capability to write posts while I am there, so unfortunately I will have to put this blog on hiatus until I return to the States at the end of March. Take care of yourselves, and I wish you all the best! See you in five weeks.


Cheers,
Sayrina

Beyond bruises

After being in several abusive relationships, the thing that took the hardest hit was my self-esteem. I don't think my shaky sense of self-worth even has much to do with the sexual assaults-- those events affected certain parts of my self-esteem and identity, but really the damage comes from partners who regularly hurt me and said it was all my fault. What that led to was the serious, deep-down conviction that I am broken or tainted, that I can't do anything right, and that I can't have/don't deserve a healthy relationship. Those feelings have resurfaced several times during the last month with D*; I overreact to something, get upset, cause a fight, and then become convinced that this is evidence that I can't do anything right in a relationship. I've set myself up a self-fulfilling prophecy, and it's a cycle I'm finding it really difficult to break out of. I know it's there, I recognize it for what it is, yet I still can't stop myself from following the path I've laid out.

What an insidious aftereffect. *shakes head* Abusive relationships that lack physical violence often get overlooked or brushed off by outsiders. Some people think, how bad could it actually be? The answer is: bad. In an ironic way, it can be worse without physical violence because that's the only thing society seems to accept as clearly wrong. If you weren't hit or kicked, it's difficult to find validation for your experience. How can I explain to people what it was like to be screamed at everyday? to be constantly made to feel stupid and worthless? How can I explain how quietly, insidiously damaging that is? I've had trouble, honestly. I usually don't identify myself as a survivor of domestic violence because of it, not only because I worry it minimizes what others ("real survivors of DV") have gone through, but also because I feel like no one will believe me.

The other day I found myself faced with a huge myth about domestic violence. A friend of mine said something that I thought was just a tasteless joke, and so I reproached him for it. He said, "Who said it was a joke?" He honestly believed that women who stayed with abusive boyfriends did so because they secretly liked it. I was flat-out flabbergasted. There was so much wrong with that statement that I didn't know where to start. It makes me wonder how many myths about domestic violence exist today in society. I often hear about rape myths, but I think the line between right and wrong about rape is much more clearly marked in society's minds than it is with domestic violence. Society seems to heavily favor looking the other way when a problem arises between two people who are involved in a relationship. All kinds of rationalization occurs to explain the existence of clearly abusive relationships-- for example, the belief that she stays with her abusive boyfriend because she secretly likes it. It doesn't occur to people to think about the other reasons she can't leave, like forced financial dependency, threat to herself or her loved ones, or having nowhere to go. That last one is particularly intricately involved with society's views on domestic violence-- you aren't received and accepted in society as a refugee from something terrible if society doesn't believe your situation was that terrible. Refugees of war-torn countries are more easily accepted here because war and violence in another country are easy to condemn, and therefore sympathy can easily be extended to those refugees. A woman fleeing from an abusive partner may not find such sympathy in her peers.

Perhaps accepting that domestic violence exists and is a terrible and painful thing is too much for society to handle because it strikes too close to home. I guess it's the same reason that women are often the harshest critics and least sympathetic peers of rape survivors-- if they accept the reality of rape or domestic violence, then it could happen to them. Better to deny it than accept that frightening reality. Ignorance is bliss? I don't know.

Returning to the original point of this post-- self-esteem. That's been my hardest struggle, believing that my abusive relationships are over and that my new relationship with D* doesn't have to be like them. I have so many insecurities to work through, so much fear to have to wade through, with just blind faith to guide me to the other side. I have to believe that things can work with D*. I have to believe that the abuse and assault has not left me broken or tainted. I have to believe that I have healed a great deal and can and will continue to heal further. I have to believe, and belief is terrifying. However, many brave survivors of sexual and domestic violence have been able to cultivate healthy, loving relationships, and therefore so can I.