Commonly associated with soldiers who’ve experienced unthinkable tragedies while at war, Post-Traumatic Stress Disorder (PTSD) can disrupt the lives of various people from various backgrounds. According to America’s Heroes at Work, a site from the U.S. Department of Labor, it afflicts 24 million people nationwide, eight percent of the population. PTSD can be acquired after enduring any kind of traumatic event, including war, physical abuse, a natural disaster or bad accident, and can result in symptoms such as flashbacks, nightmares, angry outbursts and depression. Because it’s a mental health disorder, PTSD isn’t fully understood by people with little experience dealing with it. The following common misconceptions have been disproven by mental health professionals and those who live with the disorder.
- PTSD sufferers are mentally weak: Like other mental illnesses, PTSD is considered by the uninformed to be characteristic of mental weakness. In reality, the effects of the disorder can be traced to specific traumatic events that are incomprehensible to people who haven’t experienced them. The period of recovery isn’t comparable to what people endure after stressful events such as divorce or losing a job, and how they psychologically handle the trauma varies from person to person. PTSD is recognized by the American Medical Association (AMA), American Psychiatric Association (APA), Centers for Disease Control (CDC) and the National Institutes of Health (NIH).
- Everyone has some sort of PTSD: Again, PTSD is caused by a specific traumatic event not typically experienced by the average person. PTSD sufferers undergo changes in their brains resulting in symptoms worse than just depression. People who develop PTSD were inherently more susceptible to the disorder than others, often exhibiting prior signs of mental illness. After a traumatic event, the possible onset of PTSD can be exacerbated by receiving little or no help or coping with it inappropriately.
- PTSD sufferers aren’t victims: Without question, PTSD sufferers are victims. They’ve encountered events that, in most cases, were beyond their control and very few people experience during their lifetimes. They lack the psychological capabilities to recover from such traumas and thus need help in order to cope. PTSD is not something that should be taken lightly. It’s not something that can be ignored and forgotten. Individuals with the disorder need professional help to endure the symptoms that inhibit them from functioning normally day to day.
- PTSD symptoms manifest immediately after a traumatic event: In many cases, it takes a month or two before symptoms are noticeable, and they can be brought forth by stress and old memories. According to the NIH, a psychiatrist or psychologist evaluates a patient and determines whether or not they have the disorder depending on if they’ve shown at least one re-experiencing symptom, at least three avoidance symptoms and at least two hyperarousal symptoms (see link for more comprehensive explanations), all of which need to occur during at least a month in a PTSD diagnosis.
- PTSD sufferers are always unstable and violent: Symptoms of PTSD vary depending on the person with the disorder. Angry outbursts and violence don’t always occur, even if the illness was brought forth by events involving violent crime and torture. Ultimately, how a person reacts to a traumatic event is dependent on their individual attributes and sensibilities. For example, additional symptoms may include memory disturbances and the inability to connect and reconnect with others. The severity of each symptom increases and decreases and almost never remains constant.
- PTSD is limited to a specific age group: Children are vulnerable to PTSD too despite their apparent resilience to mental stress. In fact, a recent study undertaken by University of Miami psychologist Dr. Annette La Greca showed that children exhibit signs of PTSD two years after a natural disaster. Twenty-one months after the event, 29 percent reported moderate to severe PTSD symptoms. During a family’s recovery from a catastrophic hurricane, for example, a child may struggle with adjusting to a new environment, where they may be without their friends and some of their family, making the recovery even more difficult.
- Only one treatment is needed: The simplicity or complexity of treatment is wholly dependent on the person with PTSD. If symptoms are severe, then it’s reasonable to assume several methods may be used to control the illness. Psychotherapy and medication may be combined in order to produce a desired result for a patient. Doctors typically prescribe antidepressants such as sertraline (Zoloft) or paroxetine (Paxil), both of which are approved by the U.S. Food and Drug Administration (FDA) to treat PTSD. Each combats feelings of sadness, hopelessness, anger and worry. Patients may also use benzodiazepines to relax and sleep and antipsychotics to combat other mental disorders.
- Therapy doesn’t work: Therapy does work. It educates the PTSD sufferer about the trauma and its psychological effects, and enables a mental health professional to find ways to neutralize the symptoms to the best of their abilities. Cognitive behavior therapy (CBT) is often used, including exposure therapy, cognitive restructuring and stress inoculation training. Exposure therapy enables the patient to face and control their fear. Cognitive restructuring helps the patient realistically evaluate bad memories and deal with them in a healthy manner. Stress inoculation training teaches the patient to reduce anxiety and thus the PTSD symptoms.
- PTSD sufferers are unable to function in the real world: By taking the aforementioned measures and remaining committed to treating the problem, PTSD sufferers can fulfill their duties as employees. As previously mentioned, medication and therapy can help them make it through the day. If symptoms persist and noticeably affect their productivity, they should notify their employer of the problem if they aren’t already aware. Remember, people with mental health problems are afforded the same rights as everyone else.
- Recovery is impossible: Dealing with PTSD may seem like an unwinnable battle, but with the proper commitment, it can be defeated. Note that recovery is a subjective term depending on the patient. While symptoms of PTSD can be eradicated, some may define recovery as simply functioning effectively with the disorder. There are numerous PTSD support groups in existence with members willing to share their success stories. It’s a great way to build hope when the illness is adamantly against it.
I sit in a gymnasium. My yoga mat stretched out on a cold cement floor that could use a once over with a mop. Intermittently, there are announcements or codes blaring over a loud PA system. I pray that I may be used as a vessel, an instrument for something bigger than myself, and that everyone in my class gets something they need in the next hour and fifteen minutes that we share together. I wait for my service members to be escorted in from their unit. I never know how many will come or what condition they will arrive in, but I am always eager to share myself and to be a part of their healing.
I am the yoga instructor for the Military Wellness Program at Holliswood Hospital. Holliswood Hospital is an inpatient psychiatric facility that houses a unit specifically for service members who suffer from Post Traumatic Stress Syndrome (PTSD) and other combat induced stress anxiety issues. PTSD does not discriminate. I have met members from every branch of service, with varying ranks and from every age group. Some have physical injuries, as well as mental scars. Some have been coming to class for months and some for the first time. Many of the first timers are curious to know how yoga can help them. After working with this population for close to a year now, I can say with absolute certainty that yoga is a successful component in healing PTSD.
For someone who has never practiced yoga this may sound ludicrous. Yoga, according to ancient Indian text, is the union of mind, body and spirit. It is used to create a balance between the body and the mind. This is accomplished using different movements, breathing techniques, relaxation technique and meditation. It is the oldest physical discipline known to mankind and the most complete exercise because it works from the inside out. It massages the inner organs and glands. It lubricates joints, tendons and ligaments as well as working the muscles. It helps cure and prevent physical disease.
In the treatment for PTSD, it is important to understand how PTSD itself occurs. In terms of yoga, it is also important to remember, that as humans, we are made up of three different energies- our physical, our emotional and our spiritual selves. In the case of PTSD, and more specifically combat induced PTSD, service members are affected on every one of these levels.
PTSD is an anxiety disorder that occurs after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Obviously, being in combat would fall under this category. There is a physical response that occurs when a person is placed in such conditions. It is known as ‘fight or flight response’. When the mind perceives a grave threat the brain sends messages to the body to ready it for survival, either through fleeing or through fighting. The changes that occur include a heightened awareness in the senses- you are better able to hear, see, and smell. This serves to alert a person to the approaching threat as soon as possible. The cardio-vascular system and the respiratory system go into full throttle to produce a larger amount of super oxygenated blood so that muscles are able to perform at their maximum efficiency. Blood flow is diverted from the kidneys and digestive system to the legs and larger muscle groups. Blood vessels to the skin are constricted to reduce bleeding and sweat glands open to cool the body down in this overworked state. Endorphins are released to decrease pain and natural judgement is over-ridden by primitive instinct.
Most of us have experienced this reaction. It occurs when we are threatened but usually subsides in a short period of time. Herein lies the problem with combat. Your body is in this state for such a prolonged period of time that it begins to think this is it’s normal state of functioning. In essence, the body forgets how to return to its state of relaxation.
This is what produces the physical symptoms of hypervigilance often associated with PTSD, such as the inability to sleep, lack of judgement and the anger response. It is also the reason for many of the physical illnesses commonly found in service members returning from combat. GERD, a common medical problem in returning service members, is caused by the decreased blood flow to the digestive system. So, how does yoga help heal these things? First, and foremost, yoga reminds your body how to relax. It helps to re-establish the pathways to the brain and body that allow it to respond appropriately to the situation it is in, rather than to remain in a hypervigilant state. It can be compared to creating a path in the grass, the more you walk over it the deeper it gets. The same happens with your body. Numerous, lengthy deployments increase the severity of PTSD because the body is kept hyperstimulated for a longer time. With a consistent yoga practice the body recognizes its ability to slow down and operate in a normal state. Besides the neurological effect, the physical postures also massage the organs and stimulate the body to heal any damage, even on a cellular level. Increased flexibility allows for freer movement of joints and muscles that become stiff due to injury or constant tension.
The emotional part of combat is the next issue. Military members are aggressively trained to disassociate from their emotions. This is a tool that saves your life in combat. However, this disassociation is disastrous when a service member comes home and is expecting to be overjoyed at seeing their family and is numb. Again, the number and length of deployments is a crucial factor in determining the severity of this disconnect. Another crucial factor is the past history of the individual. I like to say that when something traumatic happens to us and we are cracked open- ALL of our stuff pours out-not just the precipitating event- but all the pain we have carried for our entire lives. It is overwhelming. Yoga brings your awareness to the mind-body connection through breathing. We all breathe automatically-but in yoga, every movement coincides with an inhale and exhale. You move your body to the natural rhythm of your breathe. Because we are made up of energy, we often hold negative emotions in certain areas of our bodies. Areas such as the head, shoulders and hips hold tons of emotions. When we open these areas up in yoga it allows these emotions to flow out. It is often surprising to my service members how emotional they get in hip opening or heart opening poses. It is not uncommon to be brought to tears. Once these emotions are brought to the surface you can talk about them in a safe place. In Holliswood, it would most likely be with one of your therapists.
My personal thought on yoga is that it is a lifestyle. I like to remind the men and women in my class to be mindful of their thoughts and actions. This is where the spiritual part comes in. In my opinion, what happens on your mat is a direct reflection of what is happening in your life. If you are judging yourself and how you perform in class- you will judge yourself and others off of your mat. If you notice negative thought patterns about yourself, you probably beat yourself up over things and spend alot of time stuck in guilt off your mat. In my yoga class we focus on gratitude for what we have, releasing that which no longer serves us and recognizing that we are here for a purpose. I remind everyone that attitude is a choice. We are not in control of what happens to us but we are in control of how we respond to different situations. We focus on possibilities instead of problems. We connect to that little voice that we have been disconnected from. I end each class with a relaxing meditation. Many of the guys fall asleep. In a traditional yoga class, some instructors frown on that. I love to see it because I know that many of my students haven’t been able to sleep in days.
I have had soldiers come to me on every drug imaginable, still in pain, still unable to sleep and still feeling out of control. There are some that find it very difficult to sit still and are unable to close their eyes in our resting poses or even during the meditation when they first begin. I use this to gauge their progress. Many students report a full night’s sleep after just one class. Even the most skeptical guys have reported tremendous effects. Many of the service members were able to reduce or discontinue many of the drugs they were prescribed. Substance and alcohol abuse issues become manageable. One service member who had his knees blown up and rebuilt told me that it was the first time he wasn’t in pain. I am not saying that yoga alone can cure PTSD. I do believe that yoga in conjunction with different types of therapy can definitely decrease the symptoms and allow our service members to reconnect with themselves and their loved ones. My hope and prayer for every class is that they leave feeling a little more complete than when they arrived and I am ALWAYS, ALWAYS humbled and grateful for the opportunity to be a part in their healing process.
I wrote this to explain to friends and family what it means to have PTSD.
As you may already know I have Post-Traumatic Stress Disorder (PTSD). As terrible as it is that I have PTSD I can understand that it must be distressing to know you have a friend with PTSD. I am writing this so you can better understand me and what it means and what I ask of you.
I think its important I start off by telling you what you should not be doing. First off, do not be a social worker or another therapist. I have one of those and they are doing a good job and I do not need another. Also spare me the platitudes such as “Stay positive” or “Take it easy.” If it really were that simple then I would not have PTSD. I also do not need to hear that it could always be worse or about some person you know who you think has it worse then me.
The most important thing you need to be doing as a friend is to simply be a friend. I do not need you to have all the answers or ask the right questions. I am not looking for anything insightful. If anything just do your best to treat me as you always have because it is what I need the most right now. Feel free to ask me how I have been doing and what I have been up to.
To most people, PTSD means experiencing something distressing previously and then flashing back to the event later and being distressed about it. That description barely covers it so a few things you need to know about PTSD. Having PTSD is distressing. Knowing you have PTSD is just as distressing as the PTSD itself. PTSD destroys your normal brain activity and makes it function in ways you can not control. The worst part for me with PTSD is it makes my brain very active.
As part of this increased activity I experience things like flashbacks, distressing images, hyper-vigilance and panic attacks. My whole life is about living on the edge waiting for something bad to happen. It is why something simple like a tap on the shoulder or somebody standing behind me can give me a major adrenaline rush and cause me to panic. I understand logically that these thought processes do not make sense however I am unable to control it.
If we ever decide to hang out together you will have to forgive me if I am sensitive about the venue. I like places that are not very noisy or crowded and I prefer to sit near a wall where I can minimize the activity around me. You will also forgive me if you find me not talking and staring off somewhere. Sometimes there is just too much activity for my brain to process and it needs to rest a little. If we are picking a venue or activity please do not give me a lot of choices and try to keep things simple. If I abruptly change the conversation on you, its probably getting into topics that will trigger my PTSD.
If I do not answer your phone call or return your text message or e-mail please forgive me. It is sometimes a struggle for me to remain in the present or keep track of what I have to do. My brain will sometimes shutdown and will forget things or even who I am and where I am. Other times my brain is simply overloaded and I need to minimize stimulating it. I will get back to you but if I am not as fast as you want then I hope you will understand why.
I want to thank you for taking the time to read this letter to try and better understand me. You will never understand what it means for me to have PTSD (and hopefully you never will) but hopefully you can at least understand what I need and why I sometimes do the things I do. I am confident that with time I can resume a normal life but for now I am going to be fighting the good fight.