| Dealing
with the after effects of rape is a nightmare.
The physical hurts can often soon be mended,
but it's the inner pain that people can't see
that takes longest. It's also the hardest to
deal with because it's not like healing after
surgery, there is no set time limit. The emotional
scars can stay with us a lifetime.
What is PTSD?
PTSD is a reaction to being exposed to an
event which is outside the range of normal human
experience. Sometimes it is referred to as post
traumatic rape syndrome too. It is a normal
human emotional reaction to an abnormal
situation. Everyone reacts differently to different
situations and it doesn't have to be a life
threatening experience for someone to respond
in this way. It just has to be perceived by
the victim as a traumatic event. It is a psychological
phenomenon. It is an emotional condition, from
which it is possible to make a full and complete
recovery.
PTSD affects hundreds of thousands of people
who have been exposed to violent events such
as rape, domestic violence, child abuse, war,
accidents, natural disasters and political torture.
It is normal to be affected by trauma. There
is help, and it is ok to ask for help. PTSD
is not rare. It is not unusual. It is not weak
to have PTSD.
Traumatic experiences bring to the fore survival
skills which are valuable and useful at the
time of the trauma, but which usually become
less valuable, less useful and less effective
with time. Sometimes survivors become stuck
in problem behaviors when their pain is not
acknowledged, heard, respected, or understood.
Denial plays a great part here (it didn't happen,
or it shouldn't affect you). Put-downs, dismissal
of the pain, mis-diagnosis and other forms of
secondary wounding keep survivors stuck.
Symptoms may come on soon after the trauma
or fifty years later. That is what is meant
by the post in PTSD. It is normal too for symptoms
to come up again when faced by further trauma
and in very stressful times. It is normal to
be affected by trauma.
Society has it's own way of dealing with trauma
which can both be belittling or denying. For
a survivor to be told that what happened to
them wasn't that bad, or was no big deal or
continually being told it was time that they
were over it, or just try and forget it ever
happened cause secondary wounding in trauma
survivors. It reinforces the mistrust of everyone
and everything that trauma evokes in all survivors
who no longer can believe that the universe
is fair or just.
This ability to do whatever it takes to survive
is instinctive. We all have it, and in traumatic
enough situations, it will come out or we die.
Extreme situations which trigger this reaction
again and again may cause survivors to do things
in order to survive which can be hard to look
back on later.
Similarly shutting down feelings in order
to do whatever it takes to survive, or do your
job and help others survive, is a reality based
survival skill. Numbness is the answer. It is
effective. It will help you live.
Unfortunately when survivors numb their fear,
despair and anger, all their feelings, even
good ones, are numbed. Numbness is comfortable.
Thinking about what they have been through is
so painful survivors wind up avoiding thinking
about, feeling, or doing anything that reminds
them of the trauma. For example, if they feel
the trauma was their fault they may spend the
rest of their life having to be right so they
won't ever be at fault again. If they were happy
when the trauma hit, they may avoid happiness
forever.
Criteria for diagnosis
of PTSD
- These are simple guidelines that may help
you to work out if you are suffering from
post traumatic stress disorder. I will go
into more detail later.
- The survivor must have experienced or confronted
with an event that involved actual or threatened
injury, or a threat to their physical integrity.
i.e. rape.
- The survivor must show symptoms of intense
fear, helplessness or horror.
- The survivor must experience distressing
recollections of the event. i.e. flashbacks.
- The survivor persistently avoids things
that remind them of the event. i.e. triggers.
- The survivor must be show significant distress
or impairment by the event, either in their
social occupational or other important areas
of functioning.
- Persistent symptoms of increased arousal
(not present before the trauma) as indicated
by at least two of the following: difficulty
falling or staying asleep; irritability or
outbursts of anger; difficulty concentrating;
hyper vigilance; exaggerated startle response.
- Symptoms must last at least one month.
Symptoms often present
in Rape Trauma
- Intense fear, helplessness, or horror.
- Repeated and distressing recollections
of the event, including images, thoughts,
or perceptions. Unable to distinguish between
past events and reality. Such incidents are
often called "flashbacks".
- Distressing and or frightening dreams about
the event.
- Associating various words, happenings,
or "triggers" to the actual event
which then causes a "flashback".
- Avoidance of anything that may "trigger"
a flashback including not talking about the
attack itself.
- Pretending it never happened and an inability
to recall anything about the attack, "denial".
- A feeling of numbness, detachment or "unrealness"
about everything.
- A lack of emotion or inability to feel
love or care about anything.
- A feeling of depression and isolation.
- A change in sleep patterns. More often
or not the ability to sleep or stay asleep
for any length of time.
- A lack of concentration.
- Avoidance of being touched, and shying away
from loved ones. Sudden movements may startle.
- A lack of trust in anyone, even close family
or partners.
- More irritable than usual. Outbursts of
anger and crying. Mood swings.
- A feeling of low self esteem and confidence.
- A feeling of being dirty, or disgusting.
- Deep embarrassment or shame. Sometimes
self blame for events.
- Bitterness and morbid hatred of the perpetrator,
with a preoccupation of how to harm or humiliate
them.
- Loss of appetite or a change in eating
patterns.
Intrusive Symptoms:
Flashbacks
Intrusive symptoms can be described as those
where the traumatic event "intrudes"
into everyday life, and is re-experienced. These
symptoms are often referred to as Flashbacks.
The event is so real and so vivid it feels like
the person is actually experiencing the trauma
all over again. It is happening right in front
of their eyes, and they can't tell what is reality
and what is memory.
These flashbacks can range in severity from
mild and brief to long and strong. They can
involve both sensory perceptions and motor re-enactment
too. During a flashback you may experience vivid
images, strong smells, or noises. Some may even
involve actually acting out a traumatic experience.
Many times trauma survivors don't recognize
that they are having a flashback nor remember
afterwards what happened. It is not unusual
for someone to faint or dissociate during a
flashback and be unable to recall any part of
the experience, even when a witness describes
their behavior to them.
Sometimes after a flashback trauma survivors
are aware of what triggered especially if someone
else observes the behavior and recounts it to
them, or if it is a recurring situation.
Sometimes these flashbacks occur as nightmares
or bad dreams too. There is some evidence to
suggest that traumatic nightmares occur in the
earlier, lighter stage of sleep than other dreams,
and are more easily recalled upon waking. Traumatic
dreams may however contain accurate and inaccurate,
literal and symbolic, information and should
always be interpreted with caution.
Sometimes there is no actual reliving of the
trauma itself, but instead survivors experience
a sudden painful emotional breakdown. These
can involve crying, anger or fear for no apparent
reason, and can occur repeatedly like flashbacks.
Sometimes a flashback can involve just having
feelings that are far more intense than a situation
calls for but would have been appropriate in
the original traumatic situation.
The important thing to remember about flashback
experiences, especially those related to abuse
and rape survivors, is that they can make you
feel as afraid, as helpless, and as out of control
as you were during the actual trauma, even if
you don't consciously remember it. Others have
the experience of losing their sense of where
the flashback stops and reality begins.
Avoidance Symptoms:
triggers
Symptoms of avoidance can be described as
an emotional numbness or coldness towards people
who are close to us. Survivors shut people out,
or push them away. This in turn affects their
relationships with those who are often the ones
who are trying hardest to help. When survivors
are coping with flashbacks it takes a lot of
energy to try and suppress the flood of emotions
that threaten to overwhelm them. They find that
they have no real emotion left for anyone else,
and often feel emotionless or numb towards everyone
else. Inability to recall important aspects
of the trauma is another of the ways avoidance
and numbing may work. This means the person
cannot remember exactly what happened. Many
trauma survivors forget in order to survive.
Survivors may also have learned to dissociate,
to literally not be there, to survive. They
automatically "switch off" during
a stressful situation because it is too painful
to deal with.
Numbness makes it hard for survivors to take
care of themselves. Feelings are there to tell
us how to do that. If you can't tell what you
feel, you can't choose healthy behaviors for
yourself.
Another symptom is avoidance of situations
or activities that may trigger reminders of
the traumatic event. These are commonly referred
to as "triggers" Other symptoms may
worsen when a situation or activity occurs that
reminds them of the original trauma. Often the
survivor is unable to identity a trigger without
help from someone who knows about their traumatic
experience.
Triggers can be people, places, sounds, images,
feelings, smells, tastes, films, animals, the
tone of someone's voice, body positions or sensations,
weather conditions, time factors, or any combination
of things that even remotely resemble traumatic
experiences. They can be as subtle, complex
and obscure as clues in a good detective novel.
Survivors can become so scared of particular
situations that their daily lives are ruled
by their attempts to avoid them. PTSD sufferers'
inability to work out grief and anger during
the traumatic event means that the trauma will
continue to control their behavior without their
being aware of it. Depression is a common product
of this inability to resolve painful feelings.
Hyperarousal Symptoms
The survivor part of us is not able to listen
to "reason". It is going to be constantly
looking for danger from now on whether or not
others think it is reasonable. Real physiological
changes occur in the brains of survivors which
make them quick to react. In order to live through
the trauma, survivors may develop the capacity
to go from being completely fine into a killing
rage in seconds. That defensive mechanism helps
them live.
Some survivors may stop sleeping soundly.
Sleep can get you killed, so they won't take
the risk. Survivors may be uncannily able to
read the moods of those around them because
the moods of their abusers defined their lives.
Sometimes they also become hyper vigilant, searching
for physical danger everywhere they are and
all of the time.
Due to hyper vigilance and lack of sleep,
it is hard for survivors to concentrate on everyday
things. They may do poorly in school and in
their everyday lives that leads them to believe
they are stupid or inept when actually they
have a symptom of PTSD.
Survivors often react faster and more completely
to sudden noises or movements. These are lifesaving
skills that the survivor feels they need while
they are still at risk. These are reality based,
effective survival skills. They keep you alive.
They don't go away by themselves.
Recovery
Recovery is a slow process which doesn't come
easily or without pain. The survivor must be
heard, feel they are understood, believed and
find the ability to reconnect to a community.
Recovery takes time. The survivor sets the pace.
Recovery is not a race, and can't be given a
set time limit. Recovery doesn't erase the trauma
as if it had never happened, it just makes it
easier to deal with.
Further trauma will always affect survivors.
PTSD symptoms may come back during times of
further stress, but the negative effects can
be minimized as the survivor learns what they
are and feels able to take care of themselves..
True healing is knowing it is okay to ask for
help again.
Recovery is about learning better ways of
coping with trauma and letting go of fear, even
fear of change. Slow growth is good growth.
You can't rush survivors and we must not dismiss
their pain. Instead of comparing pain, survivors
and survivor groups are encouraged to respect
each other's pain and to focus on what they
have in common and to share recovery. Each person's
unique experience and pain is respected.
PTSD symptoms, numbing, hyper vigilance and
flashbacks, are strong hints that you need to
get help! They helped you survive, but they
do not go away by themselves. People have to
alter their lives to control them. They can
become both ineffective and a source of constant
pain.
It takes time to get better. Getting better
is the reward for taking the time to recover.
Getting better, however, is a slow process.
The state of almost constant physiological arousal
which many trauma survivors live in makes it
difficult for them to take in the kind of information
needed to heal. This is part of the brain chemistry
of survivors. It is not resistance or stubbornness
on their part. People can talk about changing
but all survivors may see is their lips moving.
The words and concepts make no sense. They are
incapable of taking what is being said on board
because they are too busy taking in information
for their survival. Things like who is in the
room, where are they sitting, where is the door,
which is the quickest way out, do they look
hostile or friendly, how are they reacting to
me?
Until they start to feel safe a survivor won't
be able to react to anything or anyone. They
have to feel safe and feel as though there is
an element of trust there. When they have been
treated with respect, not discounted, not pushed
to hurry up and recover, which are secondary
wounding experiences and make PTSD worse, they
will feel safe and know it because they will
be able to hear and understand what the therapist
or group is saying in a new way.
When they can hear, survivors can begin to
work on safety issues. They can begin to understand
and protect themselves from triggers. They can
learn to handle emotions such as anger and fear.
Survivors can develop the capacity to respond
rather than react, like having a pause button
instead of an on-off switch.
Searching for the right help is important. You
need to be comfortable enough with the therapist
or group. On the other hand searching for the
perfect group or a therapist who will never
make a mistake can put off recovery for life.
The therapist or group is not going to fix you.
They will however provide you with information
and a variety of coping skills, but it is you
who does the work and heals.
There are many forms of therapy available
to survivors. Two of the most common used are
cognitive/behavior therapy and psychodynamic
psychotherapy. Cognative/behaviour therapy involves
focusing on ways of correcting the survivor’s
painful and often intrusive patterns of behavior
and thoughts. This is achieved through teaching
them relaxation techniques and examining their
mental process. This can involve exposing the
survivor to certain triggers in a controlled
environment until they are "desensitized"
to the trigger and is no longer afraid of the
situation.
Psychodynamic psychotherapy tends to focus
on helping the survivor to look closely at the
way behavior and experience during their traumatic
experience violated them. Often the way a survivor
differentiated between their individual personal
values and the reality of what they experienced
during the traumatic event can result in PTSD.
This therapy aims to resolve the conscious and
unconscious conflicts that evolved from the
trauma. They also work on building self confidence
and esteem, self control and an all round renewed
pride in themselves and their abilities.
Each person heals in their own way, there
are no hard and fast rules, just as there is
no pill that can cure PTSD. Yes drugs can be
used to help with the side effects of PTSD,
like helping sleeplessness or hyper arousal.
Unfortunately there is no simple clear cut solution
for such a complex phenomenon. I firmly believe
that survivors have to confront what has happened
to them, and by repeating this confrontation,
learn to accept the trauma as part of their
past. There is no magic wand. However counseling
and therapy can help to find an easier path
through the trauma and set you on the path to
healing.
|
