Psychologists are always talking about "inner conflicts." Why is that? Well, certainly "inner conflicts" can't have anything to do with a disorder that arises due to trauma. Right?... Nooooo, wrooonng!!! Post-traumatic stress disorder (also known as PTSD) is, believe it or not, also caused by an inner conflict. The inner conflict of PTSD, however, is not borne from a troubled past or conflicted feelings about right and wrong. Those kinds of issues can exacerbate PTSD, sure, but they are not what causes it. PTSD is actually caused by a conflict between two essential biological imperatives. These imperatives are at the core of health and development. The first is the avoidance of pain. The second is the integration of experience.
It should come as no surprise that we avoid pain. It is obvious that we humans, just like all animals, survive largely because we do avoid pain. Most organisms move away from physical pain instinctively. The instinctual first cry of birth is an impulse to have some kind of tension or discomfort soothed, whether it be the actual pain of being born, the first pangs of hunger, or the first experience of terror. We then move on to cry for comfort of all kinds, which is not just avoiding pain, but is also deeply involved in connecting to others. And of course, from the earliest ages, although we might reach out to touch the glowing embers of the fire or the red hot burner on the stove, our first burn teaches us a clear respect for anything with a yellow, red, or orange glow.
Trauma is, by definition, out of the ordinary, extremely painful, experience. Sometimes severe physical pain is involved, but often the most horrendously damaging aspects of a traumatic experience involve the impact it has on others whom we love or for whom we feel responsible, or our feeling that we might be to blame for the trauma. Emotional pain is somewhat different than physical pain. Nevertheless, the impact of emotional pain is every bit as powerful as physical pain in traumatic experiences. Just like any other kinds of pain, it is natural that we avoid all the different kinds of pain involved in trauma, including both the physical and the emotional aspects. Avoiding emotional pain is at the core of PTSD.
The second primary factor involved in PTSD, the integration of our ongoing experience, is just as essential for living as the avoidance of pain. Life has little meaning without the ability to remember what we've been through, or who we know, or where we've been. Our earliest experiences, perhaps by design, are especially difficult to integrate. Maybe that is one of the reasons that being born is not especially traumatic (from the viewpoint that it is not recalled repeatedly with horror). At that point we have not yet integrated any of our experiences. As we develop, however, our ability to recognize our closest caregivers, to know how best to get their attention, and to steer clear of physically painful objects grows in importance. Soon, our understanding of everything we perceive gets organized for the specific purpose of helping us manage our ongoing functioning in the most efficient manner possible.
Trauma is especially chaotic experience that defies logical understanding and thus is especially difficult to integrate. Although we typically expect to be able to avoid disasters, traumatic experience brings into question our ability to avoid accidents or painful experience. Thus, we don't want to integrate traumatic experience because doing so requires us to admit that we might be in danger that is unavoidable. Not only are many accidents unavoidable, but we also would like to remain in denial about how true it is that we are taking chances on a daily basis. Our desire to deny the possibility of danger, even when it might be avoidable, makes it difficult to integrate trauma in that doing so requires us to realize how dangerous things are. When we're making ourselves vulnerable in some way, we're typically in denial of the danger we're in. For example, we operate motor vehicles so frequently that we forget how ludicrous it is to believe that it's safe to hurtle ourselves at 60 mph in a metal box on wheels, and to expect our vehicle will never malfunction, and to expect that we ourselves will never malfunction, and to expect that all the other drivers will follow all the rules.
In spite of how safe we'd like to think we can make ourselves, when something does go wrong, the results can be horrifying. We likely blame many circumstances and perhaps we blame others we don't know. We can blame ourselves as if our ability to avoid disasters should be flawless. Any loss of material possessions, a loss of the feeling of safety, or God forbid, loss of life or limb, can seem utterly incomprehensible. Although traumatic events should be integrated into our understanding of life, maybe even more than other experiences since they could help us learn better what to avoid, these events defy logic, seem to make little sense, and hurt us so deeply and personally, that such events are often not remembered at all (even when head injury is not involved). Our desire to avoid the pain of trauma often actually makes us forget the incident entirely.
More than anything else, really, it's the severity of the emotional terror that makes it impossible to integrate a trauma into our ongoing experience. Our emotions go into turmoil over the trauma, and the pain is so bad that we just can't bring ourselves to think about it. Yet we can't help it. Our minds do want to make sense of the event. Flashes of the event thus push themselves into our consciousness, begging for recognition. Although we do not want to think about the trauma, the trauma will not leave us alone because it must be integrated. We do need to understand what went wrong and how similar disasters might be avoided. If we cannot get such an understanding, we're likely to feel we're damned to experiencing the same trauma again and again. That is the essence of PTSD. The traumatic experience is both impossible to remember or integrate, and impossible to forget or avoid.
So we avoid the pain by avoiding memories and thoughts about the trauma. We attempt to avoid anything that reminds us of the trauma. Yet reminders are everywhere. Colors, sounds, smells, and all sorts of familiar everyday occurrences make us think and feel about the trauma. Anything that could remind us of the trauma brings back a flood of thoughts and memories. We busy ourselves so our mind can't possibly let thoughts or feelings related to the trauma bother us. But as soon as our defenses are down, when we're not so busy, thoughts push their way into our minds. Our defenses are always down when we sleep, and nightmares related to the trauma begin to plague us.
When we're supposed to be at our most relaxed, instead we find ourselves in hyper-vigilant states, watching out for anything that might hurt us. In fact, quite often, because we have not properly integrated our trauma into our understanding of life, we start to generalize our traumatized state to areas that are completely unrelated to the initial trauma. We start to be on edge all the time. We can become hyper-vigilant to the point that we become paranoid. Now, because we have not integrated our traumatic experience, the trauma sneaks into our way of being in the world. We are avoiding all sorts of things. We're irritable, tense, often paranoid and angry. Now, because we have generalized our emotional state to all our experiences, the trauma in effect, has us avoiding relationships altogether.
In spite of how much we love our loved one's, it's often our relationships that suffer more than any other area of our lives. Those closest to us are typically those who see us at our worst. Unfortunately, the anger we feel about how unfair things are, or the anger that simply derives from feeling so tense, is often aimed the most at those at home. Suspicion leads to lack of trust. Simultaneously, the confusion of someone with PTSD often leads to their need for immediate gratification. Family members rarely understand the need of the afflicted family member to have some sense of control which might permit them to feel things are not in complete chaos. In short, trauma creates a complete mess, not just for the individual who develops PTSD but also for his entire family.
It is also typical that a person with PTSD gets no treatment whatsoever. Because they are paranoid and avoiding the pain of the trauma, someone with PTSD often has no desire to visit a complete stranger for the purpose of confronting their problems. It is far more likely that they will become increasingly withdrawn and find various ways to escape even from themselves. Substances or behaviors that help numb the pain of the trauma are sought and often result in addictions. Anything is better than experiencing the feelings and recalling the events of a serious trauma. When the victim of PTSD does not seek help, their problems often fester within their hearts and minds and dissolve their relationships, and all too often, the trauma ruins their life.
There is hope, however. Treatment for trauma generally focuses on helping people integrate the traumatic response in spite of the pain involved. Talk therapies, hypnosis and EMDR (Eye Movement Desensitization Reprocessing) help individuals combine the meanings they have derived from the trauma, with their memories, emotions, and body feelings. It is remarkable how often traumatized individuals have taken the trauma to mean they are responsible for the pain of others, or have no one who cares about them, or that they just have bad luck. Others will think the trauma happened for a reason. If the trauma occurred at the hands of a loved one, they'll think the trauma was related to their behavior or that it showed them who they really are, or who they will always be. Treatments for PTSD help people see how memory involving the trauma is associated with body sensations as well as painful, but irrational, feelings.
In the absence of, or in addition to, interpersonal psychotherapy, writing can provide huge relief (please see article, The Writing Cure). Strangely, this simple tool can help a person get feelings, thoughts, and body sensations out of one's mind and onto paper. The desire for integration in the mind pushes thoughts and memories into consciousness almost as if there's fear the the thoughts and memories will be forgotten. In fact, in the case of PTSD, the mind is trying to forget that which must be remembered. But when things are written down, the mind can start to work through the complications of the trauma. An individual should specifically attempt to remember every detail – everything said, all the colors and movement, shading, textures, times of day, sensations, smells, tensions, stresses, tastes, emotions. One can also try to remember the beliefs these feelings and sensations bring them to and how the feelings make them view their role in the world. When it seems there may not be any more to write, any other thought evoked should also be written down. Writing makes the mind know that what must be integrated has been acknowledged. As long as the information is all written down, the mind often finds much less need to repeat the experiences, almost as if the mind believes the trauma has been integrated simply because it is written down.
Although trauma can be psychologically devastating, and can lead to a short-circuit in normal functioning as painful memories are avoided and integration of experience is prevented, it need not always be a completely life-changing event. Treatments for trauma are very effective and are often relatively accessible. In the absence of treatment, some individuals can treat themselves with focused writing, or can find that expressing their feelings to friends is not as unacceptable as they might have thought. There is great hope for those with PTSD even though a lack of treatment can lead to a lifetime of avoidance and withdrawal. With proper help, the splintered life of the trauma victim can be rebuilt so that pain is no longer considered impossible to face, and integration of experience can lead to a newly integrated life. In recovery from trauma, the victim of PTSD puts life back in perspective, opens up to new possibilities, and begins to develop new relationships. With recovery, the traumatic experience is integrated and the pain it inflicted, although remembered, is no longer overwhelming. Often, then, the traumatic experience can be utilized in helping one relate to others who have also experienced trauma, and can actually thus make a person a more connected individual than ever. With treatment, once traumatic memories are successfully integrated, what was once horrifically traumatizing is reduced in intensity to a powerful learning experience, and that age-old adage is often true, "what doesn't kill you, can make you stronger."
