One thing (of many) that fascinates me about PTSD is the role of dissociation: that is, the distancing of oneself during or when reliving a traumatic experience. Think of dissociation as someone experiencing a trauma, but watching it happen from another's point of view.
What is the role of dissociation? Simply to cope with the trauma as it is occurring. When someone experiences trauma that is so psychologically uncomfortable or traumatizing, a natural defense mechanism is to avoid it completely.
This can be helpful in the short-term, but as Professor Richard Bryant from the University of New South Wales points out, it has some serious psychological consequences, but it prevents the trauma from being processed, and it could lead to PTSD. However, it doesn't always mean that PTSD will develop.
When we as people experience any type of hyper-arousing or stressful circumstance, we experience dissociation to a degree. We have temporary lapses in memory, we can't remember certain details, we stifle emotions related to the event, and the like.
In PTSD, this is a uniquely manifesting degree of symptoms, because while it initially may strive to help by distancing the survivor from the trauma, it comes back in ways like flashbacks, blind rages, the sense of being out of body, detachment, or other similar symptoms. What might start by appearing to be an escape of sorts can easily turn into a tonic for a type of amnesia or repression. It doesn't take a lot to come to the conclusion that this is a destructive coping pattern, not just for the survivor, but for the survivor's closest circles.
My wife has experienced this several times on several occasions brought on by several stimuli and environments. There are a few common results of a highly dissociative episode (especially in the form of blind rages):
1. The survivor remembers little to nothing of what happened during the episode. The survivor might remember feelings, fragments of thoughts or conversations, or other elements of the episode. We usually can't talk about everything that was said because she says, "I don't remember."
2. The survivor has feelings of guilt or remorse afterwards (when the survivor comes back to the present).
3. Depending on the responses during the conversation, the episode can last from several seconds to several hours. Flashbacks or blind rages can usually bring heated conversations, and it's important to recognize when they are happening and stay grounded (see my other blog post on developing a safety checklist to help you and your survivor cope before, during and after a flashback).
It is crucially important to help your survivor by maintaining an atmosphere of safety. The degree of safety depends on your relationship, but safety begets trust, and trust begets intimacy. True intimacy is what keeps a couple together. Your survivor is on a rough road, no doubt, but there's no fooling yourself into thinking that you're on a separate path. Maintain an atmosphere of safety, and you'll go a long way to helping your survivor manage their symptoms and trauma in a constructive and safe way.
Sunday, February 22, 2015
Sunday, February 8, 2015
Safety Checklist: Before, During, and After Flashbacks
Your partner has PTSD, you might or might not. This is a world that is most likely foreign to you, filled with chaos that seemingly comes out of nowhere and brings about a host of reminders of problems that might have happened long before you two met. Whatever happens during a flashback or a trigger, it is important to seek understanding. The first thing that you can do to start to understand is to validate the other person. Even if the person is remembering something that happened differently than what you remember, validate it. To them, it is true.
Ask about it. Even when symptoms are highest, talking about what's going on might prove more helpful than detrimental. Our natural human instinct is avoidance (and I'm often guilty of this). If the time is right, it might help to sit down and discuss the degree of symptoms and offer support. Be careful here, as this is getting into dicey territory. It only takes a few phrases that can make the difference between a thoughtful and open conversation and the catalyst to a blind rage or intensified flashback. Ground your partner by saying things that are happening around you—the state of the weather, a pet running across the room, children talking, or even asking if your partner can hear you. When a survivor is having a flashback, they have no awareness of their surroundings. It's like they're there, but not really there [a future post on the role of dissociation is coming soon]. A few things that have helped with my wife and me has been calling out a term of affection for my wife, asking if she is going into flashback mode, or asking if she can see or hear things that are going on. Every situation is different, so you'll need to play each situation by ear: It is as important to talk about it as it is to give the other person the space they need. Sometimes talking about things afterwards makes for a better conversation. Always maintain that your partner has control.
PTSD comes out of trauma that is out of the person's control, so make sure that during elevated times of symptoms, triggers, and flashbacks that you communicate that the other person is in control. During these times, safety is the utmost priority and should not be compromised—period. If your partner tells you to stay away, back off. If your partner is belligerent, calmly validate the things they are saying, and calmly reassure that you are there for them. Do NOT under any circumstances threaten the safety of the survivor; it will only escalate the survivor's symptoms. When your partner is in flashback mode, it can seem like a minefield, but stay the course and watch what you say and do. It will pass eventually. If the flashback hasn't lifted for a few hours, it might be time to call a mental health crisis line or 911. If the survivor threatens the safety of themselves or you, it's always important to call 911.
Living with someone that has PTSD presents a new set of challenges to a relationship, so it's extra-important that communication be as strong as possible. My wife and I remind each other often, "Don't forget your Vitamin C [C meaning communication]." It helps us immensely, especially when her symptoms are high.
A concise checklist summarizing what was said above follows:
Before flashbacks begin:
1. Ask your partner if they are still in the present. Ask if they can hear things, see things, smell things that are going on. Help them by grounding them in what's going on around you.
2. Prepare a "grounding box"—together. Include things that will help your partner remain in the present as much as possible. Remember, the survivor is in control, and they know themselves best.
3. Be sensitive to their requests. If they need some space, give them space. If they need some alone time, give it to them, but check in every once in a while to make sure they're okay. Never threaten them or disrespect what they ask for when it comes to space or time apart, but don't abandon the situation, either.
During flashbacks:
1. DO NOT try to take control. You're now in the supporting role. Your job is to bring your partner back. Talk about what you see, ask what they're hearing, seeing, or feeling.
2. If they become physically belligerent, back off.
3. If things get too prolonged or unsafe, call 911 or a mental health crisis line.
After flashbacks:
1. If the mood permits, talk about what happened. Ask again if your partner is in the present.
2. Discuss possible prevention measures you both could have taken.
3. If you don't have a conflict management system in place, discuss it (I'll write about one in a future post).
Ask about it. Even when symptoms are highest, talking about what's going on might prove more helpful than detrimental. Our natural human instinct is avoidance (and I'm often guilty of this). If the time is right, it might help to sit down and discuss the degree of symptoms and offer support. Be careful here, as this is getting into dicey territory. It only takes a few phrases that can make the difference between a thoughtful and open conversation and the catalyst to a blind rage or intensified flashback. Ground your partner by saying things that are happening around you—the state of the weather, a pet running across the room, children talking, or even asking if your partner can hear you. When a survivor is having a flashback, they have no awareness of their surroundings. It's like they're there, but not really there [a future post on the role of dissociation is coming soon]. A few things that have helped with my wife and me has been calling out a term of affection for my wife, asking if she is going into flashback mode, or asking if she can see or hear things that are going on. Every situation is different, so you'll need to play each situation by ear: It is as important to talk about it as it is to give the other person the space they need. Sometimes talking about things afterwards makes for a better conversation. Always maintain that your partner has control.
PTSD comes out of trauma that is out of the person's control, so make sure that during elevated times of symptoms, triggers, and flashbacks that you communicate that the other person is in control. During these times, safety is the utmost priority and should not be compromised—period. If your partner tells you to stay away, back off. If your partner is belligerent, calmly validate the things they are saying, and calmly reassure that you are there for them. Do NOT under any circumstances threaten the safety of the survivor; it will only escalate the survivor's symptoms. When your partner is in flashback mode, it can seem like a minefield, but stay the course and watch what you say and do. It will pass eventually. If the flashback hasn't lifted for a few hours, it might be time to call a mental health crisis line or 911. If the survivor threatens the safety of themselves or you, it's always important to call 911.
Living with someone that has PTSD presents a new set of challenges to a relationship, so it's extra-important that communication be as strong as possible. My wife and I remind each other often, "Don't forget your Vitamin C [C meaning communication]." It helps us immensely, especially when her symptoms are high.
A concise checklist summarizing what was said above follows:
Before flashbacks begin:
1. Ask your partner if they are still in the present. Ask if they can hear things, see things, smell things that are going on. Help them by grounding them in what's going on around you.
2. Prepare a "grounding box"—together. Include things that will help your partner remain in the present as much as possible. Remember, the survivor is in control, and they know themselves best.
3. Be sensitive to their requests. If they need some space, give them space. If they need some alone time, give it to them, but check in every once in a while to make sure they're okay. Never threaten them or disrespect what they ask for when it comes to space or time apart, but don't abandon the situation, either.
During flashbacks:
1. DO NOT try to take control. You're now in the supporting role. Your job is to bring your partner back. Talk about what you see, ask what they're hearing, seeing, or feeling.
2. If they become physically belligerent, back off.
3. If things get too prolonged or unsafe, call 911 or a mental health crisis line.
After flashbacks:
1. If the mood permits, talk about what happened. Ask again if your partner is in the present.
2. Discuss possible prevention measures you both could have taken.
3. If you don't have a conflict management system in place, discuss it (I'll write about one in a future post).
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