Ah, Facebook debates. There is no format better suited to oversimplified, and therefore heated, exchanges. A big one that came up over the last few days was about the idea that Christian Bale should visit the victims of the Aurora movie shooting in costume. When several people (including me) said this was a PTSD disaster waiting to happen, the conflicting replies fell into two groups: 1) the shooter was not dressed as Batman, so it’ll be fine, and 2) OK, Bale should come without the costume. As someone with PTSD, I can tell you, neither is a good idea, but Facebook is not the place for long explanations. Blogs are. (Addendum: Apparently Christian Bale is in Aurora, visiting victims who are happy to see him. I have absolutely no problem being wrong on this count. The following description remains valid, I think.)
I think people have the idea that every case of PTSD looks like this: An Iraq war vet is walking down the street when he hears a car backfire. Suddenly, he thinks he is being fired at, imagines he’s back in Iraq, and goes home to get his gun. And maybe it does look like that sometimes, but not always by any stretch.
I’m going to explain PTSD in very much layman’s terms here, not as a clinician, but as one who has it. First, I will try to explain the physical cause in a way that made sense to me, hoping it clarifies it for you, too: Let’s say you’re a primitive man, hunting on the plains of Africa with your best friend. It’s a warm, sunny day. The plain is dotted by antelope and zebras. You smell dry grass and something musty. You feel the tall grass tickling your bare legs. You hear something snap, a low growl, the sound of something rushing through the grass, and the next thing you know, your best friend is being eaten by a lion. Unable to stop it, you run, leaving your friend behind, screaming. Your brain is not going to sort through all that sensory input and focus solely on the lion. It’s going to take all that sensory input and build a neural pathway that says, “Sunshine, plains, antelope, zebras, feel and smell of grass, musty smell, snap, growl…mortal danger!” These become triggers for the fight or flight instinct we all associate with PTSD. This is a survival mechanism, ensuring that we will avoid future danger of a similar kind or run sooner if we encounter it again.
Not all of these triggers will cause a PTSD reaction. It may be triggered by one; it may require several simultaneously. It may not just be the most logical one, say the growl or snap. It may be something unrelated to the mortal danger, say the sunshine and antelope or feel of grass on your legs—something you felt innocuously as you and your friend walked, then felt again in more intense circumstances as you ran, hearing your friend’s screams. From that time on, walking through grass on a sunny day makes you feel nervous and anxious—maybe debilitatingly so for a while.
Fast-forward a few thousand years. You go to the movies with your best friend. You walk into the theatre, and the smell of popcorn hits you, making your mouth water. You’re more thirsty than hungry, though, so you buy a Cherry Icee. You sit down, the theatre goes dark, and you settle in to watch the movie. (I have no idea what was on the screen at the time. I’m picking something less intense than a shooting scene to make a point.) Gary Oldman, as Commissioner Gordon, is standing in front of a picture of Aaron Eckhart and extolling the virtues of Harvey Dent’s organized crime laws. The film is flashing back to scenes of Two-Face, so your brain is accessing everything it remembers about The Dark Knight, including images of Christian Bale as Bruce Wayne and as Batman. The guy behind you shakes Mike and Ike’s from a box into his hand, the rattle momentarily distracting you. You’ve been slurping mindlessly on your Icee, and just as you get a bout of brain-freeze, all hell breaks loose in the theatre. A man dressed in black and wearing a gas mask shoots your friend, and you are powerless to help. Later that night, you watch the paramedics take your friend away, and maybe he lives, maybe he doesn’t.
The immediate reactions are classic: shock, denial, depression, etc. Your family and friends understand. You are confused, but you understand your confusion. You’ve just been through hell. Everyone understands your fear of the shooter.
But they weren’t there. They weren’t in your brain when it happened. You may not even be aware of everything your brain was doing when it happened. Others may not understand that you were thinking about Christian Bale’s double-role (you may not even realize it), so it seems to make no sense that the sight of his face makes you uneasy. After all, he wasn’t on screen in any form when it all went down. Everyone, including you, wonders what the hell is wrong with you.
Months later, you might be driving down the street, drinking one of those Cherry Icees you love. You’ve had several since the incident with no ill-effect, no recollection of the shooting. But this time, you drink too fast. The cold goes to your head, and suddenly you’re shaking uncontrollably. You have to pull over to the side of the road where you sob, hard, for twenty minutes straight wondering what the fuck is wrong with you. Finally, you manage to get back on the road, but you can’t bring yourself to go where you were going. You go home, make a lame excuse to whomever you were supposed to see, not telling them what happened because you’re embarrassed. It was crazy. It made no sense. How do you explain that, out of the clear blue sky, you just fell apart?
Six months later, you decide to screw up your courage and go to a movie. You’re with supportive friends who listen patiently as you walk into the theatre and explain that you have a hard time with the smell of popcorn. They understand. You’re a little on edge, but doing OK. You settle into your seat when suddenly, for no reason at all, you can’t stay there one more second. You’re about to come out of your skin. You push and shove and trip over people to get the hell out. Outside, while you hyperventilate and your friends miss the movie to comfort you, you feel like a freak because you can’t explain what just happened. You can’t explain because you don’t even know that the trigger was the sound of someone shaking candy from a box into his hand.
You never do get used to the smell of popcorn. No one who lives with you can make it. It makes you sick and anxious. After a while they’re getting pretty sick of accommodating your irrational reaction to something so harmless. For crying out loud, the guy was shooting bullets, not throwing popcorn. Get the hell over it! But you can’t. You agree with your family/roommate/partner; it’s crazy. In fact, you like popcorn, and you feel like a selfish bastard because you resent not being able to eat it anymore. All those people are dead, and you’re mad because you miss popcorn, and your roommate is mad because he can’t have it either, and you feel like you’re going to be crazy the rest of your life. And when you try to explain to someone who wasn’t there, well, after a while they just lose patience. Get over it. Get over it. Get over it. And you want to scream, “DON’T YOU THINK I WANT TO?”
The collective pressure can result in depression, the shame in silence, and the total impact can be devastating. There are thoughts I had during the worst of it that I have never spoken aloud to anyone to this day.
I don’t know how my husband came by the patience he had with me; I only know that I was profoundly blessed to be married to him when the shootings happened at school. He is very protective of me, and that protectiveness helped me feel safe and slowly heal. If I told him not to touch me, he didn’t. If I told him I needed a hug, he gave me one. He let me cry and be pissy for no apparent reason.
Many forms of therapy for PTSD involve taking the victim back over and over to move the memories from the short-term into the long-term section of the brain and give them distance. For some, this works. Not for me. For me, the best therapy was escape through writing and a few years away from the scene of the tragedy. (I’m back at Columbine and happy now, so there really can be a happy ending—it just takes a while.) Also, for years I refused to take medication because I felt like I was being irrational, and I should just be able to talk myself down. After a particularly wicked episode resulting from a series of triggers all at once, I gave in and took an anti-anxiety med. The chemical calming effect on my brain did finally allow me to talk myself down the rest of the way, and I am no longer too proud to pop a pill when a hard-core anxiety attack hits (like in tight-packed crowds, especially of teenagers). I don’t need it very often, but I know when I do.
I’m just not a one-size-fits-all person. Some people need meds, some don’t; some recognize their PTSD early and find effective ways to deal with it, some take a while to realize they have it and/or struggle to find solutions that work. All I can say is if you’ve never had PTSD, don’t make assumptions based on your rational thoughts. (Christian Bale was not on screen and the shooter wasn’t dressed as Batman, therefore Batman images will not trigger an episode.) If you love someone who has it, try to be patient, though I’m sure my husband can sympathize with the way it disrupts your life and changes a relationship you depended upon, yourself. Having said that, I would imagine there are times relationships just can’t make it through this. It’s a challenge, for sure.
My heart is with all the folks who struggle with this condition and the people who love them. If you know someone with PTSD or someone who loves a person with PTSD, feel free to pass this along. Maybe it will let them know they’re not alone and it really can get better.