PTSD

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.

About admin

Paula is an author of historical fiction as well as a wife, mom, and teacher.
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21 Responses to PTSD

  1. Daniel Riley says:

    That might the best explanation of PTSD I’ve read/heard. Regardless of its origin, whether it’s the battlefield or a high school cafeteria, PTSD manifests itself the same way: irrationally. Thanks for sharing.

    • admin says:

      So good to hear from you, Daniel! I hadn’t seen any updates on your blog. Hope you’re doing well, and thanks for the feedback.

  2. Barbara Hirokawa Gal says:

    Thanks for this clear and understandable explanation of PTSD. My mind has played some interesting tricks on me since April 20th, some which can be analyzed, some that I still don’t understand. I too got a lot of “Get over it” comments, some as soon as two weeks after! You are lucky to have a relationship that survived, as a lot of ours didn’t. We at Columbine are lucky though that we had a built in community with the school and the neighborhood. The poor people in Aurora are going to have a hard time connecting, whereas we are still connected all these years later. I will share this with others.

  3. Gina Doucett says:

    As always, you speak eloquently and from the heart. Enjoy the days left of summer and I will see you soon.

  4. Theresa Allison, MD says:

    Thank you, Paula, for that heartbreakingly perfect description. With your permission, I’ll share it with my medical trainees at the San Francisco VA Medical Center. We see far too much PTSD in our veterans, and these young doctors need to understand it on a more personal level if they are going to be compassionate and effective providers.

  5. Diane Miller, Carlisle MA says:

    This enlightened me. It is very helpful to have this clear description. Thank you, Paula.

  6. John McDonald says:

    Paula, as you know,my family has been with you all along since Columbine. Thank you for sharing how it has affected you over the years. I get teary when people mentions Columbine in conversation, and I was not nearly as involved as you were. The incident in Aurora brought tears again as I vicariously sat through the carnage being played out before me. Thank you again for expressing your feelings in hopes that someone else can live with tragedy. To your family from my family, we love you all.

    • admin says:

      John, I don’t know what my family would have done without yours. Thank you for all you did, and I’m so sorry that it still hurts you, too.

  7. Kallie says:

    Wow, Paula. You are a master with words. I know what you say is true; I’ve watched it for years. But I never could have explained it. You have given me a tool, and I hope lots of people have the chance to read this. Thank you

    • admin says:

      Kallie, you and Tory should talk one day. The mental health folks breathed down our necks at school, but it never once occurred to them that maybe our spouses and partners needed support. We fought like hell to hold it together at school, so you guys got the brunt at home.

  8. Rev Ryan Khan says:

    Paula, thank you for taking the time and energy to write this post. I work at the University of Colorado Hospital as a Chaplain and one of my chaplain co-workers sent me this link. I never thought to consider the implicatons of Christian Bale’s visit in that way. Your perspectives and insights are extremely helpful. Thank you.

    • admin says:

      Rev. Khan–I’m so glad you found this helpful. If you remain in contact with any survivors who would like to talk to someone who understands what they are are going through and has some perspective, please don’t hesitate to contact me using the email on this website. God bless you for the the work you’re doing. (I take it Todd sent this to you? He’s a great guy.)

  9. Michael says:

    Thank you so much for this explanation. Even years after CHS and going through all sorts of emotions and grappling to deal with them in healthy and unhealthy manners, even after going through med school and becoming a doctor who can explain the physiology of PTSD, this remains the best explanation I’ve ever read. Wouldn’t expect anything less from you though Mrs. Reed 😉

  10. admin says:

    Thanks, Michael. Feel free to use it if it can ever help someone else understand.

  11. Thank you, Paula. Can’t even begin to describe how this resonates. For those who weren’t “actually” there, but still suffer from PTSD surrounding these events, you help put a reality on some people’s fantasy (if that makes any sense).

    May I share this as a guest post on my own blog? I’d really like to.
    Ted

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