Some Thoughts About PTSD

Post-Traumatic Stress Disorder (PTSD) is an unique disorder in several ways. It can occur in people who are exposed to a highly stressful event, but may not in all those exposed. It takes two forms: the acute form, which develops quickly after the stressful event, and the chronic form, which develops months or years after the event. In my opinion, acute PTSD is a normal reaction to an extreme event. Chronic PTSD, I believe, is the response of a more "neurotic" character structure to an extreme event, and is not a "normal" reaction.

In some ways PTSD can be seen as a response to a sudden exposure to unpleasant reality. The reality is that we live in a very dangerous world, and we manage our appropriate anxiety through the rather primitive defense of denial. We drive on the highway at 70 mph, with cars going the opposite direction at 70 mph only feet or inches away. We have the illusion of safety, even invulnerability, in our air-conditioned and quiet automobiles. We also know, though we avoid thinking about it, that we are a fraction of a second away from a terrible death. We don't want to know how vulnerable we are; in some ways we really can't afford to know how close we are to disaster.

When something happens to shatter our sense of invulnerability, it may shake us deeply. It breaks the wall of denial and suddenly we are forced to be aware of just how near we are to death at almost every second. We lose our illusions of safety. In a sense, acute PTSD is a mental state closer to reality than our "normal" state of comfortable illusion. We want to retreat to our previous state of blissful ignorance, but find that impossible to do easily. We become angry that we have lost our sense of safety. How we adjust to this sudden onslaught of reality determines whether we come to terms with what has happened and the precarious nature of our lives or whether we become chronically terrified. The more protected our lives have been, the more disturbed we are when we suddenly are exposed to the often terrible reality. The story of how Siddhartha Gautama was suddenly exposed to death and illness (which started him on his search for the philosophy that became Buddhism) is especially enlightening.

The events that result in PTSD are life-changing events. However, instead of seeing our reactions to trauma as necessarily pathological, we should consider that our mental state prior to the incident was one of ignorance or deliberate denial, and that our recognition of the potential awfulness of life, as unpleasant as the experience is, is more healthy and realistic. Our reaction to the necessity of changing our belief about reality may be pathological, but react and change we must. Some people bitterly resent the imposition of change and/or the recognition that they are not as safe as they believe they should be. Some become self-pitying or resentful or victimized or helpless. None of those reactions are healthy, but the reactions are not caused by the traumatic event itself. They are the result of the impact of the traumatic event on the dysfunctional attitude and belief system of the individual to whom they belong.