Post Traumatic Stress Disorder (PTSD) and activists.
Activist Trauma and Recovery
One of the amazing things about activists is that we often deliberately expose ourselves to brutality when we believe it necessary. What is sometimes equally surprising is how little we know about the psychological effects of this violence. We need to prepare ourselves and learn how to support each other through the physical and emotional consequences of trauma.
People’s reactions to traumatic events vary enormously; some may become withdrawn, others may be tearful or angry. The time it takes to recover from trauma also varies from hours or days to weeks, months and sometimes years – though most people recover within a month. Post-traumatic stress can take many forms. Some may find themselves more scared of the police or of crowded situations; others may become angry while others feel paralysed and vulnerable. You may feel changed as a person. Opening spaces to exchange experiences and communicate our emotions are important first steps to deal with experiences of violence.
Post-traumatic stress is a normal response to abnormal circumstances.
Possible signs and symptoms of a traumatic stress reaction
- Emotional signs include: sadness, helplessness, feeling numb, anxiety, fear, apprehension, uncertainty, grief, denial, guilt, depression, feeling overwhelmed, loss of emotional control, irritability, agitation, intense anger with self or others, shame.
- Cognitive(thinking) effects include: confusion or mental fuzziness; poor attention and concentration; poor problem-solving; poor decision-making; memory problems; loss of orientation; disturbing thoughts; flashbacks and intrusive images; avoidance of thinking; nightmares, panic attacks, hyper-vigilance, guilt, and blaming others or yourself.
- Behavioural signs include: withdrawal; tearfulness and emotional outbursts; an inability to feel settled; suspiciousness; hyper-alertness/intensified startle-response; a loss or increase in appetite; increased alcohol consumption; increased use of medication; change in sexual functioning; altered sleep patterns; strained relationships; increased accidents; avoidance of places, people or situations; loss of interest in life; reluctance to discuss the event or wanting to talk about it all the time; apparent personality change or anti-social behaviour.
- Physical effects include: fatigue, weakness, nausea, dizziness, chest pain, elevated blood pressure, difficulty breathing, sweating, teeth-grinding, rapid heart rate, muscle tremors, visual difficulties, menstrual changes, feeling faint, stomach upsets, muscular tension leading to head, neck or backache.
Note: it is highly unlikely that all of the symptoms will apply at the same time. Remember that these symptoms are natural reactions to very disturbing situations, and some of these symptoms are attempts of your body and your brain trying to protect you.
If these symptoms apply to you, make sure the people surrounding you get to see this list, so they are able to understand your reactions better.
What Is Post Traumatic Stress Disorder?
Most people recover from trauma within a few weeks. However, some 20-30% of people exposed to trauma develop a range of symptoms which psychologists call Post Traumatic Stress Disorder. It is officially considered an illness and should be treated on the NHS. This diagnosis applies when stress symptoms do not disappear after a month or so. Effective treatments for PTSD are available, and awareness of the condition and personal preparation can reduce the risk of developing symptoms after an incident.
PTSD is diagnosed when there has been exposure to an extreme stressor, resulting in a set of symptoms that persist for more than a month, and can continue for much longer. These stressors are, for example, being attacked by the police, raped, mugged, a serious accident, child abuse, the sudden unexpected death of a loved one, or witnessing a traumatic event. Recently, therapists have also begun to talk about ‘complex PTSD’ where the person has been exposed to a series of repeated stressors rather than a single one – for example previous (childhood) trauma plus being attacked by the police.
A person with PTSD has three main types of symptoms:
- Re-experiencing of the traumatic event indicated by: Flashbacks, nightmares, exaggerated emotional and physical reactions to things (called “triggers”) that remind the person of the event
- Avoidance and emotional numbing indicated by: Avoiding anything that reminds the person of activities, places, thoughts, feelings, or conversations related to the trauma. A loss of interest, “in life”. (Some may feel that activism seems pointless.) Feeling numb and detached from others, being withdrawn and avoiding social interactions
- Increased arousal indicated by: Difficulty sleeping – or conversely sleeping longer. Irritability or outbursts of anger, often over “minor incidents”. Difficulty concentrating and performing normal tasks. Hyper-vigilance, seeing or feeling danger “everywhere”, not necessarily connected with the original incident. An exaggerated startle-response, e.g. diving for cover if a car back-fires
Note: It is always worth getting an official diagnosis from a psychologist. With this paper you can, for example, ask to resign from work for some time. It also useful in case you have to go to court in connection with the traumatic experience as it is possible that your sentence might be reduced due to the suffering you have already gone through or that you will be compensated more.
Some specific problems associated with PTSD
Panic attacksIndividuals who have experienced a trauma may have panic attacks when exposed to something that reminds them of the trauma (eg. seeing police officers - especially riot police). Physical symptoms include pounding or racing heart, sweating, trembling or shaking, a feeling of shortness of breath or choking, chest pain, nausea, dizziness, chills, hot flushes, numbness, or tingling. The person may also experience psychological symptoms such as feeling unreal or detached or fearing that they are going crazy, dying, or having a heart attack.
Severe avoidance behaviourSometimes avoidance begins to extend far beyond reminders of the original trauma to all sorts of situations in everyday life. This can become so severe that the person becomes virtually housebound.
DepressionMany people become depressed and no longer take interest or pleasure in things they used to enjoy before. They may also develop unjustified feelings of guilt and self-blame and feel that the experience was their fault, even when this is clearly not true. For example, an activist may blame themselves for being attacked by the police or not being able to prevent someone else being beaten.
Suicidal thoughts and feelingsSometimes depression can lead to thoughts of suicide. (As many as 50% of rape victims report suicidal thoughts.) If you or someone you know is having suicidal thoughts following a traumatic event, it is very important to consult a professional immediately and get help.
Substance abusePeople with PTSD may, understandably, turn to alcohol or drugs – legal or illegal – to try to deaden their pain. However, inappropriate substance use greatly aggravates the symptoms and makes successful treatment difficult. Alcohol and drugs will make a bad situation much worse.
Feelings of alienation and isolationPeople with PTSD need support, but they often feel very alone and isolated by their experience and find it very difficult to reach out to others for help. They find it hard to believe that other people will be able to understand what they have gone through. They may also find it difficult to function socially. Relationship difficulties with partners, friends and family are very common after a severe trauma.
Anger and irritabilityAnger and irritability are common reactions among trauma survivors. If you have been assaulted, anger is a natural and justified reaction. However, extreme anger can interfere with recovery and make it hard for a person to get along with others at home, at work, and in treatment. A survivor may express disproportionate anger about a minor issue – this can turn out to be displaced anger about the trauma.
Severe impairment in daily functioningSome people with PTSD have very severe problems functioning in simple day-to-day life. A person may lose their ability to do ordinary tasks that were formerly easy and may be unable to fulfil their previous obligations.
Uncontrolled cryingSometimes people cry a lot for a long period of time. The pure thought of the event, or any “triggers” produces a deep grief that expresses itself through intense crying sometimes screaming, sometimes voiceless.
Delayed PTSDAlthough the symptoms of PTSD usually begin immediately after (or within a few weeks of) the trauma, they sometimes appear only several months or even years later. This may be more likely to happen on the anniversary of the traumatic event or if another trauma is experienced, especially if it reminds the person of the original event.
Why do some people recover from a trauma while others don’t?
The following factors appear to make it more likely that a person will develop PTSD:
- the more severe the trauma
- the longer it lasted
- the closer the person was to it
- the more dangerous it seemed
- the more times the person has been traumatized
- if the trauma was inflicted deliberately by other people (eg., police and prison officer brutality)
- if the person gets negative reactions from friends and relatives – which is why it’s so important to support each other more effectively
- the longer it took to get into safe/supported circumstances afterwards – the first minutes and hours can make a massive difference.
The Treatment of PTSD
Good informed support is the most useful treatment for most people but in some serious cases then appropriate psychotherapy, support groups and even sometimes medication may be necessary.
Alternative TreatmentsTraditional Chinese medicine: acupuncture or acupressure (basically acupuncture without needles) can be used as prevention, i.e. to maintain good health and readiness for action/demos; and as treatment, after the event, to help heal any wounds. Acupuncture is not just for physical health problems. It can help the 'shen', or spirit, just as much as the body and has been shown to help ease PTSD symptoms. Try to go to a practitioner who specialises in/has experience of treating psychological/spirit disorders and make sure they always use disposable needles. (Read on-line guides to choosing a practitioner.) Other therapies known to help psychological trauma include: Shiatsu, Reiki, holistic massage, Bach flower remedies and yoga.
ExercisePhysically energetic activities are helpful so go cycling, swimming, walking etc. if you can.
Find a place of retreatIt is important to be in a place where you feel safe and where you have friends around you who can look after you. PTSD is like being ill, and you should take your time, let others take care of you.
AcceptancePTSD can happen to anybody. It does not mean you are weak. You have the right to feel how you feel, and to accept that is an important step in recovery.
PsychotherapyFind a therapist who has experience of dealing with PTSD, and preferably one who is politically sympathetic. Rape helplines can often give good advice and have contacts for therapists who are clued-up on PTSD.
Four types of psychotherapy are especially effective in treating PTSD:
Anxiety management(involving relaxation training, breathing retraining, positive thinking and self-talk, assertiveness training.)
Cognitive therapy(helping to change irrational or unrealistic beliefs associated with the trauma.)
Exposure therapy(helping you confront situations, people or emotions which evoke the trauma, eg. asking a copper for directions. Your fear will gradually begin to dissipate if you force yourself to remain in the situation rather than trying to escape it.)
Group therapySelf-help groups can be very useful especially if people who have been through similar traumatic experiences.
There is no drug that cures PTSD. Conventional drugs which you might take include antidepressants, mood stabilizers and anti-anxiety medication, all of which may well have undesirable side-effects, which should be reported to your doctor. Medication is sometimes helpful if:
- Your symptoms are severe or have lasted a long time.
- You have another psychiatric problem (e.g. depression or anxiety) that is halting recovery.
- You are thinking about suicide You are having a very hard time functioning.
- You have been receiving psychotherapy but still have disturbing PTSD symptoms.
- You have to ‘function’ for something important, say a court case, when light temporary medication can be helpful.
How to come off medication
If medication has been prescribed by any health practitioner, talk to her/him about how to reduce or stop taking drugs. It is often helpful to come off medication gradually and also to discuss the timing of withdrawal with friends or family.
Why Do Many People Not Receive Appropriate Treatment For PTSD?
People with PTSD often do not seek help. There is a natural tendency to avoid dealing with the unpleasant feelings associated with the trauma. The very symptoms of PTSD – withdrawal, feelings of guilt or mistrust – may make it difficult for some people to get treatment. People may not know that there is such a thing as PTSD, and may not be aware that it is a diagnosed illness and may not know that treatment is available.
Are There Ways To Prevent PTSD?
Some activists use meditation, martial arts, other eastern disciplines (like tai chi, chi gung) to help prepare for, and recover from, events where there may be trauma. They can help ground you, give you focus, confidence, and help you defend yourself, physically and mentally.
Being aware of potential violence will reduce the shock-factor. Good immediate support will help lessen the symptoms or even onset of PTSD. Taking vigorous exercise immediately after may help to release stored-up adrenalin.
Emotional awareness in preparatory group meetings is important, to enable people to talk through their feelings. Knowledge of post-traumatic stress is important, because if traumatic events occur, you will be better supported by people who already know about PTS, and you will be better able to help others.
If an action/demo is coming where there may be traumatic events, plan your support and a debriefing session afterwards. Plan to do nice stuff afterwards, and take time off. Encourage your group to do this also.
On the day, bear in mind the ‘golden hour’ which medics speak of, as that may also be the vital time for limiting the emotional impact of a trauma. In the minutes, hours, and day/s after a trauma, assist a trauma survivor to:get somewhere safe and calm be cared for medically and/or homeopathically, eat and drink good food stay warm — one of the body’s responses to shock is to feel very cold be listened to not be left alone know what has happened to friends/family, and know any children will be cared for know that support will be available for the next few days to safely experience whatever emotions may arise not take on new responsibilities and have old obligations taken away for the time being.
An activist’s immediate response to trauma may well be – ‘I’m fine, leave me alone, I have to go and… rescue my friends/ throw myself back into the fray/ go to work in a couple of hours/ single-handedly look after my children/ do prisoner support/ attend the big post-protest party… These may be the choices that make the difference between taking a month or ten years to recover from the trauma. Discuss the right response to trauma in advance, with our friends, action groups, and communities, and attempt to commit in advance to the appropriate response, regardless of how ‘fine’ we feel at the time.
What Can Families And Friends Do To Help?
The support of friends and families is enormously important, and cannot be overstated. (Lack of support and understanding, on the other hand, contributes to the persistence of trauma.)
Don’t expect a traumatized person to recover quickly. Some will, but some won’t be able to do that. If someone is taking a long time to recover from a crisis, offer your support repeatedly, so that they do not feel alone.
A traumatized person may have symptoms which are very hard for those around them to deal with, for example anger or withdrawal. Bear in mind that the traumatized person is not deliberately acting this way: it is the trauma which makes them behave like this. Don’t take it personally but recognize it as a symptom and as a sign that they need your support.
Provide emotional support and be a good listener.
People are tempted, time and time again, to encourage the person to stop reliving and simply forget about the trauma and get on with life. Unfortunately, this seemingly reasonable advice is usually not helpful in this situation and is likely to make things worse, as it may make the person feel even more isolated and hopeless.
The person may need to talk about the traumatic events over and over again, and one of the best things family members and friends can do is to be patient and sympathetic listeners so the person feels less alone. It may be the case that the person doesn’t want to talk about it, in which case don’t force them because they might shut down on you.
One of the most important things you can do is to give the message:
‘You are not to blame – and you are not alone. This is normal and it will pass.’
It is also important to have realistic expectations while the person is recovering and not to expect too much or too little from the person. Encourage your loved one to join a PTSD support group.
Learn about the disorder and encourage the person to stick with treatment even if it is painful.
Go with them when, for example, they try to go on demos and actions again. Keep an eye on them, and check how they feel, before, during and after. During treatment, the therapist may try to help your loved one get in touch with feelings about the trauma. This can be very difficult and there may be a temporary increase in symptoms and distress. Emotional support from family and friends can be especially helpful during this period.
Also, when the symptoms of PTSD are over, it is important to help the person to reintegrate into an active life.
From the states: http://healingtrauma.pscap.org
A very good book is ‘Trauma and recovery’, Judith Herman.
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Write to Activist Trauma: East Oxford community Centre, Princess St. Oxford OX4 1DD