| The before you, and the after you

Examining the long-term effects of PTSD

We’ve all seen it in the movies: a returning veteran suffering from Post Traumatic Stress Disorder (PTSD), who loses a sense of normalcy, becomes dependent on alcohol or drugs, and puts himself and his family into danger. While movies depict some aspects of PTSD, they  often present simplified accounts of what is a highly nuanced syndrome. It is time to disabuse what is popularly understood about having PTSD.

According to Alain Brunet, Director of the Psychosocial Research Division at the Douglas Mental Health University Institute and Professor in the Department of Psychiatry at McGill, PTSD affects 10 to 15 per cent of the population. These statistics can be interpreted in two ways. First, not everyone exposed to a traumatic event suffers from the disorder. Second, how one develops the disorder depends on the intensity of the trauma, the appraisal of the event, and the experience of distress and dissociation during the event.

Brunet’s personal anecdote about John* demonstrates the importance of appraisal in the syndrome. It was like any other day for John when it happened. As a bus driver, he was driving his route when he noticed that a man was sexually assaulting a girl. Afraid to intervene, he let it slide. However, John felt guilty for letting this happen to a girl who seemed close to his daughter’s age. Waking up in the middle of the night with nightmares for months, he repeatedly said to himself, “Had it been my daughter…” A direct experience like John’s is not the only factor that determines a trauma. It is the combination of personal history, an individual’s specific reaction to a particular event, and other factors that lead to trauma formation.

In PTSD, there is a “before you” and an “after you.”  It is a forever life-changing experience, often making recovery seem insurmountable. Though different types of trauma lead to different processes of recovery, the catholic way of recognizing improvement is in the capacity to put trauma behind oneself and cultivate personal growth.

It is important to note that most  people do recover from traumatic incidents in due time. Contrary to common belief, PTSD is resolvable, though the timing varies depending on the severity of the case. With that being said, it is important to note that a substantial number of people do not fully recover.

The most well known method of recovery from PTSD involves Cognitive Behavioural Therapy (CBT) coupled with an anti-depressant. But many who suffer from PTSD do not get effective treatment. Some are unaware of the existence of psychotherapy for their disorder, while others are unable to pay the high costs of therapy or feel ashamed to admit to having PTSD.

What are the ways to help someone suffering from PTSD? There are three steps that Brunet recommends. The first thing to do is to stop giving negative support – telling the person to snap out of the situation and giving “I told you so” comments. Though the intention may be good from the other person’s perspective, it is detrimental for those suffering from the mental disorder. Second, be an active listener. Encourage the person to talk about trauma, and remain impartial and non-judgmental about what is being said. Forcing a person to talk could have deleterious effects, thus, patience and careful attention are required. Lastly, monitor how the individual is doing over time. If there is no gradual improvement, seek help on behalf of the person. This is generally recommended several months after the initial trauma.

Of the three clusters of PTSD, which include intrusion, avoidance, and hyper-arousal, John’s case corresponds to hyper-arousal. It is characterized by an individual being hyper vigilant, easily startled, irritable, and lacking concentration. Intrusion and avoidance are similar; those with either tend to avoid other people, places, or anything that reminds them of a traumatic event. The fundamental way in which intrusion is unique, is that it involves imagery relating to the trauma constantly popping into a person’s head.

The most easily identifiable symptom of PTSD is nightmares similar to those John had. Other common symptoms include avoidance of places, situations, people, and topics, symptoms of hyper-arousal and hyper-alertness, lack of concentration, and flashbacks, and hallucinations. Having these symptoms for more than a month is considered PTSD.

For those who believe they qualify for PTSD or know someone who does, it is worthwhile noting that there is a free PTSD clinic at Douglas Hospital, where an individual can obtain a free complete assessment by certified psychologists. There is also an ongoing project examining the individual differences in recovery process and the effectiveness of new treatments. Thus, an opportunity is open to participate in research for those diagnosed with disorder.

At the end of a nearly two-hour interview with Brunet, he remarked, “what is not well known about PTSD is that the traumatic events happen all the time. Trauma is all around us. Most of us will experience at least one – or several – in our lifetime. No one is protected. It’s not something that happens to the others – the soldiers or people who were walking alone at night. Trauma can strike anybody, good or bad. Life can be very unfair. This is something that we should be prepared to deal with.”

*Real name has been changed


To schedule or an assessment visit for the PTSD clinic, please contact Raymonde Lemieux. Tel.: 514 761-6131, extension 3430.  raymonde.lemieux@douglas.mcgill.ca

For more information on PTSD, please visit, www.info-trauma.org