What It Looks Like

Brushing my teeth. Eating right and running every day. Shaving every day. Communicating (anything of importance)- with almost anyone, but especially with God, and especially through prayer or song. Paying bills on time (also for financial reasons, though). In general, managing the every-day-ness of my life. In light of my recent C-PTSD diagnosis, these are the things that I’ve noticed are a constant challenge to me, a daily struggle. This is what my C-PTSD “looks like.” I startle easily, find lots of noise oppressive, and am loathe to reveal anything unscripted about myself. I have a humiliating (to me) vocal/verbal tic that increases in frequency based on fatigue and stress (especially the stress of having to speak to others publicly), and I’m always fatigued and stressed and my job requires me to meet with others publicly on a daily basis. I’m perfectionistic, hypercritical of myself (and too often others), hypervigilant, and I catastrophize (and have anxiety about) almost everything. I know more about the new SARS-like virus and the newly emerged variant flu strains than many CDC workers. I’m likewise aware of most of the scenarios by which our society could come crumbling down, including rogue nuclear detonations, cyber or EMP attacks, and the looming global crises in our food, energy, and financial systems. I struggle to maintain relationships, and usually feel abandoned when they wane or fail (as I expect them inexorably to do). I stay up late, wake up often, and get up early until the fatigue is too much and then I cycle into going to bed early, getting up late, etc. I’m irritable and pessimistic. I swing between extremes and am told I’m an “all or nothing” kind of guy.

 

And this is just the tip of the iceberg.

I Don’t Remember, and I Don’t Think I Want To

What do you remember about your childhood? Can you describe what it was like to live with your family, in your home, in your own skin on a daily basis growing up not just because you know the broad outlines of your own story but because you have at ready recall a slew of memories, of events and experiences that you compiled along the way? If so, good for you. Congratulations, even; you probably didn’t grow up as a victim of prolonged, repeated trauma over which you had little control and no escape. I wish I could say the same. For my part, I don’t remember much. Oh, I can tell my own story, but only because I have a well-rehearsed script which has been reinforced by what others have told me about my own childhood. Ask me to remember it, though, and I more or less can’t. Or won’t. Or both. And for damn good reason.

As those who have read the last few posts know, my latest foray into therapy has led me in an unexpected direction, as I’m now diagnosed with PTSD. In fact, the term that was cavalierly mentioned in passing was “Complex PTSD,” or “C-PTSD,” which actually isn’t even a diagnosis yet. It’s a proposed diagnostic category for the next DSM; I think it’s been proposed for a while, but hasn’t been officially recognized yet. My exploration thus far of C-PTSD has been revelatory, however, because boy does it fit. For ease of reading and the overabundance of “wow, that’s me” moments as I read, the following from the self-help website “Out of the Fog” was especially enlightening. It’s a little long, but as I said is easy to read and was super especially helpful. I’ll have a little more to say myself at the end. Here’s the info:

Complex Post Traumatic Stress Disorder (C-PTSD)

Definition:

Complex Post-Traumatic Stress Disorder (C-PTSD) – Complex Post-Traumatic Stress Disorder is a psychological injury that results from prolonged exposure to social or interpersonal trauma, disempowerment, captivity or entrapment, with lack or loss of a viable escape route for the victim.


C-PTSD Introduction

Complex Post Traumatic Stress Disorder (C-PTSD) is a condition that results from chronic or long-term exposure to emotional trauma over which a victim has little or no control and from which there is little or no hope of escape, such as in cases of:

  • domestic emotional, physical or sexual abuse
  • childhood emotional, physical or sexual abuse
  • entrapment or kidnapping.
  • slavery or enforced labor.
  • long term imprisonment and torture
  • repeated violations of personal boundaries.
  • long-term objectification.
  • exposure to gaslighting & false accusations
  • long-term exposure to inconsistent, push-pull,splitting or alternating raging & hooveringbehaviors.
  • long-term taking care of mentally ill or chronically sick family members.
  • long term exposure to crisis conditions.

When people have been trapped in a situation over which they had little or no control at the beginning, middle or end, they can carry an intense sense of dread even after that situation is removed. This is because they know how bad things can possibly be. And they know that it could possibly happen again. And they know that if it ever does happen again, it might be worse than before.

The degree of C-PTSD trauma cannot be defined purely in terms of the trauma that a person has experienced. It is important to understand that each person is different and has a different tolerance level to trauma. Therefore, what one person may be able to shake off, another person may not. Therefore more or less exposure to trauma does not necessarily make the C-PTSD any more or less severe.

C-PTSD sufferers may “stuff” or suppress their emotional reaction to traumatic events without resolution either because they believe each event by itself doesn’t seem like such a big deal or because they see no satisfactory resolution opportunity available to them. This suppression of “emotional baggage” can continue for a long time either until a “last straw” event occurs, or a safer emotional environment emerges and the damn begins to break.

The “Complex” in Complex Post Traumatic Disorder describes how one layer after another of trauma can interact with one another. Sometimes, it is mistakenly assumed that the most recent traumatic event in a person’s life is the one that brought them to their knees. However, just addressing that single most-recent event may possibly be an invalidating experience for the C-PTSD sufferer. Therefore, it is important to recognize that those who suffer from C-PTSD may be experiencing feelings from all their traumatic exposure, even as they try to address the most recent traumatic event.

This is what differentiates C-PTSD from the classic PTSD diagnosis – which typically describes an emotional response to a single or to a discrete number of traumatic events.


Difference between C-PTSD & PTSD

Although similar, Complex Post Traumatic Stress Disorder (C-PTSD) differs slightly from the more commonly understood & diagnosed condition Post Traumatic Stress Disorder (PTSD) in causes and symptoms.

C-PTSD results more from chronic repetitive stress from which there is little chance of escape. PTSD can result from single events, or short term exposure to extreme stress or trauma.

Therefore a soldier returning from intense battle may be likely to show PTSD symptoms, but a kidnapped prisoner of war who was held for several years may show additional symptoms of C-PTSD.

Similarly, a child who witnesses a friend’s death in an accident may exhibit some symptoms of PTSD but a child who grows up in an abusive home may exhibit the additional C-PTSD characteristics shown below:


C-PTSD – What it Feels Like:

People who suffer from C-PTSD may feel un-centered and shaky, as if they are likely to have an embarrassing emotional breakdown or burst into tears at any moment. They may feel unloved – or that nothing they can accomplish is ever going to be “good enough” for others.

People who suffer from C-PTSD may feel compelled to get away from others and be by themselves, so that no-one will witness what may come next. They may feel afraid to form close friendships to prevent possible loss should another catastrophe strike.

People who suffer from C-PTSD may feel that everything is just about to go “out the window” and that they will not be able to handle even the simplest task. They may be too distracted by what is going on at home to focus on being successful at school or in the workplace.


C-PTSD Characteristics

How it can manifest in the victim(s) over time:
Rage turned inward: Eating disorders. Depression. Substance Abuse / Alcoholism. Truancy. Dropping out. Promiscuity. Co-dependence. Doormat syndrome (choosing poor partners, trying to please someone who can never be pleased, trying to resolve the primal relationship)

Rage turned outward: Theft. Destruction of property. Violence. Becoming a control freak.

Other: Learned hyper vigilance. Clouded perception or blinders about others (especially romantic partners) Seeks positions of power and / or control: choosing occupations or recreational outlets which may put oneself in physical danger. Or choosing to become a “fixer” – Therapist, Mediator, etc.

Avoidance – Avoidance is the practice of withdrawing from relationships with other people as a defensive measure to reduce the risk of rejection, accountability, criticism or exposure.

Blaming – Blaming is the practice of identifying a person or people responsible for creating a problem, rather than identifying ways of dealing with the problem.

Catastrophizing – Catastrophizing is the habit of automatically assuming a “worst case scenario” and inappropriately characterizing minor or moderate problems or issues as catastrophic events.

“Control-Me” Syndrome – “Control-Me” Syndrome describes a tendency that some abuse victims and some people who suffer from personality disorders have to nurture relationships with people who have a controlling narcissistic, antisocial or “acting-out” nature.

Denial (PD) – Denial is believing or imagining that some factual reality, circumstance, feeling or memory does not exist or did not happen.

Dependency – Dependency is an inappropriate and chronic reliance by one adult individual on another for their health, subsistence, decision making or personal and emotional well- being.

Depression (Non-PD) -Depression is when you feel sadder than your circumstances dictate, for longer than your circumstances last – but still can’t seem to break out of it.

Escape To Fantasy – Escape to Fantasy is sometimes practiced by people who routinely shun transparency with others and present a facade to friends, partners and family members. Their true identity and feelings are commonly expressed privately in an alternate fantasy world.

Fear of Abandonment – Fear of abandonment and irrational jealousy is a phobia, sometimes exhibited by people with personality disorders, that they are in imminent danger of being rejected, discarded or replaced at the whim of a person who is close to them.

Hyper Vigilance – Hyper Vigilance is the practice of maintaining an unhealthy level of interest in the behaviors, comments, thoughts and interests of others.

Identity Disturbance – Identity disturbance is a psychological term used to describe a distorted or inconsistent self-view.

Learned Helplessness– Learned helplessness is when a person begins to believe they have no control over a situation, even when they actually do have the power to change their circumstances, leading them into an unneccessary state of depression, where initiative, action or investment is deemed futile.

Low Self-Esteem – Low Self-Esteem is a common name for a negatively-distorted self-view which is inconsistent with reality. People who have low self-esteem often see themselves as unworthy of being successful in personal and professional settings and in social relationships. They may view their successes and their strenghts in a negative light and believe that others see them in the same way. As a result, they may develop an avoidance strategy to protect themselves from criticism.

Panic Attacks – Panic Attacks are short intense episodes of fear or anxiety, often accompanied by physical symptoms.

Perfectionism – Perfectionism is the practice of holding oneself or others to an unrealistic, unsustainable or unattainable standard of organization, order or accomplishment in one particular area of living, while sometimes neglecting common standards of organization, order or accomplishment in others.

Selective Memory and Selective Amnesia – Selective Memory and Selective Amnesia is the use of memory, or a lack of memory, which is selective to the point of reinforcing a bias, belief or desired outcome.

Self-Loathing – Self Loathing is an extreme self-hatred of one’s own self, actions or one’s ethnic or demographic background.

Tunnel Vision – Tunnel Vision is the habit or tendency to only see or focus on a single priority while neglecting or ignoring other important priorities.


C-PTSD Causes

C-PTSD is caused by a prolonged or sustained exposure to emotional trauma or abuse from which no short-term means of escape is available or apparent to the victim.

The precise neurological damage that exists in C-PTSD victims is not well understood.


C-PTSD Treatment

Little has been done in clinical studies of treatment of C-PTSD. However, in general the following is recommended:

  1. Removal of and protection from the source of the trauma and/or abuse.
  2. Acknowledgement of the trauma as real, important and undeserved.
  3. Acknowledge that the trauma came from something that was stronger than the victim and therefore could not be avoided.
  4. Acknowledgement of the “complex” nature of C-PTSD – that responses to earlier traumas may have led to decisions that brought on additional, undeserved trauma.
  5. Acknowledgement that recovery from the trauma is not trivial and will require significant time and effort.
  6. Separation of residual problems into those that the victim can resolve (such as personal improvement goals) and those that the victim cannot resolve (such as the behavior of a disordered family member)
  7. Mourning for what has been lost and cannot be recovered.
  8. Identification of what has been lost and can be recovered.
  9. Program of recovery with focus on what can be improved in an individuals life that is under their own control.
  10. Placement in a supportive environment where the victim can discover they are not alone and can receive validation for their successes and support through their struggles.
  11. As necessary, personal therapy to promote self discovery.
  12. As required, prescription of antidepressant medications.

What to do about C-PTSD if you’ve got it:

Remove yourself from the primary or situation or secondary situations stemming from the primary abuse. Seek therapy. Talk about it. Write about it. Meditation. Medication if needed. Physical Exercise. Rewrite the script of your life.

What not to do about it:

Stay. Hold it in. Bottle it up. Act out. Isolate. Self-abuse. Perpetuate the cycle.

What to do about it if you know somebody else who has C-PTSD:

Offer sympathy, support, a shoulder to cry on, lend an ear. Speak from experience. Assist with practical resolution when appropriate (guidance towards escape, therapy, etc.) Be patient.

What not to do about it if you know somebody else who has it:

Do not push your own agenda: proselytize, moralize, speak in absolutes, tell them to “get over it”, or try to force reconciliation with the perpetrator or offer “sure fire” cures.

This makes so much sense to me because I certainly was exposed to long term emotional trauma in a situation in which I had little or no control and little or no hope of escape as a victim of childhood emotional abuse. The description of the layering of trauma and the interaction of one trauma with another was important too, as the roller coaster of my life certainly didn’t stop when I finally fled my family of origin at 18. I’ve often talked about being something of a “crisis junkie,” about how crisis seems to follow me and I seem to live best in that state. I talk about being conditioned to accept crisis as “normal” and expecting- if not creating- it when things seem calm. These statements too are “spot on” in describing me:

  • (C-PTSD sufferers) “…may feel unloved – or that nothing they can accomplish is ever going to be “good enough” for others.”
  • (C-PTSD sufferers)  “…may feel afraid to form close friendships to prevent possible loss should another catastrophe strike.”

Some of the language about how C-PTSD can manifest in the victim over time was apt-

“Rage turned inward: Eating disorders. Depression…Co-dependence.

Rage turned outward: Becoming a control freak.

Other: Learned hyper vigilance. Clouded perception or blinders about others (especially romantic partners) Seeks positions of power and / or control: choosing to become a “fixer” – Therapist, Mediator, etc.”

Finally, when it starts listing 18 characteristics of C-PTSD starting with Avoidance, then Blaming, etc., I could readily identify with no less than 16 (SIXTEEN!) of them, especially Catastrophizing, Depression, Fear of Abandonment, Hypervigilance, Low Self-Esteem, Perfectionism, Selective Amnesia, and Self-Loathing.

Yea, me. So…..now what?

Toddlers and Stairs, Part 2

It’s a lazy Saturday morning as Samuel is watching a movie, Kirsten is sleeping after work last night, and Nathan has finally settled for a nap. It’s not supposed to be a lazy Saturday morning, though. We should be on our way home from Canton after Samuel’s first race this season for the Cuyahoga Falls Running Black Tigers. We decided not to go late last night after Nathan followed in his brother’s footsteps- literally- by falling down our (thankfully carpeted) basement stairs. Samuel did it when he was a little older than Nathan and was just learning to walk using a toy walker that he stood behind and pushed around. In Nathan’s case, Kirsten had just left for work and Samuel was going downstairs to brush his teeth. He dutifully closed the door with Nathan nearby, but then turned around and talked to and interacted with Nathan through the door. I was not more than 4 feet away, but looking down at something. We have a child lock on the door now, but it has to be activated from upstairs; so Samuel couldn’t lock it from the other side after going through the door. I should have locked it immediately. I should have known. I didn’t, though, as Nathan has never- until last night- successfully been able to reach, grasp, and pull the handle, though every day he’s been surprising us with what he can reach and do and what kind of trouble he can thus manage to get into.  So not long after Samuel finally went down the stairs, I heard a ruckus in the stairway. It sounded a lot like Samuel noisily making his way up the stairs, which he is prone to do, and for the first few milliseconds that’s what I thought it was. A few milliseconds after that, though, I heard Nathan crying downstairs and a pit suddenly opened in my stomach as I realized what had happened. Even as I rushed downstairs to get him the guilt and blame began, but more about that later.

As we did with Samuel, I immediately ignored common sense and sound medical thinking as I scooped Nathan up and rushed him back upstairs. I think it’s that parental (and even more so, paternal) protective instinct that made it impossible to not remove him from the scene of danger.  I knew pretty quickly that Nathan was probably fine. He had cried right away and there were no obvious signs of injury- no blood, no bumps,  no scratches even. He was awake, alert, and responding to me and being himself. I undressed him, looked him over, checked out his limbs, etc.; everything seemed okay. I called Kirsten and then the “after hours” number/nurse line for his doctor, and it seemed okay not to go into the ER but to watch him instead for signs of any brain trauma, etc. I had a hard time getting him settled for bed (couldn’t give him milk yet), and not long after he finally puked a little bit; so I decided to take him in to the ER (at the hospital where Kirsten works and was working that night)  just to be safe. They were busy, but they saw him relatively quickly and concurred that “we got away with this one,” as the doctor put it. Relieved, we went back home after seeing Kirsten for a minute as she was able to get away from her floor to come down and see us.

After all that drama we decided to just lay low this morning rather than get up early and drive a half hour for Samuel’s race. Some not-very-often-had donuts and a viewing of “American Tail 2” took Samuel’s mind off missing the race pretty quickly. As I alluded, though, I feel terribly guilty and responsible for what happened. I feel responsible, because I am. I’m the parent, the adult; I should have predicted what would happen and known that we had crossed that line where the door had to be locked at all times now. I, especially, should have been aware of what was happening. I, the just-officially-diagnosed PTSD sufferer with hypervigilance as one of the hallmark symptoms I experience, should have sensed the danger and acted to stop it. So I, especially, feel all that much more guilty. Thank God, Nathan seems fine. I’m not so sure when I will be, though.

Darkness…or What I Thought About During “Church” Yesterday

My wife wants me to take drugs….for depression. She may be right, of course. I was famously told by a therapist that I’ve been “mildly depressed for fifteen years,” and that was eight years ago.

I wrote the above over a week ago. Since then I started seeing a counselor again, which I knew (and was told) that I needed to do. I may have been depressed now for over 20 years (and, I would wager, for quite a bit longer than that), but the depression and anxiety I struggle with on a daily basis are related to the other elephant in the room….which I’ve also suspected for some time- PTSD. Well, now apparently I can suspect it no longer, as I have an official PTSD diagnosis. It may be an insurance/billing contrivance, but a professional thinks enough of it to recommend ongoing treatment. Not insignificantly, I don’t doubt the truth of it. I’ve long been “stuck” in a hyperaroused state, and my “baseline” for what it takes to send me over the edge in anger has shifted dramatically. To my credit (I’d like to think), it’s controlled well, but the effort is….immense. It’s not just anger either. As I told the therapist this evening, the weight of my own story is increasingly burdensome, not unmanageable just yet, but it feels like it’s getting that way. I used to feel some cathartic relief in telling my story, but no longer. Now, the thought of speaking of my life, of all that I’ve been through, is incredibly daunting. Silence is so very much better. And yet the need to be known, accepted, approved of, and loved has not waned, though the hope of finding/growing in my awareness of those things certainly has.

As for what I thought about during “church” last week, well, suffice it to say it was not uplifting, and I’ll try to say more about it perhaps next time.

Hey, I blogged.

4 Reasons I’m Quitting Facebook

  1. Facebook creates the illusion of community, but it just that- an illusion. It is false community because it is contrived and ghettoized; it isn’t real because I get to control it and only have to see/be seen and interact in ways that I “allow.” I typically choose to follow those personalities and news sources or interests that reinforce my worldview. Likewise, I become “friends” with folks on Facebook that I know or am acquainted with or maybe want to know, but at all times I’m in charge. I may be, and in fact am, FB “friends” with folks from my childhood, for example, who are very different from me (now) ideologically, politically, and so on, but I can control what they see of what I post, and what I see of what they post, etc. Hence, this interaction is in no way “natural.” I get to be the arbiter of what I know and see about the other. That’s not community. That’s pretense in regard to what I let others see about me, and the worst kind of contrivance in regard to what I choose to see/know about others. Moreover, chances are my FB “friends” are engaging in the same kind of pretense in regard to how they present themselves on FB as well. Again, that’s not community. By way of contrast, real community that’s rooted in a place comes with the good and the bad, with ideas and facts that both reinforce my worldview and challenge it. More importantly perhaps, folks still see my public self, but I can exert far less control and hopefully will exert far less effort at trying to manage their perceptions of me.
  2. Not only does FB create false community, it distracts me from opportunities to be a part of the real thing. I spend far too much time voyeuristically watching the online contrived selves of my “friends,” and not nearly enough time making real friends, or simply loving my family, who are right in front of me. I “peek” at FB on my phone as I’m walking through parking lots, thereby risking life and limb, or while in the car (as a passenger, hopefully), etc. It’s a major time-waster, and I have far too much to do as it is.
  3. Perhaps most importantly, not only does FB create false, contrived community and distract me from the chance to build the real thing, I believe it actually harms relationship. It harms community. When I post something political or theological that others disagree with and they comment about it, or when I comment to express my disagreement with the political or other posts of my “friends,” in almost every case that interaction ends badly. To my knowledge I’ve never convinced a conservative fundagelical to love their neighbor by supporting higher taxes on the 1% so that the social safety net for the “least of these” could be strengthened (see what I did there?). Likewise, I find the statements of my conservative fundagelical “friends” infuriating, and our online arguments accomplish nothing.
  4. Finally, FB reinforces my vanity. My automatic posts about every run or links to my blog are all too often little more than an attempt on my part to generate page hits or elicit comments, and this can serve to link my self-worth to those blog readers or FB comments in an obviously unhealthy way. Sure, for the fitness related posts there’s a measure of accountability that might be offered, but it seldom happens and the negative motives on my part I suspect far outweigh any good that might come. Moreover, desperate for attention and approval though I may be, quite simply it’s time for me to grow up.

I won’t be giving up an online presence altogether, of course. I’ll maintain this blog, and will strive as always to do so more consistently, and I’ll probably stay on Twitter too (I’m @robfredbuck), as I still want to be informed about some things, however ghettoized my choice of sources may be, and Twitter like FB can be a good means for doing so, if used well. Who knows, I may even tweet the occasional inflammatory political thought every now and then.