Tuesday, August 23, 2005

When Acute Trauma Becomes Chronic PTSD

Symptoms of PTSD – Part Two

We’ve been discussing the physiological and psychological symptoms of acute stress and chronic post-traumatic stress disorder, particularly as they relate to abortion-induced PTSD. The symptoms of autonomic nervous system arousal arise normally to assist us when we are faced with a life-threatening situation. In meeting the tiger last time, I took the response to its most extreme level, and tried to describe the effects of “freezing.” Sometimes people do “faint” in moments of extreme stress, but not often. Dr. Scaer postulates that the human neuropsychological equivalent to the freeze response noted in the animal kingdom is dissociation (Scaer, p. 109).

Psychological dissociation is defined as “a psychological defense mechanism in which specific, anxiety-provoking thoughts, emotions, or physical sensations are separated from the rest of the psyche.” It is characterized by depersonalization, derealization, and psychogenic amnesia, (http://answers.com/topic/dissociation). As a survival mechanism, it probably enables our greater intellectual and problem-solving abilities to be used in our defense to a threat while subduing or separating our thought processes from the emotional responses which may hinder them (even while the emotional responses are necessarily kick-starting the autonomic nervous system response to prepare the body for fight or flight). When I met the fictional tiger on the jungle path, the last thing I needed to do at that moment was cry about my misfortune. Crying would come later. For the moment, dissociating myself from my emotional response was a good coping mechanism.

Having survived the tiger experience, I could return to my village. There, I would form my narrative of the event, using the sensory and emotional memories I had retained. I would probably meet with other villagers who had survived tiger attacks, in what we would call a support group. In so doing, I would be exercising that part of my brain which was traumatized, and I could dissipate the unused autonomic nervous energy with intellectual resolution and social bonding. I would undo the dissociative mechanism by recalling the event and its emotions in a safe setting, with others who would be able to validate my emotional responses by comparing them to their own. Exposure to the memories and emotions of my traumatic experience would, over time, help me to recover by reconnecting my psyche to my emotional responses and sensory perceptions.

But in reality my brush with the tiger was quite different. I had known ahead of time that there were tigers in the jungle and that it was dangerous for me to be walking the path, but I was sixteen years old. That area of my brain which would be able to assess risk-taking behavior had not fully developed. And I wasn’t walking alone. In the jungle, cornered and with no escape, my tiger offered me a deal: “Give me your unborn child, and I’ll let you go back to your walk down the path as if nothing had ever happened. I will even show you the way out. Otherwise, you and your baby will wander lost through this jungle for the rest of your lives. There are other tigers out there who will devour both of you anyway, and lions, and bears, too.”

The tiger wasn’t alone, either. Standing around him in a circle were all of the people in my life upon whom I relied for love, a home, food, and my daily needs. I turned to them to protect me from the tiger, but they were in agreement with him. They pointed out to me that I was the one who had entered the jungle in the first place. As my baby’s father said, “I didn’t want a child right now. That’s why you came to see the tiger, isn’t it? I won’t walk the rest of the way in the jungle with you if you choose to go to another village, have the child, and leave it. I couldn’t live with the thought that my child was walking around out there in another village somewhere. Let the tiger have the child, and we can forget about the whole thing.” I turned to my mother then, believing she, at least, would understand why I didn’t want to give my baby to the tiger. But she said, “Fine. You want to have the baby and give it up for adoption. But I know you, and you won’t go through with that in the end. I won’t lead you out of the jungle, either, so good luck with it on your own.” Then the tiger turned to my family doctor, who told me that many women escaped the tiger this way – it was perfectly acceptable, medically-sanctioned, and everything would be fine.

Alone and threatened with the withdrawal of the supports I needed to live, I acquiesced. I gave the tiger permission to reach into the most private depths of my being and my body with a giant claw. He tore my baby from my womb, and then he tore him to pieces in front of me. Then he kept part of his end of the deal. He let me go back in to the jungle, to continue my walk as if nothing had ever happened. But he couldn’t lead me back to the path, because he had lied, and everyone else left me once the tiger had done what they all wanted him to do. There was no longer a way out of the jungle, because I had sacrificed my child for my own security.

Somehow I made my way back to my village, and instead of finding other tiger survivors to bond with who could share my experience, shame made me hide. I knew there were other women who had sacrificed their children to the tiger who weren’t talking about it, either, for the same reasons. Everyone knew we existed, but very few women would speak of it openly as a personal experience. I wondered why someone didn’t kill that damned tiger, and then I learned that some people felt the lost children were a necessary sacrifice, an unavoidable consequence of women walking alone in the jungle. Many women were deliberately using the tiger to get rid of unwanted and inconvenient children before they were born. But even among those who thought the tiger had a purpose, there was still the idea that child sacrifice was very wrong, and it should only happen on rare occasions. There were a few women who wore t-shirts advertising their relationship to the tiger who wanted the rest to think of infant sacrifice as a good thing for women to do – “Go, find the tiger.” They were the strangest, embracing the beast who brought death and destruction, and calling it “freedom.”

Still others carried pictures of infants who had been torn to pieces by the tiger and protested at the entrance of the jungle against those who were complicit in feeding him on unborn children. There were a few, too few, who offered to escort women through the jungle to keep them and their unborn children safe (but there were more who offered to take women directly to the tiger by the shortest route). I avoided them along with anything else that would remind me of my walk in the jungle, and I avoided the jungle itself. I felt strongly that I should have found another way to escape the tiger. I would never tell anyone what I had done, and I hoped the whole experience would just fade away. I pretended to be fine (even to myself), and I remained dissociated – my sense of self grew more distant from my emotions until I became unable to express them properly at all. Eventually, I developed an almost purely somatic response to my emotional distress, so great was the chasm between my psyche and my experience. In an effort to escape, I would eventually repress most of my tiger memories, until they were no longer accessible to my conscious mind. But my body would suffer the consequences of undissipated emotional nervous energy, because repressed memories are not forgotten. They, and the emotions they produce, live on in my non-declarative memory. Like kindling, they ignite quickly and with intense heat, trying to get the fire going so the trauma will be burned away completely. Unable to sustain a controlled burn, unresolved, the acute trauma grew into the flash fires of chronic post-traumatic stress disorder.

The American Psychiatric Association’s Diagnostic and Statistical Manual (1994), known as DSM-IV, lists the following symptoms of PTSD for psychiatric diagnosis.

“The traumatic event is persistently reexperienced in one (or more) of the following ways:

1. recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions.
2. recurrent distressing dreams of the event.
3. acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated)
4. intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
5. physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.” [The emphasis added here is mine]

The DSM-IV continues:

“Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:

1. efforts to avoid thoughts, feelings, or conversation associated with the trauma [50% of all women who have abortions will never disclose it]
2. efforts to avoid activities, places, or people that arouse recollections of the trauma.
3. inability to recall an important aspect of the trauma.
4. markedly diminished interest or participation in significant activities.
5. feeling of detachment or estrangement from others.
6. restricted range of affect (e.g., unable to have loving feelings)
7. sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

“Persistent symptoms of increased arousal (not present before trauma), as indicated by two (or more) of the following:

1. difficulty staying or falling asleep
2. irritability or outbursts of anger
3. difficulty concentrating
4. hypervigilance
5. exaggerated startle response”

The duration of the symptoms must be for longer than one month. It is referred to as an “acute” response if the duration is less than three months. It is “chronic” if these symptoms endure for more than three months. And it can be referred to as “delayed onset” PTSD if the symptoms do not arise until at least six months after the stressor (all of the above text of the DSM-IV reprinted from MacNair, pp. 4-5).

Am I suggesting that if I had only had someone to talk to, I would have been able to resolve the trauma of sacrificing my child to the tiger? If only it were that simple, but it is not. There is an element to our complicity in killing another human being that complicates our recovery from perpetration-induced traumatic stress. Our evidence for that comes from research into the psychological consequences of sanctioned killing, mostly the kind done by soldiers during wartime. Lt. Col. David Grossman, in his book, On Killing, suggests that “…military training artificially creates depersonalization in soldiers, suppressing empathy and making it easier to kill other human beings,” (http://answers.com/topic/dissociation). Dr. Rachel MacNair also describes Grossman’s work in her book, Perpetration Induced Traumatic Stress: The Psychological Consequences of Killing. She tells us how Grossman “..goes over evidence that the human being has a high resistance to killing….Even under situations of self-preservation, the resistance to killing is strong.” She describes the research that suggests only about 15% - 20% of soldiers prior to the Vietnam conflict ever fired their weapons in combat, and those who did often deliberately aimed high so as not to kill anyone. Based on these findings, the military tried to correct this “problem” by making war training more realistic and teaching soldiers how to depersonalize their human victims. They were successful. In the Vietnam war, 90-95% of the combatants shot their weapons, but there was a high price: “…the same training that ensured greater efficiency in the short term also contributed to greater psychological costs in the long run,” (MacNair, p.3).

Our military showed how we can effectively desensitize people to an innate aversion to killing other human beings. However, in doing so, they also demonstrate the consequences of violating this natural law. We may be able to kill easily. We can walk into the abortion clinic/jungle over and over again, terminating our unborn children as easily as we sit down for coffee. But we come out of the jungle damaged because we were not designed to survive on the blood of the next generation. While Darwin’s theory of evolution is just that, a theory, there are many pieces of it that are observable and measurable in the natural world. One piece is the necessity of reproduction for survival of the species. In the animal kingdom, the primary goal of both males and females is to reproduce and to provide for the next generation, because they must. The species will only survive if there are young to carry on.

Human beings are not like other mammals. Human females have no equivalent to periods of “heat” or estrus, as animals do. We can and do engage in reproductive behavior at will, regardless of fertility, while other mammals go through seasons during which they are compelled to engage in this behavior because it is only at this time that they are able to produce young. In this we see that human beings have a free will. But having the free will to choose does not mean we have the ability to do things that are contrary to our nature and survive them unscathed, and that includes sacrificing our children to the tiger in order to save our own sorry butts.

Monday, August 22, 2005

Dear Anonymous

In response to this post, "More on Graphic Images," which is a continuation of "Is the Picture Worth a Thousand Words?" I received this anonymous comment, and made the reply that follows. I wanted to bring this discussion to the forefront, because there are lives at stake. I encourage discussion, but will not tolerate any attack on my reader.

Anonymous writes:

"I'm a post abortive woman, I had an abortion at 19 and I'm 24 now and I have viewed several sites containing graphic images lately. The fetus in the coffin, the scattered arms and legs, as well as the ole' babies in the trash can. I'm not effected. I'm pregnant now and will have an abortion in two weeks. You have made in error in judgement if you really think these images will have a significant impact. Peta has been showing grisly images of slaugter and cruelty for years. Yet I've seen people who winced viewing video of screaming cattle vomiting blood after having it's throat cut, being skinned alive, and their meat being dragged through feces on it's way to McDonalds go out the next day and slobber all over their Big Mac. If someone really wants that Big Mac or feels they need that abortion, they will still get it."

I replied as follows:

"Dear Anon,

I don't disagree with you at all about the gory pictures. We can become and are desensitized to violent images and violent acts. I hope you will visit to read again, because I will be posting about dissociation this week.

Dissociation is how we separate ourselves from the emotions that are naturally, biologically, and rightly engendered at seeing violence done to fellow members of our species. But it is a very, very poor coping mechanism that leaves us damaged.

You are also correct in that these pictures and words will only work on those who are open to the effect. People will always kill other people because we can't legislate or wish away aberrant and maladaptive behavior.

I saw pictures of aborted fetuses before I had my abortion. And then I saw my real aborted baby, in little baby pieces. It was 1979, and young people were more immature and less exposed to violence, then. You have grown up in a different world, one made more violent by the people in my generation and that of my parents. I am very sorry for that.

I love a good steak, but seeing a cow in the field doesn't make me hungry, and neither would watching it be slaughtered. I'm glad that's someone else's job, though, because people have to eat.

But psychologically that has nothing to do with the death of human infants in the wombs of human women, or pictures of dead human beings. Our brains don't respond the same way, because a dead cow is not intrinsically threatening to our own lives.

I made no judgment that these pictures have a significant impact. I have been told by others that they do. I will never use them or link directly to them. I believe hurting the one to save the ninety-nine is wrong, because as Christians, we are taught in Scripture that the Lord leaves the ninety-nine in order to save the one.

In fact, I personally believe (and my conviction is growing) that if Jesus Christ Himself was standing at the door to an abortion clinic, the LAST thing he would do is shove a picture of a brutally killed infant in my face to keep me from going in [read the post to find out why it would not work and why it is an act of violence against me and others who have the same PTSD triggers]. He would talk to me about positive things instead, like the value of each and every human life.

I have a link at the sidebar to 4-D images of the child in the womb, alive. I don't know how far along you are, but I can tell you researchers say he or she has enough of a neurological system by eight weeks to feel the pain of being aborted. Slaughtered cows are put out of their pain before they are killed. Infants in the womb have no such protection.

You have the legal right to choose to abort your child. That doesn't mean you have to choose it, or that you have to do so in ignorance of the damaging effect it might have on you now, and in the future when you want to keep your children.

A fetal infant is not a Big Mac or a cow. You have new life in you, life that is a part of your own genetic make-up. You and your child are communicating on an autonomic level via hormones. He feels safe. He is exercising his reflexes. He is growing, maturing, and loving the sound of your voice. Your own body and the subconscious part of your brain have welcomed him and made a place where he can grow. So even if you don't want to go on with your pregnancy, you are already his or her mother. It can't be undone, just terminated, and "it" is your child.

Please consider all of the information available to you now that may not have been available to you five years ago. I encourage you to look for scientific explanations, to see what women are learning when they want to carry their pregnancies to term, because those aren't lies or shady truths aimed at making you feel better about your choice to abort. The program, "In the Womb," keeps rerunning on the National Geographic Channel. It is not a political statement. It is a documentary based on physical, measurable, objective evidence of how very much alive the child is and has been from Day One.

My prayers are with you regardless of your choice. Thank you for stopping by and for commenting."

Saturday, August 20, 2005

The Lady and the Tiger

When we left off last time, I said I would attempt to explain the why and how behind the symptoms of post-traumatic stress disorder that I listed in the form of questions. By the way, my answer to each of the questions is, “Yes,” but not deliberately so, as if I chose to list only those things that bother me. It’s a fairly comprehensive list, if short on detail. I just happen to have experience with much of the full range of symptoms. This might be a good way to segue into a disclaimer of sorts: I also seek answers, and I don’t want to be taken as an expert in anything but my own experiences. I write here what I am learning from others, and those references are listed at the sidebar.

Hopefully, I have been gifted with some understanding, which would be due to the fact that I suffer from this, PTSD induced by abortion. I have a B.A. in psychology, and that helps me with the terminology, but it doesn’t qualify me to dispense medical or therapeutic advice, even to my dog. So I encourage every one who suffers to ask the same questions I ask. Please - run these ideas by your doctors or therapists, if you have them. Then come back and tell me where they say I have it wrong, so we can all benefit from greater understanding. (But if he or she won’t tell you why it’s wrong, I’ll give you some direct advice – get another doctor. Don’t waste time on medical professionals who will not give you enough respect and courtesy to at least try to understand.)

Dr. Scaer gives us specifics about the acute stress response, listing all of the hormones that are released, and the neuronal receptors to which they bond and where. It’s quite technical, and I find it difficult to slog through the acronyms and medical terms. So I thought instead to demonstrate how these chronic symptoms arise as normal responses during the acute traumatic experience by going back into the jungle to meet the tiger. As I do, I will describe some of the things my mind and body are experiencing, in every day words. When we understand how the autonomic nervous system response to trauma works normally, it’s easier to recognize how the symptoms of chronic post-traumatic stress disorder arise from its dysfunction. So, here we go.

I’m walking along a narrow path, surrounded by jungle growth, when I see a tiger sunning in a patch of light on the path ahead of me. I recognize him by visual cues – his distinctive coloring and feline appearance say, “tiger,” because I’ve seen pictures, and Wild Kingdom. He resembles my housecat, only he’s much, much bigger. He’s certainly big enough to devour me, and has the teeth to show it, too. I see those as he growls at me. The hair on the back of my neck stands up at the sound, and my mind and body trigger red alert. The tiger is a threat to my existence. Immediately, my body gets ready for what I must do to save myself, doing things that are regulated and controlled by the autonomic nervous system. There’s no time to waste conscious thought on preparing my body to fight or flee in response to this threat. So the autonomic nervous system starts flooding my body with chemical signals that affect each and every system, because each and every system will be involved until the threat has passed. No energy will be wasted on bodily functions that do not contribute to my immediate need for survival.

In the cardiovascular system, my respiration changes. I begin to inhale more than I exhale. This oxygenates my blood more quickly. My heart accordingly starts to beat more rapidly, increasing blood flow. Blood cells in my limbs dilate so the oxygen-rich blood can feed the muscles quickly and efficiently, as the blood cells feeding the non-essential internal organs like the stomach constrict. All digestive activity is turned off, because this is no time to be thinking about what I had for lunch. I can finish digesting that after I get away. I’m also not feeling hunger or satiation, signals regulated by the autonomic nervous system, because feeding isn’t important right now. Saliva is part of the digestive process, so my mouth immediately goes dry. No energy wasted there, either. The muscles in my limbs, neck, back, and waist will tense in preparation for hard use. Even my immune system is on hold for the time being, not working at all against that cold virus I picked up the day before.

Constantly seeking escape from the threat, my eyes are darting to and fro, and my thoughts race as I take in every aspect of my environment. The vestibular system in my brain is on “all systems go,” compensating for my rapid eye movement, and ready for sudden changes in posture. I need to know where I am in relation to my environment. My ears are finely tuned to the slightest sound the tiger may make if he starts to move toward me. My nose is recording his smell, which is also a measure of his proximity. The warm blood rushing into my limbs and a gush of perspiration will cool my body more efficiently during exertion (as blood rushes to the surface of the skin, it release its heat into the air).

Not only am I not digesting lunch, I have also stopped higher brain functions that have nothing to do with my survival. I’m not writing poetry, solving trigonometry problems, or composing music, although there is a funny tune that runs through my head as that part of my brain fades into sleep mode. I’m not contemplating Plato, and how the planets orbit around the sun. I’m not wasting any brain energy recording a narrative of the events as they happen, either, but the sensory input and the emotional responses they engender will be hard-coded in my brain so I can access them again, when I need to later on, if I survive this time.

Sensory input has been processed, and I have determined there are no handy trees to climb or weapons at hand. He is too big, too obviously dangerous and better armed for me to fight bare-handed, so my only option is to flee. As soon as the choice is made, the body reacts. I turn to the side and dart off into the jungle, running at top speed. Adrenaline gives me more strength than I would normally have. My heart and lungs are still working furiously to feed the muscles with oxygenated blood. Endorphins flood through my body killing the pain caused by the scratches of branches, and the pain in my ankle when I take a misstep into a hole. I’ve taken the tiger by surprise – he was lazy and sleepy in the afternoon heat, and fortunately for me, not particularly hungry. My ears are still highly tuned for any sound of pursuit. My eyes are constantly scanning the scene as I zigzag through the heavy greenery. I haven’t chosen a destination, because that would have required some heavy thought, a process that was shut down so it would not slow down the life-saving choices I needed to make. All of my decisions as to which direction to run are being made based on information I have stored previously – I don’t have time to read a map and learn the geography now.

So it’s no surprise when my arms automatically fly out in front of me to stop my slamming headlong into a thicket of bushes climbing a steep cliff wall that blocks my path. I turn, too late, to discover that I’ve run straight into a natural enclosure of jungle growth and boulders that lie at the foot of the cliff. My only way out is to backtrack, but the tiger has not been outrun. He blocks my exit, and I am trapped.

As I stand in the jungle facing the tiger, which while not hungry, has been quite intrigued by my resemblance to prey in flight, my eyes stop darting around looking for escape or a weapon I can use against strength, teeth, and claws. There is nothing – no way over the boulders or up the cliff. No tree limbs to use as a club. I have no recourse but to accept the threat, and my eyes lock on the tiger and approaching death.

At this point the autonomic nervous system may take complete command. There is one more option available to me, but in order for it to work, my conscious thoughts have to be turned off. I have to run silent. Playing dead, or freezing, is my last chance to escape death in the tiger’s jaws.

I lose conscious thought, and crumble to the ground as my muscles relax, losing tone to resemble lifelessness. My senses, previously so acutely attuned, are muffled so I will no longer respond to threatening cues. More endorphins are released, so I will not reflexively move in response to pain. And the reflexes themselves are inhibited for the same reason, to keep me from moving and showing signs of life. The game only works if the tiger believes I am dead, so there must be no sign – even the swallowing reflex is inhibited.

The blood vessels are stimulated to do the reverse of what they have done – they will constrict in the limbs, restricting movement and creating a cold, dead appearance to the tiger’s senses. My respirations slow, and my heart rate falls, so blood pools in the internal organs. This may help save my life if I am injured while I am “out” by keeping me from bleeding to death before I revive. The muscles and reflexes in the urinary and digestive systems also relax, and their contents are released. This happens when creatures die, so it’s an attempt to make the tiger believe through his sensory perceptions that his prey is already dead (and therefore less desirable to eat).

As I crumble to a heap on the ground, the tiger charges in. He reaches out with a massive paw and bats me like toy. His claws dig deep into the flesh of my upper back, but I make no response. I am not consciously aware any longer, and there are endorphins easing the inflamed pain warnings so I don’t even unconsciously twitch. Thankfully, the tiger really isn’t hungry, and isn’t quite sure I was ever edible in the first place. After a few more swipes, he buys into the act, loses interest, and turns to make his way back into the jungle to finish his nap.

Some time later, I stir. Some sensory perception must have remained in order for my body to know when the danger has passed, or freezing wouldn’t be a very useful survival tool. My consciousness snaps back on, and I sit up, immediately as alert as I am aware, and I remember the tiger. I can’t recall much else, except the blurring of green as the jungle rushed by me and the fear. All systems come back on full alert again, muscles constricting, blood richly oxygenating and heart pounding. My eyes dart, my ears perk, my nostrils flare, and I use all of my senses to determine consciously whether the danger has truly passed. As soon as I have assured myself that it has, I start to feel the pain in my shoulder wound where the tiger has clawed me. My ankle hurts now, too, and I notice it for the first time. The endorphins are retreating, and the pain is allowed to give me the signal to get to safety in order to tend my wounds. Somehow, although I will never remember the details, I stagger out of the jungle.

If I was a mouse, or a gazelle, this period of unconsciousness would have been immediately followed by the dissipation of unused energy, called “the freeze discharge:”

“…the animal will arouse and begin to tremble. This may be as imperceptible as a shudder, or as dramatic as a grand mal seizure. In some cases, analyzed by slow motion video, the trembling will resemble the last act of the animal before freezing – the act of running. The animal’s behavior at times seems to resemble an unconscious attempt to complete the act of survival, as if the last protective motor or muscular activity is locked in unconscious procedural memory and needs to be released, or completed, perhaps as a means of ‘discharging’ retained autonomic energy. At the same time, the animal may perspire. This motor and autonomic response may persist for several minutes, and is usually terminated by a series of deep, sighing breaths. The animal at this point will usually arouse fully, regain its feet, often stagger a bit, shake itself, and then run off, apparently none the worse for its life-threatening experience. Long-term observations of such animals do not seem to show any harmful effects on behavior, health, or other measures of survival. It would appear from these observations that animals in the wild possibly possess an instinctual means of dissipating autonomic activity stored and accumulated in the freeze response,” (Scaer, p.18).

But I am a human being, endowed by my Creator with an intellect and free will. I will work out my traumatic experience and dissipate that nervous energy cognitively and socially, with other humans also gifted with intellect. I will have access to the sensory and emotional memories of the event to help me resolve the trauma and discharge the built-up nervous energy by decision, resolution, action, acceptance, and supportive social bonding and interaction with other humans, particularly those who have also escaped the tiger.

In the next segment, we will continue the tiger saga. We will discuss what happens when this trauma is not resolved, and what the consequences are when acute traumatic stress becomes chronic post-traumatic stress disorder.

Thursday, August 18, 2005

Symptoms of PTSD, Part One

Case History – Part One

In “The Body Bears the Burden: Trauma, Dissociation, and Disease,” Dr. Robert Scaer begins with the case history of Beth. Beth was involved in a low-speed motor vehicle accident (5 to 10mph) prior to developing the symptoms that brought her to Dr. Scaer. There was no damage to either car, and the other driver was uninjured.

“Beth, on the other hand, continued to suffer from terrible neck and shoulder pain, numbness of her right arm, disabling headaches, and temporomandibular joint syndrome. Six months of chiropractic treatment and massage therapy brought her only temporary relief from pain, and a dental splint only slightly helped her morning headaches. Recently she developed severe pain in her right hip and buttock, with the pain radiating down the back of her leg. X-rays and MRIs failed to show any cause for her spinal or leg pain.

Since the accident, Beth had also experienced worsening problems of distraction and an inability to concentrate. Her memory was terrible, and she would constantly go somewhere and forget what she had intended to do. She had recently started to drive again, and would travel to some familiar place in town, and on arriving, realize she could not remember how she got there. She would stumble over words, say the wrong word for what she meant, and then feel stupid. She even had developed a stutter whenever she was stressed. She constantly made errors in her checkbook.

Worst of all, since the accident, she had become panicky when traveling in a car, especially as a passenger. Her heart would pound for no reason. She had become edgy and irritable, and jumped at every loud sound. Thoughts and images of the accident kept popping into her mind, producing distraction and anxiety. Although she was able to fall asleep without drugs, she kept waking fully aroused, sometimes with a racing heart, sometimes with dreams of the accident or of being threatened with no means of escape. During the day, she was exhausted by every physical and mental effort, and had dropped out of her master’s program in clinical social work. Her extreme sensitivity to almost any stimulus had resulted in her isolation from almost all of her prior social activities.

She admitted that at times she was worried that she might have a brain tumor. She experienced dizziness when she moved her head too quickly, kept losing her balance and bumping into things, and noticed that her vision blurred whenever she moved her focus from one object to another. Reading caused blurring of vision and a headache,” (Scaer, pp. xvii-xviii).

When Dr. Scaer questioned her about her past traumatic life experiences, he discovered that from the age of six to twelve, her brother, who was seven years older, would come into her room after bedtime at least twice a week, overpower and rape her. Beth entered counseling in college, and thought she had put it all behind her. Her motor vehicle accident was the event that precipitated her symptoms, but it was not what initially caused her nervous system dysfunction, the unresolved flight/fight/freeze response.

Do any of Beth’s problems sound familiar?

What about these?

Do you have frequent urinary tract infections? Painful urination or intercourse? Loss of bladder control or sphincter muscle tension?

Do you have unexplained pelvic pain?

Are you often fatigued or exhausted by comparatively minor activities that others seem to do with greater ease?

Have you designed your workspace, if you are able, so that no one can “sneak up behind you?” Are you easily startled by the “sudden” appearance of another person?

Do loud sounds “hurt,” or make you feel irritable, edgy, or angry?

Do you suffer more than others from the symptoms of premenstrual syndrome?

Do you get frequent headaches?

Do you have digestive problems – alternating constipation and diarrhea – frequent heartburn? Difficulty swallowing? Do you experience frequent dry-mouth?

Do you have problems with your memory (ever forget your own phone number)? Do you stutter, stammer, and search for the right words, especially in stressful situations (job interviews, doctor appointments)? Have you ever experienced, “word spaghetti,” when an archaic or little-used word pops out of your mouth instead of the word you intended to say? Do you often lose your train of thought in mid-sentence?

Does your heart race, or feel as if it’s going to jump out of your chest at times (ka-THUMP)?

Do you have sharp, shooting pain in your limbs that seems to have no source? Does the pain radiate? Do your arms and legs go numb or tingle?

Do you have tender spots that hurt under pressure? Is it hard to find a comfortable position? Do you feel sore and achy when you haven’t changed position for some time? Have you ever experienced “referred pain” – pressure on one part of your back, for example, may feel like pain radiating from your chest?

Does your jaw ache?

Do you have pain in your teeth that is hard to localize, and your dentist can’t find any problems?

Does the surface of your skin go numb in odd, seemingly random places, such as a patch on your upper arm, or do you feel as if you are wearing gloves on your naked hands, or stockings on your bare feet?

Do your hands, especially the palms, redden? Have you ever noticed a red, lattice-work appearance under the skin, sometimes called a “strep rash?”

Do you have any tremors? Muscle spasms or “fluttering?”

Do your tendons hurt for no apparent reason? Do you have joint pain, but no sign of osteoarthritis or injury?

Do you suffer from back aches with no sign of spinal injury?

Are your muscles tired as though you’ve been working out?

Do you have burning sensations in your limbs? Sciatica, or pain that radiates from the buttock down the back of your leg?

Do you have sharp, shooting pain in your chest wall, especially on either side of the sternum?

Do you feel faint when you stand up?

Do you have difficulty breathing (especially exhalation) or symptoms of asthma but normal blood oxygen levels when tested?

Do you feel dizzy (vertigo), as if the world is moving around you while you stand still, or do you perceive that your body is moving as if on a merry-go-round?

Are you clumsy or accident-prone?

Do you miss a lot of work due to flu-like symptoms?

How well do you sleep? Do your dreams often involve falling? Dying? Being pursued? Do they wake you? Are you even able to remember your dreams?

Do any of these problems intensify during times of increased stress? Have you ever looked for a pattern of illness that occurs at about the same time every year, as in, “I get sick every spring – it must be allergies?”

Do you have difficulty telling others (or identifying for yourself) how you feel emotionally?

Do you have an eating disorder – anorexia or bulimia – or obesity?

Do you have a history of psychological or physical trauma, such as sexual abuse, abortion, motor vehicle accidents, surgery, serious illness, slip and fall accidents, physical abuse, assault, or have you been a witness to any traumatic events?

Have you been tested for, diagnosed with and/or treated for, or troubled by any of the following conditions:

Alzheimer’s Disease?
Anxiety disorders?
Alcoholism or other substance abuse?
Chronic Fatigue Syndrome?
Diabetes or hypoglycemia?
Anorexia Nervosa and/or Bulimia?
Hyperparathyroidism and hypothyroidism?
Seizure disorders?
Sleep apnea?
Systemic Lupus Erythematosus?
Multiple Sclerosis?

These are a few of the conditions listed by the University of Maryland as having similar symptoms as Post Traumatic Stress Disorder, which gives us an idea of the systemic (fully-involved) range of physical symptoms that accompany this physioneurosis. It also helps explain why PTSD and many of the illnesses mentioned above are difficult to diagnose.

Dr. Scaer dedicates his book to a professional colleague and friend who taught him that “…the diagnostic truth lies more in the uninterrupted story told in its entirety by the patient than in a dozen diagnostic tests.”

In the next segments I will be discussing more symptoms, pick a few, and then go into an explanation of why and how PTSD causes them. Commentary here would be really helpful - there are so many to choose, that I would like to hear what others are most interested in discussing. After that, we will look at therapy for the disorder. I will warn you that the prognosis is not the greatest - and no, I am not going to sell you a book or a video, either, so read in peace. When I have covered everything I need to cover, I will condense this in a booklet format, and make it available to view, download, and print in .pdf format - free of charge. There isn't much that ticks me off more than buying a book that proposes to help me and finding an advertisement in each chapter for more junk I have to buy before they let me in on their secrets. I've linked to several of my sources at the sidebar. None of these professionals purports to sell you a cure, but they do help us understand what's going on - and that in itself is therapeutic.

When abortion hurts, it hurts permanently. As a medical solution to the temporary condition of unwanted pregnancy, we will discover it's like amputating the leg to relieve an ingrown toenail.

Friday, August 12, 2005

Lightning Crashes

lightning crashes
a new mother cries
this moment she’s been waiting for
the angel opens her eyes
pale, blue-colored iris presents the circle
and puts the glory out to hide, hide.

~ “Lightning Crashes,” Live

Most of us can picture the scene, at least from movies and television if we haven’t actually been there: Mom, newly-delivered, red-faced, sweaty and exhausted, but smiling, cradles her newborn child. The infant’s eyes stare, fixed, back into hers, pupils dilated wide. In normal childbirth, this is what we can expect to witness. These moments of post-natal bonding are brought to us courtesy of various hormones released by the mother, in response to labor, and by the newborn, in response to the signals from his mother’s body.

But in the post-Roe world, Mom has a problem. There’s about a forty-percent chance she has had one or more pregnancies before this one that she chose to end with abortion because the pregnancy and/or the outcome were undesirable at that point in time. This may be all the recall of past stressors that she needs during labor to inhibit the adequate production of oxytocin and the other hormones she needs to protect her from the pain and trauma of childbirth. [Author's Note, 9/27/2005: further research has led me to conclude that the amount of oxytocin may be less significant than where it is utilized in the brain. In rats, the presence of adrenal steroids, released in response to fear and anxiety, increases the ability of oxytocin to bind with its receptors (or be put to use), but mainly in the amygdala. To facilitiate bonding behavior, the endorphinergic, opiate-like rewards of oxytocin must be used by the anterior cingulate, which we have already seen does not activate properly in those with PTSD.]

These are also the biological mechanisms acting on her brain by which she is encouraged to bond with her child. Stress and anxiety inhibit the production of these hormones, which can make childbirth a traumatic event. Environmental triggers will stimulate the sensory memory portion of Mom’s brain, and she may experience all of the anxiety and stress that surrounded the difficult moment(s) in time when pregnancy did not result in birth. And for about one in four post-abortive Moms, these cues are triggers for post-traumatic stress syndrome, and Mom’s stress response to childbirth will be elevated. Her labor may be prolonged because these hormones also facilitate birth in other ways. Prolonged and difficult labor can lead to the use of forceps and other complications that result in birth trauma.

So Mom’s problem isn’t hers alone, and for another very good reason: it is her production of these hormones that stimulates the infant to produce his own endorphins. They protect him from the traumatic pain of birth. They also dilate the infant’s pupils, encourage him to fix his gaze, and stimulate the bonding center in his brain, as well. His fixed stare is thought to attract just the kind of activity we see – long, loving, and bonding looks between mother and child. The lack of a maternal bond has been shown to lead to maladaptive behaviors later in life, such as an increase in criminal behavior, substance abuse, and violence.

But something else happens to the child who doesn’t have the protection of endorphins against the pain of childbirth: Strike one – at birth. Recently, the Veteran’s Administration announced they were going to “audit” the disability claims of some veterans who are suffering from post-traumatic stress disorder. They claim to be doing this in response to the increasing numbers of cases that they are seeing. The VA suspects the condition is being over-diagnosed. I don’t think that’s necessarily accurate. The number of cases has been rising in the last three decades. This can be attributed to the current conflicts, and to a growing awareness of the disorder, but here’s another factor we aren’t considering. We started growing these young men and women in the post-Roe, post-traumatic-stress disorder world.

There are more cases of post-traumatic stress disorder being reported because there are more cases of PTSD to report, especially among our soldiers. These 30-and-unders are the legacy of the Roe decision. Minorities and the poor are over-represented in both our military and our abortion populations. So there’s a good chance our brave soldier’s Mom aborted one or more of his older siblings before they were allowed to reach the outside air alive. Did she produce enough endorphins during labor to prompt his own body’s response to protect him from birth trauma? We don’t know. But we know our traumatic experiences weaken us, may summate, and cause some degree of PTSD. It isn’t unreasonable to at least suspect that our current generation of young soldiers may be more susceptible to the disorder precisely because abortion was legally and widely available to their mothers.

Thursday, August 04, 2005

Yup, It's All In My Head

“Where do we go for help?” was the question posed by two readers who also suffer from post-traumatic stress disorder induced in part by abortion. I say in part, because I recently read in commentary at After Abortion a very good argument against even having a subset disorder known as post-abortion stress disorder (PAS, or PASS). I concurred, so I will no longer use these acronyms. There was no single event in my life that caused PTSD; there were many. Several occurred in childhood and adolescence, when I was most vulnerable to trauma, including my abortion. My symptoms began then, and continued. As in every life, the years brought more strikes, and with each successive strike, my symptoms would worsen with weaker shocks required each time. I believe I have some understanding of kindling theory because I live it.

I admitted I had no answer for the questioners, but promised to discuss the problems. I originally wanted to do so by scolding the medical community for its inadequacies, because I was on the Doctor-Go-Round for many years. I was one of their hard-to-diagnose cases. According to the various general practitioners and specialists I have seen over the years, I could have any number of things: fibromyalgia with an unrelated peripheral neuropathy of unknown origin; multiple sclerosis; lupus; a congenital connective tissue disorder; and, most often, “I don’t know, but something’s not right.” I really wanted to verbally rip to shreds every physician and therapist I have ever seen over the last two decades who missed the PTSD link, dismissed my complaints, misdirected my therapy, over-medicated me, misdiagnosed and underdiagnosed me, and ultimately left me to find my own way in the dark. It would be more graceful, though, and perhaps much more helpful to others, if I explain why I was such a lousy patient. Since I did nothing to help any of these professionals come to the correct conclusions in the first place, it doesn’t seem fair to lay the blame squarely on the medical community – but they are not innocent.

I was always afraid my problems were being dismissed as just in my head. I was right on both counts. My problems were being dismissed and/or misdiagnosed, and they are all in my head. But that didn’t mean they weren’t real. Step one is not to make the mistake in thinking that those who suffer from mental disorders are imagining their physical symptoms, and that the mind and body are separate entities to be treated in different ways. Anti-depressants might be a good example to use in this regard.

In clinically depressed patients, researchers discovered the link between the amount of free-floating serotonin, a neurotransmitter, and the psychological symptoms of depression. With the administration of SSRI’s, serotonin-reuptake-inhibitors that we know by such brand names as Paxil and Prozac, the symptoms of clinical depression may abate. But it is not logical, nor is it proper scientific method, to conclude that it is this chemical imbalance that causes depression. Depression may cause the chemical imbalance in the first place, and what we are doing is observing and treating a physiological sign of a mental disorder. There isn’t a thought that passes through our brains that isn’t accompanied by an electrical signal between neurons. It is very likely that future researchers will find, not a physical cause for mental illness (and bad behavior - ! – coming soon, “The Wages of Sin”), but that mental illness is displayed by measurable physiological dysfunction of the human nervous system, which produces real, not imagined, systemic physical sensations and problems as part of the stress response, and also in response to kindled signals: chronic pain, fever/flushing, digestive disturbances, difficulty swallowing, dry mouth, sensitivity to temperature, vertigo, sensitivity to sound (this is also a dysfunction of the vestibular system, like vertigo), urinary difficulties, inhibition of reflexes, cardiac arrhythmia and postural hypotension, tremor, muscle spasms, paraesthesias (numbness), and more.

I didn’t understand the complexities of the problem for a very long time, and blamed the medical community in general for failing. But I was part of the problem. I have not had a good relationship with any of the physicians I have ever seen, male or female. I have doctor-hopped dreadfully, not seeking medication, which I was either too freely given or flatly (and with prejudice/suspicion) denied, when I had no intent to ever ask; instead, I was seeking an explanation for systemic neurological dysfunction that was measurable, and therefore, real – not merely psychological, as I considered it then. I have been an enigma to at least four neurologists; a rheumatologist (who thinks he knows what it is, but he didn’t have the whole picture); two pulmonologists; an ear-nose-throat-don’t-make-me-spell-it-ologist; a urologist; several cardiologists who didn’t help by looking at me and my test results with alarming alarm; and too many family practitioners to count. Doctor-hopping is not a good idea. But I dreaded every appointment, and disliked almost every one of the physicians I saw even as I plodded on in search of an answer. I argued with them (which was often necessary in order to get permission to stop medications that were making me feel worse). I would not hesitate to butt heads and rudely debate their opinions about things which they knew better than I. Is this due to my own arrogance? Yes, in a strange way. I don’t trust the opinions of others, but not because I love my own so very much. There was one time when the advice I received was quite wrong, and I lost the argument about the choice made on my behalf, for my own good. The decision to abort my child when I was sixteen had been aided by our family physician, someone I trusted. I have no confidence in the ability of others, particularly medical professionals, to make right decisions for me because that trust was once so deeply violated. No, I was not able to handle having an abortion, and I am angry that no one in the position to do so was able to see it. These were adults and professionals. If they didn’t know what was best, who could?

But the problem runs deeper than that, to areas beyond my control. It is also hyper-vigilance, anxiety, and all of the symptoms of PTSD that became an obstacle to proper treatment. I could not find help from medical doctors because every occasion to visit one was triggering a post-traumatic stress response, and no one could see that, either, especially me. Now, here’s a problem to overcome. When I go into a doctor’s office, hospital, emergency room, clinic – it doesn’t matter what kind of medical facility it is – there are always environmental cues that are triggering the emotions of fear, anxiety, horror, guilt, and shame that are associated with my abortion experience. I’m going to close my eyes and try to recall some details from my abortion, and while I do, I will record what my senses remember, those I am able to verbalize, and I won’t over-edit my recollections:

White – everything was white. The blankets, white cotton, woven in a pattern of small squares. The nurse’s white uniform (I prefer people who wear brightly colored and patterned scrubs). The walls were white. The abortionist was all in white, and his hair was white. He was old to me, but I was young then.

Red – the only color I see is red, because everything else is black or gray. I sat up before she took the cart away, and I see how black. No, it can’t be a dissecting tray, I don’t care what it looks like. Long, coiled tubes that should be transparent, clotted with red. Glass jars that should have been used for sun tea, and were not. The nurse’s face was white in contrast, just then, when I sat up too soon. My feet were still in the stirrups. [Ladies, for a moment, assume the stirrup position – what are your legs doing? Our toes are pointed at the ceiling, and the calf muscles from the back of the knee to the back of the ankle are stretched taut. This is a posture that I fight with even when I am “at rest.” And isn’t it an odd coincidence, that I have nerve conduction studies showing dysfunction in the nerves that feed these specific muscles? It brings to mind Dr. Scaer’s description of posturing, when an animal recovering from the freeze response assumes the last physical position and/or activity it was performing just prior to the loss of conscious control. The gazelle, waking up on its side in the grass after the not-so-hungry-after-all lion has left it alone, flails its legs as if running. My toes pull to the ceiling, as if I am in gynecological stirrups, frozen in that moment in time when I reached the utmost state of helplessness and horror, too.]

Examining tables – they are so hard, my rear-end gets cold. The vinyl is also cold. Needle pricks and the niggling discomfort of the IV.

Sounds – the humming of machines and voices, office noises. Phones ringing. The creak of the vinyl of the examining table. Vacuuming with a gurgling sound, like the appliance dentists stick in our mouths to suck out debris and fluid when they are working. No, I don’t like dentist appointments, either. All of the sounds seem to be filtered through ear muffs.

Smells. They are the hardest. [They are known to evoke the strongest emotions, because the sense of smell is processed differently than the input from our other senses. It is a more direct route to the emotional connection made by the amygdala.] Disinfectant. Blood. Cotton.

When I am sitting in an examination room today, for whatever reason, I am fighting the post-traumatic stress response to these and other triggers, because the last straw needed to feed the kindled flames of my post-traumatic stress disorder was delivered by medical professionals in a clinical setting. So much for finding help from physicians. Could I be a better patient now? Possibly, since I understand why I am so emotionally wrought in a doctor’s office. Also, I now know why I never felt as much pain under examination as I do at home – the stress response releases endorphins, natural pain killers that result in the physician’s inability to elicit to its fullest extent the worst of the myofascial and neuropathic pain that I feel.

But what about getting help from a mental health professional? I mentioned my abortion and my anger about it in a group therapy session once many years ago, and the information landed in the room with an audible thud before the group leader changed the subject and moved on. This was an anger-management group to treat my cutting behavior, which did me absolutely no good since it disregarded the source of my anger. The APA refuses to acknowledge the traumatic effects of abortion. What chance do I have of finding a sympathetic ear? I am also not likely to be comfortable with a male therapist because of the gender of my abortionist and the physician who advised abortion. But a female therapist may be an abortion victim herself. If she feels fine, can she validate my own, not-so-fine, feelings? I have great doubts.

So this limits my options. I had thought to seek psychological help from the pro-life community, where many different groups are offering post-abortion counseling. Many of these are based on the group-therapy model that has had good results in PTSD treatment, and which has the victims offering help to each other. Unfortunately, I have trust issues, and the two programs I looked into each let me down in one way or another – in one case, it was the counselor who bailed, as unreliable in her post-abortive state as am I; in the other, it was me – I didn’t feel I could place trust there for some reason I haven’t been able to identify. I have used this as a convenient reason not to pursue professional counseling at this time, and yes, it is clear to me that my efforts in writing about the disorder are certainly an attempt to treat myself for the condition. I don’t recommend it, but it’s all I have at the moment.

Fifty-percent of women who have had one or more abortions will never admit it. It’s not going to be easy for any of us to receive help from the medical community in this regard if we don’t start complaining, loudly. Why should they “believe in” what they have not seen? I don’t go to doctors any more, though, so they aren’t likely to hear from me unless they read this blogspot. I decided nearly three years ago that I was getting off the Doctor-Go-Round, and I did. I have no desire to see any more white blankets, or to experience the smell of disinfectant, or continue filling my system with medications that more often than not make the problem worse. This is not a reasonable and long-term solution, I know. As I said, I have no answers, just problems. There are treatments that are specific for post-traumatic stress disorder, and I will go into those in a future segment. For the moment, I need to recover from the stress of remembering, and the best answer I have found to that is prayer.