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
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.