Tag: ptsd

From Quora: Is there a way to make yourself immune to PTSD?

I wrote the following in response to a question on Quora.

Although all of the reasons PTSD develops are not understood, the first thing to keep in mind is that it is a spectrum. For many people it is usually mild and manageable, although it can become quite uncomfortable (or just tiresome) when it is triggered. Realize that hundreds of thousands of public safety workers, who don’t fit any of your categories, live and work with PTSD. Many go though most of their days without giving it a thought.

One of the strong correlations to PTSD risk is how much REM sleep you get. A person who isn’t getting good REM sleep, due to sleep apnea, alcohol or drug use, or anything else that prevents them from dropping into that deeper sleep, is at higher risk. The theory is that our brains consolidate memories during REM sleep, so that we we essentially forget the emotions along with the event. (PTSD is sort of like “remembering” – or re-living – the emotions separately from the event.) There is a good argument that energy drinks and other substances that improve memory also can increase your risk, simply because they improve your memories of the bad event.

It is a mistake to decide if you “should” have a post-traumatic stress injury, based on what happened. “Should” is a word to get rid of in this context. What matters is how you reacted. I meet with people who witnessed or experienced terrible things, but they don’t have a strong reaction – they didn’t feel particularly helpless or out of control. They may not need any intervention at all, even though the incident would have been traumatic for many other people. But the converse is true – a person can experience extreme feelings of helplessness and out-of-control from a seemingly “minor” event and have a significant post-traumatic stress injury. Although those events usually involve loss of life or the threat of it, serious injury, etc. , the common factor is the reaction, not what happened.

There is absolutely nothing in the news article that would indicate whether or not someone involved might be at risk for PTSD. Again, the facts of what happened are not very important; your perception of what happened, along with physiological factors and what else you may have experienced previously (prior trauma can set you up for a more serious injury) all contribute.

I often invite people in your position to say this to themselves: “My stress is the worst stress because it is MY stress.” Comparing yourself to others – especially based only on the facts – is always a mistake (“No comparison stress shopping.”)

Be gentle with yourself. Be as gentle with yourself as you would be with a friend who had the same reactions.

I doubt there is any guaranteed way to become immune to PTSD, but if you aren’t getting good REM sleep and can make changes to do so, that almost certainly will help. Social support has also been shown to correlate to reducing the impact of traumatic events. Connecting with your body and nature – things like meditation, yoga, hiking – also help to activate the part of your nervous system that tells your “fight or flight” response that it is safe to de-activate. Spirituality, in the sense of having bigger-than-self values, also seems to help.

Stress doesn’t have to be toxic. Kelly McGonigal (“The Upside of Stress”) gives a good summary of this in her TED Talk. Watch to the very end, where she gives a great bit of advice: “Chasing meaning is better for your health than trying to avoid discomfort.”

Article: How One Paramedic is Recovering from PTSD

The Journal of Emergency Medical Services has published the PTSD recovery story of Benjamin Vernon, a paramedic/firefighter in San Diego. Vernon and his partner who was knifed by a bystander during an ordinary call. He describes the attack, recovery and the nightmares – a word he says isn’t strong enough – that followed. Unfortunately, the therapist he saw had never treated a firefighter or a victim of workplace violence.

“On the fifth day, I finally understood suicide,” Vernon writes.

The story ends well – he finds a competent therapist (whom he’s still seeing weekly) and receives EMDR (Eye Movement Desensitization and Reprocessing), which he describes as “the coolest Voodoo.” (It’s also sometimes called “FM” for “F%&#ing Magic.”

Retreat to move forward

For almost 25 years, I’ve helped put on spiritual retreats (the Walk to Emmaus) that focus on renewal – building up leaders and potential leaders, rekindling passion for their values and beliefs. I recently participated in a different kind of retreat. WCPR‘s goal is to help first responders find their way again in the aftermath of high-stress events or careers.

The starting point for attendees at these retreats are different – Emmaus retreats are for building people up from a foundation, while WCPR is focused on healing after psychological injury. WCPR is run by public safety peers and therapists, often with a chaplain present; Emmaus retreats are run by lay people and ordained clergy.

The activities are more similar than I might have expected. Not surprisingly, both kinds of retreat feature great food and fellowship.  There’s a lot of education – Emmaus is essentially a short course in Christianity, with a lot of kindness and love; WCPR is a short course on living with post-traumatic stress, also with much kindness and love. Both give the attendees a safe place to talk about the toughest parts of their lives, along with symbolic steps to let go of old hurts and habits.  In both cases, some of the weekend’s safety and support come from being among strangers who have been through similar circumstances.

Betrayal and forgiveness are common themes of injury and healing at both retreats. Betrayal is a deeply spiritual issue, I realized at WCPR.  A Darwinist view – survival of the fittest, no room for spiritual issues – says that there’s nothing wrong with betraying others if you can get away with it. Nothing personal, just competition! Or, to use a more popular reference – in Star Trek VI: The Undiscovered Country, Mr. Spock, basing his decision on Vulcan logic, had no problem betraying Captain Kirk to volunteer the crew for a peace mission to the Klingons. (Okay, no more Star Trek; back to forgiveness.)

At WCPR, I was introduced to Dr. Fred Luskin’s excellent book, Forgive for Good: A Proven Prescription for Health and Happiness. Luskin describes how we can lose ourselves in shoulds and should nots (my words) – things that should not have happened, but did, or things that should have happened, but did not. When these things are beyond our control, Luskin calls them “unenforceable rules.” They have the power to make us miserable. For example, one of my unenforceable rules was that rescuers should not make mistakes that kill the people they are supposed to be rescuing. Yet that happened right in front of me once and it haunted me for a long time. A common one, not just for responders, is “children should not suffer or die.”

One of Luskin’s guidelines is to separate what is personal from what is not. Rescuers make mistakes every day and some of them are fatal – it’s not personal when it happens on your shift. Children die every day; in that sense, it’s not personal when your child dies. When another person betrays your trust, it feels terribly personal, yet in reality such behavior is almost entirely their issue (they treat everyone that way) rather than about you. That difficult co-worker may have had a rough upbringing – “If they were raised by wolves, they’re going to bite” is a reminder not to take others’ bad behavior personally.

Luskin presents the idea of a “grievance story,,” which I found enlightening because I’ve always believed in the power of stories to transform and redefine experiences, lives and even entire communities. Narrative is powerful – but Luskin points out that we can become stuck in a negative one, which he calls a grievance story. His methods for processing a grievance story – forgiveness – are relatively simple. Sometimes telling your story doesn’t bring healing or growth.

He argues that forgiveness is something we do entirely for our own well-being, not for the sake of the person who hurt us. He separates the idea of forgiveness from any requirement to repair a relationship that has been broken by abuse or other betrayal. This is food for thought relative to the central role that forgiveness plays in Christian theology. “Forgive us as we forgive others,” is perhaps the most challenging line in Christianity’s most central prayer.

I don’t think that Luskin is talking about exactly the same thing as the Lord’s Prayer. The prayer is entirely in a plural voice, while Luskin’s approach focuses entirely on individuals. At the same time, Luskin expresses great hope that his methods will bring about greater peace in troubled communities – he has developed and tested his approach with people deeply impacted by violence in Northern Ireland.

The Lord’s Prayer is often translated as “Forgive us our sins as we forgive those who sin against us.” Luskin is a psychologist, not a theologian or pastor, so sin isn’t his topic. It is a loaded word, sometimes referring to particular actions, but its deeper meaning is to be disconnected from God, to be outside of God’s will. Forgiveness then is re-connection. Applying that thinking to Luskin’s work, I find myself wondering what kind of re-connection is happening in his process. The trivially easy answer is that Luskin is talking about re-connection to life. When we are consumed by how we were wronged by parents, lovers, business partners or others who have the power to betray our trust, we’re often stuck, unable to enjoy much of anything. Christianity at its best is an invitation to life – not the moral code it is often misrepresented to be. Luskin, though secular, clearly recognizes that we are not fully living when as long as we are carrying a grievance story.

Forgiving is a letting go, always a kind of surrender. Retreats can create a safe place in which to let go, to surrender the need to be in control of everything, to see others and be seen for who we really are, warts and all. In that safe place, people often gain great insights into themselves. The best retreats also help them figure out what actions to take in response to the new insights – how to move forward from the retreat.


How to protect sleep-deprived EMS personnel

EMS1 published an article yesterday, “How to protect sleep-deprived EMS personnel,” in which the main point is the danger of driving home while sleep deprived.

Sleep is also essential for processing traumatic incidents. REM (rapid eye movement) sleep is when our brains put them to rest. Anything that interferes – lack of sleep, alcohol, some medications, sleep apnea – makes it harder to process the day’s emotions. Poor sleep sets you up for post-traumatic stress disorder.