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A new approach to understanding PTSD as a form of grief rather than a medical disorder
Have you ever felt that something essential was missing from your post-traumatic stress disorder (PTSD) treatment options? If you suffer from PTSD, you know the problem is complex, but what you probably don’t know—and what the medical establishment isn’t telling you—is that post-traumatic stress is not fundamentally a medical disorder but rather a form of grief. Your body, mind, and soul experienced tremendous loss, and to fully integrate the many losses into your ongoing life, you must explore and express your necessary grief. In other words, you must mourn. This groundbreaking book reveals a new approach to understanding PTSD and its debilitating symptoms. With compassion and insight, it affirms the nature and severity of your experience while providing you with a step-by-step plan to transcend it. A full review of traditional medical treatments for PTSD are presented and included as part of the healing plan. Whether your PTSD is severe or more subtle, whether your traumatic experience was recent or in the distant past, this book unlocks the secret that will finally allow you to once again live and love fully.
|Publisher:||Companion Press CO|
|Product dimensions:||6.00(w) x 8.90(h) x 0.50(d)|
About the Author
Alan D. Wolfelt, PhD, is a speaker, a grief counselor, and the director of the Center for Loss and Life Transition. He is the author of numerous books, including Companioning the Bereaved, Companioning the Grieving Child, Healing Your Traumatized Heart, and Understanding Your Grief, among many other bestselling titles on healing in grief. He lives in Fort Collins, Colorado.
Read an Excerpt
The PTSD Solution
The Truth About Your Symptoms and How to Heal
By Alan D. Wolfelt
Center for Loss and Life TransitionCopyright © 2015 Alan D. Wolfelt, Ph.D.
All rights reserved.
This book and the thinking it contains about post-traumatic stress are probably different than what you've heard before. The reason they're different has to do with my belief in asking '"What if?"
Here are the main "What if?" questions that form the foundation of this book. Please join me in asking and attempting to answer them.
"If there is something to gain and nothing to lose by asking, by all means, ask."
— W. Clement Stone
What if you do not have an illness or disorder but instead an injury?
Post-traumatic stress is commonly diagnosed as an illness, disease, or disorder. Let's think about those terms for a moment. An illness or disease is an intrinsic, internal going-awry. It is a malfunction within us. The word "disorder" describes a similar internal flaw or impairment but is often applied to mental, or brain, health.
An injury, on the other hand, is the result of an external blow. When we are injured, something physically and often violently happens to us. Injury is the effect of an outside action.
"I want to show that the dividing lines between sanity and mental illness have been drawn in the wrong place."
— Anthony Storr
When we experience a traumatic event, something significant and often sudden, violent, and horrible outside our control happens to us. When it happens, we sustain an injury. We might be bodily injured, of course, but even when we are not, our psyches are injured in a way that creates often severe physical, cognitive, emotional, social, and spiritual symptoms.
Traumatic events injure us. They do not make us sick or ill.
But wait. Why does the distinction between illness and injury I am trying to make matter in the first place? The chief reason is that the terms "illness," "disease," and "disorder" carry a stigma. When someone has heart disease or cancer, for example, we tend to place, consciously or unconsciously, a degree of blame on the sick person. After all, he might have done something that contributed to or made him more susceptible to the illness. While this rationale is occasionally true, it's often untrue. And so, while our tendency to stigmatize illness is also unfortunate and also needs to change, let's call traumatic stress what it is — an injury — as part of our effort to de-stigmatize it.
TRAUMATIC BRAIN INJURY
Many military veterans as well as people who have experienced violent accidents and natural disasters have PTSD and traumatic brain injuries (TBI). In other words, in addition to a psychic injury to the brain, heart, and soul, this subset of people with PTSD has also suffered a physical injury to the brain, which compounds common PTSD symptoms and also creates additional symptoms. If you have a TBI in addition to post-traumatic stress, you need and deserve well-coordinated care among medical and mental health caregivers. You will need extra care and compassion, including self-compassion.
Mental health illnesses, in particular, suffer from stigmatization. We tend to blame people for their own mental illnesses, as if they somehow should be more capable of controlling them than illnesses that occur from the neck down. Again, this thinking is antiquated and harmful and, thank goodness, oh-so-slowly changing. But in the meantime, because PTSD falls into the mental health category and is in the DSM, under the oversight of psychiatrists instead of general physicians, when we think of PTSD as an illness, its stigma is multiplied. What if we instead were to think of it as a sort of brain injury? Doesn't that immediately make it a more sympathetic condition, one deserving of everyone's compassion and patience? I believe it does.
What's more, the terms "disorder," "disease," and "illness" can seem more permanent than "injury." Many diseases are incurable or chronic, right? Disorders are often forever. The concept of injury, on the other hand, implies that the symptoms are something that, with appropriate attention, can and will heal. The idea of injury is essentially more hopeful.
"The struggle you're in today is developing the strength you need for tomorrow. Don't give up."
— Robert Tew
You may be one of the millions of people worldwide to have been formally diagnosed with PTSD. If you were, you were probably told you have an illness or disorder. This categorization and the stigma that comes with it may well have made you feel a sense of shame. If so, I would like you to take off the cloak of shame and throw it away. You are not sick; you were injured. It is not your fault. You did nothing wrong. Now try on the injury understanding instead. You were and are injured. How does it make you feel to know that you are injured instead of ill?
I count myself among the people now calling for the "D" to be dropped from PTSD. It is not a disorder. It is a normal and natural response to a serious injury. While I will occasionally use the acronym PTSD in the remainder of this book, I do so only because we are all familiar with it and because at times it works as the best, most expedient shorthand.
What if your symptoms are normal and necessary responses to this injury?
When you are injured physically, your body's response to the injury depends on the severity of the injury.
If you accidentally bump into a wall, you might say "Ow!" and later notice a small bruise, but that will be the extent of it. Yet if you are badly injured in a car accident, you may be rushed to the emergency room by an ambulance, undergo surgery, and spend weeks recuperating in the hospital, followed by months of physical therapy, pain management, and other treatments.
"We're getting rid of the D. PTS is an injury; it's not a disorder. The problem is when you call it a disorder, [people] don't think they can be treated."
— George W. Bush
The same pattern holds true for psychic injuries. Your response to the injury will depend on its severity.
We suffer psychic injuries all the time, but most of them are relatively mild. Remember, we have said that injuries are caused by external factors. An example of a mild psychic injury might be an unkind remark by a friend or family member. Another might be the sudden (but not life-threatening) illness of a child or news of a dear neighbor's impending move to another part of town.
All of these things may "hurt" us, if only for a moment or a day or two. We feel a twinge of sadness, panic, concern, fear, regret, despair, and/or other painful emotions. And then typically we incorporate these everyday injuries into our understanding of how life works and we move forward.
But sometimes we experience more profound psychic injuries. A spouse says she no longer loves us and wants a divorce. We are fired from a job we like or need — a job that may also form the lion's share of our identity. A child estranges himself from us. A loved one dies. The particulars of how we feel inside and how we behave outside after these kinds of blows depend on many factors, but it is safe to say that the more profound the psychic injury, the more extreme our pain, our thoughts, our feelings, and our behaviors.
You suffered a severe psychic injury of a particular kind — one that was likely sudden and violent. And if you believe or have been told that you are suffering from post-traumatic stress, that means your physical, cognitive, emotional, social, and spiritual responses to this injury have been relatively extreme. Your symptoms may have been serious enough that they prevented you from completing essential daily activities and interacting lovingly with others.
A mild injury causes minor symptoms, while an extreme injury causes severe symptoms. This may seem like a ridiculously obvious claim, but it's one that doesn't seem to be fully respected by the current thinking about post-traumatic stress.
The severe symptoms of post-traumatic stress are, I believe, normal and necessary. That is, when they exist, that means they are normal and necessary for the person who experiences them. While they may be painful and frightening, they are not bad. They are not wrong. They simply are. Just as leg pain or internal bleeding or heart-rhythm problems are not "wrong" after a serious car accident, severe post-traumatic stress symptoms are not "wrong" after a severe traumatic experience.
Do you see how your post-traumatic stress can be understood as an extreme reaction caused by an extreme external reality?
Whatever it consists of, your post-traumatic stress is your unique but natural response to a serious injury. We'll talk more later about why your post-traumatic stress might seem more or less severe than that of someone else who experienced a similar trauma, but for now I hope you'll agree to think of your symptoms as a normal and necessary response to the psychic injury you suffered.
"Sanity remains defined simply by the ability to cope with insane conditions."
— Ana Castillo
You are not abnormal. There is nothing inherently "wrong" with you. You are not ill, sick, or diseased. Instead, you are profoundly injured, and you deserve equally profound understanding and care.
What if post-traumatic stress is really a form of grief?
When we hear the word "grief," we tend to think of death. Grief is what we feel after someone we love dies, right? This is true. But this understanding of grief is also far too narrow. Actually, grief is what we think and feel whenever something we value is harmed or taken away.
"Pain is the difference between what is and what I want it to be."
— Spencer Johnson
And so, we grieve after divorce. We grieve when we are diagnosed with cancer. We grieve when our children grow up and move away. We grieve all the time, because life is full of bittersweet transitions and painful losses.
When we experience a traumatic event, we also suffer losses.
What those losses are depends on the circumstances of the event. We may lose someone we care about. We may lose some aspect of our health. We may lose our home or belongings. We may lose our trust in others. We often lose our sense of safety and predictability in the world around us. We often lose, for a time, our ability to think clearly. This is to name just a few of the many, many losses that may affect you (consciously or subconsciously) in the aftermath of a traumatic event.
THINGS WE GRIEVE OVER AFTER A TRAUMATIC EVENT
PRIMARY AND SECONDARY LOSSES
All significant losses create a ripple effect of other losses. When someone I love dies, for example, I lose much more than the physical presence of that person (the primary loss). Depending on the roles that person played in my life, I may also feel that I have lost my history (if the person was a parent or sibling), my financial security (if the person was a financial provider), and/or my sense of immortality (any death).
The traumatic event you experienced may or may not have caused what we think of as a primary loss. During a tornado, for instance, I may lose my house or belongings. Or someone I care about might be injured or even killed. Those would be considered primary losses. But even if those things don't happen to me, if the tornado came near to me or to people I care about, I will still be affected by secondary losses.
Here's a partial list of what I mean by "secondary losses."
LOSS OF SENSE OF SECURITY
- Physical security: Because of the body's fight-or-flight response, people who experience a traumatic event commonly feel physically unsafe.
- Emotional security: Emotions may feel out-of-control. Friends and family who had always provided emotional support may now step away.
- Financial security: The event might have caused costly damage.
Also, post-traumatic stress sufferers whose symptoms prevent them from working may end up with serious money problems.
LOSS OF SELF
- Self: "I feel like part of me got left behind at the traumatic event."
- Identity: Post-traumatic stress sufferers sometimes have to rethink their roles as employees, husbands or wives, mothers or fathers, sons or daughters, best friends, etc.
- Self-confidence: People with post-traumatic stress commonly experience negative self-esteem.
- Health: The physical symptoms of of fight-or-flight or freeze as well as normal grief can create a feeling of physical unwellness.
- Personality: "I just don't feel like myself."
LOSS OF MEANING
- Goals and dreams: Hopes and dreams for the future can be shattered.
- Faith: People who've experienced a traumatic event often question their faith.
- Will/desire to live: People with post-traumatic stress may question their futures. They may ask, "Why go on?"
- Joy: Life's most precious emotion, happiness, is naturally compromised after a traumatic event.
As with all loss, the many losses caused by a traumatic event naturally give rise to grief. We cannot help but grieve after loss. We cannot help but grieve after a traumatic event causes losses in our lives. We automatically grieve. Everything we think and feel inside about the event or as a result of the event, in fact, is our grief. In this book I will talk a lot about grief, and it is this broader understanding of the word "grief" that I ask you to bring to bear on this chapter and all those that follow.
Grief isn't just sadness, by the way. It can also be feelings of shock, denial, disorganization, confusion, anger, fear, and panic. It may be regret and sometimes relief. It's physical pain and social discomfort. It is often disjointed thinking and spiritual despair. It's all of that, mixed up into a soup whose specific ingredients and intensity of flavor change from day to day, week to week, month to month.
Does that soup sound at all like your post-traumatic stress? If so, we might be onto something here.CHAPTER 2
THE GRIEF WE CALL PTSD
If you've been diagnosed with PTSD or care about someone who has, you probably have a solid understanding of what is meant by the term. But to review, the website of the National Center for PTSD, which is a division of the U.S. Department of Veterans Affairs (the VA), defines PTSD in this way:
After a trauma or life-threatening event, it is common to have reactions such as upsetting memories of the event, increased jumpiness, or trouble sleeping. If these reactions do not go away or if they get worse, you may have Posttraumatic Stress Disorder (PTSD).
"PTSD isn't about what's wrong with you. It's about what happened to you."
In its turn, the website of the National Institute of Mental Health (NIMH) offers this explanation of PTSD:
When in danger, it's natural to feel afraid. This fear triggers many split-second changes in the body to prepare to defend against the danger or to avoid it. This 'fight or flight' response is a healthy reaction meant to protect a person from harm. But in post-traumatic stress disorder (PTSD), this reaction is changed or damaged. People who have PTSD may feel stresses or frightened even when they're no longer in danger.
PTSD develops after a terrifying ordeal that involved physical harm or the threat of physical harm. The person who develops PTSD may have been the one who was harmed, the harm may have happened to a loved one, or the person may have witnessed a harmful event that happened to loved ones or strangers.
PTSD happens because horrible things happen to people. PTSD was first brought to public attention in relation to war veterans, but it can result from a variety of traumatic incidents, including (but not limited to) mugging, rape, torture, being kidnapped or held captive, child abuse, car accidents, train wrecks, plane crashes, bombings, or natural disasters such as fires, floods, and earthquakes. (Note that most of these experiences are single events, often short in duration, occurring one time. That is why I will use the term "traumatic event" throughout this book. However, some traumatic experiences, such as sexual abuse or military combat, often occur over a longer period of time and are not single "events." They are really better described as "ongoing traumatic experiences." But for simplicity's sake, when I say "traumatic event," I mean to include both categories.)
MORAL INJURY AND PTSD
In your quest to understand and heal from your post-traumatic stress symptoms, you may have encountered the term "moral injury." Often associated with combat veterans, moral injury is a psychic injury caused by the violation of one's own core moral beliefs. War often forces service members to carry out or participate in actions that deep down they believe are morally wrong, though war is not the only possible arena for moral injury.
Regardless of the how or the why, when people go against their own conscience, even if it seemed the right or only thing to do at the time, they often sustain a deep psychic injury. In the aftermath they typically feel overwhelming guilt, worthlessness, remorse, and despair. They may be depressed and turn to addictive substances or activities for relief. Depending on the source of the moral injury, they may or may not also have the terrible fear-based symptoms associated with PTSD.
I believe that moral injury is also a form of a grief because what violating one's own core beliefs does is create losses. Loss of innocence. Loss of self-esteem. Loss of trust in self and others. It is these and the other very significant losses caused by the morally repugnant event or ongoing situation that gives rise to feelings of guilt, remorse, despair, etcetera.
Excerpted from The PTSD Solution by Alan D. Wolfelt. Copyright © 2015 Alan D. Wolfelt, Ph.D.. Excerpted by permission of Center for Loss and Life Transition.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
You deserve compassionate care 10
You are a whole person 11
The prevalence and history of PTSD 11
It's time to reconsider our thinking about post-traumatic stress 13
Part 1 What If? 15
What if you do not have an illness or disorder but instead an injury? 15
Traumatic brain injury 16
What if your symptoms are normal and necessary responses to this injury? 18
What if post-traumatic stress is really a form of grief? 20
Things we grieve over after a traumatic event: Primary and secondary losses 21
Part 2 The Grief We Call PTSD 25
Moral injury and PTSD 26
Diagnostic criteria for PTSD 27
What is grief? 29
Shock, numbness, denial, and disbelief 29
Disorganization, confusion, searching, and yearning 30
Anxiety, panic, and fear 31
Explosive emotions 31
Guilt and regret 32
Sadness and depression 33
The fear factor 34
Fear in traumatic grief 34
Fear in uncomplicated grief 40
PTSD versus grief 43
Traumatic grief 45
Traumatic grief as a form of complicated grief 47
Care-eliciting symptoms 47
Ten risk factors for complicated grief 49
1 The specific circumstances of the loss 49
2 Your personality, including the ability to understand and access emotions (emotional intelligence) 50
3 In the case of the death of someone loved, your relationship with the person who died 51
4 Your access to and use of support systems 51
5 Your cultural/ethnic background 52
6 Your religious/spiritual/philosophical background and current worldview 52
7 Other stressors in your life 52
8 Your upbringing and unwritten family rules 53
9 Your participation in meaningful rituals 53
10 Losses that tend to be stigmatized 54
What complicated grief can look like 55
Absent or delayed grief 55
Distorted grief 56
Converted grief 56
Chronic grief 58
Part 3 Mourning as "Treatment" 61
First, seek safety and comfort 63
Your grief in action: mourning 64
The six central needs of mourning 66
Mourning Need 1 Acknowledge the reality of what happened as well as the losses it created 66
Mourning Need 2 Feel the pain of the losses 68
Clean pain versus dirty pain 68
Chronic wallowing 71
Mourning Need 3 Remember the event 74
Mourning Need 4 Develop a new self-identity 78
Mourning Need 5 Search for meaning 79
Mourning Need 6 Receive and accept ongoing support from others 82
Finding a good counselor 85
The power of telling your story 86
Medical therapies for PTSD and how and when they support healthy mourning 89
Psychological debriefing 90
Early cognitive-behavioral interventions 90
Short-term cognitive behavioral therapy 91
Complementary therapies for traumatic grief 93
Drug therapy 94
Psychosocial rehabilitation 96
Part 4 What Happens When You Don't Mourn Your Traumatic Grief 99
Symptoms of carried grief 100
Difficulties with trust and intimacy 100
Depression and negative outlook 101
Anxiety and panic attacks 103
Psychic numbing and disconnection 104
Irritability and agitation 104
Substance abuse, addictions, and eating disorders 105
Physical problems, real or imagined 106
Catch-up mourning for traumatic grief 107
A model for catch-up mourning 112
Step 1 Acknowledge carried grief 112
Carried grief self-inventory 114
Step 2 Overcome resistance to do the work 119
Step 3 Actively mourn the carried grief 121
Mourning Need 1 Acknowledge the reality of the loss(es) 123
Mourning Need 2 Feel the pain of the loss(es) 124
Mourning Need 3 Remember the losses and their aftermath 124
Mourning Need 4 Develop a new self-identity 125
Mourning Need 5 Search for meaning 125
Mourning Need 6 Receive and accept ongoing support from others 126
Step 4 Integrate the carried grief 126
Part 5 Believe in Your Capacity to Heal 129
Setting your intention to heal 130
No reward for speed 132
Caring for yourself as you heal 133
The physical realm 134
The cognitive realm 137
The emotional realm 138
The social realm 140
The spiritual realm 143
Reconciling your traumatic grief 147
Closure: a misnomer 149
The transformative nature of grief 149
A Final Word 153