the wages of a life spent in crisis
September 19, 2013 12:22 PM   Subscribe

"As I thought about that spot, as I considered the mounting reports of suicides, homeless vets, col­lapsing families, I began to get the uneasy feeling that PTSD is a lot like autism: A thing identified, but poorly understood. I read about the supposed symptoms, the heightened alertness, the re-experiencing of specific trauma, the going numb. It was all true. Up to a point." -- Writer and veteran Myke Cole writes about post traumatic stress disorder and how it's portrayed in the media.
posted by MartinWisse (25 comments total) 21 users marked this as a favorite
So PTSD is kind of like... middle age?
Most of us in indus­tri­al­ized western soci­eties live with feeling that we are safe, that our lives are sin­gular, mean­ingful, that we are loved, that we matter. We know intel­lec­tu­ally that this may not be the case, but we don’t feel it.

PTSD is what hap­pens when all that is stripped away. It is the cur­tain pulled back, the deep and the­matic real­iza­tion that life is fun­gible, that death is capri­cious and sudden. That anyone’s life can be snuffed out or worse, ruined, in the space of a few sec­onds. It is the shaking real­iza­tion that love cannot pro­tect you, and even worse, that you cannot pro­tect those you love. It is the final sur­ren­dering of the myth that, if you are decent enough, eth­ical enough, skilled enough, you’ll be spared.
posted by jokeefe at 12:32 PM on September 19, 2013 [5 favorites]

I think even this is a very narrow view of PTSD, limited to a direct warrior-culture military view of the condition. I'm not comfortable with the idea that PTSD is solely the idea that life is short and easily snuffed out - although I do believe that can be an aspect of it, and that PTSD is linked to death or the risk of it.

Mine isn't "My life is short and easily snuffed out and could be meaningless." - not that I am unaware of that, because I am very aware of it but the recurring memories and numbing and heightened awareness isn't linked to thoughts of death. It is linked to thoughts of pain and fear and having to live through the aftermath of those.

My PTSD is tied to a single horrible incident, and after that, years of physical and mental abuse. I feared dying in an abstract way -but mostly I feared it never ending and never letting up, and living with the abuse and that is just as valid.

(I have a diagnosis, I've had several, I would be less acute if I hadn't voluntarily taken on a temporary condition that actively triggers my PTSD right now. )
posted by FritoKAL at 12:44 PM on September 19, 2013 [4 favorites]

I think it's important to look at this in context.

A lot of people with PTSD are unwilling to get treatment for it because they view it as a disease. By viewing it as a "worldview" instead, it's easier to talk about.
posted by corb at 12:52 PM on September 19, 2013 [1 favorite]

Also, this guy is who he is talking about when he says "Cooper Yellow".
posted by corb at 12:53 PM on September 19, 2013

it does seem that he's specifically speaking to a certain type of ptsd, but using overarching language that burrs a little bit to me as an abuse survivor with ptsd. what he describes is very unlike my experience - which puts him in the role that he's putting the charities and stuff - speaking broadly about something that looks different depending on circumstances.
posted by nadawi at 12:58 PM on September 19, 2013 [2 favorites]

PTSD is what hap­pens when all that is stripped away. It is the cur­tain pulled back, the deep and the­matic real­iza­tion that life is fun­gible, that death is capri­cious and sudden. That anyone’s life can be snuffed out or worse, ruined, in the space of a few sec­onds. It is the shaking real­iza­tion that love cannot pro­tect you, and even worse, that you cannot pro­tect those you love. It is the final sur­ren­dering of the myth that, if you are decent enough, eth­ical enough, skilled enough, you’ll be spared.

Is there anyone who doesn't know this? I don't see this as PTSD, I see this as the facts of life.

I would imagine anyone trying to maintain a belief that the above was not the case would find daily life incredibly stressful.

To me, PTSD is when those events of your past continue to fill your mind and crowd out the present. And I am probably wrong.

But the above...them's just the rules. Might as well seek therapy to cope with disliking the sunshine or the rain.
posted by lon_star at 1:01 PM on September 19, 2013 [1 favorite]

By viewing it as a "worldview" instead, it's easier to talk about.

DSM-V has its multiple sober criteria for meeting the diagnosis's requirements, but those can't convey what it does to someone from the inside.
But, in my expe­ri­ence, PTSD doesn’t get fixed. That’s because it was never about getting shot at, or seeing people die. It was never the snap trauma, the quick moment of action that breaks a person. PTSD is the wages of a life spent in crisis, the slow, thematic build that grad­u­ally changes the way the sufferer sees the world. You get boiled by heating the water one degree each hour. By the time you finally succumb, you realize you had no idea it was get­ting hotter.
And that's why it's so hard to get across, even to trained therapists, and why it can be a great comfort to seek out those with similar experiences.

Is there anyone who doesn't know this?

There's a world of difference between comprehending, philosophically, that death can be capri­cious and sudden and experiencing it firsthand in its horror, whether during a firefight, bombing, or rape. That's why DSM-V defines PTSD's stressor as either "direct exposure" or "repeated or extreme indirect exposure" to "death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence".
posted by Doktor Zed at 1:11 PM on September 19, 2013 [7 favorites]

Thanks for posting this. I'm not a combat veteran by any means, but this is pretty much it, exactly:
PTSD is the wages of a life spent in crisis, the slow, the­matic build that grad­u­ally changes the way the suf­ferer sees the world.


It is the final sur­ren­dering of the myth that, if you are decent enough, ethical enough, skilled enough, you'll be spared.
Incredibly succinct, incredibly true. Eventually, you completely abandon the notion of ever being able to attain better treatment, safety, or peace, and you start to expect serious danger at every turn. Everything is a threat, every move you make is necessarily in harm's way. The hypervigilance is constant and there is no respite. Having a startle reflex that is so out of whack that it kicks off a scream I can barely stifle whenever someone drops a pen on the floor at work is so exhausting. Running a white noise machine 24/7 helps to drown out some of the smallest stuff, but it doesn't make it go away, and my ears still prick up whenever I can discern any unusual sound. I still have the tendency to make myself small and limp at inopportune times, and when something Actually Bad happens, it gives me a spike of such intense fear that I freeze up and black out for minutes at a time, gasping for air.

From a page on Emotional Survival for Law Enforcement:
The social consequence of a perceptual set of hypervigilance and its consequence of over-interpreting the environment as potentially lethal would be a loss of capacity to discriminate which situations are in themselves genuinely dangerous.
Growing up in an abusive household is a bit like living in a war zone, except you're a kid defending your tiny little zone of bodily autonomy and the adults who are supposed to be taking care of you are the invading army. It turns your perception of actual threats into a funhouse mirror -- things that are truly dangerous are often easily dismissed because everything is dangerous, things that are innocuous seem threatening because, well, everything is dangerous. Fire and fury rain down on you randomly, and there is nothing you can do to protect yourself or predict it because your guardians have power over you in every conceivable way. It's a hell of a thing to learn at any age, in any situation.

Unfortunately, being forced to view every aspect of your environment as a potential threat because you are in a threatening situation much more often is not something that just dissipates once the original threat has evaporated, you've come home after a long day in your inherently traumatic line of employ, you've moved away from or cut off your abusive parents, or you've been returned to ostensible normalcy following an overseas military conflict. It's not something you can reason your way out of, no matter how many times people get frustrated by repeatedly informing you that everything is OK and you shouldn't be worried. No pun intended, but the one-two punch of learned helplessness and trauma reenactment is a bona fide life-ruiner. It's not a matter of cure, it's a matter of mitigation.

I was just going through some old boxes of stuff and happened upon a little treasure trove of my old obsession: a collection of little trinkets, rocks, sticks, and other random effluvia. When all else failed, and I was still unable to ensure my own safety, I resorted to raw superstition. I'd happen upon a pretty leaf or a candy wrapper on an evening following a day when no abuse had occurred and suddenly the tiny object would become imbued with this weird talismanic Otherworldly Very Serious Meaning. In retrospect, it's hilarious and probably a little sad to remember myself as this strange, small human marveling over some random pebble or shiny twist tie just because it happened to be around at a moment I perceived to be fortuitous. Something I still struggle with is truly believing that if I just hold something closely or loosely enough, if I just say or do the right thing when I have it in my grasp, I will be blessed with some sort of power that can prevent bad things from happening. At least until the next round of shit goes down, anyway.

And I wholeheartedly second the notion that PTSD is more of a worldview than a disorder, and as such that it isn't necessarily something that can be fixed. You can adapt to living with it, but it never leaves you. It's probably really tough for people who don't have direct experience with it to imagine what it's like to feel utterly naked, totally defenseless, and under attack at all times -- you don't realize how much your base perception of "safety" is integral to your ability to function on a daily basis until it is forcibly taken from you.
posted by divined by radio at 1:43 PM on September 19, 2013 [52 favorites]

Thank you for that, dbr. I think I understand it better now. Wishing you all the best.
posted by jokeefe at 2:10 PM on September 19, 2013

dbr, I think that's the concept I could never adequately get across to my therapist. She'd say, okay, these mind-patterns and behaviors are learned, you don't have to keep having them. And I'd shake my head, change the subject, resist. I am going to need this again, so many times, because that's how life works.

Yeah. I didn't get mine from combat either, and I had it before I was old enough to bleed. So it goes.
posted by cmyk at 2:17 PM on September 19, 2013 [2 favorites]

Depression is to depressive realism as PTSD is to...what?
posted by Sticherbeast at 2:24 PM on September 19, 2013

This essay reminds me of this:
A man named Flitcraft had left his real-estate-office, in Tacoma, to go to luncheon one day and had never returned. He did not keep and engagement to play golf after four that afternoon, though he had taken the initiative in making the engagement less than half and hour before he went out to luncheon. His wife and children never saw him again.

"He went like that," Spade said, "like a fist when you open your hand."

"Here's what happened to him. Going to luch he passed an office-building that was being put up - just the skeleton. A beam or something fell eight or ten stories down and smacked the sidewalk alongside him. It brushed pretty close to him, but didn't touch him, though a piece of the sidewalk was chipped off and flew up and hit his cheek. It only took a piece of skin off, but he still had the scar when I saw him. He rubbed it with his finger - well, affectionately - when he told me about it. He was scared stiff of course, he said, but he was more shocked than really frightened. He felt like somebody had taken the lid off life and let him look at the works."

Flitcraft had been a good citizen and a good husband and father, not by any outer compulsion, but simply because he was a man most comfortable in step with his surroundings. He had been raised that way. The people he knew were like that. The life he knew was a clean orderly sane responsible affair. Now a falling beam had shown him that life was fundamentally none of these things. He, the good citizen-husband-father, could be wiped out between office and restaurant by the accident of a falling beam. He knew then that men died at haphazard like that, and lived only while blind chance spared them.

It was not, primarily, the injustice of it that disturbed him: he accepted that after the first shock. What disturbed him was the discovery that in sensibly ordering his affairs he had got out of step, and not in step, with life. He said he knew before he had gone twenty feet from the fallen beam that he would never know peace until he had adjusted himself to this new glimpse of life. By tht time he had eaten his luncheon he had found his means of adjustment. Life could be ended for him at random by a falling beam: he would change his life at random by simply going away. He loved his family, he said, as much as he supposed was usual, but he knew he was leaving them adequately provided for, and his love for them was not of the sort that would make absence painful.

He went to Seattle that afternoon," Spade said, "and from there by boat to San Francisco. For a couple of years he wandered around and then drifted back to the Northwest, and settled in Spokane and got married. His second wife didn't look like the first, but they were more alike than they were different. You know, the kind of women that play fair games of golf and bridge and like new salad-recipes. He wasn't sorry for what he had done. It seemed reasonable enough to him. Idon't think he even knew he had settled back naturally in the same groove he had jumped out of in Tacoma. But that the part of it I always liked. He adjusted himself to beams falling, and then no more of them fell, and he adjusted himself to them not falling."
--------- Dashiell Hammett, The Maltese Falcon

But a glance at my post history tells me a lot of things remind me of this.
posted by Diablevert at 2:28 PM on September 19, 2013 [9 favorites]

Reminds me of Thomas Ligotti.

Excerpt from "I Have A Special Plan For This World":
I first learned the facts from a lunatic
In a dark and quiet room that smelled of stale time and space
There are no people
Nothing at all like that
The human phenomenon is but the sum of densely coiled layers of illusion
Each of which winds itself upon the supreme insanity
But there are persons of any kind
When all that can be is mindless mirrors
Laughing and screaming as they parade about
In an endless dream
But when I asked the lunatic what it was
It swore itself within these mirrors
As they marched endlessly in stale time and space
He only looked and smiled
Then he laughed and screamed
And in his black and empty eyes
I saw for a moment as in a mirror
A form the shade of divinity
In flight from it's stale infinity
Of time and space and the worst of all
Of this world dreams
My special plan for the laughter
And the screams
posted by Sticherbeast at 2:33 PM on September 19, 2013

divined by radio, thank you for your illuminating comment. It spoke to me. Wishing you better days ahead.
posted by MonkeyToes at 3:01 PM on September 19, 2013 [1 favorite]

FritoKAL and dbr, thanks so much. Thanks so so much.

My experience with PTSD is similar, connected with a couple of key abandonments from a few years ago. I struggled for so long to let myself put that term on it: being in combat or the victim of physical abuse looked so much worse. It took me so long - shit, is still taking me so long - to wise up to the full meaning of my shrink's frequent refrain that the most important thing that happened to you is far more relevant than the worst thing that happened objectively.

I'm a little bit closer to getting it now, I think. The injury itself, though it may have many many other implications, is not what's most relevant to the experience of PTSD. The experience of PTSD (at least in my experience) is the view that trauma (emotional or physical or both) is right around the corner, all the time. Unfortunately, while DSM still renders PTSD through the prism of particular instigating events, it means semi-covertly treating PTSD in me while calling it something else.

I do not want to diminish one iota from the severity of the pain visited upon some survivors of combat, disaster or abuse. I count my blessings, in many ways, that my PTSD is relatively manageable, perhaps because death did not stare me so directly in the face. Still, I hope calling what I have PTSD, talking about it that way, helps produce some understanding and some solidarity.
posted by Apropos of Something at 3:57 PM on September 19, 2013

Yeah, I think the key insight isn't that PTSD (or, for that matter, depression — which I have more experience with) is a worldview rather than a disorder. The key insight is that PTSD (and for that matter, depression) is a more coherent and complete worldview than the "healthy" ones, a worldview that seems to much better match up with reality on the whole.
posted by You Can't Tip a Buick at 4:00 PM on September 19, 2013 [1 favorite]

An interesting article, thank you. Comments, too. At one point, the author states:

"It isn’t just sol­diers and cops and ER nurses. Life in poverty can bring on PTSD. An abu­sive parent can have the same effect."

Fair enough. But he also talks about a 'world view'. Do the local civilians who survived the trauma and mayhem that was Vietnam or Iraq have a different world view, one that was an antidote to PTSD? What about the Palestinians? The Syrians? Is PTSD culturally specific?
posted by Mister Bijou at 5:32 PM on September 19, 2013

Around 35 years ago, I had an odd experience.

I was in the emergency room, getting my stomach pumped out, and charcoal pumped in, to mitigate the effects of the antidepressant OD that had got me that ambulance ride to the ER in the first place.

At some point before, during or after that procedure (cut me some slack, that was a LONG time ago) I remember I was lying on the gurney, and it was as if someone had pulled back a curtain, or pulled off a veil, and it was if I was seeing life clearly for the first time. And not in a good way. The only way I could explain it would be it felt like an atmosphere of death. As if all the good things, all the routine things, all the normal things had absolutely no meaning whatsoever, and all there was was me, and the empty room, and the presence of evil. And it felt like that THAT was the true reality, and the normal life going on around me was some sort of cosmic scam.

I have felt that same feeling only a few times since, almost always, oddly enough, in a hospital location.

Reading the linked essay, it's like someone put words to what was, for me at least, blessedly, a brief experience.

It also explains some of the reactions a family member has to what seems like such casual unimportant things. His childhood was a living hell. He escaped seemingly unscathed and cheerful, but occasionally, something peeps out around the edges.

Thank you for posting this.
posted by St. Alia of the Bunnies at 5:42 PM on September 19, 2013 [4 favorites]

I was just going through some old boxes of stuff and happened upon a little treasure trove of my old obsession: a collection of little trinkets, rocks, sticks, and other random effluvia. When all else failed, and I was still unable to ensure my own safety, I resorted to raw superstition. I'd happen upon a pretty leaf or a candy wrapper on an evening following a day when no abuse had occurred and suddenly the tiny object would become imbued with this weird talismanic Otherworldly Very Serious Meaning. In retrospect, it's hilarious and probably a little sad to remember myself as this strange, small human marveling over some random pebble or shiny twist tie just because it happened to be around at a moment I perceived to be fortuitous.

I've been thinking of this all afternoon.

It seems to me to have been a brave, completely human, and wise thing that you did, picking up those scraps and keeping them close. Something that I'm not sure you couldn't call art. Something that perhaps did keep you safe and alive and brought you, all those years later, here to tell us about it and to help us understand.

So thanks again. Today I learned about a child who tried to keep fear at bay using fragments of the world collected when the world was right. I won't soon forget it.
posted by jokeefe at 6:29 PM on September 19, 2013 [9 favorites]

PTSD is not about what happened, it's about what it means.

PTSD is not an attitude problem.

It's not about what you feel so much as why you feel that way, not so much about what you think as about why you keep thinking it.

PTSD ... you don't get it from a single traumatic experience. You get when the experiences create a change in your body chemistry. It may be a little like some sort of autism, I can't say for sure, but that seems like a way to look at it.

Here's what I mean by that: you learn to feel fear when you hear the lion roar. Then, later, you learn to fear the lion. Then, later, you feel fear when you think of the lion. You have created a feedback loop. The lion doesn't cause your fear. Fear is the result of a series of chemicals being released into your bloodstream.

PTSD represents a sea change in the way your body chemistry works. Everybody knows he'll eventually die, but most of us don't spend a lot of time worrying about it. Not all PTSD sufferers have issues with mortality. In fact, I believe that those of us who've leaned over the edge of the Pit and looked into the Abyss don't worry as much about it as others who keep denying the idea of a personal death. But death is something to obsess on. But not the only thing Sometimes you keep thinking about a dog you saw, and it makes you cry. Sometimes you have obsessive dreams--same theme night after night. Sometimes you get gaps in your memory. Sometimes you can't feel normal emotions, only those that rise in intensity to the point of mania. More often, though, you are flat, and need to create a context before you let yourself respond to something. More about that later.

The point is that most PTSD folks could check of most of the ten-point items on the "Do You Have This Shit" list, but their particular brands of Hell of unique to each of them. This is harder to explain than it ought to be. I don't get flashbacks, for example, and I don't ever hallucinate. I never saw VC hiding behind the couch. I stopped dreaming about being killed the day I left Vietnam. I'll cover my symptoms here with the statement that they involved memory issues and problems with relationships. Oh, and a propensity to put myself in dire situations--this includes a willingness to do mortal injury to someone under the right circumstances. There's more, but I can link them all to the way my emotional profile described the world to me.

So it wasn't just an attitude problem. I suppose world view suggests the way it worked, but that's pretty general. Although I agree that PTSD isn't something that can be cured, I believe it can be modified. The key resides in the way your body produces emotions. I believe that if you can rewire your emotional referents you can relieve yourself of some of the inappropriate responses you have to deal with. The problem is, nobody really knows how to do that. Some tactics aimed at desensitization seems to have an effect, but the effect isn't predicable, and it sometimes creates other issues. Some of us can get a handle on it by creating a "normal" context, and learning to savor it. I can't vouch for this as a general tactic, but in my case I have learned to cope with certain things that seemed to be problems for me in the past. Mostly I feel like a poser, pretending to be normal and all that. I can frankly say that, well, I'm still like that, but I've gained a few chops in the meantime, so being like that isn't all I'm about.

We are a stew. Nobody knows what all the secret ingredients are.

Also, some folks put a lid on the more obvious symptoms, and don't run into a wall with them for decades after their wires have been crossed. Nobody knows why.

One thing the writer got right was that the imagery of "combat" PTSD is terribly misleading. Another thing most people get wrong is that you can get PTSD from getting in a firefight or watching your friends--or, I hasten to add, anyone else--get killed. This event may work as a pivot or trigger, but it's not in itself a cause of anything in particular. Everyone comes out of a firefight with a different version of how it felt. Most of the time exhilaration is the prime feature of something like this. Ask any grunt. Okay, fear, too. But anytime you and your buds turn your guns on the enemy and come out alive, you are pumped. I'm going to notice, here, that the reaction to a friend's death is more complicated than I want to deal with in this comment.

This goes back to the most important principle behind PTSD: it ain't what happened as much as what it means. Your interpretation of the world is part of the equation, but the way you feel about your world's "facts" has been chemically scrambled. After a while, your efforts to tidy up the paradigm puts you into your own, unique, somewhat skewed, version of reality. More broadly, you aren't any different than anyone else, you just have your own referents to work with, so you no longer share the same wallpaper your bros from high school have.

You can relate to other veterans, but not all of the other veterans. Some of us feel more comfortable around others who've stalked and found the elephant. I suspect that PTSD sufferers who've had serious childhood abuse would feel similarly in that respect.
posted by mule98J at 10:27 AM on September 20, 2013 [3 favorites]

After years of working through issues the major remnant of my PTSD is that my autonomic nervous system is set on high.

This isn't going to change. There are drugs I can take (the same set that is used for epilepsy) to calm things down, but nobody knows how to set the switch back to "normal".

There are still times when I'm hypervigilant, but it's nothing to do with a fear of death. It's because being surprised causes a myoclonic seizure -- in layman's terms I jump through the roof 1 -- and that sucks.

Looking back it is interesting to me how many conclusions I arrived at that were based on the fact that I was jumpy. If the world wasn't a dangerous place, why would I be so nervous? If I liked people, why did I avoid any place with more than 4 or 5 of them? If I were a strong and competent man, why did I jump at shadows?

There was quite a lot of other stuff going on of course, but in any case to treat PTSD as just a worldview or emotional state and downplay the very real physical changes that can occur is probably a mistake.

1 An interesting side effect of this being the autonomic nervous system is that I have no memory of ever jumping. I know that my body is in a different position and that my adrenaline is pumping but I never actually witness it happening. Indeed due to the fact that I react before any thought takes place I can legitimately claim to be reacting precognitively. :-)
posted by Tell Me No Lies at 9:56 PM on September 20, 2013 [3 favorites]

His distinction that PTSD is a world-view, and not a disease, may actually be too narrow. I'd be willing to bet almost all mental illness is actually a dysfunctional worldview. It can only be handled in certain ways - cropping, adjustments to hue, intensity, and saturation, to further the imaging paradigm. It can't be erased or replaced.

You get blank film at birth (or near to it). You add images to it. You can partially overwrite some of them, but with less-than-full opacity: the underlying image is always still there. Life events tweak your settings. And drugs, therapy, and self-work can do the same.

You'll never erase images. You'll never get fresh film. You can't have mistaken world views ("I'm horrible and nobody loves me."/"I'm ugly"/"Women will hurt me, just like Mom did") removed. You can only work to change their influence on your world view.

Anyway, that paradigm really makes sense to me. My anxiety disorder is a life sentence, not a treatable infection. I have to deal with its effects on my outlook, today, and 20 years in the future.
posted by IAmBroom at 9:56 AM on September 21, 2013

Actually, IAmBroom, that might not be ENTIRELY accurate. I have been involved with -and a recipient of-particular types of Christian prayer ministries that have really helped to, shall we say, refresh the film. And I have seen it help others as well, including people I am very close to.

That having been said, there is more than a kernel of truth in what you said.
posted by St. Alia of the Bunnies at 10:52 AM on September 21, 2013

I'm somewhat surprised that people are taking on (metaphorical) faith the idea that the accurate worldview is that of the functional, ordered mind. Despite how I'm saying this in a relatively flip tone, it seems to me more or less self-evident that life itself is by its very nature, well, mad. Functional behavior, the type produced by a non-traumatized mind, looks on its surface to be a sign of a worldview that is, deep down, out of sync with reality.
posted by You Can't Tip a Buick at 8:27 PM on October 4, 2013 [1 favorite]

You Can't Tip a Buick, it may not be your intention, but the implication I get from your comment is that "mentally ill" people are the ones in-sync with reality.

That's not true, either. No human is perfectly logical; every worldview is colored heavily by experience-based judgments and expectations.
posted by IAmBroom at 3:19 PM on October 5, 2013

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