A User's Guide to PTSD, Part I: What I Did In The War
This is Part I of a three-part essay on post-traumatic stress disorder: understanding it, having it, writing it.
Part I: What I Did In The War. (Introduction; background; what happens during trauma; what happened to me.)
Part II: What Does A Flashback Feel Like? (My history with PTSD, and what it felt like to me.)
Part III: I Don't Have To Do This Any More. (On recovery; lingering effects; book, film, TV, and music recommendations.)
ETA: Several years later, I added Part IV: Postscript.
You probably all know what PTSD is, in general terms: a mental illness resulting from trauma, often occurring in combat veterans but not limited to them, best-known for causing flashbacks, nightmares, and acute anxiety states. But people who have it often don't realize what's going on or don't seek help, and much of the fiction which deals with it reads as if the authors referred to a checklist of symptoms rather than finding sources from the point of view of someone who actually has it.
That would be my point of view.
Have you ever wondered what it feels like to have a flashback? I can tell you. (It does not typically involve acting out the entire trauma in real time, complete with dialogue and screaming. Vomiting is also not essential, nor even, as far as I know, likely.)
Also, the method I used to recover, more or less, and one of the issues I'm dealing with now, are both things which I have literally never seen addressed anywhere. I shall be very curious to hear if anyone else has had similar experiences.
I'm not a psychologist, and so can only speak from my own idiosyncratic perspective, plus a bit of research and discussion. But if you’re writing a story about someone who has cancer or know someone who does, it’s fine to look up cancer on Wikipedia, but you’ll learn more by going on to talk to a person who’s doing chemotherapy right now. And if you've ever done any interviewing, you know that the shortest route to an interesting response is "What did it feel like?" So I will tell you how it feels: how it feels to me.
Keeping that in mind, I mean this as a public service announcement- if nothing else, I hope that it will improve the depiction of PTSD in fiction, fan- and otherwise, for my own reading enjoyment, and reduce the incidence of gratuitous vomiting- so feel free to link far and wide.
Here's the DSM-IV criteria for PTSD. The DSM-IV is the American manual on diagnosing mental illness. I don’t think it's the be-all and end-all of existence, but it’s more familiar to me than other countries’ criteria, so that's what I'm using.
The single biggest misconception about PTSD is that it either occurs only in soldiers, or that the trauma has to be as monumental and severe as combat or being a civilian in a war zone.
That probably came about because it was first noticed in soldiers, and was originally thought to be unique to them. (It may have had other labels, like “hysteria,” when observed in abused children or raped women.) If one considers the history of which gender was considered important and worthy of attention, and also the logistical problems that arise when you're still fighting a war and large numbers of your soldiers are so mentally disabled that they're unable to fight, you'll see why PTSD was first studied in soldiers, and why for a long time they were the only group who seemed worth studying.
The history of PTSD in soldiers is very well documented but largely beyond the scope of this essay. Just to give you a taste of what's out there, here's Lady Percy's speech about her back-from-the-war husband Hotspur, in Shakespeare's Henry IV Part I: insomnia, nightmares, depression, restricted affect, loss of pleasure in formerly enjoyable activities, exaggerated startle reflex-- it's practically The DSM-IV criteria in iambic pentameter. In Achilles in Vietnam: Combat Trauma and the Undoing of Character
, Jonathan Shay draws parallels from Homer. The earliest name I could find was "soldier's heart" after the Civil War, and it wouldn't surprise me if it got re-named again during my lifetime. I'd be very interested to hear of early reports on it from non-Western countries, if anyone happens to have some references.
It's now known that you can develop PTSD from many types of trauma- rape, child abuse, natural disasters, accidents, on the job as a cop or disaster relief worker or war correspondent, etc. Here's the DSM-IV's criteria of "trauma":
Criterion A: stressor
The person has been exposed to a traumatic event in which both of the following have been present:
1. The person has experienced, witnessed, or been confronted with an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others.
2. The person's response involved intense fear, helplessness, or horror. Note: in children, it may be expressed instead by disorganized or agitated behavior.
I’ve several times come across people who have the symptoms, but don’t think their trauma was significant enough to warrant their reaction, since they weren’t in combat or were only molested and not physically injured or it was a car crash rather than an act of violence. This seems a sufficiently common idea that I suspect that it’s a manifestation of the illness all by itself, possibly a form of survivor’s guilt.
If something traumatic happened to you and you fit the other criteria, you should go to a mental health professional and get yourself evaluated, regardless of whether or not you think your trauma was "good enough."
As a writer, you might consider inflicting PTSD upon your characters who have been through traumas that one does not normally associate with it, such as natural disasters, accidents, or even life-threatening illnesses. They would probably take a long time to figure out what’s wrong with them, and others might not take them seriously once they do realize. There is great and largely untapped potential for fictional angst here.
Why some people develop PTSD and some people don't is complicated, not well understood, and seems to depend more on the nature of the trauma than the nature of the people. But the perception that having PTSD means that you weren't tough enough or you have some kind of character flaw is a big obstacle in admitting that you have it, which is obviously a big obstacle to getting treated.
To analogize, lots of people trip and fall. If they're young and healthy, they'll usually dust themselves off and get up. But sometimes they break bones. Lots of people crash their cars. A larger percentage of those don't dust themselves off. Complex operations of chance, geography, psychology, and physiology determine whether the accident happens at all, whether you were injured, and how bad your injury was, not some shameful faultline in the accident victim's personality.
If you get PTSD, it means you drew the short straw. That's all.
If you're writing about it, however, your characters are likely to not take such a healthy attitude. Especially if they're in some macho occupation like demon hunting or Gundam piloting. This is another great and under-appreciated opportunity for angst: not just the commonly written-about survivor's guilt or more specific guilt over things they actually did during the trauma, but guilt, shame, and denial over being affected by it now.
They may also conceal their symptoms for fear that they will be judged unfit to continue on the job which caused them, or will be disbelieved and disrespected. This may be a completely realistic fear, and is a recurring problem in the military and other organizations in real life.
Conversely, just because your character was in a war does not automatically mean that she will have PTSD! For example, the prevalence in Americans who fought in Vietnam is estimated at 30%. Even if that's underreported, there's still, say, a 50-70% chance that any given Vietnam vet won't have it. That doesn't mean that your character who's been through some trauma was totally unaffected, just that they did not develop a specific mental illness as a result. (They might develop a completely different mental illness!)
Note that certain PTSD symptoms can also be trained into you in a more healthy and non-traumatic way. So a guy who's never been in combat and does not have PTSD could acquire an exaggerated startle response just from going through boot camp, particularly if it's limited to the more survival-oriented areas of being snuck up on or startled while sleeping. A lot of martial arts training may also give you some of the instant-fight responses common in PTSD, though in my experience, that's not something you're going to get by training six hours a week as a civilian. I'd find it plausible if the training had a military or paramilitary slant, though.
I was physically and emotionally abused as a child.
I was raised on a weird commune by negligent parents in a rural town in middle-of-nowhere India, where I was the only foreign child in the whole town. The school was abusive, and the other kids took it out on me. Plus some adult lunatics and sadists took advantage of the obvious fact that my parents were not going to raise more than a verbal protest if anyone did anything to me.
I was bullied, struck, tied up, threatened with weapons, had gangs of kids throw rocks at me literally every time I left the walled compound where I lived (unless I had an adult escort), witnessed other kids being abused and once so seriously injured that I wasn't sure till later that he had survived, was forced to stand in the sun until we collapsed from sunstroke, and a couple times had to grab a weapon and prepare, I thought, to fight for my life. I got in a lot of fights; I frequently had people sneak up on me; I had absolutely no sense that anyone was looking out for me or that there was anything I could do to change what was going on, and I think I was right about that.
I'm being brief because my childhood literally filled a book. If you're curious, it's All the Fishes Come Home to Roost: an American Misfit in India. I swear, it is nowhere near as depressing as the summary above makes it sound. Ordering info for that and my other works, since some people have asked, is here.
A sense of helplessness is very significant in causing trauma to reverberate through later years. Not having a support system at the time, or having no or little support later, is also a big predictor of PTSD. And it's bad to be a child, because you haven't yet evolved adult coping strategies, or a sense that things will get better in the future. Children do develop their own strategies, but they don't usually work as well, and, like adult strategies geared toward extreme circumstances, may cause their own problems later on.
Unsurprisingly, I started having mental problems while I was there. (Ages 7-12.) I do not believe that I had any pre-existing issues, though I may have had a genetic predisposition; mood disorders run in the family, plus the occasional case of paranoia and other delusional disorders. (Trauma can tip you over into various mental illness that you were, for whatever reason, already vulnerable to. I suspect that as a factor leading to the major depression that I got along with the PTSD.)
Other than a generalized depression, later noted by every adult who ever met me as a child and later as an adult (none of whom bothered to do anything about it), the main symptoms I had at the time were blackouts and suicide attempts.
I mean "blackout" in the sense that alcoholics use it: a lost chunk of memory, not a faint. I don't mean that I woke up in the morning and couldn't remember where in San Francisco I left my best friend's car. (As actually happened to someone I know. It took him three days to find it. Then he joined AA.) These were not something I realized after the fact, but during. I experienced them like a jump-cut in a movie: one moment I was fully awake in one place doing one thing, and the next instant I was fully awake somewhere else doing something else, with no recollection whatsoever of what had happened in the interim.
This was extremely disorienting and frightening, because it was so obvious that something was profoundly wrong. About the only good thing I can say about depression, which I also had, is that at least you don't feel crazy. (You are! But your crazy thoughts tend to feel completely realistic and rational. This has its own set of problems, but it's not quite so distressing.) PTSD has a couple of symptoms which, if you have them, are guaranteed to make you feel like you are losing your mind.
These time-skips were not frequent, but they were incredibly disconcerting. They happened in moments of extreme emotion and arousal. (By "arousal," I mean the fight/flight/freeze stress response, not sexual response. "Hyperarousal" or "increased arousal" are key terms in understanding PTSD. That's the "stuck on overdrive" phenomena that later makes you jump out of your skin when you hear a twig snap behind you.) I think they lasted a couple of minutes. For instance...
I had just started fighting a boy. We were under a tree. I grabbed the front of his shirt with one hand and raised the other to punch him--
-- Someone was pulling at my shoulders and screaming in my ear. He was on his back, crying, his face bright red. I was sitting on his chest and punching him in the face. His mother, who had not been there previously, was trying to haul me off of him. We were not under the tree any more, but about ten feet away.
--How had we gotten there? Why didn't I remember getting there? Where had his mother come from? Confused, I stopped hitting him and let her pull me off.
To a certain extent, bits of intense experiences, like sparring in martial arts or taking an important test, are often a blur or even a blank. I've often had that experience. What I've described above is totally different. I have never, under normal circumstances, felt as if I'd teleported, or been cut out of time and dropped back in somewhere else. That is abnormal. Or, at any rate, it's abnormal for me.
This didn't happen a lot, but it happened enough to scare the hell out of me. The other really memorable time was when a guy tied me up and I thought I was going to be sexually abused, and I lost the time between when I thought it would happen and when he untied me. (Long story, it's in my book.) As a consequence, I have no idea whether I was or not, but unlike what I would usually think if I heard someone say, "Well, I might have been molested, but I don't know because I had a blackout," I really don't know. (No, I don't really care at this point. It was one of those rare events which was so bad already that sexual abuse would not have actually made it worse.)
I don't think I was repressing memories, especially because I later got to experience that phenomenon too, and it was entirely different. I think my brain overloaded and temporarily failed to record to memory. So I don't expect to ever get those moments back-- they're not suppressed, they were never saved to begin with. But if anyone is aware of research on that phenomenon, I'd be interested to know about it. I do know that this is fairly common, especially among children. I've met quite a few people who have had similar experiences.
I never did anything while blacked out that I wouldn't have done normally, so it wasn't like Alter!Rachel emerged to fight for me. There was no fragmenting of self involved. This was purely a phenomenon of memory.
At the same time, I was obsessively thinking about suicide, and spent quite a bit of time locked in a room with a knife pressed to my throat, trying to get up the nerve to drive it in. Failed, obviously. And then I felt incredibly ashamed of what I saw as a failure of courage and willpower.
This is an example of coping mechanisms causing their own problems. I was running on nothing but courage and willpower at that point, so when I felt that I'd lost those, I felt like everything I valued about myself had been smashed to pieces. That was how I visualized the heart of my self, for years and years afterward: a heap of shattered glass.
I never told anyone anything about any of this. From here on, just assume that if I did tell anyone, I'll mention it. I didn't tell because of what I again think was the realistic perception that it wouldn't make a difference, based on early attempts at telling which did not make a difference. It's more crushing to put yourself out there and painfully recount a painful event, and then be fobbed off with worthless promises, than it is to not tell. That's another example of behavior which made sense at the time, and so got ingrained as a successful one, but later turned out to be absolutely counterproductive.
I had a whole set of endurance tactics which I pulled out when I was being abused. One was to recite poetry to myself. Writers, note that this wasn't just some weird idisyncratic technique I developed because I read a lot. It turns out that mentally reciting something is a trick that a lot of people come up with independently under bad circumstances, and it helps if it has a strong beat. It's a slightly more advanced technique than imagining yourself somewhere else, and it will work when that one doesn't. I used to use "Invictus" ("I am the master of my fate/I am the captain of my soul"), and I later found out that it's popular for that purpose. Seriously.
The way that it works is that it gives you something which you need to concentrate on, but which isn't too hard because you do already know it. The beat and the rhymes carry you, and probably help to induce a kind of light trance state. The meaning of the words engages the emotional part of your mind. If you have some specific goal, like "stand there like a rock and don't flinch or make a sound," that's what enables you to do it. You don't not notice or not care that you're being beaten or whatever else is being done to you, but it keeps a bit of yourself free.
This last is hard to describe, but it comes up a lot in abuse and survival narratives. It can involve splitting yourself into other personalities, but that's not how I mean it. Basically, you think of the part of you which is essential, your heart or soul or will. Then you imagine that part as untouched by whatever is going on. ...This is really hard to describe. If you want to use it in fiction, comment and maybe I'll take another crack at it.
The problem with that sort of thing, at the time, is how absolutely devastating it is when it fails. The problem that comes up later is that you've trained yourself into all sorts of weird mental states which are not conducive to normal life.
That may be a form of dissociation, but I've more commonly heard the term used to describe the feeling that whatever's happening is happening to someone else, or somewhere far away from them, or isn't quite real. That sounds like a form of self-hypnosis that's a bit different from what I was doing, and I imagine that like my own methods, it can cause quite a lot of problems down the line.
The general principle here, for writers, is that people never only suffer: they come up with ways to alleviate or bear their suffering. This is true even if they're little kids-- who frequently invent quite sophisticated strategies with no outside input whatsoever. The methods that don't help get dropped, and the ones that do are kept, repeated, and reinforced. And so some mutant version of them is likely to show up later on, often long after it's dropped into the unconscious and you have no idea that you're still doing it or how you started.
Again, why some people go on to develop PTSD and some people don't is a mystery, especially when you consider that when put under enough pressure, just about everyone will develop interesting coping techniques, and everyone will go a bit crazy at the time. There are excellent portrayals of the latter in Lloyd Alexander's novel The Kestrel
, the anime Fullmetal Alchemist: Season One Box Set
and Mobile Suit Gundam Wing - Complete Collection 1
, and a lot of nonfiction Vietnam war narratives.
The duration of the trauma is a big factor. For instance, the single best predictor of whether or not a given soldier will get PTSD is how much total time he or she spent in combat. As the time adds up, the rates of PTSD for the group go up. The shorter the trauma, the less opportunities there are for you to be traumatized in new and interesting ways, the less your central nervous system and adrenal glands will get accustomed to being in crisis mode, and the less time you will have to optimize your mind for survival and nothing but. If your trauma was one time only and of brief duration, you can still get PTSD, but it may be rather different in mechanism and effect to what I'm describing here.
The way that this works may be a form of "kindling." This concept came from some pretty cruel experiments in which animals were neurologically stimulated to give them seizures. After a while, the seizures started happening by themselves, without stimulus.
The trauma generates feelings of fear, anger, and helplessness. The specific situation generates physical/psychological responses which are adaptive at the time, like a constant state of hyperarousal. (That may include a hypersensitive startle reflex so you'll know when people are creeping up on you from the air currents they disturb, being able to go from sound asleep to on your feet and fighting if your startle reflex trips in your sleep, and a general state of twitchiness.)
The events burn themselves into your memory like a computer left on without a screen saver, but perhaps they get stored abnormally, either because of your general overload or because the trauma is screwing with your ability to form and access memories, as I described above. You get used to the perfectly realistic-at-the-time belief that something horrible can and will happen at any moment. You develop coping skills that will turn out to be very unsuitable to ordinary life. And you very likely have been practicing self-hypnosis without a license.
Essentially, you have been programmed and have programmed yourself for a particular set of circumstances. When those circumstances end, you are still programmed. Your switch flips by itself.
This is trauma: You are walking along the path you always take, when suddenly the ground cracks under your feet like rotten ice, and you fall. You're shocked and terrified and you think you're going to die. Then you slam into the bottom. Maybe you break some bones, maybe you're just shook up and bruised.
This is normal recovery: You climb out of the pit. You go to a hospital. Depending on the extent of your injuries, recovery may be long or short, but after some length of time, the casts come off and you get on with your life. Maybe you're a little more cautious about where you put your feet, but it doesn't interfere with your life.
This is PTSD: You break bones at the bottom of the pit. You move to get out, and the bottom of the pit crumbles just like the path did, and you're falling again, stuck in that same moment of terror and shock and pain. And you keep on falling, and you will fall forever unless you grab a rope.
Grab that rope.
Feel free to ask questions, comment, share your own experiences, correct my science and statistics, or recommend media on the subject.
I am a fan and I read and write fic, so I will not feel in the least that you are being voyeuristic or trivializing if you want to ask me a question about how to make your Spooks/MI-5 or Magneto/Professor X or 3x4 story more realistic. In fact, I would probably request that you send me the link when you're done.
ETA: I do still read and am grateful to receive comments on these posts, even many years later. I can't guarantee to respond to every one because it can be a bit overwhelming, but I do read them.
Part I: What I Did In The War. (Introduction; background; what happens during trauma; what happened to me.)
Part II: What Does A Flashback Feel Like? (My history with PTSD, and what it felt like to me.)
Part III: I Don't Have To Do This Any More. (On recovery; lingering effects; book, film, TV, and music recommendations.)
ETA: Several years later, I added Part IV: Postscript.
You probably all know what PTSD is, in general terms: a mental illness resulting from trauma, often occurring in combat veterans but not limited to them, best-known for causing flashbacks, nightmares, and acute anxiety states. But people who have it often don't realize what's going on or don't seek help, and much of the fiction which deals with it reads as if the authors referred to a checklist of symptoms rather than finding sources from the point of view of someone who actually has it.
That would be my point of view.
Have you ever wondered what it feels like to have a flashback? I can tell you. (It does not typically involve acting out the entire trauma in real time, complete with dialogue and screaming. Vomiting is also not essential, nor even, as far as I know, likely.)
Also, the method I used to recover, more or less, and one of the issues I'm dealing with now, are both things which I have literally never seen addressed anywhere. I shall be very curious to hear if anyone else has had similar experiences.
I'm not a psychologist, and so can only speak from my own idiosyncratic perspective, plus a bit of research and discussion. But if you’re writing a story about someone who has cancer or know someone who does, it’s fine to look up cancer on Wikipedia, but you’ll learn more by going on to talk to a person who’s doing chemotherapy right now. And if you've ever done any interviewing, you know that the shortest route to an interesting response is "What did it feel like?" So I will tell you how it feels: how it feels to me.
Keeping that in mind, I mean this as a public service announcement- if nothing else, I hope that it will improve the depiction of PTSD in fiction, fan- and otherwise, for my own reading enjoyment, and reduce the incidence of gratuitous vomiting- so feel free to link far and wide.
Here's the DSM-IV criteria for PTSD. The DSM-IV is the American manual on diagnosing mental illness. I don’t think it's the be-all and end-all of existence, but it’s more familiar to me than other countries’ criteria, so that's what I'm using.
The single biggest misconception about PTSD is that it either occurs only in soldiers, or that the trauma has to be as monumental and severe as combat or being a civilian in a war zone.
That probably came about because it was first noticed in soldiers, and was originally thought to be unique to them. (It may have had other labels, like “hysteria,” when observed in abused children or raped women.) If one considers the history of which gender was considered important and worthy of attention, and also the logistical problems that arise when you're still fighting a war and large numbers of your soldiers are so mentally disabled that they're unable to fight, you'll see why PTSD was first studied in soldiers, and why for a long time they were the only group who seemed worth studying.
The history of PTSD in soldiers is very well documented but largely beyond the scope of this essay. Just to give you a taste of what's out there, here's Lady Percy's speech about her back-from-the-war husband Hotspur, in Shakespeare's Henry IV Part I: insomnia, nightmares, depression, restricted affect, loss of pleasure in formerly enjoyable activities, exaggerated startle reflex-- it's practically The DSM-IV criteria in iambic pentameter. In Achilles in Vietnam: Combat Trauma and the Undoing of Character
, Jonathan Shay draws parallels from Homer. The earliest name I could find was "soldier's heart" after the Civil War, and it wouldn't surprise me if it got re-named again during my lifetime. I'd be very interested to hear of early reports on it from non-Western countries, if anyone happens to have some references.
It's now known that you can develop PTSD from many types of trauma- rape, child abuse, natural disasters, accidents, on the job as a cop or disaster relief worker or war correspondent, etc. Here's the DSM-IV's criteria of "trauma":
Criterion A: stressor
The person has been exposed to a traumatic event in which both of the following have been present:
1. The person has experienced, witnessed, or been confronted with an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others.
2. The person's response involved intense fear, helplessness, or horror. Note: in children, it may be expressed instead by disorganized or agitated behavior.
I’ve several times come across people who have the symptoms, but don’t think their trauma was significant enough to warrant their reaction, since they weren’t in combat or were only molested and not physically injured or it was a car crash rather than an act of violence. This seems a sufficiently common idea that I suspect that it’s a manifestation of the illness all by itself, possibly a form of survivor’s guilt.
If something traumatic happened to you and you fit the other criteria, you should go to a mental health professional and get yourself evaluated, regardless of whether or not you think your trauma was "good enough."
As a writer, you might consider inflicting PTSD upon your characters who have been through traumas that one does not normally associate with it, such as natural disasters, accidents, or even life-threatening illnesses. They would probably take a long time to figure out what’s wrong with them, and others might not take them seriously once they do realize. There is great and largely untapped potential for fictional angst here.
Why some people develop PTSD and some people don't is complicated, not well understood, and seems to depend more on the nature of the trauma than the nature of the people. But the perception that having PTSD means that you weren't tough enough or you have some kind of character flaw is a big obstacle in admitting that you have it, which is obviously a big obstacle to getting treated.
To analogize, lots of people trip and fall. If they're young and healthy, they'll usually dust themselves off and get up. But sometimes they break bones. Lots of people crash their cars. A larger percentage of those don't dust themselves off. Complex operations of chance, geography, psychology, and physiology determine whether the accident happens at all, whether you were injured, and how bad your injury was, not some shameful faultline in the accident victim's personality.
If you get PTSD, it means you drew the short straw. That's all.
If you're writing about it, however, your characters are likely to not take such a healthy attitude. Especially if they're in some macho occupation like demon hunting or Gundam piloting. This is another great and under-appreciated opportunity for angst: not just the commonly written-about survivor's guilt or more specific guilt over things they actually did during the trauma, but guilt, shame, and denial over being affected by it now.
They may also conceal their symptoms for fear that they will be judged unfit to continue on the job which caused them, or will be disbelieved and disrespected. This may be a completely realistic fear, and is a recurring problem in the military and other organizations in real life.
Conversely, just because your character was in a war does not automatically mean that she will have PTSD! For example, the prevalence in Americans who fought in Vietnam is estimated at 30%. Even if that's underreported, there's still, say, a 50-70% chance that any given Vietnam vet won't have it. That doesn't mean that your character who's been through some trauma was totally unaffected, just that they did not develop a specific mental illness as a result. (They might develop a completely different mental illness!)
Note that certain PTSD symptoms can also be trained into you in a more healthy and non-traumatic way. So a guy who's never been in combat and does not have PTSD could acquire an exaggerated startle response just from going through boot camp, particularly if it's limited to the more survival-oriented areas of being snuck up on or startled while sleeping. A lot of martial arts training may also give you some of the instant-fight responses common in PTSD, though in my experience, that's not something you're going to get by training six hours a week as a civilian. I'd find it plausible if the training had a military or paramilitary slant, though.
I was physically and emotionally abused as a child.
I was raised on a weird commune by negligent parents in a rural town in middle-of-nowhere India, where I was the only foreign child in the whole town. The school was abusive, and the other kids took it out on me. Plus some adult lunatics and sadists took advantage of the obvious fact that my parents were not going to raise more than a verbal protest if anyone did anything to me.
I was bullied, struck, tied up, threatened with weapons, had gangs of kids throw rocks at me literally every time I left the walled compound where I lived (unless I had an adult escort), witnessed other kids being abused and once so seriously injured that I wasn't sure till later that he had survived, was forced to stand in the sun until we collapsed from sunstroke, and a couple times had to grab a weapon and prepare, I thought, to fight for my life. I got in a lot of fights; I frequently had people sneak up on me; I had absolutely no sense that anyone was looking out for me or that there was anything I could do to change what was going on, and I think I was right about that.
I'm being brief because my childhood literally filled a book. If you're curious, it's All the Fishes Come Home to Roost: an American Misfit in India. I swear, it is nowhere near as depressing as the summary above makes it sound. Ordering info for that and my other works, since some people have asked, is here.
A sense of helplessness is very significant in causing trauma to reverberate through later years. Not having a support system at the time, or having no or little support later, is also a big predictor of PTSD. And it's bad to be a child, because you haven't yet evolved adult coping strategies, or a sense that things will get better in the future. Children do develop their own strategies, but they don't usually work as well, and, like adult strategies geared toward extreme circumstances, may cause their own problems later on.
Unsurprisingly, I started having mental problems while I was there. (Ages 7-12.) I do not believe that I had any pre-existing issues, though I may have had a genetic predisposition; mood disorders run in the family, plus the occasional case of paranoia and other delusional disorders. (Trauma can tip you over into various mental illness that you were, for whatever reason, already vulnerable to. I suspect that as a factor leading to the major depression that I got along with the PTSD.)
Other than a generalized depression, later noted by every adult who ever met me as a child and later as an adult (none of whom bothered to do anything about it), the main symptoms I had at the time were blackouts and suicide attempts.
I mean "blackout" in the sense that alcoholics use it: a lost chunk of memory, not a faint. I don't mean that I woke up in the morning and couldn't remember where in San Francisco I left my best friend's car. (As actually happened to someone I know. It took him three days to find it. Then he joined AA.) These were not something I realized after the fact, but during. I experienced them like a jump-cut in a movie: one moment I was fully awake in one place doing one thing, and the next instant I was fully awake somewhere else doing something else, with no recollection whatsoever of what had happened in the interim.
This was extremely disorienting and frightening, because it was so obvious that something was profoundly wrong. About the only good thing I can say about depression, which I also had, is that at least you don't feel crazy. (You are! But your crazy thoughts tend to feel completely realistic and rational. This has its own set of problems, but it's not quite so distressing.) PTSD has a couple of symptoms which, if you have them, are guaranteed to make you feel like you are losing your mind.
These time-skips were not frequent, but they were incredibly disconcerting. They happened in moments of extreme emotion and arousal. (By "arousal," I mean the fight/flight/freeze stress response, not sexual response. "Hyperarousal" or "increased arousal" are key terms in understanding PTSD. That's the "stuck on overdrive" phenomena that later makes you jump out of your skin when you hear a twig snap behind you.) I think they lasted a couple of minutes. For instance...
I had just started fighting a boy. We were under a tree. I grabbed the front of his shirt with one hand and raised the other to punch him--
-- Someone was pulling at my shoulders and screaming in my ear. He was on his back, crying, his face bright red. I was sitting on his chest and punching him in the face. His mother, who had not been there previously, was trying to haul me off of him. We were not under the tree any more, but about ten feet away.
--How had we gotten there? Why didn't I remember getting there? Where had his mother come from? Confused, I stopped hitting him and let her pull me off.
To a certain extent, bits of intense experiences, like sparring in martial arts or taking an important test, are often a blur or even a blank. I've often had that experience. What I've described above is totally different. I have never, under normal circumstances, felt as if I'd teleported, or been cut out of time and dropped back in somewhere else. That is abnormal. Or, at any rate, it's abnormal for me.
This didn't happen a lot, but it happened enough to scare the hell out of me. The other really memorable time was when a guy tied me up and I thought I was going to be sexually abused, and I lost the time between when I thought it would happen and when he untied me. (Long story, it's in my book.) As a consequence, I have no idea whether I was or not, but unlike what I would usually think if I heard someone say, "Well, I might have been molested, but I don't know because I had a blackout," I really don't know. (No, I don't really care at this point. It was one of those rare events which was so bad already that sexual abuse would not have actually made it worse.)
I don't think I was repressing memories, especially because I later got to experience that phenomenon too, and it was entirely different. I think my brain overloaded and temporarily failed to record to memory. So I don't expect to ever get those moments back-- they're not suppressed, they were never saved to begin with. But if anyone is aware of research on that phenomenon, I'd be interested to know about it. I do know that this is fairly common, especially among children. I've met quite a few people who have had similar experiences.
I never did anything while blacked out that I wouldn't have done normally, so it wasn't like Alter!Rachel emerged to fight for me. There was no fragmenting of self involved. This was purely a phenomenon of memory.
At the same time, I was obsessively thinking about suicide, and spent quite a bit of time locked in a room with a knife pressed to my throat, trying to get up the nerve to drive it in. Failed, obviously. And then I felt incredibly ashamed of what I saw as a failure of courage and willpower.
This is an example of coping mechanisms causing their own problems. I was running on nothing but courage and willpower at that point, so when I felt that I'd lost those, I felt like everything I valued about myself had been smashed to pieces. That was how I visualized the heart of my self, for years and years afterward: a heap of shattered glass.
I never told anyone anything about any of this. From here on, just assume that if I did tell anyone, I'll mention it. I didn't tell because of what I again think was the realistic perception that it wouldn't make a difference, based on early attempts at telling which did not make a difference. It's more crushing to put yourself out there and painfully recount a painful event, and then be fobbed off with worthless promises, than it is to not tell. That's another example of behavior which made sense at the time, and so got ingrained as a successful one, but later turned out to be absolutely counterproductive.
I had a whole set of endurance tactics which I pulled out when I was being abused. One was to recite poetry to myself. Writers, note that this wasn't just some weird idisyncratic technique I developed because I read a lot. It turns out that mentally reciting something is a trick that a lot of people come up with independently under bad circumstances, and it helps if it has a strong beat. It's a slightly more advanced technique than imagining yourself somewhere else, and it will work when that one doesn't. I used to use "Invictus" ("I am the master of my fate/I am the captain of my soul"), and I later found out that it's popular for that purpose. Seriously.
The way that it works is that it gives you something which you need to concentrate on, but which isn't too hard because you do already know it. The beat and the rhymes carry you, and probably help to induce a kind of light trance state. The meaning of the words engages the emotional part of your mind. If you have some specific goal, like "stand there like a rock and don't flinch or make a sound," that's what enables you to do it. You don't not notice or not care that you're being beaten or whatever else is being done to you, but it keeps a bit of yourself free.
This last is hard to describe, but it comes up a lot in abuse and survival narratives. It can involve splitting yourself into other personalities, but that's not how I mean it. Basically, you think of the part of you which is essential, your heart or soul or will. Then you imagine that part as untouched by whatever is going on. ...This is really hard to describe. If you want to use it in fiction, comment and maybe I'll take another crack at it.
The problem with that sort of thing, at the time, is how absolutely devastating it is when it fails. The problem that comes up later is that you've trained yourself into all sorts of weird mental states which are not conducive to normal life.
That may be a form of dissociation, but I've more commonly heard the term used to describe the feeling that whatever's happening is happening to someone else, or somewhere far away from them, or isn't quite real. That sounds like a form of self-hypnosis that's a bit different from what I was doing, and I imagine that like my own methods, it can cause quite a lot of problems down the line.
The general principle here, for writers, is that people never only suffer: they come up with ways to alleviate or bear their suffering. This is true even if they're little kids-- who frequently invent quite sophisticated strategies with no outside input whatsoever. The methods that don't help get dropped, and the ones that do are kept, repeated, and reinforced. And so some mutant version of them is likely to show up later on, often long after it's dropped into the unconscious and you have no idea that you're still doing it or how you started.
Again, why some people go on to develop PTSD and some people don't is a mystery, especially when you consider that when put under enough pressure, just about everyone will develop interesting coping techniques, and everyone will go a bit crazy at the time. There are excellent portrayals of the latter in Lloyd Alexander's novel The Kestrel
, the anime Fullmetal Alchemist: Season One Box Set
and Mobile Suit Gundam Wing - Complete Collection 1
, and a lot of nonfiction Vietnam war narratives.
The duration of the trauma is a big factor. For instance, the single best predictor of whether or not a given soldier will get PTSD is how much total time he or she spent in combat. As the time adds up, the rates of PTSD for the group go up. The shorter the trauma, the less opportunities there are for you to be traumatized in new and interesting ways, the less your central nervous system and adrenal glands will get accustomed to being in crisis mode, and the less time you will have to optimize your mind for survival and nothing but. If your trauma was one time only and of brief duration, you can still get PTSD, but it may be rather different in mechanism and effect to what I'm describing here.
The way that this works may be a form of "kindling." This concept came from some pretty cruel experiments in which animals were neurologically stimulated to give them seizures. After a while, the seizures started happening by themselves, without stimulus.
The trauma generates feelings of fear, anger, and helplessness. The specific situation generates physical/psychological responses which are adaptive at the time, like a constant state of hyperarousal. (That may include a hypersensitive startle reflex so you'll know when people are creeping up on you from the air currents they disturb, being able to go from sound asleep to on your feet and fighting if your startle reflex trips in your sleep, and a general state of twitchiness.)
The events burn themselves into your memory like a computer left on without a screen saver, but perhaps they get stored abnormally, either because of your general overload or because the trauma is screwing with your ability to form and access memories, as I described above. You get used to the perfectly realistic-at-the-time belief that something horrible can and will happen at any moment. You develop coping skills that will turn out to be very unsuitable to ordinary life. And you very likely have been practicing self-hypnosis without a license.
Essentially, you have been programmed and have programmed yourself for a particular set of circumstances. When those circumstances end, you are still programmed. Your switch flips by itself.
This is trauma: You are walking along the path you always take, when suddenly the ground cracks under your feet like rotten ice, and you fall. You're shocked and terrified and you think you're going to die. Then you slam into the bottom. Maybe you break some bones, maybe you're just shook up and bruised.
This is normal recovery: You climb out of the pit. You go to a hospital. Depending on the extent of your injuries, recovery may be long or short, but after some length of time, the casts come off and you get on with your life. Maybe you're a little more cautious about where you put your feet, but it doesn't interfere with your life.
This is PTSD: You break bones at the bottom of the pit. You move to get out, and the bottom of the pit crumbles just like the path did, and you're falling again, stuck in that same moment of terror and shock and pain. And you keep on falling, and you will fall forever unless you grab a rope.
Grab that rope.
Feel free to ask questions, comment, share your own experiences, correct my science and statistics, or recommend media on the subject.
I am a fan and I read and write fic, so I will not feel in the least that you are being voyeuristic or trivializing if you want to ask me a question about how to make your Spooks/MI-5 or Magneto/Professor X or 3x4 story more realistic. In fact, I would probably request that you send me the link when you're done.
ETA: I do still read and am grateful to receive comments on these posts, even many years later. I can't guarantee to respond to every one because it can be a bit overwhelming, but I do read them.