"PTSD is the enemy within ... in the mind, slowly exploding before our very eyes, but unidentified, and therefore invisible, even to those who suffer directly from its effects".
(Peter Tucker)

The psychiatric definition of "trauma' is "an event outside normal human experience". Trauma leaves you feeling powerless, ehlpless, paralyzed. It tends to be sudden and overwhelming. It "owns" you. You can not think clearly during a severe trauma, yet you are forced to focus your consciousness in an attempt to deal. Trauma has been defined as "any suddent and potentially life-threatening event".

As the name implies, Post Traumatic Stress Disorder (PTSD) occurs after (post) an extremely stressful event (trauma). The more severe the trauma and the longer the person is exposed to it, the greater the liklihood is of developing PTSD.

The traumatic event is relived repeatedly. This can take the form of recurrent images, thoughts, dreams or "flashbacks" of the event. Even reminders of the event can cause extreme distress, so many people go out of their way to avoid places or events that bring to mind the traumatic event. Many experience increased anxiety, restlessness, sleeplessness, irritability, poor concentration, hypervigilence or an exaggerated startled response. Some are even plagued by feelings of "survivor's guilt" because they survived when others did not. The symptoms are obviously very disruptive and stressful to the victim, as well as their family and loved ones. It can even impair job performance and social functioning.

It has been called shell shock, battle fatigue, accident neurosis and post rape syndrome, and is too often misdiagnosed and misunderstood. PTSD is a diagnosis which was first made following the Viet Nam War. Veterans who saw combat in Viet Nam were found to have a number of symptoms not cleraly documented in any other diagnostic category. These symptoms had been observed in combat veterans in may previous wars, so it seems that PTSD is constantly being rediscovered.

War has always taken a toll. Throughout history, accounts tell of nightmares and other emotional problems associated with the horrors of war. We repeatedly discover the effects of trauma on human beings every time we go to war. Terms like "combat fatigue" and "shell shock" were used in the past to describe the effects of combat. These terms were misleading because they imply that th effects of combat are short-term.

PTSD is not a mental sickness, but a "syndrome". In other words, a collection of symptoms. It describes the often chronic reaction experienced by people exposed to the particular kind of intense stress encountered in war zones and other catastrophic situations. This reaction is a normal human response to the impact of abnormal situations and events. The specific type of PTSD suffered by soldiers is known as Cmobat PTSD. There is no shame attached to it; it is often the most courageous man in a unit who gets hit by this syndrome.

A delayed stress reaction may surface after months or even years, including some or all of the symptoms below. Few suffer every symptom listed here; but if you recognize several of your own or some loved one's behavior, the chances are that person suffers more or less from severe post traumatic stress.

**"Intrusion" refers to the unwanted invasion of one's mind and body by memories of past traumatic events.

**"Constriction" refers to the strategies taken by the mind to stop this invasion.

**"Hyperarousal" refers to the state of constant alartness that is the legacy of having been involved in such events.

1. Nightmares, flashbacks, hallucinations and other forms of uncontrollable invasion of the present by memories of the past (intrusion).

2. Intense distress at exposure to events that symbolize or resemble an aspect of the traumatic event, including anniversaries of the event; certain smells can trigger waves of fear, as can loud noises and certain television shows (intrusion).

3. Difficulty in recalling events from the war years, especially those that were traumatic; unwillingness to remember the war; reluctance to meet people, read books, see films, etc. that remind one of the war (constriction).

4. Sleeplessness; difficulty concentrating (hyperarousal).

5. Hypervigilance; unmotivated, keyed-up alertness (hyperarousal).

6. Episodes of severe rage (hyperarousal).

7. Violetn impulses towards what may be indiscriminate or innocent targets; unnecessarily violetn reaction on being taken by surprise (hyperarousal).

8. Severe survival guilt; feelings of guilt at having survived the war while other (who the victim sees as more deserving) have died (constriction).

9. Psychic numbing; feeling that one has no feelings (constriction).

10. Alientation from one's own feelings; reacting with emotions that do not seem appropriate to the situation; periods of acute depression, interrupted by periods of sometimes manic behavior (constriction/hyperarousal).

11. Markedly diminished interest in significant activities; apathy (constriction).

12. Feelings of detachment or estrangement from others (constriction).

13. Sense of foreshortened future; feeling of being older than one's true age (constriction).

14. Doubt about whether one can ever love or trust someone else again; pessimism about the very nature of lvoe and life itself (constriction).

PTSD is definied in the following way:

A. The person has been exposd to a traumatic event in which both of the following were present:

** The person experienced, witnessed or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others;

** The person's response involved intense fear, hopelessness or horror.

B. The traumatic event is persistently reexperienced in one (or more) of the following ways:

** Recurrent and intrusive distressing recollections of the event, including images, thoughts or perceptions;

** Recurrent distressing dreams of the event;

** Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations and dissociative flashback episodes, including those that occur on awakening or when intoxicated);

** Intense psychological distress or reactivity at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

C. Persistent avoidance of stimuli associated wtih the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:

** Efforts to avoid thoughts, feelings or conversations associated with the trauma;

** Efforts to avoid activities, places or people that arouse recollections of the trauma;

** Inablity to recall an imporant aspect of the trauma;

** Markedly diminished interest or participation in significant activities;

** Feeling detachment or estrangement from others;

** Restricted range of effect (as in, unable to have loving feelings);

** Sense of a foreshortened future (does not expect to have a career, marriage, children or a normal life span).

D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:

** Difficulty falling or stayign asleep;

** Irritability or outbursts of anger;

** Difficulty concentrating;

** Hypervigilance;

** Exaggerated startle3 resonse.

E. Duration of the disturbance (symptoms in B, C and D) is more than one month.

F. The disturbance causes clinicaly significant distress or impairment in social, occupational or other important areas of functioning.

IMPORTANT NOTE:

When identifying trauma and its' s ymptoms, it is always best to ask "What HAPPENED to this person" rather than "What is WRONG with this person"!

I understand when someone says they have PTSD. It can be very debilitating, affecting one's ablity to work, maintain relationships and to simply function in everyday living.

But there is a light in the darkness where PTSD resides -- it is a treatable disorder. With the help of medications, therapy and an adequate support system, there is hope for healing.

Please remember ...

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