“It seems to me that you have PTSD,” she said.
I had sat most of the session on the edge of the couch but at that moment, I fell back into my seat as the words struck me in my chest and I considered my therapist's words.
Let me start by saying that therapy sessions are non-linear. In fact, they seem at times more like a game of Dizzy Bat – where you are just staggering around, walking in circles – retelling old memories and then looping back around to the present.
In one session, I had talked about the moment in time when I had left my husband and kids, despite my life goal for years of never doing that. Notwithstanding my cognitive desires, I was somehow on a train taking me in an entirely different direction. I had just become business partners with a man who, after our honeymoon period was over, yelled at me and put me down constantly – to the point of having my employees do “welfare checks” on me after meetings because they could hear the degrading tongue-lashing from outside the office walls.
Then I’d go home, emotionally exhausted and hurt, unable to unburden myself to my husband because he wasn’t interested in hearing about it. It was my choice to be an entrepreneur and therefore my hardship to carry. And then I had two small children who neither understood nor cared what had happened to me, and I was supposed to be the one to feed, dress and attend to them, regardless of my feelings or needs.
My life had become a perfect storm that would sweep me away: Kids. Family. Abusive relationship. No one to listen or help. People need me to take care of them. But no one taking care of me.
Unknowingly, the constant yelling and degradation slowly tore away at the weak scars on my old wounds until they were re-opened completely. I began to re-live old trauma without knowing it and responded to it as half-child/half-adult. I aggressively started protecting myself from the threat to my well-being and seeking ways to escape the danger that was all around me.
The first thing I changed was I ran from home. But I didn’t do it right away. In fact, I tried not to do it at all. It was, however, the place I felt like I had the least control to change and the place I felt the most insecure.
As my last salvo, I sent an email to my husband because he was unwilling to have an actual conversation with me. I warned him about my sadness and that I was drifting away. I asked him to help bring me back. And he ignored it. This was September of 2009. By February of 2010, I was gone.
Once out and on my own in Seattle, I started to unravel at work. I started yelling back at my business partner. I became depressed which lead to low productivity, which only increased the acrimony between him and I. I became defiant and unyielding. I stood my ground like my life depended on it.
To find something to fill my emotional center, I went out and took on a night job as a bartender/manager in one of the most dangerous neighborhoods in Seattle. There I dealt with gangs, drugs, prostitutes as well as drunks. I was the gate-keeper at night – without a security guard. Just me. And it was exciting. Dangerous, but it at least it was something.
But by July of 2011, everything was over. My marriage. My business. It was gone. I had told the business partner I’d had it. He answered by changing the locks on the doors. I answered by taking him to court for breach of contract. Neither one of us got anything in the end.
The problem, however, was the damage was done. In only two years, I had become this raw, pulpy form of myself. I wasn’t perfect before, but now I was even less so. And only until 2017, I continued to operate, unknowingly, in this fragile, wounded state of mind.
The experience informed what I continued to do in business. I had this uneven balance between my intelligent, educated rational self with my overreacting, self-protecting mode when challenged or put-down.
It also informed my choices in romantic partners. I pursued younger men. I sought the exciting yet “emotionally unavailable” types - "Danger Boys" is what I called them. I worked tirelessly to prove myself worthy of respect and love. The less they gave me, the harder I worked. I was a slave to approval. I needed them to know that I was worth keeping.
I was facing adult situations but reacting at times from some damaged place of fear.
And then, not surprisingly, my life blew up in my face again... Thank god.
But what has this to do with PTSD you might wonder? While life can feel like a battle, this isn't really war I'm dealing with.
Post-Traumatic Stress Disorder is something that can happen to a person when they are exposed to or threatened with death, experience or threatened with a serious injury or sexual violence. The exposure happens in the following ways:
· Direct exposure
· Witnessing the trauma
· Learning that a relative or close friend was exposed to a trauma
· Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)
In the Diagnostic and Statistical Manual of Mental Disorders, also known as the DSM, these are called Criteria A events. And I can tell you that, as an adult, while White Center bartending was exciting & dangerous at times, I never truly felt extreme terror or danger to my life then or ever as an adult. Which is why when my therapist said that was what I was dealing with, I was taken aback.
But she wasn’t talking about my adult life. She was talking about childhood. Because, after walking with me in the circles of past looping to present back to past, she put pieces together for me and saw the relationship of certain events with my life today. That’s why therapists are amazing.
So, naturally, after my session with her, I had to look into this concept further. Because that’s who I am. I have to know.
What I found through researching PTSD was that in the 2013 updates of the DSM, a new sub-type of the disorder was added called “Posttraumatic Stress Disorder in preschool children.” Of the many reasons for the change, it was because, at a young age (6 years old and younger), a child’s abstract thinking of the world around them means that they can view certain situations as life-threatening, even if to an adult they aren’t. Such as being hospitalized for an illness or witnessing family conflict.
One way to screen for PTSD in children and teenagers is using the Traumatic Events Screening Inventory (TESI-C). The TESI-C protocol is a guide for therapists or researchers to determine a child’s history of exposure to potentially traumatic experiences.
The questions are arranged in a hierarchy of experiences so a child being interviewed can tolerate the possible stress of disclosing traumatic experiences. This means the Level 1 traumas are considered less harrowing than Level 6.
The Interview Questions Are:
1.1 Have you ever been in a really bad accident, like a car accident, a fall or a fire?
1.2. Have you ever seen a really bad accident that you weren't actually in?
1.3. Have you ever been in a really bad storm, like a tornado, a hurricane, or a blizzard? Or in a flood or an earthquake? Or were you ever hit by lightning?
1.4 Have you ever known someone who got really hurt or sick, or even died?
1.5 Have you ever had to stay overnight at the hospital or have an operation?
1.6 Have you ever had to go away from your parents or family for a long time? Like going to live with another family, or a boarding school or camp, or a hospital or detention center? Or did your mother, father, or someone else who looks after you ever go away for a long time?
2.1 Has someone ever attacked you or tried to hurt you really badly on purpose—like beating, shaking, biting, burning or choking you, or stabbing you with a knife or shooting you with a gun? Or has anyone ever punished you so hard that you were hurt really badly or had to go to the doctor or hospital-like a spanking, whipping, or beating?
2.2 Has someone ever told you they were going to hurt you really badly, or acted like they were going to hurt you really badly?
2.3 Children 12 or younger: Has someone a lot older ever tried to steal from you? Or from a family member or friend when you were right there? Teenagers: Has someone ever mugged you or held you up to try to steal from you? Or have you ever been present when a family member or close friend was mugged?
2.4 Has someone ever kidnapped you or taken you away when they weren’t supposed to? Or has someone in your family or a close friend ever been kidnapped?
2.5 Have you ever been attacked by a dog or another animal?
3.1 Have you ever seen people in your family fighting or attacking each other? Or shooting with a gun? Or stabbing with a knife? Or beating each other up?
3.2 Even if they weren't physically attacking each other, have you ever heard people in your family really yelling and screaming at each other a lot?
3.3. Has someone in your family ever been put in jail or prison? Or have the police or soldiers ever come to your house and said you or your family were in big trouble?
4.1 Have you ever seen people outside your home fighting or attacking each other? Or shooting with a gun? Or stabbing with a knife? Or beating each other up?
4.2 Even if they weren't physically attacking each other, have you ever heard people outside your home really yelling and screaming at each other a lot?
4.3 Have you seen or heard people attacking each other for real on television or radio? Like a war or a building blowing up?
5. Has someone ever touched your body in a way you didn’t want them to or in a way that made you uncomfortable?
6. Have there been some other times when somebody did or said something that made you feel the most sad or scared or unhappy you’ve ever felt, or that bothers you a lot now? Or when you were left all alone and you were afraid you would die or no one would ever help.
As one can see from the list, the questions are designed to respect the nonconcrete way children observe the world. For example, abandonment and death feel and appear the same. A parent is leaving and never coming back. Looking at it in this regard, then children are likely to experience the feelings of a Criteria A event without actually being threatened with bodily harm. And this is why, in part, the DSM was updated to reflect this.
So, now imagine a child experiences an event or series of events of this magnitude and doesn’t receive any support. Sometimes its due to a lack of awareness of the event by an adult – they didn’t see it happen, for example. Or the child is too young to communicate their feelings or fears. Further, if the events in question don’t appear to be “traumatic” for an adult, they may not be aware that the child involved is in complete terror for her life and needs to be consoled or receive care. Thus, you now have a potential situation of PTSD for this child.
Sadly, what is also known about PTSD is that the immediate follow-up care and treatment, for adults and children, has a profound bearing on the psychiatry of the person and how well they handle the events emotionally. So if a child is in extreme fear or sadness and no one attends to her then or after, it can devastating long-term effects. This is one reason different people can experience the same event, but each handle it differently.
Fast forward, and now this child who has experienced an undiagnosed traumatic event has to relive a similar circumstance over again years later. The child may have a confusing and seemingly irrational response because of the injury of the original trauma. In my case, it was a brief period of intense emotional stress at about 11 years of age that left me unable to go to school because I believed my mom was going to die while I was gone.
In the end, the some of the effects of undiagnosed complex trauma disorders are healthy regulation of responses, such as controlling anger. Anxiety. Depression. Nightmares. Problems with jobs and personal relationships.
This sounded all too familiar.
That is because, as neuroscience has shown, the rush of stress hormones released by these events into a developing child’s brain builds a defective neuro-system that we as adults inherit. Which means, in turn, if this person is put into the right set of circumstances as an adult, this can trigger them and they may end up re-living the original trauma and re-experience the stress all over again because their brain was wired to respond to threats in a particular way. Hence, PTSD.
When I reviewed this list, it was number 6 - abandonment - that stung the most because it was the root of “The Memory” that I have had burned into my brain for 40 years. The memory, that when I pulled off the shelf and revisited it, would still bring tears to my eyes as an adult. This one moment in time as a young girl, followed by many similar ones later was the source of my nightmares. My anxious feelings about being left alone and rejected. And my eventual development into a person who needs to be alone at times to sooth herself and recharge.
And, through therapy, seeing that this is also a key fountainhead for my response to stressful situations today as an adult, is making all the difference in the world.
I have been discovering through my mental game of Dizzy Bat that “awareness” and “healing” are not mutually inclusive. Awareness is the first step, but healing is the journey. And for some people, they may never reach the destination. But neuroplasticity - the concept our brains can be rewired - makes it hopeful for getting better.
Recovering will be a long, complex process. But well worth it.
Final Words: Sharing personal stories is a tricky endeavor especially since we all have so many people in our lives who are party to these events. And so it bears mentioning that my ex and I have talked about the "Hail Mary" email (his term, not mine) and our life together during this time. We have both admitted our faults and parts in the failure of our marriage and so I have not disclosed anything that he would not acknowledge himself. I'm grateful, in fact, that he and I have been able to maintain a relatively warm and compassionate relationship - not just for our children but for ourselves. Xoxo.