I’ve had a lot of reasons to think about PTSD lately. The ideas in this post have been bubbling forth lately and I thought I’d try to write them down as they are developing.
PTSD as a defined diagnostic category is a sort of severe anxiety response to trauma characterized by long-term hyper-vigilance and a hair-trigger startle response along with a whole host of other symptoms associated with the increased arousal.
I’ve said on this blog before that perhaps all I ever had was PTSD rather than bipolar disorder when I was first (mis) diagnosed with bipolar disorder many years ago now as a teenager. See Undiagnosing Myself. It would have been more correct (in light of the current clinical definition) to refer to the distress of my youth as a post traumatic response since when I was a young woman I had nothing resembling the clinical definition of PTSD as it is now described, being a distinctive anxiety based phenomena.
I now experience something much more PTSD-like. I say PTSD-like because it was chemically and iatrogenically induced by psychiatric drugs…there was no specific external traumatic event. I never had anything like the PTSD-like experience before I used maintenance psychiatric drugs and subsequently withdrew from them and I see it in many others who withdraw from particularly benzodiazepines, but also very commonly with those coming off of antidepressants.
This PTSD-like experience is primarilty a sort of brain injury and insult to the autonomic nervous system. It’s extreme and unrelenting in some people and the autonomic dysfunction tends to cause much more systemic havoc than someone with straight PTSD with a more recognizable and external trauma. These include neuropathies and parasthesias as well as drug and food sensitivities and a whole panoply of other odd and diverse often crippling symptoms. The comparison to PTSD is, to some degree, hypothetical, but parts of the lived experience is very similar indeed.
The response among those coming off psych drugs happens even among people who took these two classes of drug without any prior psychiatric or anxiety history. They were prescribed for muscle pain or some other physical issue for example and not anxiety at all. These drugs are prescribed now for many physical issues outside of psychiatry and so the withdrawal groups see many folks who never had a psychiatric diagnosis and still find themselves in this hell.
Our suffering is often conveniently dismissed as a product of the imagination of one who is mentally ill and so it’s worth noting how many “normal” folks succumb to this too. I don’t do this to give credence to those who think the “mentally ill” cannot accurately report what is happening to their bodies. That is complete BS of course, but the tragic fact is many people do not believe much of anything that comes out of the mouth of someone with a psychiatric label. We need to gain credibility in any way we can. As it stands people are very sick and often denied needed care at this time.
So the second half of the title of this post refers to what I’m calling a post-traumatic response. I think that many so-called mental illnesses are the result of a post traumatic response. Because they do not all have the hallmark signs of PTSD, as currently clinically described, it’s worth making it clear that I absolutely think that what is labeled schizophrenia, bipolar, depression and other forms of anxiety, are often indeed also post traumatic responses. The reason I’m making a distinction is only because of the current clinical understanding of PTSD which is limited to ONE form of post traumatic response at this time which is characterized by extreme forms of anxiety.
Trauma-informed care is a movement which recognizes that trauma precedes much of what gets labeled mental illness. I’m suggesting that we need to clarify all the sorts of manifestations of post-traumatic responses. There have, for example, recently been many studies revealing the fact that those with a schizophrenia diagnosis have trauma in their histories and certainly schizophrenia too is characterized by great fear, but it looks a bit different from the outside. My own personal experience of psychosis, too, suggests whatever fear was there was being experienced very differently from what I am now experiencing that is more like the clinical definition of PTSD.
In any case I certainly saw that trauma was in the lives and histories of most of my clients when I worked as a social worker in mental health. It is an element in the majority of those who get diagnosed with serious mental illness.
Perhaps ultimately we need to understand that trauma causes all sorts of distress and it’s manifestions are many. Right now the clinical definition of PTSD is greatly lacking since numerous phenomena that get labeled mental illness are in large part post-traumatic responses. The other way of going about this is to expand the definition. For now the way it’s all categorized offers nothing but confusion. Of course that is the nature of diagnostic labels in general.
So in short, most mental illness is likely a response to trauma but PTSD as clinically described right now only speaks to one manifestation.
More on the subject on Beyond Meds: