PTSD: A Breakdown

Many compare life with PTSD to walking through a fogbank.

Post-

You might’ve pictured a grizzled veteran, head in his hands in a gloomy V.A. hospital on the outer edge of town. I know him well. He drinks more than he used to, enough for people to notice. The man is on medications that extinguish his sex life. He’s gained a shit-ton of weight. He wants help, but at what cost? Having driven away his girlfriend with his outbursts and lethargy, he lives with his mom and rarely goes out anymore. Friends call less and less, and he thinks even killing himself isn’t worth the hassle. The soldier won’t burden anyone else if he can help it, but as waking life grows more intolerable, alternatives to ending it seem to keep disappearing.
When exactly does post- begin? The soldier is my brother, a Potawatomi man, a veteran discharged from the Army. The government relocated our tribe not once, but four times. Have we earned “post-” status now that our ancestral home is gone, and we measure our blood in fractions as a way to conserve our culture? If trauma’s effects persist for years like the slow decay of plutonium, is it ever really over?

Since my diagnosis in January of 2016, I’ve sought treatment and therapy to manage and better understand how having PTSD affects myself and others. I’ll bet my brother has PTSD. We shared the same parents. The answer seems obvious, but what is post-traumatic stress disorder? What does the condition actually entail? How do you explain the sense of having been “marked” by tragedy? Trauma hasn’t changed who I am or taken that from me, but it has shaped my outlook. I still hesitate to engage, even with people I love, because I can’t anticipate their moods and prepare for adversity. Whatever the source of your trauma, that’s what translates into the rubric for your lived experience.

You don’t get a PTSD diagnosis just from going through a rough patch. Something scares the hell out of you.

Traumatic

Were I to have a say in how the next edition of the DSM qualifies PTSD, I’d drop the “post” in favor of “traumatic stress injury,” something that mirrors the very real neurological changes trauma makes to the brain. It is always useful to define the terms of your illness. Each departure from the world of the healthy to the realm of the sick consists of unspeakable horrors. Ordinary language fails to truly capture the depth of your Kafka-esque transformation.

First, trauma looks deceiving on paper. Greek for “wound,” trauma (τραῦμα) is sometimes mistaken for an irregular plural noun of Latin origin. While not technically correct, it is both countable and uncountable. The same spelling points to a single ordeal or a series of disasters, concealing the way it hides multitudes. Even used properly it can still fool you into sorting the psychic suffering of others in order of precedence. You may regard yours the same way, elevating stigma while shrinking the concerns of loved ones to near-oblivion without success. Despite the wishes of patients and their caretakers, it never disappears completely.

Think of it in terms of proximate cause: a child grows up in an abusive home. She breaks free as an adult only to fall in with a man that beats her. Following her boyfriend’s arrest, a friend assaults her while she’s passed out drunk. She withdraws from everything and everyone they love, convinced of their worthlessness. Though she lives in a city known for its beauty, she feels unable to enjoy it. While she has friends that care for her deeply, she’s hesitant to reach out, and although she now has a partner who loves her more fiercely than anyone has before, she cannot shake the feeling that the other shoe will drop.

Stress

The earth convulsed beneath the sleeping residents of Northridge at half past four in the morning on Martin Luther King, Jr. Day, 1994. Multiple pulses from eleven miles underground rippled across the San Fernando Valley in its first major quake since 1971. Like with its predecessor, the full extent of damage would not be clear until dawn. Daylight revealed just how many structures previously thought safe were profoundly ill-affected. Freeway overpasses crumbled, sending vehicles and motorcycles careening to the desert valley floor. Steel-frame towers had cracked, exposing critically brittle welds.

Earthquakes don’t need to be especially violent or their destruction particularly widespread for them to have devastating personal consequences. If it’s strong enough to cause damage at home, it makes sense that the same event wouldn’t wreak as much havoc fifty miles away. Like the shaking of the earth, stress is subjective, but is there a Richter scale for trauma?

By 1935, seismologists began rating quakes according to a scale recently devised by Dr. Charles Richter and colleagues. He wished to decode their signature peaks and valleys into something we could all comprehend. His figures weren’t perfect though. Richter’s figures translated the output of the era’s seismometers, tracing shocks to their origins and averaging their severity. Traditional seismographs go wildly off-scale in major quakes, leading to unreliable readings. The threshold at which an earthquake overwhelmed the devices became known as the saturation point.

To make assessments correspond more truthfully with the strength of the shock, Dr. Hiro Kanamori modernized the Richter scale in 1979. He shifted focus from the localized expression of seismic energy to the moment it tears through the earth. This metric takes into account the behavior of a fault’s geometry. PTSD and seismicity have so much in common. Structure informs.

There is no Richter scale for trauma, and if there were, it wouldn’t be fair because it couldn’t be honest. The stresses of a traumatic experience are too specific to each person experiencing it. Although plenty of commonalities exist to make talking about it much easier, the specifics frighten many into silence. Reminded of the earthquake twenty-three years before Northridge, longtime San Fernando Valley residents felt “Jolted by Ghosts of Horrors Past.”

“That’s why it was so terrifying,” survivor Beatte Huesse explained to writers at the LA Times. “It was happening again.”

Disorder

Before COVID, saying the following would seem melodramatic, but here it is: we have always been in crisis. It’s only lately that everyone can see it.

Plenty saw the United States government’s flaccid response to the pandemic coming. My brother, a veteran painfully familiar with America’s indifference to suffering, saw it coming. The lackluster federal response did not shock those with PTSD, most of whom are accustomed to being ignored. Its manifestation was nonetheless infuriating. The poles have shifted, and the world finally reflects the catastrophic visions of people once thought to be crazy.

I always thought if I were going to die in some calamity that I’d at least see it coming: a school shooter, a tornado, gentrification. COVID-19 however came as a surprise. I don’t think I’m bound to catch it and die. I just thought that, if and when the time came, it’d be literally anything else. Full-scale nuclear war would be less surprising—that’s how much trauma has informed my worldview.

If you too survived lockdown with PTSD, you may also carry a secret twinge of guilt at having felt a strange peace inside. It’s only natural. You’ve courted death in some form, and you’re prepared for it to collect you. You’re surfing the spectrum between peace and discomfort with the fact that nothing matters, and if what you’ve learned is true, then life will go on. But we will never go back to “the way things were.” Not psychologically at least. For the time being, and until another socio-seismic shift usurps it, disorder is the new normal.

This piece comes from a manuscript in-progress.