It has quite surprised me how many people are now trying out writing as a contributory means to help treat PTSD, post traumatic stress disorder. Questions levelled at me, as to how writing helped me, have prompted me to put this post together.

PTSD – the chemistry

In examining PTSD, one of the known factors is that an instance of overwhelming terror can alter the chemistry of the brain, making people more sensitive to adrenaline surges even decades later.

This sensitivity to adrenaline surges is a major factor in post-traumatic stress disorder, in which people can experience normal events as repetitions of the original trauma.  PTSD affects combat veterans, crime victims and millions of others. Its cause has biological basis in its affect on the brain.

New studies in animals and humans suggest that specific sites in the brain undergo these changes. Scientists say the findings may allow development of medications to blunt the biological changes present in post-traumatic stress disorder.

For the brain changes to occur, scientists now say that people usually have to experience the stress as catastrophic, an overwhelming threat to life or safety and one over which they have no control. Less severe stresses, such as the death of a loved one or relentless financial problems, do not seem to trigger the biological changes.

When I started  receiving counselling, it was explained to me like this.

When you are working in a high stress environment such as a war zone or any work where you are subject to regular, frequent and high adrenalin surges the brain is slowly, cumulatively, affected by this regular level of adrenalin in the body. Whilst adrenalin is an incredible aid in the preparation for and enactment of the flight and fight response, it has a side effect in that it ‘eats up’ a chemical called serotonin.

Serotonin is a naturally produced chemical that works in the body as a neuro-transmitter. It is widely thought to be a contributor to feelings of well being and happiness. What is does is smoothly transmit thought processes so that the brain operates in an organised and structured way.  Serotonin also has some cognitive functions, including memory and learning. It’s presence in the body is essential to the regulation of mood, appetite and sleep.

So, when exposure to a work environment or a series of events causes the body to regularly produce adrenalin, the effect is that serotonin levels drop.

As a result, the brain starts to operate less efficiently. Thought processes become less clear, sleep is interrupted, memory confused etc.

Then a major catastrophic event causes a massive adrenalin  and chemical surge in the brain. A hormone called cortisol is released into the amygdala section of the brain, the section that handles memory. This hormone release acts as a memory enhancer. Thus, an incredibly detailed and indelible memory of the catastrophic event is retained by the brain.

This enhanced memory explains, to an extent, why victims of PTSD struggle to ‘forget’ the event and move on and also why they suffer flashbacks and dreams about the event.

PTSD symptoms

I wonder how many people reading this will have heard of PTSD and wondered exactly how victims are affected? How many will have seen veterans talking on TV about experiences and see that brave people become emotional and unable to talk any further, the surge in feelings overcoming their ability to talk.

In fact, symptoms are far more wide ranging than most people realise and can vary widely between individuals. They may develop during the first month after a person witnesses a traumatic event. However, in many  of cases there may be a delay of months or even years before symptoms start to appear.

This is a summary, it is not exclusive, as I am not an expert.

A person with PTSD will often relive the traumatic event through nightmares and flashbacks, and have feelings of isolation, irritability and guilt.

Problems sleeping and find concentrating difficult. The symptoms are often severe and persistent enough to have a significant impact on the person’s day-to-day life.

Some people with PTSD experience long periods when their symptoms are less noticeable. This is known as symptom remission. These periods are often followed by an increase in symptoms. Other people with PTSD have severe symptoms that are constant.

Re-experiencing is the most typical and widely publicised symptom of PTSD.

A victim may involuntarily and vividly relive the traumatic event in the form of flashbacks, nightmares or repetitive and distressing images or sensations. Being reminded of the traumatic event (the trigger) can evoke distressing memories and cause considerable anguish.

Trying to avoid being reminded of the traumatic event is another key symptom of PTSD.

Reminders (triggers) can take the form of people, situations or circumstances that resemble or are associated with the event.

Many victims of PTSD will try to push memories of the event out of their mind. They do not like thinking or talking about the event or events in detail. Think of those WWII veterans who well up when being interviewed for documentaries, a display of emotion repeated by Iraq and Afghan veterans who appear to talk about their experiences in more recent programmes.

Some victims repeatedly ask themselves questions that prevent them from coming to terms with the event. For example, they may wonder why the event happened to them and whether it could have been prevented. Often, they may blame themselves and many feel guilt that they survived when others didn’t.

Someone with PTSD may be very anxious and find it difficult to relax. They may be constantly aware of threats and easily startled. This state of mind is known as hyperarousal. Irritability and anger may be a clear indication of this arousal state.

Some victims try to dampen down their feelings by trying not to feel anything at all. If you know an ex-cop or a veteran who you might describe as a ‘cold fish’ then what they may be showing is emotional numbing, a way of coping.

Someone with PTSD can often seem deep in thought and withdrawn. They may also give up pursuing the activities that they used to enjoy.

Other possible symptoms of PTSD include depression, anxiety and phobias. Drug and alcohol misuse are common as a means to dealing with the symptoms experienced.

PTSD often  leads to the breakdown of relationships and causes work-related problem.

Surprised at the range of symptoms? Imagine trying to cope with them and you will have a handle on the challenges facing victims.

Writing

Many victims, me included find that counselling helps them to understand what is going on within their own minds and bodies. It helps to appreciate how a simple chemical imbalance in the brain has been triggered and how the physical and psychological effects that follow are a result of that imbalance.

But counselling doesn’t fix the symptoms on it’s own. Anti depressants are a great help and they worked for me. The pills help the body restore chemical balance so that the brain can then start to regain control.

For me, writing started as a way of helping the counselling. Like many victims, I became emotional when prompted to talk about experiences and describe what had caused the PTSD in the first place. Like many, I was advised not to worry and to try and make notes to bring back to counselling session that I could use to refer to and which might help the counsellor to help me. I made the notes at times when I felt up to it, writing down what had happened, how I had felt, how it had affected me. I recorded dreams that I had, flashbacks and imaginary. Over the weeks and months I found that writing things down helped my brain to get things focussed, to get my thoughts back in order and to regain structure and control.

It helped immensely.

And had an unexpected benefit when my counsellor was moved to comment on how much she enjoyed my writing.

So, one day I followed her advice again and started to weave the notes jotted down into a novel. The more I wrote the better I felt. There were several dips, several times when I found myself reliving things in a way that I preferred to avoid, but, despite the low points, the overall direction was onwards and upwards.

PTSD affects people in many ways, so what works for one will not necessarily work for another, but the fact that so many people have had such enjoyment out of reading a book that came about in such an unexpected way has given me immense reward. People have contacted me, some have described me as inspiring. That may be. What I can say is that the feedback has inspired me to carry on writing and we’ll just see if it continues to help keep the demons at bay. Not just for me, but also for the many others that have and will experience the nightmare as well.

Recommended reading: How the Mind Forgets and Remembers – Dr Daniel L Schacter.