Friday, January 8, 2016

Chronic PTSD, Ada, and Me

This is a cross-post from http://www.teenlibrariantoolbox.com/, something I wrote as part of their special month-long blogathon about mental health issues in YA books. I hope it helps someone somewhere. It's about as personal as I've ever gotten in print, so be nice to me, please.

Chronic Post-Traumatic Stress Disorder, Ada, and Me

Back when I fell to pieces, about ten years ago, the therapist who helped me said that she thought I had Chronic Post-Traumatic Stress Disorder, as a result of years of childhood sexual abuse. She also told me I needed to be on anti-depressant medication, yesterday, and on anti-anxiety medication until my overall health improved.

I didn’t have any qualms about taking medication. It was very clear to me that I needed help. I already took medication to control my asthma and allergy symptoms, and, for that matter, used oral contraception. Medicine to keep me from harming myself and my family, and to help pull me out of my current abyss? Yes, please.

But my scientific mind—I make my living as a writer, but I was trained to be a research chemist—had questions. The psychologist was telling me that 1) my symptoms were a direct result of the abuse in my past; and 2) my symptoms were the result of faulty chemistry in my brain. For this to be true, then my abusive past had to have caused my faulty brain chemistry. (Clearly there could be a genetic predisposition as well, which I think likely looking up the branches of my family tree.)

Ten years ago my psychologist said, probably yes. Today, with a decade more of neuroscientific research on the topic, we know that the answer is actually, oh hell yes. Chronic Post-Traumatic Stress Disorder is similar to the sort of PTSD that battlefield veterans get, but differs in some specific ways important in terms of its treatment. (For more on this, I recommend the excellent book The Body Keeps The Score, by Bessel Van Der Kolk, M.D.)

I get annoyed when people say glibly, “Oh, trigger warning,” about something that might make a person a teeny bit upset. A real trigger feels like an explosion. An atom bomb. Something, some small phrase, or sound, or smell—especially smell—sends those of us with PTSD straight back into the actual experience of our trauma—the sights, the sounds, and especially the terror. Real triggers set off wailing air-raid sirens in my nonverbal brain—what I call my Inner Lizard—and I descend straight into memories of forty years ago, as though they are my current reality. Telling myself that I’m grown up, I’m safe, I’m strong, doesn’t help at all—my Inner Lizard can’t access verbal logic. I can only be soothed by what is physical—such as my heavy blanket, a special therapeutic comforter that weighs 25 pounds—or chemical, such as Atavan.

Trauma survivors avoid triggers at all costs. Luckily, most of us have become ace at a handy defense mechanism called dissociation. It’s when we psychically leave a situation we can’t physically escape. Our bodies and brains disconnect. This keeps us more-or-less sane through moments of crisis, but unfortunately can cause to big problems in dealing with the everyday, non-traumatic world. Once you’ve learned to dissociate, you can’t always stop doing it, even in times when you’d like to stay fully present and aware. And people hate it when you leave them.

In my novel, The War That Saved My Life, triggers, flashbacks, and dissociation plague my ten-year-old protagonist. Ada has grown up imprisoned by disability and by physical and mental abuse. She’s evacuated—this is London, World War II—to the home of a woman who treats her kindly, but Ada carries internal scars. She dissociates when people touch her. Several incidents—memories of her mother’s insults, the smell of damp air raid shelter—send her into full-blown meltdowns. Because it’s England, 1939, I can’t give my dear Ada modern medication, nor can I give her the trained, patient help of a modern therapist. (Even 30 years ago, therapy quite often did more harm than good to people with Chronic PTSD. My current psychiatrist says it’s one of the most challenging mental health problems to treat.) But I give her all the small things that I found helped me along the way. Ponies. (I’m not being funny—look up the use of horses in therapy.) Being wrapped tightly in a blanket. Physical ways to counteract triggers—such as Susan hanging sage and lavender in the air raid shelter, to mask the damp smell. Susan learns to be patient and careful about how she physically interacts with Ada; Ada learns to keep breathing through her distress.

It’s a slow process. There’s never a magic turning point in the book in which Ada is suddenly healed. Trauma survivors don’t heal like that. In nurturing, safe environments we can advance in small steps, gradually rebuilding ourselves from the shattered pieces of our past. Then, if we’re very lucky—as I was--we become better, more empathetic, more compassionate versions of who we might have been. I would prefer not to understand trauma as well as I do. Yet without my past I never could have written The War That Saved My Life. I can’t say I’m grateful I was harmed. I’m not. I know I’m lucky to have healed as fully as I did. And yet—I’m grateful I could write this book. Grateful every day, to have told Ada’s story well