Post Traumatic Stress Disorder
Please see the information below as it pertains to Black and White, a story of a veteran transitioning to civilian life while coping with combat experiences.
According to the National Institute of Mental Health, an estimated 7.7 million American adults ages 18 to 54 have PTSD, or Post Traumatic Stress Disorder. It is estimated that 15% of returning veterans experiencing PTSD seek treatment.
PTSD is a disorder that can develop following a traumatic event that threatens your safety or makes you feel helpless. Following a traumatic event, almost everyone experiences at least some of the symptoms of PTSD.
Military combat is the most common cause in men – but any overwhelming life experience can trigger PTSD, especially if the event is perceived as unpredictable and uncontrollable.
The symptoms don’t decrease over time. You don’t feel a little better each day. In fact, you may start to feel worse. PTSD doesn’t always develop in the hours or days following a traumatic event, although this is most common. For some people, the symptoms of PTSD take weeks, months, or even years to develop.
The symptoms of PTSD can arise suddenly, gradually, or come and go over time. Sometimes symptoms appear seemingly out of the blue. At other times, they are triggered by something that reminds the patient of the original traumatic event, such as a noise, an image, certain words, or a smell. While everyone experiences PTSD differently, there are three main types of symptoms, as listed below.
Jason in Black and White and Post Traumatic Stress Disorder
The character of Jason Keller suffers from Post Traumatic Stress Disorder as is frequently experienced by combat veterans. His symptoms are diverse and cyclical, and as with many PTSD sufferers, various and unique. For him, his traumatic memories are barely kept at bay because of his severe mental awareness, control, avoidance and denial. He is exceptionally strong-willed and has excellent mental control, but while this control is necessary for him to cope, it is not a realistic approach to managing his Post Traumatic Stress Disorder. He cannot control his condition and he will have to learn that before he can cope with it.
Many sufferers from PTSD experience a wide range of symptoms, which can vary from individual. Regardless of the type or the person, PTSD can be an incredibly disabling condition. Jason’s ability to control his panic attack and resultant symptoms are not the result of magic. Ava’s influence is not a mystifying event in this relationship. She offers him a focus point away from his condition, hope for something beyond his current state of despair, hopelessness and depression. She also represents everything that the idealist in Jason lost while losing faith in himself, his life, and everything he’s ever lived and loved, except his mother.
Her involvement in his life has given him something powerful to hold on to, which only infuses his drive to want to obtain some form of stability from his condition. Jason, however, believes that he must control his condition first before he can pursue said hope. Here in lies the problem.
Jason’s Symptoms and Coping Mechanisms
The manifestation of physical responses to his condition are due in part to his anxiety, which is a result of facing repressed memories or feelings. Hence, for this reason and others, Jason experiences anxiety disorders. Anxiety-induced panic attacks, depression and Generalized Anxiety Disorder.
Generalized Anxiety Disorder
GAD, is an anxiety disorder characterized by chronic anxiety, exaggerated worry and tension, even when there is little or nothing to provoke it. are all resultant causes and outlets for his Post Traumatic Stress.
Repression
Because Jason exercises incredible mental control over himself and his actions, including blocking out or completely avoiding (consciously and subconsciously) undesirable triggers, events, images, memories, words, and even the prevention of free association while in an heightened state, any loss of “control” as he deems it, can resurrect traumatic events.
His avoidance and repression during his first few years in combat were predominant themes in his life, enabling him to continue to be fit for command of an armed military unit. This is how the military trains; one must be able to cope with the horrors of war if they are to be an effective soldier.
For this reason, seeking treatment, disclosing symptoms, and even expressing or relaying the feelings associated with PTSD is very discouraged in the military. It is a point of pride for these men and frequently, they avoid any and all related discussions of their symptoms. Even verbalizing or thinking of these connections can trigger a reaction in a patient.
For Jason, as described in the Prologue, he had successfully repressed many unpleasant things associated with his time in the military because he was a “warrior”, an experienced Marine and a man of strength and professionalism.
The traumatic event in Fallujah not the only trigger for the resurrection of the unpleasant memories he’d avoided though; the sense of hopelessness to control situations ignited his condition as well, and continues to do so throughout the events of the novel. Denial, fear, and anxiety are resultant feelings and affects of this hopelessness. Many patients, including Jason, will do anything to avoid feeling this way again.
Jason’s predominant outlet of dealing with these symptoms is to seek adrenaline based activity and exhaustion, avoidance, distraction, and a rigid, self-controlled lifestyle. He seeks these “numbing” activities because, through these, he can control his mind and his body by decreasing the ability for his body to respond to stimuli and by reaching a state of exhaustion that forces the body to rest. Conversely, the adrenaline felt during his running is the closest he can come to battle, which was something he’d at one time thrived on, but the difference is that he subconsciously seeks safe ways to feel that way. He’s kind of a self-controlled adrenaline junky. For someone suffering from depression, this is essential. His exercise is critical to his mental health – there are countless studies that support the connection between decreased depression and exercise.
It’s quite a cyclical process because his body becomes used to the adrenaline and the rush of exercise. If he were to stop these activities, his symptoms of PTSD would not likely return in new ways, or increase in their frequency, but his body would experience a drop in endorphins, which would then trigger his depression.
Jason experiences the following conditions/effects as a result of his PTSD:
Flashbacks
Nearly all PTSD sufferers experience some form of flashback. Most people with PTSD repeatedly relive the trauma in their thoughts during the day and in nightmares when they sleep. These are called flashbacks. Flashbacks may consist of images, sounds, smells, or feelings, and are often triggered by ordinary occurrences, such as a door slamming or a car backfiring on the street. A person having a flashback may lose touch with reality and believe that the traumatic incident is happening all over again.
Flashbacks are terrifying. Jason specifically has flashbacks in the form of vivid images, some fleeting and some quite violent. They are seemingly random, but usually they are triggered by responses to situations in life. Jason cannot control these flashbacks and doesn’t necessarily seek to, he simply wishes to control the results of said reminders and images, which usually trigger other response (panic, anxiety, nightmares). For this reason, he seeks exhaustion, distraction, or adrenaline. He busies his thoughts with the mundane for this reason as well, which is not just his choice, but a part of his GAD.
Generalized Anxiety Disorder
GAD affects about 6.8 million adult Americans. GAD is diagnosed when a person worries excessively about a variety of everyday problems. People with GAD usually realize that their anxiety is more intense than the situation warrants. They can’t relax, startle easily, and have difficulty concentrating. Physical symptoms that often accompany the anxiety include fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, nausea, lightheadedness, feeling out of breath, and hot flashes.
GAD is commonly treated with medication or cognitive-behavioral therapy, but co-occurring conditions must also be treated using the appropriate therapies.
Panic Disorder (Panic Attacks)
Panic Disorders in their various forms affect an average of 6 million Americans. It is characterized by sudden attacks of terror, usually accompanied by a pounding heart, sweatiness, weakness, faintness, or dizziness. During these attacks, people with panic disorder may flush or feel chilled; their hands may tingle or feel numb; and they may experience nausea, chest pain, or smothering sensations. Panic attacks usually produce a sense of unreality, a fear of impending doom, or a fear of losing control.
Jason is highly aware of the process of losing control and suffers from these attacks to the point of losing consciousness, which only increases his fear of circumstances which can contribute to “triggers”. This condition is the most manageable of all of the anxiety disorders.
Clarifications
Jason does not suffer from Social Phobias, or social anxiety disorder; he does not like crowds because he cannot control them. He is not agoraphobic, nor does he shut down emotionally or mentally as a result of his trauma, except in situations in which his panic, loss of control, and anxiety trigger this reaction in him mentally and emotionally. Instead, he is in a constant state of heightened control, seeking to prevent (7 P’s) any instances from occurring. The fear of this occurring for him is his primary motivation for seeking solitude. That, and his desire to heal so that he can be “normal”. As a patient that is ashamed of his condition, he does not want to place himself in any position in which it could exposed.
Jason has an incredibly aware, and intense cognitive connection to his panic attacks which only makes the condition worse. The triggers, which appear without warning, can start the physical response, but his mental state (as he sees the loss of control and hopelessness to stop the attack approach) when an attack begins, only heightens his condition. His hopelessness (which triggers further emotional responses and memories, which are themselves secondary triggers), his loss of control of himself and his environment, and his shame and humiliation contribute to the violence of his condition. Again, in his mind, his inability to control his responses only makes the condition worsen.
Jason does not suffer from OCD, or Obsessive Compulsive Disorder. He is just a Type A personality; he was a well-adjusted young man before entering the military.
Traumatic events that can lead to PTSD include
War
Rape
Natural disasters
A car or plane crash
Kidnapping
Violent assault Sexual or physical abuse
Medical procedures (especially in kids)
Symptoms of post-traumatic stress disorder (PTSD)
PTSD symptoms of increased arousal
Difficulty falling or staying asleep
Irritability or outbursts of anger
Difficulty concentrating
Hyper-vigilance (on constant “red alert”)
Feeling jumpy and easily startled
Re-experiencing the traumatic event
Intrusive, upsetting memories of the event
Flashbacks (acting or feeling like the event is happening again)
Nightmares (either of the event or of other frightening things)
Feelings of intense distress when reminded of the trauma
Intense physical reactions to reminders of the event (e.g. pounding heart, rapid breathing, nausea, muscle tension, sweating)
PTSD symptoms of avoidance and emotional numbing
Avoiding activities, places, thoughts, or feelings that remind you of the trauma
Inability to remember important aspects of the trauma
Loss of interest in activities and life in general
Feeling detached from others and emotionally numb
Sense of a limited future (you don’t expect to live a normal life span, get married, have a career)
Types of treatments for post-traumatic stress disorder (PTSD)
Trauma-focused cognitive-behavioral therapy. Cognitive-behavioral therapy for PTSD and trauma involves carefully and gradually “exposing” yourself to thoughts, feelings, and situations that remind you of the trauma. Therapy also involves identifying upsetting thoughts about the traumatic event–particularly thoughts that are distorted and irrational—and replacing them with more balanced picture.
EMDR (Eye Movement Desensitization and Reprocessing)
EMDR incorporates elements of cognitive-behavioral therapy with eye movements or other forms of rhythmic, left-right stimulation, such as hand taps or sounds. Eye movements and other bilateral forms of stimulation are thought to work by “unfreezing” the brain’s information processing system, which is interrupted in times of extreme stress, leaving only frozen emotional fragments which retain their original intensity. Once EMDR frees these fragments of the trauma, they can be integrated into a cohesive memory and processed.
Family Therapy
Since PTSD affects both you and those close to you, family therapy can be especially productive. Family therapy can help your loved ones understand what you’re going through. It can also help everyone in the family communicate better and work through relationship problems.
Medication
Medication is sometimes prescribed to people with PTSD to relieve secondary symptoms of depression or anxiety, but it does not treat the causes of PTSD.
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Helping a loved one with PTSD
Be patient and understanding. Getting better takes time, even when a person is committed to treatment for PTSD. Be patient with the pace of recovery and offer a sympathetic ear. A person with PTSD may need to talk about the traumatic event over and over again. This is part of the healing process, so avoid the temptation to tell your loved one to stop rehashing the past and move on.
Try to anticipate and prepare for PTSD triggers. Common triggers include anniversary dates; people or places associated with the trauma; and certain sights, sounds, or smells. If you are aware of what triggers may cause an upsetting reaction, you’ll be in a better position to offer your support and help your loved one calm down.
Don’t take the symptoms of PTSD personally. Common symptoms of post-traumatic stress disorder (PTSD) include emotional numbness, anger, and withdrawal. If your loved one seems distant, irritable, or closed off, remember that this may not have anything to do with you or your relationship.
Sources:
American Psychological Association
Psychology Today, Exposure Therapy
United States Department of Veterans Affairs, PTSD Fact Sheet
