Police Psychology | PTSD 2: Crash and Burn
by Gary S. Aumiller, PH.D. ABPP
Have you ever had the chance to be in a drunk driving simulation or even play a game on a drunk driving simulator? You try to keep the car on a straight path, but it keeps moving around. Every turn you make for the car is exaggerated and you end up swerving and pretty much out of control down the road. They even have games where you can add a pint of beer or a shot to the mix and see how hard it is to control the car with the extra drink. Essentially, you feel like you are separate from the vehicle, and the vehicle is doing whatever it wants. Until you crash and burn at the end. You almost always crash and burn or else there was no lesson taught.
When you have PTSD (Post Traumatic Stress Disorder), it is very much like being the driver in one of those simulators. You can usually control the directions, but the magnitude of the response is often not connected to the action you thought you made. Your emotions and feeling seem almost not linked to the events that are happening. It weird when you go from calm to angry in a matter of seconds or you go from smiling to crying because someone got a “A” on their report card in a kid’s movie that your child was watching on the Disney channel. There’s a name for all this, of course, us doctors give names for anything and everything. But the name is not as important to understand as the problems this can cause, the fact that it is normal and how to get rid of it!
Putting a Name on It
Depersonalization disorder, or effect, or syndrome is what it is called. It is a feeling that you are in some way detached from your emotions. At times, it feels like you are out of control like driving in a drunk driver simulator. Life goes by too fast for you, and you are screaming in the car as it is moving through, except it is a silent scream that comes from every tissue in your body, every cell. Depersonalization adds to the brain fog that we talked about in PTSD Part 1, except combined with the vestibular effect, you don’t feel like you can do much of anything right. Your view of yourself in control and your capacity to do the right thing is greatly affected. Everything is a chore, and you feel you have to over-concentrate on even the small things to get through the day. It’s exhausting, so you shut down the extra functions in your life. Your body doesn’t show any problems, nothing broken, so others don’t expect less of you. As they expect more and more, you have to shut down more and more. You got the idea, now let me add to it.
Another disorder, effect, syndrome during PTSD is call derealization disorder, nothing seems real anymore. It is like you are seeing your life on TV, or in a dream. It is not real and it doesn’t feel like it is you going through the motions of your own life. It is a feeling that you are watching yourself go through the trials of life from an outside point of view instead of being the one who is acting on it. That sounds similar to depersonalization, but us doctors need to add another step and give something else a label. So we added “de” to another word. Essentially it’s another way to feel further detached to your own body.
Why does this happen? We’ll it is you guess or mine. One theory would be with PTSD sometimes there is some brain changes from the trauma. PET scans show that the use of chemical in the brain change significantly in traumatized person. It shows some structural changes as well, up to 8%. I am always telling people “this is your brain,” and I hold up a piece of paper, then I rip off a corner “and this is your brain on trauma.” (Okay, it is a stupid speaker trick, but it gives a visual image.) With changes to the brain, your probably won’t feel normal.
Another theory is that that you defend yourself again the full pain of the trauma by disassociating from it thus you lose memory, etc. Another viable theory. A third one is that the brain cannot handle the changes and that causes you to get little failures in your functioning. The theories go on and on. Whatever the reason, with PTSD you’re going to be different, so how do you deal with it.
In therapy, I focus on the idea that trauma happened and now you have to find a new normal or else you feel off for a lifetime sometimes. If your brain changed, you need to grow into the new brain. A portion of people blame some trauma in their life for not functioning the rest of their life. How many times have you heard that “when so-and-so left me it ruined my ability to have any further relationship?” Or when “I almost got killed involved by that truck I have been the same psychologically?” And how many times have you heard, “when the bomb blew up when I was in the building it took a while to adjust but I got a better perspective on life and decided to not sweat the small stuff anymore?” See the fix for depersonalization is to learn to accept the change and use them to make oneself active again. Some things you can’t correct and they have to be accepted. Others you can and getting the obsessive mind (another symptom we will talk about next) working on that change can have a major effect. That is why therapeutic intervention is highly necessary, to let the person know what is happening to them is normal, and getting them back to working on building the new person they will be after the trauma.
So, you let them know this is physical. Let them know feeling a little weird is normal, they are not going crazy. Let them know that others will have expectations because they look normal that they can’t meet . Get them functioning with changing their life and growing to whatever changes have happen to them. Point them in a positive direction by re-framing what happen to them as an important part of their future simpler life. Final step is to get them talk of what happen to them as in the past. Get them to review the trauma and instead of re-living it constantly, Think about it as a past event that shaped who they are at the time. That works into the obsession which we will cover later.
So driving you own car in a drunk driving simulator or driving you own body and mind on trauma means being out of control for a while. In a simulator you can learn to enjoy it, and actually if you do the simulator enough you can get some sense of control over the device. With you own mind and body, that will take a little time but the ultimate fix is learning how the mind/body works and making it go from there. Most people trying the simulator do a crash and burn after a few minutes. The game almost always ends with a crash and burn. With PTSD, you decide if you beat the game or crash and burn.
Site Editor: Gary S. Aumiller, Ph.D. ABPP
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