Roadblocks to Recovery

From an outside perspective, it might be difficult for someone who does not have post traumatic stress disorder to understand the difficult road to recovery. People might expect recovery to go by quickly, they might feel as though the event is simply a part of life and something that person needs to get over, or they might not understand why seeking and staying in therapy and taking medication as part of treatment is hard for those with PTSD.

On the other hand, veterans with PTSD going through treatment might approach some hurdles and feel as though they cannot jump over them or that they are a signal that treatment is not working. Both seeking and staying in treatment can prove difficult for someone with PTSD for a multitude of reasons, especially for someone who served in the military. Society looks at people serving in the military and expects them to be immune to trauma, leading that person to associate seeking help with vulnerability or weakness1.

As a society, we tend to think in a concrete manner rather than an abstract one. We stigmatize mental illness because there is often no physical injury to point to as the cause or source of the psychological distress. We seem to think that without a wound or scar as evidence, there is no trauma. Psychological bruising or scarring is much different than an external wound, because although our bodies go through relatively the same biological processes to heal, our minds all deal with emotional or psychological trauma in different ways.

The Ghost Rider Foundation aims to educate the general public about PTSD, and one way to accomplish this is to illustrate why the process of recovery is not as easy as swallowing a cure-all pill. Those going through the treatment process also should know that their preoccupations about treatment are not unfounded, but those obstacles are common and do not mean that treatment will be unsuccessful.

Treatment can be very successful for people with PTSD, but listed below are some obstacles to illustrate to the general public that dealing with PTSD is difficult. The way someone with PTSD reacts and responds to certain situations can often be unconscious, so even the person with PTSD can’t explain why they act the way they do. By getting a better understanding of PTSD, the GRF hopes the families of those with PTSD will be better prepared to offer help and support, and the general public will be less apt to prejudge those with PTSD.

Suppressing the pain

One of the main symptoms of PTSD, avoidance, involves one suppressing painful memories by choosing not to talk about them. Traumatic memories are etched into our brains, meaning that memories that are ignored or blocked out are not memories that are forgotten forever. People sometimes will not show symptoms of PTSD until months or years later when, after years of bottling up stressful experiences, a trigger activates that memory when the mind is at its limit for dealing with the accumulation of stress2.

Often, it is difficult for people to talk about their problems with someone who hasn’t gone through a similar experience because they feel as though they won’t be understood. On that same note, people without PTSD tend to avoid asking about traumatic events, change the conversation away from topics that are related to the event, or try to force their opinions about the situation of the individual with PTSD1. This might lead someone with PTSD to believe that people do not or will not want to listen to their problems

Treatment for PTSD has the lowest effectiveness on combat-related PTSD, often related to the nature of the traumatic event being very intense and the tendency to avoid wanting to discuss the trauma or alerting anyone else the symptoms exist3. This does not at all mean treatment is unsuccessful, but it does mean that it can be more difficult to deal with because of the intensity of the traumatic event and the reluctance to want to relive it.

Battling stereotypes

One of the goals of the GRF is to eliminate the uneasiness that people might feel around people with PTSD so that they don’t feel singled out. Some might avoid treatment because they seek a return to a normalcy they had before the traumatic event occurred, and they fear they will be viewed in a different light if they are diagnosed with a mental disorder.  Some might avoid treatment because they don’t want to be labeled as “crazy.”

PTSD is not something that is contained to one specific type of person – anyone who goes through a traumatic event could develop PTSD. For instance, car accidents are a common cause of PTSD because they often are life-threatening situations. If society looks at people with PTSD as substantially different and treats them as outcasts, then that will contribute to one’s decision to avoid or not accept a diagnosis of PTSD.

Ignoring the problem or trying to fix it by one’s self because of either the stigma associated with it or not being aware those symptoms are related to PTSD can be detrimental in the long-run if symptoms do not dissipate on their own. The effects of a traumatic event can naturally go away, but if the symptoms persist for longer than a month than a diagnosis of acute stress disorder is possible4.

If symptoms continue for three months, then a diagnosis of PTSD is possible, and if someone has symptoms of PTSD for six to eight months and does not seek treatment, there is a high likelihood of chronic PTSD developing. If the symptoms have not begun to diminish after three months, there is a small chance that they will naturally recover from the trauma1. Again, diagnosis is not always clear-cut because many people do not immediately show symptoms of PTSD, but early treatment can be valuable to those who do.

Employment

Another roadblock to recovery is the feeling that being diagnosed with a mental disorder will hurt one’s ability to find and maintain employment. In an American Psychiatric Association survey of people in the military, 60 percent said that although they felt seeking mental health care was fairly easy, they thought doing so would negatively affect their careers5.

As a young veteran of the war in Iraq, Operation Iraqi Freedom (OIF), one faces an unemployment rate that is double the national rate. For people whose job experience is mainly military, it can be tough to return home and find a niche in the workforce6.

One also faces being associated with the stigma of the war itself, for people may judge those who served in the military based on their personal opinions of OIF and Operation Enduring Freedom, the war in Afghanistan. This is only exacerbated when PTSD is put into play, because being open with an employer about having a mental illness can be reciprocated with its above mentioned social stigma, with employers feeling uneasy, uncomfortable, and unsure about how to deal with or approach talking about it.

The GRF hopes that by educating the general public, those employers will have a better understanding of what PTSD is, and they won’t use stereotypes and preconceived notions to make a judgment about employees or applicants. On that same token, the GRF also hopes that veterans will not shy away from treatment because of the perceived negative impact it could have on their career.

Sticking with the program

Staying with a recovery plan can be difficult for someone in treatment for a multitude of reasons. Different types of therapy or medication might not begin to show results for weeks7, leading one to believe that treatment is not working. Therapy can be difficult to continue for those with PTSD because it causes them to relive the traumatic event, and not going to therapy is a way to avoid the anxiety associated with doing so8.

If someone is seeking therapy to get rid of the anxiety, he or she might find it counter-productive to go to treatment where he or she is constantly forced to relive the memories and subsequently continue to have symptoms of PTSD. Different types of therapy involving exposure to and reliving the event can be successful, but it is a process that can be difficult to go through. One study showed that the drop-out rate for people in cognitive behavioral therapy was higher for people who went through a more severe or intense traumatic event, because they were more likely to try to avoid reliving the memory9.

Especially since one of the symptoms of PTSD is a shortened sense of the future, the long-term benefits might not outweigh the short-term costs for someone with PTSD because they are not convinced they will ever see a positive outcome. Some see a positive outcome, believe they are cured, and they do not continue with treatment. For people who have chronic PTSD, treatment could last for the rest of their lives. Feeling better during treatment should often be seen as a signal to continue treatment rather than end it.

The magic of medicine

Frequent changes in the dosage and kind of medication prescribed also can make it difficult for one to stay with a treatment program7. Multiple pills may be prescribed at once, and the side effects associated with taking those pills may be worse than the symptoms of PTSD. It’s important to note that there isn’t one cure-all pill to take to eliminate PTSD forever.

Different people react differently to certain medications, so a mixture of pills that works for one person might produce a contradictory response in another person. Trial and error might be the only way that someone finds a manageable combination of prescribed medication, and the process can take its toll on someone who already is emotionally drained from dealing with the aftermath of a traumatic experience.

Recovery can be a difficult process, which is why the support of family and friends can be an irreplaceable asset for someone who has PTSD.

FOOTNOTES

  1. Brewin, Chris R. Posttraumatic Stress Disorder: Malady or Myth? New Haven: Yale UP, 2003.
  2. Allen, Ph.D., Jon G. Coping with Trauma: A Guide to Self-Understanding. Washington, D.C.: American Psychiatric P, 1995.
  3. Bradley, Ph.D., Rebekah, Jamelle Green, M.A., Eric Russ, B.A., Lissa Dutra, M.A., and Drew Westen, Ph.D. "A Multidimensional Meta-Analysis." American Journal of Psychiatry Feb. 2005. 7 July 2008 <http://ajp.psychiatryonline.org/cgi/reprint/162/2/214>.
  4. Diagnostic and Statistical Manual. 4th ed. Washington D.C.: American Psychiatric Association, 2000.
  5. Kingsbury, Kathleen. "Stigma Keeps Troops From PTSD Help." Time 1 May 2008. 26 June 2008 <http://www.time.com/time/health/article/0,8599,1736618,00.html?xid=feed-cnn-topics>.
  6. "The Impact of War: Attitudes, PTSD Complicate Iraq Vet's Job Search." Morning Edition. NPR. 12 Nov. 2007. 7 July 2008 <http://www.npr.org/templates/story/story.php?storyId=16175287>.
  7. Wilson, Jennifer F. "Posttraumatic Stress Disorder Needs to Be Recognized in Primary Care." Annals of Internal Medicine 17 Apr. 2007. 7 July 2008 <http://annals.org/cgi/reprint/146/8/617.pdf>.
  8. Schulz, Priscilla, Reviewer. "A Randomized Trial of Cognitive Therapy and Imaginal Exposure in the Treatment of Chronic Posttraumatic Stress Disorder." Journal of Consulting and Clinical Psychology 1999. 7 July 2008 <http://www.musc.edu/vawprevention/research/trial.shtml>.
  9. Bryant, Richard A., Michelle L. Moulds, Julie Mastrodomenico, Sally Hopwood, Kim Felmingham, and Reginald D. Nixon. "Who Drops Out of Treatment for Post-Traumatic Stress Disorder?" Clinical Psychologist 11 (2007): 13-15. 7 July 2008 <http://www.informaworld.com/smpp/content~content=a772389850~db=all>.