Stress and Trauma

Day 11 of our series on stress.

Wow, it feels like we’ve done heaps in such a short amount of time! But there is still so much to cover that it also feels like it will take forever to reach the end of the month! I have faith that we’ll get there though. We’re a resilient lot, really! We’re almost half way through the month and if you’re reading this, I’d like to thank you for sticking with us and hope you’re enjoying the series.

Today is all about trauma. Like we did in the first few days of the series, it’s probably a good idea to define what we’re dealing with here. So, according to the free dictionary, trauma is a noun:

1. 1. A body wound or shock produced by physical injury, as from an accident.
   2. The condition produced by this.
2. Psychiatry. Psychological shock or severe distress from experiencing a disastrous event outside the range of usual experience, as rape or military combat.
3. Any wrenching or distressing experience, esp. one causing a disturbance in normal functioning.

When I read this definition I am reminded of the simple definition that we learned about earlier in the month – stress is a force, pressure or strain.

Though it seems like it is an extreme form.

So, I’m going to connect the dots for you here and state that trauma is an extreme level of stress.

Like we did with our definition posts, let’s explore those things that create trauma. You’ll notice that many of the things on this list were also on the lists for physical, mental and emotional stress.

• Abuse – physical, sexual, emotional/mental, financial etc
• Bullying
• Car accidents
• Medical crises
• Muggings
• Physical fights
• War
• Yelling
• Injury
• Pregnancy or birth difficulties
• Illness or medical crisis
• Rape
• Animal bites
• Poisoning
• Seeing a distressing news article
• Drug taking
• Watching a distressing movie (I won’t go near horror movies for this reason!!)
• Witnessing someone else experience trauma
• Hearing a story about someone else experiencing trauma

I’ll come back to these final two items as they deserve special mention.

Once again, this list is not exhaustive in its content. There are plenty of other items that need to be added but right now my brain isn’t providing me with what I need. And like stress, trauma is a very individual experience. One person will be impacted by watching a specific movie and another won’t. One person will be impacted by witnessing a car accident and another won’t. There are a lot of factors that come into play.

I feel that the majority of it comes down to the neurobiological stress response that we have already discussed in several posts. We introduced it with Stress and the Triune Brain and continued it with Stress and the Amygdala.

If we’ve identified that trauma is an extreme stress response, doesn’t it make sense that its impacts also come from the stress response?

Except that since trauma is an extreme level of stress, so too are the impacts. In addition to those mentioned previously, people who have been traumatised may also experience items from this list, which has been taken from the Beyond Blue site.

• Re-living the traumatic event – The person relives the event through unwanted and recurring memories, often in the form of vivid images and nightmares. There may be intense emotional or physical reactions, such as sweating, heart palpitations or panic when reminded of the event.
• Being overly alert or wound up – The person experiences sleeping difficulties, irritability and lack of concentration, becoming easily startled and constantly on the lookout for signs of danger.
• Avoiding reminders of the event – The person deliberately avoids activities, places, people, thoughts or feelings associated with the event because they bring back painful memories.
• Feeling emotionally numb – The person loses interest in day-to-day activities, feels cut off and detached from friends and family, or feels emotionally flat and numb.

You’ll notice that some of these items are the same as those we came up with for stress, while others are different. One of the key things to remember about traumatic experiences is that these reactions are an absolutely normal response to a horrid, not normal event (or series of events). And it is possible that these responses can persist for a long period of time and can be diagnosed as Post Traumatic Stress Disorder.

This is a serious mental health concern that can be treated, and yet often isn’t due to stigma and a fear of being thought of as weak. If you have been traumatised and recognise these symptoms as things you have experienced, please, please, please seek support from a medical or mental health professional. And if you come across a professional who doesn’t want to know, find another one who is willing to listen. If you know a friend or family member who has been exposed to trauma and who is not receiving any support, please encourage them to read this post.

It’s important that everyone understands that this response comes about from the violation of our in-built, biological need for survival. It’s not something we can control. That sense of safety can be regained – with support from professionals who understand where it comes from and who have the skills to treat it. If you or someone you know needs some guidance on finding professional support, you can email me at mindseteffect@optusnet.com.au

One more note I’d like to make here. Trauma doesn’t have to be experienced to occur. Witnessing it or simply hearing about it can produce the same results. It’s real and it has a name – vicarious trauma. Many emergency personnel and mental health professionals or those in other helping professions (nurses, social workers, doctors etc) experience it, as do family members caring for someone with a disability, illness or mental health condition. There is support available.

I’d like to leave you with one final thought. There is no shame in reaching out for help.

Warning: If reading this post triggers your stress response, please consider seeking support from your team of professionals.

Reaching for the Light

This was posted on Facebook on August 13 by Kat Lambert and in my opinion it needs to be shared. Widely. It especially needs to be seen by those that live with depression and thoughts of suicide. It’s a long post so you might like to grab a cuppa and settle in. And it’s confronting, so be prepared.

If you experience depression and suicidal thoughts yourself, or have someone close to you that does, please pay attention. These are not things to be played with. They are serious and people need support to get through it! If you’re concerned about yourself or a loved one please reach out. Treatment is available! Either contact your mental health professional or if in crisis after hours, please call Lifeline on 13 1114 from anywhere in Australia.

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I was somewhat reluctant to post this. Not because it’s something I am hesitant to share, but because a lot of other people are posting similar posts. Then I remembered the point of my post, being about breaking the stigma so people feel comfortable asking for the help they need to save their lives.

Obviously the suicide of Robin Williams has taken the world by surprise. How can this hilarious, wonderful human being, who has lit up our faces in lounge rooms and cinemas across the world, and made us laugh so hard that the tears have rolled down our face, have been in such a dark, depressing place that the only way out was for him to take his own life?

And that’s just it. Depression, actually mental illness in general, affects people from all walks of life. Mental illness does not discriminate. Even those that seem the happiest, those that have the ability to light up the room with their enthusiasm, and those that seem to have it all can be fighting their own battles beyond their exterior facade.

Suicide is alarmingly, one of the highest causes of death in the world. Yet, unlike cancer, heart disease, SIDS, and other common illnesses where we raise awareness and we do everything we bloody well can to help our loved ones and the population in general, suicide is swept under the carpet.

Suicide is the “unknown”. People are scared of what they don’t understand. It’s easier to pretend it never happened, or to note the death of a loved one as “sudden” or “unexpected”. Because, God forbid, if you drop that “S” word into the conversation, guaranteed there’s always someone that has an opinion about it. So, on top of the guilt you already feel for not realising that your loved one was in such a horrible place, the guilt and the “what ifs” that run through your mind CONSTANTLY, you need to pretend like your son, your brother, your mother, your sister, died some other way, because otherwise people will judge you, and they’ll judge that family member, that friend, that you loved so dearly and couldn’t save. They’ll judge them for being weak, they’ll judge them for being selfish… And neither of these statements are true. It takes a fuckload of courage to step off that bridge, to pull that trigger, to swallow those pills, knowing that this will be the last time you take a breath, that you’ll never see your loved ones again, that once this has been done, it can not be undone. Once you’ve pulled that trigger it’s all over. Your decision is final.

Suicide is selfish. Are you fucking kidding me? Suicide is anything BUT selfish. Firstly, unless you’ve been in a place where you have not been able to see a way out, unless you’ve been in a place where nothing looks to ever get better, unless you’ve been in a place where you TRULY believe that your family would be less burdened if you weren’t around, then do NOT make assumptions that suicide is selfish.

How about instead of making ridiculous assumptions, we listen? We REALLY listen. Instead of judging people who constantly think about it, instead of judging those who’ve tried it before and failed, instead of making assumptions that these people are just screaming for attention… JUST LISTEN.

Listen to the people that have been there before, listen to those who have lost loved ones, listen to those who right this moment, need someone to listen. Listen to those who need someone, anyone, to tell them that life will get better. Someone to tell them that they are worth it, and that regardless of what they believe, the world would not be the same without them in it. Someone to hold them and tell them it is okay to NOT be okay.

And this is where the system fails. There are a very small amount of people in your life that you’ll feel comfortable opening up to when you’re in this state of mind. And even then, the information you give them is a lot less intense than those emotions, those thoughts that are running through your head. Then the guilt comes. “I’ve just burdened them with my problems. They have their own issues to deal with and I’ve just dumped all of my garbage on them. Maybe they’ll be better off without me. It’s not fair that I keep burdening them over and over again. At least if I’m gone, they won’t have to deal with the burden again and again. Sure they’ll be upset for a small while, but once the initial grieving to deal with my death is over, they’ll go back to their normal lives, and won’t have to worry about their crazy sister, daughter, friend. And I won’t have to feel this pain any more.”

I wish I could say that I’d never had thoughts like that. I wish I could say that I’d never even contemplated taking my own life. But I can’t. I have had thoughts like that, for many years at a time. And there was a time where it felt like suicide was my only option. I became ridiculously close to losing my life, and on more than one occasion.

Seeking help wasn’t always an option. The ironic thing is that if you present at Emergency telling them that you don’t trust yourself to control your suicidal urges at the moment, they’ll shrug it off and tell you that you’re just looking for attention, and to take these sedatives, go home and sleep it off. That courage that you worked up for the previous three hours has been crushed in a matter of seconds. That last hope of help you managed to reach out for, has been thrown in your face. And right then, you make that decision that if you can’t go to a health professional for help, clearly you can’t get help anywhere. The drugs they give you to take home may assist you in sleeping off this period of inability to give in to the urges to take your own life. But next time, and most times, there is a next time, you think about taking yourself to Emergency, you think about reaching out for help, but then you remember last time. You remember the shame you were made to feel, those feelings of little importance, and judgment. So instead of reaching out your hand for help, you reach out your hand for that bottle of pills, for that gun, for that rope, and you truly believe that this is your only way out of the hell that exists inside your head.

Then, after all this, if you’re lucky enough, you’ll end up in Emergency. You’ll be faced with those same nurses and doctors who made you feel ashamed because of your thoughts and feelings. Those who judged you and continue to judge you, those who turned you away, because your illness wasn’t real, and there were patients who NEEDED this service more than you did. If you thought that they’d understand now and things would change, think again. Now you’re the idiot that tried to kill herself when all the other people in Emergency are fighting for their lives. That patient next to you has been in a car crash, and is not expected to last the night. And here you are, distracting them from attempting to save the life of someone who doesn’t want to die. At that moment, the moment you notice their disgust, the moment you feel the shame that has been forced upon you, you make a decision that next time, you won’t fail and you won’t end up back here.

And that is where the problem lies. In our society, even though the stigma around depression has greatly decreased, suicide is still so much, a taboo subject. Clearly, like any illness, there are varying levels of symptoms, and whilst telling your friends that you’ve been depressed, and haven’t been able to eat and sleep is a fine conversation to have, if you dare mention that “S” word, if you dare mention how bad it is for you and how much suicide crosses your mind in a day, prepare to be judged. If you mention that the reason you can’t sleep at night, is because you can’t stop thinking of ending your life. The reason you can’t eat, is because you feel physically sick from the constant suicidal thoughts running through your mind. If you dare mention these things, you’ll be labelled as an attention seeker who is exaggerating your illness. You’ll be made to feel shame, on top of everything else you’re already feeling. And as such, any attempts to reach out for help, will be no more.

Sure, we can just continue to pretend that suicide doesn’t happen. We can pretend that nobody thinks about it. And that there’s nothing we can do to stop people anyway. But where’s that going to get us? Where will we be in 20, 50, 100 years’ time? At exactly the same place we are now. At the exact same fucking place where it is not okay to reach out for help. At the exact same fucking place where we constantly lose loved ones to something that could have been prevented. At the exact same fucking place.

So why don’t we do something about it? I don’t believe human kind can all be so stupid to believe that the current way is working. Talking about suicide doesn’t make people decide to attempt suicide, any more that talking about cancer gives people cancer. Talking about cancer, allows people to look out for the signs, and limit the severity if they notice them. Talking about suicide will do the exact same. Talking about suicide will bring it out of the shadows. Talking about suicide will mean that the person consumed with suicidal thoughts and feelings won’t feel ashamed about talking about it. That the person in this state, won’t feel ashamed to reach out for the help they so desperately need. Talking about suicide will mean that the stigma will be reduced, and when your mother, your child, your dad, your best friend, get to a point where they don’t think they can go on any longer, they will be able to reach out for help. In that split second, the fact that they can reach out for help without feeling ashamed, will save their life. In that split second, that very fact, will save you from heartache of losing someone you love so much and never understanding why. That split second, will save you from feeling such guilt and wondering if there was something you could have done differently, wondering why you didn’t figure out how bad it was for them, wondering “if only” for the rest of your life.

I’m not going to make out it’s an easy task, let’s face it, this is huge. This is massive. This is going to take a tremendous amount of funding. The Government is going to have to step it up a notch so that people can afford help. The Government would have to ensure that help was available to those in need, as so often, too often, patients are turned away due to a lack of available beds. But isn’t it worth a try?

Keep turning your back on suicide, and sweeping it under the carpet if you like, but what you’re really doing is turning your back on loved ones and judging, dismissing their feelings. I’m not telling you have to change your way of thinking, all I’m saying is, at some stage in your life, you’re likely to have a close friend or family member take their life, or at least attempt it, and in that moment, I want you to remember the decision you made right now, to keep this under the carpet. The decision you’re making, which means that your friend and family member hasn’t been able to source the help they need.

Who cares for the carers?

People with mental illness usually have a support team around them. Psychologists, psychiatrists, mental health nurses, social workers, general practitioners. People in mental health organisations such as the Richmond Fellowship (this link is QLD but you can google other states). People handing out medications and people providing emotional support. For the most part, these people do fabulous work in paving the way to wellness.

But there is a whole other population that often gets overlooked. The family and friends. Husbands, wives, sons, daughters, mothers, fathers. The carers. They are often excluded from treatment due to “confidentiality”. How do carers help monitor medications if they don’t have accurate information about which prescriptions to fill or how many tablets are needed? How do they help regulate moods if they aren’t up to speed on which strategies have been used in therapy? And that also means they are unable to provide feedback to give the professional team a full picture of what is happening for their loved one. While I can’t speak for all carers, I know that the ones I have spoken to genuinely want to help support the road to wellness. And they want to respect personal space and privacy.

During periods of illness, carers are often confronted with some pretty tough stuff. Major mood swings. Irrational demands. Thought processes that aren’t based in reality. An inability to reason. Violence; to self and others. Hospital visits. Self-harm. Suicide attempts. Manipulation. Sometimes even homicidal tendencies. And they are often in the middle of the fray, caught up in the maelstrom of chaos.

Chaos

Watching the people they love most in the world go through these experiences is heartbreaking. You watch your spouse with depression stay in bed day after day, week after week. You know that they are in pain and you try everything you know to help them. Encouragement, tough love, praise, cajoling, bringing friends in. You try talking to the doctors but you don’t get anywhere because they can’t talk back. You take over the running of the household, managing the children, cooking, cleaning. And you listen to your husband or wife talk about their inner pain and how much better off you and the children would be without him or her in it. You feel helpless and scared. What if they kill themselves? You wonder what else you can do to help. You don’t always understand why they can’t get themselves out of bed and rejoin the family. You feel lonely because the partner you knew isn’t there anymore. You feel alone because you don’t have your best friend to bounce things off. And you feel hopeless and helpless because the professional team won’t talk to you and tell you what you can do to help. Not to mention feeling guilty, fearful, resentful (of the illness), and a whole host of other emotions.

If you are a carer and can relate to this, please understand. You are not alone. There are hundreds of thousands, or even millions of people with mental illness, and each of them very likely has a group of family and friends around them, feeling exactly the same way you do. That is a lot of people feeling like you.

Exhausted. Stressed. Alone. Afraid. Confused. Helpless. Guilty. Isolated.

That is a lot of stress to deal with. And when you feel it for long periods of time, it is really important that you take care of yourself. Some very simple strategies can make a big difference in how you well you bounce back from the stresses and ultimately in the quality of your life.

When you’re looking at specific strategies there is one thing to keep in mind. Given the amount of stress most carers experience, sometimes thinking about doing extra can be overwhelming. So keep things really simple and you’ll be able to incorporate some of them into your normal routine. Try these:

• Take 3-5 long, slow deep breaths. Try to focus on slowing your breaths down and smoothing them out. This will get some oxygen into your brain and help you think more clearly.
• Pamper yourself. Take a bath, paint your nails, get a massage. This helps you relax your muscles and allows those stress hormones to dissipate.
• Surround yourself with nature. Visit a garden, sit under a tree, get your hands dirty with soil. This will help ground you and release the stress.
• Slow your brain down. Meditate, do yoga, or simply sit on your own for a while and breathe.
• Do something you absolutely love.
• Laugh.
• Connect with other people. Often speaking with other carers can help you realise you aren’t in this on your own and give you a chance to pick some brains about strategies that others have used successfully.
• Talk to someone. Sometimes seeing a professional can help you sort out the jumble in your head and give you some direction.

Australia has a network of carers organisations in each state that provide support for carers. They offer a variety of services, including access to support groups, workshops and counselling. They can also link you in with other services you may need. You can find details on each state’s organisation here, or call 1800 242 636 from anywhere in Australia. Some other countries also have carers organisations, including the UK and USA. Other support organisations in Australia include ARAFMI and COPMI (for the kids).

 

Dementia

When people think about dementia they usually (accurately) think about memory loss, forgetfulness and not recognising others, particularly family members. What most people aren’t aware of is that dementia is classified on the DSM. If you remember from our very first post in this focus month on mental health, the Diagnostic and Statistical Manual is a system for classifying different mental illnesses. So, this means that dementia is a mental health issue.

Dementia can be a complex and confusing illness. Most people know of two illnesses, Dementia and Alzheimer’s, and use the two titles interchangeably. However, they are different. The simplest way of thinking about it is that Alzheimer’s is a type of dementia. This website from a Gold Coast Psychologist shows a youtube video on the essential differences.

So what actually is Dementia? According to this site, dementia is:

“a collection of symptoms that are caused by disorders affecting the brain. It is not one specific disease. Dementia affects thinking, behaviour and the ability to perform everyday tasks. Brain function is affected enough to interfere with the person’s normal social or working life.”

That covers a pretty wide scope!

The early warning signs of the disease are:

• Progressive and frequent memory loss
• Confusion
• Personality change
• Apathy and withdrawal
• Loss of ability to perform everyday tasks

But, these symptoms don’t necessarily mean it is dementia. They could be caused by a number of things, including other neurological disorders and brain tumours. So it is very important to get a proper medical assessment from a qualified professional.

Some of the symptoms common to people who are further along in the illness are:

• Wandering
• Random noises
• Irritability
• Verbal and physical abuse
• Incontinence (both with bladder and bowel), sometimes including smearing of faeces
• Depression
• Hoarding (collecting random items or objects, including those that most would consider useless)
• Repetitive behaviours
• Anxiety or aggression
• Agitation
• Hallucinations, paranoia and delusions
• Inappropriate or offensive behaviours
• Sundowning (becoming restless, particularly in the evening)

Each of these may cover a variety of symptoms under one particular category. One of the most important things to remember is that every person with a type of dementia is different. One person with the disease may show a completely different set of behaviours to the next person. There are specific strategies that can be used to manage category and the Alzheimer’s Australia website has fact sheets on them.

To describe specific behavioural disturbances, strategies to deal with them and how best to treat the dementias would not only take forever, but would also be very complex and long. I was sent an article that covers a lot of that information so thought I would share it with you. It is an academic article with an American focus and is quite technical and lengthy, but it gives really good information. If you would like anything in the article clarified, please seek the advice from either a dementia specialist or a doctor skilled in the illness.

If you have a loved one experiencing these kinds of disturbances it can be very tough to cope with. Often, as one of the closest people to the person with the disease, the behaviour can easily be directed toward you. When you face constant aggression or the need to settle anxiety, or even managing frequent wandering, it can send your emotions into turmoil and your energy levels spiraling downwards. You can feel guilty, overwhelmed, like you aren’t coping, and you can blame yourself for being unable to control the behaviour. All of these emotions are a natural response to the situation. I work with family carers on a daily basis and often see the impacts of caring for someone with dementia. It is very important that you seek support. In Australia there is a network of carers organisations around the country that offer free counselling services along with more practical assistance. You can find contact details for them on our resources page. If you are in a different country, you may also find assistance from a similar organisation. I am aware that the UK and USA have carers organisations. You can probably find them using google. If searching in the USA, try using the term “caregiver”. There are also often dementia specific organisations that offer support and information.