Understanding post traumatic stress injuries
15 Sep 2020
We are all human and, no matter how big and tough we are, if the right thing hits us in the right spot, we can all be injured. These are some of the tell-tale signs of PTSD: heightened physiological arousal, hypervigilance, irritability, anger and an exaggerated startle response. These are often linked to being haunted by the past via disturbing intrusive memories, images and physiological states.
There is a well-established literature about the causes of traumatic stress injuries and an ever growing scientific understanding about how the body’s stress, memory and survival systems can be changed by traumatic events. In this literature, events that threaten one’s life create a sense of helplessness, fear and vulnerability, and overwhelm the brain’s capacity to assimilate this experience (especially when occurring in an environment that does not support coping or undermines recovery in some way).
However, for many veterans, this way of understanding PTSD does not account for the full range of experiences that can cause deep psychological wounds.
There is a fast growing literature highlighting broader mechanisms of traumatic injury causing PTSD. An individual may be exposed to events that involve horrifying scenes, deep betrayal or behaviour that either deliberately or accidentally transgresses one’s sense of what is right. These can create a sense of threat and harm to one’s moral integrity that is every bit as real and visceral as a threat to one’s physical integrity. Such experiences trigger reactions of shock, horror, ‘pollution’, hopelessness and demoralisation and can lead to a different type of traumatic stress often referred to as moral injury. Moral injury can include many of the same symptoms of PTSD but also includes themes of embitterment, anger, injustice, guilt and shame.
There is a third, often overlooked, category of traumatic stress injury referred to as traumatic loss. When exposed to the sudden, unexpected and sometimes violent death of another person, for example in combat, people may find themselves dwelling on these events and their meaning. There is often a strong sense of personal connection with the deceased person and feelings of responsibility, guilt, helplessness and unbearable sorrow. It is also marked by an inability to accept the loss and difficulty resuming normal activities, lest the person be forgotten or dishonoured.
Undiagnosed PTSD, with its chronic stress, anxiety, anger and guilt, can go unchecked for years and sometimes decades and have a significant impact on veterans’ health and their relationships with family and friends. But PTSD doesn’t have to be a life sentence. You don’t have to suffer alone. There is treatment available which, although challenging, can be tailored to the specific and very personal nature of your traumatic stress injuries and set you on the path to recovery, allowing you to feel less haunted by the past and able to enjoy more meaningful connections with the people who matter.
Dominic Hilbrink is a senior clinician at St John of God Richmond Hospital and manager of the VEAP program. He has proudly worked with veterans and their families for almost twenty years.
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