So let me be the first to acknowledge that I might be committing complete professional suicide with this post. Whenever I have asked anyone for advice, their first piece has been "Whatever you do, don't share with people what's going on." And I'm 25 and dumb and like a true millennial, I'm disregarding the advice of people much wiser than me. But I have a dream that one day every life plagued with mental health challenges will be valued just as much as every other life. 1 in 5 people in the US seek professional help for mental health every year. So when I talk about people with mental health challenges, I'm not talking about the anonymous lunatics roaming public spaces. I'm talking about your family and friends... your "inner circle." I'm talking about you. I'm talking about me.
And I don't have anything revolutionary to say, except for what I just said. But May is Mental Health Awareness month, and I would like to share with you a glimpse of my journey over the past few months.
I temporarily left my job in February because my PTSD became unmanageable. I was forgetting things like I had Alzheimer's, and I couldn't feel normal without risk, chaos, or danger. When things were quiet and everyone was okay, I felt empty and meaningless, which triggered a tidal wave of anxiety... shaking, crying, disorientation, flashbacks... as my dad puts it, "the whole circus coming to town." And the only way I could get myself back in rhythm was to throw myself into the middle of a dangerous situation and fix it. I knew this was dysfunctional and unsustainable, but I could only do three things: fight, flee, or freeze. So I fled.
PTSD could accurately be called a brain injury, because parts of your brain, such as the prefrontal cortex, shut down and stop working. The prefrontal cortex takes up the entire front of your head. If you trace your eyebrows back to your ears and then up to the part of your hair, you've basically outlined it. It's huge, and protected by the forehead: the hardest part of the body, because it's pivotal to human functioning. It plans complex cognitive behavior, expresses personality, makes decisions, and moderates social behavior. So saying something like, "How are you going to cope with your triggers today?" is completely useless to someone with PTSD, because their problem-solving cortex is fried. You will get 1 of three responses: they will defend themselves, avoid the question, or get stuck on one irrelevant topic. That's because reasoning has been passed to the amygdala: the fight, flight, freeze alarm.
The amygdala, alternatively, is a piece of grey matter the size of an almond on the bottom of your brain. Pretty much all it does is pump adrenaline. To have PTSD is to have an almond doing the job of a computer with nothing but a fire hose full of adrenaline. No wonder we sit with our backs against the wall, avoid crowds, throw furniture, and abuse substances at higher rates than any other population. If more than 1 thing is happening, we have no idea what the hell is going on; all we can do is burn up adrenaline.
For women with PTSD, ideas are going to pass from the amygdala through the left frontal lobe and be converted to words before they become actions, so the "fight, flight, freeze" will often manifest verbally. For men, the train doesn't stop anywhere verbal, and ideas are transported directly to the primary motor cortex and are expressed as actions. Men aren't going to verbalize the problem or ask for help, and probably will have no verbal response to the question, "What are you doing?" In my opinion, this is why men with PTSD are 4 times more likely to abuse substances and 4 times more likely to die following a suicide attempt. Women, alternatively, are 5 times more likely to attempt suicide, but they don't die nearly as often. I theorize that women utilize suicide attempts as communication.
Behavior, personality expression, and decision making will be especially more difficult for anyone with PTSD under the age of 25, because the prefrontal cortex fully developed until the age of 25. We don't have the ability to control impulses, which is why we do stupid and dangerous things even if we don't have mental health issues. And for a young person with PTSD, just about all of their impulses are bathed in adrenaline. So if anyone under the age of 25 with PTSD says something like, "I'm going to harm/kill myself," has weapons or substances, is squared up to fight, or is at risk in any way-- someone else needs to stop them because they can't stop themselves. They will not "calm down" or reason with you. They will not "get moving" or "help themselves" or "get it together." Their foot will be on the gas until they hit the wall. Incidentally, I was released from the hospital the day before my 25th birthday.
When I first got to the hospital, I was remarkably clumsy and messy, and frequently confused about places and times. PTSD shrinks the hippocampus, which regulates spatial awareness and memory. So I could usually remember events, but not where I was in time or space. This would spark a slight feeling of fear, which my amygdala would blast with adrenaline. I would begin yelling at people and self-injuring, and I felt like I was in the moment of trauma all over again. I saw the blue face of my deceased loved one everywhere. I finally would just break down crying, repeating, "She was so young, she was so young," and then I would fall asleep. You know this as a "flashback." I spent 12 days wearing earplugs for a majority of the day, and I only felt relief in silence and isolation.
Prior to being hospitalized, I had tried a lot: psychotherapy, EMDR, cranial sacral therapy (that was a trip...), CBT and DBT, group therapy, a day program, talking about the trauma, having a set routine, eating specific diets, etc. etc. Some of these things helped, but clearly none of them kept me safe enough. My trauma had outpaced my brain's healing capacity, which meant it was time to consider medication. I had a lot of views on medication for PTSD which were all stuffed somewhere in my shipwrecked prefrontal cortex. I was prescribed Prazosin, which blocks adrenaline, and for me, it was a miracle. Once they shut off the fire hose, I could finally sit down and look at what I was dealing with.
From there, DBT, art therapy, music therapy, and routine became the next set of healers. With DBT, I charted out each emotion, and what my body feels like when I have those emotions at mild, moderate, and intense levels. Then, at each level, I noted a coping skill that I could use to handle the emotion. Something I learned about myself is that I'm most volatile when my emotions are only moderate. When they escalate to severe, I don't explode; I actually turn inward and commence with the backdoor dangerous behavior. So now, when I find myself yelling, I choose to hear myself yelling for help and I reach out to my supports before I go inward. In addition to keeping me safe, this pulls me out of isolation.
My favorite art therapy project was to draw a box for something I didn't want to think about. I always think about the same thing when my mind is running from something painful. So I drew a calm sea with a red sunset, and whenever that one thought comes, I float it away and seek out whatever I was thinking about before my thoughts fled, and I ask God for courage to face it.
Music is probably just as healing as medication, because it actually activates every part of the brain. It wakes up my prefrontal cortex, flexes my hippocampus, and mellows my amygdala to a manageable rhythm. Music is the neurological opposite of trauma, and I continue to spend time with music for several hours a day, because it literally heals me.
With better sleep, improved emotional intelligence, and practical coping skills, I was discharged from the hospital, and now, I have the strength to process all of my traumas, one at a time. For some, EMDR has been most effective. For others, psychotherapy methods such as writing a letter to my younger self has helped. For others with pieces that remained unresolved, it was time to take the skeletons out of the closet and see them to their caskets. Processing trauma allows me to make plans in reverse: what could I have done, what couldn't I help, what can I do with what I have left. It oils my prefrontal cortex. I still take my medication, and I will most likely go back to a partial hospitalization when I'm ready to start tapering off. I'll do the DBT program again at that time as well, to learn what my emotions feel like and how to manage them when I'm not on medication.
Going back to work has been remarkably healing for me. I like feeling productive, and my organizational skills are better than ever. I spend time at a park by the water after work, reading my Bible and writing in my journal. I still need earplugs in chaotic places. This sensitivity is called "hyperacusis" and is defined as "a collapsed tolerance to normal environmental sounds." My central auditory processing system still scans every sound through the amygdala to check for safety, which makes me really anxious. Something tells me this will be one of the last parts of me to heal.
So until I can take out my earplugs, I would like to ask you to take out yours when it comes to mental health. Listen to those who struggle, read our stories, take a suicide intervention class, read a book about grief, visit an Al-Anon meeting, book a therapy session for something that upsets you, or take whatever step you can to embrace the reality that mental health is a part of life. Isolation is the first step down the path of suicide; we are stronger together.
Oft times, He weaveth sorrow,
And I, in foolish pride,
Forget he sees the upper,
And I, the underside.
And I don't have anything revolutionary to say, except for what I just said. But May is Mental Health Awareness month, and I would like to share with you a glimpse of my journey over the past few months.
I temporarily left my job in February because my PTSD became unmanageable. I was forgetting things like I had Alzheimer's, and I couldn't feel normal without risk, chaos, or danger. When things were quiet and everyone was okay, I felt empty and meaningless, which triggered a tidal wave of anxiety... shaking, crying, disorientation, flashbacks... as my dad puts it, "the whole circus coming to town." And the only way I could get myself back in rhythm was to throw myself into the middle of a dangerous situation and fix it. I knew this was dysfunctional and unsustainable, but I could only do three things: fight, flee, or freeze. So I fled.
PTSD could accurately be called a brain injury, because parts of your brain, such as the prefrontal cortex, shut down and stop working. The prefrontal cortex takes up the entire front of your head. If you trace your eyebrows back to your ears and then up to the part of your hair, you've basically outlined it. It's huge, and protected by the forehead: the hardest part of the body, because it's pivotal to human functioning. It plans complex cognitive behavior, expresses personality, makes decisions, and moderates social behavior. So saying something like, "How are you going to cope with your triggers today?" is completely useless to someone with PTSD, because their problem-solving cortex is fried. You will get 1 of three responses: they will defend themselves, avoid the question, or get stuck on one irrelevant topic. That's because reasoning has been passed to the amygdala: the fight, flight, freeze alarm.
The amygdala, alternatively, is a piece of grey matter the size of an almond on the bottom of your brain. Pretty much all it does is pump adrenaline. To have PTSD is to have an almond doing the job of a computer with nothing but a fire hose full of adrenaline. No wonder we sit with our backs against the wall, avoid crowds, throw furniture, and abuse substances at higher rates than any other population. If more than 1 thing is happening, we have no idea what the hell is going on; all we can do is burn up adrenaline.
For women with PTSD, ideas are going to pass from the amygdala through the left frontal lobe and be converted to words before they become actions, so the "fight, flight, freeze" will often manifest verbally. For men, the train doesn't stop anywhere verbal, and ideas are transported directly to the primary motor cortex and are expressed as actions. Men aren't going to verbalize the problem or ask for help, and probably will have no verbal response to the question, "What are you doing?" In my opinion, this is why men with PTSD are 4 times more likely to abuse substances and 4 times more likely to die following a suicide attempt. Women, alternatively, are 5 times more likely to attempt suicide, but they don't die nearly as often. I theorize that women utilize suicide attempts as communication.
Behavior, personality expression, and decision making will be especially more difficult for anyone with PTSD under the age of 25, because the prefrontal cortex fully developed until the age of 25. We don't have the ability to control impulses, which is why we do stupid and dangerous things even if we don't have mental health issues. And for a young person with PTSD, just about all of their impulses are bathed in adrenaline. So if anyone under the age of 25 with PTSD says something like, "I'm going to harm/kill myself," has weapons or substances, is squared up to fight, or is at risk in any way-- someone else needs to stop them because they can't stop themselves. They will not "calm down" or reason with you. They will not "get moving" or "help themselves" or "get it together." Their foot will be on the gas until they hit the wall. Incidentally, I was released from the hospital the day before my 25th birthday.
When I first got to the hospital, I was remarkably clumsy and messy, and frequently confused about places and times. PTSD shrinks the hippocampus, which regulates spatial awareness and memory. So I could usually remember events, but not where I was in time or space. This would spark a slight feeling of fear, which my amygdala would blast with adrenaline. I would begin yelling at people and self-injuring, and I felt like I was in the moment of trauma all over again. I saw the blue face of my deceased loved one everywhere. I finally would just break down crying, repeating, "She was so young, she was so young," and then I would fall asleep. You know this as a "flashback." I spent 12 days wearing earplugs for a majority of the day, and I only felt relief in silence and isolation.
Prior to being hospitalized, I had tried a lot: psychotherapy, EMDR, cranial sacral therapy (that was a trip...), CBT and DBT, group therapy, a day program, talking about the trauma, having a set routine, eating specific diets, etc. etc. Some of these things helped, but clearly none of them kept me safe enough. My trauma had outpaced my brain's healing capacity, which meant it was time to consider medication. I had a lot of views on medication for PTSD which were all stuffed somewhere in my shipwrecked prefrontal cortex. I was prescribed Prazosin, which blocks adrenaline, and for me, it was a miracle. Once they shut off the fire hose, I could finally sit down and look at what I was dealing with.
From there, DBT, art therapy, music therapy, and routine became the next set of healers. With DBT, I charted out each emotion, and what my body feels like when I have those emotions at mild, moderate, and intense levels. Then, at each level, I noted a coping skill that I could use to handle the emotion. Something I learned about myself is that I'm most volatile when my emotions are only moderate. When they escalate to severe, I don't explode; I actually turn inward and commence with the backdoor dangerous behavior. So now, when I find myself yelling, I choose to hear myself yelling for help and I reach out to my supports before I go inward. In addition to keeping me safe, this pulls me out of isolation.
My favorite art therapy project was to draw a box for something I didn't want to think about. I always think about the same thing when my mind is running from something painful. So I drew a calm sea with a red sunset, and whenever that one thought comes, I float it away and seek out whatever I was thinking about before my thoughts fled, and I ask God for courage to face it.
Music is probably just as healing as medication, because it actually activates every part of the brain. It wakes up my prefrontal cortex, flexes my hippocampus, and mellows my amygdala to a manageable rhythm. Music is the neurological opposite of trauma, and I continue to spend time with music for several hours a day, because it literally heals me.
With better sleep, improved emotional intelligence, and practical coping skills, I was discharged from the hospital, and now, I have the strength to process all of my traumas, one at a time. For some, EMDR has been most effective. For others, psychotherapy methods such as writing a letter to my younger self has helped. For others with pieces that remained unresolved, it was time to take the skeletons out of the closet and see them to their caskets. Processing trauma allows me to make plans in reverse: what could I have done, what couldn't I help, what can I do with what I have left. It oils my prefrontal cortex. I still take my medication, and I will most likely go back to a partial hospitalization when I'm ready to start tapering off. I'll do the DBT program again at that time as well, to learn what my emotions feel like and how to manage them when I'm not on medication.
Going back to work has been remarkably healing for me. I like feeling productive, and my organizational skills are better than ever. I spend time at a park by the water after work, reading my Bible and writing in my journal. I still need earplugs in chaotic places. This sensitivity is called "hyperacusis" and is defined as "a collapsed tolerance to normal environmental sounds." My central auditory processing system still scans every sound through the amygdala to check for safety, which makes me really anxious. Something tells me this will be one of the last parts of me to heal.
So until I can take out my earplugs, I would like to ask you to take out yours when it comes to mental health. Listen to those who struggle, read our stories, take a suicide intervention class, read a book about grief, visit an Al-Anon meeting, book a therapy session for something that upsets you, or take whatever step you can to embrace the reality that mental health is a part of life. Isolation is the first step down the path of suicide; we are stronger together.
Oft times, He weaveth sorrow,
And I, in foolish pride,
Forget he sees the upper,
And I, the underside.