The Shepherds Need Help!: Journey through the life of a PTSD survivor

By Dr. Cornell E. Lewis

I and all of the first responders that I know have experienced spontaneous or cued recurrent, involuntary, and intrusive distressing memories of traumatic events. Also, recurrent distressing dreams in which the content or affect of the dream is related to the events. Many times, flashbacks or other dissociative reactions in which I have felt or acted as if the traumatic events are recurring. ore times the not, intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic events physiological reactions to reminders of traumatic events. This book should offer some response to let them know that they are not alone.

• Language: English
• Publisher: BookBaby
• Release date: May 12, 2021
• ISBN: 9781098379087

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Bibliography

Chapter 1

Post-Traumatic Stress Disorder

There are many things that can cause a person to develop PTSD but surely, trauma is the most circumstantial cause. Trauma and events that are controllable in some way by others should be looked at in this case. The hand that I was dealt had many thorns and thistles in it. Many people of color and underserved individuals are dealt into a game that is impossible to win. No one can simply come in and be at their best when there is a different set of rules based on circumstances that one cannot control. To ignore the truth and historical facts concerning the dangers of experienced traumas is a massive part of the problem. For example, I did not ask to be born black, and I did not ask to be put in situations early in life that would label me along the way with letters and derogatory names which encompassed the alphabet. ADHD, PTSD, and oppositional defiant are just a few of the terms that were thrown at me. It seemed that these terms were covered in crazy glue as they stuck to me no matter where I went.

A variety of threats, injuries, and losses could be listed as the serious life events that may lead to post-traumatic stress disorders. When people experience such serious life events, they react at individual psychological, social levels. Loss of social supports at a crucial moment may lead to psychological demoralization, which may contribute to tension and fatigue. Exhaustion will lower coping capacity and lead to the pathological intensification of an otherwise normal psychological response to stress. Subtle forms of brain damage involved in an injury may also affect the person's capacity to process the meaning of the event and may be manifested as changes in mood during the post-traumatic period. Our human response to Post Trauma is represented Fig 1 below (Horowitz, 1983). When a person gets into the denial phase of an event the criticality of a situation is not immediately recognized or known on an expressive level. Examples can be shown in vehicle crashes when one person has a perfectly normal reaction to the events that are happening such as screaming, crying or emotional outbursts. However, the driver who is in denial phase is steering the car in an effort to avoid the situation and, the driver is not fully present at the moment to emote until the car has come to a complete stop. What appears afterwards can be emotional numbness, frantic over-activity to withdrawal, loss of reality, nonexperience, amnesia (complete or partial) and inability to appreciate significance of the situation. An example is the denial that one could have been seriously harmed or killed by actions or inaction directly related to the denial response.

Intrusive

Intrusive thoughts are common in individuals with post-traumatic stress disorder (PTSD). The signs and symptoms of intrusiveness range from hypervigilance, sleep and dream disturbance, topic deviations and overgeneralizations. A consistent theme after a loss or injury is exhibited as rage at the source of the loss or injury. There is also rage at the people who did not experience the same injuries as well as fear of repetition of the events. One might say, I will never let this happen again. Learning takes place through the interaction between short-term memory and long-term memory. Our short-term memory allows us to retain small amounts of information in the mind for a short period of time after which we learn this information by encoding it into long-term memory. One type of task that is frequently used to study short-term memory is a short-term memory span task, in which participants are asked to recall increasingly longer lists of items (e.g., digits) and the longest list in which the subject recalled all the items in the correct order is recorded as the subject’s

Short-term memory span. A larger span indicate that the individual has a greater short-term memory storage capacity (Liu, Squires, Bonita, 2016.)

Urban Youth

Separate lines of research have demonstrated that community violence predicts post-traumatic stress disorder (PTSD) symptoms in youth and, that social support is one protective factor against the development of PTSD symptoms (Affrunti, Suarez, Simpson, 2018). Unexpectedly, the findings of one study indicated that PTSD symptoms relate to deficits in anger recognition more than other displays of negative affect, specifically sadness or fear. Furthermore, PTSD was associated with the over-identification of other expressions of negative affect such as fear (Javdani, Sadeh, Brown, 2017). Accurate perception of facial expressions is a central mechanism for communicating emotional states and is crucial for the development of adaptive social functioning (Eisenberg, Cumberland, & Spinrad, 1998). These deficits in interpersonal functioning may in part reflect the misinterpretation of social cues conveyed via facial expressions (Pietrzak, 2011).

Others find that when teachers are race-neutral or race-evasive, they may be exacerbating youth trauma. For instance, after six pre-service, social studies teachers watched a documentary film that highlighted race and politics to tell a story about the devastation of Hurricane Katrina on New Orleans, Louisiana in 2005. Researcher Garrett, (2011) found that some teachers made no connections to how Black students were disproportionately affected by the disaster and how slow the government response was in sending relief support. Essentially, micro and macro level supports are meant to mitigate the impact from traumatic exposure.

I characterized microlevel supports as skills or individual practices that can support trauma-exposed youth. Additionally, macro level supports focus on programmatic structures and large-scale initiatives that include varying levels of social support.

Early Mental Health Interventions

Early in the mental health field, institutions were not readily accessible and mental health facilities were archaic at best. I have vivid memories of people screaming from the place they called the Hilltop on the Westside of Columbus, Ohio. The actual location of the mental facility where the worst of the worst would go when they could no longer handle society. Those screams could be enough to scare away anyone who may be seeking help for a mental condition. Moreover, I had been a resident at a facility when I was a child, and I can honestly say that the treatment was borderline criminal. The first time I was treated for PTSD was in the fire service in 2004. Voluntarily, I sought help from a counselor in the Employee Assistance Program or EAP. I was going through divorce and working two jobs. The lack of sleep was nerve bending and my issues with money, the kid’s mother and the job were driving me insane. I had come to the conclusion that I was completely responsible for everything that was happening. I wanted to end it all, but I knew that I had kids and I loved them so much even if I did not know how to always express it.

I was so nervous the day that I saw the counselor because I was afraid that I may see someone from my work. As I entered the office, I was pleasantly surprised to see that the lights were not blinding because I had been having headaches from bright lights for about two weeks. The EAP counselor helped me to understand that there was no way that everything could be my fault. At the moment that she said that I broke into tears because I began to realize that there were things in my life that were just not right. I also realized that I could not make anyone happy no matter how hard I tried. Until that moment, I had not looked deeply within myself.

I had a habit of just absorbing everything and never letting it go. In my ignorance, I did not divulge my issues from earlier in my life because no one ever really asked. I had begun drinking heavily again at this time, and it was taking a toll on my life. Post-traumatic stress disorder (PTSD) and Substance Use Disorders (SUD) often co-occur. According to one national epidemiologic study, 46.4% of individuals with lifetime PTSD also met criteria for SUD (Pietrzak et al., 2011).

For example, if someone is asked about drug use, and they state that they have used drugs than the information should be utilized to determine early onset PTSD. Follow-up questions such as, did you grow up in an abusive household or were you abused as a child" should open the eyes of the establishment that training must be more comprehensive. There are people who go to marriage counseling, and they are never asked about past childhood experiences or where some issues are coming from that are causing their current issues.

Whenever I talk to couples, I want to know who they are and where they come from because it helps to know if there are past traumas. Soteriades, Psalta, Leka and Spanoudis 2019 found in their research of occupational stress and musculoskeletal symptoms in firefighters that there is a relatively high percentage of firefighters reporting work-related stress. A much higher percentage of firefighters who also reported musculoskeletal symptoms. Within people who have experienced these issues you will find a deep resilience. It is remarkable what people who have gone through so much can physically and mentally accomplish when they are faced with inhuman circumstances. When you don’t know how the body is affected by stress than it is assumed that things will get better with a pain medication or some other reliever.

Based on decades of research it has become increasingly clear that we can ebb and flow through these phases thereby seeming to exhibit resilience in one moment and mental failure in the next moment. Each phase has its own responsively process.

For example, in the Outcry phasic response, the brain is assessing threats so rapidly and determining fight or flight responses so quickly that a person will act before there is time for the brain to reflect on the threat. It is the same as running simply because you see other people running. Sadness is not the only visible determination of the crying out phase. One can also cry out by exhibiting fear, rage, or the action of begging for something in a very humble way such as expressing a deep and longing desire for help. While evidence-based treatments for PTSD also reduce anger, there is often significant residual anger. In a recent study examining changes in anger and aggression after treatment for PTSD among active-duty service members (Morland et.al, 2020)

Traumatic Brain Injuries

It has long been recognized that in the context of certain life events, brain impingement from head injury and symptoms of traumatic stress goes hand-in-hand. The co-occurrence of traumatic brain injury or TBI and traumatic stress was thrust into the forefront during World War I, when the use of high explosives led to a phenomenon that became known as shell shock (Hayes, 2019). I have suffered an innumerable number of concussions in my life. There was a time when people would say that you could just shake it off" but that has no longer been then case. An area of emerging research examines the notion that TBI and PTSD accelerate cellular and brain aging. In the same vein, PTSD is associated with accelerated aging, as measured by deoxyribonucleic acid (DNA) methylation, which has been linked to increased odds of poor outcomes including lower cognitive performance (Wolf et al., 2016).

As in World War I and other wars, veterans were not believed about the symptoms they were feeling until a significant amount of them began committing suicide or dying early deaths.

The comorbidity or compound problems of concussions and PTSD are a clear sign that many are struggling, but we cannot pinpoint just how many. Traumatic brain injury in sports, once considered an injury you could rub some dirt on and get back in the game afterwards, has risen to the level of a public health epidemic over the past decade (Paolini, 2019). Consistently, one of the major issues of PTSD for the first responder is, we are not allowed to claim to be a super-hero and then ask for mercy at the same time. We are not allowed to feel the same way that everyday citizens feel. This is because we have inadvertently and unrealistically set ourselves up as shepherds of the world.

The ignorance and problematic reporting on PTSD are as much our fault as it is the fault of the institutions we work for and the leadership that is above us. First responders espouse to a code that we try to live up to. People have been fed a steady diet of brotherhood, love and sacrifice so, why would they believe us when we say that we are no longer able to deal with the consequences? Why would fellow countrymen believe us about our pain when we are constantly in our throes of passionate belief regarding badge and unity? We have left ourselves without a leg to stand on when we perpetuate a false reality and caress those who are newly hired to accept our way of life without compunction.

I know many first responders who have become disenchanted with their positions because change has become inevitable. Many are wondering why they cannot simply stay the same and be left alone to make decisions for the sheep. Shepherds do not ask the sheep where they would like to graze. The shepherd is given power by the sheep to choose the best pasture and the most profitable place for the sheep. Shepherds are supposed to