Ptsd Symptoms Quotes

Avoiding triggers is a symptom of PTSD, not a treatment for it.

The ORDINARY RESPONSE TO ATROCITIES is to banish them from consciousness. Certain violations of the social compact are too terrible to utter aloud: this is the meaning of the word unspeakable. Atrocities, however, refuse to be buried. Equally as powerful as the desire to deny atrocities is the conviction that denial does not work. Folk wisdom is filled with ghosts who refuse to rest in their graves until their stories are told. Murder will out. Remembering and telling the truth about terrible events are prerequisites both for the restoration of the social order and for the healing of individual victims. The conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma. People who have survived atrocities often tell their stories in a highly emotional, contradictory, and fragmented manner that undermines their credibility and thereby serves the twin imperatives of truth-telling and secrecy. When the truth is finally recognized, survivors can begin their recovery. But far too often secrecy prevails, and the story of the traumatic event surfaces not as a verbal narrative but as a symptom. The psychological distress symptoms of traumatized people simultaneously call attention to the existence of an unspeakable secret and deflect attention from it. This is most apparent in the way traumatized people alternate between feeling numb and reliving the event. The dialectic of trauma gives rise to complicated, sometimes uncanny alterations of consciousness, which George Orwell, one of the committed truth-tellers of our century, called "doublethink," and which mental health professionals, searching for calm, precise language, call "dissociation." It results in protean, dramatic, and often bizarre symptoms of hysteria which Freud recognized a century ago as disguised communications about sexual abuse in childhood. . . .

First, the physiological symptoms of post-traumatic stress disorder have been brought within manageable limits. Second, the person is able to bear the feelings associated with traumatic memories. Third, the person has authority over her memories; she can elect both to remember the trauma and to put memory aside. Fourth, the memory of the traumatic event is a coherent narrative, linked with feeling. Fifth, the person's damaged self-esteem has been restored. Sixth, the person's important relationships have been reestablished. Seventh and finally, the person has reconstructed a coherent system of meaning and belief that encompasses the story of trauma.

Blame is a Defense Against Powerlessness Betrayal trauma changes you. You have endured a life-altering shock, and are likely living with PTSD symptoms— hypervigilance, flashbacks and bewilderment—with broken trust, with the inability to cope with many situations, and with the complete shut down of parts of your mind, including your ability to focus and regulate your emotions. Nevertheless, if you are unable to recognize the higher purpose in your pain, to forgive and forget and move on, you clearly have chosen to be addicted to your pain and must enjoy playing the victim. And the worst is, we are only too ready to agree with this assessment! Trauma victims commonly blame themselves. Blaming oneself for the shame of being a victim is recognized by trauma specialists as a defense against the extreme powerlessness we feel in the wake of a traumatic event. Self-blame continues the illusion of control shock destroys, but prevents us from the necessary working through of the traumatic feelings and memories to heal and recover.

I have met many, many severely distressed people whose daily lives are filled with the agony of both remembered and unremembered trauma, who try so hard to heal and yet who are constantly being pushed down both by their symptoms and the oppressive circumstances of post traumatic life around them.

Ultimately, forgiveness is usually about one thing—“This is for me, not for you.” Hatred is exhausting; forgiveness, or even just indifference, is freeing. To quote Booker T. Washington, “I shall allow no man to belittle my soul by making me hate him.” Belittle and distort and consume. Forgiveness seems to be at least somewhat good for your health—victims who show spontaneous forgiveness, or who have gone through forgiveness therapy (as opposed to “anger validation therapy”) show improvements in general health, cardiovascular function, and symptoms of depression, anxiety, and PTSD. Chapter 14 explored how compassion readily, perhaps inevitably, contains elements of self-interest. The compassionate granting of forgiveness epitomizes this.41

People generally don’t suffer high rates of PTSD after natural disasters. Instead, people suffer from PTSD after moral atrocities. Soldiers who’ve endured the depraved world of combat experience their own symptoms. Trauma is an expulsive cataclysm of the soul. The Moral Injury, New York Times. Feb 17, 2015

Amnesia, which is a loss of memory, is a symptom of many different trauma and/or dissociative disorders, including PTSD, Dissociative Fugue, Dissociative Disorder Not Otherwise Specified and Dissociative Identity Disorder. Amnesia can affect both implicit and explicit memory.

Complex PTSD consists of of six symptom clusters, which also have been described in terms of dissociation of personality. Of course, people who receive this diagnosis often also suffer from other problems as well, and as noted earlier, diagnostic categories may overlap significantly. The symptom clusters are as follows: Alterations in Regulation of Affect ( Emotion ) and Impulses Changes in Relationship with others Somatic Symptoms Changes in Meaning Changes in the perception of Self Changes in Attention and Consciousness

Their manipulation is psychological and emotionally devastating – and very dangerous, especially considering the brain circuitry for emotional and physical pain are one and the same (Kross, 2011). What a victim feels when they are punched in the stomach can be similar to the pain a victim feels when they are verbally and emotionally abused, and the effects of narcissistic abuse can be crippling and long-lasting, even resulting in symptoms of PTSD or Complex PTSD.

So, what role does memory play in the understanding and treatment of trauma? There is a form of implicit memory that is profoundly unconscious and forms the basis for the imprint trauma leaves on the body/mind. The type of memory utilized in learning most physical activities (walking, riding a bike, skiing, etc.) is a form of implicit memory called procedural memory. Procedural or "body memories" are learned sequences of coordinated "motor acts" chained together into meaningful actions. You may not remember explicitly how and when you learned them, but, at the appropriate moment, they are (implicitly) "recalled" and mobilized (acted out) simultaneously. These memories (action patterns) are formed and orchestrated largely by involuntary structures in the cerebellum and basal ganglia. When a person is exposed to overwhelming stress, threat or injury, they develop a procedural memory. Trauma occurs when these implicit procedures are not neutralized. The failure to restore homeostasis is at the basis for the maladaptive and debilitating symptoms of trauma.

In research supported by the National Institutes of Health, my colleagues and I have shown that ten weeks of yoga practice markedly reduced the PTSD symptoms of patients who had failed to respond to any medication or to any other treatment.

Dissociative symptoms—primarily depersonalization and derealization—are elements in other DSM-IV disorders, including schizophrenia and borderline personality disorder, and in the neurologic syndrome of temporal lobe epilepsy, also called complex partial seizures. In this latter disorder, there are often florid symptoms of depersonalization and realization, but most amnesia symptoms derive from difficulties with focused attention rather than forgetting previously learned information.

Yes: we have arrived at our common thread, the underpinning factor that lets us answer our tangled questions about causes and treatments, symptoms and overlaps. Mental disorders—all of them—are metabolic disorders of the brain.

vital that people who have survived violence become habituated to ordinary cues and reminders woven into the fabric of daily life.31 Avoiding triggers is a symptom of PTSD, not a treatment for

At the same time, in my readings, I discovered some evidence that traditional talk therapy might not actually be particularly effective for C-PTSD. In The Body Keeps the Score, van der Kolk writes about how talk therapy can be useless for those whom “traumatic events are almost impossible to put into words.” Some people are too dissociated and distanced from these traumatic experiences for talk therapy to work well. They might not be able to access their feelings, let alone convey them. For others, they’re in such an activated state that they have a hard time reaching into difficult memories, and the very act of recalling them could be retraumatizing. One study showed that about 10 percent of people might experience worsening symptoms after being forced to talk about their trauma.

PTSD is a disorder of recovery, and if treatment only focuses on identifying symptoms, it pathologizes and alienates vets. But if the focus is on family and community, it puts them in a situation of collective healing.” Israel

Somatic Symptoms: People with Complex PTSD often have medical unexplained physical symptoms such as abdominal pains, headaches, joint and muscle pain, stomach problems, and elimination problems. These people are sometimes most unfortunately mislabeled as hypochondriacs or as exaggerating their physical problems. But these problems are real, even though they may not be related to a specific physical diagnosis. Some dissociative parts are stuck in the past experiences that involved pain may intrude such that a person experiences unexplained pain or other physical symptoms. And more generally, chronic stress affects the body in all kinds of ways, just as it does the mind. In fact, the mind and body cannot be separated. Unfortunately, the connection between current physical symptoms and past traumatizing events is not always so clear to either the individual or the physician, at least for a while. At the same time we know that people who have suffered from serious medical, problems. It is therefore very important that you have physical problems checked out, to make sure you do not have a problem from which you need medical help.

I go from Wikipedia to a government page about C-PTSD as it relates to veterans. I read the list of symptoms. It is very long. And it is not so much a medical document as it is a biography of my life: The difficulty regulating my emotions. The tendency to overshare and trust the wrong people. The dismal self-loathing. The trouble I have maintaining relationships. The unhealthy relationship with my abuser. The tendency to be aggressive but unable to tolerate aggression from others.

Physical symptoms such as muscle tension, back problems, stomach distress, constipation, diarrhea, headaches, obesity or maybe even hypertension can be caused by suppressing your emotions. Suppressed anger may also cause you to overreact to people and situations or to act inappropriately. Unexpressed anger can cause you to become irritable, irrational, and prone to emotional outbursts and episodes of depression.

People with Complex PTSD suffer from more severe and frequent dissociation symptoms, as well as memory and attention problems, than those with simple PTSD. In addition to amnesia due to the activity of various parts of the self, people may experience difficulties with concentration, attention, other memory problems and general spaciness. These symptoms often accompany dissociation of the personality, but they are also common in people who do not have dissociative disorders. For example everyone can be spacey, absorbed in an activity, or miss an exit on the highway. When various parts of the personality are active, by definition, a person experiences some kind of abrupt change in attention and consciousness.

the post-traumatic-stress-disordered often vacillate between phases of symptoms, moving from intrusion—the crying and howling nightmares and other asylum-worthy behaviors—to constriction and back, without predictability or reason. It’s one of the many things that undermine their credibility with the outside world: People seem fine for a while, but then they’re not fine, or they go from one extreme set of symptoms to an opposite one.

Posttraumatic stress disorder (PTSD) also has dissociative symptoms as an essential feature. PTSD has been classically seen as a biphasic disorder, with persons alternately experiencing phases of intrusion and numbing... [T]he intrusive phase is associated with recurrent and distressing recollections in thoughts or dreams and reliving the events in flashbacks. The avoidant/numbing phase is associated with efforts to avoid thoughts or feelings associated with the trauma, emotional constriction, and social withdrawal. This biphasic pattern is the result of dissociation; traumatic events are distanced and dissociated from usual conscious awareness in the numbing phase, only to return in the intrusive phase.

Accepting PTSD is like taking baby steps. The progression may be unsteady—often, the progress is so minute that we’re not even aware of it—but at some point, it does bring relief.

The findings indicate that having higher levels of PTSD symptoms, such as being easily startled by ordinary noises or avoiding reminders of the traumatic experience, can be associated with increased risks of ovarian cancer even decades after women experience a traumatic event.” The more severe the trauma symptoms, the more aggressive the cancer proved to be.

Their manipulation is psychological and emotionally devastating – and very dangerous, especially considering the brain circuitry for emotional and physical pain are one and the same (Kross, 2011). What a victim feels when they are punched in the stomach can be similar to the pain a victim feels when they are verbally and emotionally abused, and the effects of narcissistic abuse can be crippling and long-lasting, even resulting in symptoms of PTSD or Complex PTSD.

Although it is important to be able to recognise and disclose symptom of physical illnesses or injury, you need to be more careful about revealing psychiatric symptoms. Unless you know that your doctor understands trauma symptoms, including dissociation, you are wise not to reveal too much. Too many medical professionals, including psychiatrists, believe that hearing voices is a sign of schizophrenia, that mood swings mean bipolar disorder which has to be medicated, and that depression requires electro-convulsive therapy if medication does not relieve it sufficiently. The “medical model” simply does not work for dissociation, and many treatments can do more harm than good... You do not have to tell someone everything just because he is she is a doctor. However, if you have a therapist, even a psychiatrist, who does understand, you need to encourage your parts to be honest with that person. Then you can get appropriate help.

Unfortunately, even as we try to submerge our pain deep down inside, it finds a way to bubble up: Through addiction. Through anxiety. Through eating disorders. Through insomnia. Through all the different PTSD symptoms and self-destructive behaviors that assault survivors experience for years on end. These incidents may last minutes or hours, but their impact lasts a lifetime.

It was difficult to find information because Post Traumatic Stress Disorder was called shell shock during W.W.II, and when Vietnam Vets were found to suffer from the same symptoms after exposure to traumatic war scenes, a study was embarked upon that ended with the new, more appropriate name in 1980. Thomas was diagnosed with P.T.S.D. shortly afterwards, before the term P.T.S.D. was common.

Too often the survivor is seen by [himself or] herself and others as "nuts," "crazy," or "weird." Unless her responses are understood within the context of trauma. A traumatic stress reaction consists of *natural* emotions and behaviors in response to a catastrophe, its immediate aftermath, or memories of it. These reactions can occur anytime after the trauma, even decades later. The coping strategies that victims use can be understood only within the context of the abuse of a child. The importance of context was made very clear many years ago when I was visiting the home of a Holocaust survivor. The woman's home was within the city limits of a large metropolitan area. Every time a police or ambulance siren sounded, she became terrified and ran and hid in a closet or under the bed. To put yourself in a closet at the sound of a far-off siren is strange behavior indeed—outside of the context of possibly being sent to a death camp. Within that context, it makes perfect sense. Unless we as therapists have a good grasp of the context of trauma, we run the risk of misunderstanding the symptoms our clients present and, hence, responding inappropriately or in damaging ways.

Because of media portrayals, clinicians may believe that dissociative identity disorder presents with dramatic, florid alternate identities with obvious state transitions (switching). These florid presentations occur in only about 5% of patients with dissociative identity disorder.(20) How ever, the vast majority of these patients have subtle presentations characterized by a mixture of dissociative and PTSD symptoms embedded with other symptoms, such as post-traumatic depression, substance abuse, somatoform symptoms, eating disorders, and self-destructive and impulsive behaviors.(2,10)

By listening to the “unspoken voice” of my body and allowing it to do what it needed to do; by not stopping the shaking, by “tracking” my inner sensations, while also allowing the completion of the defensive and orienting responses; and by feeling the “survival emotions” of rage and terror without becoming overwhelmed, I came through mercifully unscathed, both physically and emotionally. I was not only thankful; I was humbled and grateful to find that I could use my method for my own salvation. While some people are able to recover from such trauma on their own, many individuals do not. Tens of thousands of soldiers are experiencing the extreme stress and horror of war. Then too, there are the devastating occurrences of rape, sexual abuse and assault. Many of us, however, have been overwhelmed by much more “ordinary” events such as surgeries or invasive medical procedures. Orthopedic patients in a recent study, for example, showed a 52% occurrence of being diagnosed with full-on PTSD following surgery. Other traumas include falls, serious illnesses, abandonment, receiving shocking or tragic news, witnessing violence and getting into an auto accident; all can lead to PTSD. These and many other fairly common experiences are all potentially traumatizing. The inability to rebound from such events, or to be helped adequately to recover by professionals, can subject us to PTSD—along with a myriad of physical and emotional symptoms.

HYPERAROUSAL After a traumatic experience, the human system of self-preservation seems to go onto permanent alert, as if the danger might return at any moment. Physiological arousal continues unabated. In this state of hyerarousal, which is the first cardinal symptom of post-traumatic stress disorder, the traumatized person startles easily, reacts irritably to small provocations, and sleeps poorly. Kardiner propsed that "the nucleus of the [traumatic] neurosis is physioneurosis."8 He believed that many of the symptoms observed in combat veterans of the First World War-startle reactions, hyperalertness, vigilance for the return of danger, nightmares, and psychosomatic complaints-could be understood as resulting from chronic arousal of the autonomic nervous system. He also interpreted the irritability and explosively aggressive behavior of traumatized men as disorganized fragments of a shattered "fight or flight" response to overwhelming danger.

In many countries, antisocial behavior is known to decline during wartime. New York’s suicide rate dropped by around 20 percent in the six months following the attacks, the murder rate dropped by 40 percent, and pharmacists saw no increase in the number of first-time patients filling prescriptions for antianxiety and antidepressant medication. Furthermore, veterans who were being treated for PTSD at the VA experienced a significant drop in their symptoms in the months after the September 11 attacks. One

...the vast majority of these [dissociative identity disorder] patients have subtle presentations characterized by a mixture of dissociative and PTSD symptoms embedded with other symptoms, such as posttraumatic depression, substance abuse, somatoform symptoms, eating disorders, and self-destructive and impulsive behaviors.2,10 A history of multiple treatment providers, hospitalizations, and good medication trials, many of which result in only partial or no benefit, is often an indicator of dissociative identity disorder or another form of complex PTSD.

Many survivors of relational and other forms of early life trauma are deeply troubled and often struggle with feelings of anger, grief, alienation, distrust, confusion, low self-esteem, loneliness, shame, and self-loathing. They seem to be prisoners of their emotions, alternating between being flooded by intense emotional and physiological distress related to the trauma or its consequences and being detached and unable to express or feel any emotion at all - alternations that are the signature posttraumatic pattern. These occur alongside or in conjunction with other common reactions and symptoms (e.g., depression, anxiety, and low self-esteem) and their secondary manifestations. Those with complex trauma histories often have diffuse identity issues and feel like outsiders, different from other people, whom they somehow can't seem to get along with, fit in with, or get close to, even when they try. Moreover, they often feel a sense of personal contamination and that no one understands or can help them. Quite frequently and unfortunately, both they and other people (including the professionals they turn to for help) do misunderstand them, devalue their strengths, or view their survival adaptations through a lens of pathology (e.g., seeing them as "demanding", "overdependent and needy", "aggressive", or as having borderline personality). Yet, despite all, many individuals with these histories display a remarkable capacity for resilience, a sense of morality and empathy for others, spirituality, and perseverance that are highly admirable under the circumstances and that create a strong capacity for survival. Three broad categories of survivorship, with much overlap between them, can be discerned: 1. Those who have successfully overcome their past and whose lives are healthy and satisfying. Often, individuals in this group have had reparative experiences within relationships that helped them to cope successfully. 2. Those whose lives are interrupted by recurring posttraumatic reactions (often in response to life events and experiences) that periodically hijack them and their functioning for various periods of time. 3. Those whose lives are impaired on an ongoing basis and who live in a condition of posttraumatic decline, even to the point of death, due to compromised medical and mental health status or as victims of suicide of community violence, including homicide.

The codependent’s unbalanced relationship patterns eventually lead to serious emotional issues, which they may continue to ignore until it becomes so serious that they begin to manifest symptoms of C-PTSD—hypervigilance, revenge fantasies, mood swings, and isolation. This severe discomfort may feel unfair and wrong, but it’s actually a blessing in disguise.

Avoidance symptoms refer to the way you might avoid going to places, participating in activities, or seeing people who are associated with the traumatic event.

Avoiding triggers is a symptom of PTSD, not a treatment for it.

CONSENSUS PROPOSED CRITERIA FOR DEVELOPMENTAL TRAUMA DISORDER A. Exposure. The child or adolescent has experienced or witnessed multiple or prolonged adverse events over a period of at least one year beginning in childhood or early adolescence, including: A. 1. Direct experience or witnessing of repeated and severe episodes of interpersonal violence; and A. 2. Significant disruptions of protective caregiving as the result of repeated changes in primary caregiver; repeated separation from the primary caregiver; or exposure to severe and persistent emotional abuse B. Affective and Physiological Dysregulation. The child exhibits impaired normative developmental competencies related to arousal regulation, including at least two of the following: B. 1. Inability to modulate, tolerate, or recover from extreme affect states (e.g., fear, anger, shame), including prolonged and extreme tantrums, or immobilization B. 2. Disturbances in regulation in bodily functions (e.g. persistent disturbances in sleeping, eating, and elimination; over-reactivity or under-reactivity to touch and sounds; disorganization during routine transitions) B. 3. Diminished awareness/dissociation of sensations, emotions and bodily states B. 4. Impaired capacity to describe emotions or bodily states C. Attentional and Behavioral Dysregulation: The child exhibits impaired normative developmental competencies related to sustained attention, learning, or coping with stress, including at least three of the following: C. 1. Preoccupation with threat, or impaired capacity to perceive threat, including misreading of safety and danger cues C. 2. Impaired capacity for self-protection, including extreme risk-taking or thrill-seeking C. 3. Maladaptive attempts at self-soothing (e.g., rocking and other rhythmical movements, compulsive masturbation) C. 4. Habitual (intentional or automatic) or reactive self-harm C. 5. Inability to initiate or sustain goal-directed behavior D. Self and Relational Dysregulation. The child exhibits impaired normative developmental competencies in their sense of personal identity and involvement in relationships, including at least three of the following: D. 1. Intense preoccupation with safety of the caregiver or other loved ones (including precocious caregiving) or difficulty tolerating reunion with them after separation D. 2. Persistent negative sense of self, including self-loathing, helplessness, worthlessness, ineffectiveness, or defectiveness D. 3. Extreme and persistent distrust, defiance or lack of reciprocal behavior in close relationships with adults or peers D. 4. Reactive physical or verbal aggression toward peers, caregivers, or other adults D. 5. Inappropriate (excessive or promiscuous) attempts to get intimate contact (including but not limited to sexual or physical intimacy) or excessive reliance on peers or adults for safety and reassurance D. 6. Impaired capacity to regulate empathic arousal as evidenced by lack of empathy for, or intolerance of, expressions of distress of others, or excessive responsiveness to the distress of others E. Posttraumatic Spectrum Symptoms. The child exhibits at least one symptom in at least two of the three PTSD symptom clusters B, C, & D. F. Duration of disturbance (symptoms in DTD Criteria B, C, D, and E) at least 6 months. G. Functional Impairment. The disturbance causes clinically significant distress or impairment in at least two of the following areas of functioning: Scholastic Familial Peer Group Legal Health Vocational (for youth involved in, seeking or referred for employment, volunteer work or job training)

Healing dissociation involves differentiating between the past and the present, and you can do so by cultivating mindful awareness of the “here and now” (see here). INTRUSIVE SYMPTOMS

diagnosis of C-PTSD includes the symptoms of PTSD, but also has three additional categories of symptoms: difficulties with emotion regulation, an impaired sense of self-worth, and interpersonal problems. C-PTSD is associated with intrusive flashbacks, feelings of panic, overwhelming feelings of rage, debilitating feelings of hopelessness, chronic feelings of shame, a harsh and unrelenting “inner critic,” and a lack of trust in other people.

Instead of showing visibly distinct alternate identities, the typical DID patient presents a polysymptomatic mixture of dissociative and posttraumatic stressdisorder (PTSD) symptoms that are embedded in a matrix of ostensibly non-trauma-related symptoms (e.g., depression, panic attacks, substance abuse,somatoform symptoms, eating-disordered symptoms). The prominence of these latter, highly familiar symptoms often leads clinicians to diagnose only these comorbid conditions. When this happens, the undiagnosed DID patient may undergo a long and frequently unsuccessful treatment for these other conditions. - Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision, p5

The experience of psychological trauma, as is typically diagnosed (posttraumatic stress disorder [PTSD]), has at least some of the following symptoms: • Reliving the trauma: This can happen through nightmares, flashbacks, or reexperiencing as a result of being in the presence of stimuli reminiscent of the traumatic event. • Efforts to avoid thoughts or feelings that are associated with the trauma. • Efforts to avoid activities or situations that arouse memories of the trauma. • Inability to remember some important aspect of the trauma (psychogenic amnesia). • Marked reduced interest in important activities. • Feeling of a lack of interest or expulsion by others. • Limited affect; such as inability to cherish loving feelings. • A feeling of not having any future (foreshortened future); not expecting to have a career, get married, have children, or live a long life. • Hypervigilance (heightened sensitivity to possible traumatic stimuli).

That question became even more salient to me as I began my clinical work with troubled children. I soon found that the vast majority of my patients had lives filled with chaos, neglect and/or violence. Clearly, these children weren’t “bouncing back”—otherwise they wouldn’t have been taken to a child psychiatry clinic! They’d suffered trauma—such as being raped or witnessing murder—that would have had most psychiatrists considering the diagnosis of post-traumatic stress disorder (PTSD), had they been adults with psychiatric problems. And yet these children were being treated as though their histories of trauma were irrelevant, and they’d “coincidentally” developed symptoms, such as depression or attention problems, that often required medication.

UNDERSTANDING DISSOCIATION Dissociation, like all other symptoms of C-PTSD, is a learned behavior that initially helped you cope with a threatening environment. A neglected or abused child will rely upon built-in, biological protection mechanisms for survival to “tune out” threatening experiences. In adulthood, dissociation becomes a well-maintained division between the part of you involved in keeping up with daily tasks of living and the part of you that is holding emotions of fear, shame, or anger.

Extreme versions of DID occasionally develop in response to particularly horrific ongoing trauma (e.g., children exploited through involvement in years of forced prostitution), with so-called poly-frgamentation, encompassing dozens or even hundreds of personality states. In general, the complexity of dissociative symptoms appears to be consistent with the severity of early traumatiation. That is, less severe abuse will result in fewer dissociative symptoms, and more severe abuse will result in more complex dissociative disorders.

shocking conclusion. It suggested that there appears to be one common pathway to all mental illnesses. Caspi and Moffitt called it the p-factor, in which the p stands for general psychopathology. They argued that this factor appears to predict a person’s liability to develop a mental disorder, to have more than one disorder, to have a chronic disorder, and it can even predict the severity of symptoms. This p-factor is common to hundreds of different psychiatric symptoms and every psychiatric diagnosis. Subsequent research using different sets of people and different methods confirmed the existence of this p-factor.25 However, this research was not designed to tell us what the p-factor is. It only suggests that it exists—that there is an unidentified variable that plays a role in all mental disorders.

All too often, society is horrified with trauma survivors; their symptoms; and the burdens it places on the health care, child welfare, criminal justice, and educational systems—and insufficiently horrified by the systems of oppression that underlie so much trauma, violence, and abuse.

Of course, the diagnosis of PTSD was only itself introduced into psychiatry in 1980. At first, it was seen as something rare, a condition that only affected a minority of soldiers who had been devastated by combat experiences. But soon the same kinds of symptoms—intrusive thoughts about the traumatic event, flashbacks, disrupted sleep, a sense of unreality, a heightened startle response, extreme anxiety—began to be described in rape survivors, victims of natural disaster and people who’d had or witnessed life-threatening accidents or injuries. Now the condition is believed to affect at least 7 percent of all Americans and most people are familiar with the idea that trauma can have profound and lasting effects. From the horrors of the 9/11 terrorist attacks to the aftermath of Hurricane Katrina, we recognize that catastrophic events can leave indelible marks on the mind.

PTSD is curable when one realises how the unconscious mind works and that the symptoms of PTSD are actually the unconscious mind attempting to protect the person experiencing them. With the right therapies it is possible to take a person with extreme PTSD and help them to neutralise all their painful memories and emotions permanently.

Without trauma-informed treatment, traumatized clients may not respond optimally and they may even be re-traumatized by the mental health system if they are labeled as “treatment resistant” because the treatment does not address the core issue of trauma; some may be misunderstood as fabricating or exaggerating their trauma history or symptoms.

Adult survivors of family scapegoating abuse have historically been diagnosed with one or more mental health conditions that ignore the trauma symptoms they are regularly experiencing. Rarely will their most distressing symptoms be recognized as Complex post-traumatic stress disorder (C-PTSD) secondary to growing up in an unstable, non-nurturing, dangerous, rejecting, or abusive family environment.

Thoughts of suicide are common symptoms of combat PTSD. Paradoxically, they are also signs of life. If a person enters the zombielike state of indifference beyond despair, rage, suicidality, and fear, he or she simply dies. This is the testimony of concentration camp survivors and combat veterans. The ability to kill oneself is the bottom line of human freedom. Many combat veterans think daily of suicide. Knowledge that one has this freedom seems to be sustaining.

DID patients often feel very isolated/lonely, in the sense that they believe they are the only one in the universe who is “different” from others and that they do not understand themselves... DePrince et al found that alienation was the only cognitive appraisal variable to differentiate DID from PTSD. While the groups had similar appraisals of shame, betrayal, self-blame, anger, and fear, the DID participants had higher appraisal of themselves as experiencing alienation. This construct is associated with feeling alone, disconnected, and different.

In fact, some might argue that starting C-PTSD treatment by diving into the back of your closet and chasing out your scariest, most deeply buried skeleton is a terrible idea. You could find a murderous clown in the storm drain of your life, and he could start haunting your everyday existence. You could dig up something that triggers you badly and makes your symptoms worse or is so unpleasant to look at that you just quit therapy and never come back. That’s why many trauma therapists try to set up a strong framework of coping mechanisms before people launch into their foundational traumas.

... as Herman (1992b) cogently noted two decades ago, these personality disorders can be iatrogenic, causing harm to individuals as an inadvertent result of the social stigma they carry and the widespread (but not entirely accurate) belief among professionals and insurers that those with Cluster B personality disorders (especially borderline personality disorder[BPD]) cannot be treated successfully, cannot recover, and are a headache to practitioners. For example, the BPD diagnosis continues to be applied predominantly to women often, but not always, in a negative way, usually signifying that they are irrational and beyond help. Describing posttraumatic symptoms as a personality disorder not only can be demoralizing for the client due to its connotation that something is defective with his or her core self (i.e., personality) but also may misdirect the therapist by implying that the patient's core personality should be the focus of treatment rather than trauma-related adaptations that affect but are distinct from the core self. In this way, both therapists and their clients may overlook personality strengths and capacities that are healthy and sources of resilience that can be a basis for building on and enhancing (rather than "fixing" or remaking) the patient's core self and personality.

Admitting the need for help may also compound the survivor's sense of defeat. The therapists Inger Agger and Soren Jensen, who work with political refugees, describe the case of K, a torture survivor with severe post-traumatic symptoms who adamantly insisted that he had no psychological problems: "K...did not understand why he was to talk with a therapist. His problems were medical: the reason why he did not sleep at night was due to the pain in his legs and feet. He was asked by the therapist...about his political background, and K told him that he was a Marxist and that he had read about Freud and he did not believe in any of that stuff: how could his pain go away by talking to a therapist?

Paralysis, rage and disembodiment, three main elements of the Medusa story, are classic symptoms of post-traumatic stress disorder (PTSD). According to trauma healing expert Bessel van der Kolk, numbing, freezing, and immobilization are common responses to trauma, particularly sexual trauma. As well as causing a sense of being emotionally shut down, long-term trauma held in the body can result in ‘stiff,’ ‘rigid,’ or ‘stilted’ movement, posture, and expression, resembling paralysis. Trauma can also erode key social skills of self-control and self-regulation, causing the uncontrollable rage characteristic of PTSD. The brutal separation of head from body, a third element of Medusa’s story, may reflect the dissociation, fragmentation, and disconnection from the body also typical of the post-traumatic state.

Healing childhood trauma is more difficult and complex because the child’s brain is not yet developed. And most children don’t have an adult nearby who is wise and supportive enough to help. On their own, a child will try to think his way out of the trauma, and that’s a task no child is up to. His mind can end up resembling a piece of twine that’s become hopelessly knotted and tangled. The child, and later the adult, will make twisted assumptions about himself, about the world, about life. He will blame himself for the events that caused the trauma. Ultimately, he will disconnect from himself and suffer from depression, dissociation, anxiety, insomnia, negative self-talk, and low self-esteem. Trauma specialists now believe that the experience doesn’t need to be a dramatic, life-endangering accident to cause post-traumatic stress disorder or PTSD. Growing up in a dysfunctional family can cause relational or attachment trauma and lead to complex PTSD symptoms. In a dysfunctional family marked by emotional abuse or neglect, as I have come to view my family, a child is often scapegoated. The family, overtly and covertly, blames a child for their problems as a means of deflecting attention from the real problems. Instead of a single traumatic event, a child in this role might experience a continual barrage of subtle attacks on his worthiness, sense of belonging, and even his very identity. These attacks might come in the form of gaslighting, verbal abuse, and other obvious forms of manipulation. But they also can come in the form of thousands upon thousands of subtle negative facial expressions and sarcastic put-downs over years or decades.

I just want to know if you think I should.” “I think it would cause you severe stress,” Ruby says. “I’d worry the symptoms you described would become even more intense to the point where it would be difficult for you to function.” “But I’m talking on a moral level. Because isn’t it supposed to be worth all the stress? That’s what people keep saying, that you need to speak out no matter the cost.” “No,” she says firmly. “That’s wrong. It’s a dangerous amount of pressure to put on someone dealing with trauma.” “Then why do they keep saying it? Because it’s not just this journalist. It’s every woman who comes forward. But if someone doesn’t want to come forward and tell the world every bad thing that’s happened to her, then she’s what? Weak? Selfish?” I throw up my hand, wave it away. “The whole thing is bullshit. I fucking hate it.

The prediction of false rape-related beliefs (rape myth acceptance [RMA]) was examined using the Illinois Rape Myth Acceptance Scale (Payne, Lonsway, & Fitzgerald, 1999) among a nonclinical sample of 258 male and female college students. Predictor variables included measures of attitudes toward women, gender role identity (GRI), sexual trauma history, and posttraumatic stress disorder (PTSD) symptom severity. Using linear regression and testing interaction effects, negative attitudes toward women significantly predicted greater RMA for individuals without a sexual trauma history. However, neither attitudes toward women nor GRI were significant predictors of RMA for individuals with a sexual trauma history." Rape Myth Acceptance, Sexual Trauma History, and Posttraumatic Stress Disorder Shannon N. Baugher, PhD, Jon D. Elhai, PhD, James R. Monroe, PhD, Ruth Dakota, Matt J. Gray, PhD

Of course, the diagnosis of PTSD was only itself introduced into psychiatry in 1980. At first, it was seen as something rare, a condition that only affected a minority of soldiers who had been devastated by combat experiences. But soon the same kinds of symptoms—intrusive thoughts about the traumatic event, flashbacks, disrupted sleep, a sense of unreality, a heightened startle response, extreme anxiety—began to be described in rape survivors, victims of natural disaster, and people who’d had or witnessed life-threatening accidents or injuries. Now the condition is believed to affect at least 7 percent of all Americans and most people are familiar with the idea that trauma can have profound and lasting effects. From the horrors of the 9/11 terrorist attacks to the aftermath of Hurricane Katrina, we recognize that catastrophic events can leave indelible marks on the mind. We know now—as my research and that of so many others has ultimately shown—that the impact is actually far greater on children than it is on adults.

With regard to complex trauma survivors, self-determination and autonomy require that the therapist treat each client as the "authority" in determining the meaning and interpretation of his or her personal life history, including (but not limited to) traumatic experiences (Harvey, 1996). Therapists can inadvertently misappropriate the client's authority over the meaning and significance of her or his memories (and associated symptoms, such as intrusive reexperiencing or dissociative flashbacks) by suggesting specific "expert" interpretations of the memories or symptoms. Clients who feel profoundly abandoned by key caregivers may appear deeply grateful for such interpretations and pronouncements by their therapists, because they can fulfill a deep longing for a substitute parent who makes sense of the world or takes care of them. However, this delegation of authority to the therapist can backfire if the client cannot, or does not, take ownership of her or his own memories or life story by determining their personal meaning.Moreover, the client can be trapped in a stance of avoidance because trauma memories are never experienced, processed, and put to rest. Helping a client to develop a core sense of relational security and the capacity to regulate (and recover from) extreme hyper- or hypoarousal is essential if the client is to achieve a self-determined and autonomous approach to defining the meaning and impact of trauma memories, a crucial goal of posttraumatic therapy.

Meanwhile, scientists are studying certain drugs that may erase traumatic memories that continue to haunt and disturb us. In 2009, Dutch scientists, led by Dr. Merel Kindt, announced that they had found new uses for an old drug called propranolol, which could act like a “miracle” drug to ease the pain associated with traumatic memories. The drug did not induce amnesia that begins at a specific point in time, but it did make the pain more manageable—and in just three days, the study claimed. The discovery caused a flurry of headlines, in light of the thousands of victims who suffer from PTSD (post-traumatic stress disorder). Everyone from war veterans to victims of sexual abuse and horrific accidents could apparently find relief from their symptoms. But it also seemed to fly in the face of brain research, which shows that long-term memories are encoded not electrically, but at the level of protein molecules. Recent experiments, however, suggest that recalling memories requires both the retrieval and then the reassembly of the memory, so that the protein structure might actually be rearranged in the process. In other words, recalling a memory actually changes it. This may be the reason why the drug works: propranolol is known to interfere with adrenaline absorption, a key in creating the long-lasting, vivid memories that often result from traumatic events. “Propranolol sits on that nerve cell and blocks it. So adrenaline can be present, but it can’t do its job,” says Dr. James McGaugh of the University of California at Irvine. In other words, without adrenaline, the memory fades. Controlled tests done on individuals with traumatic memories showed very promising results. But the drug hit a brick wall when it came to the ethics of erasing memory. Some ethicists did not dispute its effectiveness, but they frowned on the very idea of a forgetfulness drug, since memories are there for a purpose: to teach us the lessons of life. Even unpleasant memories, they said, serve some larger purpose. The drug got a thumbs-down from the President’s Council on Bioethics. Its report concluded that “dulling our memory of terrible things [would] make us too comfortable with the world, unmoved by suffering, wrongdoing, or cruelty.… Can we become numb to life’s sharpest sorrows without also becoming numb to its greatest joys?” Dr. David Magus of Stanford University’s Center for Biomedical Ethics says, “Our breakups, our relationships, as painful as they are, we learn from some of those painful experiences. They make us better people.” Others disagree. Dr. Roger Pitman of Harvard University says that if a doctor encounters an accident victim who is in intense pain, “should we deprive them of morphine because we might be taking away the full emotional experience? Who would ever argue with that? Why should psychiatry be different? I think that somehow behind this argument lurks the notion that mental disorders are not the same as physical disorders.

PTSD is a disorder of recovery, and if treatment only focuses on identifying symptoms, it pathologizes and alienates vets. But if the focus is on family and community, it puts them in a situation of collective healing.

In those early days at the VA, we labeled our veterans with all sorts of diagnoses—alcoholism, substance abuse, depression, mood disorder, even schizophrenia—and we tried every treatment in our textbooks. But for all our efforts it became clear that we were actually accomplishing very little. The powerful drugs we prescribed often left the men in such a fog that they could barely function. When we encouraged them to talk about the precise details of a traumatic event, we often inadvertently triggered a full-blown flashback, rather than helping them resolve the issue. Many of them dropped out of treatment because we were not only failing to help but also sometimes making things worse. A turning point arrived in 1980, when a group of Vietnam veterans, aided by the New York psychoanalysts Chaim Shatan and Robert J. Lifton, successfully lobbied the American Psychiatric Association to create a new diagnosis: posttraumatic stress disorder (PTSD), which described a cluster of symptoms that was common, to a greater or lesser extent, to all of our veterans. Systematically identifying the symptoms and grouping them together into a disorder finally gave a name to the suffering of people who were overwhelmed by horror and helplessness. With the conceptual framework of PTSD in place, the stage was set for a radical change in our understanding of our patients. This eventually led to an explosion of research and attempts at finding effective treatments

Beneath every protective behavior is a feeling (emotion) of the fight, flight, freeze, or fawn. And beneath each feeling (emotion) of the fight, flight, freeze, or fawn is a need to be safe. When we meet that need of safety rather than focus on the protective behavior that does not protect, we begin to deal with the cause and not the symptom.

Many traumatologists see attachment disorder as one of the key symptoms of Complex PTSD. In the psychoeducational phases of working with traumatized clients, I typically describe attachment disorder as the result of growing up with primary caretakers who were regularly experienced as dangerous. They were dangerous by contemptuous voice or heavy hand, or more insidiously, dangerous by remoteness and indifference.

Trauma has the power to reach out from the past and claim new victims,” writes addiction psychiatrist Dr. David Sack in Psychology Today. “Children of a parent struggling with post-traumatic stress disorder can sometimes develop their own PTSD, called secondary PTSD.” He reports that about 30 percent of kids with a parent who served in Iraq or Afghanistan and developed PTSD struggle with similar symptoms. “The parent’s trauma,” he says, “becomes the child’s own and [the child’s] behavioral and emotional issues can mirror those of the parent.”42 Children with a parent who was traumatized during the Cambodian genocide, for example, tend to suffer from depression and anxiety. Similarly, children of Australian Vietnam War veterans have higher rates of suicide than the general population.

Consider changing your scent and see how it affects your mood for the better. Here are some common scents and their effects on your system: Lavender promotes relaxation and restful sleep, reduces heart rate, and soothes muscle pain. Bergamot lowers cortisol (a stress hormone) and decreases depression. Vanilla reduces restlessness and promotes stress relief and relaxation. Orange gives you a dose of energy, reduces anxiety, and has been shown to help with PTSD symptoms. Lemon reduces stress and tension and eases depression and anxiety.

When someone has symptoms in each of those four categories, the DSM label is PTSD. It is really important to remember, however, that PTSD is not the only way that trauma impacts our mental and physical health. The adverse effects of trauma that we discussed at the beginning of the chapter can have just as significant an impact on someone’s life. In fact, the majority of the long-term effects of trauma don’t manifest as PTSD.

Childhood trauma can leave you feeling powerless or helpless, especially if there was no way to stop the abuse or get the love you needed. When trauma is ongoing, these feelings of helplessness can form the basis of your sense of self. In this chapter, you will gain an understanding of depressive symptoms in the context of C-PTSD.

You might have feelings of shame, unworthiness, or helplessness. Perhaps you feel plagued by anxiety or believe that you don’t belong in this world. These kinds of thoughts and feelings might lead you to withdraw from relationships in order to avoid further rejection or hurt. Or, you might use food, alcohol, or drugs to disconnect from or numb yourself to the pain. If you relate to these symptoms, it is important to know that you are not alone. The painful emotions of complex PTSD are remnants of your past. More importantly, you can heal.

There are three main categories of PTSD symptoms: re-experiencing, avoidance, and pervasive feelings of danger.

In contrast to its effectiveness for irrational fears such as spiders, CBT has not done so well for traumatized individuals, particularly those with histories of childhood abuse. Only about one in three participants with PTSD who finish research studies show some improvement.38 Those who complete CBT treatment usually have fewer PTSD symptoms, but they rarely recover completely: Most continue to have substantial problems with their health, work, or mental well-being.39

This study, published in 1991, had one of the best outcomes ever recorded for PTSD. The neurofeedback group had a significant decrease in their PTSD symptoms, as well as in physical complaints, depression, anxiety, and paranoia. After the treatment phase the veterans and their family members were contacted monthly for a period of thirty months. Only three of the fifteen neurofeedback-treated veterans reported disturbing flashbacks and nightmares. All three chose to undergo ten booster sessions; only one needed to return to the hospital for further treatment. Fourteen out of fifteen were using significantly less medication.

ten weeks of yoga practice markedly reduced the PTSD symptoms of patients who had failed to respond to any medication or to any other treatment.

The critical question is this: Do you feel that your therapist is curious to find out who you are and what you, not some generic “PTSD patient,” need? Are you just a list of symptoms on some diagnostic questionnaire, or does your therapist take the time to find out why you do what you do and think what you think? Therapy is a collaborative process—a mutual exploration of your self.

In contrast to its effectiveness for irrational fears such as spiders, CBT has not done so well for traumatized individuals, particularly those with histories of childhood abuse. Only about one in three participants with PTSD who finish research studies show some improvement.38 Those who complete CBT treatment usually have fewer PTSD symptoms, but they rarely recover completely: Most continue to have substantial problems with their health, work, or mental well-being.

The effort to ward off intrusive symptoms, though self-protective in intent, further aggravates the PTSD, for the attempt to avoid reliving the trauma too often results in a narrowing of consciousness, a withdrawal from engagement with others, and an impoverished life.

The critical question is this: Do you feel that your therapist is curious to find out who you are and what you, not some generic “PTSD patient,” need? Are you just a list of symptoms on some diagnostic questionnaire, or does your therapist take the time to find out why you do what you do and think what you think?

Tetris as Therapy Have trouble getting to sleep? Try 10 minutes of Tetris. Recent research has demonstrated that Tetris—or Candy Crush Saga or Bejeweled—can help overwrite negative visualization, which has applications for addiction (such as overeating), preventing PTSD, and, in my case, onset insomnia. As Jane explains, due to the visually intensive, problem-solving characteristics of these games: “You see visual flashbacks [e.g., the blocks falling or the pieces swapping]. They occupy the visual processing center of your brain so that you cannot imagine the thing that you’re craving [or obsessing over, which are also highly visual]. This effect can last 3 or 4 hours. It also turns out that if you play Tetris after witnessing a traumatic event [ideally within 6 hours, but it’s been demonstrated at 24 hours], it prevents flashbacks and lowers symptoms of post-traumatic stress disorder.

The anxiety in my life isn’t every moment. Sometimes it’s manageable. Occasionally I don’t think about it that much. But it’s always lurking.

everyday life experiences, such as relationship problems or unemployment, can produce just as many, and sometimes even more, symptoms of PTSD.

PTSD focuses on experiences of safety, related to life-and-death threat, and the symptoms associated with physiological dysregulation. C-PTSD focuses on experiences of inner security, related to the threat of the Self, and the symptoms associated with psychobiological disorganization.

Research in contemporary exposure treatment, a staple of cognitive behavioral therapy, has similarly disappointing results: The majority of patients treated with that method continue to have serious PTSD symptoms three months after the end of treatment

Unresolved trauma from previous generations can alter the expression of DNA, making subsequent generations more susceptible to certain health issues, increased anxiety, PTSD and wariness to danger. This means that certain mental health or physical symptoms that you are experiencing today at the self level may have actually been inherited from collective traumas that your ancestors went through generations ago.

PTSD symptoms includes hyperarousal, hostility, mistrust, social withdrawal, hopelessness, impulsivity, and low self-esteem, according to the International Statistical Classification of Diseases and Related Health Problems,

Yehuda’s research demonstrates that you and I are three times more likely to experience symptoms of PTSD if one of our parents had PTSD, and as a result, we’re likely to suffer from depression or anxiety.4 She believes that this type of generational PTSD is inherited rather than occurring from our being exposed to our parents’ stories of their ordeals.

exercise? Has

Fear is more of a present-moment emotional experience. Fear is what you experience when you are actually in a stressful or threatening situation.

Anxiety, on the other hand, is more of a future-focused emotion.

One emotion is about the anticipation of an event, and the other is about the actual experience of that event.

Indeed, David Barlow, a leading expert in the treatment of anxiety disorders, has said that one of the most important things people with anxiety problems can do is to learn to stop avoiding their emotions

Children are especially dependent on their parents and caregivers to provide the stability and unconditional love that will help them establish a core of resiliency and a sense of self-efficacy to draw upon when faced with adversity later in life. Childhood events that can lead to PTSD and serious difficulties in regulating emotions, and are often linked in research to cutting, certainly include the most abject forms of abuse—physical, sexual, and emotional. But a child's emotional response system—which is controlled by the still developing brain, the sympathetic nervous system, and stress hormones—can be thrown off-kilter by a wide range of painful experiences, whether they are the result of intentionally abusive acts or purely accidental circumstances. Confusing and overwhelming feelings experienced as a result of adoption or abandonment, natural disasters (such as hurricanes or earthquakes,) deaths in the family, serious illness or disability, or witnessing or being the victim of an accident or violent crime can result in symptoms of posttraumatic stress. These kinds of taxing and traumatic events, as well as other societal stressors—from school bullying to identity struggles to perfectionism to body-image issues and the eating disorders often associated with them—have been linked to cutting in various populations.

...some adolescent survivors describe feeling special, powerful, and sometimes entitled. This is especially true of those for whom excessive attention was part of the abuse relationship by virtue any power they held over the abuser or members of the family - especially their mothers in some cases of father-daughter incest - and of any affection or sexual pleasure they experienced. All of these feelings can coexist with self-loathing and shame or might alternate with them. Some victims experience this power as personally affirming, resulting in feelings of grandiosity, whereas others believe themselves to be malignantly powerful and defective. As children, these victims may have developed the belief that they could willfully manipulate others and "make or break" the family or their peer group (or the broader community setting) with their terrible powers or the secrets they hold. In adolescence these largely implicit ideas no longer manifest mainly or only as the egocentrism associated with early childhood. A more pervasive form of narcissistic entitlement and power and an apparently callous indifference to and contempt for others can lead to conduct disturbances and the victimization of others. Many individuals with apparent sociopathic tendencies and conduct disorders were victimized as children. Such individuals at some point had the capacity for respect, empathy, and genuine social responsibility that was lost and corrupted in the struggle to survive, to make sense of, and to remove themselves from the receiving end of victimization. Identification with the perpetrator and the victimization of others is specifically included as a core feature of complex PTSD.

Psychotherapy is the cornerstone of a multidisciplinary treatment plan for dissociative disorders and other trauma-related disorders and must be incorporated into the interventional strategy; whether the mode of psychotherapy is supportive or psychodynamic in nature, or some combination of various approaches, the treatment must be based on the quality and acuity of the patient’s symptoms.

But in fact, Cambodia is the only nation in the world where it has been demonstrated that symptoms of PTSD and related traumatic illnesses are being passed from one generation to the next.

I went to a psychiatrist (NBC insisted we all go) and told her I had been through traumatic experiences before and understood that the kidnapping would leave “fingerprints” on me for a while. The key was knowing what to expect. If you get blind drunk, you know you’re going to wake up with a hangover. By the same token, I expected post-traumatic stress symptoms—anger, irritability, a sense of isolation—and I experienced those feelings, off and on, for several months. It’s like having the monkey on your back again, and being self-aware helps shake him off.