The Impacts of Post-Traumatic Stress Disorder
Discussing the topic of post-traumatic stress can feel particularly overwhelming because so many of us are currently in a state of ongoing post-traumatic stress. Dan and Rachael approach this conversation feeling weary, yet determined to unpack the impacts of PTSD so that we all might have more awareness, understanding, and grace for ourselves and those around us. We especially acknowledge the leaders and helpers – healthcare workers, teachers, parents, friends, and family members helping loved ones.
- Trauma and the Body in Pandemic
- Mental Health: How to Help Kids in a Pandemic
- When Rage Keeps Us From Community
Dan: Well, Rachael, I’m gonna just start by saying, I’m not particularly thrilled, uh, to talk about what we’re gonna talk about. And that is post-traumatic stress, and post-traumatic stress disorder, and the reality of living in an ongoing pandemic and a complicated world, uh, including levels of grief with ongoing racial trauma, ongoing political demonization and divide, and, uh, just the wicked heartbreak of Ukraine. And so we’re gonna talk about trauma which is it’s our work. But I’m like, you need to help me today. This is a bit like that one podcast we did where we both had to acknowledge I’m, we, are not doing well. And especially as we focus something of this labor today on being help to people who like us, are considered to be leaders or helpers, whether you’re a parent whether, you’re a friend, whether or not you are in some position of authority to care for others, nonetheless, we all are in an ongoing post-traumatic stress and we are all so wickedly, tired of talking about this. So, that’s where I’m beginning.
Rachael: Yeah. I hear your words. And I, there is something I felt even in my body, like when we talked about needing to step into some of these waters, you know, I, I just wanna name for those of you listening. We come to this too, with that sense of like, it’s, it’s so pervasive right now, it’s almost overwhelming. And I think, especially for the helpers, right? Like the people who are in positions, pastor leadership, like you just named, therapists, medical professionals, teachers where you really haven’t gotten to stop, like there’s been an ongoing tending to the people in your midst while you’re also tending to your own. And it can feel completely and utterly overwhelming. And almost like, you know what, it’s fine. Let’s just keep surviving. Um, and that’s not to say there’s not moments of reprieve and rest and restoration and joy and all of the parts of being human, but I, I’m just kind of going, like what I’m taking with me today into this is a little, two things. We just talked about this in the Easter podcast last week. But that sense of like, it’s, when we’re in the midst of complex trauma, that’s pretty pervasive. It can feel like there’s just such futility and nothing lasts. And any gains you make in health or, you know, attempting to push back the burnout that’s coming, it feels like it’s so easy for it to be depleted. And just that sense of like our labor because of the resurrection is not in vain. So even the smallest things remain, they matter, they have impact, they change neural pathways and we’ll get into that. And I just think we have to step into this with a sense of, we’re gonna be talking about trying to put some language to what is, what is post-traumatic stress, you know, disorder? What is post-traumatic stress? How does that kind of trauma impact us? We’re gonna put some language to that. Um, we’re gonna have a follow-up conversation around, you know, what do we do? How do we, how do we move toward any kind of healing or hope when that is our reality? So I just wanna state from the beginning, God is with us. And we don’t, our labor is not in vain and we are not left to our own human devices. So this is just a, a place where I need to know something of the spirit of God is with us providing gifts of grace that exceed our human capacity. They don’t deny our humanity or spiritually bypass our humanity. Um, but we do not labor in vain and we do not labor alone and on our own limitations.
Dan: And, uh, to that end, uh, I’m just gonna ask for the privilege to at least for my own heart to acknowledge the presence of Jesus. And so Jesus, for those of our listeners that are too, too weary to even bear more conversation, be their blessing, be the blessing of knowing when to listen to this. Indeed, Jesus give us discernment, even in the conversation, uh, I’m asking for hope, I’m asking for a restoration in my own traumatized body. Um, I ask for the presence of your resurrected body and we pray that for each person listening as well. We pray that in your name. Amen. Well, jumping into what some of our listeners have heard. Let me say it again. There are three huge components to all forms of post-traumatic stress. And that happens to be that all trauma brings fragmentation and it isn’t just, I’m not thinking well, it is that our brain was never meant to hold the complexity of trauma. And so the fact that certain parts of our brain go off and certain brain portions come lighted on. So what goes off just quickly? Uh, our left frontal lobe. Particularly Broca’s area, um, where we manage language, thought, logic, linearity, deduction, will, and choice, um, essentially goes offline. So that’s one of the realities with regard to the effect on memory. When we go through an event that bears significant traumatization, we will not remember it with a kind of “A to B to C, to D” because our brain isn’t working as it normally would to be able to code, to be able to store, and be able to retrieve memory as we normally might, but as well, portions of our brain, like the thalamus, which integrates so much of our visceral, somatic body experience and meaning, that is language, uh, essentially goes offline. So we’re really at a deficit in the middle of, but the portion of our brain in the limbic system called the amygdala, which produces a great deal of our stress by chemicals like cortisol, adrenaline, noradrenaline, catecholamines. It’s a pumping, it’s a movin, in our body so that we are on an evolutionary basis able to fight or flee or make in some sense, uh, the incoent decision to really freeze. So what we’re saying is fragmentation is inevitable in terms of almost all forms of trauma. And before we go a whole lot further, I, what I find is that a lot of people go, yeah, I get it, I get it. But you know, what I’ve been finding for myself and for a lot of others is I would call fragmentation in the normal sense of just the day-to-day sense of up and down, like a kind of graying of our world or fogging of our world. It isn’t just, we’re fragmented and can’t think, it’s that like, I am forgetting so many elemental things. Like Becky asked me just today. Like, do you remember when, so and so visited? And I’m like, no, when, and when she began talking about the event, I’m going, I have zero memory of the event, which wasn’t that terribly long ago. So let’s just spend a moment talking about the haze and fog that grays out our experience of, of life. Yeah.
Rachael: Well, and even just to name, part of why we’re talking about this now and why we’ve talked about it at different iterations of the past few years is we’ve been in this a long while now and that fogginess, like when you think about being in fog, you can’t see in any direction. Can’t see behind you, you can’t see what’s around you. It’s hard to locate yourself in context. I also think about like, you know, like when I think about fogginess, I think of like, um, the incapacity to like locate myself in time. I mean, how many moments, you know, like, so like, oh wait, that was, that was two years ago. Like, like, uh, it feels like it was yesterday, but no, that was two years ago. And like, what did we even do? Like Michael and I were trying to remember what we did last Easter. Couldn’t remember. We totally went to Washington D.C. To see the cherry blossoms. That does not feel like, it was a year ago. It feels like it was three years ago. So that sense of timelessness and not being able to locate things. I mean, I think we’ve joked about this on here before, but like even just trying to, to talk and how many moments I’ve been like, wait, what’s that word? The thing, the door that shuts, it keeps your pantry… cabinet. The cabinet door. Like, and, and then we also know on top of that, for those who have, you know, suffered COVID and the impacts of COVID, we know it’s doing things to the brain and adding to the fogginess and fragmentation. So it’s just frustrating to not be able to access language, to not be able to, um, have like a clear sense of time and memory of things to be able to hold… You know, I was talking to a colleague the other day and she got something confused and she was like, that’s what I get for trying to just hold something in my brain and not looking at a piece of paper. And it’s hard when you still have memory of being able to really hold a lot together in your mind and in your brain. But you find yourself in a season where it’s like, nope. Things definitely just disappear. Yeah. And if it’s, if I don’t have it in front of me, like, I’m maybe not gonna remember. And again, this may not be everyone’s experience, but when there’s been massive disruption that impacts the brain in all the ways you talked about, and sometimes you certainly experience it in the moment, but it can be something that lingers, which is why you have language like a post-traumatic stress. You know, um, often you start to notice it the most when you’re not in as much pervasive trauma in the moment. It’s when all of a sudden the dust starts to settle a little bit, but you can’t quite get back to what was before.
Dan: Yes. And the fact that I know at least a little bit, a little bit about the dorsal lateral prefrontal cortex and the meso limbic prefrontal cortex, where we hold space and time, particularly again, there are other portions of, of the brain that hold that it doesn’t help. It just doesn’t help because I have recollection enough of how I at least think I used to function and the disparity between what was, and what is, creates again, not only this sense of haze, but distortion. So like as a mariner, uh, sailor, uh, particularly in Puget Sound, when thick, thick fog comes. You, you know, you don’t know where sounds coming from you. You think it’s coming from your bow, but actually the fact is, is coming from behind you the stern. So I think with all that sense of haze and fog or forgetfulness, I’m much more like I’m just not able to do what I used to do. And, and I feel the sense of distortion around me. So even a question like, do you remember when becomes something? I actually feel panic. When somebody begins to ask me that, because I’m already aware.That for the most part, that particular part of my prefrontal cortex, ain’t doing great. So when we begin to talk about post-traumatic stress, one can assume fragmentation, will it show itself in very different ways? I’m just giving one category, right? What I’m calling the graying, the fogging, the haze, the distortion that opens up a second huge category, that the sense of numbness where indeed what is called our vagal system that runs, it’s really the nerve highway from our brain, particularly our kind of our, reptilian, our ancient brain, all the way down through to our stomach and our viscera. And that’s where so often I I’ll just feel like I can feel in my stomach. Something’s not well, and it’s not indigestion. Uh, it isn’t that I ate too much. It’s just that my stomach is not well. And I, the only, in one sense response when things are already foggy, is I just, I just shut down. And it’s another way of saying the vagal system is very directly related to our capacity to dissociate. And dissociation is not dis-association, which is like leaving a club, but dissociation is that disconnection from a reality, that we find intolerable that somehow there is either too much or too little cortisol, too much or too little capacity to engage. And that’s one of the things that’s crucial to understand about post-traumatic stress is that though there is a numbing, there’s also a heightened level of capacity to, in some sense, feel the intrusion of, of, uh, strong, uh, emotion or images. Uh, in other words, the right hemisphere still is operating, bringing a whole lot of debris that shows up, particularly with regard to our dream life or just what we’re functioning on a day to day basis. We were just in a meeting, the two of us, conversations occurred. And literally I had flashes of events that were almost a year or more ago. Yeah. And I don’t know if you noticed on the screen, but I was like,
Rachael: Yes, yes. I did notice
Dan: Trying to keep some level of regulation and not go, I think I just need to go off screen… screen and scream. Um, so when I say numb, don’t think it’s just like, I don’t feel it’s a kind of numbness where I don’t seem to have the capacity to engage and process and to feel what I feel in a way that bears at least some degree of regulation.
Rachael: Yeah. I mean, I think, again, this is, I mean, I don’t know if you saw, I just saw that. I don’t. And honestly, I don’t remember who was suggesting it, that, that all children eight years and older get screened for anxiety. It’s like, this is where we’re in the realm of anxiety and depression. Again, that can sometimes be so biochemical because our bodies have been amping up and then they have to come down. So, you know, when we see post-traumatic stress in this realm of numbing, it can be where sleep disorders manifest. Like either you have insomnia or you need to sleep all the time. It can be where depression and anxiety, all of a sudden, maybe you’ve never really struggled with that, but this is a way your body is trying to cope with all the dysregulation. This is where, you know, we have language like burnout, but there’s also medical terms like adrenal fatigue, where, you know, your adrenals just go, there’s only so much cortisol I can flood for you. You know, the mania was great while it lasted. It got you through. I mean, I think of every parent who had kids at home trying to get them through school for a year, you know, there was a lot of mania and, and cortisol flooding involved to get us through that. And then there, it can be like a let down where your adrenals just go. They are still, they’re, they’re creating cortisol, but your capacity to regulate it, it’s like a drain that goes so fast. And you feel that sense of exhaustion and fatigue. And again, that grayness that can feel real close to depression, but sometimes it’s also your body’s way of just being like, I’ve felt enough, like. I don’t wanna feel anymore again, but what also you’re saying, you know, I definitely tend to toward much more towards anxiety and, you know, it’s like, I actually know PTSD is manifested when all of a sudden I don’t feel anxious and I can’t be bothered to care. I’m like, oh, okay. We just ran. We ran out of, We ran out of the, the, the trauma fear and now we’re in the realm of like, well, what just happened? How do I recover? Um, and it can, it’s really, I mean, we’re talking about painful, painful things. And, and I also, when you’re bringing the brain into it, it’s that reality of like, and these are not things that discriminate like, oh, some people are just much more resilient. I do think resiliency, resource, community care, um, you know, not being, not having to bear levels of oppression, certainly help people have a different kind of resilience to bear trauma. So I don’t think it impacts us all equitably. Um, unfortunately I think that’s part of the wickedness of, of living in a world that evil still exists, but I still don’t think anyone gets to escape some of the impact of this level of stress on our bodies.
Dan: So again, let’s, let’s see if we can just not so much get it under management and control, but numbness does not mean you’re not going to have something of this intersection between despair, depression, and irritability and anxiety. There is this fluctuation, but where we come back to the word numbness is, there’s just this internal. I don’t have it. I don’t have the ability to manage my anger or irritability or my anxiety. And it’s just in some sense, almost better for the universe, let alone the people I’m in relationship with. And me, if I just don’t care, I, I just don’t want to do any more than what I absolutely, at the most basic biological level, need to do in order to survive. And that sense of, I don’t have the ability to process context. And I, I go back to the thalamus, the integrating work of our brain has to, in one sense, see the event in a larger context and without context there isn’t meaning. And without meaning, we don’t have a sense of purpose or capacity to hold the complexity of what’s happening around us. So when we lose the ability to have time and context, we’re pretty much like, uh, without a rudder and some tumultuous seas, and that kind of, I’m gonna go down. I I’m gonna hope my boat doesn’t flip over, but I’m just gonna hope that things just don’t get worse. That’s where so often in my own depletion, lack of reserve, lack of ability I, I could quit, but here’s the complication; life doesn’t and trauma doesn’t.
Rachael: And we, haven’t also named that sometimes in order to quit, you actually have to turn to addictions, right? Like you, you actually have to turn to things that, that help take you out that help bring kind of build a little bit of a barrier. So you’re, you’re absolutely right.
Dan: Shut up. Shut up… What you, is there something you wanna say to me?
Rachael: No, I was mostly thinking about myself. So I wasn’t, I was just thinking about, I would just I’m I’m so aware for, for so many of us, um, just where there might be places that maybe we haven’t dealt with in a long time, or we’ve experienced a lot of freedom from that are making their way back, uh, as, as a, as something we’d gravitate towards and where that can, we can so easily turn against ourselves. I’m not saying, but it’s okay. I’m more saying, can there be a little mercy to understand there’s something your body needs, there’s something you need. There’s there is like some reprieve, you’re needing now turning to addictions is not actually gonna give you what you need. We know it actually just reinforces it and makes it worse. And then you need more, just that sense of like, sometimes we have to acknowledge, oh, this is what’s at play. You know, I’m in some post-traumatic stress. Yes. It’s very real.
Dan: Uh, the, the biochemical process of stress has the capacity to be disrupted moment by an infusion of dopamine. And we know dopamine is the biochemical of pleasure. So if you were to, like, I thought you were gonna be asking like, how’s your drinking? How’s your, how’s your sugar? Um, and you know what, I’ve, I, I don’t know how it took so long for me. I don’t know how I got on Instagram to begin with, but you know, that this thing called reels. Like, like, like there are people who are like playing tennis with incredible shots. And then there are people who are dancing and then there are people who are snowboarding. And like, I, I probably thought I was on one of those reels for maybe 10 minutes. Becky took a snapshot of me, uh, because she knew I would deny. And I was on for a full hour before she brought it back and said, how long have you been looking at your Instagram reels? I said, I don’t know, five or 10 minutes. She goes, uh, look at this. I took a photo of you. And like, like she knows she needs data. She needs prima facie data ’cause I’m gonna work my language system to deny and attempt to bully her into a distortion of her own sense of time. Nonetheless, when she showed it to me, it’s like, yeah, I was on for a full freaking hour. And I couldn’t even tell you other than tennis snowboard, uh, motorcycle racing, what was on there, but nothing. So the addictive process is another form of chemical or guided dissociation, which is why people end up drinking or using pornography again, not excusing it, but simply saying it’s an effort to deal with post-trauma stress to lower. But what we know is at least with regard to sugar and alcohol candy, et cetera, is it creates inflammation. And in that our bodies are actually being dis-eased by our own efforts to, in one sense, numb, but create pleasure, which works not so well.
Rachael: Well, and it’s so very fleeting and that’s like a, I saw this video of a little toddler who was eating pizza. I thought, this is this the exact articulation of the impact of dopamine. And it was like, the toddler was crying cuz she was like, I want more. But my body’s saying no, it’s like that desire. Like you don’t want the dopamine to stop. So you want that you want one more bite, but also you’re so full and you know, the pleasure, it’s the, it’s really the grief of the loss of that pleasure and just was like, oh, I feel that in my bones. Little one. So.
Dan: Well, if, if it’s a reel, send it to me, I, I, I don’t think you can actually send reels, but nonetheless, so a third factor, uh, is isolation. So as we’ve talked about fragmentation, but asking you all to go, don’t think about it as like this huge breakdown. Think far more about the graying and the fogging, not only a memory, but of a sense of how you see and how easy it is to misinterpret, to distort, to not hold reality. Well, and then a numbing, but seen in these jagged edges of irritability and anxiety. And then some degree of shutting down. A third issue is again, isolation. And that isolation is closer to, I’m not just overwhelmed, but at some level, I feel at fault, I feel blameworthy, I feel, and this is crucial to understanding particularly post-traumatic stress disorder. There’s always with post-traumatic stress, a, a sense of fragmentation and in the exhaustion, a kind of powerlessness, but when we get to this third category, uh, it’s where there is self blame for good reason or for perceived and inaccurate. But that kind of comparison of, I used to be able to do this, what the heck is wrong with me? So the internal isolation, like I’m shutting down with others and I just don’t want, in some sense, the complication of more failure, more relational tension, more requirement for engagement. And in that isolation, there is, I mean, again, this is so heartbreaking to say, evil is so effective. Divide. Conquer. To the degree you are divided from the people who can care most for you, uh, who can honor your own struggle, be attuned and help you contain, be able to work towards some degree of repair. To the degree you isolate. You are literally cutting yourself off from the resources you need in order for a healing process. Even if it is a lengthy process to actually occur. Isolation is a big issue. And I see it particularly with regard to how apt I am, I mean, I, I don’t carry a gun, I don’t own a gun, but there have been moments with road rage. Uh, I’m just, I’m just grateful that I’ve not been arrested. Um, uh, shouting because somebody cut in line, um, where isolation shows itself, I’m putting words to is a level of blame shifting, uh, scapegoating, a, a kind of an indulgence of rage because it feels like it’s restoring a level of energy and, and power and giving me what I once had, even if it is deeply ungodly and really deeply irrational.
Rachael: Well, and I mean, I’m sorry, you don’t have to travel too far out. Well, I live in Philadelphia, so maybe it’s different for me, but you don’t have to travel too far outside your door to just feel, you can feel that, that rage and isolation just in the air right now, you know, it’s like, I, I try to move. I mean, I, I have it in myself and I’ll be like, wow, I got there real quick. Um, that contempt, right? Like whether it’s self contemptuous or other contemptuous, but how quick we can move to rage right now in this season. And it feels so volatile. Like it is a really volatile time and that’s not just because people are just angrier, which I mean they are, but it’s coming out of traumatic stress and a response to traumatic stress and, and in some ways, um, it’s almost like how, what we feel is we need it. Like you just said, we need it in order to feel any sense of volition or like survival. Um, and we feel entitled to it again, that’s that makes it, probably gives it sometimes more will and intention than I think sometimes is happening with post-traumatic stress. It’s like, you know, this would be the realm where we see this a lot with, um, war veterans and PTSD, where there’s just outbursts of violence and anger that is may, maybe doesn’t actually line up with who they are and how they’ve known themselves to be. And it can feel really scary. And, you know, it takes us back, I think to those like toddler spaces when like toddlers are feeling intense, extreme emotions, and they’re having a breakdown and you can see both the rage and the terror in their little bodies. Like I feel out of control. Um, I just responded in a way that is not like, how did I get so angry so quick about something. And maybe for some, the isolation doesn’t lead to anger, but leads to more of a sh again, that more back to that, like shutting down that, um, you know, incapacity to actually lean back into community and rhythms that have been really important to you. Um, and it makes sense when we’ve been in a kind of trauma that has disrupted community rhythms and has made them feel, you know, we’re afraid, like in some ways there’s been threat to being around a lot of people and not mostly just ’cause of disease and trying not to spread a virus. But I think, you know, we’re now experiencing the, oh, it’s, there’s a, there’s an intensity in our social interactions, in our relationships, um, in our emotional world.
Dan: Well, I’m, I, I would say I am seeing, particularly with the people I have the privilege of work with as a therapist, a kind of virulent season of contempt and that, when I say, you know, blame shifting, sometimes the blame shifting is to some perceive part of me that I, uh, a assault as, as the cause of my current malaise or struggle with my marriage or friendship or, or parenting. Like I, I am so deeply aware of the kind of assault that many parents are experiencing against themselves for their actual and or perceived or intersecting failures. And to be able to bring a kindness, a, a, a mercy, a could we slow down here? The contempt for oneself shifts pretty rapidly. Like you, you don’t get it. I mean, I, I had a client just nearly bite my head off with a, you don’t get it. Do you understand how severe things are right now with my, and I, I’m not trying to role play beyond the kind of intensity was much greater than what I I’m vocalizing. So the rage is often directed toward ones self, or younger parts of ones self, or idealized parts of yourself that aren’t doing, what you think you should be able to do in this moment. And that kind of volatility of violence of assault. Again, we’re seeing levels of tragic, multiple, um, shootings, uh, that feel virtually like it’s every day, some mall, some party, some event, some subway. And I, I don’t intend to be either or, or naive, but if we’re in a period of post-traumatic stress and I wanna underscore such a brilliant point, you made where you begin to see the effects, uh, of post-traumatic stress is not when you’re in the thick of it. But when there is some degree of amelioration and as the severity begins to lessen it’s as if the body is able to say, Okay.
Rachael: This is what we’ve suffered.
Dan: Now. Now you need to begin to tend to this fogging, to this exhaustion and irritability, and even more so to this kind of violence against self or perceived others that have done you harm. So we are in a season where at some level, even if things keep getting so called better with regard to the pandemic, I don’t think we’re out of it by any stretch personally, but even if we’re tapering, the fact is in the tapering, we’ve gotta have an awareness that the people around us are going to begin to feel even more some of the effects of these realities.
Rachael: And it can feel almost despairing for us to talk. Like I feel in myself like, oh no, we’re moving toward despair. Um, but I think what it can also do and where we’ll, where we will move, is it can also help us know how to tend, um, how to be creative together, um, and how to understand how to have more context and understanding as to what is actually at play. You know, whether that’s again and playing out in our church community in our families and our schools, um, in multiple places. Um, I think anytime you have more awareness, it doesn’t drastically change things, but it certainly gives you more choice, uh, as how you, how you want to live and move and breathe in the midst of that. Um, and what kind of tools and skills and resources are needed to tend. Um, and I, you know, I don’t know if there’s a way to, like, this is an overwhelming time. Um, this is an overwhelming time for teachers, an overwhelming time for nurses and doctors and medical professionals, an overwhelming time for parents and ministers and therapists. Um, and so, and
Rachael: And marriages and just all the places where we’re so human. And so there has to be mercy for that, but we are not, we are, we, we don’t, we’re not bound to despair and we’re not bound to futility, but it will take, I mean, as we know, healing takes intentionality, it takes tending, it takes time and it does take, um, disrupting, um, patterns. And so there is hope there is possibility and there is healing. Um, and, uh, I think it can be hard when in some ways, like what you’re saying is, we’re not like there’s gonna be more trauma. There’s going to be more places where our bodies feel under threat. Um, and so we also are learning to heal and to mend and to cope, um, when there’s there might be ongoing, ongoing realities. Um,
Dan: Well, let me go back to the phrase that you created: human size. To become human-sized means that to some degree, we have to understand that our humanity is not fundamentally bound to trauma, but trauma has to be human–sized in order for us to begin a process of seeing change. Again, I’m not sure trauma is going to be better, but certainly the reality of post-traumatic stress is going to be even more clearly something that we have to tend to as helpers, as people who need to put the oxygen mask on first in order, whomever is sitting next to us. Uh, in this case, I always want my wife to put the mask on me first, but none the less, uh, the reality is we need to put our mask on in order to be able to put the mask on those we’re with. And that’s what we’ll address in a lovely week.