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WHEN I WAS FOUR YEARS OLD . . .

Dear Doctor:

When I was four years old, my parents took me to the local hospital, where, as instructed, I lay down on a cot. Without any warning, a mask was clamped on my face and I was suffocated with ether. I struggled and cried out for help but soon lapsed into unconsciousness, where I had a vision of falling through black space. When I awoke, Mr. Winkie was wrapped in bandages and felt sore. Later, I learned that I had been mutilated. An undercurrent of terror, horror, and pain was created and is with me to this day. How can I get rid of it?

Dear Bothered:

1. These feelings are precisely normal. They are the inevitable result of your constitution, history, and circumstances. They are in Nature/life. They are created in you, not by you.

It is interesting to note that "mind" is not unique to human beings. Just as we exist purposefully (that is, we move through time and space from moment to moment with a purpose), all living organisms exist purposefully. Anything that can maintain itself somehow "knows" what it is doing - it goes places, it stays in its proper environment, it has a way of getting food, it defends itself against predators, nutrients circulate in its body, and so on. This is to say, every living thing follows its own ways of surviving. The "knowledge" of doing this is its mind. A human mind operates in Nature/life just as any living organism's does.

2. The terror, horror, and pain seem to be overwhelming, but they need not be. They are feelings, like any others. Also, they are themselves - "A feeling is a feeling is a feeling." The person is much more than any terror, horror, or pain.

3. Walling off the bad feelings doesn't help. Bad feelings grow in power when they are ignored or denied. They have to be recognized before they can be dismissed. Turn toward yourself in self-love.

There is value in naming your disorder - PTSD or posttraumatic stress disorder. The following information about PTSD was gleaned from "Rethinking Posttraumatic Stress Disorder" (Harvard Mental Health Letter, August, 2007).

In personality, people with PTSD share three kinds of symptoms:
1. Hyperarousal. We are irritable, easily startled, and constantly on guard. We sleep poorly and have difficulty concentrating.

2. Re-experiencing or intrusion. We recall the traumatic event involuntarily in the form of vivid memories, nightmares, and flashbacks. We may feel or even act as though it is happening again. Any object, situation, or feeling that reminds us of the trauma may cause intense distress.

3. Avoidance and emotional numbing. We avoid feelings, thoughts, persons, places, and situations that evoke memories of the trauma. . . . We feel estranged from other people and even from our own feelings.
The first documented case of psychological distress was reported long ago - in 1900 BC by an Egyptian physician who described a "hysterical" reaction to trauma. However, only since 1980 has it been classified as a psychiatric disorder by the American Psychiatric Association. War, of course, has been the chief source of this disorder. In the American Civil War, the symptoms were sometimes called "battle fatigue." In the First World War, they were called "shell shock," and in the Second World War they were called "combat neurosis." In the Korean war they were called "gross stress reaction." Soldiers in those wars with these symptoms were sometimes scorned - they were thought to be weak, unmanly.

Nowadays the symptoms of PTSD are seen as normal responses to abnormal circumstances. In the 2000 edition of the American Psychiatric Association's diagnostic manual, a traumatic experience is defined as one that involves a threat (or reality) of death, serious injury, or damage to physical integrity and inspires intense fear, helplessness, or horror. The experience might be our own, or it might be one that we observe in someone else. TV brings potentially traumatic experiences to us almost every day. However, we do not all develop PTSD.

Statistically, men and women differ somewhat in susceptibility to PTSD. Men suffer more from non-sexual physical violence, whereas women suffer more from rape and childhood sexual abuse. Even when both sexes have the same experience, women are more likely to develop PTSD. Differences in social support may be a factor. Maybe men are less willing to admit PTSD than women are.

Intentional injury creates a greater risk of PTSD than a natural disaster or an accident. The risk is even higher for victims who feel guilty because they believe that they bear some responsibility for the event.

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