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PTSD: The animal within

The reptilian brain exists within all of us, not only in those with past trauma. Trauma seems to keep this area of the brain alert, extra sensitive, unable to rest. The image below explains many areas of the brain, including the reptilian inner brain.

brain

(image from http://www.traumarecoveryinternational.com/the-reptilian-brain—where-ptd-lives.html)

The brain is divided into 3 main areas, reptilian, limbic, and neocortex. The chart below is from http://thebrain.mcgill.ca/flash/d/d_05/d_05_cr/d_05_cr_her/d_05_cr_her.html

The reptilian brain, the oldest of the three, controls the body’s vital functions such as heart rate, breathing, body temperature and balance. Our reptilian brain includes the main structures found in a reptile’s brain: the brainstem and the cerebellum. The reptilian brain is reliable but tends to be somewhat rigid and compulsive. The limbic brain emerged in the first mammals. It can record memories of behaviours that produced agreeable and disagreeable experiences, so it is responsible for what are called emotions in human beings. The main structures of the limbic brain are the hippocampus, the amygdala, and the hypothalamus. The limbic brain is the seat of the value judgments that we make, often unconsciously, that exert such a strong influence on our behaviour. The neocortex first assumed importance in primates and culminated in the human brain with its two large cerebral hemispheres that play such a dominant role. These hemispheres have been responsible for the development of human language, abstract thought, imagination, and consciousness. The neocortex is flexible and has almost infinitelearning abilities. The neocortex is also what has enabled humancultures to develop.

The reason I was thinking about the parts of the brain, and the reptilian part specifically, is because I wanted to understand more about what happens to me during my response to hide (or freeze), when the flight part of fight or flight is activated. This is a powerful feeling, stronger than butterflies in your stomach or stage fright or social anxiety. I was talking to hubby, and he said something that after all these years with me I could not believe he still misunderstood, and so I need to clear this up here as well.

PTSD – and the actions within flight or fight – are not my choice. I do not choose to run away. I have to run away. No thought has happened. I have run before I know I have run.

Before the running, when anxiety and fear is lower, when the danger seems manageable, yes, I can choose whether to attend an event or not. But once certain triggers are activated, it is an automatic process, my brain has decided for me that the situation is far too dangerous and tells me to hide – NOW. It does this by turning off the neocortex, and possibly even turning off the limbic brain too to get me moving. It’s why you don’t cry until later, gets in the way of fighting or running.

So why do we have this part of our brain that allows us to act without thinking? Well to save our lives. If we had to debate whether an oncoming car was moving fast enough to kill us, or if that intruder has a gun, or if that bear saw us, well we would already be dead. We need our automatic reactions to pump the adrenaline, to get our heart and muscles going, to move us out of harms way without standing there thinking about it.

I also suffer from the freeze response. When fight or flight does not seem a good option, our reptilian brain freezes us. It is like playing dead while wishing you were dead. Many child abuse victims know this response, they could not fight back or get away, so instead they experience system shut down. I did this so many times as a child. I still do now for certain triggers. For years I would lay there frozen, unable to speak, while hubby had his hands on me, thinking I am enjoying his touches. He was devastated and even angry when I finally told him. He still doesn’t understand that being frozen was NOT my CHOICE. That inside my head I am screaming and crying, but outwardly unable to do or show any thing.

Sometimes when I retreat to my room, I am not being rude, I am not trying to hurt anyone’s feelings, I am not choosing to ignore people, my brain thought I was in danger and believe me, there is no arguing with your reptilian brain because it nicely shuts off your thinking portions for a while, as part of the safety feature. Once the adrenaline slows and my brain can send out the ‘all clear’ call, then I can start to reason through what happened and make choices about coming out of hiding or not.

I am learning the early alert signals, when fear and anxiety are rising, I can try and breathe and ground to keep the reptilian brain from taking over. Sometimes I can, and sometimes I can’t. Although I know more about it now, I am also more sensitive now, like I have mental trip wires everywhere that I don’t even about – a side effect of my current ongoing therapy stirring up symptoms.

I made a connection one evening to this idea of the animal brain. Before a storm, my dog started pacing and looking anxious, coming to me for support for her fear. I know not to comfort her with affection, but that she needs a strong, calm leader in those moments. Someone to show her that she will be safe with me. I don’t pet her or talk to her. I walk around with her, distract her, get her to lay quietly, massage her, call her out if she tries to hide. I don’t let her fear overtake her. I realized I was grounding her and not letting her reptilian brain take over. It really made me start thinking.

Because when I am afraid, I act just like a frightened animal, and also like her I am unable to communicate exactly what is wrong. I also need a strong, calm leader. I look to those around me to provide safety and comfort, and not finding that, I need to be my own leader. I tried explaining this to hubby. That he instinctively knows a bit more about frightened animals than how to treat me. Would you yell at the dog? Would you let her hide, scared, shaking and alone, for hours or days? Would you tell the dog how frustrated you are that she won’t let you hug her when she is frightened? Would you blame the dog or would you comfort and gently try to help her overcome the fears?

I know it must be difficult for hubby, I truly do. That my brain is afraid of him, that he keeps triggering me. But when he leaves me alone after the flight or freeze, it does nothing to disprove those triggers in my brain and instead reinforces those pathways that he cannot be trusted. I keep asking him to let me go for a bit, let me cool down, 20 minutes is usually enough for the nervous system to restore itself. Then come check on me and be strong. Don’t ask me a question – I will say no. Bring me coffee or ice cream, don’t ask if I want any, just bring it to me. (like luring the dog out from under the bed with a treat, right?) Tell me to get a shower or take a walk – don’t ask me. Tell me to ride with you to the duck pond or the grocery store. Make up any reason to draw me out of my hiding place. If you are strong I will listen because I want a leader, someone strong to take care of me. Show me you are not the enemy.

Because in reality – that is all I have ever wanted. someone to properly care for me, to nurture, to understand, to lead with strength, to show me the way when I am scared. I have done this my entire life, when I should not have done this for myself. So maybe I am asking too much of a husband. Maybe it isn’t his job. But maybe he needs to do it anyway, just for a while, just to get me through this. But I know he can’t because he doesn’t. It is what I want, but will never get from him. I try not to be disappointed because I don’t think that is entirely fair to him.

So I will continue to go it alone, relying only on myself to lead the way in these dark moments, and hope that one day the moments will slow down and the triggers will not be daily. No one is saying to hope for triggers to go away completely, only to be less than they are now, easier to manage.

I am getting tired of shaking, hiding and licking my wounds and would like to use all of my brain again. We weren’t meant to function on reptilian brain alone.

Doing the impossible

Fear, anxiety, panic, triggers…these can make certain things seem impossible because you feel like you are dying or battling lions or jumping out of airplanes. We can’t do it because we have the stress chemicals in our bodies as if we are in a life or death situation. We can try reasoning, you will be fine, and it helps, but is not always enough to overcome how we feel. If you feel like your head is in the mouth of the lion already, you are sweating, heart racing, choking, about to scream, vomit or pass out…saying to yourself, or hearing someone else say “you are safe, you will be fine” seems like a lie. In that moment I have to trust my feelings, it is how our bodies are designed to keep us safe.

So I can wait out this response though, and try not to trigger it to level 10. If I approach something that causes this response in me very slowly, breathe through it, wait until I am calm again, I can keep moving forward.

I have successfully tackled a few items on my avoidance list using this method. I prefer to do it all in one day, but very slowly, rather than repeated exposures on multiple days as my counselor suggested. I use my ability to hyperfocus. 

There was an entire city I was avoiding. I completed an art commission there with an intimidating man. He fooled me and my name got involved with a lawsuit from another artist. I had huge amounts of guilt, shame, and overall feelings of failure. I have avoided the city to avoid seeing my art, avoid running into this man, and avoid confronting my feelings.

Last week I decided it was time to stop avoiding this. I headed to that city and got to my safe zone, about 5 miles away, and pulled over at a park. I stayed there about 20-30 minutes until I felt restless and bored instead of anxious. I drove a little closer until I felt like choking and pulled over at a Walmart. I went in and bought some cookies. I ate a few until I was calm and drove a bit closer. Next I stopped at McDonalds and got some coffee to go with my cookies. This stop took a little longer. I did some writing on my phone to distract me. I drove a little closer and stopped at a movie theater. I looked up the movies and considered seeing one, but nothing sounded interesting or worth the back pain of seats not meant for me. I drove closer and realized I was on the same street now as my art. I was feeling dizzy, so pulled over again and did some breathing exercises and texted my sis in law. I drove again and parked across and down the the street from my art. I could just see it now. I cried. I cried a lot.

I sat there for about 2 hours, looking at my art, crying, feeling hurt, angry, guilty, sad, whatever came up I allowed myself to feel it. I listened to the radio and wrote to online friends. Then another wave would hit and I cried again. Once it was dark and the place had closed, and I was sure I would not run into the owner that hired me, I drove across the street and into the drive next to it to really see my art close up. I have not been here for years. It was in bad shape. Many spots were damaged by weather and many were repaired by less skilled artists. Oddly, this made me happy. It brought me comfort that it no longer resembles my work and I can get some distance from it now.

I drove past it again yesterday with no anxiety, no hesitation, just a bit of sadness, no crying.

So I am learning how to process these huge emotions, stop avoiding so much of my life, and keep moving forward as I heal.

People keep expecting me to be normal

I am far from normal. I used to pretend really well. I used to smile and force myself through each day desperate to blend in, to hide my troubles, to appear normal. It used to be easier, with numbed out emotions, drinking too much, and dissociating. Now that I am present, the world continues to be terrifying and overwhelming. Triggers wait for me around each bend, around each thought at times. 

This is my new normal. I have complex PTSD. I have for many years, but I am in a different stage now. I know it is confusing. You and I both know intellectually this thing, whatever it is today, that I am unable to do is safe, totally not dangerous at all. And yet I have to do mental and breathing exercises to prepare for it. 

Sometimes I get hit with a triggering event or multiple events so fast I am not even sure why I changed my mind until I reflect and fill out ABC and challenging belief sheets later. All I know in the moment is I want to go home or stay home or get out of the room you are in and hide. The shame and fear chokes me.

All I do know is that if you keep expecting me to have normal reactions and act surprised, angry, hurt, confused each time I am triggered, like you don’t know me at all, then my shame is increased. You want me to be better, but I am not. I am sorry.

Face it to fix it

Do your demons live in your peripheral vision, off to the side, just out of sight like mine do? I know they are there, I readily admit it, but struggle to face them and really give a good look.

Avoidance has been the biggest symptom of my ptsd for years. Avoid the triggers. Avoid the feelings. Avoid the pain.

New counselors are coaxing me out of hiding, teaching me to stop avoiding. Like holding out bacon to a scared lonely puppy. I come out for a moment to inspect the bacon then retreat back into hiding safely again, not sure I want it, not sure I trust them, not sure it is worth the risk.

My assignment for couples counseling has seemed impossible this week. I don’t know why I agreed to do it, other than I always agree to try. He asked me to write a list of all of my touch-related triggers so we can work on creating safety at home.

This is my fault…I opened my big mouth and complained that hubby often seems to forget about my specific triggers, and sets me into flashbacks or panic, and I am always reminding him don’t do it like that. And then I have to go somewhere horrible, recover, and forgive him. Repeat nearly daily. It never gets better no matter how much I remind him.

And so I have been asked to put it in writing. All of the things that terrify me. The things I don’t want to happen to me, so I won’t be triggered and reminded of AF or my brother abusing me. I am supposed to round them up, list them out, and share in counseling with two men? Yes one is hubby…but sometimes he is just a scary man when I am frightened.

I do NOT want to do this.

My inner lost puppy is whimpering and hiding under the bed and does not want bacon.

I put it off all week. I have to leave for my session soon. I decided to post it here, because my friends are here, and I feel braver here, and because knowing it may help someone else gives me strength.

So here it is. I may be vague on some of these, writing just enough to know I looked quickly. Some of these are quick startles. Some of these are context specific, like time of day, room, position, preceding events and mood. Some are mild while others are instant and extreme. Some cause me to get upset, some I try to hit the ‘attacker’, some I freeze up and can’t move or speak for some time. Some make me feel used and owned, like my body does not belong to me. Some make me feel luke I am a bad person, a whore even.

* Unexpected touches of any kind
* Grabbing or hugging me from behind me, reaching around me
* Swatting, grabbing my butt
* Hovering or leaning over me while I am lower than you
* Waking me up with touch and no sound
* Me sitting on someones lap
* Me laying on top of someone, facing up
* Someone sitting next to me grabbing my knee or leg
* Thumb in my hand without noticing
* Slow motion touches
* Massage that turns into touches
* Asking me if I like being touched
* Watching me change my clothes
* Touching or kissing me or leaning over me while i am sleeping
* Opening my bedroom door at night

Out of the crisis zone

Little guy is an awesome good natured little guy and handled his birthday disappointment beautifully. When his one and only guest arrived, he beamed with joy, and had a wonderful, if cozy party.

Hubby handled my absence and entertained the mother that stayed. He told me that the same thing happened to her a few weeks ago…no one showed for her daughters party. Summer is apparently a difficult time with sports and vacations and split homes.

Little guy did not seem to notice my absence, so absorbed in his friend. That was good.

We decided to take him out to a movie to extend the fun on our own since his party was so short. I was nervous, already feeling down and out of sorts, and not having been to a movie theater in a couple years. But I wanted to try.

At the theater, the previews had started already when we arrived. The theater was loud and dark and crowded. We could not find enough seats together and my anxiety was building. It started to feel dangerous. I was having trouble seeing and hearing, and now struggling to breathe and remain grounded. Crap, crap, crap.

Hubby started walking to the front with kiddos and I backed up to the back wall, leaned there and hugged my back support pillow, trying to breathe and focus. Hubby came back for me, looking torn, does he follow me or his kids. An usher came and asked how many seats we needed, and just laughed and walked away when we said how many.  Hubby pointed to some in the middle and by then I was near panic and could not pass by or touch those strangers knees. I wanted to get out of there. So I did.

I left the theater and sat in the food court by myself. It was bright and quiet out there. I did several grounding exercises and felt normal thoughts returning. What was I going to do for 90 minutes now? What was I going to say to kids for why I left? I could not get back in, hubby had the ticket stubs. I was thinking of ways to explain my situation without sounding entirely insane when hubby texted that he found seats and would come and get me.

He didn’t give up on me! I was so grateful.

The theater seat was horribly uncomfortable, curved ergonomically for someone that can bend their spine. I did my best to adjust and use my pillow but I was really hurting by the end. Other than that, the movie was cute enough, I started to calm down after about 30 minutes, and was pleased to be there with everyone and not excluded.

Being excluded sometimes hurts worse than the pain or anxiety, I am finding. It makes me feel I am not good enough and let everyone down.

I need to fight harder to find ways to be a part of my own life.

Best part was my lesson I learned from my 8 yr old on rolling with it and having fun anyway. We were cuddling later that evening and he sweetly said to me, “today isn’t exactly how I thought it would be…but it was a good day” and he hugged me. I told him I was so happy he had a good day and that I loved him.

And in THAT moment, everything was right in both of our worlds I think. Man I love that kid.

The White Coats are Coming

lab_coats

I mean Doctors, not mad scientists, because I’m much less distressed about scientists in general. But Doctors? Doctors offices, hospitals, Eeek, gulp.

OK, I sound like I’m kidding, because I do that to lessen the intensity for myself. But seriously this is the next stage of my homework for individual counseling. If you recall I had created a list of situations that cause me distress, and then rated the situations using the 0-100 SUDS, subjective units of distress scale. We noticed that I had some doctor related situations on my list with different ratings. I told my therapist I wanted to start with doctors because I view that as more of a necessity than some of the other social situations. I can’t ask Hubby to go to the dentist or gynecologist for me – I kinda have to do that myself, and it would be great if I could do it with less distress. I’ve always managed to go…eventually…if I have to…and then my heart is racing, I sweat through my clothes or the paper gown, I shake in fear, I can’t sleep for days, I can’t eat or binge eat…I don’t manage the distress well. And because these are not daily situations, I can build up loads of anxiety for the next time, never getting exposure and practice like I do for say the grocery store. Certain situations have never become easier – I simply (ha, simply, she says) grit my teeth and get through it without passing out somehow.

So I’m supposed to break down all of the situations related to doctors and make a new list with SUDS ratings, getting as specific as possible. I have a few ways I can think of to organize this list or it would already be done. I’m not sure if it is more helpful to group by type of symptoms and SUDS rating, type of doctor/situation, or by my fears. Let’s see what happens.

 

Before the appointment is made:

  • Deciding it is an important issue (50) – I get annoyed with the hassle, feel fear what if I ignore a really bad problem, don’t trust my judgment what if this isn’t a problem at all, what if no one believes me or understands me, probably no one can help me anyway
  • Calling receptionist to make an appointment for myself or my family (40) – What if I commit to a date and something else comes up or I forgot about something else or we don’t have the money that day or I don’t feel well and can’t drive that day
  • talking to Hubby about money/schedule (80) – How do I explain my concerns without blaming him or over worrying him but get his input and support, and I might need him to drive me and get a day off of work and I hate asking too much I feel like such a burden and a pain in the butt, why can’t I do this stuff myself, I should be working and not depending on him so much right now
  • Can’t sleep several nights before appointment as I start to imagine and prepare (80) – The nights are really long and I try to relax but it gets worse, and I have nightmares when I do fall asleep
  • Get ready very early and slowly, trick myself one step at a time to stay calm (80) – I can’t rush at all or the anxiety will overwhelm me. I learned to give myselm time to move slowly, dress slowly, check and recheck my pockets and purse so I don’t forget anything, check my map, do calming breathing, drive slowly, and arrive early

 

Stressors at the appointment

  • Driving to unknown location for first time (80)
  • Driving to known location (10)
  • Arriving Late to appointment (90)
  • Forgetting something (wallet, insurance card, phone, etc) (90)
  • germs in the office, signing in touch the shared pen, people coughing near you in waiting room (80)
  • public weighing (60)
  • confusing or triggering forms to fill out with history – how much to share? (80)
  • nurse/doctor might not understand my problem (60)
  • I might be asked to undress (80)
  • I might be touched without warning (100)
  • some touching can be triggering – dentist hovering over me, ob/gyn exam (100)
  • if they hurt me i lose even more trust, hard to speak up (100)
  • new doctor – I don’t trust them yet or know what they will ask me to do (80)
  • I have to share private details about myself (80)
  • I ask for certain tests/labs and feel frustrated doctor didn’t think of it – are they idiots? (70)

 

Types of appointments

  • family doctor in town (20) – 5 min drive, been there many times, low confidence in doctor abilities for anything complex but trust to monitor vitamin D and cholesterol
  • pediatrician (50) – 30 min drive, high confidence in doctors, rarely go unless kids aren’t getting better or I know they need vaccines or other issues discussed, high fear of other germs in the office
  • my dentist (80) – 30 min drive, high confidence in ability but feel they overcharge and attempt to oversell and I hate saying no, I hate laying down in the chair while they surround me, it always hurts no matter how much novocaine is used, I feel ashamed for having bad teeth and eating candy, one hygienist knows my neighbor so there is lack of privacy too
  • back doctor (40) – 2 hour drive, hubby always goes with me and usually drives so I don’t get too tired/overwhelmed, high confidence in doctor, they don’t hardly touch me, I undress in private for xrays, everyone is kind and professional
  • neurologist for migraines (30) – 2 hour drive, hubby drives me, no touching at all, no undressing
  • botox for migraines (80) – 2 hour drive, hubby drives me, triggering position as I lay down and doctor hovers over me, procedure is fairly quick but fairly painful with 50 injections in my face, neck, head, shoulders like many beestings
  • dentists for kids (20) – 1 minute drive, no one touches me, low stress
  • optometrist (20) – 30 minute drive, no touching, once every year or two as needed, ask for dilation instead of air puff
  • urgent care center (60) – do I really need to go? it is super expensive so I don’t trust my own judgment vs fear, can it wait. minimal touching depends on what is being examined.

 

Stressors after the appointment

  • I don’t trust diagnosis and do my own research before filling Rx or doing next steps (80)
  • I don’t schedule followup if I feel fine – waste money (30)
  • I feel guilty for not following doctors orders (30)
  • waiting for lab results creates anxiety and then I feel like a failure if something is wrong, like a bad grade (60)
  • feel guilty spending money on Rx (50)
  • pick up candy with meds at pharmacy (40)
  • might get frustrated with pharmacy if meds aren’t ready on time (40)

 

(photo credit: By Pi. from Leiden, Holland (Lab 15 – Lab Coats) [CC BY 2.0 (http://creativecommons.org/licenses/by/2.0)%5D, via Wikimedia Commons)

Torn up

My youngest brother ended his silence to me. Sorta. With a letter from his attorney.

This brother still has not spoken to me directly, does not return my texts.

I had asked Hubby to try calling him when we first found out my mom was sick, when my anxiety left me unable to dial the phone, but he never found the time. I asked Hubby many times actually. Each time he said yes he would, but never did it. I don’t know why.

So now I am left with an emptiness. My brother wants to be named executor of my mother’s estate. He wants me to waive my rights to it and sign that I agree he be named.

My oldest brother told me not to sign it. This makes me sick. To be in the middle and he won’t speak to me. Oldest brother says he is trying to get all of the money for himself, like he did with dad. Said he told him he is the only one that deserves it. That I lie about my childhood and only hurt our parents. That they were good parents, both of them, and that the two of us are ungrateful for the idyllic childhood provided for us.

Ummm.

So youngest brother never said these things to me, but he is not speaking to me at all, so I’m inclined to believe oldest brother.

I can’t believe my relationship with him might be worth a few thousand dollars. He can have it. I’ve never cared about money. I’ve never tried to hurt anyone.

But I want to do what is right by oldest brother, and he wants a neutral court appointed executor. So I guess I won’t sign anything. I don’t have a clue about probate and all this legal stuff except what i googled, and my limited trust in oldest brother.

I hate this stuff.

I just want to get in my underoos and have my youngest brother fly me around again. I want him to look me in the eyes and see I am in a world of pain. I want him to know that no matter what he thinks of me, I wish only peace, health, and happiness for him. Because I love him and I’ll never stop, no matter how much his silence hurts.

But love does not equal trust. Especially not in my family.