Safe Dialogue: Understanding Post Traumatic Stress Disorders (PTSD)

Subsequent to my recent article on mental health; I received lots of feedback; some congratulating me; others thanking me for touching on a pressing issue faced by our communities on a local level and/or abroad.

Others were asking more questions related to the mental health in general or specific to Post Traumatic Stress Disorders (PTSD).

The redundant and reoccurring question was around why the symptoms of PTSD are more noticeable now and why PTSD is rampant in the younger Rwandan population.

It is even more rampant among those who were born after the 1994 genocide against Tutsi or those who lived through it at a very tender age. This is a complex question to be answered in few lines but I will attempt to briefly address it.

April 7th 2019 will mark 25th commemoration of the genocide against the Tutsi; this genocide was very unique in many ways; one important point which makes it stand alone is that other genocides known in the history were committed with distinction based on race or a nation trying to wipe out another nation.

In the case of Rwanda, genocide was committed by Rwandans against their fellow countrymen and women; and yet the same genocide was stopped by Rwandans.

This historical fact seems to make sense to some; like historians, politicians, academicians and anyone who uses analytical thinking and factual reasoning, however the psychological understanding seems to be a farfetched paradox which makes the healing more complex, especially for the younger population; needless to mention other dynamics of Rwandan social fabrics including mixed marriages.

Post-Traumatic Stress Disorders known as PTSD; is often loosely used by many in Rwanda to describe someone who shows some abnormal behavior or acts strangely as per the cultural norms and standards. It is important to caution the readers that PTSD is a clinical term which is associated and attached to a medical diagnosis; it is not fair to attribute a medical condition which hasn’t been diagnosed by a medical practitioner to anyone.

Sadly, PTSD is wrongly and largely used to refer to genocide survivors; which may lead to an unconscious labeling of a group of people. This may incite the readers to know the true meaning of PTSD; briefly, PTSD is a debilitating and severe anxiety disorder that occurs after experiencing or witnessing a traumatic event.

Just because one survived the genocide it doesn’t give him/her the status of being traumatized until he/she starts showing debilitating symptoms of trauma and is diagnosed by a practitioner.

Back to the issue of younger population and trauma; the results of many studies and researches identify 21 years of age as the benchmark of self-destructive behaviors for those who struggle with childhood chronic abuse, neglect, atrocities, exposure to violent crimes or any other unresolved issues.

Another phenomenon which causes trauma to be worse with time; is the function of the brain; one philosopher said that “humans are amazingly adaptable animals” and it all starts with our brain. We can go through unthinkable traumatic experiences, but thanks to the brain plasticity which gives us the ability to adapt to a changing environment. We survive them and develop strong resilience to amortize recurring traumas without undue fear.

There is a mechanism of our brains which can turn emotional response on or off so that traumas do not develop into a post-traumatic stress disorder. The brain has the ability to re-program receptors in the amygdala – the emotional centre of the brain.

This reprogramming affects how we react to trauma recurrences. The receptors in the brain act as an emotional command centre. Before the traumatic event, amygdala neurons remain active and produce emotional based on our experiences.

After a traumatic event, the brain tells neurons to stop producing emotions to keep fear under control so that we do not develop too strong fear to even the mildest triggers. Without this mechanism, every sensory trigger would cause us to react in fear and would make us unable to function.

It is important to note that this phenomenon is only temporary; the brain helps you to suppress emotions and in the meantime, it expects you to resolve the deeper issues and work on how to process triggers and emotional pain.

At some point in the process defensive mechanisms will gradually disappear and the victim will be faced with reality and without adequate help, victims go from bad to worse (Survival Behaviors-Activate-Freeze-Dissociate-Collapse).

That is relatively what is happening now in our communities. Right after the genocide there was no community structure to prepare those who were physically and psychologically wounded; largely due to the fact that we were all still under state of shock but also the brains were preoccupied by the basic needs and developed strong survival mechanisms.

In my previous article; I emphasized on the fact that no one should suffer; people should reach out to seek help. Those who survived at a very young age or those who suffer from trauma transfer (the offspring of survivors); require different type of therapy. Talking therapy doesn’t work for them; the therapist needs to do a thorough assessment to identify the real issue.

For adults, therapy is easy, usually their triggers are attached to their sensory systems (what they saw, heard, tasted, smelled and touched).

For the younger population; their trauma is not on the sensory level since they can’t relate to the traumatic events; therapists need to touch on their limbic systems; which requires the helper to use other techniques which assist the client/patient to create trauma narrative; to correct cognitive distortions; and if need be use the neutralization approach.

Young clients don’t relate to triggers; they display abnormal behaviors and they may not even associate their symptoms to the trauma since they don’t consider themselves in the category of first hand survivors; and adults judge them.

They perceive our youth strange behaviors as just being silly or difficult people with little or no association to trauma. This creates a polarization or intergenerational conflicts and produces a strong resentment between young and older adults.

When PTSD is embedded in the limbic systems, symptoms are far different from one in sensory systems. Everyone is different, however most of three prominent issues could be (1) nightmares which cause sleep disturbance and this result into chronic fatigue which interferes with daily functions (2) intrusive thoughts which create lots of ambiguous preoccupations hence hindering performances at school, work or relationships; and create high level of anxiety attacks (3) flashbacks of excessive fears which may prevent growth and development.

Trauma will continue to get worse when those memories and fears are not neutralized. Failing to restore flexible responsiveness is the basis for many of the problematic and debilitating symptoms of trauma; then the person remains in the state of “acute” and then “chronic arousal” and dysfunction in the central nervous system.

When untreated this creates further physiological hyper-arousal and psychosomatic problems. When young adults are not coached to appropriately process their emotions; the disruptive thoughts travel between limbic systems to brain stem which goes from hyper-arousal to panic attacks or fainting. It that point; the individual has reached the state of emergency.

Chantal Mudahogora is a Therapeutic Counsellor at Alzheimer Society of Hamilton and Halton Ontario, Canada




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