Article by Jari Lynn Smith
As a diagnosis, post-traumatic stress disorder (PTSD) has a straightforward constellation of symptoms. They include exposure to a traumatic event causing intense fear, helplessness or horror, flashbacks, nightmares, feeling as if the event were recurring, insomnia, irritability, impaired concentration, hyper vigilance and the list goes on. The above description undeniably describes soldiers returning from combat. Wars can destroy the lives of soldiers and their families. Interestingly, adults and children who have been abused, neglected or abandoned share many of the same PTSD symptoms as do those suffering from depression, but there isn't a distinct or separate diagnosis for them. The above lead to a rupture in the attachment to self and others. It's not an easy issue and requires insight and skilled treatment.
There are a variety of ways that we connect with ourselves and others. Therapists refer to these connections as attachment styles or categories. As a therapist, I assess clients as having secure attachment, preoccupied attachment or dismissing attachment. Secure attachment is characterized by responses that are fluid and goal-directed with coherent descriptions of the past. Those with preoccupied attachment give repeated and negative descriptions of the past, offer excessive explanations and have difficulty going to the next question. Those with dismissing attachment give brief descriptions of the past and normalize negative events. There are other types of attachment that are relative to PTSD. Avoidant attachment is characterized by emotional restriction and peers often refer to such people as aloof, unlikeable and controlling. Anxious attachment includes mothers who are cold and rejecting, fathers who are unfair, distrust of others and a need to maintain distance from others. Disorganized attachment is characterized by a fragmented, sense of self and unresolved states of trauma and loss. Such people are impaired in their ability to relate to others and to regulate their emotions. They can barely get the words out when the story of their lives reaches painful past experiences. PTSD can be an accumulation of trauma or loss or one terrifying experience.
If left alone those suffering PTSD can become overwhelmed and organize their lives around not feeling. Bodily sensations are the primary source of information and when any sensation is associated with guilt, helplessness, anxiety, shame and fear, PTSD sufferers shut down. The body becomes a separate world, thus distorting the entire system. What is required is an improvement in the relationship to the body and the self. It is wise to question the usefulness of addressing underlying psychological issues. Instead the task is to help the person become adept at sensing themselves physically, and as this is accomplished the body becomes more controllable and inner experience improves.
According to Thomas Hanna we do not fear without muscles and sinew that fear. We cannot hate or be angry without an organism that hates and is angry. We cannot love and hope and expect without actively, movingly, physiologically loving and hoping and expecting. Hate, anger, love and hope are not "psychological states" existing in some "mental" vacuum; they are somatic states that exist in the entirety of our living system. To change these habitual patterns of action is to change these states.
As a Marriage & Family Therapist, I prefer to approach this serious issue by organizing diagnoses and treatment around poor attachment, low self esteem, emotional distance and physical dysregulation. I help people find their way toward secure attachment, purposeful action, easy closeness and contact to others with the ability to soothe and calm the body. They are then capable of returning to self-regulating strategies independent of relationships with others.