One of the major problems I suffer from PTSD is the inability to shut off my emotional responses to stress. I can and have experienced reactions to stressful or traumatic events for many days after. As Dr. Raines has explained to me, it seems as if people with PTSD have a switch turned on at the wrong time that, once activated, can’t be turned off. This switch makes it impossible to react in a "normal" way to stress. I use the word "normal" here lightly because I believe people are more complex than any kind of median state can describe; when we’ve all defined exactly what normal is, please someone alert the media so I will know. But I digress.

The tiny kidney-shaped bit of the brain called the amygdala serves to send signals to the hypothalmus, the driver of the sympathetic nervous system, where all PTSD sufferers live quivering on the edge of a knife. I must say that I feel intimately aware of my sympathetic nervous system every minute of every day.  From the Scientific American’s write-up of the research published in Neuron, I have learned that the amygdala is connected to the rostral anterior cingulate cortex, or the rACC if you like acronyms, which researchers theorize might serve as the traffic cop of the emotions. The rACC might be the place that warns your nervous system that you have discovered the source of the loud noise that woke you, and it is just your cat falling off the couch, so it’s time to chill out. I think the rACC might also be the guy who tells you, "just keep your eye over there . . . something is not right," and keeps poking you to investigate by tweaking your nerves until you get out of bed to see what the noise is. Warning: I’m thinking of changing the name of this blog to "unscientific intuition."

So, the amygdala is the siren and the rACC is the traffic cop. When the amygdala fires, but the rACC gets an all-clear signal from somewhere else, it inhibits the nervous system. The siren goes off, the lights go down.  However, as David Biello writes on ScienceNews.com:

It is possible, however, that those roles are reversed: the amygdala habitually dampening the rACC and then letting it loose when emotional activity is reduced. . . . The finding suggests a two-stage response to perceived threats as well as what might be malfunctioning in patients suffering from post-traumatic stress disorder. It may simply be that one of the executive portions of the brain is failing to calm its emotional colleague.

This rings true to me based on my personal observations of the "clamping down" and dissociation I experience whenever I am in the middle of stress or trauma followed by the rubber-band reaction after all is well. It is as if my amygdala refuses to sound the siren and let me out of there. I can explain this with a simple story that’s kind of gross; if children vomiting bothers you, please move quickly to the last paragraph of this post.   

I was home sick with a stomach virus, with a pail by the bed and a fever dangerously high as only children can achieve, and my grandmother brought me oatmeal with honey, which immediately made me nauseous. The smell of it, and oatmeal doesn’t smell strongly; the appearance of the honey on the top of the glutinous mass like some oil slick sickened me, and the oatmeal was just this gray lump in the bowl, so I handed it back to her and immediately vomited into the pail. Well, this made my grandmother angry. She watched me vomit and drink some water. She wasn’t the nurturing type, if I even need to explain that. Then she gave the bowl right back to me and told me I was going to eat every bit of the food in that bowl. This was a mantra to her: the great depression, people starving who had it worse than me (my grandmother never mentioned Ethiopia though, it was always the Great Depression), how hard she worked to prepare it for me, and what an ungrateful brat I was to dare not eat her food. There was absolutely no thought in her mind that eating might not be a good thing for me at that point in time, or that the kind of food she was giving me was not healthy for me either. That is what she prepared, so that is what I would eat.

So I ate it. I made myself swallow every single bit. I wanted to vomit; my stomach was roiling like the sea during a hurricane, but I told myself not to be sick. I told myself not to be sick. I told myself not to be sick.

And I was not sick. To this day, I very rarely vomit unless it is a completely autonomous nervous reaction. I vomited in a hospital after my first fibroid surgery, when I had been on an IV for twenty-four hours and the nurse brought me beef broth. I smelled that and my stomach just reacted. I think that was the first time in about fifteen years. Oh, but I suffer in other ways later when the wars have passed on.   

If we can define and track what is going on in the brain, perhaps one day we can figure out a behavioral modification for it so that sufferers of trauma can re-train their amygdala to act the way it should.  No rubber bands. Nirvana.

Tags: ptsd, amygdala

My everyday, normal state is cranked about twelve points higher than it should be, thanks to PTSD. I can’t stand being late for events or getting lost in the car, for example. Every minute that ticks by, if we are driving around lost and becoming more and more late, will crank my anxiety level up higher and higher. It also takes me a long time to come down from a level of high anxiety, too; sometimes days might have to go by before I feel as if my synapses have stopped firing warning messages at me. I don’t relax well at all.

I tell you all this to explain my weekend, which was normal in every respect and even featured a little treat, in that Richard and I went to see the Broadway version of the Lion King downtown Saturday night. We left in plenty of time to get dinner, and after dinner we still had time to kill so we traipsed through a boookstore for a little bit, and then headed downtown. Richard decided to take the new Fayetteville Street drag, thinking it would let us go all the way down to the BTI center, but it was blocked, and traffic was also dragging on that street, and so what should have taken us less than three minutes ended up eating twenty, and we missed the reception I had been invited to. So I’m in the car, and we’re sitting on this thoroughfare, and I’m staring at the lights not turning green and the skateboarders skating in the street (stupid! plenty of sidewalks! they were weaving through cars! one of them is going to die, or I’m going to open up my car door and injure one of them on purpose. look, he’s coming close to the car now!) and the clock on the dashboard is creeping closer and closer to 8 o’clock and we are not even parked, and we have to walk across the street a ways and I have heels on . . . and my anxiety is cranking, cranking, cranking.

Richard is apologizing, knowing I’m getting keyed up, and it’s not his fault and I tell him so, because I’m not mad at him, I just hate being late and missing something important, and I hate the crush of crowds into a theater and we are going to have to stand in it and I hate that because it keys me up more. We get to the parking garage with about 17 minutes to spare, hurry across the street, find the sales rep I was supposed to meet and say hi, then join the queue which is moving at about the speed of slow molasses through a straw.  People are crushing in all around me, and there is a tall man next to me who keeps crashing into my shoulder. He is talking to a woman next to him, I assume his date, and I have enough time to wonder why he is not taking care of her, holding her arm and helping her through the crowd and why in the world he is walking in front of her and pushing his way through and ignoring what’s happening to her, since she’s talking to him and he’s nodding and I’m pretty sure they are together, and I’m thinking, not for long. We see David Crabtree in the crush and Richard makes jokes to try to loosen me up, but I am not having it. I hate close spaces, which we are going into, a hallway with a low ceiling and very little light, and room for perhaps two across which people are trying to get four across in. At the entrance there is one person scanning tickets and one person tearing them. I have plenty of time to wonder why they started seating so late. The woman who was handing out programs had kept apologizing for letting people in late, but even telling myself that had we got there at a respectable time we would still have been caught in this crush does not ease my anxiety. My anxiety is not going to back down for quite some time now.

We go slowly down the hall, one agonizingly slow step at a time, and at the end of the hall when we must turn to get into the theater I see why all of this is happening: there is one usher telling people where to sit. One! There are only two entrances to the main floor, and one usher at either end! There are other ushers farther in, but you have to get past the first usher to be directed to another usher. I am trying to breathe slower and calm down, because they are obviously not going to start the show with so many people unseated, but all I want to do is sit down and not have all these people pushing me and breathing down my neck.

The show was fine, in some parts incredibly moving and powerful because of the quality of the singing and the puppetry; the woman who played Rafiki was just flat-out brilliant, but a lot of it was just silly, especially the "Can You Feel the Love Tonight" number, which I disliked in the movie; perhaps I was predisposed to hate the show number but it was just . . . silly. Well, it was a Disney production. I thought the choreography left a lot to be desired. When we got home I was up for several hours, unable to sleep. Then came Sunday, when I couldn’t find my file for my tech comm class.

I had worked for four hours on a Mission Statement project due Tuesday, and anticipated it was going to take me perhaps two more hours to complete the document, so when I opened it and found it empty on Sunday morning I completely lost my mind. I searched my computer, but couldn’t find the backup or any temp files with anything I could use. I started muttering, crying and walking around pulling my hair. I hate being like that, I feel like a mental patient, but I couldn’t stop thinking that everything was ruined, everything was ruined, everything was ruined. I couldn’t even imagine starting over. I couldn’t get there at all.  

Richard tried to help, but that increased my anxiety, he couldn’t find it either and what good would it do. Finally I decided to escape my own skin, so I got dressed, jumped in the car and headed to the office to hole-punch my index dividers for my project notebook, another assignment for that class. Yes, I drove twenty-five miles for a hole puncher . . . but it calmed me down sufficiently. I listened to Edie Brickell in the car, rolled down the window and tried to smell the fall on the air and just be. Ha! There was no one farther away from Zen than me at that moment in time.

When I got home Richard wisely did not try to calm me down, and I just started making something for lunch. He left to go to work for a bit, and I resigned myself to starting over. I get on my computer and open up the template I had made for this project and voila! My document, which I had saved as a template. Not only am I a nervous wreck, but I am also an idiot.

I wish I could say everything dissipated, but it hasn’t yet. My stomach has been burning since then. I’ll be dealing with the stress repercussions for a few days. Over being late to the Lion King, and a missing document. What drama.

Tag: ptsd