Seattle writer Naomi Steinberg, who lives with bipolar disorder, posted about living with mental illness yesterday.

I read an article in The Seattle Times recently about the kids, who, while toddlers, survived the Oklahoma City bombing in 1995. They are teenagers now. Most have permanent injuries: burn scars, hearing loss, developmental disabilities, PTSD. One boy has had five major brain surgeries; the last put a plate in his head. He also suffers from seizures and wears a full ankle brace to school everyday. When interviewed, his mother said, regarding her family, “We have our own normal.” I read that and felt like a light bulb just switched on. “I have my own normal.”

So do I. Yesterday when Richard and I got back from Atlanta, we drove over to the construction site to check on the progress of our house, and we had two close calls on the way back, one while trying to make a left turn (my favorite!) and the other while coming to a stop at Highway 70 and Miami Boulevard, when a car in front of us abruptly swerved into our lane. As I was frantically groping for my anti-anxiety medication, Richard said, “I’ll take you home,” changing our plans, which had been to go grocery shopping together and then grab dinner. He knew I had to get somewhere quiet, away from any more potential shocks to my system.

That’s my normal, and it is what it is.

Sometimes people ask me why I can’t just “get over it,” and I can understand if people voice, or think and do not voice, this opinion when it comes to child abuse sufferers into their adulthood. I don’t hold with excuses for bad behavior. But that’s not quite the same thing.

I was watching William Shatner’s new show, Raw Nerve, the other day, and he had (Judge) Judy Sheindlin on. She was adamant that while abuse may be a reason for the committing of a criminal act, it’s not an excuse. When you hurt someone, you submit yourself for judgment, and abuse is not an excuse if you choose to hurt someone. I believe this just as strongly as she does. No matter what has happened to you, if you pass it on, you are responsible.

That said, complex PTSD is not something that I can just forget about or “get over.” And I don’t want to sound like someone with a chip on my shoulder when I explain that PTSD is like fallout. It’s the consequences of what happened to me. It’s a disability, just as sure as an amputation done to save someone’s life from gangrene, or the sickness from chemotherapy administered to save someone’s life from cancer. PTSD is what’s left from the extreme measures taken by my body to save myself from the abuse I suffered as a very small child.

When I was about three, or four, my father forced me to fondle him, among other things, but my brain and my body were too young to defend me from such a horror. So instinctively, extreme measures kicked in. The red alerts were sounded, the walls were shut down, and my brain insulated me from what was happening. My brain failed to register what was happening in my long-term memory as an entire memory, as the only defense mechanism I had available. Although my instinctual fight-or-flight response kicked in, I was physically unable to fight or flee, so my body shut down, failing to react to what was happening because it had no frame of reference for it. My mind and my body went, well, possum. And then it happened again, and again. The result was heightened fight-or-flight response—as if I can’t turn my internal alarms to off—combined with an absolute inability to flee.

Complex PTSD. The fallout is a heightened sense of threat combined with an inability to actually flee from stress. Most people with PTSD look like they are stone cold sober in the middle of a trauma. That isn’t actually the case. They are fighting combat on the inside. They just can’t move. So they stay in the trench. And later, the shrapnel that they have taken ricochets.

Just like fallout. From extreme measures.

While few studies have been done on the link between car accidents and PTSD, the last study sponsored by the National Highway Traffic Safety Administration (NHTSA) in 2000 found that as many as 40% of people seriously injured in a car accident suffered post-traumatic stress disorder symptoms during the first year of the crash. Luckily with treatment most of those sufferers can move forward without long-term damage, but about 5% of seriously injured car accident victims will still suffer from PTSD five years or more after the original accident. 

And, if the victim already has PTSD? Well, you know they say when it rains, it pours …

In the spring of 2004 Richard and I were struck from behind by a woman who was rushing out of a gas station into traffic on Glenwood Avenue north in Raleigh. We were stopped in traffic, and the impact forced our Toyota Corolla to collide with a large Dodge SUV stopped in front of us. My seat belt and seat broke and I was trapped in the car. Upon admittance to the hospital I was diagnosed with whiplash and contusions, and underwent physical therapy for three months for my injuries. The psychiatric treatment is still ongoing.

The wreck was my third in Raleigh; the first two involved turning left in traffic and being struck by vehicles coming from the other direction. One, which took place on Walnut Street in Cary, was probably the most traumatic of my life and involved being crushed by the steering wheel, severe bruising of my chest, an extended hospital stay, and worst of all, the mistaken belief that I had killed someone for several hours because the person who I collided with had gotten out of their vehicle, so that when I looked over I saw an empty truck and thought the person had been thrown from their car and was dead.

To this day when we are stopped at a light I can feel an impact in my right shoulder, and when I have to turn left I anticipate breaking glass and impact from the front. Even thinking about it now makes me anxious, and I am safe in my living room with a cat curled up on the arm of the couch, warm at my shoulder purring at me. In diagnostic terms it’s called “a deepened sense of threat.” It’s perfectly illogical. But it’s a door I can’t close, ever. In my less lucid moments I want to throttle my dead father for starting all of this. But my father is only dust in the wind.

The December 2008 issue of the Journal of Clinical Psychiatry has published research by an Australian team that found two definitive risk factors for post-traumatic stress disorder (PTSD): elevated heart rate and elevated respiration (breathing) rate.

Over a period of nearly two years the researchers studied 955 patients admitted to Australian hospitals after traumatic events who were then evaluated for PTSD as well as major depressive disorder (MDD) three months later. They found that the 10% of patients who were subsequently diagnosed with PTSD from the traumatic event all exhibited significantly higher heart and respiration rates than non-PTSD trauma victims.

Patients who exhibited heart rates of at least 96 beats per minute after the traumatic event, and respiration rates of at least 22 breaths per minute, were at least twice as likely to develop PTSD. Researchers concluded:

Elevated heart rate and respiration rate are predictors of subsequent PTSD. These data underscore the need for future research into secondary prevention strategies that reduce acute arousal immediately after trauma and may limit PTSD development in some individuals.

This is good news for the future because it means psychiatrists and physicians may soon be able to pre-treat for PTSD and avoid lifelong cases of complex PTSD like mine.