We were all saddened by the recent apparent suicide of Master Corporal Sylvain Lelièvre of the Canadian Forces. It was the fourth reported suicide this past week alone.
Every suicide is complex and we can never know exactly which factors go into one person’s decision. Mood is affected by our temperament, our biological makeup, and our circumstances. No two people react to the same event the same way. Nevertheless, when trauma happens, it will almost certainly be a major factor in a person’s decision to end it.
Trauma can never be prevented. We are unlikely to live in a world without wars and armed conflicts, without violent crimes such as rape or murder, or without fatal accidents and drownings. We can however prevent Post-Traumatic Stress Disorder.
Living through a traumatic experience is hell. There is no other word for it. Unfortunately we have few tools to palliate the suffering. We can offer all the therapy or medication we have available to a victim but we do not have a tool to reach into his or her brain and remove the painful memory. Nevertheless we can give victims support – and more importantly the space and time – to gradually reclaim their lives.
Traumas will never be forgotten but over time the memories will take less room in our thoughts and we will gradually be able to resume our normal functions. This is as good as it will ever be: one doesn’t ‘get over’ trauma but life will go on and trauma will no longer define or control us.
So what then is Post Traumatic Stress Disorder? Many people assume it is what people who have lived a trauma suffer from. In fact only a small proportion of victims of trauma develop PTSD. For most people, trauma-related symptoms gradually reduce over time (albeit by way of a very long and intense roller-coaster ride). But in the case of PTSD, victims seem to either have a stalled recovery or, worse still, symptoms that worsen over time. The difference between people who recover and those who develop PTSD is in how they react to their emotions.
People who fight their emotions and try to avoid them will slowly become slaves to them. Memories cannot be avoided. When we try, all we manage to do is give them strength. Here’s how it works:
If I was the victim of a serious car accident and am watching the news, there is a good chance I will see a report of a traffic fatality that will trigger a painful memory. What am I supposed to do? All I can really do is let myself feel bad. I may cry or be overwhelmed with emotion. But if I accept this as normal, I will live a wave of feelings. My emotions will rise and then slowly dissipate. At some point my mind will start to focus on other things.
This is not a fun process but it is normal. Over time what will happen is that fewer and fewer events will trigger this wave and the wave will tend to pass more quickly.
Some people fight this process. They avoid places where memories are triggered. They avoid news reports. They avoid talking about the event. They try not to think of it.
If I stay away from an intersection where I had an accident, I will feel relieved but I will also confirm to myself that the intersection remains dangerous. I will not learn that the world is relatively safe and that, although bad things can happen, we are not surrounded by death and trauma. Instead I will learn that the world is a place where danger lurks around every corner.
People who fight their emotions or attempt not to feel them are very likely to develop PTSD. Over time they will be more and more overwhelmed by flashbacks and memories. They will live in an ever-shrinking prison. A person being tortured by memories and feeling that recovery is hopeless, is at a significant risk of suicide.
This brings us back to Canadian soldiers. I have treated enough of them to know that the culture of the armed forces is a significant factor in PTSD. I recently heard an interview where one soldier described the general attitude toward trauma as “Suck it up and move on.” I can understand that when we are surrounded by death and destruction we want to be able to keep going. I get that. I can’t imagine the strength it takes to be a soldier in a war zone. But I think the reluctance to admit weakness of any sort forces victims to suffer in silence. If they think they are supposed to just suck it up and they can’t, how will they see themselves? Weak, defective? Or worse yet, not cut out to be with their fellow soldiers?
I do agree that we should make professional help more readily available to our veterans but I also think the real solution is one of prevention. This can only happen through a change of mindset and culture. Trauma will not be prevented but if we do not discourage soldiers from experiencing normal emotions and from feeling free to express their struggles, at least we can prevent PTSD.
Here is a video of a conference I gave on PTSD as part of our 2012 Mini-Psych program:
06 Dec 2013