PTSD is difficult to treat because it is stored throughout the brain.
To paraphrase neuroscientist David Eagleman in his fascinating book, Incognito, the Secret Lives of the Brain, there are as many connections in a single cubic centimeter of brain tissue as there are stars in the Milky Way galaxy! This makes the brain the most complex organ in the known universe and helps us understand why such all-encompassing problems such as PTSD can become deeply embedded in our brain and subsequently our psyche.
So how is this incredibly multifaceted organ, the brain, affected by trauma? As you can see in the illustration, a traumatic experience that involves most or all of the senses - sight, hearing, smell, physical pain - as well as emotions, speech and thought, is stored in multiple regions throughout your brain. Since we are all unique, individual, complex beings the experience of PTSD is somewhat different for everyone, although there are basic commonalities that set this form of suffering apart form to her types of mental illness.
And just as you can suffer from a little to a lot of depression or anxiety, you can suffer from minimal to extreme degrees of PTSD. If a traumatic event is extreme, it becomes a long-lived deeply embedded memory as opposed to a short-term memory like what you had for lunch last Tuesday. A person who suffers from minimal PTSD will probably get better over time without therapy. For instance if they were in a fender bender, they will get their car fixed so they don’t think about the accident every time they see the car. In time they will be able to drive by the accident site without constantly thinking of the “what ifs”: What if I had left home five minutes earlier? What if I had taken a different route to work?
But if you have been brutally physically assaulted and raped, no amount of time will ever completely erase the trauma if you don’t get help. You start adjusting your thoughts and routines around these dark memories and the emotions they evoke. And these adjustments cost you dearly. You’ve kept it a secret, so you don’t want to talk about it, much less see anybody. You don’t feel good about yourself, so why go to the trouble of trying to look presentable? Because you don’t want to see anybody and you don’t care about how you look, why go to the gym or take that walk or get out of bed at all?
Eventually, the normal things you would do for or with others - going to work, preparing meals, being interested in what they did that day - become chores that eventually turn into resentment, which causes you to feel irritable and angry toward them. Simple things both at work and at home that would never have bothered you before the trauma - finding a parking place in a crowded parking lot, riding the elevator to the office, the mounting pile of laundry – are now monolithic obstructions that must be dealt with before you can mentally curl up in the fetal position and go over and over the what ifs again and again.
They may seem closed off and uncaring, but deep down inside people with PTSD know they need help. Sometimes getting help seems like one more chore that’s just too overwhelming to contemplate. Often they don’t get help because they are afraid of being judged, compartmentalized, and deemed mentally ill. And for the rest, fatalism and cynicism step in and say, ‘‘Why bother? Nothing’s going to change no matter what you do or what they say.’’ People with untreated severe PTSD can sink into the deepest, darkest depth of depression with no apparent way out. They don’t dare look up, afraid they might find their ugly trauma looking back down at them. People suffering from PTSD are trapped in the past traumatic event. They are frightened of the future because they are afraid the past trauma will be recreated, and live in a fatalistic present. For many, the only relief is from what might become addictive behavior. You can fill in the blank - “I am going to: a) drink this, b) take this pill, c) smoke this, d) eat this, e) play this video game and/or f) surf the internet… because it will make me feel a little better.”
Time Perspective Therapy
One of the keys to Time Perspective Therapy is the realization that we always have the choice to change how we view the times of our lives. Over the course of this exciting new therapy, PTSD sufferers move away from a narrow focus on the traumatic past and a cynical present and the possibility of ever achieving a hopeful future. Instead they journey toward a balanced time perspective in which it seems possible once again to live a full and promising life.
This concept is reflected in ordinary language that time perspective therapists use. Most people suffering from PTSD have already been labeled as anxious, depressed, or even mentally ill. When they hear these words, and identify with them, the possibility of ever emerging from such a state feels very distant. Reframing their ‘‘illness’’ as an ‘‘injury,’’ and recasting their depression and anxiety as a ‘‘negative past’’ that they can replace with a ‘‘positive present’’ and ‘‘brighter future’’—and ultimately with a balanced time perspective—may seem overly simplistic, especially to those trained in psychotherapy. But to PTSD sufferers, the idea of having a forward-leaning framework in which to understand and work on their issues most often comes as an enormous relief and a welcome ray of light in the darkness.
The image below illustrates how in Time Perspective Therapy (TPT), we show people how to lift their back foot that is stuck in the muck and mire of the traumatic past while standing firmly on the ground of the solid present, and place it into a brighter future.
In the next column, we’ll discuss some differences between TPT and other therapies as well as delve deeper into the nuts and bolts of TPT.
Illustrations by Noah Milich
For more information on the effects of PTSD, see The Time Cure: Overcoming PTSD with the New Psychology of Time Perspective Therapy (Zimbardo, Sword & Sword, 2012, Wiley Publishing,) and for strategies to reduce stress and improve communication, visit www.timecure.com and www.lifehut.com.