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PTSD and Depression

What to do when the world intrudes.

Source: Rosenthal

Trauma is an event where an experience bears down on your physical and emotional life. It can be mild, like when someone cuts in front of you while you’re driving; moderate, as in the car careening with yours causing an accident, or severe, the accident resulting in life threatening injuries. For many, once a traumatic event ends, they can return to their regularly scheduled lives with not too much interference. But for others, trauma leaves an indelible imprint – interfering with daily life in overwhelming ways.

Post Traumatic Stress Disorder (PTSD) is a serious anxiety disorder that results after a significant traumatic event. Long ago, it was called shell-shock, combat stress and battle fatigue, and thought to only occur with soldiers or individuals who endured unspeakable trauma. What we know now is that PTSD can occur in children and adults, and can be caused by direct exposure to a horrifying experience or the witnessing of a traumatic event. Research shows that rates of depression increase after a trauma and are especially high for a child or adult with PTSD. In fact, depression is nearly 3 to 5 times more likely to occur in those with PTSD than those without PTSD.

In 1981, Michele Rosenthal was just a regular thirteen year old girl – but a medical allergy called Toxic Epidermal Necrolysis Syndrome ravaged her little body, turning her into a full-body burn patient almost overnight. The trauma she endured was so extreme that it stunned her doctors, terrified her parents and threatened her very life. Michele lived day to day enduring unspeakable pain, nearly dying from symptoms. With luck and grace, she pulled through, but not without physical and emotional scars. Her memoir "Before The World Intruded" details this journey and her triumph over trauma. It is an inspiring read about what it takes to make sense of trauma, how to rise above depression and despair, and how self-discovery leads to change. Now a mental health advocate and certified professional coach, she uses her personal experience to help survivors learn to cope with, manage and strategize the PTSD recovery process.

What is the one thing Psychology Today readers should know about trauma?

The absolute number one thing readers should know is that trauma imprints deeply in the brain in ways you might not even be aware of. We all spend our waking moments in the conscious brain, which is only 12% of your brain. The conscious part of the brain is responsible for short-term memory, analytical thinking and decision-making. The subconscious part of the brain, however, equals 88% of the brain. That’s the part responsible for long-term memory, beliefs, associations and feelings, to name a few of the processes that go on below the realm of your conscious awareness. The subconscious mind actually remembers everything since the day you were born, even when your conscious mind doesn’t. The reason this is important to understand is because very often you can survive a trauma and think you are fine, that you’ve let go of any connection to what you experienced. Later, however, you may begin to see behaviors that indicate otherwise. Nightmares, for example, or new fears and anxieties. It’s important to understand that this is absolutely normal and only indicates that you’ve got some things that need to be processed around the event. The effects of trauma are not always logical, predictable or expected; survivors need to be aware of differences in themselves and explore how those differences may be in response to a recent traumatic experience.

You explored and experienced many different kinds of treatment interventions and specialists during your illness and recovery. What advice would you give Psychology Today readers when it comes to seeking answers to chronic illness, trauma or emotional struggles?

The most critical element is checking in with yourself! Trauma and emotional struggles have no single prescription for resolution. Each of us has to find our own personal roadmap to relief. The key is to work with modalities and practitioners that resonate with you. That is, treatments with which you feel reasonably comfortable and professionals with whom you feel connected and safe. I did move through ten modalities before I ultimately found relief. Along the way there were some that felt good to me, and some that made me enormously uncomfortable. I learned early on to trust my instincts and eliminate those processes that compounded the normal stress of recovery work. There’s a certain amount of treatment that is going to bring up uncomfortable feelings and emotions. That unavoidable discomfort is part of facing what needs to be faced. In order to do the tough work it helps to be working with a technique and an individual that allows you to focus on the work and not your discomfort with the actual process itself.

What was one of the most meaningful things you learned about yourself through your journey?

Great question! So often we think of trauma and recovery in terms of what’s lost, destroyed or broken. While those elements may exist in certain moments, the larger picture is that trauma and recovery force us to grow in ways we never may have discovered without such challenges. In my own journey, one particular example comes to mind: My trauma occurred due to a medical mistake when I was thirteen years old. An allergy to a medication turned me into the equivalent of a third-degree burn patient almost overnight. While I made a full physical recovery, I never rebounded emotionally. For the next twenty-five years I lived in the shadow of that event. I was plagued by nightmares, sadness, depression, anxiety and fear for my safety. After several years I just accepted that that was the kind of person I was. I accepted that I was not joyful and even thought that it was impossible for me to feel joy. And then one day I decided that I really wanted to be the kind of person who could feel joy, so I set about developing that experience for myself. I was enormously successful. What I learned along the way was that I contained a natural resilience I hadn’t been aware of or tapped into, and also that I have a deep well of joy within me – all I had to do was learn how to access it. In trauma recovery we have a chance for posttraumatic growth. In engaging in that growth I learned I was stronger than I expected, more creative and life-loving than I knew, and more empowered than I ever expected in the creation of the life I desired.

You often say that “we don’t heal in isolation, we heal in community.” Tell readers what you mean by that?

In my own recovery and in that of so many of the survivors with whom I work and speak, there’s an enormous tendency toward isolation. We’re not happy with ourselves and our lives, we don’t feel safe or in control and so we hide out. As one military psychologist calls it, we ‘hunker in the bunker.’ The problem is that it’s very difficult to heal in that isolated and detached state. We need the support, knowledge and advice of others to help us navigate the ever-changing terrain of trauma recovery. So, one aspect of what I mean by the quote you mentioned is that we heal better and more quickly when we accept help. The other element of that has to do with my belief in how much survivors can teach each other. Survivors have a meta-language that allows them to understand each other on a deep and experiential level. When we connect with each other, we strengthen ourselves. When we help each other, we move ourselves forward through an exchange of energy, ideas, education and support.

Before the World Intruded, your memoir of your traumatic experiences, is a powerful story of determination in the face of despair. What do you most want readers to learn from your personal narrative?

The most important message in the book, I think, is that we all have enormous healing potential. The goal is learning to access that potential to conquer the past and create the future. I went through twenty-five years of struggle before I found the information I needed to begin charting a path to relief. If I can overcome the built up effects of twenty-five years, there’s hope for us all! Trauma recovery is, as my mom says, ‘a long and winding road.’ There will be successes and failures, certainties and doubts. The key along the way is to maintain your hope and develop a deep belief in your ability to achieve your goals.

Is there anything else you would want Psychology Today readers to know about PTSD, depression or anxiety?

So many things I’d want them to know! Most importantly: First, if you are struggling with the effects of the past, it’s not your fault. Feeling posttraumatic stress is a reasonable response to an overwhelming, unexpected and shocking experience. Second, help exists and it’s your job to seek and engage in the therapeutic process. Third, it is possible for you to transcend trauma no matter how deeply you feel affected or how long it’s been since your experience. It will take time, but you do have the potential to feel better. Fourth, self-care is enormously important after trauma and in recovery. Find a way to take care of yourself in terms of routines and activities that soothe and restore your energy, vitality and resilience. Finally, the key to finding relief lies in finding the courage to face what needs to be faced, do what needs to be done and accept the ups and downs of the process until the job is complete.

Michele Rosenthal, a certified PTSD coach, is the founder of and the host of YOUR LIFE AFTER TRAUMA, Thursdays on Seaview Radio @ 7pm EST. She welcomes your comments and questions.


Kessler, R.C.; Sonnega, A.; Bromet, E.; Hughes, M. & Nelson, C.B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52(12), 1048-1060.

O’Donnell, M.L.; Creamer, M. & Pattison, P. (2004). Posttraumatic stress disorder and depression following trauma: Understanding comorbidity. American Journal of Psychiatry, 161, 1390-1396.

Skelton, K.; Ressler, K.J.; Norrholm, S.D.; Jovanic, T. & Bradley-Davino, B. (2012). PTSD and gene variants. New pathways and new thinking. Neuropharmacology, Volume 62(2), 628–637.