Post-traumatic stress disorder 

What is PTSD?

Post-traumatic stress disorder (PTSD) is part of a response to experiencing trauma, whether repeatedly or as a one-off event. PTSD occurs when our brain’s natural actions to try to make sense of what has happened, and the emotions it has triggered, clash with our understandably not wanting to remember or relive the experience and our attempts to avoid the anxiety that memories trigger.

PTSD is typically described as three things: intrusive images or thoughts of a past event (sometimes called flashbacks), a general feeling and experience of being on edge, and an avoidance of the actual place or places similar to where the trauma happened. This best describes one-off traumas, such as assaults and natural disasters. Some people experience PTSD-like symptoms after repeated or historical traumas, like childhood sexual abuse. This may be called complex trauma or type-2 PTSD.

What causes PTSD?

We know that events out of context can cause PTSD, such as a freak natural disaster, a car crash or an assault. Adrenaline, when it is expected, does not cause trauma. (Think of an athlete at a major competition.) But when it comes as a surprise, we know it can change the way the brain works. It turns on our ‘fear’ centre (called the amygdala) and shuts down the bit of our brain that usually discriminates (called the hippocampus). As a result, we become oversensitive to stimuli or triggers that might previously have been linked with danger or trauma and we react to more things than are helpful.

We also know that the brain responds to trauma by replaying traumatic memories and emotions as it attempts to process them. If our fear of these causes us to try to repress or suppress them, we interrupt this natural process and end up in opposition to our own brain. Instead, we need to find safe methods and places where we can enable this processing to occur in a controlled way, and allow our mind to move on from what we have experienced.

People can beat themselves up when they get PTSD, often wondering why they can’t ‘snap out of it’. They may never have experienced emotions like this before and feel overloaded and out of control. Understanding the processes behind it can be an essential part of recovery. They may also struggle with feelings of guilt – for what happened or sometimes for other things, such as their having survived when others did not. Many sufferers also develop depression and can be prone to substance misuse as they try to self-medicate or control what they are feeling.

Can it be treated?

PTSD requires a combination of approaches. Talking treatments like cognitive behavioural therapy (CBT) can help moderate powerful emotions and help people feel more in control. This can better enable them to talk through and recall what happened, so the memories can be filed away like any other past events. Other therapies, such as EMDR (eye movement desensitisation and reprocessing) also aim to help people recall and process traumatic experiences whilst limiting the strength of the emotions they trigger.

In some traumas, people may need to learn skills to stabilise and manage anxiety or panic first, before looking at the event(s) in any detail. Medication can also help reduce the intensity of thoughts and emotions, making talking treatments more possible.

What about faith?

Life is not fair – we know that from the Bible: that bad things happen to good people. When this happens, it turns our worldview on its head, and we can begin to assume it is deserved and that God is not good. We must remember the lesson from the story of the wise and foolish builders (Matthew 7:24-28): no matter how good your foundations, storms will come.

It is inevitable that tragedy will bring many questions. The Book of Job reminds us that there is far more at play than we can ever know. There are times we just need to worship God and turn our trust to him.

At its best, the Christian community is made up of people who all have questions too. Simplistic responses (often from those who have never suffered themselves) can be hurtful and wrong. Look at the advice Job got from his friends! Churches need to be supportive and non-judgemental, offering hope that things will work out in the end, but not asking the sufferer to accept this overnight. They can also help decrease isolation and loneliness.

Some spiritual exercises, like mindfulness, meditation and contemplation, are very helpful in PTSD. They allow us to focus on what matters, to be non-judging of ourselves. They allow us to approach our questions and past experiences in a measured way, meaning we can process them rather than suppress them.