Updated: Apr 25, 2022
Just a man casually carrying a swan through a London park…
Not what you would usually expect to see when you are out for your weekly run but there it was: a man walking in front of me with a large swan cradled in his arms! The swan was completely calm when I came across them. Then suddenly, with what appeared to be no provocation at all, it started flapping wildly and trying to get away. The man struggled for a few moments and then managed to get the swan under control and was able to carry it calmly again.
Watching this got me thinking: those of us who have suffered with trauma are a bit like this man carrying his heavy and unwieldy swan. The traumatic memories are always with us; we carry them wherever we go. And every now and then, sometimes without warning or obvious trigger, those memories start ‘flapping about’ uncontrollably; we experience intrusive thoughts and memories, flashbacks, panic attacks, or nightmares. Eventually we get the ‘swan’ back under control and continue our journey encumbered with its heavy weight.
Imagine if we could take the swan to the lake where it belongs, put it down and set it free. We’d be able to visit when we wanted, to see it swimming there. The rest of time, we can walk freely, that huge weight lifted, the exhausting effort to keep it under control no longer required.
Post-traumatic stress disorder (PTSD) affects about 15 million adults during a given year. You can develop PTSD after experiencing a frightening or life-threatening event or series of events. This could include a road accident, violent personal assault, serious health problems, or childbirth experiences. PTSD is frequently experienced by people who have served in the armed forces or emergency services. Some people develop PTSD immediately after experiencing a disturbing event, but for others it occurs weeks, months or even years later.
How does PTSD develop?
The way our brains process memory is very complex. Our everyday memories are stored in a part of the brain called the hippocampus. Here, memories are catalogued and made sense of; turned into a cohesive event that you can recall at will. For example, I am sure if I asked you to, you could easily recall the sequence of events of your last birthday, even if you had not thought about it until right now.
The process for storing memories of a traumatic, frightening or distressing event, however, is different. Emotional memories, particularly fear-related ones, are stored in the amygdala, which is the part of the brain that controls our fight-or-flight system. This system has evolved to protect us from danger, by ensuring we recognise and respond quickly to threats. It works by releasing adrenaline, noradrenaline and cortisol, raising our heart-rate and breathing and sending glucose to our muscles so we can easily flee danger or fight off an attacker. During a traumatic event, the fight-or-flight mechanism takes over. The memories are stored in a place where they can be accessed immediately if anything similar happens to us again. The amygdala is over-activated, while the hippocampus is suppressed, and as a result, our memory becomes jumbled.
Later on, if we encounter things that remind us of the traumatic event, like a sound or smell that was present when it happened, our amygdala will retrieve that memory and respond strongly. It will signal that we are in danger and automatically activate our fight-or-flight system. This can be subconscious, often we are not even aware of what the trigger is. Normally when the amygdala senses a possible threat, the hippocampus will then activate. It will use context from past memories to determine whether or not we are really in danger. But because the hippocampus wasn’t functioning properly during the traumatic experience, the context of the memory wasn’t stored. There is no feedback system to tell the amygdala that this situation is different and we are not currently in danger. Since the memory is retrieved without context, such as where or when the experience happened, it can even feel like the traumatic experience is happening again.
Symptoms of PTSD
This is why people who suffer with PTSD commonly experience a range of distressing symptoms, one of the most typical being re-experiencing. As described above, this is when a person involuntarily and vividly relives the traumatic event, in the form of flashbacks, nightmares, or repetitive and distressing images or sensations. They may have physical sensations, such as pain, sweating, feeling sick or trembling.
It is also common for people with PTSD to have panic attacks, be very anxious or find it difficult to relax. They may be constantly alert to threats or be easily startled; or feel continually ‘on edge’, irritable, or prone to angry outbursts.
Another common symptom of PTSD is dissociation, a feeling of being cut off from reality. You may feel disconnected from your thoughts, feelings, memories, or surroundings. It can affect your sense of identity and your perception of time; you may forget things or have gaps in your memory.
Often, PTSD sufferers have sleeping problems, find it hard to concentrate or have physical symptoms such as headaches, dizziness, chest pains and stomach aches. PTSD can affect work and personal relationships; and can sometimes be a contributing factor in drug and alcohol use, self-harm or depression.
Some people cope by avoiding reminders of the traumatic event, staying away from certain people or places that remind them of the trauma, or they avoid talking about their experience. Others attempt to manage their emotions by trying not to feel anything at all, which can lead to them becoming isolated and withdrawn. They might give up pursuing activities they used to enjoy, which can contribute to depression.