In the previous posts, I have entered my objections to the way PTSD is defined in the diagnostic literature and also discussed potential problems I see in traditional treatments. To move ahead, I would like to broaden my scope so that I can better elaborate on what I believe has been missed in the literature. What follows focuses specifically on symptoms and conditions that researchers and most practitioners appear to have overlooked. To do that, I am going to borrow a technique from Freud, introspection, realizing of course that this has been rejected by many as unscientific. I would argue, however, that any scientific investigation will have limited use as long as the research does not generate questions based, not on clinician observation of pre-defined symptoms, but on careful observation of symptoms that are revealed through in-depth interview.
Given that revealing this kind of clinical information in a blog would run the risk of violating confidentiality, I will take a different course. Rather than reveal confidential information about one or several clients to remain nameless, I present myself as the focus of discussion. Through my own introspection as a former PTSD sufferer, I will introduce the concepts that I believe are missing in diagnosis and treatment.
What prompted this kind of investigation was asking myself some basic questions. How can you know so much about PTSD? You never took a class in it. You haven’t had any specific training. Yet, you have so many opinions. Where did they come from? You have treated some PTSD clients successfully in the past. How could that be without being taught how? You even break the rules of accepted care, but have worked successfully. Why is that?
My answer, as I recently became aware, was that I had PTSD, but never thought about it and, although I had received therapy in the past, was never diagnosed with PTSD or any related condition. I am sure I was diagnosed with some form of depression long ago, but never PTSD. The reason that this could have happened was that I never paid much attention to my own history, but limped along through life from day to day trying to solve the problems of the moment and with a desire to improve my mood. I never plumbed the depth of my experience, not until recently. I only did so because I had the time, being away from my home for extended periods, and a renewed curiosity about what makes me so unlike most people, including psychologists, around me. Why am I so weird, in other words? How come I recognize things in people others don’t see? While answering these questions about my own personality, I came to recognize that I had PTSD and had overcome it without realizing I had done so.
Like most people with PTSD, I had triggering events, some were clear, others subtle, but each carried their own lessons, leaving a stamp on my character. My history of PTSD is complex and even convoluted in some places, but there were a number of events and symptoms that would have led an astute clinician to make the diagnosis. Had one of them continued to follow my case, they would also have discovered that there was a point in my life where I became symptom-free. Was this an epiphany, a cause for celebration? No, I don’t think I was even aware it happened. I simply stopped feeling that way. I was still too busy doing other things to even notice. But, there was a trauma that could be considered a triggering event, if there hadn’t been so many distressing events that preceded it, an event that forced me to recognize how worthless my life had become and how little I had in the way of resources to deal with it.
In September 1967, I was living in a rundown tenement as a hippy in New York City in the East Village. I will recount some features of the neighborhood. I recall one situation after dark when my friend brought a young woman back to the apartment. When she left after a little while, she quickly returned to tell us that her motorbike was being stolen. We responded quickly. I recall the neighbor grabbing his machete as we ran downstairs. There was a faceoff with the thieves smiling coldly, sadistically, not caring the least for the only weapon that we had, but recognizing the fear that most us had. The young woman ended the brief impasse by saying it was okay to let them have the bike. My friend later accompanied her to the subway and took her home.
Two months later, I entered the building and found myself quickly surrounded by three men, perhaps the same group. It was dark. In a matter of seconds, they had me up against the stair post with three knives pressed against my throat. I didn’t see them, but saw the same sadistic smiles. I panicked. I yelled that I didn’t have anything. They laughed and rifled my pockets. I remember all I possessed were three pennies and an old cigarette lighter. They kept the lighter and threw the pennies away. Suddenly, one of them looked up. He saw someone and, after a moment’s hesitation, they took off. When I went up the stairs, I passed the people he saw. It was a young couple. It was all like Westside Story with the Puerto Rican gang and the Puerto Rican lovers. They may have saved my life just by looking over the rail. I don’t recall if I said anything to them as I passed.
As I describe the neighborhood, I also recall that it was a place where you had to lock your car. If you didn’t, the locals would have it stripped in minutes and would set the gas tank on fire. At sunset you could see the light from the blaze reflect off the wall of the neighboring building that could be seen out our window that did not face the street. The car seats would become settees for people in the neighborhood. Likewise, when the city condemned a building across the street, people immediately moved in for free rent. Still another event that probably started all my symptoms was when a local psychedelic drug dealer showed up with blood on his shirt after a scuffle with some local hoods who were going to rob him. I think it was then that I started having nightmares.
The first thing that most people ask who hear this story, when they learn that I had family in NY, is why didn’t you go to them for help? My early history, that part that led to all this, is the reason that I believe for many people PTSD doesn’t occur in a vacuum, but there are events that precede the trauma that make the trauma itself more difficult to manage. The preceding events may seem benign because, especially when we are young, we don’t have a grasp of their significance. When you’re young you just think, that’s the way my life is. It’s normal for me. But, when put in context, the early life circumstance can have devastating effects no matter how or whether we understand the conditions we come out of.