Post-traumatic stress: understanding it and rebuilding

1. Before you begin

Eight months have passed since the accident. That day, at the roundabout, a van hit you from the side, and for a few seconds you thought you were going to die. The injuries have healed. The rest has not. A car horn in the street, and your heart races before you have even understood why. You see the white grille again, you hear the sound of the metal. You now take the bus, on a route that doubles the journey time, and you no longer go through that part of town. Your nights are broken. You jump when a door slams, you lose your temper with your children over a spilt glass, and yesterday evening your partner said to you, without any unkindness: "it has been quite a long time now, though".

Your story may be quite different: an assault in a car park, years of violence at home, the sudden death of someone close, a rescue operation that turned out badly, a birth during which everything suddenly went wrong. Perhaps, too, you are reading this guide for someone you love and no longer recognise.

Three things, straight away.

What you are going through is a known reaction, not a weakness. The images that come back, the permanent state of alert, the urge to avoid everything that recalls the event come from a defence system that worked at the moment of danger and did not switch off afterwards. When these reactions last, they have a name: post-traumatic stress disorder, or PTSD.

Most reactions in the first weeks settle by themselves, and those that last respond well to treatment. Psychotherapies have proved themselves in many trials, including when the event happened long ago.

Your safety comes before everything else. If the danger is not over, for example if you still live with the person who is hurting you, the priority is to protect yourself.

The method in this guide prepares and supports the work done with a therapist, without replacing it: work on the memory itself is done with a trained professional, and section 9 explains why.

2. What is called a traumatic event

A narrow definition, for a good reason

Clinicians use the word "traumatic" in a narrower sense than everyday language does. The diagnostic manual of the American Psychiatric Association, the DSM-5-TR, which serves as a reference in many countries, speaks of a traumatic event when a person has been confronted with death, the threat of death, serious injury or sexual violence. You may have lived through it yourself, witnessed it directly, learned that it happened to someone close to you when the event was violent or accidental, or have been confronted repeatedly, through your work, with the harshest details of such events, as rescue workers, police officers and healthcare staff are. This definition is reworded here in simple words, not copied.

The National Institute for Health and Care Excellence, or NICE, the public body that sets standards of good medical practice in the United Kingdom, lists among its examples serious accidents, assaults, abuse in childhood or in a relationship, war and torture, but also serious health problems and difficult births.

Common, but not with the same risk

In the surveys of the World Health Organization, or WHO, carried out in twenty-four countries, around seven adults in ten had experienced at least one traumatic event. The risk of then developing PTSD was highest after violence committed by other people, in particular sexual violence.

What does not fall within this definition

A break-up, a redundancy or a humiliation are not traumatic events in the sense of the classifications. They cause suffering and deserve help, but their consequences, often depression, anxiety or a difficult bereavement, call for other approaches, which are also effective. If your suffering looks more like a mood that has gone out than like images that keep coming back, Understanding depression will probably be more useful to you than this guide.

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