Waking up from Terror to Panic – PTSD Awake and Asleep

Art by Charlotte Farhan
Art by Charlotte Farhan
Art by Charlotte Farhan

Waking up this morning was a torturous affair, opening my eyes, feeling that sensation in my stomach, the one that feels as if you dropped off the earth but your body is still looking over the edge waving you goodbye. It feels like sinking in pain – as if pain was quick sand, if I did not know better I would say someone had opened me up in an operating theatre, during my sleep and rearranged my internal organs and sewed me back up.

Laying there with only feelings not thoughts, no rational thinking commencing in this lucid state. However the pain is reminding my brain of other hurt, other ordeals. Like a back catalogue of torture, my mind runs through a long list, flashing images in front of me, in an attempt to condition me or subliminally coerce me. Then with no warning, I am awake! My fight or flight has been triggered, blood is rushing from my head to my extremities, preparing me to run away. There is no where to run, no where for me to escape this danger, for the danger only exists in my brain, my own neurology is basically trying to run me out of town.

Peoples opinions and past criticisms enter my stream of thought, “It’s all in your head”. I chuckle maniacally to myself and say repeatedly “Yes, it is indeed in my head”. The idea that this is said to us, the mentally ill, the neuro-divergent, is laughable to me at this moment. As if our species has taught itself that the head/brain/mind are not part of us, not part of our physical selves or bodies. We never say to a “physically” disabled person, its all in your legs/arms etc.  All the while my brain is trying to desperately stay in the moment and ponder on the complexities of people’s lack of understanding for anything related to the unseen, our illnesses are less believable than Father Christmas, fairies, lizard people and the all powerful dude sat above us and the evil one living down in the depths of hell, but mental illness is utterly unbelievable without being in a straight jacket throwing yourself into walls, dribbling and wanting to kill people – because of course it is perfectly believable that the mentally ill are criminals.

My body is still preparing itself for battle. The pins and needles in my arms and legs are going crazy, there seems to be no blood left above my heart. My mouth becomes very dry and then my need to vomit takes over, as apparently the sickness is trying to escape me. The blurred vision begins, bringing with it more panic – I am certain I am about to die. With my breath getting quicker and my body perspiring at a scary level, the only option is to lay on the floor and accept my fate.

With no ability to leave the house, on my own – my only choice is to call someone, something I can only do with a few people. So with my double vision, tapping away at my keypad, the ring tone begins…

“Lisa?? I am dying! I can’t do this anymore, I am sure I am going to die alone here”, the uncontrollable need for safety and reassurance is like someone giving me oxygen, I hear Lisa’s voice, she knows how this feels, so I do not need to explain. Lisa try’s to distract me and get my brain out of the immediate fight or flight state that I am in, trying to focus my attention outside of myself, so that every sensation that is felt is not interpreted as a sign of dying. Eventually she gets me from the bathroom to my living room, all I can do is sedate myself now, lay in my chair and hope to sleep.

Before long sleep takes over, my parallel world opens up, a world created from old buildings which are derelict shells, past homes, schools and locations where trauma was created. There is no day or time here, no summer and no order. It is grey with darkness lurking everywhere, like every horror film ever watched muddled up with my own life events. Old faces appear behind corners and in the darkness, natural disasters erupt on a frequent rotation, buildings collapse without warning, stair cases and corridors never end, fluorescent lights flicker, music plays in the distance – songs played as soundtracks to the violence endured, smells are vivid with scents of perfumes and aftershaves by the oppressive abusers. This is where I come to rest. This – the place my mind rebuilds and orchestrates every night, a haunting performance of memories and trauma.

Sometimes the only thing my brain conjures up are flash-backs, which can be on repeat for what feels like an entire life time. The brain is able to retrieve the most long forgotten detail and with a force of pure malevolence this detail is forced down your gullet like an over-fed goose. Chocking on the terror and the overwhelming taste of bitterness, my eyes often feel pulled open, when in fact they are closed – being forced to face the shame. Upon awaking from this, the particular detail is seared into my conscious mind and begins infecting my hippocampus and amygdala, whilst poisoning my thalamus and hypothalamus, and the sickness spreads to my peripheral cortex and temporal cortex. Soon I start to feel physical pain in the places most violated, there is no time to slowly open my eyes, stretch and ponder my day, the alarm has been raised, high alert is here and my day begins again as it ends.

Here are some facts about Post Traumatic Stress Disorder, brain damage and sleep:

“When patients re-experience traumatic events and flashbacks during sleep, these nightmares can be accompanied by real physical reactions to feelings of fear, such as a pounding heart and sweating. The re-experience can occur at random or might be triggered by sights, sounds, or smells that remind the person of the trauma. Therefore, patients suffering from PTSD often try to avoid objects, places, events, or even emotions that trigger memories of the traumatic event.

In addition to nightmares, people with PTSD can manifest a state of hyperarousal, in which the individual is subconsciously “on guard” to protect himself, and as a result feels anxious, has difficulty falling asleep, is irritable, suffers emotional outbursts, or is easily startled.”

(  https://sleepfoundation.org/sleep-topics/ptsd-and-sleep )

“Psychological trauma has great effects on physical aspects of patients’ brains, to the point that it can have detrimental effects akin to actual physical brain damage. The hippocampus, as mentioned above, is involved in the transference of short-term memories to long-term memories and it is especially sensitive to stress. Stress causes glucocorticoids (GCs), adrenal hormones, to be secreted and sustained exposure to these hormones can cause neural degeneration. The hippocampus is a principal target site for GCs and therefore experiences a severity of neuronal damage that other areas of the brain do not. In severe trauma patients, especially those with post-traumatic stress disorder, the medial prefrontal cortex is volumetrically smaller in size than normal and is hyporesponsive when performing cognitive tasks, which could be a cause of involuntary recollection (intrusive thoughts). The medial prefrontal cortex controls emotional responsiveness and conditioned fear responses to fear-inducing stimuli by interacting with the amygdala. In those cases, the metabolism in some parts of the medial prefrontal cortex didn’t activate as they were supposed to when compared to those of a healthy subject.”

Tarara, R., Else, J.G., Suleman, M.A., Sapolsky, R.M. (1989). Hippocampal damage associated with prolonged and fatal stress in primates. J Neurosci 9:1705-1711.

McNally, Richard J. (2006) Trends in Cognitive Science, Volume 10, Issue 6: Cognitive Abnormalities in Post Traumatic Stress Disorder. P271-277)

 

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