Should You Talk About Your Trauma? A PTSD Specialist Explains
More than half of Americans will say that, at some point in their lives, they have lived through a major trauma during which their life was threatened, they were rendered helpless, and their sense of normalcy shattered. Being raped, robbed at gunpoint; surviving a severe car accident; escaping a deadly fire; or witnessing a spouse, child, or parent be brutally assaulted are just some of the examples of the types of trauma that millions of American survive every year.
For the clear majority of trauma survivors, once the danger has ebbed, distress is natural. They may feel on edge, have nightmares, and be overwhelmed by traumatic memories. They may feel like this for hours, days, or weeks, but humans, by design, are psychologically resilient. The clear majority will heal, organically, with the tincture of time.
A significant minority, however, won't heal naturally. Despite no longer being in danger, they are unable to transcend their traumatic pasts. Instead, they suffer every day with the invisible wounds of post-traumatic stress disorder (PTSD). At any given moment, 6 million Americans are living with active symptoms of PTSD that require professional mental health attention.
PTSD is a condition famous for causing nightmares, flashbacks, and an exaggerated startle reaction. In other words, PTSD is largely a disorder of memory. An essential function for the human brain is to consolidate our memories, and this process involves stabilizing memories and allowing them to ripen and mature. After a traumatic event, the consolidation process goes into overdrive. It is this overconsolidation that lends trauma memories their vivid and unforgettable quality. These trauma memories can intrude into a survivor's life weeks, months, and even years later in a highly visual manner and involve a sense of reliving the trauma. These involuntary intrusions can be so intense that they have been described as indelible images.
Too often, I meet people who have silently lived with PTSD, not talking to anyone about their trauma nor seeking professional help. Unfortunately, their silence often comes at a huge personal cost.
Why is it so hard for PTSD sufferers to speak about their trauma?
Denial of the trauma.
Humans are hard-wired to deny the unpalatable. Often, the natural response to surviving trauma is to banish the memory of it from one's mind and pretend like it did not happen. This strategy might work in the short term to restore temporary order to chaos, but rarely does it work in the long run.
I've lost count of the times patients have told me that they kept their trauma a secret for decades, saying things like "I did not think anyone would believe me," "I was terrified to rock the boat," or "I would have lost my job." The need to survive becomes paramount. For too many trauma survivors, speaking their truth does not feel like a viable option.
The unspeakable nature of trauma.
Trauma often represents the violation of all we hold to be dear and sacred. Such events are simply too terrible to utter aloud, and hence they often become unspeakable. Sometimes the survivor wishes to speak, but the wider community is unwilling or unable to bear witness to their story, so the survivor is forced into silence.
A hostile culture.
It is natural that trauma survivors feel cautious about disclosing their trauma story. Even if a survivor is willing to speak of what happened, cultural context plays a huge role in a decision to disclose. Women are more often victims of violent crimes, like rape, that are associated with stigmatizing social responses. Culturally defined gender roles and expectations, a woman's status compared to a man's, and her social capital all determine how her social network will respond to her disclosure. Will they believe and empower her—or shame, blame, and ostracize her?
Indeed, when survivors speak about their assault, instead of getting sympathy, they are sometimes blamed. These "secondary injuries" are caused by friends, family, and professionals. Even when their account is believed, their character may be questioned. These secondary injuries can have an undesirable influence on whether they disclose their problems in the future and how severe their psychological injuries become.
Why it's important to speak up.
Despite all the reasons and conditions that encourage survivors to stay silent and avoid talking about their trauma, PTSD thrives under such conditions. Traumatic thoughts and memories that remain "unspeakable" or "unthinkable" for too long often impede our brain's natural process of recovery after trauma. They become stuck points that inhibit the mental reintegration that is required for healing to begin.
If talking about your trauma with your peers seems impossible right now, consider using therapy as a way to open that door. Trauma-focused talk therapies (such as eye movement desensitization and reprocessing therapy, cognitive processing therapy, or prolonged exposure) are the gold standard treatment for treating PTSD, and core to their effectiveness is the survivor relaying their trauma story, over and over, with the assistance of a skilled professional. This allows the trauma narrative to be properly worked through. Fragmented trauma memories need to be integrated into a larger narrative, new learning needs to be added to old memory cues, and pre-trauma beliefs need to be reassessed.
Contrary to popular belief, deliberately speaking about trauma memories in this fashion does not make symptoms worse; indeed, when it is done with the help of a skilled therapist, PTSD symptoms improve.
Of course, no one should ever coerce survivors into talking about their trauma when they are not ready to do so. Some survivors feel they are coping well in the aftermath, and they have moved past their trauma and found their own coping strategies or ways of dealing with any residual consequences. In such situations there may be no need to formally address trauma or rehash the past.
However, survivors should be aware of the insidious ways PTSD can exert its influence. Sometimes PTSD subtly constricts a life, shaping the way a survivor loves, creates, and works and inhibiting their ability to truly thrive. PTSD's influence may not be obviously connected to the initial trauma and might manifest instead as issues with being unable to be present in personal relationships, poorer than expected work performance, problems with regulating one's emotions, or feeling disconnected when you should be feeling joy and contentment. These aren't the type of side effects we commonly associate with PTSD—the nightmares and flashbacks—but they are very prevalent among trauma survivors, even if they don't connect the dots between these present-day issues and their past trauma.
In the therapeutic process of healing from PTSD, recovery is rarely linear and often follows a three-steps-forward, two-steps-back cadence. This is good wisdom for any healing process, whether or not you choose to pursue therapy. A certain comfort with tolerating psychological discomfort is needed for progress to occur—and often the experience of talking about what you've been through is a good way to build up that tolerance.
When PTSD sufferers even think about their trauma, it is common for them to experience psychological distress and marked physiological reactions such as sweating, breathing difficulties, or heart palpitations. It's important to understand the symptoms of PTSD and the brain's response to trauma exposure—and then to learn applicable anxiety management skills, such as breathing and muscle relaxation exercises, which are taught in therapy. Grounding techniques, also taught in therapy, can further help them detach from emotional pain and regain control over their feelings. These can include clenching and releasing your fists when bombarded with intrusive trauma memories or self-soothing by remembering the words of an inspiring quote.
There are many reasons for trauma survivors to be optimistic. PTSD, which was once considered disabling and incurable, is today very treatable and manageable. Regardless of the path chosen, the overarching goal should be for trauma survivors to go beyond surviving—to thriving in their new normal.
Shaili Jain, M.D. is a psychiatrist and PTSD specialist who currently serves as the Medical Director for Integrated Care at the VA Palo Alto Healthcare System. She is a trauma scientist affiliated with the National Center for Posttraumatic Stress Disorder, a consortium which is widely regarded as the world's leading center of excellence on PTSD, and a Clinical Associate Professor affiliated with the Department of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine. Her debut non fiction book The Unspeakable Mind is a textured portrait of PTSD, a widely misunderstood yet crushing condition that afflicts millions of Americans. The Unspeakable Mind stands as the definitive guide to PTSD and offers lasting hope to sufferers, their loved ones, and health care providers everywhere.
Dr. Jain’s work is widely accredited for elucidating the role of paraprofessionals and peers in the treatment of American veterans with PTSD. Her research has been published in some of the most prestigious medical journals, such as the Journal of the American Medical Association, Psychiatric Services and the Journal of Traumatic Stress, in addition to being featured in national publications such as The New York Times. Her medical essays and commentary have appeared in the New England Journal of Medicine, Psychology Today, Kevin MD, STAT, public radio and elsewhere.