Monday, May 18, 2009

PTSD Education: 8 Dos & Don'ts For Breaking the News

Let’s face it: While there are literally thousands of resources for how family members and friends can and should approach us about mental illness, there’s not a single resource for how we should approach them. Time to get creative and make a resource of our own.

I’m taking as my inspiration here one of my favorite (and the most fun) mental health bloggers, Alicia Sparks’ piece, ‘Don’t Avert Your Eyes: Know How To Talk About Mental Illness’. In this great piece (for people who don’t have any mental issues) Alicia outlines how family members should approach us about our problems. I’m going to turn the tables for a minute and use Alicia’s list to our advantage in how to approach family and friends to discuss our PTSD experience and diagnosis. Here are Alicia’s 8 dos and don’ts, from our PTSD point of view:

DO spark up a conversation
As difficult as it can be (and as stressful as it may be to think about doing) it really is necessary to speak to select family and friends about your PTSD diagnosis condition. Bad things grow when you hide; good things wither when you don’t take care. It’s so easy in the beautiful isolation of PTSD to just let familial and friend relationships fall into disrepair, but these are exactly the people who can turn out to be a part of the support system we need to build for health. Opening up to them is an important step and can be done simply by telling someone or the whole clan you’d like to discuss an important issue. Get their attention by letting them know something serious is at stake.

DON’T Be Aggressive
In the PTSD state we’re already so frustrated, annoyed, anxious and angry that it’s easy to take this out on family and friends when they don’t immediately understand or embrace what we’re saying and asking for. But let’s think about this from their perspective for a second: We’re telling them there’s something wrong with us – and they can’t do anything about it. Their own natural reaction could understandably be: frustration, annoyance, anxiety and anger. It won’t help the conversation if we don’t reign in our emotions, or don’t allow our audience to have emotions of their own. Getting angry will effectively shut down everyone on both sides. Before you spill the beans do some centering exercises (i.e. breathing, meditation, relaxation, yoga) so that your own core self is as calm as possible.

Do Show Concern For Them
As much as it feels like it, this conversation about your PTSD diagnosis is not all about you. Take a step back and realize that this news can be overwhelming to family and friends. Tell them you understand this, and that you’re willing to answer as many questions as you can so that they can better grasp the situation and what it means. If we set the stage for compassion it can more easily be returned to us.

DON’T Act Like It’s The End Of The World
This is a serious conversation, but it doesn’t have to feel like the earth is about to implode. PTSD is not exactly a mysterious, rare disease. Using facts about symptoms, stats, and causes, let your family know that PTSD is not unusual given the trauma you experienced. Outline for them the many treatment options you have and let them know that people can heal. Although it takes time, PTSD is not a death sentence; don’t present it as if it is.

DO Spend Time With Your Family & Friends
Even though all we really want to do is crawl under the bed and stay there, for our own sake and that of friends and family it’s better that we try to remain in touch. True, sometimes we just have to fake it when we’re out and the fog descends or panic sets in, but this is part of how we learn to cope and manage our symptoms. PTSD can mean we become hermits, or we can decide that we’ll go for a 2 hour dinner with family or friends and then scurry home. Especially after we explain our PTSD diagnosis, people will worry about us and want to reach out. Make it easy for them to remain in touch while continuing to maintain the boundaries you need to cope and get well. In everything there is a balance; strive to find it.

DON’T Smother Anyone
The tendency toward isolation can be overturned once we reach out: When we know people appreciate and understand our situation it is easy to then just fall apart all over them. Not a good idea. While we want, need and should have the support of family and friends, we still need to support ourselves. While we have every right to lean, we don’t have the right to assume anyone’s full-time job is now going to be taking our sobbing phone calls at all hours and running around the globe picking us up when we crumple. Sharing the facts of our situation doesn’t give us license to assume anyone now becomes our personal caretaker. This is still a battle to be won by our own acts of self recovery.

Do Keep It Light
Find the humor in your symptoms. When you’re dragging around exhausted from insomnia, let people know your subconscious was particularly chatty and kept you up all night. Personalize PTSD in a human way so that rather than being frightened of it friends and family can view it as its own (albeit unwanted) presence. You have a shadow; everyone should become friendly with it. The last thing you need is for anyone to add to your heaviness by lending some of their own.

DON’T Act Like It’s A Joke
While a little levity never hurts a situation, don’t use any humor that connotes something negative about you. Don’t say, Well, you know I’m nuts after all. You and PTSD are separate entities temporarily conjoined. You are not crazy. You are coping with symptoms. While you can make light of the symptoms, never demean or make light of your experience of them or your struggle to be free. You are doing the best you can (aren’t you??) given the circumstances. Always respect yourself, your battle to overcome, your intention to heal, your commitment to be well and your desire to be free. The attitude you project – one of strength, knowledge and strategy – is the one others will mirror. Plan wisely. Speak well.

Everyone’s situation is different; everyone’s family and friends more or less supportive than we’d like. But when it comes to educating those around us this list gives us a good starting point.

What would you add, clarify or define here? Leave a comment or shoot me an email.

(Photo: Shade Thinker)


Alicia said...

This is a fantastic post, Michele (& I love the spin on the "dos" and "don'ts"!). A few of them especially remind me of a conversation I had not too long ago about making sure you don't isolate yourself (with any mental health issue) - isolation is SO easy to do, but so dangerous.

Anonymous said...

I'd suggest that a Salami approach might sometimes be helpful - expose a little at a time.

"I have nightmares sometimes"

"Some things such as .... I find difficult"

On another day you could go into more details and add more symptoms.

It can be a lot to take in at one go.

Jaliya said...

What a fantastic post. Why not go all the way with it and grow it into a book? :-) There is so much wisdom in people who have survived and remained sane (or regained sanity) after great existential injury ...

A most important consideration is *who* a survivor initiates conversation with. It's so important to begin the telling with someone who you know will *listen* ... someone whose integrity you have come to trust. My first telling was with a gifted therapist who helped keep me sane and intact as the horror began to storm out of me ...

*Particularly* with family members, there needs to be safety established ... for all. Who knows what our telling might evoke in the ones who are listening ...

I like to keep these things as underwhelming as possible -- I speak with one or two people at a time, in as quiet, comfortable and safe a setting as possible, making sure that there is ample time for the conversation. I always make sure that I have a cherished comfort in my hands: a cup of chai :-)

Thank you, Michele and Alicia ...

Jaliya said...

Whoops -- another thought ... I've found it helpful, with people I'm close to who don't yet understand PTSD, to focus on some of the physical symptoms and experiences; others "get it" more easily when they can relate somehow to bodily events. Example (I've said this): "You know how you startle if you're walking along the street and a car comes along and backfires right beside you? ... That's a natural, instinctive reaction to the sudden noise ... Well, my body is conditioned to react like that to just about any sudden sound or change in the environment ..."

If you can link your experience with the listener's, and they can relate with what you're describing, you're halfway home ... and starting the conversation about the body, rather than the mind (which some folks are so scared to discuss), might begin to "normalize" PTSD for them ...

It often falls to the survivor to educate other people (including "professionals"!) about PTSD ... or at least begin another's education ... Again, I talk from a place of common ground. Nowadays, stress in general is a hot topic. Who isn't stressed! ... and here's where humour can melt any ice ... ;-)

... Make sure to have an exit and support strategy in place BEFORE the conversation, in case it doesn't go well ... You might, too, want to have a buddy/witness with you -- someone you trust, who can keep eyes and ears open, who understands PTSD, who can help the listener make sense of what s/he is hearing ...

... A book I've found very helpful in understanding the sacredness of stories and their telling is Richard F. Mollica's *Healing Invisible Wounds: Paths to Hope and Recovery in a Violent World.* Dr. Mollica is, among other things, the director of the Harvard Program in Refugee Trauma; he considers both personal and cultural trauma with a compassionate, lucid eye ...

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