Category Archives: PTSD
27th January is Holocaust Memorial Day – a chance to remember the estimated 11 million people (six million of them Jews) who lost their lives in the Holocaust, and future genocides. In understanding trauma that survivors live with, we as a society demand history doesn’t repeat itself, and we acknowledge those affected.
This date was picked as the official memorial day back in 2000, by governments from around the world, stating that ‘we value the sacrifices of those who have risked their lives to protect or rescue victims, as a touchstone of the human capacity for good in the face of evil’.
But how did Holocaust survivors deal with the psychological trauma in 1945, and how do we begin understanding trauma like this in 2018?
Being told to forget
When most survivors returned home, or began new lives in other cities or countries after liberation, they faced negative reactions from neighbours, friends and colleagues. Hostility, silence and indifference were all common, because nothing like the Holocaust had ever happened before, where certain groups (including Jewish and Polish people, gypsies and gay men and women) were systematically targeted. Though camp conditions were reported worldwide before and after liberation, trials were delayed and took a long time, and many perpetrators escaped punishment. Every time war criminals were brought to justice – some only in the last decade – survivors faced trauma triggers.
Victims were either told to forget about their experiences, or they decided to repress the memories as a coping strategy, ploughing their attention into normal life and trying not to think about the past. This is not something psychologists, or indeed psychiatrists, would suggest today. In order to recover from trauma, and process it, patients use talking therapy with psychologists, and treatments such as EMDR would be recommended for those suffering from PTSD (Post-Traumatic Stress Disorder).
Early studies of Holocaust survivors
In 1950, survivors in Israeli refugee camps were found by sociologist Judith Shuval to be more ‘pessimistic’ than control subjects, and also ‘hard’: hardened to the setbacks they encountered. By the late 1960s, more research emerged on the psychological impact of surviving the Holocaust, and terms like ‘survivor syndrome’ were coined (by psychiatrist William G. Niederland, who studied 800 cases in 1964). For many survivors, symptoms of what we’d now call PTSD didn’t emerge until years afterwards; technically, when symptoms emerge at least six months after the traumatic event, this is late-onset PTSD.
Jewish people in Nazi-occupied Europe who weren’t in concentration camps but were hidden in plain sight (in children’s homes, convents or strangers’ homes), became resistance fighters, or fled abroad – perhaps on Kindertransport – had different experiences, but still faced emotional distress. We still call them Holocaust survivors, because they are. They lost many relatives, friends and neighbours, and had no community to return to after the war. Anti-Semitism didn’t die with the Nazis, either; the remaining Jews scattered across Europe faced stigma in the decades afterwards. Despite the distress those in hiding suffered, it wasn’t until 1983 that any researchers (Shanan and Shahar) included them in scientific studies, and we began understanding trauma for those who survived in different circumstances.
Understanding trauma in a second generation
Helen Epstein, the daughter of two Holocaust survivors, published a ground-breaking book in 1979. Children of the Holocaust: Conversations with Sons and Daughters of Survivors suggested that these children had inherited fears and anxiety because of their parents’ suffering. A mixture of learned behaviour in the family unit, and having no outlet to discuss their concerns, meant survivors’ children faced their own specific challenges. Epstein’s book struck a chord with people all over the world. It reminds us that trauma doesn’t end with the patient, but can affect those around them.
Furthermore, there’s science to back up her theory. Scientific American reported in 2015 that children of Holocaust survivors have different stress hormone profiles to their peers. The survivors themselves had lower levels of cortisol, and younger survivors had less of an enzyme that processes cortisol, freeing their bodies to focus on storing glucose (essential during starvation); this seems fairly logical. But the stress hormone profile of their children features high levels of cortisol – perhaps compensating for their parents – and a greater predisposition to PTSD than their peers.
Long-lasting effects of trauma
In 2010, the American Psychological Association summarised decades of research which showed that Holocaust survivors still had symptoms of PTSD and that they reported poorer wellbeing than peers who hadn’t been Holocaust victims. Many of these survivors won’t have had early psychological intervention; as we discussed earlier, they may have been discouraged from talking about what happened, or they may have tried to repress their memories and refused to reflect on the past, as a coping mechanism, not understanding trauma within themselves. Whatever their family circumstances, they often battle loneliness and isolation, but meeting fellow survivors can help increase their sense of community.
Sadly, other genocides followed the Holocaust. In the decades since, we’ve seen groups persecuted across the world – for example, in Bosnia, Cambodia, Rwanda, Sudan, and the current actions against Rohingya Muslims in Myanmar. That’s sadly why Holocaust Memorial Day doesn’t just remember past horrors, but what’s going on right now in the world, affecting vulnerable men, women and children. Understanding trauma in 2018 is much easier than in 1945, but survivors of more modern atrocities won’t necessarily have access to better treatment, or any therapy at all. Here in the UK, we are also fighting for Syrian refugees to be given trauma assessments and treatment to process the horrors they’ve seen (the war in Syria is on the verge of being categorised as genocide), as they adjust to starting again thousands of miles from home.
This Holocaust Memorial Day, we pay tribute to all those who’ve experienced the trauma of genocide, and their families, and wish them well in their ongoing recovery.
Written by guest contributor and mental health campaigner Polly Allen, for Dr Chrissie Tizzard, Chartered Consultant Psychologist, PsychD, BSc, MSc, C.Psychol, C.Sci, AFBPS. Dr Tizzard is the Clinical Director of Christine Tizzard Psychology (ctpsy.co.uk).
Christmas is the season of fun and good will, but having PTSD at Christmas means the reality is often very different. The Christmas countdown can be one of the worst times of the year. The reasons for this are many: an expectation of the perfect day, having to shop in packed malls, thoughts of entertaining… all these things can lead to feelings of being out of control. This is especially true when there is already constant overthinking going on in your brain. Christmas often feels too much. For those with hyperarousal, the run up to Christmas usually increases trauma triggers. A rise in triggers is associated with more frequent acts of self-harm and increased suicidal thoughts. This is very frightening.
For those with PTSD at Christmas, the season can and does ramp up perceptions of powerlessness. This may lead to increased numbing and depersonalisation. At worst, it can feel as if the Amygdala can’t and won’t take any more. In these moments, you may feel like fighting, running like hell or freezing. Sometimes, it’s all of these things together.
It’s also common for those with PTSD to increase their alcohol or substance use as triggers rise. This not only hurts the person with PTSD, it causes unintentional pain to loved ones. It is crucial that you put some control into Christmas to prevent feelings of helplessness escalating.
Your Action Plan to Deal with PTSD at Christmas
- Limit engagements. Accept invites only to those events that you really want to attend. Make sure you know what the set up will be. If there is a strong feeling of not wanting to go, listen to yourself. If you want to stay at home, allow yourself to. Banish negative self-talk about being weak by not going.
If you do attend and feel the need to leave early, do just that. The people that matter will understand. Disregard the views of others.
- Structure plenty of downtime during the celebrations. Listening to music, walking or jogging are three undervalued and powerful tools. Recent research findings are clear – activities that involve a strong rhythmic focus are proven to reduce hyperarousal in the Amygdala. These activities calm the hyperarousal element of PTSD much more effectively than the use of talking therapies which often do little to reduce core feelings of rage and distress. It is thought this maybe one reason why EMDR is so successful in treating PTSD.
- Maintain a routine of meditation, progressive relaxation, yoga and visualisation. These tools can be truly lifesaving in an emergency, which may happen if you’re dealing with PTSD at Christmas.
- Limit alcohol. Alcohol is a depressant. It might feel as if it makes it easier to get out of the door. The reality is hyperarousal and depression are increased after the initial buzz goes. If you don’t want to go out, stay home and do something genuinely calming. Things will get better as hyperarousal reduce.
- Lower expectations. Having PTSD is very hard. Most people haven’t a clue what you are living. You are a survivor and a warrior. Allow yourself to be discriminate in your wishes. You are your ultimate cure. Respect that.
Written by Dr Chrissie Tizzard PsychD, MSc, BSc Chartered Consultant Psychologist and Chartered Scientist. Dr Tizzard has over 20 years experience working with the emergency services, the military and civilians who have experienced PTSD in their lives. She has researched, lectured and developed training programmes pertaining to PTSD vicarious traumatisation and post traumatic growth.
It had been a perfect day, despite PTSD.
You were having fun. All of a sudden the fear, the flashbacks, the avoidance and the panic of PTSD returns. Why now?
This is the question often asked by patients in clinic. There is a simple answer: panic frequently re-appears in PTSD. When it does, it often reduces sufferers to jelly.
This often happens suddenly and without warning. It is all to do with PTSD triggers – things that resemble or remind the brain of the original traumatic incident.
Big triggers and small triggers can both cause a massive panic response
Most people are aware of the big things connected with a trauma. Some people consciously make a list of things that were connected with the traumatic incident – these lists become their conscious trauma triggers. They believe that they can then anticipate the ‘hot spots’ and take action to manage the uncomfortable scenarios. However, this doesn’t often work. The problem is, it’s the unconscious and unknown triggers that knock us off balance and onto our knees.
For example, Gill* is a successful career woman. She was raped six months ago, on her way home from a nightclub. Gill is very aware of certain triggers: she is scared of being alone in town at night, particularly in a certain part of town. She also jumps at the sight of a certain make of car, and freezes if she hears any door slam.
Gill recalled that recently she was hosting a presentation at her gallery in Geneva. All was well. There were many high-profile clients attending. Naturally, she wanted to make a great impression. Instead, she suddenly found her mind racing, her heart pounding, and a pressing desire to sprint right out of the room.
At that moment, she felt that her very survival depended on escaping. She lurched to the ladies room, where involuntary shaking gave way to floods of tears. The presentation now seemed a threat. She was unable to regain her composure. Instead, she called a friend to collect her and left by the back entrance.
Hidden PTSD triggers
It was the following week, during treatment, that she suddenly recalled that she had registered a strong smell of a particular masculine fragrance at the gallery presentation. She remembered that her attacker had smelt the same. She hadn’t been aware of that hidden piece of the jigsaw previously.
Suddenly it made sense: it had been an unconscious trigger, that had remained below consciousness until the evening of the presentation. Now she is aware of a new trigger, she is able to use techniques learnt in therapy to tolerate her acute sense of fear. She is able to use learnt strategies to reduce that trigger’s effect on her.
PTSD set-backs are temporary
The point is that, for as many triggers we are aware of, there are also just as many that remain out of range. These are like rocks under the water. It is so important to recognise this fact.
It is tough to accept that, even where fantastic progress is made during treatment, there are likely to be temporary set-backs. But these set backs are exactly that: temporary ones. This is the nature of PTSD.
*Client’s name and occupatiation has been changed due to client confidentiality.
Written by Dr Chrissie Tizzard, Chartered Consultant Psychologist, BSc, MSc, PsychD, C.Psychol, C.Sci, AFBPS. Find out about EMDR treatment for PTSD at Christine Tizzard Psychology here.