November 10, 2016 – The sight of a street lamp inspires fear in Sal Schittino. “A lamp post makes my heart race,” he says, “especially at night or on a side street.”Two years ago, he nearly died when he slumped against a lamppost in a Baltimore alley at 4 a.m. Schittino, a 24-year-old visitor from Ellicott City, MD, had gone out for pizza and was on his way back to see friends when a youngster snatched his cellphone. He then attacked Schittino with a knife, stabbing him in the center, lungs, stomach and back.”It was overwhelming. I was bleeding out pretty badly,” says Schittino. “Of course, I knew I probably wouldn't survive. I remember wanting to hold on to someone or something to find comfort or to feel like I wasn't so alone. That was really scary – the fact that I was alone.”He became unconscious. An ambulance team took him to a trauma hospital where surgeons performed open-heart surgery to avoid wasting his life. After the crime, Schittino, now 26, suffered from post-traumatic stress disorder. Old Sal, an affable young man who aspires to a profession as a psychologist, is grateful to have survived. He finds comfort in family and friends. He returned to work and worked as an assistant in a psychiatric clinic.But a latest Sal is confusing him. He has spent long periods of time crying in his bedroom, screaming in fear within the woods near his home, and battling nightmares and flashbacks of being brutally stabbed. His old self, he says, “cannot comprehend the magnitude, the scope of the trauma that has happened.”Many consider PTSD as a “war wound” that affects veterans traumatized on the battlefield. But PTSD also affects civilians traumatized by violent crime, rape, kidnapping, domestic violence, serious accidents, terrorism, natural disasters, and other events that put them vulnerable to serious injury or death. Physical injury will not be needed; even a threat, akin to a weapon pressed to the body, can trigger PTSD. So can witnessing a horrific event. Most individuals who experience trauma adapt over time; only a minority develop PTSD. For the latter, high levels of distress and disruption to life for greater than a month are warning signs, in response to the National Center for PTSD. It is estimated that 8 million people within the United States suffer from PTSD every year. About 10 percent of ladies develop the disorder in some unspecified time in the future of their lives, in comparison with 4 percent of men.However, many individuals don't realize that PTSD also affects civilians and that treatment can promote recovery. Untreated PTSD carries serious risks, including an increased risk of suicide and alcohol or drug abuse to numb distress.Raising awareness
In some parts of the country, doctors are taking a proactive stance. In New Orleans, Dr. Erich Conrad, associate professor of clinical psychiatry at Louisiana State University School of Medicine, has brought people to the University Medical Center's trauma unit who had been injured in automobile or construction accidents, falls from heights, or by gunshot or stab wounds.
Patients went home with physical treatment but no mental health care. “We knew there was a huge need that wasn't being addressed,” says Conrad. He now runs a program to screen all trauma patients for symptoms of PTSD, depression and substance abuse. Those with symptoms are referred to mental health services.
In Oakland, California, Dr. Mark Balabanis, a psychologist in private practice, has treated PTSD patients from all walks of life – civilians and veterans. Both groups report similar symptoms, he says, including some that result from the body's fight-or-flight response: tension and startle response, hypervigilance, intrusive memories, flashbacks, nightmares and avoidance of reminders of the trauma.
For Schittino, these memories were haunting. “I just wanted to run as far away from them as possible,” he says. At first, he was even afraid to walk down the road. “I was constantly looking forward and behind. I always wanted to have everything in view.”
In his nightmares, “someone came and tried to attack me in some way, and I was absolutely helpless,” he says. In his waking hours, he would have flashbacks for a couple of seconds. “Just before that, I got this feeling of panic. The event that night – it always reminds me of sitting there alone and then being stabbed. I literally couldn't see what was happening in front of me in real life.”
While it's hard to face one's PTSD-related fears, avoiding triggers and memories causes the fear to proceed, Balabanis says. He teaches his patients that the unique trauma was dangerous, however the memories aren't harmful, even in the event that they trigger the fight-or-flight response that causes the person to feel unsafe again. “We need to show them that the memories aren't going to overwhelm them or hurt them,” he says.
Treatment of PTSD
Treatment for PTSD will be done in numerous ways. Prolonged exposure therapy goals to desensitize patients to the trauma and things related to it. By talking in regards to the traumatic event again and again with a therapist, patients grow to be less anxious and learn to achieve more control over their thoughts and feelings.
Sometimes exposure therapy takes place in the surface world. For example, one in every of Balabanis' patients gave up driving after a serious accident and couldn't take a look at the kind of automobile. He took her to a carpark and exposed her to the identical kind of vehicle until she lost her fear.
For patients with hypervigilance—those that compulsively scan their surroundings for threats—Balabanis teaches them to stop watching people so closely for signs of danger or conflict during walks across the neighborhood.
Other treatments for PTSD include cognitive therapy and medications, including antidepressants. Cognitive therapy teaches patients to acknowledge false or negative thought patterns—akin to blaming themselves for the trauma. By difficult these distortions, they will reduce their distress.
Some therapists use eye movement desensitization and processing (EMDR). It's unclear how this non-traditional psychotherapy technique works, but proponents consider rapid eye movements help the brain process traumatic memories and weaken their emotional power. A patient thinks in regards to the distressing images and feelings while a therapist controls the attention movements together with his or her hand or an object.
A therapist treated Schittino with EMDR, waving a pointer to guide his eye movements. “She said, 'Allow yourself to experience the feeling. Go really deep.' I think that kept me from pushing it into my subconscious,” he says. “The progress I made in such a short time was so helpful.”
On the technique to a latest self
Anyone who has experienced trauma knows that it will probably strike anyone suddenly and divides life right into a before and an after. Many patients integrate a traumatic experience into their lives and form a narrative, “a testimony of what they went through,” says Balabanis. “They know how difficult the world can be, but they also find great resilience within themselves. Some even want to help other people overcome trauma.”
Schittino continues to be completely unprepared from the trauma and the story has yet to unfold. Recently, at work, he visited a patient in her room. When she didn't respond, he checked out her face. To his horror, he realized she had died. “That incident brought everything back to the surface,” he says. “I thought again about how I almost died and had to deal with the fear that that made me feel. The fear became so overwhelming. It was like a thought of mine that I didn't want to deal with.”
The woman's death triggered a latest self-examination. “I always wanted to focus on being grateful,” he says, “that I can still do so many things, that so many people around me love and support me. I didn't want to leave any room for questions: 'Why me? Why did this have to happen?'”
But having to confront these painful questions “was a relief,” he says. Instead of suppressing the sensation of injustice and the fear of death, he’s looking for a latest self after the trauma.
“I feel like I still have a lot to process,” he says. But as a psychology student, he hopes to someday have the option to assist trauma victims and folks with PTSD.
His old self has definitely disappeared, he says. “After this trauma, this new person was no longer 'me',” he says. “I had to give my life a new meaning.”