I have been “carrying around” the term post-traumatic stress disorder #PTS with me since around 2011. I can’t remember exactly how I came across it. When I went to a clinic at that time because I was so overcome with grief for my mother, who died in 2007, that I was just crying, I said during the anamnesis: “I would like to join your trauma group.” But the people in charge didn’t comply.
Almost 10 years later, the topic came back to me – more precisely: on the desk in the guest room I stayed in with a friend for a night at the end of 2019. There lay the standard work by Bessel van der Kolk, a Dutchman in exile at Harvard University in the US: The Body Keeps the Score. That means something like: The body forgets nothing and even if you repress it, it will show its owner.
I picked up the book, somewhat surprised, and could have underlined every other sentence on the first few pages. A little later, I attended the DGPPN 2019 as a representative of Seelenerbe e.V. and tried to attend as many trauma symposia as possible. There, at the DGPPN, I also came across the DeGPT, the German-speaking Society for PsychoTraumatology.
By now, I had shed my shame enough to be able to simply approach people at specialist stands. My goal: I wanted to find out to what extent the topic of #COPMI and #trauma was receiving any attention at all or whether it could even be a kind of focus (I couldn’t imagine that it already was).
Suicides vs. Psychosis
I was kindly referred and was then allowed to speak on the phone to one of the board members at the time, a professor at a university of applied sciences for social pedagogy When I told her about my case, she said that she was surprised that no therapist had explicitly mentioned PTSD before. And she said: “Well, it’s clear that you have trauma! WITH TWO SUICIDES!”
At first, of course, I was happy that someone immediately understood this point of view. At the same time, however, it also caused irritation. Because if it was so clear to her, why had no (!) therapist explained the PTSD issue to me so clearly before?
The only answer I had was that it depends on your perspective. It’s understandable that a professional who deals with trauma on a daily basis will at least “check out” the possibility of traumatization in almost everyone. I can therefore understand why another professional who is “at home” in a different field with a different focus would think of this focus first. Other therapists, other focuses, other topics.
Then I asked my last therapist what she thought of this view and she wrote back: “… it was always clear that you were severely burdened (traumatized) by your father’s suicide and your mother’s illness.” Okay, that did surprise me. I didn’t ask myself why she hadn’t made it so explicit. But maybe that will come later…
Two days later, it suddenly occurred to me: it’s interesting that the trauma researcher focuses first on the suicides rather than on my mother’s mental illness. Suicides, for many people that seems to be a much clearer and more tangible connection than what a psychotic can do. But if I had to say what probably burdened me the most, then it was my mother’s paranoid schizophrenia and everything it meant for my upbringing and my personality.
Complex Post-Traumatic Stress Disorder
For me, at any rate, the PTSD issue became increasingly clear, partly because I had been made aware of the new trauma classification in ICD 11 for some time. The reference was given to me by PD Dr. Ulrike Schulze from Ulm, where I once gave a lecture. She also said that it would change a lot. And that is also the second aspect why I have never been explicitly referred to it before when it came to therapy sessions: there is simply a lot going on in this area and a lot is different today than it was back in 2002 when I started my first therapy.
The ICD 11 includes complex PTSD (#kPTBS, here is an overview in German) and thus becomes much more sensitive than the previous classification, which remains in place. You could perhaps summarize it like this: The classic PTSD, these are the war veterans, the victims of bad accidents or of rape. That’s why a friend of mine, who I also know from the #COPMI context and who is affected herself, told me that she was indeed confronted with a PTSD diagnosis. However, she also experienced physical violence – and in my opinion, this made her the focus of the practitioners as a trauma patient.
Complex PTSD, on the other hand, is much more subtle and broadly defined – but therefore also more difficult to recognize, as it is often confused with other symptoms. Now one could argue about what the point of such a supposedly diffuse definition is. But I would like to make my personally strongest argument on this right away: I found myself very much (!) in the kPTBS and had the feeling: Yes, I know that! I can subscribe to that! That’s me!
Maybe not 100%, but 80% in any case.
Sleep Routine
At the end of 2019, I stumbled across a podcast with sleep researcher Albrecht Vorster, who described going to bed as an important routine that signals to the body that it’s time to rest. So we learn that going to bed also means switching off. It is not so important whether the light on the tablet is blue or orange, but more important that we do not get unnecessarily excited and then try to fall asleep with what we have just experienced or seen.
When I go to bed, I can do whatever I want – after a few minutes in a horizontal position, my pulse and blood pressure skyrocket and I can’t fall asleep (well). It clearly feels as if my body is resisting letting go and falling into a deep sleep. Or, if I do fall asleep, I wake up in the middle of the night and my pulse is similar.
Bed equals terror for me
I read in Bessel van der Kolk’s book that there are also physical memories of trauma. This can also qualify as a flashback in the diagnosis. And flashbacks are, as it were, the hard core of classic PTSD, without flashbacks there is almost no talk of trauma, you could say in a nutshell. And that’s not what I had, as the cliché goes: sweating in broad daylight for no apparent reason, tendencies to self-harm, etc.
But when I connected both sides – physical memory and the routine of falling asleep – it rang a bell: my body associates “going to bed” with stress. The connection is so obvious and striking that I hadn’t been able to look at it from this angle before. Because what happened in my childhood and adolescence at home when I went to bed at 10 p.m. was that my mother, in her schizophrenic paranoia, started to cause real terror. She would scream, bang her tennis racket in the air to fight the supposedly alien forces that she imagined were controlling us remotely with rubber bands and machines – and she would come storming into my room, tears streaming down her face, shouting that I should hide my money, that we were being robbed and even killed.
In short: you don’t fall asleep well in a scenario like this.
I was always aware of this, of course, and I remember the anger and rage that erupted inside me because I wanted to sleep.
And that went on for years. I lived with my mother for almost ten years. She was seriously ill for at least seven of those years. My brother was with our grandparents for more than five years. So I got most of it on my own.
During this time, I “learned” that when I go to bed, the terror comes.
It’s over!
If the sleep researcher is right that we have to train ourselves to have a routine, and that our body needs this routine as a learned way to shut down, to switch off, to relax and let go, then I had to teach myself that all the stress, all the terror is no longer happening. That it was over!
I stood in my room (this was a coincidence, because I was standing there when I had this thought) and told myself – without any psychotherapeutic or methodological underpinning – that it was over. I said: “It’s over.”
“It’s over.”
“It’s over.”
I said it out loud to myself three times. That was enough and I burst into tears and cried profusely.
Three times! That’s how little it took for me to feel this deep sadness. I sobbed violently and was confused at the same time! Because what was going on here? Is this grief? What exactly am I grieving for? And why did I also feel something like joy?
I have nothing against tears – on the contrary. But I need a safe space for this and perhaps it helped that my flatmate at the time wasn’t around much during this time. In any case, I was able to call up this sadness almost on command. And for the first time in my life, I was also able to let it out on the street when it came without asking for it.
Crying because it’s so beautiful
What bothered me the most was the inner closeness to this grief and how intense it was every time. And it had several sides. On the one hand, it was certainly the memory of the intensity of the stress and terror, the domestic hell that I had been exposed to as a child and teenager. What had my environment put up with? And no one had seen it and assessed it correctly. Staying at home in this situation was certainly wrong for me. I would rather not have been exposed to this burden.
But I also felt a touching sense of relief. I remember a scene with my first therapist. At the time, he asked me what would happen if I was well.
I replied: “Then I would be sad.”
“Why?” he asked.
“Because it’s so beautiful,” I replied.
So this is the positive side of grief, because in its contrast to sadness, the relief makes clear the extent of the sadness. It is only when you feel the relief that the burden takes on its full depth and dimension. If we do not feel relief, we have no concept of the burden, because on the one hand the latter becomes everyday, dangerously “normal” and therefore part of our lifeworld, and because on the other hand it cannot be distinguished or set apart from what is positive.
It is an almost cathartic moment of liberation.
But what happens next? How much longer do I have to grieve and cry so hard before I can fall asleep and sleep through the night? The sea of tears seems endless…
By “accessing” the trauma, the whole thing is given a name and giving things names is important for us as humans, because it is about identity. Identity here means above all: knowing yourself. Only if I go through life and have no terms for my conditions – whether internal or external – will I remain a restless seeker.
Trauma, in other words.
And sadness. Endless.
