Tuesday, April 30, 2013

Process and Pathology

Fevers can come from a lot of different things.  I was taught that sometimes it is simply the way your body kills viruses, or at least keeps them from reproducing.  The fever is part of the process of healing.  The virus is the problem, not the fever.  The fever is not just a symptom, it is also part of the healing process.  When we lower the fever, we ease the visible signs of the sickness, but we also may be prolonging the illness.  Protecting the virus.

Stress after a big event is normal.  For most people, a huge violent event completely restructures their reality map.  It can show you that everything you believe and value is context-dependent.  Or I can be harsh and more honest and say that you will come to know that almost all of your cherished beliefs about what people are were simply lies.  Pretty lies and pleasant lies and things that most of the population works very hard to make true... but lies none the less.

But because most people are good people and work hard to make some of the harsh truths less true. Might does, in fact, make right-- unless strong, good people stand up and through action and force of will make it untrue.  Violence works, and has for millennia and across all species-- until we came up with the will and the vision that we can make it not work. And that requires a capacity for violence as well. The only defense against evil violent men are good men with more skill at violence.

That's a digression. The point is that there will be a period of adjustment after a violent event.  Some will always be damaged.  Most of those I know are the ones trying to return to 'normal'.  The normal that a deep part of them now knows never really existed.  They feel that the only thing that can make them right is to go back to a state that they now know was always false.  Just like someone crushed with responsibilities wishing to be a child again.

Some will find a new normal, and that normal will largely depend on how much of what they were exposed to.  With a single aberrant event, they can rewrite a reality map pretty much like the old one.  Pretend the event was an abnormality.  With lots of exposure in different areas, the violence becomes the new normal and, at least for me, you feel a little awe over the power of will and human vision and technology that has made the natural so rare.  Peace occurs in nature about as often as suspension bridges.

A lot of the adjustment and 'healing' is a recalibration process.  One of the symptoms of PTSD is hypervigilance.  You know what?  There's some shit you don't survive without a hefty dose of hypervigilance.  It's not just a super-power, it's a necessary survival trait.  Does that make it pathological?  Are the people treating this symptom aware that they, the counselors and doctors, might have died in that environment without that 'symptom'?  Are they trying to help people be better, or help them return to normal?  In extreme environments, 'normal' is rarely better.

But it can get uncomfortable, and can be dangerous.  Just like going from dim light to bright light or vise versa, there will be, must be, an adjustment time.  That's normal.

And waking up from a nightmare.  That's part of the healing process.  Dreams are one way you work through things.  And part of the recalibration process is to snap awake in a cold sweat...and have someone you love hold you and say, "It's okay.  It's okay.  It's just a dream.  You're home now."

Don't confuse the healing process with the pathology. And it is a process.  And it is growth, not repair. You will be different afterwards.  Stronger, if you manage the process well.


Tiff said...

Awesome post, Rory. (Like many of your writings, this deserves to get around to the people who need to hear it.) Thanks.

Kai Jones said...

I would never intentionally give up my hypervigilance, but I have to admit it tires me out sometimes.

I've had skull surgery a month ago to correct a problem that (among other symptoms) took away my ability to exercise hypervigilance-there was no brain power left to do it. The surgery (one of two that I will eventually have) has restored the space in my brain and my ability to observe my environment usefully.

Anonymous said...

Great post Rory. Scary stuff but so true. See you soon in Oakland! mn

Josh Kruschke said...

Post Traumatic Growth.

Events either break us, slide off us like water of a ducks back or make us stronger.

I can't stand the label PTSD. Disorder implies that their something wrong & it needs fixed. There is nothing wrong or abnormal it is just what the brain needed to cope with the situation it found itself in. Some might cope with stress better naturaly. And others might need to learn new menttal skills & or resolve some moral dilemmas, but denying current reality never works or works poorly as long as it is not chalenged.

But what do I know I'm not a mental health professional.

My 2 cents,

Anonymous said...

I've read of authors who ran a mild fever after a feverish run of creative effort. And I've spent a weekend in bed just coming down from some physical scare- car crash say. Rory, you are one of the few people I can think of who've maybe had both fevers.

Unknown said...

'Peace occurs in nature about as often as suspension bridges.' I laughed so hard :-)

Unknown said...

It occured to me that this process is somewhat similar to adjusting to the frequent adrenaline rushes and fear. Trained and experienced professionals feel the same fear, but it doesn't cause the same cognitive dissonance as in most people. They see fear as something to be avoided (does not belong on the reality map), while for pros, it's normal.

Natalie said...

Interesting post. A subject hubby and I have often discussed from a similar viewpoint. There is a point though where I think context cannot be forgotten. The "disorder" portion, IMO, is when responses are out of current context. For example, if during a heated argument with loved ones at home, the response to a normal married fight becomes a violent life-preserving assault, that is disordered because it is inappropriate for the context and puts the wrong people into danger which is now issuing from the person with PTSD. The everyday struggles, moral, psychological, hyper vigilance, etc... All normal and NECESSARY, yes. But here is where one can compare folks who go throug similar experiences for similar durations, and some struggle with severe psychological after-effects and some, after a while, do not. According to studies and therapists, lingering PTSD almost always occurs in folks who have suffered childhood trauma. Which suggests to me that severe PTSD comes more from the shattering of a world-view one had created/imagined and that now comes crashing down and leaves the person with both the original and the new trauma as gaping wounds with no coherent, loving, safe "home base" for understanding them.
Which I guess ties in to the lies people make up for themselves. Vicious circle?

Anonymous said...

As individuals we can get stronger through tribulations, or get weaker and sicker when a % of critical circumstances catch-up with us. In this sense, everybody's best and worst day is just another version of the same thing happening to us all, all of the time. Lots of us don't stop to think of it that way though.

This is also true scaled up to another level of understanding about who and what we are doing here. Civilizations experience the same dynamics of survival and we don't always see the full cycle of their development. Groups of peoples have been growing and dying for 10,000 years.

At street level we only have view of the moments in our life. It surprises the hell out of some of us when caught right next to the heartbeat of life, as it thumps everything around it. The damage of struggle is acutely shocking when don’t feel and hear it for awhile, and listen to those who choose to believe we’ve conquered the human condition. People are amazing in their ability to reason these moments of life, but reason is just a creative tool. It can lead us to approach fiction just as well as it can truths.

I think it could be that very few societies have been able to effectively change their paths without great effort and sacrifice of both people and ideals. It seems plain to me at the moment anyway. It is certainly true in an individual, so why not?

There was a post here a while back about training mental toughness. Simple enough that it needs little discussion. The obvious trait to cultivate is endurance, and endurance beyond consideration, nothing more. Everybody does not enjoy the benefits of developing this on their own. I am sure genetic predisposition of character is part of the equation. Nurture/nature arguments, etc… However the single thing we might always be able to do is to help those around us meet a level of challenge they can each endure. And, in the process grow strengths.

Now, I guess can say this at the end of a long couple of weeks, but warrior building is a very tall order. The good advice found here is always helpful in this challenge. Thanks as usual.
-Billy G.

J Stanley said...

Writing as a mental health professional, there are virtually no symptoms that in and of themselves are considered pathological. Hypervigilance, grief, even hallucinations - not considered a disorder. What makes something go from 'symptom' to 'disorder' is the presence of pathology. Symptoms are not in and of themselves pathological.

By 'pathology,' most mental health professionals mean disruption across someone's life. To take an extreme (but still valid) example, if I am having constant visual hallucinations, but it is not having a negative impact on my life? Not a pathology / disorder. If it starts impacting my ability to shower, to get to work, to have social relationships, to do the things I want to do? Now it is pathological. Now it may be part of a disorder.

In the case of PTSD, hypervigilance alone will not merit a diagnosis. A person must have a wide range of non-adaptive symptoms that behave pathologically. Nightmares are not in and of themselves enough. Nightmares every night that disrupt sleep patterns, coupled with extreme, non-adaptive hypervigilance (non-adaptive = all the time, even when it is not desired / needed), and daily flashbacks that intrude upon a person's waking life and cannot be controlled? Now we're probably talking PTSD.