Thursday, December 22, 2011

PTSD the INTJ way

I became familiar with Post-Traumatic Stress Disorder when I was a teenager. After my parents divorced, my mother fell in love with a man who would fill the role of step-dad in my life and it was through his experiences in Vietnam that I saw firsthand the long term effects of traumatic events on the human psyche.

The U.S. National Library of Medicine defines it like this: 

Post-traumatic stress disorder is a type of anxiety disorder. It can occur after you've seen or experienced a traumatic event that involved the threat of injury or death.

Causes, incidence, and risk factors PTSD can occur at any age. It can follow a natural disaster such as a flood or fire, or events such as assault, domestic abuse, a prison stay, rape, terrorism and war.... Veterans returning home from a war often have PTSD.

There are more unknowns about PTSD than there are knowns: why two people could experience the same traumatic event and only one develops the PTSD symptoms; whether genetics, psychology or social conditions play a role - there are no "medical" tests for PTSD. It's entirely behavioral - having an abnormal response to a seemingly normal environment or event. 

The effects of PTSD are nonetheless very real - it changes the body's response to stress. It physically alters the stress hormones and chemicals that carry information between the nerves.

The symptoms of PTSD tend to fall into three main categories (USNLM):

1. "Reliving" the event, which disturbs day-to-day activity (flashbacks, nightmares, strong uncomfortable reactions to situations that remind you of the event)

2. Avoidance (emotional "numbing", feeling detached, memory loss about the trauma, lack of interest in normal activities, moodlessness, avoiding things that remind you of the event, feeling like you have no future)

3. Arousal (difficulty concentrating, startling easily, having an exaggerated response to things that startle you, hypervigilance, irritability, outbursts of anger or emotion, trouble falling or staying asleep)

For my step-dad, his PTSD experience would have been of the "Reliving" variety. He had flashbacks and nightmares... I distinctly remember one night that he must have been sleep walking and talking but I didn't realize that right away. It was the middle of the night and I'd gone into the kitchen for something to drink. When I opened the refrigerator door, the light revealed that he was standing there. I was startled, but he shushed me and motioned for me to get down. I remember he said a handful of things that didn't make sense (and not all of them were in English) and then I caught on that he was sleep walking and reliving something from one of his 7 tours in Vietnam (Air Force, EOD). I called his name and, although I don't think it woke him up, he turned, looked me dead in the eye and said, "and you are not going to see that new Jane Fonda movie!" and went back to bed. 

Flash-forward 11 years and I had a new context for PTSD when I became the victim of a violent crime. As an INTJ, my reaction to the event could have been described with the PTSD symptoms listed under the "Avoidance" variety… or was that just an INTJ being and INTJ? To this day, I don't talk about it (and no, I won't be writing about it here) I have so effectively disconnected from it that when I stumbled upon some old court documents and news articles a few months ago, it was like I was reading about a stranger - it was completely foreign to me. I had no emotional reaction to it (then or now). No anger, no sadness, no breakdown, no resentment, no vengeance - a sense of protectiveness, yes, but not vengeance. I would definitely use the word hypervigilance (from "Arousal" PTSD symptoms) to describe how protective I became of my boys to ensure no further harm would come to our family. I definitely looked over my shoulder a lot in the beginning, even post-conviction, sure I'd see that face in the crowd, but even that gave way to either logic (that I can't be harmed by someone behind bars) or INTJ-disconnectedness and I just didn't think about it anymore. 

Two years ago this month, I was diagnosed with cervical cancer (that could qualify as something traumatic, right?) and in classic INTJ style, I went with disconnectedness (and humor, of course). So was that "Avoidance" PTSD or is that just my standard coping mechanism as an INTJ? Did God wire me as an INTJ knowing that my life would have traumatic experiences and that my gift/flaw of INTJ disconnectedness would enable me to cope most effectively? I was cancer-free within 40 days so I hardly had time to process it... or did I just process it in an INTJ way?

So here's the more interesting, and perhaps more revealing, puzzle piece of Avoidance PTSD or INTJ disconnectedness... 

Last week, I went for my annual checkup and cancer screenings and my doctor thought she felt a lump. "I doubt it's anything, but if it is, your mammogram will catch it. I wouldn't worry." Okay, I'll roll with that - don't worry. Well, within 24 hours of my mammogram, I'm getting the urgent call from radiology that I need to make an appointment right away with this specialist to have a more intensive mammogram and ultrasound where the doctor will interpret it while I wait so we can immediately address next steps. Yeah, I'd gotten that kind of call before and I definitely had a flashback. 

What happened next (and for the next 24 hours) would definitely fit the description of "Arousal" PTSD which would not be characteristic of an INTJ. Although in typical INTJ fashion, I'm sure no one around me knew it, but there were at least 10 to 15 occasions where I nearly burst into tears in the middle of any of the six business meetings I had that day. It was everything I could do to keep my emotions in check and I absolutely felt like I was reliving the emotions (not actually experienced) of two years ago. Then, I disconnected from an actual diagnosis, whereas here, we're just talking about more tests - yet I was losing it (by INTJ standards). By the end of that 24 hours, my INTJ kicked in to get me through the next three days before the specialist could see me and as it turned out, my regular doctor was right. It was nothing. PRAISE GOD! 

I read an article this week (the catalyst for me writing about this) that was talking about how multiple traumatic events increase the likelihood that someone will develop PTSD symptoms. So maybe that's explains my previous reactions and most recent reaction. INTJ coping mechanism, INTJ coping mechanism, Arousal PTSD.... maybe. Technically, with PTSD the symptoms are present for at least 30 days. When similar symptoms are experienced for a shorter period, it's characterized as ASD or Acute Stress Disorder. My "INTJ-ness" is a life-long condition so definitely more than 30 days, but 24-hour-freak-out over my additional tests, more like ASD.

One other related article caught my attention this week that really got my blood boiling about the US Preventative Services Taskforce issuing new guidelines that women should begin annual mammogram screenings at the age of 50, rather than the previous recommendations of beginning at age 40, to reduce the number of false positives that are reported. WHAT?!??!?! After we get past the mathematical "Duh" factor, how about this... instead of having kids going to the dentist at 3 years old, we'll push that recommendation 10 years and have them start seeing the dentist at 13 years old to reduce the number of cavities on baby teeth reported each year. Heck, I think we could cure diabetes all together if we just stopped testing for it. Seems logical right? 

Now the argument for needing to reduce the number of false positives is the emotional trauma that women experience as a result of the false positive, balanced against the statistical probability of a woman under 40 having an accurate positive. Seriously? We are still talking about hundreds of thousands of women under the age of 50 whose breast cancer was caught by a mammogram and live today because it was. As freaked out as I was, I don't think it's worth those women's lives just so I don't have to have a little anxiety attack over a false positive. Wow. How incredibly selfish would you have to be to think that's the right course. “Hey, You few hundred thousand women there, you can die from undiagnosed cancer so I don't have to feel anxious for a few days.” That seems fair.

Perhaps I'm devaluing and minimizing the true level of emotional damage that most women would experience with a false positive - that would be very INTJ of me - but seriously, I just can't wrap my head around that one. Despite the recommendations, ladies over 40, get your mammogram!

1 comment:

Monica said...

Lauren, as a former PTSD survivor, and yes, I say "survivor" I want to thank you for bringing such a crucial topic to light...not only discussing the seriousness of PTSD, but for women all over of all ages to get their breast cancer screenings. My grandmother and aunt are both breast cancer survivors and even in my 30's I make sure I get regular check-ups. Praise God that your results are good and you are still cancer-free!