Sunday, November 29, 2015


I have thought of writing this for a while now.

In the interest of finding balance, I think it is important to attempt to gain a better understanding.  This is especially important in areas where there exists a social stigma that would predispose a person to forming certain opinions and judgements.  This is one of those issues.

I had the privilege to come upon a written transcript of a wonderful talk given several years back by a gentleman named Ralph Wexler.  He was a psychologist for the VA for 20 years.  In it he used a wonderful analogy that I would like to share because it has positively informed my practice as an ED nurse for many years now.  Imagine you are sitting in one of those fancy and yet nondescript hotel ballrooms listening to a man at a podium.

Think about it this way.  You are sitting here, in this ballroom, and suddenly a big Easter Island statue sized face looms out of one of the walls with its mouth gaping at you. At that moment, you are faced with a decision.  Either, you are really seeing this, and everything you thought you knew about the world was wrong, or you are seeing something that isn't real and you are crazy.  This is such a monumental, earth shattering, paradigm shifting thing that you cannot ignore it.  If decide you are crazy, you can no longer trust anything else in this world that you think is real.  Everything is questionable now.  If you are crazy, your mind can't be trusted to tell you anything related to the truth and you are lost and adrift now.  Forever uncertain and afraid.

If you decide you aren't crazy, you have just learned something about the world and subsequently your world has changed.  Your behavior will change accordingly.  If you accept that walls can harbor huge faces with mouths large enough to eat you, you probably won't hang out much near walls.  In a narrow corridor you might just take the very middle and keep a close eye on the walls on either side in case one of them starts looking hungry.  To people who have never seen the faces, and don't believe they are real...not really real anyway, your behavior seems abnormal.  What's wrong with that guy, he's such an asshole.  I was walking down the hall and he was just taking up the whole hall.  He even pushed me out of the way and wasn't even really looking at me.  What an asshole!

Of course, if you know about those faces, his behavior makes total sense.

But you don't.

So, don't think of PTSD as some disease that deserves pity or sympathy.  This is a person who is aware of the world in a way that you aren't.

Each of us walks around every day in a state of some degree of illusion.  We often think and act in ways that are totally irrational if you think about them too long.  We routinely pilot tons of steel at high speeds and in close quarters with other people of questionable training and maturity.  We frequently eat and drink things that we know are unhealthy and perhaps even mind altering with little regard to our personal well being or safety.  We do this because we only understand the danger and our own mortality on an academic level. There is a big difference between understanding that death and destruction exits and having death itself come up and give you a big kiss on the lips.

Some people live in a world where trash cans explode and kill all of your friends.

Some people live in a world where the people you most trust and depend on rape and torture you.

Some people live in a world where people of a certain ethnicity or race actually are trying to harm and kill them.

Each of these people will act accordingly, often rationally and perfectly logically if you understand what their life is like.

"Normal" people, who live under many benign and helpful constraints, see these behaviors and label them a disorder.  That does a disservice to both them and us.  We lose out understanding and they become something less of a person who is fit for our pity and our sympathy, but often not our understanding.

If you value that person, don't pity them.  Try to understand them.  Often they will explain it if you let them. 

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