the past, it wanted me dead
February 23, 2019 5:49 PM   Subscribe

Does it really matter if my problem is PTSD and not depression?

It's not like I've never connected the dots between these things that happened to me the twenty-odd to thirty years ago when I was growing up and the way I've thought and felt and behaved since. It's not like I don't see myself acting out over and over a script written long ago by a child. It's not like I haven't used the word "traumatic" with the half dozen therapists I've seen over the past 20 years. Is there really some other way to rehash it that makes a difference?

Seeing F43.12: Post-traumatic stress disorder, chronic on a piece of paper was unexpectedly validating, as if I finally had permission to feel as bad as I have. Some of the things that happened to me are considered what's called an Adverse Childhood Experience in the scientific literature, which are linked to a higher risk of a whole host of negative physical and mental health outcomes in adulthood. This science, too, makes me feel like it's okay to feel bad. Still, looking at the list of ACEs makes me feel like an imposter. What happened wasn't so bad compared to the worst of these. I've never been physically or sexually abused. I've never witnessed or been victim of an act of violence. I had two parents who were married and held jobs.

I've been looking through the threads on PTSD. There was no singular event, so anything geared in that direction would not be appropriate. I asked a question about a year ago about moving beyond CBT and a couple of the therapies suggested overlap with therapies with PTSD. I'll probably read a couple of the PTSD books suggested, but I'm really burnt out on therapy. I feel like it's never done all that much for me relative to how much time I've given it, and I want to get on with my life instead of rehashing this over and over (because my God it's not like I don't think about it all the time already and see it everywhere I go). But would treatment oriented toward PTSD be different or helpful, if the main symptom of my PTSD is depression anyway? Thanks. MeFi Mail welcome if you don't want to post publicly.
posted by unannihilated to Health & Fitness (16 answers total) 14 users marked this as a favorite
If you haven’t tried EMDR therapy because you didn’t think your condition applied, I believe it was developed specifically with PTSD in mind. It’s definitely a very different sort of therapy than analysis which sounds like the sort of therapy you’re exhausted with? If anything book a single session and let the therapist decide if whatever you’re dealing with could be PTSD and you decide if what they have to offer is different enough to try.
posted by griphus at 6:10 PM on February 23, 2019 [9 favorites]

Yes!! Having a counselor who specializes in trauma makes a world of difference. PTSD is best treated by a professional who understands. Until I found my current therapist, I had therapists who were kind and somewhat helpful but did not get where I was coming from when it came to my background. I've had a very good and privileged life in many ways but that didn't make me -- or you or others -- immune to developing PTSD.

I am a fan of EMDR but there are many treatment possibilities; the connection you have with the counselor is most important or at least as important as the modality. I fought the diagnosis for a long time but then cried tears over the session where my suffering felt truly seen and understood for the first time in my life. PTSD, like any other illness, has common symptoms but each person is affected differently; there are different types of PTSD and differences in severity, too. You deserve treatment and compassion as much as anyone else. Just as you'd think someone with diabetes deserves full treatment, regardless of the type, it's the same for you and PTSD.
posted by smorgasbord at 6:10 PM on February 23, 2019 [4 favorites]

Treating just depression if you have PTSD may end up like taking cold medicine if you have a sinus infection- it kind of helps, but not fully, and the sinus infection just stays infected.

As for the comment about your trauma not being “that traumatic” - look, I broke my leg last year doing stuff everyone else was doing around me. But my body landed differently and my bone broke. No one stood around saying that I shouldn’t get treatment because my bone shouldn’t have broken. Your unique self had the unique experiences at the unique time and in the unique ways you did. So you compensated and that became a way of managing that is now disordered and impacting your life. It’s ok to be tired and want a break but please give yourself the respect that you deserve...if you have PTSD, then you do, it’s ok to work to find treatment that works.
posted by warriorqueen at 7:01 PM on February 23, 2019 [23 favorites]

I recently made this switch under similar circumstances, and so far so good.

I have a serious-business mood disorder diagnosis, no PTSD diagnosis, and some ACEs in my past that, like yours to you, don't always really feel valid or important to me. I recently switched from CBT to something more trauma-oriented.

I'm already feeling like it's worth it. Even when we're just talking about mood stuff, or present-day situations that are hard for me because of my past, it's a huge relief having a therapist who gets that some things are unambiguously awful — that there are things in life that you don't want to find silver linings in, or reimagine as hidden strengths, or whatever other song-and-dance; and that you've already gone and checked the facts on; and that if someone tries to CBT you on them one more time you're going to lose your fucking shit. Having depression my whole life was bad, getting bullied as a kid was bad, and it often felt like CBT folks wanted to change my mind about that and convince me that they were okay. Working with someone instead who's willing to accept that there was nothing good about those experiences is a huge relief.

(Also, FWIW, every single person I know with trauma can point to someone else and say "No, but they're the one with real trauma." A friend of mine whose childhood ought to have resulted in multiple prison sentences has people he feels less valid next to. It turns out "I have impostor syndrome over whether to count this as trauma" is basically just part of the having-trauma experience.)
posted by nebulawindphone at 7:07 PM on February 23, 2019 [22 favorites]

I've been going through just this sort of transition! Last summer, I started seeing a therapist specializing in trauma - she practices EMDR among other modalities, though in my case we haven't actually done rapid eye things. but we absolutely have built on the insights of the EMDR truama-informed school of therapy - resource building, embodied memories, etc.

All in all, I've spent a long time in therapy. And I've made more progress in the last eight months with my new therapist than the previous half a decade.

For me, I spent a lot of my depression/anxiety-oriented therapy trying to manage rolling gusts of emotions - to anticipate and be gentle with myself through low-energy lows and high-worry times. I learned a lot about myself in the process, absolutely, but I think the framework at play assumed I wasn't able to control the generation of the rolling emotions, or only control them to a point.

The main change with trauma therapy is that my attention is focused around the way I experience fear in my body, and the internal theater of mind that is a relic of something that helped me survive an extremely stressful childhood environment. For the first time in a while, it felt like there were specific things to investigate and test and learn more about, versus responding to rolling crises without that much context. It also just rang true in a new way -- like you, I was reluctant to claim my past trauma for various reasons, or more specifically some part of me judged myself very harshly for making that effort. That is part of the trauma, I've learned. And while yes, it might seem like going deep into feelings about these past events is excessively inward- or backwards-gazing, it's allowed me to understand myself holistically in a way I didn't have access to prior, and that is propelling me to reorient the way I'm living my life right now, bit by bit.

I may have gotten there with other forms of therapy eventually too -- there's research that suggests all therapy modalities achieve similar outcomes, and the determining factor is your trust and rapport with the therapist. But I don't know, there's something so powerful about finally being able to work with this low-key buzzing fear and threat and long-lingering embodied feelings, to understand it all and transform it into a better way of being day-by-day. I'm not saying this is exactly what you might experience, but it may be worth investigating.

However you decide to proceed, sending you strength and encouragement! Good luck!
posted by elephantsvanish at 7:24 PM on February 23, 2019 [7 favorites]

My childhood wasn’t “that bad” - but yet I ended up with PTSD from the parts that WERE that bad for me.

I’ve mentioned how helpful EMDR was for me in the past here - and how quickly it helped me. In my case, I was having panic attacks and nightmares along with some pretty poorly thought out coping techniques that were doing me more harm than good.

It was very helpful to treat the trauma. It was the only thing that was going to help.
posted by hilaryjade at 8:12 PM on February 23, 2019 [1 favorite]

I've had my PTSD diagnosis for decades, but I've found that reading about Complex PTSD and thinking of my condition as C-PTSD no matter what the DSM specifications say at the moment has gone a long way towards reducing my "but other people have it worse" feelings. Also, seeing a therapist who specializes in trauma-informed therapy has done wonders for my mental health -- I had a wonderful therapist for many years who helped me a lot but was grounded in older therapeutic models and it's been so validating to be seeing someone now who can say, "yup, that's a normal reaction...for someone with your history" when I come in all weirded out about my reactions, boundary issues, whatever.

I don't do a lot of rehashing -- to be honest, we've got a lot of it shorthanded at this point, so when something comes up we'll acknowledge that whatever is going on is reminding me emotionally of a past trauma and then we focus on how to think about and deal with it in the present. Trauma-informed does _not_ have to mean reanalyzing the trauma all the time.
posted by camyram at 8:18 PM on February 23, 2019 [7 favorites]

What happened wasn't so bad compared to the worst of these.

Someone recently told me that there's Trauma, capital-T, and trauma, lower-case t. Both are trauma.
posted by MonkeyToes at 8:38 PM on February 23, 2019 [2 favorites]

Just because someone else has it worse, doesn't mean you don't have it at all. There is a reason the ACE list includes experiences beyond outright abuse or catastrophic dysfunction. Those experiences matter too.

I have an unambiguous history of major depressive disorder, and most of my previous experiences with therapy focused on dealing with that in isolation. I never explicitly sought out trauma-focused therapy as such because I didn't think it applied to me (I also didn't think anything "bad enough" had happened to me), but started exploring and working with trauma history via my current therapist. Somewhat to my surprise, this has felt explanatory, validating, and ultimately healing in a way that therapy focused more on CBT techniques or just depression management alone never did. There is a tendency to think of depression as something that occurs independent of circumstances ("it's a brain chemical imbalance", "it runs in the family") but certainly there can be a link between trauma history and depression and therapy that works more on treating the trauma-related part of the problem might be helpful to you.
posted by 4rtemis at 10:16 PM on February 23, 2019 [2 favorites]

Studies on the type and timing of adverse childhood experiences suggest that several nuanced factors affect what causes a trauma reaction in childhood rather than just one BIG event.

There's also such a thing as Secondary Trauma. And there is evidence that the risk factors for incurring trauma may be genetic, making some people more prone than others. Then, of course, not everything that you experience as traumatic feels like trauma, as Psychcentral's relatively nuanced description explains.

There are a variety of ways to diagnose trauma. Nearly all rely on matching symptoms to four distinct overarching response categories, as outlined in the APA's DSM-5. Extreme depression is one of those symptoms, but there are many others.

The military (which think a lot about PTSD) use a self-assessment as a screening tool. You can find a 2018 PCL — C (short for Personal Checklist — Civilian) PDF here.

Therapy and meds aren't the only treatment options for PTSD. For the past decade, research has been growing on the use of stellate ganglion block (SGB), a one-time anesthetic injection to the neck which can, effectively, reset overactive nerve cells and related chemical reactions within the sympathetic nervous system that cause the symptoms of PTSD. A fair amount has been written about this, and you can find everything from peer-reviewed research, to news articles and puff pieces on Google Scholar, Google and Google News. The military has also just completed a major study on this. They should be publishing their conclusions sometime in 2019.
posted by Violet Blue at 10:39 PM on February 23, 2019 [6 favorites]

I'm really burnt out on therapy. I feel like it's never done all that much for me relative to how much time I've given it, and I want to get on with my life instead of rehashing this over and over

CBT was a necessary step for me, but ultimately it failed to strike at the roots of my problems. After a point, the only thing CBT did was give me sharper mental tools to cut myself to pieces with. It made me aware of the fact that my young brain had been very well molded to cope with chaos, but very poorly trained for living a normal life among normal people. CBT helped me to become aware of that... but that was all it did. I would see myself repeating old thoughts, old behaviors, giving in to old fears, and I was powerless to stop myself despite all the good sensible logical tools that CBT had to offer. Which only made me beat myself up harder. I could see my brain hijacking my life in real time. It was frightening and frustrating and discouraging. So I hit a wall with therapy until I started to talk to someone who dealt specifically with chronic childhood trauma. (As with you, there was no single event; it was just suffused into the fabric of my early life.) And it turns out this is a much more useful process than CBT would be at this point in my life.
posted by Vic Morrow's Personal Vietnam at 10:55 PM on February 23, 2019 [5 favorites]

ime trauma therapy is a huge difference from therapy for depression. One way of putting it: depression is my brain lying (maybes) to me about what a piece of shit life is and how much I really should die. Trauma symptoms are me remembering actual evidence that something was wrong and not being able to get past that lack of safety because it's become a deep-rooted survival instinct.

Good trauma therapy doesn't "rehash" trauma. With EMDR the therapist doesn't need you to recount it in detail for the processing to happen.
posted by ahundredjarsofsky at 11:04 PM on February 23, 2019 [2 favorites]

Another vote here from team "seeking mental healthcare for trauma is qualitatively different from seeking mental healthcare for the depression that resulted from trauma on its own terms." I spent years getting nowhere trying to reduce depression symptoms by treating the depression itself.

CBT never resonated (to the point where I refused to try it) because I felt fundamentally unsafe and unseen within a methodology that told me my thoughts and feelings were wrong but had no space within it for why that was true when those thoughts and feelings were the results of things that were done to me as a child. I've always had a deep need to know & acknowledge the why and the root cause of everything and CBT felt like it had a big hole in it in this regard.

Last year I started seeing a new therapist. Every previous attempt at therapy had been under the premise of "I'm horribly, chronically depressed; I don't want to know why or dig very deep into my painful past about it, I just want to feel better". Huge surprises all round when that approach didn't work. I went into therapy again last year from the premise of "traumatic and unsafe things happened to me as a child and I'm still experiencing problems in my adult life from this", and I've found the work much more useful because it's actually addressing the root causes of the way I feel and not just trying to stick a plaster over the top of a howling void.

Also, the validation from taking this approach in therapy has been tremendous; I feel much more seen and heard than in previous therapeutic settings. It really means a lot to hear my therapist say things like, "wow, I've never heard a parent say that specific bizarre and deliberately cruel thing to their child before, that's a new one", and this helps significantly with the feelings that my trauma is less real or important than other people's worse and more intense trauma.

It's also done a lot to help me recognise and deal with flashbacks, particularly the emotional ones - it took me a long time to realise that getting stuck and frozen in a feeling of being deeply unsafe and threatened is basically the same process as getting stuck with an image of my dad's face yelling into my face, and that I can use similar tools and techniques to deal with this feeling rather than getting stuck in it.

I totally hear you on being burnt out on therapy - I was too for a long time, after a decade of seeking treatment for depression on its own terms without acknowledging the trauma backdrop, and I took a long break from therapy before going back last year. I think that break was the right choice, but it was also the right choice to return to it when I had a significant uptick in flashbacks, rumination and other trauma-related feelings and behaviours last spring.

For me, there has been a meaningful difference in the outcome of the "rehashing" of my life when doing focused trauma therapy vs regular therapy for mood stuff. I still find it frustrating and boring that I've had to spend so much of my own time, energy and money on fixing something that was fundamentally done to me and that I had no control over at the time, but I do feel meaningfully better for having changed my approach and started doing even more of this expensive, boring, painful and necessary work.
posted by terretu at 12:50 AM on February 24, 2019 [5 favorites]

Trauma therapist here. Yes, modalities targeting PTSD can help, even if depression seems to be the most pressing concern. If you're tired of analysis and CBT then you might want to research sensorimotor psychotherapy and EMDR (helpful for complex trauma, ongoing emotional abuse and neglect, as well as single "criterion A" events).

Prolonged Exposure may also be useful to consider. Prolonged Exposure does work by processing a single event but EMDR and sensorimotor psychotherapy can work on bits and pieces of several difficult experiences.

Memail me if you have other questions.
posted by crunchy potato at 8:07 AM on February 24, 2019

(Also, FWIW, every single person I know with trauma can point to someone else and say "No, but they're the one with real trauma." A friend of mine whose childhood ought to have resulted in multiple prison sentences has people he feels less valid next to. It turns out "I have impostor syndrome over whether to count this as trauma" is basically just part of the having-trauma experience.)

As a trauma therapist, my experience is that every single one of my clients has told me, "But it wasn't that bad, I shouldn't be so upset about it," regardless of the extent of the trauma they were dealing with. As others have said, feeling unentitled to help or to your own feelings is a common part of the traumatic response, and it doesn't mean you don't actually deserve help.

And as others have said in their excellent advice in this thread, finding a therapist with training and experience in treating trauma does make a huge difference (I speak as both a therapist and as a client on that one!). I've found that therapists without that training and experience can end up providing inappropriate treatment that comes across as judgmental and bootstrappy to clients who are dealing with trauma at any level, whether it would qualify for a PTSD diagnosis or not.
posted by lazuli at 8:41 AM on February 24, 2019 [3 favorites]

Response by poster: These answers were all so insightful in so many ways, I can't mark a best. Thank you. If any of you are NYC locals, I'd love a therapist recommendation.
posted by unannihilated at 5:14 PM on March 1, 2019

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