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KosAbility: Was it a reminiscence or a flashback? PTSD is tricky & terrifying [1]

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Date: 2024-06-30  

We all have memories, some lovely some horrible, and are familiar with being stimulated to recall them by scents, images, and sounds, but where is the demarcation that divides benign yet unpleasant memories from disruptive PTSD flashbacks?

When I saw this article in the New York Times—PTSD Treatments Are Falling Short for Many Patients (paywall removed)—I thought it would be a good basis for this month’s story and saved it in a draft. Then, a week later I had a personal experience, what I considered a reminiscence, and wrote about it for the introduction. However, after I had finished writing, I felt disturbed, moody, unreal—not at all like my usual emotional state. The remembered event wasn’t, by far, the worst disaster I’ve lived through and I began to wonder about PTSD and the strong emotions surrounding this memory.

So before inserting my personal story, let’s look at the Mayo Clinic’s PTSD definition. Then, read about my experience and check out the poll at the end.

Post-traumatic stress disorder (PTSD) is a mental health condition that's triggered by a terrifying event — either experiencing it or witnessing it. Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event.

Driving home from buying strawberries at a farm a mile outside town, I pulled out onto the empty rural road bordered by orchards and farms and looked up at the eastern horizon to check how much snow remains on the Sierra Nevada range. But the mountains weren’t visible. Instead of nonstop brilliant sun, our summer norm, the sky was totally overcast, obscuring the mountains. I suddenly realized that I was in the exact spot as three years previously when, driving home from the picking peaches, I had looked out towards the mountains and was astounded by a massive pyrocumulus cloud.

The 2021 Dixie Fire was a behemoth blaze that began at the same locale where the 2018 Camp Fire started and continued burning for over three months covering nearly a million acres. It was the largest single source fire (not a complex of separate fires that coalesced) in recorded California history, the first known to cross the Sierra crest (second fire to do so started a month later), and the most expensive fire fighting effort in U.S. history ($637.4 million).

I revisited all that in what seemed like a few seconds, feeling both disturbed and nostalgic, when a few fat raindrops splattered onto the windshield, and a deeper level of nostalgia kicked in. I snapped back to the 2008 Solstice and the “Yay summer rain!” joy I’d expressed while dancing and dodging the big raindrops, unaware of what was happening a few miles away as the Butte Lightning Complex Fire was kindled with dry lightning strikes.

I thought guiltily, as I have many times before, about my celebration of those sparse raindrops in 2008 and the accompanying petrichor, the spicy earthy scent of rain. Guilt because those raindrops pressaged the first catastrophic fire to hit my home, to send my entire community scrambling downslope in the middle of the night to huddle together in Chico for … 10 days? One? Two weeks? How long were we in limbo, not knowing where the fire was or how much it had destroyed? It was a super hot grim period of waiting for information as an inversion layer held the smoke overhead, preventing air flights over the fire. We spent the days indoors as ashes and char rained down on us, coating everything with black soot.

Suddenly, I was startled by a red stop light just ahead of me and realized I’d already left the empty country road where my reminiscing began. I was two miles further along, having passed one traffic light and turned onto a main street, zombie driving, lost in memory of the 2008 fire but also navigating other vehicles, traffic lights, and pedestrians.

That snapped me back into the present moment briefly. I don’t know what happened, mentally, after that, but with my next flash of awareness I was slowly driving down an empty city street wondering where I was. My eyes shifted around the landscape searching for something familiar and fixed on a stone fence—I abruptly realized I had to turn at the next street, I was only six blocks from home and had zombie driven a further five miles.

I intended to share this vignette to illustrate how memories can be poignant yet not alarming, living in the liminal space between reminiscence and PTSD flashback. Yet upon writing of the event, I realized it wasn’t a harmless nostalgic moment but a potentially dangerous flashback. And I also recalled how the day began. The dry season has been with us long enough this year that I expect to see sunshine when I wake up in the morning, but that morning’s light was a dingy yellow-tinged gray. I woke up feeling alarmed and my first thought was “Where’s the fire?”

I hustled up and checked the Watch Duty app for NorCal fires and found nothing. So I checked the air quality data for smoke from distant fires and again saw nothing. It was just clouds, normal clouds, although by later that day I learned those clouds presaged another dry lightning storm that kindled a few fires in the central Sierra that still burn.

After all this, I realized I don’t know where memory becomes pathology, where reminiscence turns into flashback, and the PTSD article became much more pertinent to me personally.

The NYT article on PTSD (paywall removed), begins by noting that people with PTSD tend to close themselves off, they are reluctant to talk about their experiences, sometimes being distrustful of other people or themselves. The problem is that effective treatment generally requires just that—talking about the events—and some people drop out before being effectively treated because it is too disturbing.

PTSD can include intrusive thoughts, flashbacks, and nightmares. Another problem with treating PTSD is step one—being diagnosed. Family doctors and even people with PTSD may not recognize it as a possible diagnosis, especially if you haven’t been in military combat, a natural disaster, or experienced assault.

‘One of the problems with PTSD is, you pull inward,” said Dr. John Markowitz, a professor of clinical psychiatry at Columbia University. “You avoid people, because you feel you can’t trust them, and so you might not seek help even if you need it.’

The NYT goes on to talk about existing treatments like EMDR (eye movement desensitization and reprocessing therapy) that “activates both sides of the brain as a patient describes a traumatic event, and interpersonal psychotherapy, a form of talk therapy that focuses on how trauma affects relationships.

Two PTSD drug treatments have been approved, sertraline (Zoloft) and paroxetine (Paxil). However while “medications can help with symptoms, they don’t address the underlying causes of PTSD. Between 40 to 60 percent of people who have received treatment for PTSD still meet the diagnostic criteria for the disorder…”

The NYT claims that (only) six percent of the U.S. population will develop PTSD at some point in their lives. I suspect that number is rising faster than our ability to treat PTSD, given climate chaos and the exceptional number and intensity of unnatural natural disasters these days—floods, tornadoes, hurricanes, heat waves, and wildfires. What about unhoused people? Surely their lives are rife with experiences that can trigger PTSD. New cases of PTSD happen daily and there’s still 40 to 60 percent of the past cases that still experience the symptoms.

We can’t have more people driving or wandering around on autopilot, zombies lost in past memories. That could create another type of disaster and another reason for PTSD. Meanwhile, I’ll be calling my therapist for help, and I recognize that I’m fortunate to already have a therapist and coverage of the cost.

We’d better hurry up and fix the U.S. healthcare system before the zombie apocalypse begins for real.





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[1] Url: https://www.dailykos.com/stories/2024/6/30/2244788/-KosAbility-PTSD-when-reminiscence-become-terror?pm_campaign=front_page&pm_source=more_community&pm_medium=web

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