Post-traumatic stress disorder (PTSD) is a life-altering anxiety disorder that disrupts the lives of the traumatized and also their loved ones. Cynthia Orange outlines strategies for living with and helping a loved one in crisis--whether that person is a combat veteran or a survivor of rape, assault, or an accident.

Trauma Responses and PTSD: Normal Reactions to Abnormal Events

Waking Him

Quietly she calls him
"Daddy...Daddy, are you sleeping?"
She has to begin the waking slowly,
if she is too sudden, he will uncoil
a fierce spring rusted loose.

Gently she must nudge him back
into the world of fenced-in yards
and refrigerator art, and away
from the shadowy echoes of rotten canvas and death.

She knows her child hand is not enough
because she is in some of those dreams,
staggering with him, shoeless through mud.
That is all he will say. He tries
to protect her from the terror, but she hears
the screams at night. She already knows.

She must use caution in the waking.
--Jessica Orange

As I reread this poem our daughter wrote when she was still a teenager, I realize that she grasped the presence and shock wave effects of my husband's post-traumatic stress disorder (PTSD) before we knew enough to name it.

There is power in naming. For example, I have late-onset asthma. Prior to its diagnosis a few years ago, I was exhibiting symptoms that increasingly nipped away at my sense of self. I've always enjoyed hiking, but grew discouraged when I got winded on even short walks. Michael would patiently wait for me to catch my breath or firmly grasp my hand to help me up hills that only months before had been easy for me to climb. I felt old, out of shape, and horribly embarrassed that I could not keep up with my husband. We both valued our walks. They were special times to reconnect, slow down, and really be together, and I worried we might lose them.

When I finally saw my doctor, he ordered a pulmonary function test that I flunked. Yet I felt an almost happy relief when he said I had asthma. My doctor prescribed an inhaler and offered other guidance. I grew stronger, able to walk farther and more vigorously on each outing with Michael. We talked about how concerned Michael had been, and we were both buoyed by the knowledge that this was a problem that had a course of action. It could be treated. I would get better. There was power in the knowing, in the naming.

This is how we felt when Michael was finally diagnosed with PTSD in 2003. With that diagnosis came the realization that there were things we could do and experts we could each consult. We came to understand that so many of our actions and reactions over the course of our marriage were linked to trauma and PTSD. The pieces of the puzzle were coming together. We grew stronger and closer.

PTSD did not become an official diagnosis until 1980 when the American Psychiatric Association added it to its Diagnostic and Statistical Manual of Mental Disorders, but the effects of trauma on human beings are well documented throughout literature and history. In fact, Greek author and "father of history" Herodotus wrote of fifth-century B.C. warriors with PTSD symptoms. In his A Short History of PTSD, Steve Bentley writes of how Herodotus describes an unwounded Athenian soldier who went blind after seeing his comrade get killed and how a Spartan was so shaken by battle he was nicknamed "the Trembler."

Shakespeare and Homer have described the effects of trauma, and post-traumatic stress symptoms are also described throughout U.S. military history. In Civil War times, PTSD was called soldier's heart or Da Costa's Syndrome, after Jacob Mendes Da Costa, the doctor who described an anxiety disorder with symptoms that mimicked heart disease. In World War I, doctors called it shell shock, or combat fatigue, and in World War II it was also known as gross stress reaction.

Because war and trauma go hand in hand, and we've probably had battles as long as we've had people on this earth, post-traumatic stress and PTSD symptoms are commonly linked to soldiers. But, as Bentley points out, there are also early accounts of trauma's aftereffects among civilians such as Samuel Pepys, an Englishman who lived in London during the 1600s. Fortunately, Pepys kept a diary in which he entered his account of the Great Fire of London in 1666. Although his own house was saved, he describes his great fear, insomnia, and nightmares that persisted long after he witnessed the disaster.

Railway crashes were fairly common in the early nineteenth century, when the term railway spine was used to explain the post-traumatic symptoms of survivors of these accidents. Bentley describes how English author Charles Dickens told of his own horror at seeing the dead and dying when he was involved in a railway collision in 1865. "I am not quite right within," Dickens wrote in a letter after the event, and he remained "baffled" as to why his shaking and uneasiness grew worse, not less, as time passed.

The World War II term gross stress reaction actually made its way into the very first Diagnostic and Statistical Manual of Mental Disorders (DSM-I) created by the American Psychiatric Association in 1952. This diagnosis described acute psychological responses to those who had experienced problems from an extreme stressor (with no mention of any possible long-term effects). Gross stress reaction was dropped altogether in DSM-II in 1968, and mention of a stress-related anxiety disorder didn't reappear until 1980 in DSM-III, when post-traumatic stress disorder was first included.

We can thank our Vietnam veterans and those who worked with them for getting PTSD accepted as a legitimate and diagnosable medical condition with long-lasting effects for the millions of people who experience serious trauma. In the early 1970s, a group of psychiatrists used post-Vietnam syndrome to describe delayed reactions like the depression, anger, isolation, and sleeplessness they observed among these veterans. Their advocacy on behalf of these veterans led to post-traumatic stress disorder being entered into DSM-III.

Since 1980, the criteria for diagnosing PTSD have been argued over, tweaked, and expanded. The most recent diagnostic features appear in DSM-IV (2000), and might change again in DSM-V, due out sometime in 2012. PTSD expert Dr. Judith Lewis Herman of Harvard University says that an additional diagnosis called complex PTSD is needed to describe symptoms of long-term trauma, in which a person experiences repeated trauma over the course of months or years. Complex PTSD can result from situations such as prostitution brothels; long-term domestic violence; long-term, severe physical abuse; childhood sexual abuse; organized child exploitation rings; concentration camps; and prisoner-of-war camps.

The yardstick used to measure PTSD will probably never be perfect, but it is important for the medical and therapeutic communities, the Department of Veterans Affairs (VA), patients, and insurance companies to have a tool by which to measure symptoms and design appropriate treatment.

Shock Waves is not an academic text about trauma and PTSD. It is intended to help family and friends better understand what they, and their loved one, might be feeling and experiencing--whether or not the trauma survivor has had an official diagnosis of PTSD. If you have a friend or family member who has experienced severe trauma, this book will help you see how untended symptoms can spill over and affect you (or those closest to the trauma survivor) to the point where you also experience problems.

Excerpted from Shock Waves: A Practical Guide to Living with a Loved One's PTSD by Cynthia Orange. Cynthia Orange has written extensively about addiction and recovery, parenting, and post-traumatic stress disorder. She cofacilitates a caregivers' support group, and she and her husband (a Vietnam combat veteran) often speak to audiences about the effects of trauma and war in their continuing involvement with veterans and veterans' issues. She is an award-winning writer who has published hundreds of articles, columns, and guest editorials in newspapers, magazines, and literary journals. She is the author of several books, and contributed to the popular meditation book Today's Gift.


Shock Waves: A Practical Guide to Living with a Loved One's PTSD

Softcover, 204 pages

In the United States, about 60 percent of men and 50 percent of women experience, witness, or are affected by a traumatic event in their lifetimes. Many of them (8 percent of men and 20 percent of women) may develop post-traumatic stress disorder (PTSD)--a life-altering anxiety disorder. Once connected mainly with veterans of war, PTSD is now being diagnosed in many situations that cause extreme trauma such as rape, physical attacks or abuse, accidents, terrorist incidents, or natural disasters. The millions of family members of those who have PTSD also suffer, not knowing how to help their loved one recover from the pain.

Shock Waves is a practical, user-friendly guide for those who love someone suffering from this often debilitating anxiety disorder, whether that person is a survivor of war or of another harrowing situation or event. Through her own experience, extensive research, advice from mental health professionals, and interviews with those working through PTSD and their families, Cynthia Orange shows readers how to identify what PTSD symptoms look like in real life, respond to substance abuse and other co-occurring disorders, manage their reactions to a loved one's violence and rage, find effective professional help, and prevent their children from experiencing secondary trauma.

Each section of Shock Waves includes questions and exercises to help readers incorporate the book's lessons into their daily lives and interactions with their traumatized loved ones.

List Price: $14.95
Online Price: $13.45

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With self-deprecating humor, blunt honesty, and a no-nonsense style, A. J. Adams takes the mystery out of AA for anyone who doesn't understand it or believe it works. Beginning with the story of his first meeting, Adams breaks down the history, slogans, and rituals of AA, and shows why your results depend entirely on what you put into working the program.

M A. J. Gets to an AA Meeting

Alcoholics Anonymous.

Even the name put me off. Who'd want to be called an alcoholic, and why the secret-society thing? But I was on my way to a meeting for real this time, whether I wanted to go or not. My wife and kids were on my case about drinking, and I'd started to have a few at work that didn't go unnoticed. Although I dreaded it, I'd known for a while that I'd have to go to some AA meetings to take the heat off. I was running out of takers on my promises to cut back, so I was going to Plan B. I figured if I put in some time at AA, I could throttle my drinking back to a reasonable level and all would be well. Still, I felt a little queasy as I headed toward the address I'd gotten on the Internet.

As I drove through the November chill and the early evening gloom, I wondered why they couldn't put these things in places people could find. The meetings all seemed to be in church basements or out-of-the-way spots in rundown parts of town. And the meeting names--oh, the names: "Seaside Serenity," "Fresh Start," "Don't Worry, Be Happy." Why not just call it "Loserville"?

I turned into a slightly shabby strip mall that seemed to correspond to the address I had. Nothing looked like a meeting to me. Then I noticed some cars and bikes in front of one storefront. As I got closer, I counted a half dozen very nice motorcycles and a surprising collection of up-market
sedans. There were some real junkers there too. It was an odd mix. I parked as far away as possible, so that anyone who might drive by and recognize my car wouldn't associate me with this sad affair.

As I walked toward the storefront, I scanned for a sign. Nothing. But what would an AA meeting sign say? After all, they're supposed to be anonymous. For some reason that seemed very funny, which I attributed to nerves and missing my 5:00 p.m. pint of vodka. A few of what I feared were my new friends were on the sidewalk, braving the cold to catch a smoke. "Is this the meeting?" I almost whispered, not wanting to breach anyone's secret existence. A couple heads nodded toward the door. I was afraid I'd stumbled onto the hearing-impaired meeting. "How come no sign?" I asked. The group chatterbox pointed to a circle with a triangle inside it, inscribed with the words "Recovery," "Unity," and "Service." Apparently this was supposed to mean something to everyone in the world. "Cool," I said and moved on.

I walked into the meeting room, which at least was warm. A few people looked my way with a combination of civility and curiosity. There was a fair amount of chat going on around me among the twenty-five or so people who seemed to know each other well. Laughter bubbled here and there around the room. In my increasing nervousness, I couldn't accept that anything humorous was going on here, and I wondered what moved any of these desperate people to laugh. No one had spoken to me yet, and the silence triggered a familiar anxiety reaction. I really should have had a couple before trying this out. I was just about to pull out my cell phone to look busy when I noticed a sign on the wall that read "Please place cell phones in silent, vibrate, or stun mode."

I desperately needed something to do besides standing there and feeling way out of my comfort zone. My eyes settled on the only exception to the 1950s classroom decor: a world-class coffee bar. They probably didn't call it a coffee bar here, but I knew how to pour myself a cup of coffee, so I headed over. At last someone spoke to me. A smiley guy said, "Leaded or unleaded?"

Knowing that the right response would be essential to sustaining this budding conversation, I said, "Huh?"

"With caffeine or without?" smiley guy said.

"Oh," I mumbled, "I like the real thing."

"You're in the right place," he said, "and I don't just mean the coffee." With a Santa-worthy wink, he poured my coffee and moved on to another person.

With my coffee prop in hand, I took in the surroundings. The room was dominated by a large conference table that had seen many conferences. The surrounding chairs gave "garage sale" a bad name. The meeting leader's place was piled with tattered books--the holy texts, I guessed. On the wall were two large posters with the Twelve Steps and Twelve Traditions; the language seemed stilted and archaic. World War I-vintage slogans contributed to the funky feel of the place: One Day at a Time. Live and Let Live. Easy Does It. A trio of prayers, also on the wall, addressed the serious business of beating death by liver failure.

Desperate but no fool, I started inching toward the door to make my escape. I nodded jovially at the people along the way and made little toasting motions with my coffee cup. But I'd missed my chance. Suddenly it was 5:30, and everyone was sitting down. As I considered just bolting, smiley guy from the coffee bar appeared out of nowhere: "Have a seat," he said. "I'm Tim." I surrendered but obstinately did not tell Tim my own name. I checked the wall clock against my wristwatch. I would be out the door at 6:30 on the dot. I started composing the line I'd call over my shoulder as I left, about an important meeting or a rookie babysitter.

My escape planning was interrupted by the leader's voice. "I'm Quincy, and I'm an alcoholic."

Excerpted from Undrunk by A. J. Adams. Adams is a recovering alcoholic with a little more than two years in AA and a professional writer, consultant, and teacher. He lives with his wife in the Southwest. "A. J. Adams" is a pen name the author has adopted in respect for the AA anonymity tradition.


Undrunk: A Skeptic's Guide to AA

Softcover, 120 pages

In this unprecedented book, A. J. Adams uses self-deprecating humor, entertaining anecdotes, and frank descriptions to introduce anyone who "just doesn't get" Alcoholics Anonymous to the complete "Undrunk" lifestyle.

My eyes wandered around the room, taking in the strange collection of humanity seeking to claim me as a fellow sufferer. If variety is the spice of life, this crowd was the jambalaya of affliction.

Beginning with the story of his first AA meeting, he takes the mystery out what goes on behind closed doors, dispelling misconceptions of AA as cultlike, secretive, campy, or lowbrow. He then presents a user-friendly history and introduction to AA, explaining the Steps, Traditions, terms, and sayings--all punctuated by honest, often hilarious descriptions of his own struggles and eventual transformation to "getting" the program.

List Price: $14.95
Online Price: $13.45

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©2011 Hazelden Foundation