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If It Isn’t “PTSD”, What Is It?

Jan 11

G’day all!! Me again. Seems I’ve upset some of you by poking a few holes in the “diagnosis de jour” (i.e. “PTSD”). I apologize. I have been inundated with telephone calls from those of you who have my number; and those of you who were able to track me down. (Interestingly, you don’t respond with a comment on the blog.) Your calls have ranged from the irate, suggesting I should be “disbarred”, to the quizzical, wondering why the traumatic response “hurts” so much; and if it does, it must have a name?

I have actually given this some thought (it was some time ago and during a period of self absorption). I was filled with thoughts of grandeur. I pictured myself creating a whole new disorder, naming it, writing a book, directing the movie, playing the lead role and going down in the annals of Psychology beside the likes of B.F. Skinner, Pavlov and Aaron Beck…..then I got distracted by the coming of Spring and my motorcycle. (Get it?)

But for you a special!!! I’ll share my thinking with you only because I have left many of you “hanging” with my cheeky attack on the above noted “disorder de jour”. About 15 years ago, a psychiatrist who was (I believe if memory serves) a “fellow” at one of the prestigious medical schools, and shared my discomfort with the then less controversial diagnosis of “PTSD”, took a “shot” at coming up with a more accurate alternative. His idea was applicable to the general public and had more to do with the overwhelming of a Narcissistic Personality Disorder, or at the very least narcissistic personality traits. In other words, the patient was in possession of a pathologically inflated self image, and upon having this grandiose self overwhelmed by even the most insignificant challenge, shock, or embarrassment he/she would mimic the symptoms that had become associated with “PTSD”.

As my work is largely confined to military and para-military populations, I had to focus my thoughts on this unique group rather than the public at large. After much thought (and with little to do as I didn’t have my motorcycle in those days….too much time on my hands…..get it?) I came up with a discrete cluster of psychological symptoms that closely mimicked those of “PTSD”. In “BBSS” (Badly Bruised Super-Self), I hypothesized that the underlying psychological vulnerability to a trauma-like stress response stemmed from the patient’s view of him/herself as a “superman/woman”, impervious to all that was capable of falling a “normal” human being.

I suggested, based upon astute clinical observation, that “BBSS” was frequently accompanied by secondary symptoms of anxiety, depression, and mild-moderate re-experiencing (all thought to be primary in the diagnosis of “PTSD”). However “BBSS” was more characterized by its’ primary symptoms of shame, embarrassment, humiliation, or demoralization; all of which could be masked by anger as a response to the patient being unable to live up to his/her expectations of self (what I previously termed as the “super-self”). It has been my experience that in the case of these highly inflated egos, anything from the experience of an overwhelming immediate threat to the patient’s survival (or the witnessing of a serious threat to, or the loss of the life of another) to being humiliated at work through the failure to achieve, be appreciated, or the inability to deal with oppression has been enough to cause the patient to present with trauma-like symptoms.

To some degree we are all susceptible to a “super-self” and vulnerable to overwhelming disappointment upon not meeting our expectations. To risk the chance of losing you (I shall become a “tad” Freudian), our self-image never really divests itself of childhood omnipotence and a self-centred, entitled view of the world (thus, most all relationship disasters……are you listening Bobby-boy?). Day to day life, stresses, and even minor traumas have the potential to induce an element of injury to our perception of invulnerability. However, if you happen to be in possession of one of these “super-selves” (and I assure you this is not psychopathology) you are especially vulnerable to the demands of your (military or para-military) work that threatens your “super-self” image. Following exposure to a traumatic event, the typical response for one of these “super-selves” is shame, humiliation, embarrassment, and rage; more due to the shock of not coping than the traumatic stimuli experienced. The “super-self” has been defeated. A kind of disequilibrium seems to occur as our hero denies personal failure, isolates, or stifles intolerable feelings, attempts to hang on to experiences of superiority and a belief in one’s own invulnerability (I say again, none of which is a “disorder” in the sense of being pathological. After all, I spent much of my young adulthood smacking into “super-selves” on a gridiron. Do you think I always dominated: that I was never beaten? And what did I do when I was? Who me, pathologically egotistical? Of course not!).

With regard to those diagnoses of “PTSD” related to being bullied, oppressed, or abused at work, I would remind you that we have a tendency to react more strongly to stressors caused by others than by accidents or natural disasters. The “injured” person most often believes that man made stressors are preventable, whereas accidents and natural disasters are unavoidable. In “BBSS” the stressor is usually interpersonal in nature, or has a strong interpersonal flavour. We will often find (at this point, be thinking of your battle with those who represent the “outfit”) direct confrontation with the individual(s) that are involved in the inflicting or prolonging of the stress. In other words, the stress is “up close and personal”; typically we will find the interaction (with the Force?) riddled with exploitation, harassment, abuse, and humiliation. (Ever been cut from an athletic team? Ever been removed from a section you loved where you thought you were doing good work? Ever been embarrassed in front of work-mates by a supervisor? Did you believe it was righteous? Remember how you dealt with it? Did it ever really go away?) Within this group will be found a large segment of patients, who have seldom if ever witnessed or experienced the serious injury or death of another. However, these patients are vulnerable to the seeking of appreciation, admiration, and recognition of their “specialness”. The “trauma” can really be viewed as an insult to the “super-self”: a deliberate withholding of gratitude or appreciation that results in a painful mortification (death) that resembles trauma; and is often labelled as a “traumatic response” by those professionals who are unfamiliar and inexperienced treating this highly unique population.

Well there you go. Now you have it. Within the military, para-military, and elite competitive worlds I believe “BBSS” has as much merit as “PTSD”. What do you think? Now that I have unleashed this brilliant theorizing, do you think I’ll see it splashed all over a new batch of sad stories related to the work of emergency personnel? Hmmm, I doubt it, no money to be made in it and not sexy enough! Doesn’t require a pill; only the prescription below……..

As usual I want to leave you with a prescription to meditate upon…………………PLEASE RECOGNIZE WHEN AND WHAT YOU FEAR. KNOW AND EMBRACE YOUR LIMITS. DON’T RUN FROM THEM,EXPLORE THEM; LEARN TO ACKNOWLEDGE THEM; CONFIDENTLY TOUCH LIFE’S UNCERTAINTIES; STEP CAUTIOUSLY INTO THEM AND YOU MIGHT LEARN TO BE MORE RESILIENT,FEARLESS, AND TO EXPERIENCE YOUR LIFE MORE FULLY.

Dr. Mike Webster
Reg’d Psych
#0655

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From → PTSD, Stress

5 Comments
  1. janslakov permalink

    So interesting! This could apply to me, in my experiences as a teacher. I so wanted to be able to share some of what I thought was exciting in learning, to help students see openings in life for learning. But all too often, that is not what was happening when I was teaching: ) At first I felt like a failure, and embarrassment and a form of humiliation were present… I am still susceptible to stress as a teacher and the idea of really exploring what I fear could help with that. But also, just realizing that I am not omnipotent, that I cannot, by virtue of some wonderful charisma or insight or whatever, transform a group of students into free-thinking explorers, can be freeing. … Also I know that education does not come only through schooling; as Mark Twain said, “I never let my schooling interfere with my education.”
    I’m sure that is true for being a peace officer as well, that one need not necessarily wear a uniform and/or carry a gun to be effective in defending fundamental freedoms and keeping communities safe.

  2. My PTSD has nothing to do with being a police officer as it relates to the way I was treated by my employer. My 46 years were spent in front line policing and during that time I picked up a slew of physical injuries, double spinal fusion, both knees one reconstruction, the other fixed by arthroscopic surgery. Two broken hands a broken nose, repaired surgically and a list of other injuries not requiring surgery. I also volunteered for some work assignments, during my career, that had me confronting death and serious injury to my self and later in my career I also investigated deaths, suicides and serious injuries. Then I began investigating traffic fatalities and collision reconstruction. I was not bullied or mistreated by anyone who mattered, I had a long career. However I did it to long, i became numb and devoid of emotion on one day and then a blubbering mess the next. The names and faces of the dead and dying still come to me unbidden. I have been in therapy for eight years and will continue until death. I am not here because of how I was treated, I am here because of what I saw, tasted and smelled because of the death and mayhem of working a city with the high volume of calls for service. I am glad you are exploring different diagnosis and I do not take offence at such actions, I am secure in my diagnosis and the treatment and therapy that has re humanized me and allowed me to live in more peace, with more love in my retirement. I also have a motorcycle, I was a motor cop all through my career. I call her my sanity cycle and she takes me far further than the roads we follow. Keep helping those who need to heal, and i applaud your discoveries as they will aid you in treating those whom you care for. you have nothing but our best interest at heart when you push the definitions and parameters of a PTSD diagnosis.

  3. Serious Topic forsure
    but if you all want a good smile read some of the articles posted below;

    RCMP bans self-defence for NB residents

    http://themanatee.net/rcmp-bans-self-defence-for-nb-residents/

    Fredericton Police dog Enzo suspended from active duty

    http://themanatee.net/fredericton-police-dog-enzo-suspended-from-active-duty/

    Bathurst police to host body camera film festival

    http://themanatee.net/bathurst-police-to-host-body-camera-film-festival/

    Fredericton proposing to replace police officers with cameras

    http://themanatee.net/fredericton-proposing-to-replace-police-officers-with-cameras/

    Fredericton pedestrian struck by police, charged with obstruction of justice

    http://themanatee.net/fredericton-pedestrian-struck-by-police-charged-with-obstruction-of-justice/

    Police action foils manufacture of counterfeit pennies

    http://themanatee.net/police-action-foils-manufacture-of-counterfeit-pennies/

    RCMP forced to charge entire New Brunswick population with illegally importing liquor from Quebec

    http://themanatee.net/rcmp-forced-to-charge-entire-new-brunswick-population-with-illegally-importing-liquor-from-quebec/

    Office drones rush to window, watch RCMP cruiser blaze by in all its glory

    http://themanatee.net/office-drones-rush-to-window-watch-rcmp-cruiser-blaze-by-in-all-its-glory/

    Dog that killed goat, donkey not rabid, just really didn’t like goat, donkey

    http://themanatee.net/dog-that-killed-goat-donkey-not-rabid-just-really-didnt-like-goat-donkey/

    Sussex man posing as ‘HitchBOT’ busted hitching ride to job in Moncton

    http://themanatee.net/sussex-man-posing-as-hitchbot-busted-hitching-ride-to-job-in-moncton/

  4. janslakov permalink

    I want to add that I am sure PTSD can be a sign of something basically healthy, and/or BBSS too. If you don’t even aim to do a great job of helping people, then your “super self” will hardly be bruised if for some reason you fail!

    I was just reading excerpts from a book by Carol Off, “The Lion, the Fox and the Eagl”e. In it she describes how Gen. Lewis MacKenzie saw his mission to now ex-Yugoslavia as a success… but he failed to help the people of Bosnia, failed to prevent the war. As far as I know, he does not suffer from PTSD. Roméo Dallaire, on the other hand, considers his mission to Rwanda as a failure, although apparently at least he succeeded in saving thousands of lives by securing the Kigali airport so humanitarian aid could come in. But I know he has had serious problems with PTSD (or BBSS : )

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