The Fear of Re-traumatization can make even the strongest person
shut down and not be able to listen to reason, reassurance...
Nervous breakdowns come in twos. A first trauma causes the first one and leads you to feel utterly defenseless. When as sure as you thought you were is as wrong as you turn out to be, it can cause you to doubt all your past decisions and any upcoming ones, at which point you are frozen in limbo.
When you're in such a state of feeling exposed and at risk, you live with the constant fear of being re-traumatized. You think that if the first trauma caused a severe crack in the porcelain of your well-being (that you turn away from your public face, lest others see), a second one will shatter you completely and you will never recover.
This is what PTSD victims, many concentration camp survivors, rape victims, financial collapse, and prolonged unemployment have in common. All of these traumas introduce you to an extreme vulnerability that on bad days you can barely live with. The world may think you got over those traumas, but the secret you keep inside is that you never did; you merely got past them.
All subsequent behaviors following such traumas -- from social withdrawal to excessive alcohol/drug/prescription abuse to moodiness and irritability (when pushed to do something you don't want to do) to rage (when cornered or provoked) to suicide -- can be viewed as an effort to avoid re-traumatization at all costs.
Treatments from Cognitive Behavioral Therapy (re-evaluating your thinking and perceptions in light of reality) to interpersonal therapy (helping you stay involved in relationships and more effective in them) to biological (from anti-anxiety, to anti-depressant to anti-psychotic meds) and other modalities are an effort to intervene with people living in this psychological abyss and help them manage their emotion and land back on the track back to a functional life.
Sometimes one step in the right direction is to talk and walk a traumatized person back from the edge, as for example recently happened when I spoke with a financially ruined person teetering on the brink of psychologically falling apart (and something you might try with a traumatized person you know).
Dr G: How big a trauma has losing all this money been?
Dr. G: How big?
Client (now beginning to cry with upset and relief): I can't even think about it.
Dr. G: What does it make you want to do?
Client: I don't know. I guess, just hide. (He then continues to speak about this for several minutes).
Dr. G: How well do you think you could handle another trauma with your wife, children, parents, health?
Client (looking at me incredulously): Are you nuts? I couldn't.
Dr. G: What do you think you'd do?
Client: I couldn't even imagine. (He continues to speak about this for several minutes).
Dr. G: So, you're as scared as you've ever been.
Client: More than I've ever been.
Dr. G: Tell me about another time in your life that you never thought you'd get through, but that you did.
Client: I remember when my dad abused everyone and he got so angry I thought he was going to kill someone... (He continues to speak about this for several minutes)
Dr. G: Yes that. Tell me about that incident, how you never thought you'd make it through and how you did.
Client (continuing to talk at length)
As the client began to talk and answer these questions and tell the story (of another trauma he made it through) he visibly calmed and realized he'd survived bad times in his life before. As he continued to relax, he became more open to talk about his options in his current crisis.
For more information check out my book, PTSD for Dummies.
Follow Mark Goulston, M.D. on Twitter: www.twitter.com/markgoulston