Post-Traumatic Stress Disorder

Avoidance: The Biggest Threat to Our PTSD Awareness

Why we need to become a trauma-informed society.

Posted Nov 11, 2019

From the look on my patient’s face, I can tell that I am the last person he wants to see. Unfortunately, he has little choice as his internist won’t refill his prescription for Valium until he is evaluated by a psychiatrist.

Valium has been in my patient’s life for decades and was originally prescribed to treat his “nerves.” Time has revealed its troubling side effects—the risk of addiction, falls and memory problems. His new doctor insists on a psychiatric evaluation to see if there is something more to the “nerves”, perhaps an underlying condition that there might be a better, safer treatment for?

The internist’s instincts are spot on. The patient has Posttraumatic Stress Disorder (PTSD) related to a war he fought over 50 years ago. He has little of the hallmark features of PTSD—nightmares, flashbacks, and hypervigilance—rather he has severe avoidance, an often overlooked but core symptom of PTSD.

Avoidance means he denied the trauma of its existence. He has lived a constricted life—one that avoided any trauma triggers. A narrow life traversed on safe lanes that created a false sense of security. Huge cracks are evident in his unlived life—heavy drinking, poor health, multiple divorces and estrangement from his children.

As is often the case, where avoidance is the main feature of PTSD, when this patient finally received the help he needed, it felt like too little, too late.

Avoidance is an insidious symptom of PTSD, not only for individual sufferers but for society at large. “Forget it ever happened,” “it does not bear thinking about” and “don’t dwell on the past” are avoidance tactics that all humans engage in when confronted with stories of unspeakable traumas.

When it comes to raising public awareness about PTSD, avoidance is the enemy. The best way to overcome avoidance is to become a true trauma-informed society.

Since 9/11, the wars in Iraq and Afghanistan and natural disasters such as Hurricane Katrina, the term PTSD has become part and parcel of our modern vernacular. Indeed, in 2010, the U.S. Senate designated, June 27, as National PTSD Awareness Day and there is little doubt that the ensuing decade has seen more societal awareness of PTSD.

We now know PTSD is a pressing public health concern and, at any given moment in time, 6 million Americans have active symptoms that require treatment. It often goes hand in hand with depression, alcoholism, drug abuse or anxiety and all sufferers have a higher risk of death by suicide. PTSD not only impacts our brains but also our cells, organs, and bodily systems. It has emerged as a risk factor for various diseases from cancer to heart disease to obesity.

PTSD can begin after many kinds of trauma. Rape, combat, family violence, being robbed at gunpoint, escaping a natural disaster are just some examples. In cases of mass traumatization, such as torture, slavery, and genocide, we now know that PTSD’s deep footprint can last for generations. Finally, PTSD, which was once considered an incurable and disabling condition is very treatable with a wide array of talk therapies and medication.

This is all welcome progress, but the fact remains that there will never be enough mental health professionals, like me, to help every person who is living with PTSD. This is because sufferers live in a world where ongoing trauma is a fact of life and much of their ability to deal with this is determined by the community around them. Our society needs to become trauma-informed and each of us needs to live a more trauma-informed life.

Living a trauma-informed life means:

Accept the statistics: most of us will, sooner or later, experience major trauma. If you are fortunate enough not to have such an experience, the odds are that a loved one or others with whom your life is inextricably intertwined—in the community where you live, at the place where you work, where your children go to school or play—will be affected.

Accept the science: PTSD is not brought on by poor lifestyle choices, moral weakness or character flaws but by a complex interplay between human biology and the environment. Recognize how a traumatized person navigates the world: Everyday interactions such as driving a car, buying groceries or filling out the paperwork can leave PTSD sufferers feeling mistrustful, hypervigilant or anxious. Such feelings are often misinterpreted and the person is viewed as “having a bad attitude,” being “difficult” or “imbalanced.”

Sufferers are ostracized when what is needed to remedy the situation is more information and transparency about what is required from them and why. Rather than distance, trust needs to be built. Rather than annoyance or force, open-mindedness and compassion. Rather than shutting them down, creating a safe space to listen to them.

Recognize when someone needs to seek professional mental health attention and encourage them to do so. Too often, the invisible wounds of PTSD do not receive the serious attention they deserve, yet early interventions to treat it are incredibly effective in preventing some of the deadly downstream consequences such as addiction, violence, and suicide.

Beware of our own natural inclinations to deny trauma its existence and how avoidance will sabotage our attempts to live a trauma-informed life. The fact is, trauma stories are hard to listen to and traumatized people can be hard to be around.

The same way my patient sought Valium for decades, an ineffective bandaid for his mental anguish, society, too, seeks bandaids to avoid dealing with trauma. Society would rather deny, deflect and displace the discomfort created by trauma than face it. This collective tendency to avoid dealing with unspeakable traumas has, throughout history, stymied our understanding of PTSD.

But today we are at a cultural inflection point. In the past 20 years, the advances in knowledge about PTSD and its negative imprint on our lives has been unprecedented. We also know that avoiding trauma only allows PTSD to thrive. Fully confronting avoidance in ourselves, our loved ones and society means finally overcoming the biggest obstacle to our becoming a truly trauma-informed society.