Rewriting the Story Trauma Leaves Behind

Post-Traumatic Stress Disorder

Post-Traumatic Stress Disorder, or Post-Traumatic Stress Disorder (PTSD), is a psychological condition that develops after a person experiences or witnesses a traumatic event. Traumatic events include natural disasters, traffic accidents, sexual violence, war, and the like. After living through trauma, the symptoms of PTSD do not necessarily appear straight away; they may take some time to surface. These symptoms can be grouped into three categories: re-experiencing (Re-experiencing), avoidance or numbing (Avoidance and emotional numbing), and hyperarousal (Hyperarousal).

What does re-experiencing mean? People with PTSD have intrusive (Intrusive) memories, and these intrusive memories resurface repeatedly as flashbacks (Flashback) beyond the person's control. The memories may take the form of images or sensations, or even nightmares. Facing trauma that keeps replaying, some sufferers question themselves over and over for not having stopped the event from happening, blaming themselves for what went wrong and, in turn, feeling shame and guilt.

To avoid or lessen the distress brought on by a traumatic event, sufferers will steer clear of people or things connected to it, choosing avoidance over conversation. Numbness (numbness) is another phenomenon that sufferers develop in order to reduce distress. Numbness becomes a protective mechanism that shields a person from further harm; its specific symptoms include being unable to feel emotion (whether positive or negative), losing interest in everything, and feeling deeply distant from other people.

Hyperarousal refers to the way sufferers become irritable, remain in a prolonged state of anxiety and find it hard to relax, struggle to concentrate, and develop problems with sleep. These reactions are all tied to the fight-or-flight response (Fight-or-flight Response), keeping a person ready to face danger at any moment.

Under normal circumstances, we all experience the psychological phenomena described above. It may be that heartbreak makes us keep recalling fragments of the past; it may be that work is not going well, so we choose not to talk about the things that leave us feeling defeated; it may be that after watching a horror film, we feel uneasy for the rest of the day. But these phenomena that we generally go through are normal reactions, and they rarely get in the way of our daily lives. Psychologists, by contrast, describe the symptoms of people with PTSD as maladaptive (Maladaptive), meaning their reactions cause problems for their emotions or their relationships with others. We may all have lived through some traumatic event, and in the short term we may show the states discussed above, yet after some rest most of us can walk out of the shadow. What people with PTSD face, however, is different: their experiences are usually much harder to process, and time alone may not be enough to bring them through and back to recovery.

What is narrative therapy?

Among the forms of psychotherapy used for PTSD, besides the most familiar cognitive behavioural therapy, Narrative Exposure Therapy (Narrative Exposure Therapy) is also one of the most effective approaches. Narrative Exposure Therapy, true to its name, is a process in which the therapist reads through the patient's life and trauma in the form of a narrative; the process involves discussing the traumatic event afresh, as though being exposed to the trauma once more.

In narrative therapy, the therapist talks with the patient and pieces the patient's scattered fragments of memory together into a single story, a process that lets the patient uncover certain meanings, values or strengths. In understanding narrative therapy, we can first draw a conceptual distinction: cold memories (Cold Memories) and hot memories (Hot Memories). Cold memories refer to certain facts or external contextual factors (Context). Hot memories refer to our thoughts, emotions, physiological reactions and so on. The symptoms of PTSD arise because, when hot memories resurface, they cannot be linked back to the cold memories, so the sufferer feels as though they are living through the traumatic event all over again. One of the keys to narrative therapy, then, is to sort through these memories and integrate them into a meaningful story.

In narrative therapy, the therapist and the patient together take on the role of the "author", working jointly to rewrite the patient's story. In the course of rewriting, the therapist does not try to distort the patient's past or force in extra elements; rather, the hope is to view the traumatic event and the patient themselves within a healthier framing (Framing), improving their self-image. Therapy does not change the reality of what has already happened in the past, but by sorting afresh through the run-up and aftermath of the event, it can instead change the patient's way of thinking.

Narrative therapy gives meaning to the patient's experiences, so that when they recall the event again they can see it from another angle, connecting their feelings with the facts of the past and the external context, recognising that they are now in a safe reality and easing the impact the symptoms have on their lives. Of course, neither narrative therapy nor PTSD can be fully explained in a few thousand words. If you, dear reader, feel your own emotional responses have become unusual, please do not be afraid to seek help. Experiencing a psychological difficulty is not a sign of weakness, and if difficulties persist in your life over a long period, taking the initiative to seek out a professional is the best way to address the problem.