Episode 31. Post-Traumatic Stress Disorder (PTSD)

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Episode Summary:

PTSD manifests in several forms but is recoverable with support. Support is the critical word here: talking about and working through the traumatic experience and triggers with trusted therapists, counselors, or others is key.  You are not alone.

Episode Guest:

Daniel J. Singer Ph.D. Washington State Licensed Mental Health Therapist specialized in counseling and treatment on mental health diagnosis. 

During This Episode We Discuss:

  • The spectrum of PTSD presentation and causation
  • Important concepts regarding trauma and the memory of trauma
  • Presentations of PTSD experiences
  • Presenting with anxiety; is it PTSD related?
  • Triggers and solutions
  • Family Support, Support Groups, Therapy, Medications

Quotes (Tweetables):

“Anything that has caused us some kind of shock, or some kind of trauma and gives us a mental behavioral or physical effect on who we are and causes us trauma is really how we define PTSD.”

“Reach out to someone, whether it’s professionally or whether it’s to a friend, we are social creatures, we can’t handle the world by ourselves, and it’s ok.”

Daniel J Singer, Ph.D.

Recommended Resources:

  • Use your hospital resources.
  • Religious institutions may offer support.
  • Online groups
  • Call your Primary Physician.
  • Ask your Insurance company for a list of providers.

988 Suicide and Crisis Lifeline: 988 announcement PDF

Episode Transcript: 

Dr. Pelman (00:07):

A baseball game, a day in a park with friends and family, fishing in a remote stream, work, travels, providing for loved ones, or heading out for adventures. Whatever you do, whatever you enjoy, you need your health. The Original Guide to Men’s Health is presented by the Washington State Urology Society to help take you through the steps necessary to get the most out of life. If you have invested in a retirement plan for your future, why not invest in your body. After all, it makes better sense to retire healthy and enjoy your future. These podcasts are a guide for how to take care of yourself. If you take care of your car and maintain it, why not do the same for your personal machine, your body. If you know you should, but haven’t yet, the information in these podcasts contains some easy recommendations for where, when, and how to get started. Follow the podcast as we explore men’s health with renowned experts and embark on a journey towards better health.

Dr. Pelman (01:24):

Welcome to this episode of the original guide men’s health. Today, we’re going to be interviewing Dr. Daniel J. singer. Dr. Singer has previously been our guest and has presented on episode 16, Part one. Dr. Singer joins us today to speak about PTSD (post-traumatic stress disorder). Dr. Singer is a licensed therapist, a PhD in family therapy with 30 years experience licensed in the state of Washington. I’m happy to introduce Dr. Daniel J Singer PhD. Welcome Dr. Singer, and thank you again for joining us for the original guide to men’s health. It’s

Dr. Singer (02:09):

It’s nice to be back. Thank you for having me.

Dr. Pelman (02:11):

But let’s review PTSD. First of all, post traumatic stress disorder. Do you want to review a little bit about what it actually is?

Dr. Singer (02:22):

Well, let’s define what post-traumatic stress is ,first. Most people think that post-traumatic stress is something that happened a long time ago and we suffer trauma maybe 5, 10, 30 years ago, or when we were a child. And there are certain things that trigger responses that cause us to have mental and physical pain. This is the most common point of view that people have regarding what post-traumatic stress is. However, post-traumatic stress comes in different varieties. It comes in different forms. That is just one form of post-traumatic stress. So really to define post-traumatic stress: it’s anything that causes a behavioral, mental, or physical shock to the body. It’s anything that causes us to have trauma and gives us some kind of memories that traumatizes us is what post-traumatic stress is. So you can suffer PTSD from something that happened yesterday, If you suffer a traumatic event and it continues to persist in your behavior, or the most common example is you can have PTSD from something that happened in your childhood that has gone unresolved, that happened 20 or 30 years ago. But the most common example of PTSD and the easiest way to understand this is anything that has caused us some kind of shock or some kind of trauma, and gives us a mental, behavioral or physical effect on who we are and causes trauma really is how we define post-traumatic stress.

Dr. Pelman (04:07):

So you’re saying the event could have been years past, but there’s a trigger that brings it out recently? 

Dr. Singer (04:15):

Yes. So the event is something that could be passed and the event could also be something that happened recently.

Dr. Pelman (04:21):

Okay. So let’s say somebody has a trigger event. What kind of symptoms would we be looking for that would be common to someone suffering from PTSD?

Dr. Singer (04:34):

This is something that’s very recognizable. It comes in the form of nightmares. It comes in the form of flashbacks. It comes in any rapid change of behavior, any rapid change of mood of the person. Post-traumatic stress is very identifiable because the change that occurs in the person is very abrupt. It doesn’t happen slowly. It can happen very quickly and there are usually events that can trigger it. So for example, if a person was traumatized, let’s say they were traumatized because they were a prisoner of war, which is a very common example, and they go to a party and the party is in a very small room and the person feels very confined, and the person is all of a sudden feeling panicky and the person has to go outside the room. That’s something that’s very common. That’s something that we all hear about. Anything that causes us to have some kind of trauma and anything that triggers that response can give us a sense of what PTSD is. And again Dr. Pelman, the thing to note is this comes in many, many forms from nightmares to change of grooming behavior, to really the change of the way somebody physically looks, to changes in the way that they eat, to changes in the way that they sleep. There’s a variety of symptoms that one can note that somebody is going through something like this.

Dr. Pelman (06:03):

Well, let’s take the common symptom of anxiety. How would somebody differentiate an anxiety that occurs as opposed to an anxiety that’s been triggered by and as part of a PTSD.

Dr. Singer (06:21):

So this is something that really needs to be discussed and I’m glad that you brought that up. There are many therapists that see people who have anxiety and diagnose them of just having anxiety. And there are many people that have anxiety that has been brought on by PTSD. The only way that a person can find out if the anxiety is PTSD related is really by asking questions about what the person is experiencing, because anxiety is anxiety. The hard thing is, when somebody has experienced anxiety, we see them as experiencing anxiety. When somebody is experiencing anxiety from post-traumatic stress, they’re experiencing anxiety. So the symptoms look the same. However, without asking the right questions, without getting the right information from that person, we have no way of knowing as to whether it’s being triggered by an event that took place in that person’s past that might’ve happened a day ago, a week ago or 20 years ago. So really the most important thing is to really ask those questions. Those questions are very important in finding out what is really the basis of that anxiety.

Dr. Pelman (07:30):

So I imagine that it would play into making a more appropriate therapy for the individual who is triggered by PTSD, say with anxiety as a symptom versus somebody who just has anxiety as a reaction to a current event in life.

Dr. Singer (07:51):

Right,and here’s really good advice for therapists, clinicians and physicians and I’ll give the same advice to parents who say, well, “I can’t afford a therapist or a doctor, and I don’t know who to look for one at this time, nor am I able to do that because we’re going through COVID right now and it’s very difficult for me to find someone who’s available.” For the professional, it’s important to ask the questions that you would ask in an intake. The intake, I cannot stress this more, of a patient is so important to find out what happened in the person’s past, because this is what helps us diagnose where anxiety comes from. History of physical abuse, history of sexual abuse, history of bullying, history of any kind,  that could possibly give us clues that the anxiety is PTSD related.

Dr. Singer (08:51):

For teachers and for parents, it’s very easy to ask some of these questions. You can look at your child who might be experiencing test anxiety for example, and say, “honey, does this remind you of anything?” And they may be reminded of a period, maybe a week ago or a year ago, when they took a class. They don’t remember passing the class and this is causing anxiety for them, or they are experiencing testing anxiety and now that they’re walking into that situation, it’s reminding them of something that occurred months, weeks, or possibly a couple of years ago. So asking the right questions and getting historical information helps us understand whether this is PTSD or whether it’s not. Here’s the confusion that exists. Dr. Pelman the confusion is when somebody is depressed, sometimes a clinician will say, yes, this person is depressed. However, that might be the wrong diagnosis because the clinician has to find out if the person is depressed or if the depression is related to an experience that they had before, which is causing them to be depressed, which means the depression could be in the classification of PTSD. So it’s a funny thing because we’re composed of so many moods, we have to be able to get the right information to find out what’s really causing this?  Is it PTSD related or is it not? Because some of these emotions standalone by themselves and some don’t.

Dr. Pelman (10:23):

So I had brought up anxiety, you brought up depression. What other symptoms might be displayed in PTSD?

Dr. Singer (10:31):

Oh my gosh. Other than PTSD or with PTSD?

Dr. Pelman (10:35):

With PTSD,  anger or…

Dr. Singer (10:38):

Gosh, it’s the myriad of emotions. It’s anger. It’s frustration. It’s anxiety. It’s stress. Here’s kind of a different twist on this. You can also experience happiness because even though it may not be traumatic if you experience happiness, if then all of a sudden you remember during that happy time, something depressing happened, that happiness may be followed by depression because you remember you had a happy event and something tragic happened during that period of time. So the myriad of emotions is what is expressed through PTSD. The way we see it obviously is the way that your person presents themselves behaviorally and also emotionally expresses themselves as well. But again, I’ll go back to what we discussed. Without getting the right information and asking the right questions, we have no way of finding out whether it’s PTSD or not.

Dr. Pelman (11:43):

So it can be an acute event. Once it happens, is it reversible or is it a lifelong issue that has to be dealt with?

Dr. Singer (11:56):

It’s reversible if somebody is able to deal with the event. It’s not reversible if the person doesn’t deal with the event. It’s funny, what they often say is if I have recurring nightmares over past events, what’s the best way to solve that? And what they do a lot in therapy is they’ll say, “tell me the dream.” What the therapist will have you do is say, “now finish the dream”. And how would you finish the dream? You’d be surprised how many nightmares go away when a person can remember the dream and they’re awake and in therapy, they’re allowed to finish the dream and the nightmares don’t come back. The way to handle PTSD, and I’m not trying to sound negative in any way, but the way to handle PTSD is really through counseling, through proper therapy, through talking to somebody who can help you resolve that event. Once you are able to resolve the event, talk about the event, there are less things that will trigger the emotional responses that will really help you remember the event or have you remember the event. So really the best way is to go back in history with a trained counselor, with a trained therapist, and deal with that event that took place when you were a child, when you were a teen, or even something that happened a couple of weeks ago.

Dr. Pelman (13:16):

So you have led me into my next question which is: what are therapies? And I imagine they’re different based upon what emotion is being displayed, but how would you manage somebody who has an acute onset of a PTSD episode?

Dr. Singer (13:33):

Well the best way to handle it is by doing three things. Number one is to talk to the person and of course, do you have property intake. Number two is once you have that information, ask the person about that event and ask the person if they could describe what happened during that event and how it took place. The third thing is really to have them talk about that event and ask them in the type of a situation that you’re in now, what they can do differently and how they can change their behavior both in small ways and in large ways. So a really good example is if a person is claustrophobic and they remember being claustrophobic, because the child got stuck somewhere and was not able to get out of her room. The best way to handle that is to have them identify the event and then talk about the event and then let them know that if you’re in a room and it’s too small for you and you can’t handle that, what are the options?

Dr. Singer (14:35):

You can stay in the room, you can find a place in the room, you can leave the room. There are many options, but the best way is really to have a person identify the cause and then have that person talk about it. And there’s a variety of ways of doing that.

Dr. Pelman (14:50):

So you’re looking at behavioral remedies. Would medications ever be part of therapy?

Dr. Singer (14:58):

You know, that’s a funny thing. I’m gonna have to go. Yes and no. Now I’m not a person who is allowed to prescribe medication. I have a PhD. I’m not an MD. So I can’t say what should be prescribed or how it should be prescribed. However, I can tell you my point of view on this. That is most times when a person handles an event and the event is so insurmountable that it takes a lot of time for them to resolve it and the depression really is getting in the way of them communicating. Many times they’ll go on medication as a way of helping them put themselves in a state of mind so that they can deal with the event and talk about the event. I have been with people who have not been able to talk about the event without using the proper medication. I’ve seen many things change, and I’ve seen many people go through alterations and become very positive people and they’re able to resolve the events through the proper medications. So the question of medication becomes very situational because there are some folks that have been through situations ,and it’s very hard to describe this Dr. Pellman, but they have been through situations which are so horrific and so terrible that it’s something that they can’t even talk about without getting some of the necessary medical assistance. It really, really can’t.

Dr. Pelman (16:27):

So it’s obviously a gradation of experience…

Dr. Singer (16:32):

It becomes really situationally. I’d say it’s an individual thing. I was watching this just recently with COVID about people who’ve lost loved ones and even to talk about the loss of a loved one or the loss, God forbid of a child. You’re unable to even deal with that event. You’re unable to talk about that event without some of the necessary medical intervention. S, there are so many horrific things that happen out there that it really is an individual thing.

Dr. Pelman (17:09):

So if somebody is feeling overwhelmed, and there are many who have been subjected to being isolated for a long time and being overwhelmed, what would you advise them to do? And you gave one suggestion, you know, contact, friends, contact, relatives, use support groups. What other things can they do? 

Dr. Singer (17:34):

Think if you’re feeling overwhelmed ]and if the friends and support groups aren’t enough, you can reach out to a therapist. You can reach out to a counselor. Here’s one of the advantages: there are a lot of counselors now that are doing zoom therapy. Let’s say I don’t have a computer, everybody has a cell phone. Everybody has a cell phone that is such a vehicle by way of being able to talk to somebody because counselors, therapists, ministers, priests and rabbis are reaching out to people not only via zoom, via computer, online chatting, but they’re also reaching out to people with FaceTime. They’re also reaching out to people with just phone calls. Physicians are doing it as well. Therapists are doing it as well but the most important thing is to reach out to someone whether it’s professionally or whether it’s through a friend, reach out to someone because we are social creatures and we are overwhelmed, especially with what’s going on. We can’t handle the world by ourselves and it’s okay. That’s an okay thing to understand. We need other people in our lives, be they professionals or be they friends. Reach out to someone and tell somebody I need some help and ask for some good advice. Ask for some input and see what they’re doing.

Dr. Pelman (18:58):

So we always like to end up by giving people who may be seeking help some real resources. Do you have anything that you have on hand where you would say people could look up online or at least contact to set up appointments?

Dr. Singer (19:16):

I’m going to say three very important things. Use your hospitals because the hospitals are very good resources in terms of what clinics there are to call. Be it a crisis clinic, be it Sound health, be it a Valley Cities, be it Evergreen Health, the hospitals are a very good resource. Especially in human resources departments, they have a lot of information at their disposal. If you’re a member of a church, there are a lot of resources at a church to reach out to because my son right now is doing a lot of online groups. There are a lot of online groups that are available that people are doing once, twice a week, so they can discuss what’s going on in the current day. The online groups are tremendous. Reach out to some type of therapist. The best way to look for a therapist, really believe it or not, is to go on a computer and go online and Google what therapists are out there.

Dr. Singer (20:13):

There are many therapists out there and you can reach out to a therapist for help. I think that would be the best thing to do. What you also can do is call your primary physician and ask your primary physician or your insurance company. If you’re a member of the University of Washington, it is a huge resource center. Kaiser is a huge resource center. Swedish, Providence, all these people, they’re huge resource  centers. Say, do you have a list? And many insurance companies will provide this. Do you have a list of providers that I can contact that can help me? So there are many, many resources out there that people can use to ask for help. One of the things I want to say, and I like to always end on a positive note, don’t ever be afraid to ask for help because human beings are all vulnerable. The more help you ask for the better you will be, because there isn’t a soul out there, whether they’re four years old, 50 year old or 90 years old, who hasn’t got a piece of information that can help us.

Dr. Pelman (21:16):

I think that’s a nice way to sum things up. Again I appreciate the information. Any last words besides that you’re not alone and that you can get help.

Dr. Singer (21:30):

Well, the most important piece of information I can give you is that PTSD is the one of the most recoverable things that one can go through. The best way to recover is to find somebody you’re comfortable with to discuss the event. You’re not trapped. It’s not something that’s incurable. PTSD is something that is very recoverable. That is the best piece of information that I can give you. As long as you know it’s something that’s recoverable, something that we can get through, something you can’t do alone. No doctor can operate on himself. No dentist can work on his own teeth. No therapist can give himself counseling. It’s usually not the best practice. So if you’re smart, reach out and know that PTSD is one of the most recoverable things that is out there provided you’re willing to ask for the appropriate help. Asking for the appropriate help will put you on the road to recovery and give you a very, very nice life.

Dr. Pelman (22:26):

Well said. I appreciate your help today as always. Thank you, Dr. Singer

Dr. Pelman (22:32): 

This completes another podcast chapter of the Washington State Urology Societies: “The Original Guide to Men’s Health.” This is Dr. Richard Pelman reminding you to take care of yourself. The Washington State Urology Society wishes to thank all contributors, who volunteered their time and knowledge. The information presented is the opinion of the speakers. The Society also wishes to thank Sean Fox for his invaluable technical assistance, music theme “San Juan bells” written and performed by Dr. Dave Whiting, the podcast is the property of the Washington State Urology Society.  Reproduction and use without the express consent of the Society is strictly prohibited. For more information about men’s health visit wsus.org or visit your physician or care provider.

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