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Chat Transcript with Laura Russell Ph.D. 

(post traumatic stress disorder)

This chat was held on Tuesday, December 12 from 5:30PM PST until 7PM PST. The servers went down and our chat was interrupted many times. The second half of this chat was held on Thursday, February 8, 2001 from 6:00PM PST until 7:30 PST. 

Repod: I'd like to know why after years of treatment and seemingly having this disorder under control that it would rear it's ugly head again? 

Drlaurarussell: Oh, that is a great question! That happens to so many people as they go about their lives, getting better and better. There are several reasons for your symptoms to recur. One is that you have grown and are trying new things in your life. Another is that you have been triggered or re-traumatized by something going on in your life and another is that your healthy psyche has decided that it is time for you to face more of your trauma. 

Drlaurarussell: Next question. 

Drlaurarussell: I'll just 'talk' until someone has a question, then. Please jump in and type "?" at anytime. I can talk forever I think on this topic. Recovery from trauma is basically a normal experience. We all think it is not, because it is so painful and because of media coverage. But your mind or psyche is so beautiful, that it serves up exactly what you need to face whenever you are ready to face it. This is why I do not recommend to people that they dig around and try to remember the things they don't remember. If you just go along and try to build your life, to function, your psyche will give you whatever memories you are ready to face. and your psyche gives this to you in your symptoms of PTSD. These symptoms are the reliving stuff that comes up in flashbacks, dreams, unwanted memories and flashes like pictures, or feelings like the trauma you have experienced is currently happening to you or feelings of anxiety and concentration problems. Ok, I guess I'm running out of steam. Questions anyone? 

Repod: yes, then it appears that the symptoms can recur anytime? 

Drlaurarussell: Kind of, what happens is usually that you continue growing and functioning and your symptoms come back. If you know that this is normal and that it doesn't mean that you are going backward!!! 

Repod: phew... thank you drlaurarussell 

Drlaurarussell: I repeat, if you know that it DOESN'T mean you are going backward. Then you can go with your symptoms to a higher level of functioning. I really believe that the symptoms of PTSD are a normal response to outrageous experiences. And that our minds and emotions are healthy. So when symptoms come back again, they are the result of your mind trying to get even healthier. Done. 

Obsession`72: so if you have been diagnosed with PTSD...then had counseling and "so called" been treated ... Is that it? Does it come back again and again to haunt you...Is it ongoing? Or once dealt with "properly" is that the end? 

Drlaurarussell: That depends on so many factors. So, you have been traumatized, gone to treatment, and gotten better. 

Obsession`72: yes... I guess so 

Drlaurarussell: then you went on in your life. Since all life is growth, then you probably went on to doing the things in your life that are important to you. then, and there is always a then, something new comes up. A life event...a change, a new job, a relationship, a move to a nicer place to live, etc. Well, what happens is sometimes you have leftovers from your trauma to face to be able to enjoy the benefits of your achievements. For me, this has always worked liked that. I accomplish something, work thru more 'stuff' and then go on to do something more and new and different, like this chat or my web pages, and I have to face more 'stuff' from my childhood abuse. Now, there are different types of traumas, adult traumas and childhood abuse traumas. Adult traumas are often a one-time thing. So they can be 'treated' or debriefed or 'processed out' and 
chances are the symptoms won't return but traumas like childhood abuse have happened over years of your history so they are likely to come up (not back) as you hit different adult life stages then it is simply time to grow some more. Done 

Obsession`72: thanks 

Drlaurarussell: :) 

Pattysanc: I have a very difficult time answering the telephone sometimes. I even jump sometimes when it rings. Is this connected to PTSD? I don't understand why I am afraid of the phone. It is like the outside world which is unsafe is coming in. 

Drlaurarussell: this could be. Especially with the physical symptoms of PTSD...with PTSD, you also have a whole set of symptoms that are physical signs of increased arousal. Basically, being on alert all the time and having an exaggerated startle reaction. There are others, but what you describe sounds 
like a startle reaction to the telephone. You might try changing the bell to softer. But many people have reactions to the phone. I mean, logically, we don't know who is calling what they want. if it is bad news 

Pattysanc: Exactly 

Drlaurarussell: and if your experience in life is of having people talk badly to you for example, well, having difficulty answering the telephone makes sense. Done 

Pattysanc: Thanks. Very helpful. 

Niki101: do you feel that anxiety can be treated solely through therapy or is medication necessary. I realize medication always helps, but do you feel it is reasonable to assume anxiety can be treated without the use of medication. 

Drlaurarussell: 1st of all, I am not a medical doctor, nor a specialist in the treatment of anxiety. So I can talk about the symptoms of PTSD that look a lot like anxiety but medication questions are better for a psychiatrist. 

Niki101: ok, that's fine 

Drlaurarussell: Sometimes with PTSD, the physical symptoms are very painful, but people have to be careful not to overmedicate themselves many times, traumatized people have gotten into difficulties with alcohol or tranquillizers because they naturally wish to medicate symptoms except that with PTSD, the symptoms are normal and need to be processed out so you end up prolonging your difficulties. Done 

Niki101: thanks 

Repod: Can you explain 'processed out'? 

Drlaurarussell: I'll try..the official term is debriefed. When you have had a trauma, what happens is that you find yourself needing to talk and talk and talk and talk some more about what happened. This is healthy and good for you, if your lifestyle allows it. This is how people who don't need therapy after a trauma handle it...they talk about what happened to them until they are done talking. But many people have rules they learned in childhood that stop them from talking about what bothers them. The rules people have are too numerous to list here 

Repod: but isn't talk therapy counterproductive to someone w/bpd? 

Drlaurarussell: so I'll just name one error rule: "Don't bother people" for example is a way some people learn to not do what they need to do. BPD is very different than PTSD. I cannot really talk about BPD because my only knowledge about it is from Patty...I cannot claim to be knowledgeable about it at all. 

Repod: thank you drlaurarussell 

Drlaurarussell: But PTSD is something that needs to leave your system kind of like the flu when you need to vomit. Done 

Repod: :) 

Lauranator: I have a problem with repressed memory.....I have all the signs and symptoms of trauma, but don't remember what actually you think hypnotism or some other way of digging it out is necessary or should I just deal with the symptoms? 

Drlaurarussell: Oh, thank you Lauranator. I am so glad you brought this up. No. I do not ever recommend hypnosis or any way of digging things out. People can get very ill that way. Let's assume for a moment that you have a repressed memory. What that means is that your healthy defenses are there to protect you from remembering anything you are not ready to remember. I'll go back to this idea that recovery from trauma is natural and normal and that your psyche is healthy. Well, then your psyche protects you from thoughts and feelings you cannot currently handle. I actually studied hypnosis and became certified to do hypnosis in my office and I absolutely refuse to do this because if you assume that your feelings are healthy, then begin to take care of yourself and build your life, any repressed memories will surface in an orderly fashion controlled by your psyche at the time and place in your life when you can best handle them. done 

David: I grew up in a major alcoholic family and because of it I absolutely abhor Christmas. I've been out of the house or 25 years and I still hate it. Even if I work thru it will I ever feel any joy around the holidays?? Or is it not worth the effort?? 

Drlaurarussell: First of all I'd change the questions. To, instead, how can I take care of myself and meet my own needs during Christmas? Instead of placing expectations on yourself, it is more comforting to realize, as you do, why you feel the way you do AND not make yourself wrong for hating Christmas So, then you can say, ok, I feel this way, and it is normal for me to feel this way, so how can I help myself during these feelings? Done 

Pattysanc: I don't leave my house very much and I was never that way before. There seem to be so many stressors outside the house. Do many people with PTSD have difficulty leaving the house? 

Drlaurarussell: Yes. This is very common, and it is part of the avoidance set of symptoms that come with PTSD. When you are open to being triggered by anything even vaguely resembling your trauma, then it is tempting to control this by avoiding whatever it is. 

-LonewolfAz-: what exactly constitutes a traumatic event cuz every time I've broken up with a girl ... I've ended up having trouble at work or leaving work as a result... 

Drlaurarussell: people go to many extremes in their avoidance of trauma triggers they avoid anything having to do with their trauma. they avoid intimacy, hope, and finally your world narrows and narrows until you have difficulty leaving the house. done 

Pattysanc: That has been extremely helpful. Thank you Dr. Russell. 

Obsession`72: I endured childhood sexual abuse... I feel that is where my PTSD comes from... what makes some people traumatized and others not? e.g.; five people suffer from the same traumatic incident and only one suffers from PTSD 
……………………………answer is missing………………. 

The-nessie-monsta: I have, as many others here have, several other dxs as well as PTSD, how hard is it to deal with when there are several psychiatric problems rather than just PTSD? 

Drlaurarussell: Great question. And the answer is, that depends. I have seen numerous people with Dissociate Disorders and PTSD, and those just require more work, but the therapy is pretty much the same as for PTSD 

.................. Full answer is missing................... 
At this time the chat server went down. Dr Russell has promised a return engagement after the first. 

The second half of this chat was held on Thursday, February 8, 2001 from 6:00PM PST until 7:30 PST. The Servers luckily were cooperative at this chat.

TimLPN: Dr Russel what do you think about EMDR for PTSD??

Drlaurarussell: I know very little about EMDR. But I have feelings of my own about things that seem to good to be true. I know my friend did some training in EMDR and used it in her practice for a while. The clients still needed to do their therapy work after. So some of the claims of cure may be a little unrealistic.

Pattysanc: Is it realistic to think that one could begin to recover from severe chronic PTSD?

Drlaurarussell: Yes, I believe so. I think that the media has played up our disabilities too much. It takes a lot of work in the present to prevent the past from intruding in the present initially. Then the deeper processing work really does dissolve the old pain. I have seen this to be true in my own life.

MONGOLLOYD: I had to stop therapy because I move to a place where I couldn't get it forced me to work on myself and apply what I had been learning. Should therapy be interrupted by breaks ? and even though I feel good should I go back ? I was depressed and bpd

Drlaurarussell: In regard to therapy and breaks: I think therapy should be for growth and solving problems. So if you think that you need a break, I wholeheartedly support that. Some people treat therapy a little too seriously. I don't think people should just live in therapy. In re: to returning when you feel good, I think that again, therapy is not for living, living is for living and if your life is working for you, you don't need therapy right now.

Lauranator: How closely related are PTSD and you think that traumatic events can produce borderline symptoms or are they two separate entities?

Drlaurarussell: I have been sent this question by several people now. So I started reading some about BPD to answer the question. This is not my area of expertise, so I am going sort of out on a limb.

Drlaurarussell: If I make an error, please Patty and Tim, you know more about BPD than I do, just jump in and correct it ok?

Pattysanc: You're doing great.

Drlaurarussell: Anyway, it seems that the two conditions can exist together; but not necessarily I know that sometimes, people with severe child abuse histories but not really BPD, have been "accused" of having BPD anyway because the people listening couldn't handle the knowledge that these things happen to people.  I also learned in my current reading that people can have both BPD and PTSD and that the combination dramatically increases the level of suffering that the person experiences with their Trauma symptoms. But I don't think that the trauma itself causes the BPD. It seems as though the current work suggests that there is a strong biological component to BPD.

Moe43: I am dx'd with only bpd but many docs try to find some PTSD in my background so your answer was very helpful to me

Lori^57: hi, I saw a bit of information on Topamax using it for ppl with PTSD. Do you have any comments regarding it's usage?

Drlaurarussell: No, Lori, I don't know what Topamax is. I think I want to say a bit more. My training is as a counselor. I have no medical training. I don't prescribe meds I don't look at the world from a medical perspective. When people need meds, I refer them to a qualified psychiatrist that I trust.

Pattysanc: What I don't understand is when I was out there very ill and making many of my traumas I functioned on a much higher level. I worked fulltime, cleaned house, raised my daughter, cooked, etc. Now that I am home, my life is stable, I am well into recovery for BPD, etc., I am functioning on a very low level and am unable to do many basic things. I don't understand.

Drlaurarussell: adrenaline is an upper, a stimulant that may give many people extra energy then when you get into your own recovery, you find that you are very very tired and not only do you not function on as dramatically high a level, but you need quite a few years of resting at a lower pace just to make up for the stress you put your body through.

Pattysanc: Wow. Thanks Dr.

Drlaurarussell: :)

MONGOLLOYD: how long does it take for PTSD to develop after the traumatic event ?

Drlaurarussell: That depends, Lloyd. It can be immediately, and it can be as long as 30 or so years. PTSD has several components and the one that creates the diagnosable condition is in my opinion, what is known as the avoidance set of symptoms, Yet, some people have a better defensive system and can avoid their traumatic memories for many, many years, unaware that they are limiting their lives, as they avoid the memories of what hurts them. People think that the actual symptoms of trauma are the flashbacks and reliving symptoms both physical and mental, but really the symptoms of trauma come from the avoidance of what could heal you. 

Lauranator: Would traumatic events in the past cause ADD symptoms in adult life?

Drlaurarussell: No and yes. Lol.  There are symptoms of PTSD that look like lots of different conditions. Some symptoms of PTSD that look like ADD are concentration difficulties, irritability, memory problems. and the avoidance method that lots of children use like hyperactivity.

Drlaurarussell: I want to say something about all this. I am of the opinion that if we can stop making ourselves wrong for whatever we experience then what we need will be more apparent. those of us with troubles so very often judge and criticize ourselves for everything when in fact our problems make total sense in the context of our lives and personal histories and heredity.

Lori^57: I’m a vet from desert storm I have terrible day mares and flash backs. My father had PTSD for over 40 years. is there any hope that I will get control of this before  it control me?

Drlaurarussell: Yes, Lori, there is every reason to believe that you can get over this. With some good treatment loving support of others and changes in lifestyle you can recover. PTSD is curable, It is just painful hard work it seems that the same treatment still exists now that existed when my father was alive..... I usually compare PTSD to a broken arm. Rather than a mental illness that can be compared to cancer , it is more like the broken arm which is fixable. painful, annoying, but fixable and leaving you stronger than you were before the break (trauma).

Lori^57: eg Vet Admin.

Drlaurarussell: Many times, people have to go outside their medical benefits to get the real treatment that they need.

Lori^57: right

Drlaurarussell: This is especially true since the beginning of managed mental health care.

Boosnark: I always hear of PTSD in connection with a single traumatic event.  Do you think it can also develop as the result of a subtler, but pervasive situation, such as a long-term emotionally abusive relationship in which a threat of violence, or occasional violence, exists? Or would that more just be a conditioned response?

Drlaurarussell: If you asked what they books say, I'd answer one way. But you asked what I think. And I think that it doesn't matter what we would label things...if you feel badly and suffer as a result of what has happened to you then you need to recover from that. It doesn't matter if we call that PTSD or a blue duck. It still hurts you and you relive it all the time and so forth. So the answer is the same for you. I see PTSD in a lot of people who wouldn't officially qualify for the diagnosis. Fortunately I don't work in a court situation or research or a medical clinic or a place where the diagnosis is more important than the treatment

Pattysanc: What is the treatment for PTSD? How does one heal? I know that is a general question? but what should be we working on?

Drlaurarussell: LOL, you want me to give all my secrets away!

Pattysanc: Please!

Drlaurarussell: Okay, first you begin with self care. Especially mental self care, where you treat yourself the way you would treat your best friend if they were experiencing what you are experiencing. This is very important as I have met several people who needed no treatment for PTSD after a violent trauma because they had healthy homes and loving friends and were able to walk through their trauma with the love and support of their family and friends. The second thing I work on with people is to solve the current problems in their lives in a practical kind of way. I know that the emphasis, particularly in the area of child abuse has been on the processing of old feelings, but at the early stages of treatment that can be very destructive and cause people to be quite ill and dysfunctional. Then we work on any missing adult living skills that people need to function in their current lives and take emotional care of themselves when they get to the place where it is time to process old feelings. Finally, it becomes time to process the trauma, only many people feel so much better they don't go to that stage. I place so much emphasis upon doing it in this way, because you never have to dig up old memories or feelings or go past your ability to handle what comes up from inside you. Instead, if you learn to take better care of yourself, what memories and feelings you need to face inside yourself will surface automatically when you are ready for them. done

Lori^57: my trauma of chemical warfare has been a difficult thing to work thru as bringing up memories has been not been helpful. I have been only marginal in taking care of myself with regard to this trauma this has been very difficult as the community has been challenging sights sounds ects. Sirens, fear loss.

Drlaurarussell: Lori, you pointed out another aspect of recovery from trauma. That is the hurt that comes from what the trauma actually means to you as well.  And then you get to the current triggers ... the things in your current day to day life that bring it all back and cause you flashbacks. This is where the self care begins: talking to yourself, silently reminding yourself that this is in the past and you are safe now, being very specific with yourself about how today's sirens and community sights are different from what happened in desert storm.

Moe43: Does past traumatic events i.e. the loss of a parent that I have totally blocked and the constant ridicule of siblings lead to PTSD?

Drlaurarussell: The loss of a parent and the conditions under which they died can be quite traumatic and cause you much grief and pain. The constant ridicule of siblings is emotional child abuse and can create tremendous problems for you in your ongoing struggle to live fully. Officially, the diagnosis of PTSD is only for those situations where people fear the death of themselves or someone else. But the symptoms of grief, loss and child hood abuse are very similar. The treatment is the same.  It begins with not making yourself wrong for your feelings about these events.

Lori^57: Dr do you diagnosis ppl as complex PTSD as Judith Herman wrote? My therapist has told me that I fit into that category as I have several trauma's

Drlaurarussell: I don't worry so much about the diagnosis as the person I see and what they need. I am not familiar with Judith Herman other than I have read some people talking about her. I think we need to look at the needs of people to heal themselves rather than categorizing them. But yes, people go through the most horrendous events and many people have many of those and they are all significant to their troubles.

Lauranator: Dr Russell, what about when past traumatic events just never seem to stop interfering with current life, no matter what is done to "get over it" it possible that it can just be a permanent type of thing and best to just learn to live with it, rather than keep trying to get rid of it?

Drlaurarussell: Excellent question, Laura. I think we begin our recovery by accepting that these things are in our lives and causing us problems and learning to live with them just as they are. Yes, I agree. The more I fight against myself, my memories, my issues, the worse they seem to get. So, instead of trying to get over it, I do believe I should learn to live with it. But then, I know from personal experience that the inner pain from my past can be dissolved. But the process type work is very difficult and painful. At the same time, Laura, I just re-read your question, and I am not willing to settle for anything less than a full life, so if my child abuse history interferes with something in my current life I want to find a way to deal with it to minimize the effect of what was done to me. If that means learn to live with it, ok, and if that means process, well then ok too.

Soji: I am sorry, I only recently joined and am not sure if you covered this already:  but can PTSD cause physical problems... and if so, what can be done if these problems are deep seeded and as Laura said... interfere tremendously with life? Can physical conditions supposedly caused by "stress" be related to PTSD?  What can be done?

Drlaurarussell: Soji, we didn't cover that and you are correct, PTSD has a physical component that is very much like anxiety and stress. Being constantly on alert, with hypervigilence and an exaggerated startle response is very hard on the body. Only some of the stress management techniques can bring up your memories so you have to find a way to start at the beginning and go slowly so you don’t overwhelm your ability to cope with your symptoms as they surface.

Soji: Are the things you spoke about regarding the physical effects of PTSD exclusive?  Or ... can there be other physical problems caused by trauma and can you recommend any ways to help calm them?

Drlaurarussell: Soji, no these are symptoms also of anxiety and stress. PTSD does have a set of symptoms called officially increased arousal. These are usually related to being somehow reminded of your trauma. What you do about this is begin at the beginning with self care and go from there.

Pattysanc: We have found we are not crazy. We just have PTSD. Thanks again Dr. Russell.

Moe43: Thank you Dr. Russell

Lauranator: thanx Dr. were great!

TimLPN: Thank You Dr Russell

Drlaurarussell: Thank you very much for inviting me. I have enjoyed myself.

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