Chat Transcript with Laura Russell Ph.D.
(post traumatic stress disorder)
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.
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?
yes, then it appears that the symptoms can recur anytime?
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!!!
phew... thank you 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.
yes... I guess so
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
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.
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
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
Thanks. Very helpful.
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.
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
ok, that's fine
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
Can you explain 'processed out'?
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
but isn't talk therapy counterproductive to someone w/bpd?
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.
thank you drlaurarussell
But PTSD is something that needs to leave your system kind of like
the flu when you need to vomit. Done
I have a problem with repressed memory.....I have all the signs
and symptoms of trauma, but don't remember what actually
happened......do you think hypnotism or some other way of
digging it out is necessary or should I just deal with the
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
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??
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
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?
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
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...
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
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……………….
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?
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.
Dr Russel what do you think about EMDR for PTSD??
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.
Is it realistic to think that one could begin to recover from
severe chronic PTSD?
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.
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
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.
How closely related are PTSD and bpd...do you think that traumatic
events can produce borderline symptoms or are they two separate
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.
If I make an error, please Patty and Tim, you know more about
BPD than I do, just jump in and correct it ok?
You're doing great.
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.
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
hi, I saw a bit of information on Topamax using it for ppl with
PTSD. Do you have any comments regarding it's usage?
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.
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.
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.
Wow. Thanks Dr.
how long does it take for PTSD to develop after the traumatic
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.
Would traumatic events in the past cause ADD symptoms in adult
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.
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.
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?
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).
eg Vet Admin.
Many times, people have to go outside their medical benefits to
get the real treatment that they need.
This is especially true since the beginning of managed mental
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?
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
What is the treatment for PTSD? How does one heal? I know that
is a general question? but what should be we working on?
LOL, you want me to give all my secrets away!
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
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.
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.
Does past traumatic events i.e. the loss of a parent that I have
totally blocked and the constant ridicule of siblings lead to
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.
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
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.
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"...is 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?
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.
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?
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.
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?
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.
We have found we are not crazy. We just have PTSD. Thanks again
Thank you Dr. Russell
thanx Dr. Russell...you were great!
Thank You Dr Russell
Thank you very much for inviting me. I have enjoyed myself.
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