Page 265 - Total War on PTSD

it may take some time before they put the pieces together and realize that their symptoms have a name, and that they are not the only ones who are experiencing these symptoms. Until then, they may lack the words and knowledge to describe their PTSD and feel utterly ashamed that they cannot get their act together. As Canadian Lt. Colonel Stephane Grenier attests in the aftermath of his peacekeeping mission to Rwanda, “I thought that I was the only one feeling this way, and I was terribly ashamed that I was not
coping” (Grenier, Darte, Heber, & Richardson, 2007, p. 263).
Doubtlessly, each of PTSD’s symptom clusters may contribute to the exacerbation of this isolation. A hallmark of the intrusiveness of trauma related thoughts are the flashbacks: the reliving of parts of the experience in an extremely vivid manner (e.g., Hackmann, Ehlers, Speckens, & Clark, 2004). These overwhelming experiences instantaneously take Veterans back to the battlefield, the noises, the smells, the dread and trepidation all come gushing in as if one is actually there. As Veterans return to the battle, they dissociate from the engagements of the here-and-now, and become engulfed in a world of their own. Not only does this set them away from social interactions, but it is itself beyond description. Whether triggered by the coincidental shatter of a glass in a restaurant or otherwise waking up in the middle of the night, screaming and howling, covered with sweat from the nightmares that haunt their sleep, these are very lonely experiences.
The avoidance symptoms of PTSD are likewise extremely conducive to loneliness. Trying to refrain from any reminder of the trauma gradually minimizes Veterans’ social interactions. Among such avoidances one can enumerate avoiding conversations about the trauma, avoiding crowded places, and avoiding social interactions. Often, Veterans’ withdrawal from social life may be attributed to their attempts to avoid reminders or triggers that may reactivate their PTSD. As they engage in avoidance and concealment of their strife, their loneliness’ reign strengthens.
Since loneliness is predominantly interweaved with cognitive and affective phenomena (J. T. Cacioppo & Hawkley, 2009), the alterations in cognitions and mood are central to
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