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Feb 12 2016

PTSD Challenges – Communication

Trauma and communication is a huge topic. I am touching on problem areas that I have personally experienced but there are probably many more.

10 Ways PTSD Messes With Communication:

Interpersonal / Social

  1. Powerful Sense of Disconnect. Being in my own world characterized by the fight-flight perceptions means I don’t know how I am coming across and may not grasp the other person’s point of view. I won’t be able to anticipate their reactions. People may not understand what I’m saying. I feel as if I do not belong in their world which means the commutation has to cross a great distance.
  2. Unable to Create Emotional Rapport. Not being good at creating a sense of rapport in the beginning of the conversation, due to numbness and lack of affect, means the communication may fall apart easily.
  3. Lacking Assertiveness. Exhibiting PTSD symptoms of learned helplessness, shock, numbness, apathy may mean I get treated like a doormat. Feeling helpless and powerless may lead to problems getting heard and getting needs met successfully.

Nervous System Activation – High Stress Condition in Brain and Body

  1. Hypersensitivity. Being extremely sensitive – to the other person’s tone of voice, if they are rude or if they are not listening etc. – makes me cut off communication at the slightest thing. Also, being sensitive to standards of behavior that demonstrate trustworthiness, having a sensitivity around betrayal and breaches of trust, means I may exit the situation if someone is acting below my standard.
  2. Rage. Being prone to experience sudden, overwhelming rage (the fight response), whether expressed or repressed, may lead to the communication ending in a negative way – e.g. arguments, cutting off the person, leaving.
  3. Rigidity. When I won’t budge on my idea or position about what needs to happen, this can stop communication from progressing. Being rigid around specific things that are important to me is my way of preventing any danger. It’s my way of taking back the control I lost during trauma.

Mental Issues

  1. Difficulty Processing Information. Sometimes, while listening and while speaking, I may lose track of some piece of information and need to be reminded of what all the pieces are and spend a moment catching up to you and seeing the connections. I may not be able to come to a decision right away during the conversation. I may need to write some things down so I can completely process it all after the conversation and then get back to you with my decision. It takes time for me to find my own conclusion after being given a lot of information.
  2. Difficulty Organizing Information. Sometimes, I don’t say things in the most optimal order because I have not organized it all in my mind before speaking. Sometimes I mix things up even if I had them organized before beginning the conversation. If I’m nervous I might get scrambled. I may forget to give the context first and details second.
  3. Lack of Concentration and Focus. I can get distracted by things while trying to communicate. I may experience distracting thoughts or feelings. I may need to ask you to tell me what you just said again.
  4. Memory issues. Sometimes I lose my train of thought and forget what I had intended to say or what my goals were when I set out to have the communication. I may have to call back a little later when I remember something important I wanted to say.

PTSD Challenges - Communication

Adulthood Traumas Were Like Bombs Scattering My Mind

After experiencing a difficult childhood, I already had some issues with verbal communication, like getting confused, saying things in the wrong order, and being shy, but the adulthood traumas really messed things up beyond these issues.

For me, the adulthood traumas were like bombs that went off and scattered my mind and mental functioning all over the place.

So, I don’t really feel like I’m human. I feel quiet blank. Deer in headlights. So, when I call a dental receptionist, for example, I feel like an alien calling form my ship. I’m trying to sound friendly, because I need help. But I don’t really feel like I’m the same species as she is. There is this disconnect.

Example of Recent Communication Problem

I spoke with a dental receptionist yesterday (I saw a dentist in Costa Rica but I still need to find a local dentist for the future). It was a strange conversation, as many of them are! She was very abrupt. She said, “Do you want to come in tomorrow, we have a slot open.” Then we spoke about some other things. I said, “Well, I don’t think I’m ready to come in – you see I have PTSD and so I need to psychologically prepare for some time beforehand.” I said a bit more about the PTSD. It was an attempt to explain why tomorrow was too soon. In my mind it was clear that maybe in 1-2 months I would feel ready. At the most 6 months at the least a couple weeks. She asked again, “Do you want to come in tomorrow?”

I was perplexed. Actually my boyfriend was listening in and he understood all that I had just communicated perfectly. He was just as surprised as I was that nothing that I had said had made it across to her – that she literally hadn’t heard it. Or more likely had not understood any of it. This illustrates the complete disconnect I experience so much of the time when communicating. Had I just been speaking an alien language?

So, I made an appointment for sometime in the future that I will most likely cancel.

And after getting off the phone I got angry. All dental receptionists are assholes! That’s exactly what I thought. This is the rage that has built up over years, the rage from the traumatic experiences and all the aftermath. My body gets overtaken by rage in an instant.

In this example we see these communication issues: I experienced a huge disconnect from the person I was speaking with; I became hypersensitive to her abrupt way of speaking, and I became enraged completely out of proportion to the situation. I also forgot, due to memory issues, that I needed to ask a specific question, and I was not assertive.

Let’s just state the obvious: The whole thing doesn’t make any logical sense. I called so I could see a dentist. I basically got what I wanted – an appointment. But I got really angry and planned to call back later and cancel.

Here’s the thing: PTSD does not make logical sense. The anger of PTSD has no logical reason. And the anger fuels illogical actions.

So this article is meant to show how the above example actually does make sense within the world of PTSD.

In this article I’m going to discuss two types of communication problems: disconnect and hypersensitivity.

Communication Problem – Powerful Sense of Disconnect

PTSD led to me feeling disconnected, in my own self-contained world.

This could be thought of as a self-referential domain, in which it’s hard (or practically impossible actually) to take in any information or references from outside of the bubble of perception created by the fight-flight response.

The Powerful Sense of Disconnect could be caused by such things as:

  1. the state of shock and numbness, total lack of affect (emotion) that takes over
  2. the erasure and absence of the past self / identity
  3. having experienced something totally outside the reality of most people
  4. the social isolation that dulls social skills due to lack of use, and possibly reduces the parts of the brain involved in normal socializing, making it more difficult and awkward
  5. various mental impairments. Issues with confusion, memory and information processing can add to this disconnection.
  6. not being understood, feeling like you are something that is outside of peoples’ understanding

Feedback Loop. Note that feeling disconnected creates communication problems that enhance the feeling of being disconnected which creates more communication problems.

Suicidal

I honestly feel like I don’t belong anywhere, but when I was searching for a dentist before finding the one in Costa Rica I really felt like I didn’t belong.

For the last 12 months of Somatic Experiencing therapy I would many times plunk myself down in therapy and tell my therapist, with deep sadness, that I was refused treatment by another dentist. Or I got in a fight with another receptionist. Or this dentist won’t return my calls. Or I found out something bad about a dentist and now I can’t go.

I started to feel like an alien, not only that I didn’t belong but that I SHOULD NOT be here.

This is the connection with communication issues and suicide. Feeling like you don’t belong leads to communication problems that can make you feel like the world is telling you constantly that you shouldn’t exist… which, along with a number of other factors and circumstances, can lead to suicide.

I had strong urges to commit suicide for a little while when I was deeply affected by a dentist refusing to treat me, and very desperate.

Basically for 3 years I just kept hitting this huge wall to treatment that I couldn’t penetrate no matter how hard I tried. So I was in the middle of experiencing this long, long string of failures, feeling utterly powerless to see a dentist, being in a lot of physical pain. I FINALLY got an appointment, waited for a long time for the day of the appointment to arrive, only to have the dentist call the day before the appointment and refuse me treatment because my PTSD / injury made him too nervous. I was BEGGING him to treat me and he wouldn’t do it. This was the first dentist I had found that actually felt OK with going to, and he didn’t feel OK treating me!

For me, feeling suicidal is usually just feeling extremely frustrated about something for too long. I always tell my boyfriend “When I say ‘I want to kill myself!’ please substitute that in your mind with ‘I’m feeling frustrated!'” (This is my case I don’t know about others).

I think – in this incident with this dentist refusing me treatment – underlying this frustration was the distinct feeling that I should not be here – that I’m being told, over and over, that I should not exist. This level of frustration and being rejected and “not belonging” and just basically encountering a whole lot of rude, frightened, intolerant, arrogant dentists was almost more than I felt I could handle.

The day I lost that appointment was particularly devastating to me.

I was never close to actually harming myself. There is a difference between feeling suicidal and being suicidal. I was feeling suicidal.  But if I was someone else with a number of different factors going on for me – additional stressors, access to some kind of weapon, less social support, no therapist, no partner, additional aspects of personality like more impulse control issues and greater tunnel vision, it’s easy to see how this long string of events characterized by a total, complete inability to communicate effectively could end with suicide for someone with PTSD.

If I had been wired just a little differently, I would have committed suicide on Monday September 28, 2015 over being rejected by a dentist.

Although I’m focusing on my own lack of being able to communicate as the subject of this article to explore PTSD and communication, it might be more accurate to say that the total and complete lack of being trauma-informed on the part of all the dentists I spoke with could have been enough to cause me to end my life. This is because, if you were to do a neutral analysis of the communication on both sides, I at least put in a huge effort into communicating with them whereas none of them put in any effort to have high quality communication – or even just passable communication – with me.

Effects of This Sense of Disconnect On My Communication:

So let’s look at how this powerful sense of disconnect affected my communication.

1. I Overwhelmed Them

I was not aware that I was coming across as excessively detailed and thorough regarding everything I was afraid of to the point of overwhelming dentists and receptionists.

In the beginning I asked a lot of questions. In June 2014, for example, I emailed a list of 64 questions to the dentist I ended up going to for my first check up (but who I couldn’t actually be treated by). Over time I learned how to make the questions into something dentists could handle. For example, on 11/4/15 I emailed 7 questions to the dentist I ended up being treated by. And now I have 1 question for potential dentists, and I’m considering letting go of that one too. I have learned that even 1 question can result in me not getting treated, so I’m kind of being forced to not ask them anything. Maybe if I could communicate better I could ask a question and get an answer but at this point I’m too afraid to as I’ve been rejected too many times.

2. My Concerns Were Outside Their World

I didn’t know that my specific concerns seemed unusual and confusing to dentists. My concerns about the safety were generally not concerns the dentist I was communicating with had ever encountered before. What seemed to be perfectly reasonable – and even crucial – concerns to me would seem to be excessive and blown way out of proportion to them. Of course, they have probably never encountered PTSD before, so encountering concerns around safety to this degree would not ever have been part of their reality. This disconnect made it more likely they would dismiss and ignore my concerns. Maybe if I just acknowledged “These might seem a bit unusual to you…” before speaking it may make it a little bit more likely to get a response.

3. “PTSD” Doesn’t Mean Anything To Them

Because of being in my own world to some degree, I didn’t know that dentists generally have absolutely no understanding of what PTSD is, and this is why they would have either no response or a negative response to hearing “PTSD”.

I also had no idea at first that if you mention “PTSD” to some dentists, they immediately think you will sue them for something. Or rather, if you mention you were injured, they will craft up in their mind that you could be injured again – by them. This would lead to a bad review, a notification to the dental board, and in the worst case scenario, getting sued. Basically a huge pit of doom and career destruction would pass before their eyes and they would be outta there.

I finally realized I really should try to avoid mentioning PTSD at all. I would mention PTSD just to explain why I need some questions answered beforehand or a little extra time. I just assumed that they would understand that PTSD means I have a few questions and once they are answered I will feel safe – and that’s all I really want, is to know I will be safe. If they would have given even brief, one word answers I would have been OK, but I absolutely had to have the answers.

After my appointment in June of 2014 I had even found out that I would not, in fact, have a complete meltdown at the dentist’s office, so this wasn’t much of a concern anymore but sometimes I would mention that there was the possibility I could feel a little anxiety before the procedure and need a little extra time to calm down.

But – to some dentists I guess all this just meant potential lawsuit. So, now I know to try not to ever mention “PTSD” to dentists. In general they don’t know what it means. (I still forget that I shouldn’t mention it sometimes.)

4. They Want Control.

Because of being disconnected, I did not tune into the fact that dentists like to feel like they are in control. By my questions, I was basically telling the dentists I contacted that I was going to be the one in control – of everything. I was letting them know in no uncertain terms that I would allow them to do some things but not others. They would be my employee and do what I requested. Actually that was true, I was hiring them to do something for me. But I don’t think they are used to this. If I could have somehow met them halfway it may not have ended up with so many “crash and burn” conversations. Being disconnected meant I had no communicative finesse.

Communication Problem – Hypersensitivity

Unfortunately, my sensitivity – due to being highly activated – made it so I would cut off communication at the tiniest thing, especially in the beginning. This relates to PTSD symptoms of being on edge, suspicious, wary, touchy, picky, thin skinned.

For example:

1. Unanswered Question

If a dentist didn’t answer a question then I couldn’t see them.

I wrote back in 2014, “The dentist I went to for the checkup would not answer my one question about the names of filling and other dental materials. This may seem totally unrelated but it’s actually directly related to one horrifying and terrible medical accident and so it takes on a huge importance to my way of verifying safety. All I need is an answer to this one question so I can proceed in an informed way.”

Notice that I HAD to have the information because I promised myself – took a vow – never to be uninformed again. It was not as much about getting a certain answer I was looking for, it was more about knowing the terrain, understanding everything involved beforehand.

Having the information was the route to safety because not having the information was what almost killed me before. So, if they made it so I did not have the information, that meant I could die.

Every aspect of a triggering situation is LIFE and DEATH, even just getting one question answered.

2. Harmed Another Person

If a dentist ever injured anyone then I couldn’t see them.

Three dentists in this area have one or two reviews by disgruntled patients who describe some kind of injury. Even if I wanted, badly, to go to one of them I wouldn’t be able to after reading about these alleged injuries.

If it’s anything else negative – there’s a nearby dentist with some kind of complaint on his record about something not related to an injury for example – I don’t care. It’s not a trigger.

But Trigger = Absolute. Trigger is in the Body, it’s the Body saying – absolutely not.

The only way to shift that I have found is Somatic Experiencing therapy. Now I am beginning to perceive more shades of gray because my body has experienced going through the threat cycle to the end, at which point it opens naturally to perceiving more of the big picture. But back then I had not experienced the end point to the threat cycle yet.

3. Ignorance

If the dentist’s receptionist or dentist didn’t know something I thought they should know, I couldn’t see them.

Now, if I didn’t have PTSD I’d be forgiving. But PTSD means you don’t trust ANYONE. Even with no reason. If they GIVE you a reason not to trust them it just verifies that you were right not to trust.

I wrote at the time, “To me, ignorance basically means the practice doesn’t know what it’s doing and because of this they are more likely to cause harm. If they don’t know about things that other receptionists and dentists are generally informed about it makes me wonder why they are so uninformed and it makes me have doubts about the competence of the practice as a whole. Since I already don’t trust anyone and believe all medical professionals are dangerous until proven safe, this level of ignorance can turn me away from their practice. I am a bit more stable now and might think to patiently correct them and not freak out about it but until just recently that would be it; I would have nothing to do with them after that. And I have also recently realized that the receptionist is not the dentist so I don’t have to let their ignorance stop me from finding out if the dentist themselves is a good fit.”

4. Personal Weak Traits

If a dentist exhibited any of the following traits: inflexibility, impatience, egotism, controlling behavior, coldness, rigidity, closed-mindedness, superiority, rudeness, disrespect, arrogance, lying – I couldn’t see them.

I’m not necessarily blaming or criticizing dentists for these behaviors. If I was a busy professional and someone came to my office convinced my procedures would harm or kill them, when I believe my procedures to be safe, I may get impatient trying to give explanations around the safety of certain things. I might dismiss their concerns just because of not having time and not understanding the origin of the concerns. I may become uneasy or defensive.

Recipe for Disaster. Sadly, the combination of 1) the PTSD induced obsession about safety, 2) the time-pressure and ego of a typical dentist leading to impatience trying to field all the safety related questions and 3) the PTSD over-sensitivity to any hint of rude behavior from the professional is a huge recipe for disaster.

Most dentists actually did not know the answers to many of my question. Some became angry because they didn’t like the questions. Most didn’t want to put in the effort needed to find out the answers. I was very touchy about ignorance so that eliminated many dentists.

So, touchiness/ sensitivity is one reason I couldn’t find anyone for so long.

***

Dentists Are Generally Not Trauma Informed

Yes I had a lot of trouble communicating but to be honest, as I mentioned before there is a parallel problem to my struggles with communication – the dentists’ lack of being trauma informed and their lack of good communication with someone with PTSD. I never encountered a dentist in the South Eastern part of the USA that had any understanding of trauma. Even the nice ones had zero clue. Never once has a dentist reacted to my mentioning trauma with support. They have only reacted with incomprehension – avoidance of the topic – or rejection – the refusal to treat. I guess there was one female dentist who told me to see someone else as her way of being supportive, without understanding that there were reasons I couldn’t see the people she indicated. So that “support” was basically meaningless.

This meant there were two walls between me and treatment – one wall consisting of all my issues with them, and one wall consisting of all their issues with me. That’s why it took so long – I couldn’t make it past both walls for 3 years.

When I called dentists in Mexico and Costa Rica, they also did not have any understanding of trauma but they were generally way easier to deal with due to possibly cultural norms around communication and emotional connection with others. I was finally heard and dentists in both countries were willing to accommodate my requests.

***

This article is actually also Part 3 of How PTSD Can Block Successful, Effective Outcomes in Life. I am discussing #5-6, two communication problems summarized in that article, in more depth here.

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Heidi Hanson is an artist and writer in Asheville, North Carolina currently working on an illustrated book chronicling her journey healing from Post Traumatic Stress Disorder.

Comments

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