“It sounds like you have post-traumatic stress disorder,” my therapist said.
I was 21 and sitting across from my therapist on the third floor of the university health center, a box of tissues on the coffee table between us and her bulky copy of the DSM-5 spread out on my lap. The book — otherwise known as the Diagnostic and Statistical Manual of Mental Disorders — listed everything that could possibly be wrong with a person, and over the course of my weekly therapy sessions we zeroed in on one of them for me: PTSD.
I started going to the health center in the fall semester of my junior year, wanting to take advantage of free therapy sessions and figure out why my body had been acting so strangely. Since February, I was having panic attacks nearly every day. My symptoms would strike when I was quietly reading a book in my apartment or riding in a car with friends on the way to a party, or even just walking leisurely to class in the morning. Without warning, my heart would start galloping, a cold chill would run down my body, and I’d have a sudden bout of dizziness or diarrhea. I was afraid to leave the house in case something set it off. I was afraid to stay inside for the same reason. Whenever our doorbell would ring or my roommate would turn on the blender, the symptoms came roaring back. Anything could set me off. I couldn’t figure out why.
During our sessions, my therapist and I had started piecing together some answers. The symptoms started after I flew home from a semester in India, which was cut short due to a medical emergency. One morning about six weeks in, I woke up in my dorm with an agonizing, stabbing pain in my right lower back. The pain was transcendent, a white-hot knife that had jolted me out of sleep and sent me stumbling to the bathroom, retching and crying and trying to pee (without success). With two friends I hailed an auto-rickshaw to the nearest hospital and waited for hours in a crowded triage room to see a doctor, all the while rushing back and forth between the hospital bed and a squat toilet in the waiting room.
By the time I saw a doctor, I was throwing up into a kidney dish and shivering with fever. Because I didn’t speak much Hindi, I didn’t understand most of what I was told. Was this life-threatening, I wondered? Maybe some gastrointestinal infection from eating street food? I had no clue. A nurse ferried me around from one room to another for tests, and still clutching my back I hobbled around getting X-rays, ultrasounds, and an unsuccessful catheter placement. In between tests, I tried to call my family back in the United States, but all my calls kept dropping. At one point, while I was laying on a bed, an older nurse wandered over to my bedside and laid her hand gently on my back, quietly praying over me. It was a beautiful gesture, yet at the time it terrified me. Am I going to die or something?
Finally, a doctor showed up at my bedside with the test results. The X-rays showed that I had something called a urinary tract obstruction — a kidney stone had lodged itself in my urethra, and it didn’t appear to be coming out anytime soon. They would need to admit me to the hospital and do a surgical procedure to break up the stone to allow it to pass. I agreed, got some pain meds, and later that night I had the procedure — my first surgery ever.
I was discharged the next morning — but almost as soon as I had left the hospital I started feeling the same stabbing pain in my back. The periods of nausea were so strong I couldn’t do anything but lie on my bathroom floor and moan. I went back to the hospital.
“It’s normal,” the doctor said with a wave of his hand. The stabbing pains were likely “shards” that had broken off the kidney stone during surgery that my body was still trying to pass. The nausea, he said, was a side effect from one of the antibiotics with which they had discharged me. Whatever the cause, I decided I was too nauseous and in pain to keep up with any tasks of daily living — like laundry and going to class. Defeated, I decided to fly back home to recuperate. A few weeks later, I was back in the U.S. My kidney pain was gone, and my panic attacks began.
I could barely contain my embarrassment. PTSD was what people got when they survived a trauma like war.
When my therapist informed me that I probably had PTSD from the experience, I felt equal parts relieved and embarrassed. On one hand, the diagnosis made sense. My galloping heartbeat, my crying spells, my nausea and dizziness — all of it surfaced whenever I encountered something that reminded me of India, though I didn’t realize it until I got to therapy. When I had a panic attack reading books in my room, it was because one of the characters was sick and dying in a foreign jail with no one to help him. When I had a panic attack riding in a car on the way to a party, it was because I suddenly had the urge to pee and there were cars honking everywhere — exactly like there had been on the auto-rickshaw ride to the hospital in India. The doorbell- and blender-induced panic attacks were classic hypervigilance.
On the other hand, I could barely contain my embarrassment. PTSD was what people got when they survived a trauma like war. I, on the other hand, had had a kidney stone. It was a fraction of the size of a pencil eraser and probably caused, the doctors said, from drinking oxalate-rich chai every single morning. There was no way I could claim that diagnosis, I thought, as though getting a kidney stone was in any way similar to other, worse traumas.
“I mean, maybe,” I told her, reaching for the box of tissues. I felt my face flush. “It could be something else, though.”
It’s almost funny to me now that I was crying and hyperventilating every time I felt a strong urge to pee yet I still couldn’t accept that my hysterical panic could actually be due to a traumatic, pee-related experience. But as it turns out, my reaction is common. “For a lot of people, PTSD can be a struggle to recognize and come to terms with,” says Ryan Herringa, director of the division of child and adolescent psychiatry at the University of Wisconsin School of Medicine and Public Health.
“The core aspect of PTSD is avoidance, and people suffering from PTSD will go to any extent to ignore triggers or to get out of a triggering situation,” Herringa says. Rather than digging into the symptoms to find the root cause, people with PTSD often spend much of their time trying to escape or avoid them. Reminders of past trauma can be so painful, he says, that “the patient doesn’t want to admit to even having triggers in some cases, for fear of having to talk about it more.”
Like me, people with PTSD might shut down, deflect with humor (my specialty), dismiss their symptoms, or even halt treatment altogether when asked to confront their triggers. “The illness itself is what makes it so challenging to diagnose and to treat,” says Herringa.
Sometimes, as in my case, people with PTSD may not even realize they have triggers at all, or even that their bizarre cluster of symptoms is actually a response to trauma. This is due to the fact that the brain can quickly interpret danger and send the rest of the body roaring into an acute stress response without the conscious mind understanding why. Someone who’s escaped a deadly house fire and has developed PTSD, for example, might subconsciously associate certain sensory cues with extreme danger, such as the smell of smoke or a song that was playing on the radio right before the fire broke out. The next time a person smells smoke or hears that song — even if they don’t realize it — their brain will leap into action, sending signals to the sympathetic nervous system that cause the heart to race, breathing to become shallow, pupils to dilate, and skin to break out in a cold sweat. Known as the “fight or flight” response, this can happen instantaneously and on such a subconscious level that people may take years (or extensive therapy) to figure out why.
Even when triggers are easily recognizable, a PTSD diagnosis might be hard for people to embrace. Decades ago, PTSD was known as “shell shock,” a phrase that medical officer Charles Myers coined when treating soldiers during World War I. Shell shock — thought to be caused by exploding artillery — was a phrase used by physicians at the time to describe a cluster of symptoms observed in soldiers returning from combat, including nightmares, flashbacks, crying spells, dizziness, tremors, nausea, and more. Eventually, this diagnosis was included in the DSM as post-traumatic stress disorder, and doctors now understand that it can affect civilians as well, such as people who survive sexual violence or domestic abuse, or even people who have witnessed a shocking or life-threatening event. But because the disorder was first recognized in soldiers, there remains a strong cultural connotation with PTSD and veterans — and as such, many people with PTSD can feel unworthy of the diagnosis. A large part of his job, Herringa says, is helping people understand that PTSD can affect anybody, and that their diagnosis is valid. “The message I often give to families is that you may not have been through combat or war, but you’ve been through your own personal war zone — maybe in your neighborhood or in your bedroom — and it has the same effects,” he says.
Ironically, many of the veterans that Herringa treats often feel unworthy of the diagnosis too. “Even with combat veterans, they’re often comparing traumas and wounds,” Herringa says. “They’ll say, ‘my infantry colleague lost his arm and his leg, and I was only mildly injured — I didn’t have it as bad as he did.’”
As for the guilt and shame? “I think a lot of this comes back to these core Western ideas that somehow if we just have enough mental fortitude, we should be able to get through anything — which is really bizarre,” Herringa says. “There’s a lot of guilt and shame that comes up when we’re talking about our own traumas because there’s this cultural sense that we should just be able to get over it, and we should get over it on our own,” he says. “It’s not true, but it’s the myth that persists.”
After my therapist floated the idea of PTSD, she referred me to a psychiatrist, who put me on Zoloft. Within a few months, the panic attacks lessened and then went away completely — but, like a lot of other people, the guilt and embarrassment and shame around the diagnosis lived on. When people asked me about my semester in India, I shrugged it off, saying I had a nice time — which was true, aside from the hospital trip. I told almost no one that I had developed PTSD and even when I did, I followed up my admission by admitting it was my own stupid fault: I had drunk too much chai or hadn’t drunk enough water, causing the kidney stone to form. I had a fever and couldn’t stop vomiting and needed emergency surgery, sure — but I probably wasn’t in any real danger. The surgery was practically outpatient, for crying out loud. The next time I had a kidney stone, I’d know what was happening, and I wouldn’t be so scared next time. I wouldn’t think, foolishly, that I was dying.
One night a few years later I was watching a horror movie called It Follows with my husband and a few of our friends. In the movie, a girl named Jay is stalked and terrorized by a demon that takes the form of different people. The demon follows her continuously throughout the movie — and so even in scenes where she’s successfully escaped its clutches, it’s just a matter of time before the demon, always slowly moving toward her, is going to catch up. When she’s lounging on the beach or in the middle of a college class, she’s constantly looking, scanning, searching for the demon that will appear out of nowhere and upend her life.
I nearly jumped off the couch with excitement. “That’s what it felt like!” I said. “That’s exactly how it felt when I came home from India! That’s how PTSD feels!” Like Jay’s demon, my panic attacks could strike at any time, from anywhere, and flatten me. My life orbited around the trauma, even after I thought I had finished processing it, even when I was sure I should have just moved on from it already. The movie ends with Jay slaying the demon — but still glancing behind her as she walks, just in case.
Sometimes I still feel guilty when I think about getting PTSD, even though what triggered me a decade ago no longer bothers me now. My shame still tells me that it wasn’t such a big deal. But I now understand how PTSD functions, and no matter my experience, no matter how guilty I still feel, the experience still left me traumatized — so much so that I could watch a movie about a girl being stalked by a demon and feel like I was watching a biopic based on my life. It’s taken me years to realize, but there’s no getting around it: I had post-traumatic stress disorder — and my diagnosis is valid.