Is a person with PTSD “morally deficient” if they self-medicate with PTSD-coping behaviors in order to protect others?
Not too long ago a comment was left on the PTSD Spirituality website that got snagged by the spam filter. The comment is a good one, heartfelt and with meaning. So I reproduced it below without any of the questionable spam code. Usually spam is clearly spam, but this may have been a false positive. The message, however, is relevant so I have cleaned it up and present it below with minimal editing for clarity.
“It is not novel that soldiers with PTSD are self-medicating. We have known for some years that about 80% of PTSD victims will self-medicate with either alcohol or pot to suppress flashbacks. They are not doing this because they are morally deficient; they are trying to protect those around them from the possible violent side effects of their flashbacks. A great effort is being made to get treatment to these soldiers, but unfortunately, one of the symptoms of PTSD is to isolate and refuse help. If you know someone suffering this malady, encourage him or her to seek treatment. PTSD symptoms can be made manageable with the right kind of treatment.”
It is not unusual for those who have survived trauma to cope with the manifestations of PTSD by self-medicating. While the above comment focused on soldiers, the following applies to not only PTSD from military service, but also to civilian causes such as incest, spousal abuse, clergy abuse, and sexual assault.
Swinging Between Numbness and Hyper-Alertness
One of the extremes PTSD inflicts upon us is numbness. Our PTSD numbs us to where we cannot feel the good in ourselves or others; we no longer feel alive. Nothing seems to touch us, move us, or provide us with meaning. The other extreme, however, is that we feel way too much and suffer from hyper-alertness. Primary and secondary triggers activate our PTSD, even though we are safe and not at immediate physical risk. For more on this, see the category page for PTSD and Triggers.
Our hyper-alertness may cause us to physically or verbally lash out as if we are back in the original trauma. The people around us may get treated as if they are the enemy.
Whether we know that we have PTSD or not, we are usually smart enough to recognize when our symptoms place others at risk. But, we are not very good at recognizing when our symptoms place us, as individuals, at risk. As we recognize the possibility of risk to others we may respond in any combination of three ways to try and ensure the physical safety of others.
Some forms of self-medication include use of marijuana/pot, misuse of prescription medicines, alcohol abuse, thrill-seeking, fighting, pornography, sexual affairs. Sometimes, not always, these methods will seem to decrease the levels of hyper-alertness (Conversely, these techniques may be employed to try and “Feel Alive” instead of numb and dead to the world). Any perceived benefit from these behaviors will be fleeting. The more these acts are committed, the less satisfaction they provide us.
One of the major problems with self-medication is that they do nothing to treat the actual PTSD. The risks, beyond the questions of legality, are that these means of PTSD self-medication will make the problems worse. Addictions can develop and relationships get further damaged. We end up not only with the PTSD soul wound inflicted by the initial traumas, but we also get new problems due to how we have been self-medicating.
Our PTSD self-medication behaviors will often damage the very people we are trying to protect.
Sometimes our PTSD can make us so afraid of what we might do to others that we isolate ourselves from the ones we care about and from society in general. Isolation from others is a common feature of PTSD. We may be afraid to leave our home because we feel too exposed to snipers, rapists, roadside bombs. We may fear leaving our homes because we are afraid of how we might “go off” or “snap” on someone. Or, we may just start crying and trembling due to a PTSD trigger. In order to keep ourselves from being toxic to others, we may avoid going out in order to protect them.
Regular readers of the PTSD Spirituality website know that two of my PTSD triggers are helicopters and screaming/crying babies. And, I can’t say I am too enthused about large dogs either given some of my past experiences. To avoid the possibility of encountering those triggers I avoided going out. I isolated myself. This had some short-run value, but did nothing to help me heal from PTSD.
This isolation may feel protective to us. We may feel we are protecting others. But, overall, deep isolation will further damage us. The separation from love and healthy relationships plays into the hands of the PTSD-Identity. Our isolation from our loved ones will cause them anxiety and harm – instead of protecting them.
Suicide, Manslaughter, Murder
PTSD can seek to compel us to end our lives. It wants us to give up hope, despair of our own worth, and make all of life feel meaningless.
Some men and women have killed themselves out of despair, afraid they will never get better. This has also occurred when PTSD-deniers are able to prevent an individual from getting care.
Others may kill themselves out of the fear of what they might do to others.
Lastly, some trauma survivors have been killed in what the courts would call murder or manslaughter. The reason I include this is because the PTSD-Identity compels some of us to get involved in activities where life is cheap. In short: If they were not suffering from PTSD, they would not have been in the situation which led to their death. I am not blaming them for this, I understand the how and why. Indeed, there are still some fine young people who I mourn that fell into this category.
I lifted the following from the National Suicide Prevention Lifeline website:
“When you dial 1-800-273-TALK (8255), you are calling the crisis center in the Lifeline network closest to your location. After you call, you will hear a message saying you have reached the National Suicide Prevention Lifeline. You will hear hold music while your call is being routed. You will be helped by a skilled, trained crisis worker who will listen to your problems and will tell you about mental health services in your area. Your call is confidential and free.”
If you have any suicidal thoughts, call the number above and seek assistance. Your life has value and should not be squandered.
Are We Morally Deficient?
We are not morally deficient if we are engaged in PTSD-coping behaviors that are intended to protect those we care about. The actions we do, even if we think we are protecting others, may themselves be morally deficient and just cause more harm.
The PTSD soul wound may compel us into unsavory, hurtful behavior. Do we remain accountable for our behavior? Yes, we do. But my task is not so much to judge as to understand and hopefully heal.
Will there be some people who hide behind a claim of PTSD so they can assert they are not accountable for their negative behaviors? Yes, of course there will be some. But we all know better than to let a few exceptions inhibit us from feeling compassion for those who suffer from PTSD.
Regardless of the reason I engage in a PTSD-coping behavior that harms myself and others, those actions will usually cause harm. As we wean ourselves from self-medication there will probably be much left that we need to repent of. There will be much left for us – and others – to struggle to forgive. For many of us, this part of the healing journey may be the catalyst to explore God’s love and grace for the rest of our lives.
So How Do We Deal With PTSD Symptoms And Protect Others?
Seek medical care. While this website focuses on the spiritual dimensions of PTSD, we need to seek medical care for our PTSD and also for the damage our coping behaviors may have caused. For example, if a person with PTSD drank too much in order to deal with flashbacks and ended up as an alcoholic, then they need care not only for the underlying PTSD, but also their alcoholism.
Engage in healing relationships. This is often easier said than done. Given the amount of effort that the PTSD-Identity puts into destroying our loving, healthy relationships, it is pretty clear that such relationships contribute to our healing.
Risk Openness to God. Prayer, attending a Mass or service, even daily walks, exercise, or drawing, can all be forms of openness to God. It is not my purpose to turn you all into Roman Catholics. But I can say, that if you can risk being open to God, then your chances of healing have greatly improved. Stresses, self-medication, isolation, destructive temptations will NOT immediately vanish, but they will be easier to deal with.
Realize it is a Lifelong Journey. Healing from PTSD is a lifelong journey. The journey is also an opportunity for sanctification. We risk discovering the sacred value with which God has imbued your life and the life of all others.
Semper Pax, Dr. Z