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Post Traumatic Stress and Flashbacks

Crying It Out
Crying It Out
Photo by Andrew Wong/Getty Images

What is a flashback? A Viet Nam veteran with Post Traumatic Stress Disorder was driving on the New Jersey Turnpike near Newark Airport when a helicopter flew directly overhead. Suddenly, he slammed on the brakes, pulled his car to the side of the road, jumped out, and threw himself into a ditch. The unexpected sound of the helicopter had taken him back to Viet Nam and a time of being psychologically overwhelmed by incoming enemy fire. The flashback was intense. His experience was not of remembering an event, but of living the event.

In an explicit flashback. the person is involuntarily transported back in time. To the person, it does not seem so. What they experience is being experienced as if it were happening in the present. An explicit flashback involves feelings and facts.

Flashbacks from early childhood are different. They do not include factual information. Until about five years of age, factual - or explicit - memory is immature. But implicit memory, the memory of an emotional state, may go back to birth. When the memory of a strong emotional state is activated, the person is exposed to an involuntarily replay of what was felt at perhaps age one or two. Since facts are not replayed, the emotions seem to belong to what is going on in the present.

Implicit flashbacks from early childhood can be powerful. They can overtake a person, and dominate his or her emotional state. Even so, the person may have no idea that what they are feeling is memory. How could they? If they cannot remember a past event that caused these feelings, the feelings naturally seem to belong to the present.

When we have an implicit flashback, we mistakenly believe someone, or something, in the present is causing these feelings. Though something in the present triggered the feelings, the feelings do not fit the present situation. They are far more intense and far more persistent. Those two characteristics - intensity and persistence - are the clues we need to look for, clues that can tell us we are experiencing a flashback.

Research at the University at Albany and the University of California Los Angeles has confirmed what therapists have long suspected, that PTSD can be caused by early childhood trauma in which emotions flashback but memory does not.

In this research, very young rodents were exposed to one session of traumatic stress. Later, the animals were tested for both memory of the event and for fear response. Because the trauma took place early in their life, the rodents did not remember the environment in which the trauma took place. Yet, the rodents showed clear signs of PTSD: a persistent increase in anxiety when exposed to new situations, and drastic changes in levels of stress hormones.

This research indicates that a trauma can cause a stress response even when no memory of the experience is present. It also suggests that therapists need to recognize that stress can be caused by unconscious processes - not just by thoughts. Commenting on the research, Dr. John Krystal, Editor of Biological Psychiatry, said "There may be a mismatch between what people think and how they feel."

Where does early trauma come from? Violence and abuse are obvious causes. But seemingly benign practices may also cause trauma. Neurological researcher Allan Schore says the practice of putting a young child in bed, closing the door, and letting them "cry it out" is severely traumatizing. Parents, and so-called experts, have claimed that since the child will not remember this being done, it will have no impact. Schore says research shows that though a child may appear to be peacefully asleep after "crying it out," the child may not be asleep at all, but rather is in a frozen state of "dissociated terror." An article on "crying it out" can be found at this link.

Schore writes "the infant's psychobiological response to trauma is comprised of two separate response patterns, hyperarousal and dissociation." Initially, the infant responds with increased heart rate, blood pressure and respiration. The infant's distress is expressed in crying, and then screaming. "A second later-forming, longer-lasting traumatic reaction is seen in dissociation. . . . If early trauma is experienced as 'psychic catastrophe' dissociation represents . . . 'escape where there is no escape'."

Clients I have worked with to alleviate flight phobia expressed concern about having overwhelming, unbearable feelings on a flight and being unable to escape. They are unable to specify a time when they had such feelings. Yet, such feelings are too much of a threat for them to fly. Taking a flight is an emotional risk. They fear they may have an overwhelming experience, and unable to leave the plane, have no way to escape the experience. Whether they understand it or not, they fear they will have an implicit flashback. Since escape is seen as the answer to emotional overwhelm, escape from the original traumatic experience must have not been impossible.

What can a person do about implicit flashbacks? Three things: 1. Recognize that when an emotion is too intense and too persistent to fit the current situation, you may be experiencing the flashback of an experience from early childhood. 2. Face-to-face with an attuned and empathic therapist, put the emotions into words. Doing so links the therapist's presence to the emotions in the flashback, and neutralizes them; 3. Tell the therapist in detail what triggered the flashback; by linking the therapist's presence to the triggers, the triggers are neutralized.