coping – Page 3 – Coming Back Home

Sexual Dysfunction and Relationships, Part I

Published on October 2, 2013August 2, 2022 by Dr. Dee Rajska, C. Psych3 Comments

*Disclaimer: This is a really broad topic, and I’m not a sex therapy expert, so unfortunately, I won’t be able to cover everything that’s relevant. Most of my patients are male and heterosexual, so I’m addressing the topic from that perspective. I don’t mean to leave anyone else out, I just try to stick to writing about what I know.

So… Judging by the number of pageviews on the last post, it looks like some of you find it less awkward to discuss sexual dysfunction on the blog than in person.

Good – you need to have access to this information, even if you feel too embarrassed to ask about it face-to-face.

You know, I briefly considered writing the last post about Dave the Zebra. I thought, maybe that would be less awkward for people?

However – Dave the Zebra is actually named after Dave the Dude. I value my friendship with Dave the Dude. Somehow, he didn’t like the idea of putting his name in the same sentence as sexual dysfunction, in a blog read by thousands of people. Go figure, eh?

Well – let’s talk about it. (Dave the Dude, you can relax. I’m keeping you totally out of this…)

In the last post, we talked about how and why PTSD can mess up your sex life.

Today, we’re going to discuss how the mess in your sex life can have a ripple effect on the rest of your life.

Sexual dysfunction messes up your relationships, starting with the relationship that you have with yourself.

(Hey – can we try to focus please? I’m talking about the emotional relationship with yourself – not the five-knuckle-shuffle relationship with yourself! …Not that there’s anything wrong with that…)

Look – who you are in bed is part of your identity. You don’t need to go through life being Mr. Don Juan – even if you’re a relatively vanilla kind of dude, you have a sense of how your plumbing works and what you enjoy doing with it.

When that changes, it can have a big impact on how you feel about yourself. We live in a culture where, as a guy, you’re supposed to be obsessed with sex, or so the media would have you believe. So a lot of guys end up feeling like they’re somehow less of a man when stuff like this happens. You might feel angry and ashamed, and try not to think about it.

If you’re a single dude, this might really have an impact on your confidence about getting into a new relationship. You might question whether a woman would want to be with you, if things don’t quite work the way they used to.

(Answer: yes, the right woman would still want to be with you. The right woman would love you for your sense of humour, your smile, and whatever else it is that makes you awesome in her eyes. And you can sweep her off her feet with flowers and chocolates and kisses and dancing and backrubs and… Well, when it actually comes to sex, most women like all that stuff that most guys rush through to get to the main course. So, serve up a really good appetizer, and she won’t really miss the main course, you catch my drift?)

I’d love to have you share your thoughts, comments, and questions. If you do post a comment, please don’t give specific details of your trauma – these may be triggering to another reader. If you’d like to offer criticism, I’ll take it – I know I’m not perfect, and I’m always willing to learn. If you do offer criticism though, I’d really appreciate it if you could do so constructively (ie., no name-calling, please). Thanks…

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

*Fine print: Please feel free to share the link to this blog wherever you think it might be helpful! Reading this blog is a good start, but it’s no substitute for professional help. It takes a different kind of courage to admit to yourself that you’re struggling. PTSD is not a sign of failure – it’s a sign that you’ve been through a lot, and have tried to stay strong for too long. If you need help – you’re in some pretty great company. Reach out, and give yourself a chance to feel better.

**Really fine print: The content of Coming Back Home is copyrighted; please feel free to share the link, but do not copy and paste content. Unless otherwise noted, all original photography on Coming Back Home is copyrighted. The photo gracing today’s post was taken by Wojtek Rajski, and I’d like to thank him for generously allowing me to use his work. Please do not copy photographs from Coming Back Home without permission.

Spouses want to know: “He doesn’t want to talk about his PTSD”

Published on September 22, 2013August 2, 2022 by Dr. Dee Rajska, C. Psych6 Comments

Well, hello again, everyone!

Today’s question is: “He doesn’t want to talk about it [his PTSD], or tell people. But I don’t think he has anything to be ashamed of, and I think it will help people understand why he is acting this way. What should I do?”

First, a disclaimer: I usually try to write in a way that applies as widely as possible. This time, I’m answering a reader’s question, so not everyone might relate. I know that not everyone who has PTSD is male, or married. If you have a different question you’d like me to answer in a post, please let me know.

This reader’s point of view goes sort of like this:

“Honey, you have nothing to be ashamed of; you didn’t choose to get sick, this happened to you. It’s no more shameful than a physical injury. I want to tell people so that when you need your space, they can be more understanding.”

Makes perfect sense, right? So – why is her husband (and maybe yours) so adamant that he doesn’t want anyone to know?

Because being able to talk about it happens at a point in his healing called acceptance, and he’s not there yet.

Because he’s still used to being Superman, and it’s hard to wrap his head around the idea of being this “sick guy” who needs to be fussed over.

Because he’s sick and tired of being sick and tired, and talking about it just reminds him when sometimes, he’d just like to forget.

Because talking about a problem is the way we women naturally tend to cope. Guys like to fix things, and if they can’t fix it, they don’t want to talk about it.

Because facts and feelings are two different things – so his head may understand that this illness is not his fault, but he may still feel shame, guilt, and anger at himself for “allowing” this to happen to him. He may feel broken or weak, and helpless that he can’t just “buck up” and shake this thing off.

If he’s sick enough that he can’t work right now, he may be struggling with the fact that he can’t work to provide for his family.

If his illness has led to out-of-character temper outbursts that have frightened you and the kids, he may have feelings of shame and guilt about that, too.

And thinking about it all is just so painful and overwhelming, that he just can’t. Not because he’s being to be stubborn, but because it’s all just too much.

So… That leaves you, the spouse, in a bit of a conundrum: his behaviour is different, and maybe he can’t attend family functions, so friends and family are asking what’s wrong. Yes, it would be a lot easier if he was ready to talk about it – but he’s not there yet, and pressuring him won’t speed his healing process.

So – what do you do?

You take care of you. This is tough on you – so get support from other spouses who can relate, and consider getting some counselling yourself, to help you cope.

You can be helpful by doing other things, like offering a smile or a hug. If he’s okay with it, maybe the two of you can talk with his therapist about what might be fun, trigger-free things for the two of you to do as a couple, or things to do as a family – because making life seem a little more “normal” might be just the ray of hope that both of you need to see that life can go on.

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

“I know I’m safe, so why am I still freaking out???”

Published on September 19, 2013August 2, 2022 by Dr. Dee Rajska, C. Psych3 Comments

This question is important, and it comes up a lot.

Okay – for me to explain this, you’ll have to imagine that your brain is a grapefruit.

(Hey – it’s either that, or this becomes a hard-core neurobiology lesson where I start throwing around Latin words that are harder to pronounce than my last name…)

…So – we’ll go with the grapefruit then?

The peel of the grapefruit is the “gray matter”, or cortex. It’s got all your smarts – this is where you analyze, make decisions, set priorities, and so on. You’re conscious only of the stuff that the gray matter does: the other parts of your brain do their thing behind the scenes, like an autopilot.

The fruit part of the grapefruit is the “white matter”. It’s a messenger – it sends ideas back and forth and makes your brain work quickly to translate a thought into an action.

The grapefruit’s got a few seeds in it. One of these seeds is a little thing called the amygdala. (This will be the only Latin word I’m throwing out there today, promise.) The amygdala sets off your fight/flight/freeze reaction, in response to anything that reminds it of a threat. It’s a reflex, so it doesn’t ask your permission before it goes off.

So – how is it that you can realize that everything’s okay, but still find your body reacting like you’re in danger?

Simple – the realizing that there’s no threat is coming from the peel of your grapefruit. But, at the same time, one of the seeds (your amygdala) is reminded of a threat, so it’s reacting as if you were in danger. Two different parts of your brain are doing two different things, at the same time.

It’s really important to know that this is how your brain works. If you don’t know, you might end up doing one of two things:

1. Telling yourself, “I should just suck it up and stop being so (bleep)ing scared, and what the (bleep) is wrong with me?”.

Yeah… Cause that’ll help, right? Fear is part of a reflex; beating up on yourself for it is sort of like blaming yourself for letting your toenails grow; you didn’t have a choice, so quit blaming yourself, it’s not your fault. Plus – talking to yourself this way just makes you feel shame and guilt, which feeds your depression. Do yourself a favour, and remind yourself that you are not to blame for your reflex.

2. The other option is that you start thinking, “I’m feeling so nervous that there must be something to be scared of and I’m just not seeing it”.

…If you want a quick, easy recipe for freaking yourself right out, then telling yourself that there are invisible dangers that you cannot sense is a good way to do it…

However, if you want to help yourself relax instead – then remind yourself that you’re feeling nervous because a very primitive part of your brain is being triggered to think of a threat; it’s not very smart, so it can’t tell the difference between real and imagined threats.

So, how do you try to stop it? You tell yourself that it’s just your threat reflex sounding a false alarm; then use your relaxation skills to help yourself to relax. (Yes, this is exactly why I keep droning on about how important it is to practice relaxation regularly…)

It’s simple – but simple and easy are two very different things. You’ll need a lot of practice to make it a habit to think this way, but once you’re successful, it will be a helpful tool.

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

Spouses want to know: PTSD, Withdrawing, and How to Respond

Published on September 16, 2013July 12, 2022 by Dr. Dee Rajska, C. Psych4 Comments

Today’s question is: “What’s the best way to deal with withdrawal by a spouse with PTSD – call them on it, or what????”

As luck would have it, just as I was sitting down to write this post, I also received the flipside of the question:

“My wife more or less just gets mad at me when I leave the room to cool down; she says I’m running away to hide… How can I help her understand?”

If you’re the spouse of someone who has PTSD, it can be lonely and frustrating to be married to someone who keeps pulling a disappearing act. Even at the best of times, you might feel rejected and pushed away. At the worst of times, when your partner takes off while the kids are screaming and dinner’s burning, you might feel downright abandoned that your partner isn’t pulling their weight.

An important part of how you cope is to get some support for YOU – whether that means therapy, peer support, family or a babysitter to help if you have young kids, whatever you might need. You’ve got a lot on your plate, and you need to be able to vent to someone who won’t judge you or your partner.

As a spouse, you have every right to feel angry and frustrated – BUT, remind yourself that you’re angry and frustrated with your partner’s illness, not with your partner. If your partner is withdrawing because they are overwhelmed or triggered, this is very different from running away because they’re a lazy, selfish jerk who won’t lift a finger to help out, or because they don’t care about your feelings. Don’t confuse illness with selfishness; don’t treat one as if it was the other.

On the other hand, the stuff that’s going on inside the head of a person with PTSD is more than most of us can imagine. If it sometimes seems like your spouse with PTSD is only going through the motions of day-to-day life, it’s because at that moment, that might be the best they can do. Chances are, they realize that they aren’t there enough for you, and they carry a lot of guilt and shame about not being able to do more. They may be feeling helpless, worthless, and angry that they can’t do more to beat this thing. Feeling this way doesn’t help them get a leg up on coping – it just pushes them down more.

The best way to try to cope is together, as a team. Realize that you’re not angry at each other – you’re both angry at the PTSD, and at what it’s doing to your family. Thinking this way puts you on the same side, and that makes it easier to support each other.

Here’s some statements to try out:

Spouse of person with PTSD: “I know you’re doing your best; I’m not blaming you. I just hate that this happened to you. I hate that it gets in the way of things you would like to do.”

Person with PTSD: “I hate that it gets so bad that sometimes crawling into my shell is all I can do. I wish I could just shake this thing off. I know it’s not fair to you.”

Hug each other. Support each other. It won’t magically fix things, but it will get easier if you and your spouse feel like you’re on the same team, and you have each other’s back.

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

Spouses want to know: “Where does the anger come from?”

Published on September 15, 2013July 11, 2022 by Dr. Dee Rajska, C. Psych6 Comments

I have a few more questions from spouses, and this is a really important one.

The answer is pretty straight forward: PTSD is basically the fight/flight/freeze reflex gone into overdrive, and anger is part of the “fight” part of that reflex. You might remember that we discussed anger in this post.

Well then… that would make for a really short blog post, wouldn’t it?

If you’re reading this, then anger has probably had an impact on your life. I’m going to talk about it in more detail below, and that might be hard to read.

So – don’t go any further if you’re having a bad day and don’t need to be reminded of how anger has made life worse. Save it for another day. Otherwise, find a nice quiet spot where you won’t be disturbed. Set aside time to do a relaxation exercise when you’re done reading this – here‘s one that I’ve posted previously. Here‘s another.

Gee, I’m being a little bossy today, aren’t I?

If you’re just waiting for me to tell you to go pee before you read on, don’t worry. I’ll restrain myself.

Ready?

Okay.

If you’re a spouse, then you need to know where the anger does NOT come from: it doesn’t come from you, or what you said, or because you’re making the wrong thing for dinner. It’s not coming from the kids playing too loudly. It isn’t your fault. It’s easy to lose your confidence and start to blame yourself.

It’s also easy to get frustrated and blame your spouse – the anger is not coming from him/her either.

Look – you didn’t marry an idiot. (Well – if you did, then, this blog can’t help you with that…)

But – if you didn’t marry an idiot, then your spouse didn’t just magically become an angry jackass overnight for the fun of getting under your skin. PTSD makes a person feel like they’re under attack all the time, and anger is part of the reflex of reacting to threat.

PTSD is an injury. Anger is one of the ways that this injury hurts. It hurts anyone who might be on the receiving end of that anger – spouse, kids, random clerk at the grocery store.

It hurts the person with PTSD; they don’t choose to act like this, and a moment after they say something hurtful, scream at someone, or put their fist through the wall – they feel terrible about it.

As the spouse, you feel caught between trying to understand that this is an injury, but also feeling frustrated and angry that they can’t just cut it out.

Understanding is the first tool in making things better: the person with PTSD needs to understand that their anger is coming from their PTSD, and not from anything you did. So the solution is to manage their anger, not manage you. And as the spouse, you also need to know that their anger is coming from their PTSD, and not from them being a jerk. So the solution is to help them manage their anger, and to take care of yourself, because this is a lot for you to deal with too.

How’re ya doing? I warned you – it got a little heavy. If you feel a bit like this post punched you in the gut today, please take a minute to look after yourself. You don’t even have to scroll back up to find the hyperlinks to the relaxation exercises – here‘s the woods. Here‘s the water.

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

**Really fine print: The content of Coming Back Home is copyrighted; please feel free to share the link, but do not copy and paste content. Unless otherwise noted, all original photography on Coming Back Home is copyrighted. The photo gracing today’s post was taken by Murray Chappell, and I’d like to thank him for generously allowing me to use his work. Please do not copy photographs from Coming Back Home without permission.

Spouses want to know: “Why isn’t the medication helping?”

Published on September 14, 2013July 12, 2022 by Dr. Dee Rajska, C. PsychLeave a comment

Today’s question is, “If my husband is medicated, shouldn’t we see some signs of him getting better?”

Great question, and thanks for asking!

…And you might be frustrated that I don’t have a quick, easy, one-size-fits-all answer.

First of all – let me just clarify: as a clinical psychologist, I don’t prescribe medication. That doesn’t mean that I’m opposed to medication; I have some patients who won’t take medication no matter what, and I respect that. I also work with others who consider their medication to be an important part of the mix that works with for them. I respect whatever path to recovery is the best fit for each individual person.

So, you might wonder, what is it, exactly, that medication is supposed to help with? Well – it depends on the diagnosis and the type of medication Antidepressants do something very different than anti-anxiety medication, for instance.

In general, meds are supposed to dial back your symptoms. Finding the right dose often takes a bit of trial and error; antidepressants in particular can take up to six weeks to build up in your system and start to make an impact. And you need to start off at a lower dose and gradually build it up to the dose that you need, to give your body a chance to adjust. So, it can take a while to get to the point where the medication has its full effect. When it comes to finding the best medication for you, it also might take a bit of trial and error – you may need to try a few different medications before finding the best one for you. So, medication might seem like a quick solution, but like anything else – you need to hunker down and arm yourself with a lot of patience, because it might take a while.

The other issue is, pills don’t give you skills: they don’t teach you to understand what’s happening to your brain, or where it comes from or how to cope with it.

So – in a nutshell, it may take some time before you start to see a difference. You might have to try a few before you find the right one. And medication alone is frequently not enough to change behaviour.

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

Spouses want to know: “Will he always have PTSD?”

Published on September 13, 2013July 12, 2022 by Dr. Dee Rajska, C. Psych3 Comments

You may have gathered from the title of today’s post that I’m throwing something new into the mix. A few days ago, a support group for spouses asked me to answer a few questions about PTSD. I’m grateful for their permission to post the answers here, so everyone who might be wondering about this stuff can jump into the discussion.

Of all the questions they asked, I wanted to address this one first because I get asked some form of it almost every day – people ask, “Will I ever get better?”, or “Will I always be like this?”

I’d love to give you a money-back guarantee that everything will be just fine.

The honest answer though, is that how much better you will get (or your spouse or loved one will get) depends on a number of factors. Some of them we can predict; others, we can’t.

Single trauma events in an otherwise mentally healthy person, treated quickly after the event, tend to have the best outcomes. In many cases, people can make a full recovery from these types of injuries.

On the other hand, if you’ve had decades of trauma, and it’s taken several years to find a knowledgeable practitioner that you feel comfortable working with – it’s gonna be a longer, steeper, more grueling climb uphill for you. That doesn’t mean that you can’t do it, and no one has a crystal ball that can predict your specific outcome. In fact, my personal experience is that some of the patients who came to me in the worst shape are the ones who have made progress in leaps and bounds, once they’re given the right tools to do so.

Most importantly – even if you can’t be fully cured, you can get better. In many cases, you can get a lot better.

Nothing we do in therapy can take the awful thing(s) that happened to you and make them unhappen. However – how those experiences impact you now, is something we can work on. If you have a lengthy trauma history, and it’s hard for you to trust or hope, then that work might need to happen very slowly and very gently, so it doesn’t overwhelm you. If you’re a spouse trying to be supportive, it may be hard to be patient, because for the first while it might seem like therapy isn’t making any difference.

Here’s your best bet for trying to get better: find a skilled, patient, knowledgeable therapist whom you feel comfortable working with, who won’t give up on you. Let them know when the tools they give you don’t work for you – getting better is a partnership, and finding what works for you can take some trial and error.

Good therapy has two parts: tools that help you manage your symptoms, and ways to try and heal your trauma. If you and your therapist have a good partnership and you are willing to work hard on your recovery, then you will start to see a difference.

It might take a long time and a lot of hard work to get a lot better. But, “a lot better” might mean that you can manage your symptoms most of the time, and the stuff that happened might not bother you as much anymore. Worth a try, no?

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

PTSD Triggers: Dealing with Fireworks

Published on June 27, 2013August 2, 2022 by Dr. Dee Rajska, C. Psych3 Comments

Hello again!

Today we’re going to talk about specific coping skills for dealing with fireworks.

If you’re ever been in a position where loud noises mean bad stuff is going on, then you might react to the sound of fireworks, because your threat-response reflex has learned that loud bangs are a predictor of danger. (For more background on how reflex learns, read this previous post.)

If your survival reflex at one point learned that a sudden, loud bang means danger, the sound of fireworks will probably make your reflex react, even if the conscious, “smart” part of your brain realizes that it’s just fireworks.

So – what do you do?

Let’s start off with what NOT to do. Your worst bet is to just pretend like it’ll all be fine and do nothing to try to prepare yourself. That’s avoidance, and it doesn’t help. So – give yourself a pat on the back for being proactive and reading this to help yourself prepare.

We’ll talk about two parts: (1) what to do about your feelings; and (2) what to do about the noise.

(1) You might feel shame and anger at yourself for reacting. If you’ve read any of the previous posts – then I hope I’ve drummed into your head that fear is a reflex, and that you do not choose to feel fear. Fear is part of the reflex that responds to threats. It “learns” to respond to triggers based on what happened to you. You don’t have control over it, and blaming yourself for it makes as much sense as feeling guilty that your toenails grow – it just happens, you can’t control that. So – let’s work on getting rid of that shame and guilt, okay?

A more helpful approach is to accept that you’re going to react to triggers; you’ll be more prepared to cope if you expect to feel fear in response to triggers, and manage it when it happens.

If you hear fireworks, your reflex might be to hit the deck and keep your head down. If that noise had been enemy fire, your reaction might have saved your bacon. Respect your reaction for what it is – a survival reflex. You can help calm your fear by reminding yourself that feeling scared and being in danger are two separate things – your fear in this case is a false alarm, and you are safe.

(2) With fireworks in specific – you may actually find it much easier to cope if you look up and watch them. Seeing the show will make it easier to know where that noise is coming from. You can help to ground yourself by saying (or thinking), “These are fireworks. This is a celebration. I’m home, and I’m safe”.

If that’s not an option – on a holiday weekend when you can expect fireworks, finding ways to mask the noise may be your best bet. That might mean staying indoors, windows closed, playing your favourite music loud enough that noise from outside doesn’t filter in.

Please feel welcome to share this post, and any other on this blog, with anyone who might benefit.

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

**Really fine print: The content of Coming Back Home is copyrighted; please feel welcome to share the link, but do not copy and paste content. Unless otherwise noted, all original photography on Coming Back Home is copyrighted. The photo gracing today’s post was taken by Wojtek Rajski, and I’d like to thank him for generously allowing me to use his work. Please do not copy content, including photographs, from Coming Back Home without permission.