(Except from 'Dyslexia and Depression: The Hidden Sorrow)
According to The National Institute of Mental Health (2008b) Post-traumatic stress disorder (PTSD) is an anxiety disorder that some people develop after seeing or living through an event that caused or threatened serious harm or death. Symptoms include flashbacks or bad dreams, emotional numbness, intense guilt or worry, angry outbursts, feeling “on edge,” or avoiding thoughts and situations that remind them of the trauma. In PTSD, these symptoms last at least one month and can be a contributing condition to depression. The DSM-IV diagnostic criteria are indicated in Figure 15.
The ‘stressor’ from the traumatic event consists of two parts, both of which must apply for a diagnosis of PTSD. The first requires that ‘the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. The second requires that ‘the person’s response involved intense fear, helplessness, or horror.’ According to The UK’s Royal College of Psychiatrists (2005) many people with PTSD feel grief-stricken, depressed, anxious, guilty and angry after a traumatic experience. As well as these understandable emotional reactions, there are three main types of symptoms or manifestations produced by such an experience as indicated in Figure 16.
The advantages of using a biographical study such as this, is the ability to ask adults about their childhood and their long-term reactions. PTSD is one such expression of reactions and denotes emotional responses to feared stimulus. In this study, school and returning to school for ones child’s education is the feared stimulus and suggests that such a fear is a long-term effect of trauma from their own time at school, from trauma delivered by teachers, especially in mainstream education.
Table 37 investigated Post Traumatic Stress Disorder (PTSD) amongst this sample. Overall 65% of the sample felt they experienced symptoms of PTSD, with males experiencing these feelings more than females (64% to 56%) and depressives more than non-depressives (64% to 43%). There was no difference to the frequency of PTSD amongst depressives with and without a degree (64%), however there were gender differences with higher PTSD amongst depressive males to females (71% to 60%) and higher PTSD amongst non-depressive males to females (50% to 33%).
The study found that PTSD was triggered by four main types of stimuli (smell, pictures, small chairs and shouting) and there were two main manifestations (anxiety and feeling helpless).
Of the four stimuli, smell was overall the highest cause of PTSD at 23% which was higher amongst males to females (36% to 11%) and higher amongst depressives to non-depressives (23% to 14%) and degree educated depressives (27% to 18%). Smell was a much higher stimuli with depressives males to females (43% to 13%) and non-depressives males to females (25% to 0%).
Smell is one of the main senses to humans and is a powerful source of data to the human brain. The smell of school can vary from the strong sickly floor cleaner used, plastercine and to the aroma of lunch that drifted through open plan schools. Fro the interview evidence, the smell triggered anxiety and caused them apprehension.
The second emotive stimuli was seeing small chairs used in school, this was felt by 15% in the overall sample to trigger PTSD. Males tended to be triggered more than females (18% to 11%) with depressives and non-depressives scoring to similar levels (14%), however it was much higher amongst degree educated depressives to those without a degree (27% to 0%). With the gender data, chairs triggered PTSD more in depressive males to females (14% to 13%) and non-depressive males to females (25% to 0%).
From the interview data one understands that the vision of the small chairs at school triggers not only feelings of being small, but triggers inferior feelings and feelings of being victimised by others especially teachers. Being small, weak and vulnerable, describes how many dyslexics view their primary school. They were vulnerable to humiliation and were powerless or helpless to change the fact or to advocate for themselves.
The third stimuli is the sight of pictures and paintings put up into wall, overall only 8% said that this triggered PTSD, with this being higher amongst males to females (18% to 0%), higher in depressives over non-depressives (9% to 0%) and higher amongst degree-educated depressives to those without a degree (18% to 0%). The gender data suggests that this is very much a depressive male stimuli, with higher depressive male to female frequencies (29% to 0%).
The interview evidence suggests that pictures on the walls of the classroom and hallways of the school triggers PTSD reactions of inferiority and public comparison with peers. Malcolm noted in his interview that his teachers faked his work and didn’t display the real work as it was rubbish in the eyes of the teacher and would have reflected badly on the school. Others like Norman noted that pictures triggered PTSD because their work was never worthy of display.
Of the manifestations were found (in Figure 00) the highest was ‘anxiety’ with 54% of the whole sample noting this, with higher anxiety amongst males to females (55% to 44%), higher amongst depressives to non-depressives (50% to 43%) and higher amongst degree educated to non-degree educated depressives (64% to 36%). Again higher male frequencies were found amongst depressive males to females (57% to 47%) and non-depressive males to females (50% to 33%). Anxiety seems to be very much a depressive male manifestation.
The second manifestation is ‘feeling a child again’, explained as feeling small, weak and helpless. 46% of the whole sample experienced this going back into schools, with higher manifestations amongst females to males (50% to 27%), higher with depressives to non-depressives (46% to 29%) and higher with non-degree educated to degree-educated depressives (55% to 36%). With the gender data, higher frequencies were found for depressive females to males (60% to 14%) and for non-depressive males to females (50% to 0%).
The interview evidence suggests that many dyslexics go into child mode whenever they are around teachers, as one noted that it was as if the last twenty years had never happened, they transformed back to a child even though they were an adult with a degree. Even Lara who teaches in schools, feels a little girl again, withdrawn and in detention whenever she needs to sit outside the headmasters office before meetings and she has been teaching for years in various schools. As Rachel notes she has these same belittling feelings with doctors and another medical staff, a feeling of not being worthy and that others are more intelligent than she is.
‘Post-traumatic stress disorder’ (PTSD) in dyslexics can come from various factors, these include: the sudden exclusion from their peer group; intense anger from a teacher or parent, physical bullying at school; realisation that something unrecognisable is wrong (maybe realising that they are not normal or do not learn normally, being called stupid, lazy etc). There are two forms of PTSD, which Scott (2004) suggest dyslexics suffer. The first is Type 1 (an acute, single-impact traumatic event) and Type 2 or complex PTSD (a series of traumatic events or prolonged exposure to a stress or stressor), both are listed in the DSM-IV (APA, 1994). PTSD is a widely researched aspect of psychology (see Rose, 2002; Stallard, Karwit and Wasik, 1999 for reviews). PTSD is categorised by being the sudden and irrevocable perceptive change of the world from one that is safe and predictable to one that is dangerous and random. Individuals are as traumatised as if they had been in a major car crash. The behavioural effects of PTSD come from repetitive and intrusive thoughts and can be triggered by vision, sound and smell (as noted by Miles and Varma, 1995; Riddick et al, 1999). Yule, Bolton, Udwin, Boyle, O’Ryan and Nurrish (2000) found only 25% of PTSD sufferers had recovered after five years, 33% after eight years and 59% warranted a lifetime diagnosis.
Whilst Perrin, Smith and Yule (2000) note correlations between a sufferer with PTSD with concentration, memory and reading problems, it is unclear if the PTSD caused such difficulties or whether they were there before, a ‘chicken and egg scenario’. Tsui (1990) suggests that PTSD is related to academic performance and that the PTSD was the cause. Scott (2004) suggests this is not clear cut and that the PTSD might have been caused by the secondary effects of having dyslexia, a view this author supports.
The second theory presented by Scott (2004, p.164) is that of ‘daily hassles’, an opposite concept of PTSD, in that the stress of daily inconveniences are ‘even more perilous in the stress lexicon than major life events’. As noted by Lu (1991), Lazaraus (1984), Chamberlain and Zika (1990) the risk of persistent hassles that are endlessly present in the sufferers life are a powerful predictor of psychological distress and has been likened to ‘living permanently in a cloud of small, biting mosquitoes’ (Scott, 2004 p 164). Morgan and Klein (2000) observed that even adults with minor dyslexic symptoms are placed under extra stress from the constant effort needed to perform ordinary, daily tasks such as reading instructions to understanding conversations. To support such a concept, Winkley (1996) asked dyslexics at junior school to rank the most stressful things that they can think of, 12 of the 16 stressors mentioned are related to the experience of being dyslexic (getting lost, being left alone, being ridiculed in class, tests and examinations, breaking or losing things, being different, performing in public). Harrison (1995, p. 116) herself a dyslexic, suffered high levels of stress in her own life, in work with a group of PTSD sufferers she noticed ‘the similarities struck me; although I realise they are not as extreme for me. The social dysfunctionality also is, in them exaggerated, but nevertheless comparable to my own experiences and those I have known with other dyslexics’.