BCC Staff Note: You’re reading Part Two of a two-part BCC Grace & Truth blog mini-series by Greg Gifford on a biblical perspective for understanding and helping a family member struggling with symptoms of what our society labels post-traumatic stress disorder (PTSD). You can read Part One here.
Dealing Wisely with Difficult Circumstances and Memories
In the beginning of your ministry to a family member struggling with symptoms of PTSD, it will be imperative to avoid circumstances that prompt flashbacks. You will want to identify what circumstances trigger PTSD symptoms and seek to contain exposure to them as best as possible. It would be inconsiderate to constantly expose a person to circumstances that conjure up symptoms of PTSD. Yet, it would be equally terrible to never expose them to the circumstances that plague their memories.
Moreover, certain circumstances cannot or should not be avoided. For instance, one individual suffered with painful memories of a childhood that was extremely abusive—both physically and sexually. (See Stuart Scott and Heath Lambert, eds., Counseling the Hard Cases: True Stories Illustrating the Sufficiency of God’s Resources in Scripture, 39.) Her flashbacks were typically triggered when she would enter the kitchen or take a shower, which are both places that she had to visit. Therefore, the counselor could not tell her to avoid these places, but rather to observe the patterns of her flashbacks and how they relate to these places.
Do these places or circumstances conjure up the painful memory and what about the circumstances does this? Is it a smell, the lights, the noise level, or the people? What associates this place with the place that their painful memory occurred? Once you have connected this dot, then you can wisely approach a plan of thinking and doing, principles of being a truth-thinker, and other related efforts that orient your loved one back to reality.
For the circumstances that you can avoid (e.g., the market, the home, the woods, etc.) seek to wisely abstain from visiting these locations at first. You will want to counsel and disciple your loved one in preparation for visiting such places or types of circumstances. Secular psychology would term this exposure therapy, but it is nothing more than wisely and lovingly introducing the circumstances that stimulate the painful memories of a person’s past. Your goal is to teach them how to approach these circumstances, and then to live out that instruction in the midst of their difficult environment.
Yet the aim is not behavior modification. Behavior modification says, “Avoid those type of circumstances and all is well.” However, true and authentic heart change orients itself towards God’s purposes in the middle of those environments. For example, to avoid a place with a large crowd may be wise initially, but through the power of the Holy Spirit, a person can learn to trust God and believe He will not leave them even in large groups. There is an enormous importance in being wisely reintroduced to environments that stimulate those painful feelings so a person can grow in those regards. To avoid the circumstance completely is only wise in a few instances and behavior modification in most instances.
Dealing Wisely with Known Stimuli
Likewise, recognize the stimuli in a person’s life. If you know that a person struggles in a loud environment (as most with PTSD symptoms will do) then seek to keep the noise down. This is a manifestation of the golden rule (Luke 6:31) and Philippians 2:2-5; consider their interests as more important or simply how you would want to be treated. Be careful not to slam the door or play a certain song. Ensure that you do not yell in the house or touch them in a certain way. The idea is that you know these stimuli so as not to tempt or incite painful memories unnecessarily.
Here are some questions that could be helpful in identifying these stimuli:
- When do episodes tend to flare up? Is there a certain time of the day? Is there a certain event? Is there a certain context? Were you inside or outside? Was it close to a mealtime?
- What was happening? What were you doing? What were they doing? What were others doing around them (i.e., the kids running around the living room)?
- Where were you? Were you at home? On a car ride? In a shop? Eating out?
- How was the person acting before? Were they tired? Were they irritable? Were they distant? Were they brooding? Were they in deep thought? Were they manic? What was the person acting like before the symptoms started again?
These types of questions can easily be logged so you can look for themes within your loved one. And in a very real sense, you may observe what they do not. They may not see that when they are hungry they are more susceptible to flashbacks. They may not notice that when they are in deep thought with much free time, they have more flashbacks. These areas will be very important as you seek to understand your loved one and help them grow in their walk with Christ.
A warning is necessary here: even though a person may have a certain stimuli now does not mean they are sanctioned for ungodliness and unrighteous responses. Be gentle and gracious here by not exacerbating them, but also calling them to grow in this area. If your spouse really struggles to be calm and control their anger when the kids are yelling in the house, there is a two-fold obligation. The first is to address the kids and call them to be kind, considerate, and die to their own desires to be loud and rambunctious. Next, there is an obligation to call your spouse to grow in this area. Even though the kids are screaming like wild banshees, your spouse has an obligation to honor God in that moment. (This may also be a great opportunity for the family member to show their loved one the biblical teaching that a person’s circumstances does not determine their heart attitude but only reveals their heart attitude.)
Identify an Advocate
One of the common associations of PTSD symptoms is domestic violence, especially for military members suffering from PTSD. There is much research that needs to be conducted as to why certain demographics are more prone to violence than others, but do note that violence may be an issue that you need to consider. Part of that consideration is who to call alongside of your family for help. At this point, Dr. Garrett Higbee has introduced the idea of an advocate (see Lambert and Scott, p. 172).
Although Dr. Higbee uses the idea and its implementation in a different context, there are huge implications for the person struggling with PTSD symptoms. An advocate is simply a person from the counselee’s local church who attends some of the counseling sessions with the counselee and helps them to implement in their daily living what is being taught in the formal time of counseling.
In the instance of a person struggling with PTSD symptoms, it could be helpful to identify a person who could also function as an advocate. This advocate would function in the same capacities but would be on call for help with their loved one. For instance, if your husband is having flashbacks again and now his anger is quickly escalating and he is threatening, hitting walls, and throwing things, it would be a good time to call the advocate. The presence of another person who is outside of the immediate family can have cooling effects to the circumstance, but also having someone who can ensure that people are not being physically or verbally abused.
Avoid Significant Free Times
Because PTSD symptoms very much include a battle of a person’s thought life, be careful to help them to ration free time well. Meaning, look at the hours in a day and see where the gaps are in your loved one’s schedule. When are they going to have a lot of free time? When will they be prone towards introspection?
Seek to help them to positively engage those times and fill them with fruitful and helpful things. Encourage them to start new hobbies, seek out new opportunities to serve the church, find some books that would be great to read, exercise, invite friends over for dinner, and other ways that will be a fruitful way of engaging this free time.
The idea is that they will not have the time to sit around and rehash the painful memories. While this is not an end in itself, it is a very appropriate means to an end. In fact, introspection must be done in proportion for all of us, not only those suffering with PTSD symptoms. So help them to guard their time well as you help them to shepherd their thought life.
Fulfill Daily Responsibilities
One of the chief concerns you should have with your loved one is whether or not they are completing their daily responsibilities. Are they going to work on time? Are they going to school? Are they completing the responsibilities they have? Some of this will tie back into helping them to learn to manage their free time, but also seeking to help them to fulfill their responsibilities. Employers will only be gracious for so long. Schools will only be gracious for so long. If your loved one is consistently failing to fulfill their responsibilities it will snowball into a very difficult situation quickly.
Moreover, be willing to ‘check-in’ on them. This is not a mild form of enabling, but rather a form of accountability. Try things like going by their work to drop off a surprise coffee or asking them if you can come eat with them at lunch break. Take them to work and pick them up. Go by their house and help with some of the chores, and also review homework and contact teachers to ensure that your loved one is fulfilling their obligations.
The best policy is to be very straightforward with your loved one and tell them that you want to serve them and help ensure that they are fulfilling their obligations, whether they want you to or not. You do not want to breach their trust in an attempt to serve them, but you can be very candid as to why you would like to serve them in this way. And even if they would prefer that you not come by their work or school, be creative and wise as to how you can fulfill that intent in a different manner (e.g., ask a co-worker, look at pay stubs, etc.).
The principle is, however, that they must be fulfilling their daily responsibilities even in the middle of their struggles with PTSD. God has provided sufficient grace to do so and to neglect their responsibilities is only going to make matters worse. Your close accountability may seem like police work initially, but it just might prevent the downward spiral of PTSD to joblessness to drugs or any other combination.
Remain faithful as you see your loved one suffer. In a very real sense, they have experienced some of the most heinous events a person can experience. They are sufferers. Yet, don’t let them stay there. Graciously call them and prompt them towards a posture that engages their suffering and uses it to grow in Christlikeness and to glorify God. And in the process, you will see that God is working in them to will and to work His good pleasure.
Join the Conversation
What additional suggestions do you have for wise help that avoids the extremes of enabling a person struggling with PTSD symptoms or of abandoning/ignoring/pretending that the person’s symptoms are not real or do not require understanding, compassion, and assistance?