Treating PTSD (on an Artist's Budget)

Treating PTSD (on an Artist’s Budget)

This is part of a series on mental health and well-being in the music scene.

Put simply, PTSD makes life harder to live. In our cultural imagination, it’s often associated with troops who witnessed something heinous on the battlefield. Starting with the classification of Post-Traumatic Stress Disorder in the DSM–III — the 1980 edition of the American Psychiatric Association’s main toolkit for cataloging and diagnosing mental disorders — the mental health establishment started to recognize the psychiatric impact of traumatic events. “Battle fatigue” morphed into something the American medical establishment considered treatable.

If you’re interested in reading about the DSM–V’s criteria for PTSD you can read about it on the US Department of Veterans Affairs site. You’ll find that the current criteria is really geared towards people who have lived through a specific traumatic event. This criteria doesn’t necessarily account for the effects of trauma sustained over a period of time, such as sustained child sexual abuse, long-term domestic abuse, or years of experiencing intense homophobia or transphobia.

This guide will cover two forms of PTSD and discuss treatment of each. At the end, are some resources for finding mental health professionals.

It may seems peculiar for a music publication to cover a topic like treating PTSD. While there absolutely no reason to believe that PTSD affects musicians disproportionately from the rest of the population, the fact of the matter is that trauma can be so much of what drives a person to lose them, her, or himself in music or a music scene and that, conversely, a music scene can lead directly to trauma, be that by sexual violence, drug abuse, or something catastrophic like the Ghost Ship fire in Oakland.

So while musicians are likely not disproportionately afflicted by PTSD, musicians are nonetheless affected.

What is the nature of your trauma?

PTSD takes two main forms.

The first is the kind we think of when we think about soldiers, EMTs, and natural disaster survivors. This is PTSD as outlined in the DSM–V and is very much so incident based.

The second isn’t as easily classified, and is potentially a lot more common.  There has been a developing movement over the course of the past several years to classify an additional PTSD order called Complex PTSD (or c–PTSD), which addresses psychological issues stemming from trauma sustained over time and not just incurred by specific traumatic events.

There was lively debate about adding this condition to the DSM–V prior to its publication in 2013, and many many mental health professionals will treat patients living with this condition even though it has not been entered into the APA’s literature as of yet.

The more traditionally understood form of PTSD has had a lot more research behind it and is completely within the purview of the mainstream medical established. c–PTSD, on the other hand, is not quite as well understood and not always diagnosed as PTSD. More recent academic work on c–PTSD suggests that it may be a more accurate diagnosis in many cases where a survivor is diagnosed with Borderline Personality Disorder.

Methods of treatment

It’s worth noting that treatments for PTSD can be incredibly effective. A couple mentioned below can significantly better the symptoms of PTSD within just a few months and change the way that a trauma survivor lives. These are profound methods. Here are a few common ones along with some videos explaining a bit more about them:

Cognitive Processing Therapy (CPT) is an incredibly effective form of PTSD treatment that usually lasts around 12 weeks. A qualified practitioner with work with the patient on a series of writing prompts, first dealing with beliefs stemming from the trauma and then the trauma itself.

The goal of the therapy, as explained by the American Psychological Association is to help the patient “learn how to challenge and modify unhelpful beliefs related to the trauma. In so doing, the patient creates a new understanding and conceptualization of the traumatic event so that it reduces its ongoing negative effects on current life.”

Prolonged Exposure Therapy (PE) is a more confrontational therapy, and focuses on making the patient confront the trauma to decrease the amount of distress it causes. Granted, some of this methodology does appear in CPT, but PE revolves almost entirely around facing your fears. This can make it a potentially more of an intimidating therapy for survivors, but it is an effective one.

If you’re trying to choose between CPT and PE, do some reading of your own and make sure to talk to potential therapists about these treatments.

Eye Movement Desensitization and Reprocessing Therapy (EMDR) is still not entirely understood by the medical community, but it is accepted as an effective form of PTSD therapy. Like CPT, EMDR aims to negotiate a new relationship with the beliefs and stresses stemming from trauma.

During the therapy, the trauma is briefly revisited while a therapist engages the patient’s eyes in a series of movements using a rapidly moving light. This is intended to help the patient become desensitized to the trauma.

Use discretion when reading about EMDR, because there’s a lot of pseudo-science published on the topic.

Treating c–PTSD

Complex PTSD often requires a different kind of therapy than conventional PTSD since people living with it are likely to have a very different set of symptoms and afflictions. For instance, if someone living with c–PTSD is prone to dissociation, then confronting the trauma head–on like in CPT and PE may do more harm than good.

Judith Herman has done significant work defining c–PTSD and outlining treatment methods for it, which includes some stages with Dialectical Behavioral Therapy (often used to treat people with Borderline Personality Disorder, but helpful for other disorders including bipolar, eating disorders, and depression).

Herman’s method is outlined in her 1992 book Trauma and Recovery. A blog called Trauma Inform has a useful rundown of the method. You can also watch her talk about it in this video:

How to seek treatment

If you live in a city, chances are there are a good number of options for seeking treatment, including many at a very low cost intended for people coming from marginalized social groups or limited means.

Regardless of your financial situation, there are some really useful services online for finding therapists based on your location, needs, and insurance (or lack thereof). It can be a bit hard to judge the quality of a practitioner based on these searches, so give the people you’re potentially interested in talking to a preliminary call to ask some questions about their methods and current training.

Look into community health centers, non-profits, and other reputable mental and behavioral health clinics that offer sliding scale payments. Working with a health center means that it’s relatively easy to research the center’s reputation. The sliding scale system is exactly for people in need of therapy who can not typically afford it or lack the insurance that would cover it. Many of these staff grad student trainees, which can also reduce the costs of therapy.

Here are some resources for finding such organizations in some major metro areas:

Look into options offered by local universities with reputable psychology graduate programs. Universities offer some of the highest quality medical care to the public, and that can often include mental and behavioral healthcare. Certain departments will offer sliding scale or very affordable services to various specific groups, be they the queer community, women, or artists and musicians. Often, affordable therapy is available by working with graduate student trainees.

Find a private practitioner you would like to work with and ask if they do any pro bono work. This is a good route if you don’t have health insurance, or your insurance doesn’t cover mental health well. Many quality practitioners will take on pro bono patients in addition to their typical client load, or refer you to a practitioner that does.

Many thanks to Colin Adamo and Leslie Banghart for providing background on this topic. If you think anything is missing from or inaccurate in this post, please email host@groove.cafe.

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groove cafe

a little spot for the underground

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