The Road to Stanford

According to the American Psychiatric Association’s fourth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), six diagnostic criteria are assessed to determine a positive diagnosis of Post-Traumatic Stress Disorder (PTSD):

Criterion A:stressor

The person has been exposed to a traumatic event in which both of the following have been present:

A1. The person has experienced, witnessed, or been confronted with an event or events that involve actual or threatened death or serious injury, or a treat to the physical integrity of oneself or others.

A2: The person’s response involved intense fear, helplessness or horror.

Criterion B:intrusive recollection

The traumatic event is persistently re-experienced in at least one of the following ways:

B1. Recurrent and intrusive distressing recollections of the events, including images, thoughts or perceptions.

B2. Recurrent distressing dreams of the event.

B3. Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations and dissociative flashback episodes, including those that occur upon awakening or when intoxicated.

B4. Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

B5. Physiologic reactivity upon exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

Criterion C:avoidant/numbing

Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following:

C1. Efforts to avoid thoughts, feelings or conversations associated with the trauma.

C2. Efforts to avoid activities, places or people that arouse recollections of the trauma.

C3. Inability to recall an important aspect of the trauma.

C4. Markedly diminished interest or participation in significant activities.

C5. Feeling of detachment of estrangement from others.

C6. Restricted range of affect (e.g. unable to have loving feelings).

C7. Sense of foreshortened future (e.g. does not expect to have a career, marriage, children or a normal life span)

Criterion D:hyper-arousal

Persistent symptoms of increasing arousal (not present before the trauma, indicated by at least two of the following:

D1. Difficulty falling or staying asleep.

D2. Irritability or outbursts of anger.

D3. Difficulty concentrating.

D4. Hypervigilance.

D5. Exaggerated startle response.

Criterion E:duration

Duration of the disturbance (symptoms in B, C and D) is more than one month.

Criterion F:functional significance

The disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning.

Acute: if duration of symptoms is less than three months.

Chronic: if duration of symptoms is three months or more.

Delayed onset: Onset of symptoms at least six months after the stressor.¹

¹ American Psychiatric Association. Diagnostic and statistical manual of mental disorders DSM-IV-TR, 4^th edn. American Psychiatric Association, Washington DC, 2000.

I was officially diagnosed with PTSD in 2008, when the first symptoms started to emerge. It blessed me in its full-blown state within this past year. As you can see by the criteria marked in red above, I now fulfill all the criteria necessary for this diagnosis.

I have been seeing my current therapist, a trauma specialist, for almost 3 years, and we have been working with two specific modalities--Eye Movement and Desensitization Reprocessing (EMDR) and Dialectical Behavioral Therapy (DBT). Him alone worked until about a year ago, when it became apparent that I would need additional assistance. So, when a guardian angel emailed information about a study on PTSD taking place at Stanford University/VA Palo Alto, I immediately applied for it, and was quickly accepted.

I have made it through the initial 4.5-hr intake (full cognitive evaluation, psychiatric interview, and complete retelling of traumatic event), first sleep study, and first set off fMRI scans. The next set of fMRI scans is next week. Then the 9-12 sessions of Prolonged Exposure Therapy (a treatment increasingly popular with returning soldiers) will begin. It will end with another sleep study, follow up fMRI scans, and exit interview.

I am especially intrigued by the Prolonged Exposure modality. It will entail the recall of the specific traumatic memory as vividly as possible in first person (as if it was happening immediately in the present moment). Over and over. Basically, talking through the trauma, not avoiding it. I have the tendency to shove the intrusive memories of 9/11 down, and they pop up later as flashbacks, panic attacks, and the nightly barrage of terrifying dreams. The opportunity to desensitize myself to the trauma, and the memories, and make them just a part of my past experience that does not bring about a complete meltdown of emotions, sounds like freedom.

I look upon my initial fMRI scans in complete wonder. I have never seen the entire inside of my head before, only the right ear encompassing the canal, eardrum, labyrinth and cochlea. Indeed, on one of the scans I received, you can visibly see the healthy left labyrinth. Yet, on the right side, the right labyrinth is decimated by disease, now scar tissue that is no longer holding its form. The resulting injury from being in Lower Manhattan on 9/11, and another reminder of why I am here, and what I am doing.

It’s funny how looking at one’s brain does evoke those trite existential questions. What am I? Who am I? Is this body just a vessel for a traveling soul? Are my soul and mind connected? What is this mind, but a mass of tissue and electrical impulses? And, as a practicing Buddhist, it brings into sharp focus the idea of emptiness, ego, and samsara.

This mind of mine has also been the container for vast amounts of fear, anxiety, panic, 10-year-old memories parading as the present moment, and nightmares terrorizing my sleep. Half of the time, I have been determined to escape this daily suffering through addiction and sleep. More recently, I have been increasingly fascinated with the mind’s capacity to heal, and our capacity to learn new ways of coping. It is this line of inquiry that keeps me buoyant and optimistic about my future.

Stuck at Cortlandt Street Station

Two weeks ago, while in NYC, I was on the subway traveling from Brooklyn to Manhattan. I found myself riding into and stopping at Cortlandt Street station on an R train, in Lower Manhattan. It is located just underneath the World Trade Center site, now heavily under construction. Seems innocuous enough, unless you lived through 9/11, and have not been back to NYC in a couple of years, like myself. On the last NYC subway map I own, ca. 2004, it still shows parts of Cortlandt Street station “temporarily closed,” while trains rushed through on a rapidly-repaired center track. On the R line, the southbound station was hastily restored within the first months after 9/11, to quickly reinstate service. Northbound service was diverted. Since I lived in Astoria, Queens, the N and R was directly affected from day 1, and impacted daily life for 3 years.

After I left NYC in 2004, major work was done on Cortlandt Street station. The northbound platform was completely refurbished and reopened. The southbound side is now closed, and is in the midst of reconstruction. Everything was stripped down, and now shows the injuries of 2001.

As I was standing in the train and looking out onto the southbound side, I was looking out on destruction. Buckled metal beams, collapsed walls, boarded up entrances and exits, heavy moving equipment—evidence that work was indeed being carried out. I became thoroughly confused, suddenly agitated. I forgot what day and time it was. Memories came flooding back once again. I thought I could smell dust. Panic paralyzed me, and I could not breathe.

This has been my life for almost 2 years.

I freak out at planes, particularly military jets. I freak out at cops with machine guns and dogs on trains and in stations. If I now see images of 9/11, the memories are too overwhelming and I risk flashbacks. I dissociate from the present moment a good part of the day, trying not to feel into the fear, panic and anger. It’s like someone needs to sew my mind and body back together. I lose track of time; I commonly lose track of the day. Events during the day move in slow motion, yet it’s still difficult for me to keep up with what’s going on. The panic and depression has been severe enough to send me into a psychiatric outpatient program. My sleep is rarely peaceful, as I have come to expect the nightly barrage of 9/11-related nightmares.

A couple of theories are being floated for the cause of the delayed onset of the severe PTSD that now runs my life. There are studies out there showing that many New Yorkers have experienced this phenomenon of delayed onset PTSD (http://cityroom.blogs.nytimes.com/2009/08/04/study-finds-post-traumatic-stress-from-911-increasing/?scp=1&sq=ptsd%209/11&st=cse). However, in my specific case, the more likely theory is the preoccupation with the injury and rehabilitation within the first 3 years, combined with eight years of self-medication, that feasibly numbed me out enough to also numb out any and all PTSD symptoms. Then I decided to get sober. Sobriety=functioning brain. Functioning brain=active PTSD.

I remember when the symptoms first started emerging. I thought I was going insane. Luckily I had the right people around me, to assure me that, no, it’s not insanity per se. I’m just starting to experience something that I probably would have gone through almost 8-10 years ago, had the circumstances been different. But no, God has chosen now.

Next stop, Stanford University.

SEEKING A LITTLE GUIDANCE: FROM CAA 2011 CONFERENCE BLOG

Originally published February 13, 2011: http://conference.collegeart.org/2011/blog/page/3/

Seeking a Little Guidance

Posted on February 13, 2011 by Patricia Flores

At 10:30 Friday morning, I attended my Career Development mentoring session. Unlike previous mentoring appointments I’ve had at past conferences, I arrived at this one a bit more apprehensive. It was not going to be a simple check in with a colleague, to verify that I was moving along on the right and steady path. No, I was about to discuss a major left turn in my career trajectory, and needed serious advice.

As I’ve previously mentioned in posts here, I’m currently unemployed. Two years ago, I was laid off from a prominent managerial position at a leading art school. After 7 months, I cobbled together two adjunct teaching gigs, and survived the ensuing year prepping and teaching 11 classes between 2 institutions (one on semester; one on quarter), before being pink-slipped from both just 2 months apart. So here I am, another 7 months later. Yet, my decision to change things up goes a little deeper than just lack of jobs.

To make a long story short (and not too personal): I was in lower Manhattan on 9/11/01. The dust settled in my right ear, became an infection, killed my labyrinth. The 24/7 vertigo sent me to the NYU Medical Center/Rusk Institute for Rehabilitation Medicine for almost 2 years. I still have 24/7 vertigo, and now I’m almost deaf, but at least I can walk and read. Pretty important for the everyday, and for the academic.

Fast-forward 7 years: My priorities shifted for awhile, especially for the Ph.D. Now I’m 39, only have an MA in art history—not the terminal degree, and have a stalled out career. I am back in the studio for the first in many years. One of the interesting things I have learned, both in research and in experience, is that many survivors of 9/11 are suffering PTSD years later. So here I am, with panic attacks, flashbacks, and nightmares—almost 10 years later.

For the most part, I have put away the paint, and acquired an eight-harness loom. The side-to-side motion of weaving not only soothes me, but it mimics VOR—the vestibular-ocular reflex, the important eye movement connected to body positioning in space. In other words, weaving reduces vertigo for me—a happy accidental discovery. I am currently conducting additional research on its applications. Textiles are now my primary media.

I have also entered a study at Stanford University, looking at promising treatments for PTSD, which includes fMRI imaging, and a therapy modality called Prolonged Exposure Therapy. It’s connected with the Veterans Administration in Palo Alto. I’m very interested in the VA, because soldiers are coming back with blown out ears, and permanent vertigo.

So, you guessed it—the MFA.

I had been quite familiar with the art history route, and familiarity breeds comfort. Now, I am looking at a completely new route, never traveled before. Scary? Yes. Exciting? Yes. And, of course, when your assigned mentor tells you point blank that you are exactly where you are supposed to be, and on the precisely right path, it is entirely worth it to go through with the session, no matter how nerve-wracking. Personal details and all. It’s part of my story, to make my own. Soon, my completed portfolio will speak for me.

Posted in Career Services, New York | 2 Comments

This public posting was a big breakthrough for me. It was a conference in which I re-evaluated my current standing as an MA in art history, and explored my potential future as an MFA in studio-in the public eye. This has been a large, and exciting, shift to make. I have been an art historian for 17 years—a very long time to get comfortable with a very successful identity. Yet, I’m still just young enough to make a choice to change. The circumstances of the change were not under my control, but at least the choice itself is mine to make.

This is also the first conference wherein I have spoken openly about the circumstances of my career challenges. Since 2001, I had been very private about the turmoil in my private, and professional, life. As I have watched my professional life fall apart, while working to regain my health and sanity, it just has not mattered much anymore. Now that everything is out on the table, it has been incredible the support I have received, both from long-time colleagues and strangers alike. It reminds me of how important these conferences are. Not just to present papers, but to share ideas, experiences, and connections.

Time to get busy.

My Year of FAILURE

My Year of FAILURE

January 3, 2011

I have not posted in over a year.

This has been my year of FAILURE.

Not FAILURE in the sense that I have lost anything. Well, I have “technically” lost many things: I lost my mind; and my career as a professor of art history here in the Bay Area, and possibly in the state of California. If I ever want to return to that, I will need to do a serious geographic.

All I have really lost is my pride, my attachment to perfectionism, and maybe a lingering sense of embarrassment.

What I have gained is the knowledge that, no matter how bad it can possibly get, I can certainly get back up, brush myself off, and look through the lens of shifted perspective.

And proudly added FAILURE to my CV.

After the familiar refrain of yet another dressing down, in yet another director’s office, at the end of July 2010, I finally admitted defeat to the increasing flashbacks, panic attacks, anxiety, and inability to live an integral life post-9/11. Yes, it was nine years later, as one of my supervisors snapped, but what this person did not understand (many do not), is that Post-Traumatic Stress Disorder (PTSD) does not have a time-line. Sucking it up is not an option. And, as a recent study has shown, many of us 9/11 survivors are developing latent PTSD symptoms several years later (http://cityroom.blogs.nytimes.com/2009/08/04/study-finds-post-traumatic-stress-from-911-increasing/?scp=1&sq=ptsd%209/11&st=cse). During the previous year, I had prepped and taught 11 classes between 2 institutions. And my breaking point: I had just been pink-slipped from the one institution where I had just qualified for health benefits. How was I going to afford to continue taking care of myself, as a 9/11 survivor? Prime fodder for losing it.

So, I include a couple of photos of the primary place I spent the majority of my time for 5 months: Kaiser Permanente San Francisco Medical Center, French Campus, Psychiatry Department. Getting acquainted with FAILURE.

After consulting with my therapist and psychiatrist, I filed for State Disability, and checked myself into an outpatient psychiatric program in August 2010. For 5 months, I was in treatment 5 days a week. They even let me out—briefly—at the end of September, only to return 2 weeks later.

For a driven, perfectionist academic—this was the end of the road. The opposite of SUCCESS.

The dictionary definition of FAILURE is: a state of inability to perform a normal function; an abrupt cessation of normal functioning; a fracturing or giving way under stress; lack of success; a falling short.

Yes, that sounds about right. It was difficult to function normally when it felt like my life was taken over by flashbacks of events that happened 9 years before, in a place 3000 miles away. When it was not flashbacks, it was consuming panic attacks that left me paralyzed in public and calling friends to help me out. I literally felt like I was fracturing…under stress.

This was the culmination of a two-year fall, during which I experienced most of my greatest fears: losing not one, but three jobs I absolutely loved—all because of my 9/11 injury or PTSD, losing connection with my meditation practice, experiencing that feeling of exhaustion from physical and emotional burnout, and total depression and isolation. Completely broken.

What I have learned over the past half a year is, I am not in control of my own life. Something much greater and wiser is. Failure did not come often in my life before this. I drove myself fast and hard, and I have a ruthless inner critic—deadly. It is inevitable that we all fail at points in our life—so I could benefit from some failure, right? But seriously?

I have been busy deconstructing myself the past few months. The benefit of 5-day-a-week therapy. Certainly a better alternative to suicide. While I went in to this wanting the PTSD and depression to diminish, I have come out of it learning that I lack essential communication skills, and possess emotional dysregulation—all probably stemming from childhood, and setting me up for eventual FAILURE. If I continue working on those areas, they will help my PTSD and depression. Brilliant.

FAILURE has allowed me to build a new, stronger foundation on which to rebuild my life. I am learning to form trusting relationships, something very new for me—again, the communication thing. I am still working on the emotional regulation puzzle. That one may take awhile, and much assistance. One of these days, I will cry when it’s appropriate, and isolate and shutdown when it’s appropriate (like, never!). I’ve heard it said somewhere that there are no failures, just experiences and your reactions to them. That has certainly been my experience! C.S. Lewis once said, “Failures are finger posts on the road to achievements.” I want more of that view.

The greatest opportunity I’ve had in this time is to experience many different forms of healing. There have been physical forms of healing: walking and other exercises to tend to my vertigo, yoga—which has been essential to getting back into my body which I have felt disconnected from, and soon I’ll be exploring acupuncture. Emotionally, I have continued with psychotherapy, a 12-step program, and continuing to keep myself out there with my new friends. Spiritually, I have slowly returned to my Buddhist practice—which I abandoned as a workaholic—and has been a practice in patience.

I have also gone back to my art practice, another practice in patience. I hope to chronicle that path here. I’ve heard someone say that there are two benefits of FAILURE: 1. If you fail, you learn what does not work; 2. The failure gives you the opportunity to try a new approach. That is equally true of art as in life.