Monday, December 8, 2014

C-PTSD Doesn't Exist??? Cowboy Makes a Vow . . .

Cowboy, that ego state within me who flies into action when action is called for, has made a vow:  She is determined to spread the word that C-PTSD is real, that it does certainly exist, and that it can be, given the right circumstances, healed!  So--why would Cowboy feel the need to spread the word regarding C-PTSD? Of course, C-PTSD is real!  Those of us who have been diagnosed with the condition and those wonderful therapists who help people heal from C-PTSD all know that the condition/disorder exists!  Why the need to convince anyone?  Don't all mental health professionals accept the fact that C-PTSD exists??  The short answer to this last question is a resounding "No!"  And how do I know this? 

As my readers are aware, I relocated a year ago from Portland, Oregon, to a small town in Oregon's northern neighbor, the state of Washington.  Actually, I now live in Lewis County, Washington, in the town of Chehalis, to be exact.  If you look on a map, you will see that the area where I live is directly north of Portland, on I-5.  The trip to Portland by train takes about two hours, and the trip by car is about the same.  As you see, Lewis County is physically not very far from Portland, but the miles between the two places represent a huge disconnect when it comes to the attitude of professionals toward C-PTSD. 

When I lived in Portland, I had no problem finding a therapist who treated clients suffering from psychological trauma damage, and I had little trouble finding a therapist who gave me an accurate diagnosis of C-PTSD.  The "Psychology Today" list of Portland professionals treating PTSD and trauma-related conditions is almost thirty pages long.  In contrast, when I did a search today in the same data base but typed in "Lewis County, Washington" rather than Portland, Oregon, a list of nine therapists came up.  Of those nine therapists, four actually had their offices in Lewis County.  The others had offices in neighboring counties.  

Of the four therapists who were actually local therapists and who were listed as treating PTSD and trauma, all listed short-term behavioral therapy, DBT, and CBT among their modalities of preference.  None listed EMDR or Ego State Therapy.  And EMDR is a treatment accepted by the Veterans' Administration as being effective in treating PTSD!  Where several of the therapists in nearby Thurston county said they treated C-PTSD, none of the four therapists in Lewis County listed C-PTSD as a condition they treated.  Why??  The answer is very simple:  C-PTSD is not a disorder found in the DSM-V!  PTSD is in the book, but C-PTSD is not.  And if it's not listed in the DSM, the disorder doesn't exist--for all practical purposes.  Or, well, C-PTSD exists in Portland, but it doesn't exist in Lewis County, Washington.  Odd, isn't it, that the disorder can exist in one location but not in another?? 

I know Lewis County's population is small (75,081 souls) compared to that of Portland (2,314,854 metro area), Oregon, but aren't there any people in Lewis county who have C-PTSD and need therapy for it?  According to the listing, it would appear that there are no people who have this condition in Lewis County and there is no need for therapists who are trained to treat the disorder.  However, if we prowl around beneath the surface, the picture looks a bit different.

When I arrived in Chehalis last December, I began a casual survey of the therapists here.  First, I sent out flyers to every therapist listed in Chehalis and Centralia, the two major population centers in the county.  On the flyer I advertised myself as being willing to speak from experience on the topic of C-PTSD and the healing process, and I made sure to add that I would charge no fee for doing this.  Of the fifteen or so flyers I sent out, I received one response.  That came from the head of one of our major public mental health clinics.  She responded that the modality of choice at her clinic is short-term behavioral therapy, CBT.  She added that if she encounters a person with obvious trauma damage, then she refers that person to somebody outside her clinic, usually.  Public funding does not normally cover the long-term therapy that trauma work requires.  She added that she would keep my offer in mind for the future. 

Her response was the sole response I received.  I was disappointed, of course, to receive just the one response, but at least I then had some idea as to which way the wind blew. I concluded, probably accurately, that the government does not want to pay for long-term therapy, and from my own experience with C-PTSD I know that short-term behavioral therapy would not have helped me get to the roots of my trauma damage and heal.  Also, others who blog on their journey to heal C-PTSD normally have been engaged in the process for a long time, and they talk about the complexity of their process, the necessity of a trusting and long-term relationship with a competent therapist, and all the ups and downs of their process.  In other words, for these other bloggers, a short-term DBT or CBT approach would not really meet their needs anymore than it would have met my needs. 

Not a person to give up easily once I "get the bit in my mouth"--pardon the rural and equine reference!--I took my survey further and went through the phone list of therapists in Lewis County.  I decided to limit my inquiry to only those therapists who were able to answer my call in person--I'd had too many experiences with failed call-backs to trust that leaving a message would get results--and of the four therapists I talked to, three did not treat trauma patients at all.  One therapist told me that she did not have the time to treat trauma patients/people with C-PTSD, and she referred those people to a clinic in neighboring Thurston county, a county with a larger population and a higher average education level than Lewis County.  Well, at least she allowed for the possible existence of C-PTSD.  That was encouraging! 

Curious, I looked at the list of therapists in the Olympia area and discovered that there are several therapists who treat C-PTSD in Olympia.  Not only that, but there is actually a clinic that specializes in treating people with PTSD and C-PTSD.  So C-PTSD exists in Thurston County and is deemed treatable in Thurston County, but it does not exist in Lewis county?  Interesting!  Yes, very interesting, in fact!  From this discovery and from the informal information-gathering I have done, I can probably conclude with some accuracy that 1. in larger population areas where the income and educational levels are higher than in Lewis County, there is more likelihood that people with Complex PTSD can find appropriate help, and 2. there is a huge need for education among professionals and non-professionals here in Lewis county regarding the causes, symptoms, and healing of Complex PTSD.  I can also conclude that I'm damned lucky to have found the help I needed and to have healed to the point that I have healed BEFORE moving to Lewis County!!   Amen to that!! 

 Why do I believe that, despite the refusal of most professionals here to admit to the existence of C-PTSD, there are people here who are suffering the effects of the condition?  For one thing, if Judith L. Herman, M.D. ("Complex PTSD: A Syndrome in Survivors of Prolonged and Repeated Trauma."  Journal of Traumatic Stress, Vol. 5, No. 3, 1992) is to be believed--and I do believe her!--suffering prolonged child abuse and also being victimized for years in a domestic violence situation often leads to a person's developing Complex PTSD.  Common sense and the fact that no fewer than five agencies are listed when I searched for county agencies that help domestic violence victims tell me that there are plenty of residents here who possibly are long-term victims of abuse.  Child sexual abuse?  When I lived here in 1981, a professional who worked for the local Department of Social and Health Services told me that Lewis County, Washington, ranked seventh in the nation for the reported cases of incest.  Unreported cases??  No figure available.  Presently, this county and neighboring Cowlitz County, both what might be called "rural" counties, are hotbeds of drug abuse, particularly hotbeds of meth production and use.  And along with meth abuse come child neglect/abuse and domestic violence. 

With the above in mind, then, I wager that plenty of people here in Lewis County are wandering around suffering the symptoms of a disorder that is not recognized as legitimate by the bulk of the professionals in the county: "C-PTSD is not in the DSM-V;  it doesn't exist;  why would or should we treat it?"  Of course, there is the practical reason for not treating C-PTSD:  If it is not specifically listed as a disorder in the DSM, then there may be no reimbursement by insurances.  But folks in more urban areas are treated for C-PTSD, and their treatment is paid for by their insurance, including by Medicare.  All I can say with certainty is that I have been diagnosed as having C-PTSD, I received the long-term help I needed, and that help was paid for by Medicare and my Medicare supplement.  Other people I have known with the diagnosis of C-PTSD have had their therapy paid for by their private insurance.  But these people have not lived in rural areas! 

No, the general attitude here in Lewis County is that C-PTSD does not exist as a legitimate diagnosis and, therefore, nobody has the disorder.  When I asked the head of the largest public mental health facility here how she would have treated me had I presented with the symptoms of C-PTSD, she replied that I would have been medicated and given short-term behavioral therapy.  When I asked her if she would have given me a diagnosis of C-PTSD, she just stared at me and did not reply.  As I said earlier, I'm damned glad I did not relocate to this area until AFTER I had been treated for C-PTSD! 

So is there anything I can do to help bring about a change in the way people here in Lewis County regard--or disregard!--Complex PTSD?  As a nonprofessional but also as a person who has been diagnosed with Complex PTSD and who has been successfully treated for the disorder, all I can do is tell people about my own individual experience and hope that at least a few of my listeners and any local readers of my blog take me seriously enough to find out for themselves that C-PTSD does indeed exist.  Maybe these people will wonder, as I do, why they are stonewalled when they bring up the subject with local professionals.  This is a sad, sad situation, and I can only pray that eventually it will change.

There is one huge step that can be taken, however, that will do more than anything else to bring about change in the local attitude regarding the existence of C-PTSD:  Include C-PTSD/DESNOS in the DSM-VI!!  That would be the logical first step!  The second step would be to make education and training in effective methods for treating C-PTSD/DESNOS available to local therapists.  I'm almost seventy-six years old and may not be alive to see the day C-PTSD is included in the manual or to see any of the local therapists who do not believe the disorder exists accept that it does exist and receive training in its treatment, but if that day ever comes, I can guarantee that there will be clients right here in Lewis county to keep those therapists as busy as they want to be! 

As I stated at the beginning of this post, I plan to do as much as I can to educate people in this community regarding Complex PTSD.  I know, at the same time, that what I have to say will fall on a lot of deaf ears.  However, in the hope that maybe a few people will listen, become interested in the topic, and do some local investigating, making the effort to educate is worth my expenditure of energy.  This time next year I'll let you know what results from my efforts!  Have a wonderful holiday season and a great New Year! 

Note:  My 2012 post of this same topic should appear below this post.  Same general topic--different information.  Important reading for all you who have been diagnosed with C-PTSD!  And for anyone who knows a person with the diagnosis. 


  1. This is so very important. I am glad that Cowboy made a vow! It helps us all, and too bad there are not more telling you this.

    1. Thank you so much for your comment, Aimee! What makes me really unhappy is the fact that people like my therapist who have devoted their working lives to helping those of us with C-PTSD heal are regarded as quacks by the narrow-minded professionals who deny the existence of C-PTSD. Well, don't get me started . . . I plan to do what I can in this county to bring about some enlightenment, but that's just a drop in the bucket. We need a whole "herd" of Cowboys to do the job and educate the public, including the ignorant professionals. Bessel van der Kolk and Judith Herman will keep pushing to get it into the DSM, and anything we do to spread the word will help their efforts. Ride 'em Cowboy!