# PTSD



## egpenny (Apr 14, 2014)

The MC in the story I'm working on is Army and just back from Afghanistan.  He has PTSD.  I have his PTSD actions when just back as; nervous going under overpasses and with cars passing him while driving.  Every variance, or bump in the road is a possible IED. He has nightmares, anger issues and gets stressed easily.  

He is getting a medical discharge because he told the doc that he'd consider shooting someone if they made him angry enough.

So, is that about right?  Is there more.  Can stress be relieved for a time by exercise? 

 My MC heads to the gym every day, to relieve stress and tire himself out so he can, maybe, sleep without nightmares.

I know it's never going to go away, but does counseling help manage it?  How about talking to other vets?  What else can he do, beside tough it out?


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## J Anfinson (Jun 21, 2014)

PTSD is different for everyone. I was diagnosed with it. It started out as panic attacks while I was in Iraq in 2003-2004, and the attacks got even worse for a while when I got home. Every time I closed my eyes to try and go to sleep my heart felt like it was trying to beat its way out of my chest and I felt surges go through me that I later learned was adrenaline. One time I ended up in the emergency room and went into convulsions. I thought I was going to die.

I tried going to the VA but all they did was use me as a guinea pig for various meds. The medics in Iraq had me taking Buspirone, which worked for a while but never since. It wasn't long after the emergency room visit I started self-medicating with alcohol. It worked wonders for sedating me into sleep, but as most can guess it also became addictive and nearly ruined my life. I spent about 3 years being drunk more often than sober, and when I met the wonderful woman who later became my wife she had the incredible patience to help me get rid of the bottle and get me to realize I was only going to kill myself if I kept it up. I still don't trust the VA, but I did end up going to a trade school, getting a good job with great insurance, and seeking out my own psychiatrists and therapists in the civilian world which helped me out a lot. I haven't had to visit any of them for about a year now, though occasional attacks still happen I've been taught breathing excercises that help lessen or eliminate the attacks. On top of the panic attacks I also have general anxiety disorder and agoraphobia, which makes me nervous of new people, places, situations, enclosed places, crowds, etc. I'm also largely anti-social except for family and people at my job. But I've learned over the years to cope with everything. When I first got home the overpasses and stuff made me a little nervous, but I also knew the problems with those and the roadside bombs were left back in Iraq so the little worries I had were nothing more than fleeting thoughts.

To answer some of your questions more directly, now that I've given you a small picture of what it's like, yes, exercise was recommended by my psychiatrist because it feeds oxygen to your brain, and one reason it's believed that panic attacks happen is because your body forgets to breathe regularly and your brain goes into a fight or flight mode, sending adrenaline to the rest of you to get you to breathe deeply again to make up for that lack of oxygen. I think there's something to that theory because the breathing exercises I was taught have helped end attacks quicker than anything else. Exercise is also recommended for those with other PTSD related problems because the simple act of wearing yourself out helps you go to sleep easier, and they claim it reduces stress levels. So I think it's believable to use exercise in your story to help your MC sleep.

A lot of fellow veterans I've known, I've also watched turn to other forms of danger to get a similar kind of rush we had in the sandbox. Some people buy motorcycles and fast cars and drive at insane speeds that can get themselves killed, others turn to drugs and alcohol, some get into law enforcement to try to get that same feeling of brotherhood fighting evil. I got into armed security for a couple years but quit after things got insanely dangerous for me and my partners when we worked with Tulsa police to bust a drug ring. I'm probably going a little off topic here, but that's the kind of things that Army and Marine Corps people do when they get home a lot of times. Fighting and carrying a gun is what you know so law enforcement of one kind or another makes sense as a career for some. Didn't end up being for me, and actually made my stress worse, but some get the old thrill out of it.

And no, it never goes away. Counseling can help manage the worst of it, talking to others can help some, but mostly from what I've found you just have to be willing to let it all go. It's in the past and there's nothing you can do to change it, so get some help and push on with your life. It's not worth thinking about the bad moments we had while deployed, so focus on the good ones. Remember instead the smiling faces and the people you may have saved. I've written a few stories to help exorcise some of the old demons of war. Those demons can be like monkeys on your back, trust me. I say quit feeding the bastards and banish them however you can.

Another thing: Your first paragraph is accurate as long as you're talking about someone with extreme PTSD. Most have lesser problems like me, but if you're wanting your character to be a worst-case scenario then everything you have there is fine.

Sorry nobody has replied to this before now. If I had noticed this thread earlier I sure would have. Hope what I've said helps.

Jake


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## egpenny (Jun 21, 2014)

Thank you so much for the great information. I appreciate your input.
Thank you also for your service. You got about as much help from the VA as my ex-military family members have. 
I talked to my grandson when he came back from Iraq and again from Afghanistan and got my ideas from him, but I wanted to make sure I was painting a true picture...or at least one that was believable. Especially about the exercise being helpful because that plays a big part in my story.


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## Morkonan (Jun 25, 2014)

egpenny said:


> The MC in the story I'm working on is Army and just back from Afghanistan.  He has PTSD.  I have his PTSD actions when just back as; nervous going under overpasses and with cars passing him while driving.  Every variance, or bump in the road is a possible IED. He has nightmares, anger issues and gets stressed easily.
> 
> He is getting a medical discharge because he told the doc that he'd consider shooting someone if they made him angry enough.
> 
> ...



Typically, you're not going to find true relief simply from "exercise" unless you exercise to exhaustion. And, then, that's not going to really do anything to mask or relieve the ultimate problem. It may help them sleep, though, just so long as the period of exercise is not followed too closely by the desired bed-time. (You want to allow the body several hours to cool down and adjust to a less physiologically stimulating period before sleep.) It will also have other positive benefits which may help to increase your satisfaction and happiness, overall. But, it's not going to directly address PTSD.

PTSD is often characterized by hypersensitivity. For instance, your character going over bumps in the road and having flashbacks of IEDs fits in perfectly with the symptoms of PTSD. But, what's more likely for a PTSD sufferer who desperately needs to escape from nightmares, working out in the gym in order to get exhausted and go to sleep or picking up a bottle of scotch? Likely the latter, since it also allows them to forget their waking nightmares for a time.

Typically, therapy is going to include congitive behavioral therapy sessions, where the PTSD sufferer learns ways to cope with their hypersensitivity and their interpretations of the traumatic events as well as dealing with their interpretations of the aftermath. (ie: survivor's guilt, in combat cases) They will be helped to develop ways to respond to environmental stress and to more reasonably reinterpret the events surrounding the causes of their PTSD.

Support groups are there for what their name implies - Support. It is helpful for PTSD sufferers to understand that there are other sufferers who can empathize with their plight. Too often, a PTSD sufferer feels "alone" and that they are the only one who could possibly understand their experience, so they often don't get help... A support groups provides valuable contact with other sufferers. It may not, itself, help the PTSD sufferer to overcome their problems, but it will help to banish their thoughts of isolation and loneliness due to a disorder that causes them to become somewhat separated from the rest of humanity in their experiences.

The type of "stress" you're talking about will not be significantly "relieved" through exercise. There will be positive benefits from exercise, the release of endorphins and such as well as a better metabolism and higher energy levels. There's also the social aspect and the rejoining of normal society benefits that the PTSD suffer might experience which will help them in the long run. But, "relief?" Not typically, no. It's the pursuit of a positive and somewhat distracting activity, in and of itself, that could provide temporary relief, but the underlying problems will exist until they are directly addressed in some way.  (Note: PTSD sufferers do not absolutely require institutionalized and specialized help and counseling. They can, for instance, have experiences and life-altering ideas that help them get through their problems on their own. But, that's inefficient and largely left to chance, thus it's not very desirable for anyone to rely on for help.)


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## egpenny (Jul 2, 2014)

Thank you, Morkonan, for your input. I've rewritten a chapter and several scenes because of what you and Anfinson have said. This is exactly what I needed...thanks to both of you.


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## Emily Logan (Jul 6, 2014)

I'm not a veteran BUT I am a PTSD sufferer. For what cause, I'd rather not say. If someone, any one, is effected by enough trauma (meaning a situation that's more then they can mentally handle- there's only so much any one can handle), they can get PTSD. Everyone's symptoms of PTSD, and how they deal with it, are as varied as why/how they got it in the first place. 

I've never taken to the bottle; drinking is just something I have never and will never do. There was a time when I was afraid of going to sleep, however, because my issues were nagging at me every night and I wasn't getting any rest . A whole year went by where I wasn't talking to any one, apart from my husband. My life was so dark, I didn't want to drag others down with me. In effect, it's possible your character doesn't talk much/open up easily about what he/she's been through, even if they're ordered (by their company?) to see a counselor. Maybe your character goes to the gym and finds _some_ relief; or maybe they go but, despite their efforts, don't. You're right in saying that sufferers don't 100% recover. PTSD is something that's with you for life. It's no different then someone in a wheel chair, imho. However, you can learn to cope and work through your PTSD. Over time, over all, it's grip on me has lessened, but it's always there. I still wake myself whimpering in the night from my loss (trauma). I still can't handle stress. Memory is still a problem, though it seems to have improved more recently. 

I think a dog (or other pet) is so important to PTSD sufferers. I have a Service Dog in Training but, short of that, your character could just have a pet. Somehow, just his presence has been so calming on my nerves. And I've heard positive stories from vets who've been calmed by a dog too; they have even gone so far as to say their dog SAVED their lives. After all, who's gonna take care of the dog if the sufferer isn't around to take care of them? The dog can alert the handler to possible triggers and interrupt dissociative behavior. Too bad they've outlawed Psychiatric Service Dogs in VA locations. That's just plain stupid. Grrrr. If you're interested in the dog angle, I would look on YouTube. There's a few stories on there of how dogs have helped vets.

That's my two cents, for what it's worth. As I said, I'm not a veteran, just someone who knows what PTSD can be like. Good luck with your story!


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## Plasticweld (Jul 6, 2014)

My experience with it is from the end, I have had two employees work for me who suffered from it, post Vietnam.  At the time little was know about it compared to today. 

I will offer this, both men enjoyed working in the woods because of the danger and the physical element involved. Both men at one point or another where over whelmed with different things, from stuff going on at home or a combination of things, I have never seen a single instance that pushed them over the edge. When the point came that they were overwhelmed they wanted to close up and retreat.  My tactics at the time; I was younger than both of them, was to go pick them up at their house and bring them to work with the understanding that I needed them it had nothing to do with what was bothering them, I was counting on them and would go out of business if they did not help. Both men worked for me at different times, I found sympathy or understanding only seemed to make things worse, or have them always use the line " I would not understand"  Having always been kind of a hard ass pushing them came natural and always seemed to do more to get them out of their funk than anything else.  I have never found PTSD to be as debilitating as portrayed in movies and tv and thought it was always over played compared to  my limited experience with it.   For those who have been effected by, what gets you out of your funk when you slip into?


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## Emily Logan (Jul 7, 2014)

Questions about PTSD are really hard to answer, plastic. Because each of us handles the same situation differently; and each of us can only handle so much before we pop. That's what PTSD is. PTSD is like an umbrella that covers other health problems. For instance, I have Claustrophobia and Anxiety (general and social) that didn't exist before. I can also have night terrors about my loss and what happened. These are all problems in and of themselves but, because they occurred from what happened, are a part of my PTSD.

For me, personally, it's about managing stress and preventing episodes from occuring in the first place. Once I've hit an episode, only my dog can help me. I have to wait for it to pass if on my own. Medicine. Counseling. My dog. Something constructive to do with my time. Time and distance between now and then. Avoiding unnecessary stress & triggers and facing head on the necessary (to get it done and over with as quickly as possible). All of that works to help me have a healthy, happy life. But that's just me. I can't speak for others. As each individual handles specific situations differently, they also have to learn to live with PTSD in their own way because it effects them differently then it does any one else.


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## Morkonan (Jul 7, 2014)

Plasticweld said:


> ...  For those who have been effected by, what gets you out of your funk when you slip into?



Typically... nothing.

PTSD effects are best avoided when they are not present...  In other words, it's terribly difficult for one to actually "deal with" PTSD when they are deep into the throws of it. This is largely due to the fact that the brain will demand that the body respond, physiologically, releasing hormones that, without question, force the body to respond in a certain way and demand that the active mind take notice of it.

 Picture this - You're at a fireworks show. You were stupid and, because you really liked this girl, you accepted her invitation to go. So, you show up and, despite some attempts at preparation on your part, you fail at controlling your interpretation of what you're experiencing. You fail to follow all the cognitive-behavioral crap your psych worked with you on. One moment, you're enjoying the show and drop that interpretive filter you've learned to put up. Next thing you know, your heart is hammering in your chest and there is nothing else in the world other than that stairwell, which offers your only hope of shelter from the barrage... It's not as if you're going to pull yourself "out of your funk" when your brain has just finished giving orders that put your body into a mode of response that is nearly impossible to deny. At some point, there's going to be a moment where refusal is _impossible._ It may not last long, but it will be there if you can't head it off.

That's why PTSD therapy is largely focused on giving the sufferers ways to avoid the problem, to begin with, and ways to reinterpret their experience so that the odds of them uncontrollably responding to similar triggers might be lessened. For debilitating sufferers, it's not because they can't handle the "moment" - Nobody could be reasonably expected to. It's because they failed at prevented the moment from arriving. (Just my two coppers. As has been said, everyone's mind and body are slightly different and they may have unique issues. However, generally, PTSD sufferers experience similar problems, that's why its a diagnosable condition to begin with.)


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## Plasticweld (Jul 7, 2014)

Emily and Morkonan Thank you for taking the time to give me a detailed response and some understanding of what you are going through.  

If you don't mind I will ask some more questions just to get a better understanding of this as my brain does not function in the same manor, I have no idea whether that is good or bad.  I will say both of you seem far more complex than I am, I am so simple I am almost embarrassed.  While I have had some traumatic things happen in life, loss of a sister, divorced parents, molested by a priest all before the age of 11 All of those things made me stronger and more determined. 


So the question is, is it hormonal or chemical or environment?   Is it a combination of many things.  I have honestly never felt the things that either of you have felt, this is why I am trying to wrap my mind around it just so I can be a little better equipped to handle it or help someone in the future.  


Thank you both for sharing part of yourself with me, I do appreciate your candor...Bob


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## Emily Logan (Jul 8, 2014)

Wow, plastic, those are some pretty drastic things to happen to an 11 year old. Sounds like you're either stronger then you think, having been able to cope with those situations and move on, or you have symptoms you don't know about; I'm not saying you do, but sometimes PTSD goes unrecognized. As I said, a person is only able to handle so much; even they may not, and likely do not, recognize that threshold until it is too late.

Each situation is different. It's hard to say, do this or do that to help because the variables are so vast. I can tell you you won't go very far with me personally by pushing, but that's because of my own personal situation. I had people judging me and breathing down my neck for years with no personal space of my own; now I have social anxiety. I can't say pushing would/would not work for someone else. They have to learn to live with it with professional help. I honestly don't know how I would handle someone else's disabilities or even if I'd try; I'm not a quitter, but with PTSD there's just no simple answer. You could end up making things worse instead of better. I would recommend looking up PTSD symptoms up online and, even more importantly, at your local library. You may start to form some sort of an idea what it can be like. But make no assumptions. While their are similarities, as mork said, there are also differences. You can never fully figure out the disability.

What little advice I have to give. Don't push for answers, you might end up triggering them. It's just something they have to work out on their own, in my personal opinion. Be patient. Be understanding. Don't push past a person's threshold; and you'll learn what some of them are by interacting. Let them handle their situations in their own way and time. It's not business, it's just personal. 

"is it hormonal or chemical or environment?" "If a tree falls in the forest and no one is there to hear it, does it make a sound?" ~George Berkeley "It’s not what happens to you, but how you react to it that matters." Epictetus

Mork, thank you for your response. You were able to give more clarity then I feel I was able to and, in effect, help me understand why I can't help myself when it's happening. You have a great response. Thanks for sharing.


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## Kevin (Jul 8, 2014)

Mork- your post reminds me of an incident from my teenage years. It was around 4th of July and in those days terrorists did not use fireworks. Anyway, some of us neighborhood youngsters were out lighting and throwing firecrackers in the air.  They were exploding sometimes, just a few feet above our heads. This old guy(must've been in his forties) who we were friends with had a look on his face, a sort of smile but like he was not a part of it, the firecracker throwing. He looked at me and said quietly "Just like Viet Nam..."  That was it. He left and I wondered how much of what, from his prior experiences, he was feeling. No one else noticed. This was before PTSD. We'd heard of the term 'shell-shocked', but it was considered unproven guesswork and often care was denied by Veteran's affairs, even in some extreme cases.


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## Morkonan (Jul 8, 2014)

Plasticweld said:


> ...So the question is, is it hormonal or chemical or environment?   Is it a combination of many things.  I have honestly never felt the things that either of you have felt, this is why I am trying to wrap my mind around it just so I can be a little better equipped to handle it or help someone in the future. ...



Just to note: I am not "traumatized" by my experience with PTSD. Largely, I don't have any issues surrounding it and I recognize it for what it is. Typically, the triggers are fairly rare, so it's not often that I would be required to deal with it. I'm also very used to it, having experienced similar issues for most of my life. (Childhood was tooth and claw for the most part, so that kind of thing isn't a stranger to me.)  BUT, and I stress this, I am a healthy, normal, emotionally and intellectually well-adjusted human being.  I am that way because, thankfully, I still have my brain and I have learned what makes it tick, so I am not "experiencing in ignorance" the internal and external world around me. That being said, it doesn't necessarily make things that happened in the past easier to deal with, but it does reduce the odds that they will cause me any significant problems in the future.

Your question alludes to an assumption that needs to be explored - There must be something different about PTSD sufferer's brains or some other physiological difference. 

There's not. While it is _very_ true that other conditions could impact the likelihood or seriousness of PTSD, they are not _necessary_ for it to occur. (For long-term chronic sufferers, there may be other issues.) PTSD is, for all practical purposes, a outgrowth of a natural instinctive reaction that we have been built around for the last 50,000 years, give or take another fifty... Evolution has taught us that when we are threatened or experience something terrible, we should avoid those situations in the future. It has determined that we should respond in certain ways to such situations so that we are more likely to survive them. It is a lot more efficient, so Nature thinks, to just hard-code a great deal of these more serious responses so the brain, which may be busy running for its life, doesn't have to dwell on the details very much. 

When we have traumatic experiences, and remember that "experiences" require an _interpreter_, our brain-body reacts. Sometimes, these traumatic events become so significant to us that our brain-body categorizes them as _extra-special existential nasty don't-want-that-to-ever-happen-again events_. So, either due to a single especially traumatic occurrence or due to repeated occurrences, our brain-body effectively hard-codes a response. Many people like to refer to it as a "fight or flight" response, but that oversimplifies it. In nature, there are plenty of observable responses, including "fight or flight." But, then again, there's also the "_lay here and feel nothing while the lions eat my intestines and I die_" response... Ever seen a gazelle being eaten by lions? Notice the blank stare, the small jerky movements, rapid breathing, but apparent torpor and unresponsiveness to obvious physical pain? While not exactly a conditioned response, since opportunities for that would be few, it is something the body is capable of doing when faced with things beyond its capacity to deal with. Classic "Shell Shocked" victims and those who have suffered long term torture might end up like this. And, it's not limited to the "dramatic" experiences, either. Long-term victims of all sorts of abuses and terrible experiences typically remove themselves and shelter themselves from further harm by refusing to feel anything about _anything_.

All of these things are perfectly possible within a healthy human mind. We are conditioned by evolution to respond in certain ways. However, certain forms of training can reduce the likelihood of an evolutionarily reinforced response in favor of a conditioned one. Welcome to Boot Camp! That's why soldiers run to the sound of the guns instead of away from them...

Is it hormonal or environment? Remember that "experience" requires an interpreter. Have you ever been to a scary movie? Did you get scared? OK, you knew that was just a movie, right? So, later on, when you found yourself in a similar situation that was depicted in that movie, did you re-experience, even just a little bit, that same fear response? If you did, then it was probably a well done movie or scary scene. If you didn't, you've successfully interpreted your initial response, that of responding to a work of fiction on a movie-screen, and are not hampered by having experienced it. But, if you continue to respond to those same scary triggers that you witnessed in the movie, you've had a problem interpreting your initial experience and you've simply started applying it to any similar experience, even though that "experience" is nothing like what you actually had. (You experienced the movie while sitting in a movie theater, not by actually being inside the movie. Somewhere along the line, your brain has disregarded this.) "Well-Adjusted" Adults find this a bit easier to do than children, that's why children shouldn't see scary movies meant for adults... Seriously. I'm not kidding. Do you realize how many times I lay in bed, scared to death that Bigfoot was going to crash through my window? Thanks, Bigfoot horror movies!  (Some adults might have certain issues to begin with, so that's why I put in "well adjusted." But, even "well adjusted" adults can have terrible PTSD issues.)

All this is a bunch of simplified stuff, but the end results are similar - Your experiences require interpretation in order to be real and that interpretation can greatly effect how you regard these experiences in more ways than just a memory. Our entire lives are like this, so it should be immediately apparent to most that this is true. 

Human beings are a pretty sturdy bunch. It's strange, but we seem to take brushes with death and existential risk as less traumatic than internal emotional issues and social ones. A soldier might fear failing in his duty or failing to fight for his buddies more than he would fear being shot. Powerful stuff. But, only the most strongly interpreted non-existential "threats" have the slightest chance of PTSD or PTSD-Like reactions. (Physical, emotional, sexual abuse counts with that as these are attacks on the "self", which our brains regard just as importantly as the mortal meatsack we walk around in.)

If you're looking for a way to portray PTSD, then here's what I would do:

There's plenty of information about PTSD treatment and therapies. Even wiki has some good stuff. (Check the psychology wiki, too.) What I would do is look at all the therapies, especially CBT, and work backwards, unraveling what those therapies are designed to help with and using those as ques for the problems that your sufferer would likely have. Do therapies focus on the reinterpretation of traumatic events and triggers? Yes. So, your sufferer interprets these events "wrongly." They remember them "wrongly." They apply certain ques, like fireworks or a car-engine backfire, to the response that they experienced in the traumatic event, so make sure to include that sort of stuff. Something as simple as a customer dropping a bag of dogfood in a grocery store could remind them of seeing their buddy's bloody torso, headless and limbless, hitting the ground in front of them and, right at that moment, their body and brain demands that they react the same way and re-experience that traumatic moment...

(Lastly - Individual experience is anecdotal, by definition. But, knowing how different people have experienced their PTSD can lead to very interesting dynamics worth exploring. Do searches for "Case Studies" regarding PTSD and see what sorts of reactions or impairments you can find.)


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## Emily Logan (Jul 8, 2014)

All right, Freud, fess up. Are you a psychiatrist/counselor dealing with issues of your own? 

I don't believe in Evolution, I belove in a loving Creator God. I believe he built us with protective fight or flight responses. And you have a point about the healthy human mind. I'm not sure I've ever actually been healthy. When I was a kid, I was known by my family as "the drama queen", blind to gray, only able to see black & white- something either is or it isn't, no in between, no maybe. As an adult, I've been diagnosed BiPolar. Let alone any learning handicaps I may have- found learning difficult growing up. Only really got the knack for reading and writing. Minor, manageable disability, but there from the beginning all the same.

Kevin, you've missed the point. I don't know whether or not they use firecrackers in the army- like I said, I'm a civilian. But if you listen, I mean _really_ listen to the sound a firecracker makes, you'll realize that sound comes from the dawn of technology. It sounds like a cannon firing or guns shooting. It's not what it IS, it's what it sounds like and the strong memory associated with that sound.

I have social anxiety. Does that mean that every one in the world is/was against me? Are you? No. But I still have issues trusting people. Why? Because a group of them decided I wasn't good enough and watched my every move, trying to force me to conform to _their_ standards. It's not the place/event/experience itself that causes the issue, it's the memory that place/event/experience envokes. Is that a bit clearer?


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