Other Actual Or Immediate Threat Of Death Or Injury: How Does It Work?

[lostforgottensoul]

psychologically harmed

And actually thats the term, the exact term my therapist used with the words "possibly permenant in front of it.

 

[dnp]

@joeylittle I am sorry for your terrible experience. I do disagree that the way you guys are drafting the language covers the situation you described. This is an issue of interpretation. I'm not exactly a layperson in this area, but nor am I an expert. I also haven't done any real research. But my gut instinct from my "not a layperson but not an expert" perspective is that your language doesn't cover. Take it for what it's worth.

 

[dnp]

But thats what the other thread is talking about, the cause.

Just to throw that in.

I don't think we understand each other and are just talking past each other.

 

[joeylittle]

But my gut instinct from my "not a layperson but not an expert" perspective is that your language doesn't cover.

Do you think 'immediate threat of' is too exclusive/doesn't encapsulate the kind of situation I'm describing? (To me, that's the more relevant area than catastrophic injury, because there's precedent for the phrase being applied different ways)

An old version used to describe the crit A situation as being something like 'outside the realm of expected human experience' - which, I see why they dropped that, but I also get that it's attempting to codify a certain kind of horror.

 

[lostforgottensoul]

but I also get that it's attempting to codify a certain kind of horror.

Which is EXTREMLY hard to do in a few words given the amount of horror in this world!

@dnp im just trying to understand what you are saying is all.

Likely its on my end.

 

[dnp]

Do you think 'immediate threat of' is too exclusive/doesn't encapsulate the kind of situation I'm describing? (To me, that's the more relevant area than catastrophic injury, because there's precedent for the phrase being applied different ways)

Possibly. I would have to do more research and I don't have access to a proper commercial database at the moment, and Google searching on this topic isn't adequate for me.

 

[Ivan the Elder]

Not many descriptive single words in the English language are absolutely definitive with no possibility of modifiable interpretation. Even "immediate" can have a wide range of what constitutes immediacy. If compared to a normal lifetime immediate could easily be taken to mean days, weeks or perhaps even months. If my doctor told me "sorry, but you only have a few months to live" I would consider that to be rather immediate and certainly not prolonged.

A little over a year ago I was locked up in an involuntary psychiatric institution because my doctor was somehow convinced I was suicidal. I wasn't, not in the least and never have been. As he has since told me "It was a huge misunderstanding". While I was in there the resident psychiatrist assigned to me prescribed me a medication, an antipsychotic that was not at all indicated and was dangerous for me to take. I had already had two previous haemorrhagic strokes and such medications can strongly increase the risk for such strokes. I was allowed to refuse the medication and I did. But they continued to include it with the other meds I needed to take, a pain killer and a very mild stimulant because of mild narcolepsy. That dangerous medication was given to me six times a day in the same little cup with others. Every time I insisted that I dump it into my hand and carefully inspect each pill for the proper colour and other printed ID on the pills so there was no chance I would take the dangerous one. This was not easy and they would bring them at night with the lights off, walking with a flashlight while I was sleeping.

They constantly tried to hurry me up and told me to just dump the meds in my mouth, but if constantly refused. I was very afraid that I would mistakenly take the dangerous pill. It would only take a single mistake to increase my risk of having another stroke and the chances of surviving it were low. I told them repeatedly to just not give me the pill because I would not take it but they refused to do that under doctors orders. Within about a week I began to startle badly each time they woke me to take the pills. By the end of two weeks I was startling so badly I nearly fell out of bed a few times.

I was very afraid that I would make a mistake and accidentally take it. This went on for a full three weeks. Near the end the psych assigned to me was changed. In my exit interview it was determined that I had absolutely no psychiatric problems and the new psychiatrist fully admitted that the medication I refused was dangerous for me to take.

I was then diagnosed by my usual psychiatrist a week later with PTSD. Now, was the threat of death in my case immediate or was it even a true threat of death?

 

[dnp]

Immediate threat of vs. threatened: I believe 'threatened' is not specific enough. There is no time constraint.

I pasted this over from the other (main) thread. If someone is taken captive and told they'll be executed in one month, they experience a month of intense distress, and the day before the execution date they are instead released, I'm not understanding how this experience will have less biological impact than someone who experiences intense distress for a few seconds (mugger threatens to shoot them and then runs away and is never seen again).

@joeylittle Can you give me an example of "threatened death" that you don't consider specific enough to biologically cause PTSD? I think that having an example of what you consider a false positive for PTSD will help me to understand your train of thought better, rather than me throwing out a train of false negatives.

 

[joeylittle]

Can you give me an example of "threatened death" that you don't consider specific enough to biologically cause PTSD?

It's a great question - and actually, I can think of one. First: in your example (the person who is captive) - the very nature of captivity means you are living or dying at the whim of your captor. You could be in a mansion, with luxury - but if you are under guard and you are not at liberty to save yourself by leaving - who is to say that the captor will wait the month? The captor is an attacker.

At a certain time within that captivity, you might acclimate, or come to terms with your approaching execution. But (without knowing all the details), assuming you were somehow taken unwillingly and that you are not wanting to die, then I'd say that you could have been under immediate threat of death when you were first taken, or on the day you were told you were to be killed. You were in two moments that could meet the criteria of 'immediate threat of death' - even though you might have acclimated, and lived out the center of captivity under threatened death.

Now, on the other hand, let's say that I'm a college professor, and a student - one who is known for having impulse control problems and has been brought up on charges of violence to peers - becomes so inflamed (I won't reverse their failing grade), that they stand up, say "I am going to kill you, professor joeylittle", and then leave my office. They were very convincing and menacing when they said it. But they didn't lunge at me, they didn't pull a weapon, they did not physically entrap me in any way. They stood up, threatened me with death, and walked out.

I don't think that counts as a Criterion A trauma. I was threatened, but the threat had no immediacy.

If the student had lunged at me and I fell over, and they said 'I am going to kill you, professor joeylittle' - now, the situation has gained immediacy. The sudden movement towards me allows me to believe that he might be saying 'kill you' (present moment), as opposed to 'kill you' (some unknown future moment). And, the immediacy is what creates the belief that I might be killed, and that's criterion A trauma (to me). In that moment, it was possible. That moment could even be longer, or shorter, depending. It's the combination of threat and proximal possibility; fear and time plus actualization or potential actualization.

I also think that's a good example of a scenario where one person might experience it strongly enough to develop PTSD; another might be shaken for three weeks, but have it pass (acute stress disorder), and another might be kind of rattled, but fine. It depends on your background, and your brain. But in the example of no immediacy, if you develop legitimate PTSD from that situation, it's because there's something else in your background that gives you the criteria A - and that moment of non-immediate threat could fire it off.

It's why @Ivan the Elder - and I say this really with utmost respect - I do not think your example of the pills you were given creates an immediate threat of death. For one, there's this:

They constantly tried to hurry me up and told me to just dump the meds in my mouth, but if constantly refused.

You refused, and they allowed you your free will.

Also,

I was very afraid that I would mistakenly take the dangerous pill. It would only take a single mistake to increase my risk of having another stroke and the chances of surviving it were low.

I put the key bits in bold. These are two possibilities, but neither is definitive. Increasing your risk is dangerous, yes - and then, if the risk came to be reality, and you had that stroke, your chances of survival are low - but when you combine the non-distinct nature of 'increased risk' and the non-definitive 'chances are low', you are not under immediate threat of death.

You are (possibly) in immediate threat of catastrophic injury (which is the stroke). It seems medically viable, for a person who has already survived 2 strokes, to be guaranteed a level of catastrophic (life-altering/capacity-diminishing) injury, were they to stroke again. It's tricky, though, because it was under your control; they always let you sort your pills.

Being awoken by flashlights for night meds for a month in a psychiatric hospital where you believed you had no business being: that all by itself more than meets the criteria for Acute Stress Disorder (as they are now defined). And, of course, if there is any other Criterion A trauma in your earlier personal history (which I believe there is?), acute stress disorder could well trigger PTSD - just not for the reasons you proposed.

I'm happy to keep thinking this through, it's very interesting to me, and informs my own situation.

 

[anthony]

If the student had lunged at me and I fell over, and they said 'I am going to kill you, professor joeylittle' - now, the situation has gained immediacy.

Oh master :notworthy:

 

[Ivan the Elder]

Joey, I should elaborate some. The issue regarding the medication was not the only threat to my health, if not my life. I have very bad teeth and could not afford to have them properly repaired. To prevent infection I rinse with Hydrogen Peroxide several times per week and it works very well. While I was there they refused to allow me they do my rinses. Within a week I developed an infection in an upper tooth. I complained about it as soon as I was certain it was infected. They said they would inform a doctor. Every day after that I waited for the doctor to appear. As the days passed the infection became much worse and was heading into the upper sinus area. Once it gets in there it can be very difficult to treat. If it had been treated the day I complained it would have been trivial to treat since the infection is still aerobic. Once in creeps deeper it becomes anaerobic and then requires very powerful antibiotics, some of which I cannot take due to allergy. It took a week for the doctor to show up and by then the infection was at a point where there was real danger of it going into my brain. That is frequently lethal.

They then had to give me an antibiotic that was certain to reduce my platelet count. I already had very low platelets due to Hep C infection for 48 years. Sure enough, the antibiotic reduced my platelets enough that it posed greatly increased stroke risk, the very last thing I wanted or needed.

So, the weeks I was in there presented me with three possible ways to die due to the mistreatment I encountered. On top of all this certain people there were clearly breaking the law in respect of my rights to privacy. The final result of that was the destruction of my 44 years of marriage because of the seriously false information that was given to my former wife. One of the things she was told that she should very much watch out because I wasn't taking my medication. There was absolutely no indication for me to take the medication I refused. This all put me under extreme stress and duress. I knew my wife was being badly mistreated and could do nothing at all to stop it. By the time I was released my wife had already decided she should leave me just in case I tried to kill her, which she had been told by another person in the facility, a person that didn't even know me if they saw me in the hall.

I could sue them all and most certainly win but that goes against my religious belief. So, I now am divorced and must look to a future living alone as I have been doing for a year now. I still love her but it is no longer mutual. In the entire 45 years together I never once touched her in anger and I never would. It isn't her fault but it cannot be fixed.

 

[joeylittle]

I see, @Ivan the Elder - I was only speaking to your description of the pills, specifically - and only because you posited it. But really, that's a complicated time in the ward that you are outlining. It sounds very horrible and clearly was life changing. Sorry to hear you went through all that.