This story discusses suicidal ideation and sexual assault. If you or someone you know is contemplating suicide, please call or text the National Suicide Prevention Lifeline at 988.

If you’ve been sexually assaulted, you can call the Rape, Abuse & Incest National Network helpline at 800-656-4673 or chat with someone from RAINN online at https://hotline.rainn.org/online.?

LOUISVILLE — At age 17, Jeremy Harrell was helping senior citizens fill their grocery store orders when it snowed.?

Six months later, he was learning to kill.?

And that’s where post-traumatic stress disorder starts for a lot of soldiers, Harrell said: at boot camp, when the values they were raised with are replaced.?

But the disorder can look different person to person — and much more than war can trigger it, ?therapists who treat the condition told the Kentucky Lantern. Even seeing something traumatic happen to someone else can lead to PTSD.?

Car wrecks can cause it, as can home invasions, threats and sexual violence.?

The latter caused Caroline Wormald’s PTSD.?

She was a first-year undergraduate at Northern Kentucky University studying psychology, when a stranger she’d just met on a dating app?sexually assaulted her in her dorm.?

She was 19 when it happened — in March, right after Spring Break 2019.?

The flashbacks started as Wormald underwent an exam in the emergency room shortly thereafter. They joined with nightmares to keep her awake at night. ?She lives with symptoms of PTSD to this day.

Clinicians who treat post-traumatic stress disorder in Kentucky said PTSD is a complicated condition and can feel quite isolating – statements that are true in Harrell and Wormald’s cases.?

Natasha R. Porter, the CEO and clinical director of Beacon of Light Behavioral Health, said PTSD develops when a person’s brain is exposed to something that it cannot process nor move past.?

The brain gets “stuck,” she said. “And that’s why we have the nightmares and the flashbacks and all the emotion surrounding it.”?

Porter, herself an Army veteran, said it’s important to note that PTSD isn’t restricted to soldiers, though many do experience it.?

The United States Department of Veteran Affairs says that veterans are more likely than civilians to develop PTSD, especially if they were deployed. However, around 6% of the general population experiences PTSD at some point in life, according to the VA.?

That number jumps to 8% among women, who are more likely to experience sexual violence.?

Jeremy Harrell’s story?

Louisville’s Harrell, an Army veteran who served both stateside and in Iraq from 1999 to 2008, was diagnosed with PTSD after he returned to civilian life.?

But the journey to a diagnosis — and to accepting it — wasn’t a direct one.?

For Harrell, the journey to diagnosis took five years. It was that long before he knew something was off.?

He turned 21 while serving overseas. When he came home, he thought all the changes in his life were because he was older. He wasn’t happy — ever. He didn’t enjoy the same things he did before, he forgot information and struggled to stay awake in work meetings.?

“I guess this is kind of part of maturing and becoming a man,” he recalls thinking. “I just assumed that everybody else was in the same boat.” He had a young child at home and another on the way. This was all part of that, he reasoned.?

He finally went to Veteran Affairs for evaluation. Mostly, he said, he wanted to prove everyone who thought he had PTSD wrong.?

He did not.?

“Looking back, I’m glad that they evaluated me for all these things. That’s a blessing, to be evaluated,” he said. “But at the time, it was demoralizing and I felt like my whole world had collapsed.”?

The testing process made him feel like a “hamster in a cage,” he said. He felt exposed, broken.?

Depression took over, leading to suicidal thoughts so he wouldn’t “be a burden to my family.”?

“It’s really a terrible, terrible space,’ Harrell said. “I wouldn’t wish it on my worst enemy.”?

Finally, a light.?

Harrell decided to approach his PTSD like a war. “I thought: ‘if I’m going to win against this enemy, PTSD … then I must learn all I can about it.’”?

He decided to use his story to help fellow soldiers so that “maybe, just maybe, they won’t have to suffer in silence for a decade before they realize something’s wrong.”?

He founded Veteran’s Club, which is based in the Louisville area and advocates for mental health through a variety of programs. Now, he’s a well-known advocate for mental well-being in Kentucky.?

Caroline Wormald’s?story?

Wormald went to NKU’s Norse Violence Prevention Center?shortly after the assault in 2019 and reported the incident to the school, which she said was quite supportive of her during the process.?

The center’s staff helped guide her to the hospital and to the police, she said.?

She also got free weekly therapy through NKU to help cope with the flashbacks and other fallout of the assault, she said.?

Through that therapy, she got a post traumatic stress disorder diagnosis.

“I definitely felt like my sense of safety was interfered with, especially the night it happened because he was a complete stranger,” Wormald said. “I was afraid he was going to come back.”?

Wormald suffered from flashbacks and nightmares, as well as “terrifying” hallucinations.?

“I’d wake up in the morning and I’d be full on hallucinating and I knew I was but it was terrifying,” she recalled. “I had a guitar at the time … one morning … I woke up and I just saw him there and for a second I thought it was real. So … I went and … I leaned over and tried to punch him and I punched my guitar at, like, seven in the morning.”?

She missed classes and school from sleep issues — waking up from the nightmares, exhausted. It was difficult to get out of bed until everyone was awake in the dorm and the lights were on. Sleep medication finally helped her rest.?

Four years later, Wormald plans to return to NKU this fall as a law student and plans to use her experience to fight for others.?

“I want to work with families and people like me who’ve had situations similar to mine,” she said, “and just … be an advocate and stand up for them in regards to the legal system.”?

The COVID-19 effect

After her assault, Wormald socially isolated herself. She didn’t make new friends and became “petrified of strangers, but specifically men.”?

COVID-19 only exacerbated that.?

“I was isolating myself even before COVID happened,” she said. “And then with COVID happening, it just made it worse. Now I had a general reason, really, not to put myself out there.”?

The pandemic was “detrimental” to the veteran community as well, Harrell said.?

Similarly to Wormald’s experience: “It gave veterans who tend to isolate a justification to do so.”?

Kentucky got its first case of COVID-19 in March 2020. Massive shutdowns and physical distancing defined much of that year — and the next couple.?

The national emergency declaration ended in May 2023, but the virus is still present.?

So, too, is the continued fallout: educational setbacks, child welfare concerns, workforce challenges?and mental health struggles.?

“I know everybody wants to say, ‘COVID is over, quit talking about it,’” Harrell said. “But the reality is: that was a very, very serious event that lasted a long time that will forever have residual effects on our society and individuals.”?

What’s the treatment for PTSD??

Because PTSD looks different person to person, so does treatment. Common treatments include eye movement desensitization and reprocessing (EMDR) therapy, and cognitive behavioral therapy (CBT or talk therapy).?

Brothers and clinicians Travis and Anthony Andrews said PTSD can sometimes find its roots in gun violence and its effect on neighborhoods.?

Together they founded Andrews Counseling & Consulting, and also work with One Lexington, which is part of the mayor’s office and seeks to address violence in Fayette County

They said talk therapy is the main way they treat it. But, they said, to truly address PTSD requires a much more holistic approach.?

Thinking holistically about PTSD?

While a lot of people hear “PTSD” and think of acute trauma — one traumatic event or incident — there are more layers, Travis Andrews said. There is also chronic trauma, such as domestic violence or other abuse that happens over time. Finally, complex trauma features multiple traumatic events.?

“What makes this very prevalent is the fact that a lot of these traumas have been left untreated,” he explained. “So it’s no different than us going to a medical doctor and we have an ankle injury at age 4, 6, 10 and we never got that treated … and now we will be going into the doctor five or six years later saying ‘hey, can I get some rehabilitation on my leg?’”?

He also sees misdiagnoses when it comes to children with PTSD because of poverty, socioeconomic status, gun violence or other social-ecological factors.?

“People are not getting their basic needs met,” Travis said. “They’re living in a day to day not knowing how they’re going to eat, seeing domestic violence in their household, seeing all these negative incidents that they’re living with daily, which will result (in) other criminal activities.”?

Generational trauma and oppression can also result in PTSD and untreated stress, Travis said, because trauma becomes the accepted normal.?

“We think about oppressed communities … majority communities of color who have been subjected to discrimination, harsh living conditions, things of that nature,” he said. “These communities have been taught just to have a level of resilience. So what does resilience look like? Sometimes that means avoiding the problems. … So that means a person is left untreated.”?

Fighting a ‘debilitating stigma’?

Porter sees stigma constantly when treating PTSD — and exaggerated depictions in films and on television only make it worse.?

“The stigma is there and it’s horrible,” she said. “And it’s debilitating, honestly.”?

Anthony Andrews said mainstream films that show mental health as horror, as a person escaping a psychiatric ward and terrorizing their community, only hurt real people who have PTSD.?

“The media plays a huge part because what they show is going to be how people connect,” Anthony said. If movies and news only show PTSD as it relates to mass shootings, he said, “‘well, people only have PTSD when they experience mass shootings.'”?

If it’s depicted only in war movies, then, he said, people will believe “‘this is what PTSD looks like.’”?

In military circles, Porter’s heard PTSD called weak. But nothing could be further from the truth.?

“Think of your worst nightmare,” she explained. “(Imagine) the worst time that you’ve ever had, and imagine it replaying in your mind all day.”?

That’s what PTSD feels like, she said. And it sometimes drives some to think of ending their lives.?

“Suicide happens because they feel trapped,” she said. “And they don’t feel like there’s another way and they feel like a burden.” But, she said, there is always hope. Therapy can help.?

Harrell hears that suicidality a lot in his advocacy work with fellow veterans now.?

But: “That’s just a transference of pain from the person who committed suicide to their family,” he said. And: “I can assure you: the worst day with you is much better than not having you.”?

Policy opportunities?

To truly address PTSD through policy, the Andrews brothers said, lawmakers must look at those ecological factors and find ways to incorporate treatment into culture. What would it look like, they wonder, if whole campuses — professors, coaches, cafeteria workers — spoke through trauma-informed care??

Policymakers should look at ways to increase funding for mental health care and access to it, they said. Workplaces should also offer broad accommodations for mental health conditions.?

So many people have anxiety, stress and PTSD, the therapists said. Because of that, they said: everyone should have equal access to treatment and mental health care.?