PTSD: Is That All There Is?
I recently did a radio interview following the Sandy Hook Elementary School mass murder, where I was asked about the likelihood of first responders suffering PTSD. I seem to have left many of you (thank you for the emails) with the impression that I don’t recognize the disorder. Even the reporter who conducted the interview was taken aback by what I was saying. I apologize if I wasn’t clear, but here is what I was trying to communicate to you in a 90 second sound bite.
The media and many mental health professionals tend to obsess about PTSD. Do you recall Nietzsche’s message? “What doesn’t kill you makes you stronger”. The “adversity hypothesis”, in psychology, asserts that we need adversity, trauma, and challenges in order to grow, find fulfillment, develop as human beings and find our inner strength (resilience). For many thousands of years the human organism has been confronted with a variety of traumatic stressors, most of which outstrip any of those that exist in modern life. If we weren’t a naturally resilient species we would have perished long ago.
I teach a course on resilience. At the beginning of the course (could be police persons or military personnel) I often ask, “How many have heard of PTSD?” As you would expect almost all the hands go up. Then I ask, “How many have heard of PTG?” Most often the candidates sit with blank looks on their faces, staring at each other.
Just imagine now, if all you know is PTSD and you get tearful and “bummed out” after being exposed to a traumatic or oppressive event – what are you going to think? Of course, you will begin to catastrophize about having PTSD and being condemned to life as an emotional cripple. On the other hand, if you are somewhat psychologically literate and understand that getting upset after a stressful event is a normal, typical reaction and that the usual course of events involves resilience and often post traumatic growth (PTG) – the downward spiral stops.
In an effort to increase your psychological literacy let me share some illustrative data with you:
- Research has consistently shown that from the time of WWI, veterans as a group resume normal lives, are less likely to be incarcerated, have higher education, and generally achieve more success upon return to civilian life than do their non-serving peers.
- Following combat exposure, somewhere between 10-20% of soldiers may evidence post traumatic responses, anxiety, depression, and other related adjustment problems. But the majority (80%+) do not!
- The majority of Viet Nam veterans (70%) appraised the impact of their service on their present lives as “mainly positive”. Over 40% of the veterans felt that the war’s influence was still highly important in their lives.
- The vast majority of Viet Nam veterans are as well adjusted as, or even more successful than, their non-serving civilian peers.
- Studies of enlisted service members in Viet Nam indicate that 10-15% used narcotics, but follow-up assessments back home indicated only an incidence of 1% continuing addictive behaviours.
- A massive study of soldiers and their families in Operation Desert Storm found that 62-73% of respondents felt that they had readjusted to family life within 1 month of returning home; 17-21% had readjusted after several months; and only 8-17% were still adjusting 2 years after returning (single parents predominating this group).
- A survey of US Army spouses indicated some 58% believed that deployment had strengthened their marriage; 31% believed it had no effect; and only 10% felt it had weakened their marriage.
- Although deployment can be quite stressful, these studies have shown that many families report that outcomes have included the development of new skills, new competencies, a greater sense of independence, and self reliance.
- Children in military families are typically resilient even after experiencing significant trauma and family deaths.
The evidence for resilience following trauma exposure is evident in civilian populations as well. Several researchers have reviewed data from Holocaust survivors, bereaved individuals, cancer and HIV/AIDS survivors, torture victims, victims of sexual abuse, rape, and survivors of terrorist attacks and natural disasters who exhibit remarkable resilience. Over time, many of these individuals report that their lives have improved as a result of these traumatic exposures. These outcomes have been characterized as “post traumatic growth”.
Two outstanding examples highlight the pervasive incidence of resilience following traumatic exposures. (In the US it is estimated that 50-60% of adults have been exposed to a traumatic event; but only 5-10% have developed a post traumatic response or related clinical problems). Following the September 11, 2001, terrorist attacks in New York City, only 7.5% of Manhattan residents manifested clinical problems, and this decreased to less that 1% at 6 months. The residents of London England demonstrated similar resilience following the subway bombings of July 7, 2005. Less than 1% of those directly affected enlisted professional help. Victims from these two examples, like most of us, turned to natural social supports, and their faith for comfort, support, and healing.
It can safely be said that following exposure to traumatic events most people will readjust successfully. Resilience is the rule not the exception! Moreover, resilience is not only not unique but also not a sign of exceptional strength. It is a fundamental feature of normal coping and has been called by one researcher, “ordinary magic”.
With regard to “coping styles”, they are very personal and incorporate a wide range of effective strategies some of which are frowned upon by some mental health professionals; such as denial, egocentric bias bordering on narcissism, repression, blind faith in one’s own ability to cope, and smiling or laughing through the post incident phase. A leading researcher/therapist in the area of resilience has termed this, “coping ugly”. It seems that some people may not do what some mental health professionals think they should to process the trauma, but it works for them. Interfering with these natural coping abilities and telling people what they should be doing, may in fact do more harm than good.
I’ll conclude by quoting one of the above noted authors, “Sometimes the worst does happen, but our innate capacity to bounce back means that most of the time things will turn out alright”. I wonder why we don’t get this side of the story from mainstream media?
Dr. Mike Webster, R.Psych.