When a counselor told me I was exhibiting symptoms of post-traumatic stress disorder, I said that that was absurd.
After a reporting trip that involved witnessing sexual violence-related incidents and being sexually harassed and threatened, I had the symptoms: crying, gagging, flashbacks. Panting, panicking, nightmares. As the weeks went on, and I didn’t get better, shaky all the time—all the time, whatever I was doing, and I didn’t want to get out of my bed or even from under the covers, though staying there afforded me little relief— my counselor kept reminding me in successive sessions that it was all just the normal course of a not ideal but perfectly common response to a terrible thing.
“You have PTSD,” she would say.
“I don’t see how that’s possible,” I would say, though I could match my symptoms to the DSM’s [Diagnostic and Statistical Manual of Mental Disorders] criteria plain as day. PTSD was for veterans. For people who had seen a lot of people killed, and who had nearly been killed, or for people to whom other actually terrible things had happened. I kept shaking my head. “That just doesn’t seem right.”
Psychological trauma is an experience or witness of threatened or actual death, serious injury, or sexual violence.
Though these scenarios are generally associated with feelings of extreme fear and helplessness, a victim needn’t experience them or even be in danger to become traumatized; emotional disasters, such as the death of a loved one, can also produce traumatization. Further, hearing about any of the above happening to a loved one can be traumatic, as can being consistently exposed to details about any of the above for work. Post-traumatic stress disorder is simply a nervous system’s inability to return to its normal baseline after the trauma is over, a body perpetrating or suppressing memories of the incident long after the fact and firing life-or-death stress when those reactions or survival mechanisms are no longer necessary.
It’s actually pretty straightforward. But given trauma’s complicated relationship with the world, and even within psychology, the discipline to which it belongs, perhaps some understanding could be extended to my profession for its lack of openness and regular conversation about it. (One might feel less generous toward the Committee to Protect Journalists handbook at the time for not including a word about sexual harassment and sexual violence on the job.) In a 1992 book that was crucial—to psychology, to humanity— clinical psychiatrist Judith Lewis Herman documents how political and controversial the very study of trauma is and always has been. Because, she explains in Trauma and Recovery, it can’t be done without naming and confronting the people who perpetrate it and acknowledging its victims’ experience. Without belief in victims’ stories and self-reported symptoms—and an investment in their fate—the study can’t exist. Unfortunately, given the frequent demographics of oppressors and the oppressed, one key to the study’s advancement has been one of the least credible and most dispensable populations of all: women.
Ugh, women. Plaguing society with their hysterics. In Freud’s day, the young Sigmund vowed to solve the mystery of what made them act so crazy. Incredibly, after hundreds of hours of diligent, sensitive interviews, he figured it out. In a breakthrough 1896 paper, he announced that he had finally determined the root of the severe psychological symptoms of the women he was treating. It was one no one had anticipated, and no one turned out to want to know.
It was sexual abuse. Hysteria wasn’t an innate psychological weakness, Freud found, but a result of horrors inflicted on its sufferers. According to his studies, the strongest, smartest minds were susceptible to it. In fact, one of his books posited that they were especially susceptible to it. His argument and evidence encapsulated the same findings of some of the best research done today. It was not well received.
Given the prevalence of hysteria, the implication of Freud’s work was that someone, a lot of someones, were sexually molesting women and children, at all levels of society. Statistics would bear that out to be the case a hundred years later, of course, but the Establishment didn’t seem to be ready for it. (Still, many people aren’t; in the course of fact-checking this book, my researcher interviewed a prominent scholar who maintained that molestation was an exceptionally rare occurrence that almost never happened to anyone, ever.) It certainly didn’t embrace it. It wasn’t until Freud switched course, finding that the origin of his patients’ sickness was inside them rather than in their surroundings, that he was on the path to eternal fame. His original theories are as good as forgotten.
As Herman explains, there’s good reason to befuddle and forget and muddy the conclusions of trauma studies, challenging the world order as real results do. War: Was there any justification for subjecting people to it? Women and children: Should they not be voiceless slave-toys? When trauma studies don’t find that the fault lies with the victim, and when they create space for those victims’ realities to be validated, an entire society becomes responsible. More specifically, usually, men do. And so the study was picked up for a time here and there with new wars and new waves of feminism but then, until recently, abandoned again as quickly as possible.
Psychology got it together, in the face of a flood of Vietnam vets experiencing persistent mental issues, to make PTSD an official diagnosis in the DSM in 1980, uniting soldiers on the same page with traumatized civilians—who’d previously been assigned labels such as “accident neurosis” and “rape trauma syndrome.” Psychologists started to note that the symptoms were similar regardless of the cause. But popular awareness failed to follow suit.
Certainly, I had not learned in school, or at work, the signs that you’ve experienced something that has affected you seriously or might precede a nervous breakdown. It is a true testament to national ignorance about PTSD that before I was diagnosed, I’d never heard of the concept but in passing reference to soldiers. It’s not a testament just because at least 4 billion people in the world will survive a trauma at some point of their lives, or because 89.7 percent of Americans are exposed to trauma by the DSM-V’s definition, and an estimated 9 percent of those develop PTSD. Or because being in a war isn’t even close to the most common cause of PTSD in America.
Violence against women—including sexual assault and domestic abuse—is.
Sexual violence against men shouldn’t be discounted either. Among men, the rate of PTSD for rape survivors was 65 percent, versus 31 percent for in-theater Vietnam veterans. (For women, the rate was 45.9 and 27 percent, respectively.) Looking at rape victims or veterans alone was enough to overwhelm someone, and they weren’t the end of the epidemic. At least 30 percent of children who’ve suffered sexual abuse develop PTSD. Thirty-five percent who are exposed to violent neighborhoods. As many as 2.9 million American kids are abused and neglected a year, and PTSD drops an abused kid’s verbal IQ by 30 percent, with the fear centers of their brains overdeveloped and self-care, self-understanding, and self-reflection centers underdeveloped—their symptoms severe and specific enough that there’s a movement to get developmental trauma its own designation in the DSM. Ninety percent of “juvenile delinquents” have been exposed to trauma. Thirty percent have PTSD. A large proportion of the national prison population does, too.
I once read a study that found a PTSD rate of 21.6 percent in venomous-snakebite survivors. Among the civilian population, car accidents also top the list, and they could happen to anyone.
But the reason my ignorance was a testament to overall national PTSD ignorance isn’t just because of its commonality. It’s because I’d been part of one of the more collectively traumatizing civilian events in living American memory: Hurricane Katrina.
Natural disasters, unsurprisingly, are a reliable source of PTSD. New Orleans after the storm, where I was working, living, and going to grad school at the time, was like a case study of it.
There’s the horror of a disaster itself, but also the sense of continuing, imminent danger. In New Orleans, with tens of thousands of homes destroyed and nearly 2,000 dead, we were reminded, with every step down the street, that the Earth we walked on could not be trusted. And as it turns out, New Orleans then was, literally, a case study of PTSD.
Harvard and Columbia University researchers descended dutifully upon the city, finding that about a quarter of the population was exhibiting symptoms—a rate that for, say, measles would qualify as a full-scale public health crisis. On the ground, we heard nothing about it. I even participated in a study, conducted by I don’t know whom, in which I answered a survey about whether I was drinking more, crying more, exercising less and eating worse food, getting fatter because I was depressed or displaced, and/or losing my will to live. (I wasn’t.) The researcher had recruited us through someone at the university, but didn’t bother sending us the results. We heard nothing of the assessments people were making of us, unless we went academic-journal searching for them, much less how to get help for a serious but treatable condition. There were public health notices not to drink the water on certain days, but I never heard any suggesting that we should be on the lookout for symptoms of trauma.
And so, no one was. And almost no one did get treatment. Nearly two years later, in 2007, when the East Coast researchers checked back in on New Orleans’s psychological progress, they found that there was hardly any. Further, they found that, though PTSD rates almost always decrease within two years of such an event, Gulf Coast residents overall had gotten worse, regardless of race or sex. More than six percent of the population’s members were actively thinking about killing themselves. Two and a half percent had a suicide plan. Statistics in 2008 and 2009—three years after the storm, four years after the storm—would later bear out suicide rates 56 percent higher, then 85 percent higher, than those before Hurricane Katrina.
It’s not possible to start recovering from trauma, they say, until a sense of security and safety has been established. And everyone knows how the rebuilding of the city and levees was going.
“The majority of people in that one-year and certainly the two-year window’s time recover,” the Harvard Medical School principal of the post-Katrina PTSD studies said, “and in very bad situations you fail to find that, that there is not as much recovery or in some extreme cases no evidence of recovery. But we virtually never find an increase, and we are finding a doubling in the prevalence of PTSD in most of the area affected by Hurricane Katrina,” he said. “That’s really quite striking.”
It really is. Compare it, for example, with the other biggest traumatic domestic event in recent history: September 11, 2001.
Five to eight weeks after the World Trade Center attacks, researchers found that incidences of PTSD in New Yorkers who lived close to Ground Zero reached 20 percent. That’s around the same as New Orleanians’ after the storm. Six months later, though, researchers (some of whom also conducted New Orleans studies) found recovery rates of 30 percent in the city in general. And they found “resilience” rates—that is, people whose mental health improved beyond mere recovery—of 65 percent. Even among the most exposed and largest PTSD populations—people who had a friend or relative killed and saw the attack happen; were physically injured in the attack; or were in the World Trade Center—recovery was between 20 percent and 40 percent. Their resilience was between 30 to 50 percent. Like other PTSD survivors, these New Yorkers would be susceptible to their symptoms recurring later in their lives, from continuing fallout from the original event (which caused health problems, job loss), under great stress or after death or divorce, new traumas that can agitate old, even healed PTSD indefinitely. But a surprising number of them had rebounded. Politicians hailed it as a triumph of human spirit.
Of all the things New Orleanians have been accused of, lacking spirit has never been one of them. So what accounts for the disparity, then? One quantifiable difference in the disasters’ aftermaths was logistical and professional support: After 9/11, crisis counselors provided more than 40,000 free sessions to troubled New Yorkers in five months; the fire department sextupled the number of full-time counselors; employers and community centers offered therapy. In New Orleans, some people weren’t even delivered food and water for as many as five days. After the flood had been drained and the residents returned, the barely functioning city eliminated nearly a quarter of its inpatient psychiatric beds.
But another major difference was social. As Bessel van der Kolk, one of the nation’s preeminent trauma specialists, has pointed out, after 9/11, most of New York still looked like New York—a reasonably safe place to live. People retained, and returned to, their homes. After Katrina, with so many communities destroyed, communities couldn’t band together, with many residents dispersed for months, or forever. They also lacked a wider kind of cultural support: Following 9/11, New Yorkers were represented in commercials and newspapers and political speeches as heroes. Survivors of Katrina? They were hapless victims. Sad, sweating, standing helplessly on a bridge or roof or sidewalk waiting for a helicopter or a bus. Or worse, criminals. They looted, and later, when the crime rate skyrocketed, people didn’t think about how New Orleanians had been failed by emergency services and the Army Corps of Engineers and leaders of various levels of government both during the storm and long before, but shook their heads at the poor, or black, animals who didn’t know how to behave in an end-of-their-world scenario and made bad life decisions—to not leave the city earlier; to be poor in the first place.
As New Orleanians returned and walked around an Armageddon whose levees had been compromised—and remained that way for years—certain to have everything leveled again if another big storm came through, they were not nationally celebrated, or congratulated for having survived.
If validating the experience of the traumatized requires regard for the victims and the culpability of responsible parties, in the case of poor, Southern, mostly black New Orleans versus a New York City besieged by brown terrorists: trickier on both counts. And validation is another crucial component of healing. So after Katrina, not only was the first requirement for healing—security, safety—not in place, neither was the second.
When I got home from my tough reporting trip, with PTSD, having reestablished safety behind the two double-locked doors of my apartment in beautiful, highly structured San Francisco, my counselor mounted a one-woman validation campaign. It’s OK to have PTSD, she kept telling me. Your symptoms are normal for PTSD.
I did not believe her. A year later, I would have Herman’s Trauma and Recovery always on display at my house so I could look at it, and sometimes touch it, to remind myself that trauma is a real thing and that my symptoms, weird and outlandish as they seemed, were literally textbook. Later, I would go digging through libraries of universities I didn’t attend and see the similarities to traumatized Civil War vets, but for now, I felt like an overdramatic emotional freak show. My counselor was a single voice, and one I was paying to talk. I’d seen the world react to traumatized people before, even if I hadn’t known what I was looking at, and I’d learned that even a great national catastrophe wasn’t an acceptable excuse to fall apart. As far as I could be convinced, there was no space for accepting my meltdown in my culture.
“Nothing bad ever even happened to me,” I said, over and over.
“OK,” she said, shifting in her seat in a way that struck me as frustration.
“If you drew a picture of what happened to you, it might not look that bad.”
OK. If I did that, in one picture, from the recent trip, I’d be backing away from a guy in a wifebeater in a tiny concrete room with a closed door after he’d lied to me and said he was taking me to interview sources. In another, there’d be the horrific events I’d witnessed. In a thematically related frame, perhaps, I’d be sitting alone in the dark in the middle of the American Southwest, on another recent reporting trip, with several enormous drunk men with fight scars holding Budweiser cans while one of them was sliding his hand up my thigh.
OK. Maybe those would look bad even as illustrations. Maybe as a series, they’d justify why it was reasonable for me to have developed a conditioned response of fear and terror that refused to turn itself off. Either way, there was no protocol in my community for supporting a person with PTSD; nobody was going to bring me casseroles or send me cards and flowers. But my counselor insisted that just because my culture didn’t acknowledge it, one seemingly small, isolated incident could be plenty to give a person crippling PTSD. No matter what she said, though, I couldn’t agree that I had earned the diagnosis.
Excerpted from Irritable Hearts: A PTSD Love Story by Mac McClelland. Copyright © 2015 by Flatiron Books. Reprinted by permission.