What You Can Change _. And What You Can't - Martin E. Seligman [68]
So devastating and long-lasting are the effects of extraordinary loss that it has finally been given a name and a diagnostic category of its own: post-traumatic stress disorder (PTSD). No jargon, no euphemism, no psychobabble, can camouflage that this is the saddest disorder of them all. Distress is universal. Many—but, assuredly, not all people—display the hallmarks of PTSD for months or years afterward:
Reliving: The victim persistently relives the trauma in dreams or in intrusive flashbacks (or has the opposite reaction: He can’t recall the event). Not a day went by for years afterward when Hector and Jodi did not ruminate about Tommy’s death. They both repeatedly dreamed variations on Tommy’s death.
Anxiety: The victim avoids anything connected with the trauma. He has difficulty falling asleep and staying asleep. He can’t concentrate. He startles easily. He becomes passive and continually anxious. Hector couldn’t bear to talk to anybody about Tommy, and he jumped whenever the phone rang.
Numbness: The victim becomes numb to life. She may feel detached and estranged from people. She may lose the ability to love anybody. Jodi quit her job, Hector lost his ambition, and their marriage fell apart.
The worst of the common tragedies is, by all statistics, the death of a child. Each year in the United States, 150,000 people are killed accidentally. Accidents are the number one killer of children. Thus there are hundreds of thousands of parents in our country today bereaved by the worst loss of all. Unexpected death of a spouse is a close second.
Bereavement: Common lore tells us that it is difficult, but that time heals all wounds. Doesn’t it? Only some wounds, it turns out. When your spouse of many years dies, bereavement takes a predictable course: six months to two years of mourning, sadness, even depression, and an elevated risk of death yourself. And then, your life poorer, you pick up and go on. Not so for extraordinary losses.
It used to be thought that victims recovered briskly. Among the first psychiatric studies of the aftermath of disaster was one that focused on the Cocoanut Grove nightclub fire of 1942. Interviews with the survivors and the families of the dead led to an optimistic picture. An “uncomplicated grief reaction” was supposed to dissipate in four to six weeks.2 This has remained the lore ever since. When people take longer than a few weeks to adjust after their lives have been devastated, it is considered “abnormal.” In order to qualify for a certified diagnosis of PTSD, the symptoms have to last at least one month.
Dr. Camille Wortman, a social psychologist, has single-handedly changed the lore. She went through the microfilm records of every auto fatality in Michigan between 1976 and 1979. She randomly chose thirty-nine people who had lost a spouse and forty-one couples who had lost a child. She interviewed them at length and compared them to matched controls.
The parents and the spouses were in decidedly poor shape four to seven years later: They were much more depressed than the controls, were less optimistic about the future, and did not feel good about their lives. They were more “worn-out,” “tense,” and “unhappy.” More of them had died than had the controls. While they had not differed from the controls in income before their child died, the bereaved parents now earned 25 percent less. Twenty percent were divorced (versus 2 percent of the controls). The bereaved people were just as bad off seven years later as four years later, so there did not seem to be a natural healing process at work.