What You Can Change _. And What You Can't - Martin E. Seligman [69]
There are some clear cases of what counts as a loss “outside the normal range of human experience”: spending years in a concentration camp where you are forced to aid in the killing of fellow prisoners, watching your child be tortured, being the only survivor in your family of a collision with a truck, living through a catastrophic flood that decimates your community, being pinned down in a foxhole for days surrounded by corpses, being kidnapped and held hostage. Such horrific experiences routinely produce PTSD.
Dora, a Polish Jew, was sent to Auschwitz with her husband and three sons after the uprising in the Warsaw ghetto. Her husband and her baby perished in the first few hours, but she lived on until the end of the war, watching her two other sons worked to death; she survived by giving sexual favors to camp guards. Dora found her way after the war to distant relatives in Pittsburgh.
An old lady now, she has not recovered. She has never worked, and she stays in her attic room listening to classical music most of the time. When she goes out, the sight of men in uniform—policemen, even mailmen—frightens her. She thinks constantly of her dead family and feels guilty that she lived and they died. Her contact with the present is minimal. Every night she dreams of her baby burning to death in an oven. It has been forty-five years of life in Auschwitz.
Prisoners of war can show lifelong symptoms of PTSD. Forty years after captivity, 188 World War II POWs underwent diagnostic interviews in Minneapolis. Sixty-seven percent had suffered PTSD during some of the previous forty years. Of these, nearly 35 percent still had moderate or severe symptoms, and 40 percent still had mild symptoms.4
If PTSD were only about the clear cases, like Dora’s and like the POWs’, it would be of interest only to specialists and to voyeurs. But PTSD, I believe, is much more widespread and is set off by more commonplace losses than the diagnostic criteria allow. I believe that the objective definition of “extraordinary” loss masks what takes place in the minds of the victims; what takes place does not reside in the objective awfulness of the event.
Bad things, though maybe not as objectively awful as the horrors above, happen to most of us. Some of us react to our losses with resilience. After a few weeks we go about our lives, look for a new family, a new job, a new country, or a new reason for living. Many others of us are more brittle. Major loss changes our way of looking at ourselves and the world forever. We find ourselves beyond consolation. Most people, living through what Dora did, would suffer PTSD. But many people endure the same symptoms when a child dies suddenly. Some people suffer it when they are mugged or raped. And a few surfer it when they are abandoned by a spouse or, merely, sued.
The Rape-Trauma Syndrome
Rape is distressingly frequent in our society. About 100,000 rapes are reported every year, and possibly seven times as many go unreported. As many as one out of every three to five women will be raped in her lifetime.5 Rape is even more frequent in poorer societies. Using “extraordinary” as a criterion, rape, and the death of a child as well, would not qualify for PTSD. But it is clear that the death of a child usually, and rape sometimes, set off just the same symptoms as war, torture, and earthquake almost always do.
Ms. T., twenty-eight, was asleep in her apartment when she was awakened by a man with a knife. He told her not to turn oyer and look at him, and threatened to kill her if she fought. He then raped her and fled. Ms. T. reported the crime, accepted physical help and psychological counseling, and even volunteered for work at a rape-crisis hot line.
She showed full-blown PTSD. She was afraid to fall asleep and for a month could only sleep at friends’ homes—even then, only in daylight. She had nightmares in which she relived the rape. She had a pervasive fear of being watched by the rapist whenever she went