What You Can Change _. And What You Can't - Martin E. Seligman [70]
When a woman is raped, her first reaction is called the phase of disorganization. She shows one of two emotional styles: expressive—fear, anger, crying; or controlled—a calm exterior. The symptoms of PTSD usually soon follow. As many as 95 percent of the victims may show PTSD within two weeks.7 The victim relives the rape time and again, in waking life and in dreams. Sleep disturbance, both trouble getting to sleep and sudden awakening, sets in. Ms. T. woke up screaming out of deep sleep for months after the rape (in which, you will recall, her assailant woke her out of deep sleep). Rape victims startle easily. Ms. T., a year and a half later, still startled when male strangers talked to her. Normal sexual activity is hard to resume, and a total phobia about sex sometimes develops.
Most victims go through the phase of disorganization and, in time, enter reorganization. They change their phone numbers and where they live. They read about rape, write about their experience, and become active in helping other victims.
Four to six years later, about 75 percent of rape victims say they have recovered. More than half of these say that recovery occurred in the first three months, the rest say within two years. Victims with the least fear and the fewest flashbacks in the week following the rape recover more quickly. The very distressed or benumbed victims have a poor outcome. The degree of violence of the assault and how life-threatening it was also predict long-term outcome. The worst news is that 25 percent of rape victims say they have not recovered, even after four to six years. Seventeen years later, 16 percent still had PTSD.8
Severity of the objective circumstances is not that good a predictor of PTSD in either rape or physical injury. In a study of forty-eight victims of severe physical injuries, the severity of the injury did not predict who got PTSD, and it did not predict the amount of distress. Rather, how much psychological distress they felt after the injury predicted PTSD.9 PTSD should, I believe, be defined by the reaction of the victim and how long it lingers, not by the objective “extraordinariness” of the loss. A better criterion is “Do they believe it ruined their lives?”
Vulnerability
As you read this chapter, your reaction is probably like mine as I wrote it: “Please, God, not me.” Your risk of enduring some truly catastrophic event is very small. But your risk of experiencing rape or a child dying or the death of your spouse is larger. And even if you escape these, a few people succumb to PTSD from lesser traumas like lawsuits, divorce, mugging, prison, and job loss. There are expert opinions as to who among us is particularly at risk.
Psychologists comb disasters looking for the people who survive them well, without signs of PTSD, and those who crumble most readily. Here is what they have found:
A prior life history free of mental problems predicted who did best after a catastrophic factory explosion in Norway.
Among 469 fire fighters caught in a disastrous Australian brushfire, those most at risk for getting chronic PTSD scored high on neuroticism and had a family history of mental disorders. These were better predictors than how much physical trauma each one experienced.
After the Lebanon war, Israeli combat casualty veterans who were the children of Holocaust survivors (called “second-generation casualties”) had higher rates of PTSD than control casualties.
Among Israeli combat veterans of two wars, those who came down with PTSD after the second war had more combat-stress reactions during the first war.
What can be concluded from this is that people who are psychologically most healthy before trauma are at least risk for PTSD. This may be of some consolation—if you are lucky enough to be one of those people. But if the bad event is awful