What You Can Change _. And What You Can't - Martin E. Seligman [71]
A Hard-Hearted Caution
What I have presented so far is grim. Extreme trauma reliably produces devastating symptoms that last for years. Lesser trauma produces devastation, but in a smaller percentage of victims. Even minor trauma can produce devastation in some people.
Some are skeptical about these “facts.” Almost all PTSD victims have an ax to grind, critics contend. The “victims” stand to gain from prolonged symptoms. PTSD, interestingly, got its name and diagnostic status in the wake of the Vietnam War. Veterans came home complaining of all sorts of ills and ruin; not only the veterans who were physically wounded, but even the veterans who participated in atrocities—on the delivery, not the receiving, end. A sample of men interviewed six to fifteen years after violent combat in Vietnam now led lives full of problems. They had more arrests and convictions, more drinking problems, more drug addiction, and more stress than veterans who did not see combat. (Before Vietnam, these two groups did not differ.) Men who took part in atrocities were now in particularly bad shape.11 All these veterans receive compensation for combat-related disability, and PTSD is now a reimbursable disability. It is in the victims’ interests, the skeptics say, to prolong their symptoms.
Given our litigious society, this is not only true of veterans. Hector and Jodi are involved in a lawsuit against Norma Sue’s parents. The survivors of the 1972 Buffalo Creek flood in the mountains of Appalachia, from whom some of the most extensive data on chronic PTSD were gathered, were suing the Pittston Company—whose dam had burst and flooded their valley—for many millions as they narrated their stories to social scientists.12
There is probably something to this skepticism. It is hard to estimate the true duration and severity of symptoms among survivors who stand to gain by displaying a severe, prolonged, and ruinous picture. But a similar picture also emerges from victims who have little or nothing to gain: Concentration-camp survivors and rape victims have little more than sympathy to gain, and that hardly seems worth the price of living the life of a PTSD victim.
Therapy
Can there be a therapy for people who have had their lives ruined by “one phone call”? Therapists have tried drugs. In the best controlled study, forty-six PTSD Vietnam veterans were administered antidepressants or a placebo. Some of the symptoms of PTSD relented: Nightmares and flashbacks decreased, but not into the normal range. Numbing, a sense of distance from loved ones, and general anxiety did not decrease. More than a quarter of the veterans refused to take the drugs, and it is not known what happened to the improvement of those who agreed to take the drugs when they were withdrawn. In another study, antidepressant drugs produced some relief, but at the end of treatment 64 percent of the drugged group and 72 percent of the placebo group still had PTSD. Relapse is frequent. Overall, antidepressants and anti-anxiety agents produce some symptom relief for some patients, but drug researchers have concluded that drug treatment alone is “never sufficient to relieve the suffering in PTSD.”13
Several brands of psychotherapy have been tried, one growing from James Pennebaker’s important work on silence. Pennebaker, a health psychology researcher, has found that Holocaust victims and rape victims who do not talk about their trauma to anyone afterward suffer worse physical health than those who do confide in somebody. Pennebaker persuaded sixty Holocaust survivors to open up and describe what had happened to them. They related to others scenes that they had relived in their heads thousands of times over the previous forty years.
They were throwing babies from the second-floor window of the orphanage. I can still see the pools of blood, the screams, and the thuds of their bodies. I just stood there, afraid to move. The Nazi soldiers faced us with their guns.
The Right Treatment
POST-TRAUMATIC STRESS DISORDER SUMMARY