What You Can Change _. And What You Can't - Martin E. Seligman [72]
The interviewers had nightmares after hearing these long-buried stories, but the health of the disclosers improved. Similarly, Pennebaker persuaded students to narrate their secret traumas—sexual abuse by a grandfather, the death of a dog, a suicide attempt—in writing. The immediate consequence was increased depression. But in the long run, these students’ number of physical illnesses decreased by 50 percent, and their immune system strengthened.14
Prolonged exposure is the therapy that follows. In exposure treatment, victims relive the trauma in their imagination. They describe it aloud, in the present tense, to their therapist. This is repeated session after session. In the best-executed study of exposure treatment, Edna Foa, a pioneering behavior therapist, and her colleagues treated forty-five rape victims who had PTSD. They compared this treatment to stress-inoculation training, which includes deep muscle relaxation, thought stopping for countering ruminations, and cognitive restructuring. Another group received supportive counseling, and a fourth group received no treatment.
All groups, including the no-treatment control, improved. Immediately after the five weeks of treatment, stress-inoculation training relieved PTSD symptoms most, but after another four months, exposure had shown the most lasting effects.15
Psychological treatment, then, produces some relief. But one-third of all PTSD patients refused treatment or dropped out, and the PTSD and depression symptoms were still well above normal after treatment.16
But there is hopeful news from an ongoing study of Foa’s. She is finding that the combination of stress inoculation and prolonged exposure produces very good results. After five weeks of treatment (nine sessions), 80 percent of the victims were no longer showing PTSD, and symptoms were markedly reduced. No significant relapse was found. These new findings are the best outcome yet for rape patients. If replicated, they should encourage victims, who are usually quite reluctant to pursue treatment because they want to avoid thinking about the rape, to seek out this treatment promptly.17
Overall, the results for both drugs and cognitive-behavioral therapies are encouraging and call for more research, but with the exception of new cognitive-behavioral treatments for rape victims, these gains are very modest: some symptom relief, but many dropouts, and almost no cures. Of all the disorders we have reviewed, PTSD is the least alleviated by therapy of any sort. I believe that the development of new treatments to relieve PTSD is of the highest priority.
PART THREE
Changing Your Habits
of Eating, Drinking,
and Making Merry
11
Sex
OUR EROTIC LIFE has five layers, each grown around the layer beneath it.
The core is sexual identity.1 Do you feel yourself to be a man or a woman, a boy or a girl? Sexual identity is almost always consistent with our genitals: If we have a penis, we feel ourselves male; if we have a vagina, we feel female. But scientists know that sexual identity has a separate existence of its own because of the rare and astonishing dissociation of sexual identity and sexual organs. Some men (we call them men because they have penises and 46XY chromosomes) are utterly convinced that they are women trapped in men’s bodies by some cosmic mistake, and some women (with vaginas and 46XX chromosomes) are utterly convinced that they are men trapped in women’s bodies. Both are called transsexuals, and they provide the key to understanding the deepest layer of normal sexual identity.
Laying just over our core sexual identity is our basic sexual orientation. Do you love men or women? Are you heterosexual, homosexual, or bisexual? To answer this question, we need not explore our sexual history but, instead, should look to our fantasy life. If you have had erotic fantasies only about the opposite sex, you are exclusively heterosexual. If you have had masturbatory fantasies only about members of your own sex, you are exclusively homosexual. If you have often masturbated to both fantasies,