PTSD

November 18, 2017

A Unique Perspective on Traumatic Shock

It was just another late autumn Friday afternoon. A New England autumn. A lovely time to be in Boston. Warm enough, with a high in the 50s.

The greatest shocks never warn.

Matinee symphony concerts, such as those of the Boston Symphony, were then attended by more ladies than men. Surely, in the November audience, many from high society – the scions of colonial days – occupied the best seats. Old money, as they say.

The intermission concluded and Erich Leinsdorf, the orchestra’s Viennese-American Music Director, came on stage. His hands stilled the applause.

Leinsdorf had an announcement to make.

Relive the moment if you are courageous enough: the 53-word report of the November 22, 1963 assassination of President John F. Kennedy and, more remarkable, the audience’s reaction.

Countless TV and radio interruptions like this occurred, all with the same terrible news. None of the recordings of those broadcasts, however, carry the shock of Leinsdorf’s, because none allow us to hear a traumatized, horrified audience.

Some of the concert-goers knew Kennedy personally. Many had seen him close up. He was a son of their soil and their soul.

Before saying more, I will give you the opportunity to listen. Additional description, context, and analysis follow. Should you be afraid of the shock, however, you may want to read on first. One further word: I’ve included over a minute of the Boston Symphony broadcast before Leinsdorf speaks. I did this to put you in the mind of a Boston listener of the time, unprepared for the unimaginable. Leinsdorf begins to talk about a minute-and-a-half in:

Erich Leinsdorf gave two messages simultaneously, unwittingly. He was convinced Kennedy was dead, but conveyed uncertainty. The audience gasped. Then, before they could process the news – before they could admit to themselves that the President was gone – the orchestra began the Funeral March from Beethoven’s Eroica Symphony, a piece dedicated to the memory of a fallen hero. Music of consolation served, in this instance, to kill hope.

Perhaps those of you too young to remember the day cannot understand how Americans then felt, despite the more recent shocks you have known. No President had been murdered since William McKinley in 1901, 62-years before Kennedy. The closest previous U.S.A. horror was the Pearl Harbor invasion of December 7, 1941, 22-years before: before my generation, the Post WWII Baby Boomers, were born.

We were – we middle class white kids – yet untouched by national tragedy; a condition now lost in the wave of gun-related domestic massacres, the terrorist catastrophe of September 11, 2001; and subsequent (almost routine) calamities of so many kinds. By 1968, five years later, the murders of Martin Luther King, Jr. and Robert Kennedy had deflowered the virgin sensibilities of my age group. No wonder smoking marijuana became almost as common among us as saying hello.

On the other hand, if you grapple with Post Traumatic Stress Disorder from the inside, the audience reaction in Symphony Hall is within the range of your experience. And for those lucky enough not to have suffered such a blow, perhaps listening to this broadcast excerpt will bring you an inch closer to understanding what personal trauma is like.

At least, how it sounded 58-years ago.

February 12, 2017

What You Can Do When Trauma Reminders Intrude

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Victims are easy to identify — or so we think. We see them on TV each day. We are inundated with injury. Too many terrified people, mistreated people, and survivors of war zones and privation carrying their children and belongings. The images arrive from displaced persons camps, airports, and highways.

Look in the shadows, however, and you will find even more. Those are the second-hand souls, the past sufferers, the ones reinjured at a distance.

The men and women to whom I refer are recovering from Post Traumatic Stress Disorder. Some of them are rebroken by watching or reading about the latest victims and the menacing public statements of elected officials. They shudder at the unpredictability in the air. According to the conservative columnist David Brooks, we are witnessing  “a rising tide of enmity” in the USA. Indeed, swastikas have appeared in the public library men’s room of my own suburban Chicago community.

Yesterday’s unfortunates are reminded of their imperfect healing by the incivility and xenophobia around them. Their bodies respond by saying “fight or flee.” A sense of being flooded, overwhelmed — even to the point of collapse — sometimes is not escaped for minutes or days.

Retraumatization of this kind can leave the individual disoriented and dissociated. He may undergo flashbacks of his past: a psychic reexperiencing of the event. At the extreme, there is the loss of awareness of where you are, in what circumstances you are, what age you are. You time-travel to a place you escaped, reinstalled into a mental chamber of prior misfortune. Perspiration, nausea, tearfulness, and intense fear are only a few of the possible sensations and emotions.

You are alone, even if others are nearby. The triggered individual is often unable to describe his internal world. He is awash in a fetid river of word-preventing feelings. The proper vocalizations do not come.

What is one to do?

Here is an example of a young man who dealt with a mild version of the problem, but still enough to put him in treatment. He was in his early teens. A bike accident — he was struck by a car — left him with a painful recovery. Even after the physical injuries healed, the newspaper account of the collision — one which blamed him — still felt like an attack. Moreover, the intersection where he had been hurt remained dangerous. He felt both unfairly targeted and helpless to do anything either to vindicate himself or prevent harm to others. He continued to avoid the location, but traffic reports of pedestrian injuries (regardless of where they occurred) darkened his mood and made for painful and repeated revisiting of his experience.

One aspect of his treatment was a turning point. We talked about what he might do to get a sense of control and counter the wrong and wronging newspaper account. This thoughtful adolescent wrote a letter to the reporter who covered the event. Two things followed: 1. His comments were published in the newspaper. 2. The reporter researched the statistics pertaining to accidents at the place of injury and wrote another article detailing the danger. The city council then investigated the matter and made the intersection safer.

Where does that leave you?

You can, of course, hold your hands over your eyes and plug your ears. The avoidance of TV and radio is a close equivalent, as is holding to an agoraphobia-like self-protective self-confinement. Though understandable, these strategies must eventually be set aside lest you continue to remain terror-prone.

Another patient of mine, long after her father died and mother denied (in my presence) that any sexual abuse happened, chose to return to her childhood home. This was the site where years of sexual abuse by dad occurred with mom’s knowledge. She traveled 500 miles to get there. As it happened, the house was being redecorated and the new owner permitted her to look around. My client left the spot with a sense of palpable triumph. She had faced-down the ghost of her demon in the place of his iniquity.

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If you are pained by news accounts in the aftermath of the President’s Executive Order of January 27, other actions commend themselves to your attention. The American Psychological Association offered a concerned Response to this Directive on February 1, 2017. It reads, in part:

‘Refugees, particularly those displaced from war zones, experience stress, trauma and other serious mental health problems,’ said APA President Antonio E. Puente, PhD. ‘Denying them entry to the United States, particularly those who have already been vetted, is inhumane and likely to worsen their suffering. This conclusion is based on extensive research and clinical experience … .’

Such policies can lead to a perception of reduced freedom, safety and social connection for those directly affected, as well as for society at large (my italics) … .

Research has documented serious mental health consequences for immigrant children and/or their parents who have been forced to leave the United States, which may magnify earlier trauma experienced in or upon fleeing their country of origin. Sudden and unexpected family separation is associated with negative outcomes on child well-being that can last well into adulthood.

If you have been retraumatized by the human consequences of your country’s immigration policy, your decision concerning any response may be more personal than most. Others, perhaps less impacted in this way, have marched, attended town hall meetings, written public letters to news organizations; and visited, called, or emailed their elected representatives.

In the end, those without trauma histories would be wise to refrain from judging whatever action you choose or do not choose. The world presents many chances to reinvent ourselves and repair the injuries it inflicted.

Remember, however, that you and your therapist aim to help you distinguish the present from the past, both intellectually and emotionally: to realize you can act today in an effective way not possible before. And to keep the past from recurring in any form by your self-affirming assertive actions.

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The top photo is a Syrian Refugee and Her Newborn in Ramtha, Jordan taken by Russell Watkins for the UK Department of International Development. The second image is a World War I propaganda poster called Every Girl Pulling for Victory by Edward Penfield, created in 1917. Both are sourced from Wikimedia Commons.

June 12, 2016

A Remarkable Recovery From Unspeakable Grief and PTSD

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Some stories stick with you. The word “heartbreaking” is not enough to describe them; nor do “resilience,” “survival,” and “overcoming misery” say enough.” Yet all those words apply.

The therapist in the tale who helped enable a positive conclusion was Donald Meichenbaum, Ph.D. He related this account in a video focused on finding meaning in the aftermath of trauma: PTSD & Complex PTSD: Ways to Bolster Resilience. 

Don’t read further if you wish to avert your eyes from tragedy, but understand this: you cannot know of the treatment that allowed for a redemptive, healing story unless you face it.

The woman: a young, bright, intelligent mother. A good mother. Her husband was away on a business trip. Home held only her daughter and herself. An intruder could be heard downstairs. Mom entered Vicky’s room and they hid in her closet. The burglars left without going upstairs. The event upset both Vicky and the mother, worried such an episode might happen when the husband/father traveled once more to make his living. The adults installed a security system and alerted the police. They lived in a safe neighborhood. No reason to expect another forced entry. Still, the man insisted his wife get a gun, just in case. She did not like firearms, but relented. The night stand next to her bed harbored the weapon.

Time passed. The man traveled again. Late and stormy darkness. Noises downstairs. Was the mother dreaming, reliving an imaginary or remembered version of the home invasion?

No. No. No. Not again.

Yes, again.

The mother urgently reached for the gun and moved toward her bedroom door to go to Vicky’s room, just as she had the first time. Vicky came running and pushed the mom’s door open. It struck the mother’s hand and the firearm discharged. Vicky died immediately. The mother sat with her dead daughter for 24-hours until the husband returned.

No words are possible. The parents’ lives were forever changed. Guilt, horror, marital separation, grief, depression. Even loving friends became unavailable, unable to bear the story. Alienation and isolation. As the mother saw it, a life not worth living. She deserved to die.

What is a therapist to do? He can never undo the tragedy, but perhaps he can help the survivor to find a reason to live, a meaning for the rest of her life. Here is what Meichenbaum did:

The psychologist knew his job was first to establish a therapeutic alliance, to show compassion, and accept, not judge. He needed to allow the patient to tell her story as she was able, permit its unfolding, not push. A plan to prevent the woman’s self-harm was created. The therapist allowed his emotions to be touched. His own tears came as he listened.

The psychologist asked a question to understand more about the loss. The client had said that Vicky was “special.”

In what way?

She was wise beyond her years.

The first session ended and the doctor arranged a second appointment in two days’ time. Meichenbaum made a request. He said he would be “honored and privileged” if mom brought in a photo album of Vicky, but only if she wanted to: no pressure. He wished to get a further sense of who the child was.

Reviewing the pictures together was painful in the extreme. Yet this marked the beginning of the doctor’s effort to embed the only moment the mother focused on (the accident and death) within a broader narrative of Vicky’s life and her own life: to pull his client out of the single instant of horror into the stream of her ongoing existence — perhaps to create a potential redemptive story projected into the future.

This is not to suggest any kind of treatment would ever erase the pain or guilt completely. Yet, it might still be possible to help the mother give Vicky’s memory meaning. And perhaps to transform the patient’s life in the process.

The therapist asked his client another question. Two, actually. He wanted to know what this child (who was “wise beyond her years”) might say to the parent’s wish for oblivion:

What advice would Vicky give and what would happen to the memory of her if you kill yourself?

The mother affirmed the obvious answers which had escaped her: Vicky would not want her to die. Moreover, the memory of Vicky would also die with the death of the one who knew her best. Meichenbaum’s questions led her to realize she might do some good in the world, something to perpetuate Vicky’s memory and give meaning to the child’s short life. Treatment continued. Mom became a public advocate for gun locks and gun safety, thus transforming her loss and honoring Vicky.

In part, Donald Meichenbaum assisted the patient to fashion a new story of her own life different from one ending with two deaths. She became aware her time on earth was not yet completed. And that Vicky’s impact on the world offered a potential future, if only the parent gave her daughter a metaphorical life — gave voice to what her daughter’s death could still achieve.

This is not at all to suggest the mother wouldn’t have traded anything — anything — to get Vicky back. Yet, the mom might yet continue her existence with a constructive narrative of redeeming value in spite of complicity in the child’s loss.

Meichenbaum is famous for asking questions — for creating a Socratic Dialogue with his patients. He did not give his patient advice, but led the conversation so she might grasp the next rung on the ladder of recovery, not simply be handed it. Therapists should know “directions” from the counselor don’t produce as much “ownership” of the treatment process, nor as much motivation to change, as occurs when he helps the client uncover her own way, not just follow advice.

Might you also find your own way? Might the rest of your story be one of value?

What do YOU say?

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The photo is titled Pedra do Baú — Compos do Jordáo. The author is Izabel Tartari and it was sourced from Wikimedia Commons.

November 6, 2009

On the Fort Hood Tragedy

What happened at Fort Hood? Why would a psychiatrist, a physician trained in the treatment of “mental and nervous” disorders, go on a rampage against his own comrades? I suspect we will be reading about the following in the days ahead:

1. Did Major Nidal Malik Hasan, the accused murderer, have proper supervision of his work and his own fitness for duty? Did he suffer from a psychiatric disorder of his own and was he being treated? News accounts suggest that he was terrified in anticipation of an expected deployment to Iraq or Afghanistan.

2. To what extent did he feel marginalized within the Armed Services? He is said to be a man born in the USA, the son of immigrant parents. It is also reported that he had become increasingly devoted to his Muslim faith and might have experienced some harassment from other soldiers because of his religion.

3. Was the Major marginalized in other ways? He is described as a 39-year-old bachelor who had been looking unsuccessfully for a mate.

4. Major Hasan is believed to have treated numerous veterans suffering from PTSD (Post Traumatic Stress Disorder) returning from the Middle East. Is it possible that he suffered a form of vicarious trauma from hearing the disturbing, if not tragic stories of these young people?

5. To what degree have the Armed Services been able to reform an organizational culture that discourages soldiers from showing emotional vulnerability and seeking treatment before they become dysfunctional? It is one thing for the returning wounded veterans to get psychiatric services; it is another for them to believe, early on, that their anxiety, worry, and depression will not be seen as a weakness by their comrades, make it harder to perform their duties in war-time, and cause them to be ridiculed? Did Major Hasan, who apparently had not experienced combat himself, believe that his own inner-turmoil was acceptable and would have received support from his superiors?

6. Did Dr. Hasan have a history of having received treatment prior to his entrance into the military? If Dr. Hasan did seek treatment at any time, what was the result? Is their any routine assessment of the psychological status of both the soldiers and those who are given the task of treating them? Does the military realize that the nature of their work puts virtually all personnel at psychological risk?

7. What security procedures exist in military installations such as Fort Hood?

8. Is the military sensitive to cultural conflicts that are experienced by its uniformed personnel?

Most of us assume that mental health professionals have their own personal lives well under control. Unfortunately, such is not always the case. For more on this subject, please read my recent blog: “When Helping Hurts: Therapists Who Need Therapy.”

October 24, 2009

Classic Movies: Three to Treasure

I don’t go to a great many films and, perhaps, unfortunately, don’t rent many either. But this wasn’t always the case. As a result, I can recommend three very old films that continue to move me every time I watch them:

1. The Best Years of Our Lives

On almost every list of the 100 best films ever made. A 1946 film starring Myrna Loy, Frederick March, Dana Andrews, Virginia Mayo, Theresa Wright, Harold Russell, and Roman Bohnen, among others. The film won seven Academy Awards. It tells the story of three WWII vets returning to home to their small town. One a banker turned infantryman. Another, a “soda jerk” (someone who worked behind the counter making milkshakes and the like) turned bombardier; and the third man, a star high school quarterback engaged (literally) to the girl next door, turned into a sailor who did not quite go down with his ship, but lost both his arms in surviving.

The movie is touching and heartbreaking in its effort to present a frank appraisal (for the time) of the costs of even a just war as these three good men struggle to readjust to civilian life.

The newly returned banker (Frederick March) drinks too much and discovers that dollars and cents don’t have the same meaning to him as they did before he fought beside less well-to-do men of courage, loyalty, and integrity.

Dana Andrews, the Air Force captain, finds that the beautiful wife he impulsively married isn’t a good match for him now that he suffers from “combat fatigue,” a disorder that would be labeled Post Traumatic Stress Disorder (PTSD) today. Moreover, he must contend with the fact that the heroism he displayed during the war doesn’t guarantee him a good job after his service has ended.

Harold Russell, a non-actor, gives an earnest performance as someone who cannot bear to be a burden on others now that he has primitive prosthetic arms and does his best to discourage the young woman who still loves him because he believes her feelings are based only on pity.

For me, there are many extraordinarily touching moments in this film. I will mention only two: the moment that Frederick March first reunites with his wife after years away from home overseas and Roman Bohnen’s understated but oh-so-sensitive reading of the citation that his son (the Air Force Captain played by Dana Andrews) received for his heroism. That brief scene says all one need ever know about a parent’s pride in his child.

The film is long and slow-moving by contemporary standards, but the moderate pace allows more character development than usual. If you have the patience, you will be rewarded.

2. The Prisoner of Zenda

First, a disclaimer. I love Ronald Colman. He is a now largely forgotten matinée idol of the ’30s and ’40s, as elegant, suave, and handsome (but in a more refined, cultured way) than the male stars of today. I forgive him for the fact that he was not a great actor. But then Gary Cooper, John Wayne, James Stewart, Tyrone Power, and Alan Ladd, all contemporaries, were worse in my judgment.

Colman stars as a British citizen on holiday in a fictitious Eastern European country who accidentally stumbles upon a cousin who is the crown prince. The catch? They look like identical twins (Colman played both parts, of course). And when the Prince’s evil step-brother Michael poisons his favored sibling so that he can assume the throne himself, the British cousin is asked to substitute for the king-to-be at the Coronation until the real prince can recover and take the throne.

Things don’t go as planned, and the charade continues on, long enough, in fact, for our British cousin to fall in love with the woman who is betrothed to the man in captivity. This is an old-style 1937 swash-buckler co-starring Douglas Fairbanks Jr., Raymond Massey, David Niven, Madeleine Carroll, C. Aubrey Smith, and Mary Astor (of Maltese Falcon fame). And, it too will touch you, as its ending is bitter-sweet.

The film is based on the popular novel of the same name by Anthony Hope. If you’ve already seen the movie or read the book, know that Hope wrote a less impressive sequel called Rupert of Hentzau (named after the character played by Douglas Fairbanks, Jr).

Do avoid the much inferior color remake with Stewart Grainger and Deborah Kerr, as well as the later comedy adaptation starring Peter Sellers.

3. Lost Horizon

Another 1937 classic, based on a James Hilton novel, again starring Ronald Colman, Sam Jaffe, and a very young Jane Wyatt (best known for her role as the mom in the ’50s TV series Father Knows Best, which also featured Robert Young).

This time Colman plays a disillusioned British diplomat who is kidnapped along with his brother and several recently rescued Brits and Americans, to be taken to a place called Shangri-La, a community situated in a temperate valley within the otherwise bitter cold of the Himalayan Mountains. Colman discovers something unbelievable there, a utopian society where people are not only tolerant and understanding but are rumored to live unusually long lives.

Remember that this film was made on the verge of World War II and the character played by Colman reflects the contemporary sense of discouragement about continents on a collision course, as well as a “this is too good to be true” response to his new home. Of course, there would be no story unless Colman’s adjustment was less than perfect. He falls in love with Jane Wyatt but also feels duty-bound to get on with the work in the outside world required by his career in His Majesty’s diplomatic corps.

To further complicate matters, Colman’s younger brother (played by John Howard) has fallen in love too, but with a woman who can’t wait to leave Shangri-La. What will Colman do? And if he leaves, will he ever return to take over administration of the community, as this was the reason he was kidnapped in the first place?

The movie is interesting for another reason. Some of the footage in the original version of this film was cut because it was thought that there was too much anti-war and women’s liberation sentiment. Indeed, the character played by Jane Wyatt is an astonishingly independent and intelligent female for her time, when most actresses were docile and deferential by today’s standards. Unfortunately, the seven minutes of the cut film were never recovered, but the soundtrack of that portion of the movie remained intact. Thus, the videocassette and DVD releases have used “still” and publicity photos, cleverly manipulated to simulate some action, to replace the minutes where no movie film remains. But be careful not to confuse this classic with a 1970s remake in the form of a musical.

In any case, the feature remains a worthy one. Its portrayal of a better world, not in heaven, but heaven on earth, is attractive. To paraphrase one of the lines in the movie, let us hope that we all find our own Shangri-La.

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The photo is of Ronald Colman in a publicity photo for Condemned (1929). It was sourced from Wikimedia Commons.