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Dec 27 2012

Putting the “Post” in PTSD

I’ve written a number of times before about the fact that survivors of sexual assault have much worse outcomes when they face doubt and stigma from friends and family after reporting. This has, needless to say, not been a popular position among the “Women lie about rape!” and “I’m not blaming her but what was she doing there/dressed that way/flirting with him” crowds.

I’m receiving a good bit of criticism elsewhere for saying that it’s an asshole move to focus on and pile on someone who is being harassed and threatened, even if they reacted to the harassment and threats in a way you don’t find acceptable. Despite what I’ve had to say about rape victims, I’m apparently only telling people to act like decent human beings because their target is a friend of mine. Of course, that always seems to be the case, no matter who I’m standing up for in exactly the same way. Greg today. Ophelia last week. Rebecca the week before. Who will it be tomorrow?

Or maybe, just maybe, this is a consistent drum I’ve been beating because it’s important. How important?

Psychological trauma dims tens of millions of lives around the world and helps create costs of at least $42 billion a year in the United States alone. But what is trauma, exactly?

Both culturally and medically, we have long seen it as arising from a single, identifiable disruption. You witness a shattering event, or fall victim to it — and as the poet Walter de la Mare put it, “the human brain works slowly: first the blow, hours afterward the bruise.” The world returns more or less to normal, but you do not.

In 1980, the Diagnostic and Statistical Manual of Mental Disorders defined trauma as “a recognizable stressor that would evoke significant symptoms of distress in almost everyone” — universally toxic, like a poison.

But it turns out that most trauma victims — even survivors of combat, torture or concentration camps — rebound to live full, normal lives. That has given rise to a more nuanced view of trauma — less a poison than an infectious agent, a challenge that most people overcome but that may defeat those weakened by past traumas, genetics or other factors.

Now, a significant body of work suggests that even this view is too narrow — that the environment just after the event, particularly other people’s responses, may be just as crucial as the event itself.

That’s David Dobbs, writing for the New York Times on presentations made this year that are shaping and supporting this view of PTSD.

It’s a smart idea. I’d even consider it obvious, except that most work done on PTSD has been done in the U.S., where individualism has reigned supreme. It took time for family factors to be considered and even longer for the idea that social interactions and environments more generally would play an important part. Still, we’re highly social animals, so things like this shouldn’t surprise us terribly.

Since 2006, Dr. Brandon Kohrt, a psychiatrist and medical anthropologist at George Washington University, has followed the fates of Nepalese children who returned to their villages after serving with the Maoist rebels during their country’s 1996-2006 civil war.

All 141 in the study, 5 to 14 years old when they joined the rebels, experienced violence and other events considered traumatic, aside from their separation from family. Yet their postwar mental health depended not on their exposure to war but on how their families and villages received them.

In villages where the children were stigmatized or ostracized, they suffered high, persistent levels of post-traumatic stress disorder. But in villages that readily and happily reintegrated them (usually via rituals or conventions specifically designed to do so), they experienced no more mental distress than did peers who had never gone to war. The lasting harm of being a child soldier, it seemed, arose not from the war but from social isolation and conflict afterward.

This finding is echoed in studies of American soldiers returning home: PTSD runs higher among veterans who cannot reconnect with supportive people and new opportunities.

What this all means is that we choose the outcomes for the traumatized. Both by the kinds of institutional support we offer and by how we treat individuals who have experienced traumatic events. We can’t just point to the people “over there” who caused the original trauma, assuming there was even agency behind the event(s), and lay the blame elsewhere. Even when we don’t feel capable of nurturing, we still have the option to stand back and at least not make things worse.

Victims of trauma are our collective responsibility. How we treat them matters. What role will you play in their trauma or recovery?

Via Neuroanthropology, where Daniel Lende has more links and information on the phenomenon.

19 comments

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  1. 1
    chasstewart

    Has Laden said that this harassment he has received has been traumatic for him?

  2. 2
    Stephanie Zvan

    Oh, no, of course not. He’s had absolutely no reaction to it, especially not one that was pounced upon by a tool of the slimepit and used to beat on him some more.

    What kind of asshole are you?

  3. 3
    Erin (formerly--formally?-- known as EEB)

    So I’ve been pretty open about my child sexual abuse, rape, and PTSD. And since I started therapy (DBT is life-changing) I’ve been better. But I still have rough times. And, unfortunately, my parents (I’m disabled and I still live it at home) get frustrated sometimes dealing with a daughter who occasionally cannot leave her bedroom without a panic attack, or who bursts into tears at harsh words or yelling. The latest dustup came when they asked me to drop off the mail in the mailbox down the street, and I had to tell them that there was no way I could walk through the neighborhood alone (I was raped two years ago around the corner from my house), yes, even in the day time. I got the “why aren’t you over this by now” and “you just enjoy being a victim” and, of course, “look at so-and-so, they endured more trauma than you have and they’re handling life just fine.”

    It becomes very tempting to then tell them: “Well, research would indicate that the reason I’m not handling life as well as So-and-So is because I didn’t get enough support or help from the people around me after I was raped.” But I won’t. I know, in their own way, that they already feel guilty about what happened. But it is very, very tempting, at times, to remind them that it isn’t all my responsibility to buck up (and be a model victim, ahem), that maybe they do carry a little responsibility, too.

  4. 4
    Stephanie Zvan

    Oof. EEB, I’m glad the therapy is working for you, even if the parents aren’t always.

  5. 5
    Jafafa Hots

    When I finally told my dad a few years ago he got mad at me and yelled.
    That was fun.

  6. 6
    Stephanie Zvan

    Ow, no. I’m sorry.

  7. 7
    bobafuct

    First, we need to drop the “D”. Post-traumatic stress is not a disorder, it is a completely normal reaction to psychological trauma (and even those who don’t suffer trauma per se, but trauma-like stress such as first responders) that manifests in myriad ways. It’s like calling a burn “post-heat exposure disorder.” Um, no. Anyway….

    “This finding is echoed in studies of American soldiers returning home: PTSD runs higher among veterans who cannot reconnect with supportive people and new opportunities.”

    As the husband of a PTS-suffering female combat vet with lots of PTS-suffering combat vet friends, I’d guess that this research probably is outdated. I think we are only now realizing how widespread and common PTS is, particularly among soldiers, but probably also among rape/assault/accident victims as well. Pretty much every combat vet I know of suffers from it to some degree, even if they’ve never been formally diagnosed/treated for it. So yes, support is crucial, but those close to trauma sufferers need to realize that creating a supportive environment will not “cure” or “prevent” PTS, it can only help mitigate PTS. Incidence of PTS will not go down just because we become more aware of it…it will only become less stigmatized and more widely diagnosed/treated.

  8. 8
    Stephanie Zvan

    bobafuct, your comment actually does a great job of explaining why the “D” is there. Everyone experiences stress from traumatic events, but not everyone develops an ongoing stress reaction that severely interferes with their day-to-day lives or causes acute re-experiencing of the stressor.

  9. 9
    Anthony K

    Has Laden said that this harassment he has received has been traumatic for him?

    For the record, he has. On numerous occasions and in numerous ways.

    The haters do what they do because it hurts. That’s why it’s fun to them. Because they enjoy hurting people.

  10. 10
    chasstewart

    I don’t think I’m an asshole so I’ll leave my asshole classification up to you.

    My point in asking that was because I didn’t think that Laden was reacting to trauma but fighting fire with fire. Just because Laden reacted sharply does not mean that he was traumatized by Mykeru and I think you are trivializing trauma by relating PTSD to this particular event.

    Laden has attempted to explain to me and another person the magnitude of hatred that he was contending with and he did this on Facebook whenever a “Helpful FTBullies” meme was linked to on this status (I’m quite proud of this meme: http://tinyurl.com/cpyxalu) . But Laden attempted to explain his actions/reactions to this hatred in a very odd and vaguely threatening manner and I suspect this is how he comes off to many. Laden asked this person to imagine how they would react if Laden were to “start making comments about your children, the ones you’ve got photographs of posted here. And putting those comments on those photographs. Perhaps I’ll “tag” you in whatever photographs I’d like to see on your facebook page even though you would clearly want them. And so on. And then, when you start to change your privacy settings, or complain to me, or complain to facebook, I create internet memes with pictures of you on them that say things like “[Name redacted] uses the Ban Hammer” …”

    I would say it’s poor form to talk about defacing pictures of someone’s kids and is not a great way to explain yourself to others but maybe you disagree? But I can understand now (after distancing myself from that weird and blood pressure elevating exchange) that this kind of targeting could weigh on a person and I’m not sure how I’d react in the same position.

    This is just my personal experience with Laden and I imagine that if I have this kind of personal experience with Laden then very many have had similarly bizarre run-ins with Laden.

  11. 11
    chasstewart

    Thanks Anthony. It was an honest question.

  12. 12
    Stephanie Zvan

    Oh, yeah. It’s “poor form” to talk about the things that have happened to him as though the might be things that could happen to anyone else and that other people might want to think about and sympathize with before jumping in with more. Not such poor form to do it that you won’t go hang out in the slimepit with the people who have done similar.

    You want to know what kind of asshole you are? You’re the kind of asshole that’s all chummy with people who try to fat shame me and suggest that the only people who would agree with me are people who are getting sex from me–then show up here and expect that any of your comments should be taken seriously, much less those that are you expressing your opinion about whether someone else was doing it right when he told you how fucked up your life and online friendships are.

    Yes, you’re that kind of asshole.

  13. 13
    Erin (formerly--formally?-- known as EEB)

    @Jafafa Hots

    Ugh, shit. That’s awful. I’m so sorry.

    My dad reacted horribly when he found out, about both the rape and the child abuse. I never told my parents that I was being molested (I was nine, it went on for a year, it was a person who was living in our home, I was in a very conservative Christian home and didn’t understand what was happening, only that I was terrified and ashamed). When I finally told them, as an adult in therapy, my dad was so angry. He demanded to know why I hadn’t told him at the time, why I “let it happen”. When I was raped, he decided the best way to handle it was to “teach me not to be a victim” and took me out to watch people walking around. He’d point out women that he though “walked like they were asking to be raped” (head down, arms close to their bodies), vulnerable, looking like a victim (in his words), and then pointed out women that he thought walked assertively and, in his opinion, would never get raped.

    I was (well, I still am) very hurt and angry at his reactions. I try to remind myself that he loves me, that he’s upset and feels guilty about what happened, and he doesn’t know how to handle all those feelings so it comes out as anger and blame towards me. He’s also, in his own horrible, misguided way, trying to protect me and keep it from happening again.

    But it’s still really hard to deal with. And it still hurts.

  14. 14
    Jacob Schmidt

    OK. I understand your analogy over at Lousy Canuck much better. Sorry for my tactless response. I didn’t come close to addressing your point.

  15. 15
    croizat

    What this all means is that we choose the outcomes for the traumatized. Both by the kinds of institutional support we offer and by how we treat individuals who have experienced traumatic events. We can’t just point to the people “over there” who caused the original trauma, assuming there was even agency behind the event(s), and lay the blame elsewhere. Even when we don’t feel capable of nurturing, we still have the option to stand back and at least not make things worse.

    In this context, I wonder what you think about the recent spat between Dawkins and the Daily Mail over Dawkins’s comparison between child sex abuse and religious teachings about hell?

  16. 16
    Stephanie Zvan

    I wrote about the interview and the relevant claims in the book here: http://freethoughtblogs.com/almostdiamonds/2012/11/24/child-sexual-abuse-what-yucky-means/

    I hadn’t really tied the two topics together, though. The tiny bit of data we have on any ongoing harms of believing in hell are…tiny. If they hold up under study, they tell us that belief in hell rarely results in long-term consequences. People who did and did not believe in hell look the same in long-term mental health studies. That could–and I emphasize that I’m speculating here–be because no one blames those children for believing in hell. That’s what they’re supposed to do.

    Honestly, though, we just don’t have data to do more than speculate. I think Dawkins could do a world of good by securing funding for studies of these long-term consequences.

  17. 17
    Erin (formerly--formally?-- known as EEB)

    That could–and I emphasize that I’m speculating here–be because no one blames those children for believing in hell.

    I said elsewhere (Ophelia’s blog, maybe?) that one of the difficulties is that everyone experiences things so differently. We really don’t know why two people can go through the same experience and one will suffer from PTSD forever while the other goes back to normal with little problem. Yes, it looks like it may have to do with the suppor that they get. It also has to do with what they had been told previously…if you grow up in a feminist household where you are taught that rape is never the woman’s fault (a friend of mine) vs. a house where you are told that women are responsible for men’s sexual response to them (me), I think it will affect how you experience your own rape (my friend astonished me when she told me that she never struggled with feeling that it was her fault that she was raped, and honestly doesn’t understand why so many of us do). And people are just different! Heck, I can be in a house with screaming babies and chaos and I’m in heaven, but my brother loses his shit. But then, he can get in a screaming match with someone and come out totally energized and excited, where I will burst into tears and be fucked up for the rest of the day if someone raises their voice to me. Maybe someday neuroscience will tell us why this is. Maybe it’s just one of those things we have to accept, and there’s no right or wrong way to experience life; it just is.

    Also, I think part of the problem is that “child abuse” is such a wide term, including everything from a bad touch once to penetrative rape. I don’t want to get into some Child Abuse Olympics with a gold medal for Worst Experience, but I do think there’s a difference in severity and it would be silly to deny it. (It’s all wrong, it’s all tragic, it all shouldn’t happen…I hope that doesn’t need to be said, but I’ll say it anyway, just in case.) And the duration of the event will make a difference, too…repeated sexual trauma is going to have a different effect than one grope. So I don’t doubt that the woman Dawkins quotes is telling the truth when she says that a bad touch from a priest wasn’t as bad as being told her friend was in hell. That is her experience, and she’s the only one who can say what it was like. But to then decide that her experience is universal…that is a stupid, insensitive move. That’s where I think he really goes of the track. (Not that I think he explicitly says that her experience is universal–it’s been a while since I read the passage–but I think comparing them at all, setting up his own hiearchy of bad experiences, was a dick move.)

    I think Dawkins could do a world of good by securing funding for studies of these long-term consequences.

    I like the idea of studying the long-term consequences of belief in hell. And from child sexual abuse. Not both together, though, a What is Worse? study, that idea bothers the hell out of me, but I don’t think that’s what you were proposing. ;) I know for myself, for people that I’ve talked to who grew up in the same ultra-conservative evangelical culture (my parents weren’t Quiverfull/patriarchy types, but all my friends were, that’s what I learned in Sunday School), we have had some serious issues because of what we went through. I was lucky enough to find a therapist that specialized in helping people who left religious groups, who helped me work through my fears of hell. I will say that, personally, even though it took a lot of work, after a few months of therapy, I’m pretty much over my fear of hell and the trauma from growing up with those beliefs. After years of therapy, I’m no where close to being over the PTSD (and other issues) from being sexually abused as a child.

    The best study, though, would have to compare Christians (or other religious people) with atheists. Because I know that the only thing that really helped was coming to understand that it was all a myth. Actually, watching a video that scientifically explained why hell was just physically impossible was probably the thing that relieved most of my fears. But when I was a Christian, it was a constant terror, even when I was older. I was told that if I went to bed with unconfessed sins, I could end up in hell, so I would stay up hours, going over my day in my head, over and over and over, mentally replaying every mistake I made so that I could make sure that I had properly repented for each one. That fucks you up good. I used to envy my Baptist friends, who believed in “Once Saved, Always Saved.” I was a Nazarene; we could lose our Salvation. We had to always be on guard. I went to the alter at every revival, camp meeting, or convention I attended, always sure that I had strayed, always desperate to make sure I was OK. I used to lay in bed, terrified that some Future Me would become an atheist and end up in hell. I knew that I believed then, and I couldn’t comprehend what could possibly make me stop (oh, how little I knew…), but I was scared to death that it would happen, and I had no control over what Future Me was going to chose. So at the very least, I’m pretty sure that a lot of people who fear hell are suffering from some sleep disorders! Funny, I’m living my worst childhood nightmare now, and I feel pretty good. :)

  18. 18
    Stacy

    Wow. I just read this post by Justin Griffith: http://freethoughtblogs.com/rockbeyondbelief/2012/12/26/no-really-that-was-utterly-shameful-writing/

    Stephanie, you were right, and I was wrong.

    My thinking was this: Justin has PTSD, too, and Justin has suffered as a result of the Slime Wars, too. I commented on Lousy Canuck (the Sympathy for the Devil post,) that “Criticizing Greg’s behavior is not victim-blaming anymore than criticizing Justin’s is.”

    Oh, I’m sure that Justin has been through hell, and that this infighting is hard on him too. I don’t lack compassion for him. But his continued coziness with ‘pitters and his odd rejection of Jason’s post (which I found fair and reasonable to both sides) has got me doubting his good faith.

    And I understand what you and Jason have been saying about what Greg’s been through. That does NOT mean that he is above criticism, but piling on with criticism when he’s a target for idiots just muddies the waters.

    Going to cross-post on LC.

  19. 19
    Alain

    Ping: Trauma…and the environment after a trauma

    Alain

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