What is Post-Traumatic Stress Disorder (PTSD)?
It is a medical and psychological condition that sometimes occurs in people who have experienced an overwhelmingly traumatic event. In order to [be diagnosed] with the disorder, you have to have a certain number of symptoms. However, people can have these symptoms and feel as though they have posttraumatic stress and not actually have a diagnosable disorder.
What are some of the symptoms?
There are three symptom clusters. People will experience many of these symptoms following an event like the one we’ve just experienced The first group has to do with reliving the event, either through nightmares or intrusive thoughts-in other words, seeing it happen over and over again in their mind. The second group has to do with avoiding reminders of the event. People figure out ways, consciously or subconsciously, not to think about it, to be distracted. Some people space out, some use alcohol and drugs, some people won’t watch TV because they might see something that reminds them of the traumatic event. Others won’t go a certain part of town or they’ll avoid the people who were with them when the event happened.
What is the third group?
The third has to do with hyperarousal and feeling on guard and scanning the environment for danger. Once you’ve been involved in something horrendous and have seen terrible things, you don’t feel safe. It can result in sleep disturbances-people don’t want to have nightmares so they just stay awake. Or they’re waiting for the next thing to happen-they want to be prepared so they can get their shoes on and get out the door. And it’s not just intellectual and psychological, it’s physiological, too. The body’s systems [seem to] have their volume turned up. Blood pressure is up. You can’t concentrate, you’re easily startled and sudden to anger. A lot of people become irritable. Certainly depression and anxiety go with it, too. But for Post-Traumatic Stress Disorder these are the three symptom clusters: the reliving, the avoiding and the hyperarousal.
What is the difference between having the disorder and just feeling traumatized?
One has to do with duration. In the immediate aftermath of a traumatic event, it’s normal to have these symptoms-most people will have them. Generally, we’ll say that a crisis often lasts from four to six weeks, and during that time everyone feels disrupted. What we’re going through now is an extreme case, so it may take longer. But with PTSD, the symptoms may start disrupting your life in such a way that you can’t get into your routines. It’s really taken control of your life even when most people are starting to recover. If that happens, you should find someone and get an assessment.
With this terrorist attack, I would think that the people who are most traumatized are the ones who are closest to “Ground Zero”: the ones cleaning up, the ones who were involved in the disaster, or those who had friends and relatives who were involved.
Trauma can be cumulative. Sometimes people who have the hardest time being resilient after an extreme event like this are people who have had earlier trauma in their lives or repeated trauma in their lives. Partly it has to do with autonomic responses: The gearing up of one’s fight-or-flight system becomes somewhat habitual for people who have had chronic traumatization in their lives, whether it happens to be child abuse, domestic violence, combat trauma or something else. If someone has this kind of background, they may not be as resilient when an unrelated traumatic event occurs later in their lives. There are a number of factors that point to resiliency. It has to do with personality, and opportunities to vent and grieve.
When we have such a huge and tragic event such as last week’s terrorist attack, how are whole cities or communities-for instance, New York City-affected?
A situation like this dominates the news. It dominates everything. The whole nation has come to a standstill. There’s likely to be some secondary traumatization across the country. It’s a national event. We all feel that our security-and our trust that the world we know will always remain the way it was-has been shaken. So societally we may respond with some of the symptoms that I described for PTSD. If everybody is generally hyperaroused and on-guard, we may find more accidental injuries or more personal aggravation, things that might create more problems in our communities-because we’re all on edge and feeling insecure.
There also seems to be an outpouring of support for one another.
Because this is universal in our country right now, there isn’t the same sense of isolation that might happen if a person or a family had undergone some kind of trauma. If there had been a single accidental plane crash, the rest of us could distance ourselves from it. But because this is such a universal experience, we have a built-in community where just about anybody you turn to understands what you are going through. So in the immediate aftermath of this tragedy, we are seeing interfaith prayer vigils, bipartisan political reactions and people coming together in ways they wouldn’t ordinarily. We all have something in common, even if it is a common enemy. It has brought us together and built some connections between us that didn’t exist on Monday.
But that’s very different than people getting more irritable because they are hyperaroused.
I think they are both true. I think we can be conscious about turning to our peers for support, whether it’s though town-hall meetings, radio or TV talk forums, Web chats, candlelight prayer vigils. What we’ll find, in New York and in many parts of the country, is that people will eventually get back into their routines and some people will start to integrate their experiences. But then, after a time, there will be a wave of depression, suicides, anger. These things rear up later down the road.
How much later?
Again, there’s a crisis theory that says in about four to six weeks. I think it depends on the crisis-every situation is a little bit different. My guess is that healing will be faster in parts of the country that aren’t ground zero. The people who were most involved in this are going to have the hardest time recovering. Leadership is going have to set the tone, in my opinion. [We need] leaders who urge us to be supportive of each other, and who provide therapy and funding and support and so forth to attend to people’s longer-term needs. We need to be aware that it may take longer than we would like to come out of this on the other end. We are lucky that in this country, this type of event has not been common. There are traumatized societies in other parts of the world where events [such as this] aren’t as rare. We are still a young and resilient country.
What advice would you give to New York Mayor Rudy Giuliani?
Well, money always helps. But I think [he needs] to reassure people and let them have the opportunity to grieve and to come together and work through these issues. [He also needs] to get help into the communities rather than expecting people to patch things up on their own.
So who will ultimately be affected in the longer term?
It’s too soon to tell. We can’t expect that people are just going to shake out of it. And we can’t expect that the EMTs are going to be the only people affected by it. I think if we prepare for treatment and support for the people who are likely to need it, we will recover a lot faster. We’ll have to wait and see and then make sure resources are available to help them. A lot of people are going to be very resilient and are going to be able to get right back to their jobs and their lives and families.
Any advice for people who think they may be suffering from PTSD?
Don’t hesitate to see a therapist or a family doctor. There are very effective treatments, including psychotherapy and medication. Medications can be very helpful in terms of reducing the immediate symptoms so that a person can work in therapy to integrate his or her experiences and make some sense of them. Many times, people use community action, spirituality and other ways, like helping people, to transform the pain.
