Is PTSD predictable? What makes someone shut down after experiencing terrible events…while others shake off the experience and roll on with the rest of their lives?
The U.S. Department of Veterans Affairs estimates that around 30% of Vietnam Vets suffer from PTSD. For recent wars, the figures are lower, perhaps because long-term effects have not yet been measured. About 12% of vets from the Gulf War suffer from PTSD; for the wars in Afghanistan and Iraq, the numbers vary from 10% to 20%.
The New York Times reported this month that PTSD rates among trauma surgeons, who have been told to “stay in their lane” by the NRA (i.e. “Cut out the anti-gun-violence activism!”), are roughly the same –15% -although in a Philadelphia study, up to 40% showed signs of PTSD. Many have turned to activism as a way of preventing burnout in the face of the helplessness they feel, caught in the revolving door of cleaning up in the wake of gun violence.
My father-in-law is a veteran of WWII who enlisted at the age of 17. In his service he experienced combat, shooting others at close range, capture by the Germans, escape; he also witnessed the horrors of a Nazi concentration camp first-hand when it was liberated. Later, as a husband and father, he was a pretty regimented guy who tied his shoes again after taking them off, but he was consistent, fair, and loving. He did well in his career and racked up awards for community involvement along the way. He speaks of himself now as a “survivor” when many didn’t survive. But he does not have PTSD.
Are some people born stronger than others? Many people believe that the “resilient” possess innate elasticity. They are predisposed to be OK, no matter what. It’s class hierarchy as applied to the psyche: The strong are above the weak; the sane above the crazy; functional citizens pity those who are a drain on society. Who among us hasn’t been affected by judging others, or ourselves, according to these binaries?
It’s class hierarchy as applied to the psyche: The strong are above the weak; the sane are above the crazy.
The truth is that the self — the notion of “who I am” — didn’t form in a vacuum. The self who later becomes a trauma surgeon or a combat veteran emerged in the crucible of family. From there, we go on to face an uncertain world, each of us armed with adaptations learned in that crucible. We adjust to school and the larger world based on the beliefs we absorbed as if with our early feedings — in my case, the notion that a good person must writhe in guilt whenever she offends anyone else. Kind of a drag, but it kept me in my mother’s good graces.
Those skills are all about survival — staying alive and connected to one’s caregivers, by any means possible. Fierce attachment and loyalty to them may be biologically determined, but the primary adults in a young child’s experience hold the power of gods over that young soul.
Bessel van der Kolk, MD, founder of the Trauma Center and professor of psychiatry at Boston University School of Medicine, put it this way in his 2014 book, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma: “Our most intimate sense of self is created in our minute-to-minute exchange with our caregivers.”
He further describes severely traumatized children he met early in his career, saying they “had hardly developed a sense of self — they couldn’t even recognize themselves in a mirror.”
The relevance of Van der Kolk’s insights are spreading as more people in the helping professions wake up to an understanding of the long-term affects of childhood trauma. A growing movement holds great promise for understanding trauma, its treatment, and especially, for upending this nonsense of viewing PTSD victims as “weak.”
Our understanding of traumatic reaction to stress has deepened since the 1940’s, when my father-in-law was discharged from the military. A 2011 study of 746 Danish soldiers who experienced combat in Afghanistan found that the ones who experienced highest levels of PTSD had experienced high levels of “Adverse Childhood Experiences,” or ACES. The more ACES, the more combat trauma.
ACES are simple to understand and fairly simple to measure:
“Adverse childhood experiences (ACEs) are traumatic events occurring before age 18. ACEs include all types of abuse and neglect as well as parental mental illness, substance use, divorce, incarceration, and domestic violence. A landmark study in the 1990s found a significant relationship between the number of ACEs a person experienced and a variety of negative outcomes in adulthood, including poor physical and mental health, substance abuse, and risky behaviors.”
–From a 2019 infographic published by the US Department of Health and Human Services website.
Understanding the power of ACES can go a long way toward overcoming the shame of being one of the “weak” ones. The extreme individualism celebrated in Western Culture has very little to do with how we actually thrive — always, always in relation to others. Not to need anyone else is madness.
The adaptability of young children is highly creative. We adjusted to family craziness, perhaps, by becoming crazy ourselves…but how often is this recognized as a strength? The resilient, are not those for whom adverse experiences slide off as if they were made of Teflon. The resilient are those who NEEDED to be resilient in order to form a self in the first place, despite everything that made them feel undeserving of life.
This piece originally appeared on HelenWMallon.com