Thanks to generous gifts from a new donor, Gift From Within and the Dart Society are collaborating to better serve the needs of veterans, members of the Armed Forces, and military families who carry the burdens of hidden wounds of war. Post-traumatic stress disorder (PTSD) is difficult to understand, to tolerate, and to overcome. We asked an experienced war reporter and an accomplished trauma expert to explore several facets of combat trauma and PTSD in order to help you contend with these issues. We hope and expect that this conversation between Jon Stephenson and Dr. Frank Ochberg will not only inform you about current problems facing our troops, but will give you a sense of partnership and participation in overcoming military PTSD.
Jon Stephenson (JS): Frank, thanks for taking the time to speak with us. Perhaps we could start by having you tell the readers something about your background and your experience with post-traumatic stress disorder (PTSD).
Dr. Frank Ochberg (FO): Well, I’m a psychiatrist. I’m part of the team that wrote the PTSD diagnosis, and I had a government job back from 1969-79 at a place called the National Institute for Mental Health. During that time period we went from knowing that people were traumatized, that they suffered, to having an organized way to think about it.
From my own personal experience, I was fairly close to Vietnam veterans—to Vietnam-era issues—but also to the women’s movement. In fact, and I’m very proud of this, I was the male member of the Committee on Women of the American Psychiatric Association, and I learned a lot from them and with them. And it seems to me that PTSD is the outgrowth of the experiences and the observations of the men who suffered in war and women who have suffered from being battered and raped and being the subject of incest.
I don’t think we were very clear at the time that PTSD was the culmination of those experiences of both genders – but looking back on it, that’s how it appears to me. The common ground was the pattern of suffering of different men and women in different experiences, and the attention to that came in the ’70s, and the diagnosis came in 1980.
Now more recently, I’ve become very close to journalists. I guess I realized 15 years ago that your profession conducts interviews very much the way mine does in psychiatry. We talk to people; we learn from people; and, in our different ways, we’re the researchers. We’re the ones who take a hard look and draw conclusions, and then try to help in our different ways.
I was fortunate to get the support of a wealthy family who helped me create the Dart Center for Journalism and Trauma, and the Dart Society, so that therapists, doctors, and journalists could share their points of view. The goal has been to have a conversation that leads to understanding the impact of trauma, cruelty, and tragedy on normal people, and to appreciating the patterns in which survivors of trauma respond.
JS: Before we continue, let’s clarify a few terms for readers. What does it mean when we say someone—a veteran or a serving soldier, for instance—has been traumatized, or has post-traumatic stress disorder? What is the difference between the two?
FO: Being traumatized is necessary for having post-traumatic stress disorder. There are very many people who are stressed in general, who become nervous or depressed, or who have repetitive thoughts that are distressing; but in order to have post-traumatic stress disorder you have to have been traumatized. And we did struggle with that definition of what it means to be traumatized. It means to be exposed to something that could kill you; that could change your life; that could affect you in a deep and biological way, not just something that is very difficult to contend with like a divorce. It has to be more disruptive of you as a biological being, not just as someone who has dignity and a life ahead of you, a job ahead of you. It’s not losing a job. It’s not even losing your loved one, if the loss is through natural causes. There has to be something about the traumatic event that shocks you, that makes you feel scared or horrified or helpless at the very time it occurs. So, that basically is our definition of a traumatic event.
Having had a traumatic event, you then have post-traumatic stress disorder if you suffer in three different ways for a period of at least month. The three different ways are, first, having trauma memories. A trauma memory is different from a normal memory of a terrible event. In a trauma memory, you don’t want to remember, and yet your mind or body remembers. It can wake you up from sleep. It can be in the form of a nightmare. It can be in the form of a flashback, which means you see or smell things that aren’t there but that were there when you were traumatized. Or you hear things or you see things. It has the quality of a hallucination, but it’s not part of your imagination; it’s part of your memory.
And it can be something that you’re not entirely aware of, but you feel it in your bones. Your heart races because you’ve been exposed to something that is similar to the traumatic event, and afterward you realize—oh, that’s what it was. So, the first part of the syndrome is re-experiencing the trauma, when you don’t want to experience it, in one of several ways.
The second part of the syndrome is quite different: it is being numb or avoidant. You don’t do what you used to do; you don’t feel the way you used to feel. You don’t expect to have a long and good life. You’ve been changed; you’ve been diminished; you’ve been made less. Not necessarily depressed (which means feeling helpless, hopeless, and worthless), but in some ways it’s similar to depression. That’s the part of the syndrome that’s being numb and avoidant.
And the third part is being anxious—and anxious in several ways: not sleeping well; being irritable and angry; not being able to concentrate; being easily startled; being hyper-vigilant, which means being constantly on the look-out for danger. You can think of this as having lowered your threshold for being aroused. And this is a constant; this is not just when something triggers you into returning you to the traumatic event. It’s a generalized high level of fear and anxiety.