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PTSD: The Invisible Laceration

Because the wounds are invisible, we may be certain that a staggering majority of PTSD victims suffer their private agonies in complete isolation -- unnoticed and untreated, often defying help when it is offered.
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This past Wednesday, in an unprecedented act of wisdom and sensitivity, the Connecticut General Assembly unanimously passed legislation establishing a special charitable fund to help police, teachers, school secretaries, custodians, and medical examiners receive mental health assistance and expanded workers compensation in the aftermath of the Sandy Hook massacre. In the process of developing their bill, the legislators demonstrated psychological astuteness to the nuances of post-traumatic stress disorder that is remarkable for any bureaucratic body.

First, they acted quickly, which is essential in preventing toxic emotions and social withdrawal from gathering momentum. In addition, speed is critical to assist the 11 teachers and school personnel whose applications for workers compensation have been rejected, leaving them no choices but to return to work or lose their incomes. The fund, which has already received several hundred thousand dollars, will be operative by April 1, allowing those most affected to have the necessary time and assistance to continue -- indeed, for some, begin -- the healing process.

Second, the legislators understood that, because of feelings of guilt and shame, PTSD victims often find it impossible to express their suffering and need for help. In order to get an accurate picture, they actually interviewed co-workers who witnessed first-hand what the victims were experiencing.

Third, legislators were aware that the effects of trauma are sometimes delayed and built this into the provisions of the bill. For example, some teachers will likely break down during the summer when they no longer are distracted by attending to the needs of the children.

And fourth, recognizing that PTSD has a paralyzing effect on so many Connecticut residents well beyond the borders of Newtown, there is additional state legislation pending to provide expanded assistance for anyone suffering trauma in the workplace.

The sensitivity of the Connecticut legislators stands in sharp contrast to the treatment received by the overwhelming majority of those suffering from PTSD. Previously referred to among the military as "shell shock" or "battle fatigue," the term itself was coined in the aftermath of the Vietnam War to describe the conditions of tens of thousands of returning soldiers plagued by such symptoms as isolation, detachment, extreme difficulty adjusting to civilian life, unpredictable mood swings, violence, outbursts of anger or weeping, flashbacks, nightmares, descent into alcohol and drug abuse, suicidal impulses, intense anxiety and depression, as well as irrational guilt and shame managed by suppression and denial. Because the majority of Americans failed to distinguish between the perceived immorality of the Vietnam War versus the soldiers themselves, the shameful examples are well known of vets spat upon as they entered west coast airports, followed by ostracism in their communities.

In all of our wars, including current conflicts in Iraq and Afghanistan, the military is so often notoriously neglectful of the medical and psychological needs of returning soldiers. A riveting illustration is portrayed in the recent HBO documentary, Poster Girl, in which filmmaker Sara Nesson follows 20 year-old Iraq war veteran, Robynn Murray, in her nightmarish attempt to contend with PTSD following horrific war experiences as a lead convoy machine gunner. Over the course of three years, Nesson chronicles her struggles with rage, isolation, confusion, drug and alcohol abuse, panic attacks, and severe depression. Having left for war looking like "an American apple-pie cheerleader," she returned grim, furious, and self-destructive, festooned with rifle tattoos on her chest and V-E-T on her knuckles. The villain in the film is a woefully unresponsive and incompetent Veteran's Administration that lost extensive paperwork for her medical claims, causing her to have to move from Buffalo to Rochester, NY to pursue her PTSD disability coverage. The film's cautiously triumphant conclusion comes from Robynn's deep involvement with a group of similarly suffering veterans known as the Common Paper Project. Together, they find healing through creative expression, intense group support, and the reawakening of deep personal connection by making art from their uniforms. As Robynn says, "I never knew I could take some of the experiences I had... and turn them into something positive." Three years after returning home, she received her first 80 percent-disability monthly check of $1,228, providing some support for her ongoing healing process. The Veteran's Administration could learn volumes from the recent Connecticut General Assembly initiatives.

A 2005 study by Harvard Medical School found that in the United States, 7.8 percent of our population suffer from PTSD at some point in their lives, including 10.4 percent of all women and 5 percent of men. The numbers go far beyond soldiers, police, fireman, and emergency medical personnel. They include victims or witnesses of rape and extreme, often unexpected, violence. Those who experience the sudden death of family members often experience PTSD. Inner city kids and their families, who are exposed to violence or the dire threat of it every day, are among the most neglected. Children and adults who are severely bullied are another category.

Surprisingly, 25 percent of adults who spent at least one year in foster care between the ages of 14 and 18 suffered from PTSD, about double the rate of Iraq or Vietnam war vets. Sadly, the recovery rate for foster care alumni was measured at only 28 percent versus 47 percent in the general population. Again, physical, sexual, and emotional abuse were the main causes.

Because the wounds are invisible, we may be certain that a staggering majority of PTSD victims suffer their private agonies in complete isolation -- unnoticed and untreated, often defying help when it is offered. Imagine the rape victim who is ashamed and afraid to come forth for fear of further traumatization by public humiliation and a moronic legal system. Consider the abused child who is terrified of speaking up; the fireman who sees it as a sign of weakness to feel overwhelmed and vulnerable; the bullied teen who has found that reaching out for help has only made it worse.

The slaughter of 20 second graders and six heroic teachers has focused unprecedented and desperately needed attention on our nation's perversely commonplace gun violence, of which rampage killings are but a tiny fraction. Beyond Newtown, will there be analogous attention generated for the 1 in 12 of our populace who suffer from PTSD? Because of the spotlight on the surge of Newtown PTSD victims, because of the model for care and responsiveness emanating from their community and extraordinary state legislature, perhaps public awareness can be enhanced -- a prerequisite for beneficial action such as occurred in Connecticut this week.