THE PTSD PANDEMIC

Trauma Inflation

The Present Intrudes Again

If you look at the portion of this blog that offers the rather flimsy rationale for its existence you will find that I said I would likely be writing about benignly boring events and uncontroversial subjects which occurred in the remote past. Now here I am again pontificating, this time about PTSD, a topic about which I know little, but which cannot these days be avoided. And again I will be taking a contrarian position which is unfortunate since the holder of such an unpopular view will seem to be devoid of any sympathy for the suffering. (At least, I am consistent; see my earlier post about Stress and the “Anxiety Industry).

One does not have to scan a wide variety of national or international sources to find evidence of trauma inflation. Local stories about the apparent rise in the incidence of PTSD among EMS workers, first responders and the police are increasing.  Even those less directly associated with a critical trauma incident can become a victim. A recent article focussed on the PTSD experienced by a juror who had to sit through a trial involving the kidnapping, rape and murder of a young child. “Symptoms have been debilitating, she says, including memory loss, bouts of extreme anger and a shopping addiction that drained her retirement savings and children’s education plans.” Perhaps it is a good thing that in Ontario, members of juries are not allowed to discuss the deliberations with others, thus possibly preventing the infectious spread of PTSD.

I am pleased to live in a compassionate society and in such a place one expects compensation as well as commiseration. As a result, a local hospital is doubling the size of its “operational stress injuries clinic” and the province is “dedicating money and resources to preventing and mitigating post-traumatic stress disorder (PTSD) in first responders.” Earlier this year (2016) the Ontario Government introduced Bill 163, Supporting Ontario’s First Responder’s Act (Post-traumatic Stress Disorder), 2016.  The Bill sets out proposed changes to the Workplace Safety and Insurance Act, 1997 (“WSIA”) and the Ministry of Labour Act.

“The amendments to the WSIA cover a variety of first responder’s, including among others, firefighters, including volunteer firefighters and part time firefighters, fire investigators, paramedics, and police officers.  The amendments would create a presumption that a first responder who is diagnosed with post-traumatic stress disorder is eligible for WSIA benefits as if the PTSD was a personal injury.  For purposes of entitlement, the Bill removes the need to prove causation or a link to the workplace, and creates the presumption that the PTSD arose out of and in the course of the worker’s employment unless the contrary is shown by the employer.  Workers will not be entitled to benefits for PTSD arising out of an employer’s decisions or actions relating to the worker’s employment including a decision to change the work, the working conditions or to discipline or terminate the worker’s employment.” For now, at least, the last sentence seems to indicate that PTSD cannot be claimed if one is simply shouted at by a supervisor.

In the case of the traumatized juror, the jury is still out. Victims of violent crime are entitled to compensation from the Criminal Injuries Compensation Board and in this instance the juror argues that she also is a victim of the crime. Her case will be considered soon by the Ontario Court of Appeal. Some fear that “compensating a juror would open the floodgates so anyone who sits through a extremely violent trial — judges, court staff, prosecutors, defence lawyers, police and journalists — will want compensation.”

There is some evidence from abroad that the floodgates already have been opened. A veteran BBC war reporter with some experience with circumstances we will simply describe here as ‘difficult’, reported on the expansion of PTSD claims among civilians who generally operated in more peaceful and serene environments. According to his report on the “Trauma Industry”, it is now worth 7 billion (pounds sterling). One person interviewed for the program indicated that he thought that PTSD was being over-diagnosed: “ Dr.James Thompson, a trauma psychologist, made the comments on BBC's Panorama programme investigating the growing army of sufferers. The programme claims that the NHS now treats an estimated 220,000 people a year suffering with post-traumatic stress disorder, a diagnosis once reserved for those coming back from war zones. The disorder is adding enormously to the burgeoning multibillion personal accident industry business, it said. Those being diagnosed include people who have had a minor traffic accident, bullying in the workplace, even in the schoolyard. In the programme, titled “The Trauma Industry,” Dr Thompson suggested it was part of the growing "victim culture"."And that is always attractive to all of us. Now you can teach yourself PTSD on the internet within five minutes." “Post Traumatic Stress Disorder Has Become a "Fashionable Diagnosis" That is Far Too Liberally Diagnosed…”,  Richard Alleyne, The Telegraph, July 27, 2009.

Trivializing Trauma

There has been an increase in both the types of things classified as ‘traumatic’ and in the number of those individuals likely to experience them. A term originally applied to physical injuries is now applied to psychic ones and those affected include not only those who experienced the incident, or witnessed it, but even to those who have learned or heard about it. Perhaps it is the case that not every unfortunate episode is traumatic nor is everything that is horrible horrific. The merely distressing does not have to be totally debilitating. If one uses the term ‘traumatic’ to describe a bad day at the arcade, how does one describe a day in Aleppo?

Stoicism

Since you probably remain unconvinced by my argument, here is a piece by someone better credentialed than I and I encourage you to look at the full article:

“How we Became a Country Where Bad Hair Days and Campaign Signs Cause ‘Trauma’”, by Nick Haslam, Washington Post, August, 12, 2016. ( Haslam is a professor of psychology and head of the Melbourne School of Psychological Sciences at the University of Melbourne.)

“Trauma is being used to describe an increasingly wide array of events. By today’s standards, it can be caused by a micro-aggression, reading something offensive without a trigger warning or even watching upsetting news unfold on television. As one blogger wrote, “Trauma now seems to be pretty much anything that bothers anyone, in any way, ever.”

This is not a mere terminological fad. It reflects a steady expansion of the word’s meaning by psychiatrists and the culture at large. And its promiscuous use has worrying implications. When we describe misfortune, sadness or even pain as trauma, we redefine our experience. Using the word “trauma” turns every event into a catastrophe, leaving us helpless, broken and unable to move on.

All of this is problematic. The way we interpret an experience affects how we respond to it. Interpreting adversity as trauma makes it seem calamitous and likely to have lasting effects. When an affliction is seen as traumatic, it becomes something overwhelming — something that breaks us, that is likely to produce post-traumatic symptoms and that requires professional intervention. Research shows that people who tend to interpret negative events as catastrophic and long-lasting are more susceptible to post-traumatic reactions. Perceiving challenging life experiences as traumas may therefore increase our vulnerability to them.

Another fine invention of the ancient Greeks was stoicism. Contrary to popular opinion, the stoics did not think we should simply endure or brush off adversity. Rather, they believed that we should confront suffering with composure and rational judgment. We should all cultivate stoic wisdom to judge the difference between traumas that can break us apart and normal adversities that we can overcome.

Some Sources:
“Juror at Trial of Michael Rafferty, Found Guilty of Killing Tori Stafford, Suffering PTSD, Looking for Compensation,” Jane Sims, The London Free Press

Tuesday, October 18, 2016.
“London's Parkwood PTSD Clinic for Veterans, Soldiers, and RCMP Officers Expanding,” John Miner, The London Free Press, Friday, October 21, 2016.

When I poked around a little bit, I was surprised to learn that the founder of a major PTSD Association has London connections and she would certainly offer a rebuttal to this piece. For more see:“Struggling for a Way to Just Get Over It: After Witnessing a Horrific Car Crash, Ute Lawrence Couldn’t Find a Group to Help Her Recover from PTSD, So She Started Her Own,” Gerald Hannon, The Globe and Mail, Aug. 4, 2008. [The accident was indeed horrific - the fog crash on the 401 Sept. 3, 1999, 87 cars, 45 injured and 8 dead- and Ms Lawrence was in it.]

Ute Lawrence is the CEO and founder of the Post Traumatic Stress Disorder Association and has published The Power of Trauma.
(Since I have not ‘gone public’ with this blog she is unlikely to read this, nor is my son who is a first responder - nor for that matter is his mother, who is in the ‘industry’ and would surely be opposed to these opinions.)

See also this interesting article which shows how the definition of trauma has evolved: “The Man in the Gray Flannel Suit Put the War Behind Him. Why Can’t We?” Annals of Psychology and, "Getting Over It,” Malcolm Gladwell, The New Yorker, Nov. 8, 2004.

“Somehow in the intervening decades our understanding of what it means to experience a traumatic event has changed.”