Irritable Hearts: A PTSD Love Story (8 page)

Ugh, women. Plaguing society with their hysterics. In Freud’s day, the young Sigmund vowed to solve the mystery of what made them act so crazy. Incredibly, after hundreds of hours of diligent, sensitive interviews, he figured it out. In a breakthrough 1896 paper, he announced that he had finally determined the root of the severe psychological symptoms of the women he was treating. It was one no one had anticipated, and no one turned out to want to know.

It was sexual abuse. Hysteria wasn’t an innate psychological weakness, Freud found, but a result of horrors inflicted on its sufferers. According to his studies, the strongest, smartest minds were susceptible to it. In fact, one of his books posited that they were especially susceptible to it. His argument and evidence encapsulated the same findings of some of the best research done today. It was not well received.

Given the prevalence of hysteria, the implication of Freud’s work was that
someone
, a
lot
of someones, were sexually molesting women and children, at all levels of society. Statistics would bear that out to be the case a hundred years later, of course, but the Establishment didn’t seem to be ready for it. It certainly didn’t embrace it. Freud was ostracized. It wasn’t until after he switched course, finding that the origin of his patients’ sickness was inside them rather than in their surroundings, that he was on the path to eternal fame. His original theories are as good as forgotten.

During World War I, it was the soldier’s turn to become hysterical. The similar set of symptoms popped up with a prevalence that was impossible to ignore, and again, great minds set themselves on trying to solve the mystery of an invisible but incapacitating ailment. Must have been the shock of exploding shells on soldiers’ systems, doctors concluded. When that didn’t pan out, evidence-wise, they moved to calling traumatized men “moral invalids.”

In 1943, when Lt. Gen. George S. Patton met an American soldier at an Italian hospital recovering from “nerves,” Patton slapped him and called him a coward.

In 2006, the British Ministry of Defence pardoned some 300 soldiers who had been executed for cowardice and desertion during The Great War, having concluded that many were probably just crippled by PTSD.

This tendency to blame a victim’s faulty wiring or physiology wasn’t new (and would never get old). During the American Civil War, it could hardly escape the military’s attention that soldiers were suffering from … something. Never mind that the Greeks had long ago put it together that perfectly good men could become “out of heart” and “unwilling to encounter danger,” and discharged them honorably; Civil War doctors, who couldn’t think of any other thing that might be unpleasant about fighting the Civil War but homesickness, diagnosed thousands with “nostalgia.” Eventually, a physician named Jacob Mendes Da Costa nailed down a solid explanation for their inability to carry on with daily activities, the uncontrollable panting and sweating and palpitations and fatigue. The symptoms Da Costa observed are today recognized as PTSD; many of his subjects were having panic attacks. But he saved the government—and the affected soldiers—a lot of trouble and embarrassment by assigning the blame to the circulatory system in his 1871 paper “On Irritable Heart: A Clinical Study of a Form of Functional Cardiac Disorder and Its Consequences.”

As Herman explains, there’s good reason to befuddle and forget and muddy the conclusions of trauma studies, challenging the world order as real results do.
War
: Was there any justification for subjecting people to it?
Women and children
: Should they
not
be voiceless slave-toys? When trauma studies don’t find that the fault lies with the victim, and when they create space for those victims’ realities to be validated, an entire society becomes responsible. More specifically, usually, men do. And so the study was picked up for a time here and there with new wars and new waves of feminism but then, until recently, abandoned again as quickly as possible.

Psychology got it together, in the face of a flood of Vietnam vets experiencing persistent mental issues, to make PTSD an official diagnosis in the
DSM
in 1980, uniting soldiers on the same page with traumatized civilians—who’d previously been assigned labels such as “accident neurosis” and “rape trauma syndrome.” Psychologists started to note that the symptoms were similar regardless of the cause. But popular awareness failed to follow suit. Ditto in the fourth estate. Certainly, I had not learned in school, or at work, the signs that you’ve experienced something that has affected you seriously or might precede a nervous breakdown. Had I any sort of cultural or professional knowledge about trauma, I might’ve known that the conditions of my assignments were risk factors for journalists’ developing PTSD: the number of traumatic assignments, and the height of their intensity, and low perceived social support and high organizational stress. I’d fought the date of my Haiti assignment, protesting on the ground of my exhaustion, but I might’ve
insisted
on more time off before leaving. I might’ve known that one of the strongest predictors of long-term PTSD is entering a dissociative state during a traumatic event. And that my continuing failure to adjust afterward was a normal, if not great sign. It is a true testament to national ignorance about PTSD that before I was diagnosed, I’d never heard of the concept but in passing reference to soldiers.

It’s not a testament just because at least 4 billion people in the world will survive a trauma at some point of their lives, or because 89.7 percent of Americans are exposed to trauma by the
DSM-V
’s definition, and an estimated 9 percent of those develop PTSD. Or because being in a war isn’t even close to the most common cause of PTSD in America. Violence against women—including sexual assault and domestic abuse—is. Among the civilian population, car accidents also top the list, and they could happen to anyone. My ignorance was a testament because I’d been part of one of the more collectively traumatized civilian populations in living American memory.

*   *   *

The Saturday before Hurricane Katrina started destroying New Orleans, my husband made me evacuate our house. That time, I had resolved to ignore the order; hurricane evacuations were expensive, with the driving and the hotels, and always for nothing. But my husband, an ecological engineer specializing in coastal geomorphology, knew damn well the open secret that the wetlands and levees wouldn’t hold in a strong storm, and his expertise won him our debate. We were all the way back in our native state of Ohio when it hit, having first gone to Mississippi and then realized we hadn’t gone far enough, and that it maybe was going to be a while before we could go back to Louisiana.

Our displacement lasted several months—evacu-cation, some of us called it, because we were so funny, and since our jobs had ceased to exist. But after months of couch surfing and guest-room shuffling and not being sure if we could still graduate or reclaim employment, we returned.

In December, after Christmas, we arrived back in a city like a war zone, bombed-out-looking empty houses everywhere. Even those four months later, in our miraculously unscathed duplex, the water rarely ran properly. Even by the next Mardi Gras, six months after the storm, we were collecting pots of it from a painstaking dribble of the kitchen faucet to put on the stove for a bath, since the pressure was too weak to run a shower. Phone service hadn’t been restored. We lived on the second floor of a house in a neighborhood that had largely been, along with 80 percent of the rest of the city, submerged, and mostly abandoned. Tree lawns and neutral grounds—that’s New Orleanian for a grassy median—were piled with moldy refrigerators and drowned cars, and the National Urban Search and Rescue’s spray paint was all over the houses, codes for the date and time and unit of the search-and-rescue plus the hazards (
RATS
) and number of bodies found, written in quadrants formed by a giant X. Plus the tags advertising the findings of the Louisiana SPCA, such as
TWO DEAD CATS
. There were greasy black stripes drawn across almost every building, waterlines from the flood. There was no mail. My best friend and neighbor, who I’d tried to calm from paroxysm on the sidewalk, gasping and shrieking after shoving in her flood-warped door and finding her belongings ruined with black mold, was drunk all the time, and so were some of my professors. Some people felt renewed and reinvigorated by the challenge of rebuilding after the storm, but most everyone I knew was bloated from booze and weeping and junk food, anxiety and uncertainty even under brave faces and good times.

Natural disasters, unsurprisingly, are a reliable source of PTSD. New Orleans then was like a case study of it. There’s the horror of a disaster itself, but also the sense of continuing, imminent danger. Some of my interviewees in Haiti whose houses hadn’t fallen had slept in their yards for months after the quake for fear that an aftershock would bring it down on them after all. In New Orleans, with tens of thousands of homes destroyed and nearly 2,000 dead, we were reminded, with every step down the street, that the Earth we walked on could not be trusted. (Being reminded of it again with news and footage of Haiti’s earthquake proved unbearable to many residents; the nonprofit that would soon offer therapy to the fishermen’s wives during the oil spill registered a huge upswing of calls after the Caribbean quake.)

As it turns out, New Orleans then
was
a case study of PTSD. Harvard and Columbia University researchers descended dutifully upon the city, finding that about a quarter of the population was exhibiting symptoms—a rate that for, say, measles would qualify as a full-scale public health crisis.

On the ground, we heard nothing about it. I even participated in a study, conducted by I don’t know whom, in which I answered a survey about whether I was drinking more, crying more, exercising less and eating worse food, getting fatter because I was depressed or displaced, and/or losing my will to live. (I wasn’t.) The researcher had recruited us through someone at the university, but didn’t bother sending us the results. We heard nothing of the assessments people were making of us, unless we went academic-journal searching for them, much less how to get help for a serious but treatable condition. There were public health notices not to drink the water on certain days, but I never heard any suggesting that we should be on the lookout for symptoms of trauma.

And so, no one was. And almost no one did get treatment. Nearly two years later, in 2007, when the East Coast researchers checked back in on New Orleans’s psychological progress, they found that there was hardly any. Further, they found that, though PTSD rates almost always decrease within two years of such an event, Gulf Coast residents overall had got worse, regardless of race or sex. More than 6 percent of the population’s members were actively thinking about killing themselves. Two and a half percent had a suicide plan. Statistics in 2008, in 2009—three years after the storm, four years after the storm—would later bear out suicide rates 56 percent higher, then 85 percent higher, than those before Hurricane Katrina.

“Everyone’s saying this knocked us on our knees?” one of the fishermen’s wives had said in the oil-spill therapy session, in 2010. “We were already on our knees. I used to say I was a Katrina survivor until Gustav, and I realized I hadn’t really survived, because I couldn’t deal with Gustav.”

“Did you know that there are whole neighborhoods in New Orleans that are still destroyed, where it looks like the storm was five weeks ago?” I’d asked Marc on the balcony of the Hotel Oloffson, just weeks after Hurricane Katrina’s five-year anniversary. After asking me if I was
sure
that the people in charge of
the United States
had failed New Orleans, had still not got their shit together, so had evidently couldn’t, or wouldn’t, he sunk back as if he’d been punched in the chest.

It’s not possible to start recovering from trauma, they say, until a sense of security and safety has been established.

“The majority of people in that one-year and certainly the two-year window’s time recover,” the Harvard Medical School principal of the post-Katrina PTSD studies said, “and in very bad situations you fail to find that, that there is not as much recovery or in some extreme cases no evidence of recovery. But we virtually never find an increase, and we are finding a doubling in the prevalence of PTSD in most of the area affected by Hurricane Katrina,” he said. “That’s really quite striking.”

It really is. Compare it, for example, with the other biggest traumatic domestic event in recent history: September 11, 2001.

Five to eight weeks after the World Trade Center attacks, researchers found that incidences of PTSD in New Yorkers who lived close to Ground Zero reached 20 percent. That’s around the same as New Orleanians’ after the storm. Six months later, though, researchers (some of whom also conducted New Orleans studies) found recovery rates of 30 percent in the city in general. And they found “resilience” rates—that is, people whose mental health improved beyond mere recovery—of 65 percent. Even among the most exposed and largest PTSD populations—people who had a friend or relative killed
and
saw the attack happen; were physically injured in the attack; or were
in
the World Trade Center—recovery was between 20 percent and 40 percent. Their resilience was between 30 to 50 percent. Like other PTSD survivors, these New Yorkers would be susceptible to their symptoms recurring later in their lives, from continuing fallout from the original event (which caused health problems, job loss), under great stress or after death or divorce, new traumas that can agitate old, even healed PTSD indefinitely. But a surprising number of them had rebounded. Politicians hailed it as a triumph of human spirit.

Of all the things New Orleanians have been accused of, lacking spirit has never been one of them. So what accounts for the disparity, then? One quantifiable difference in the disasters’ aftermaths was logistical and professional support: After 9/11, crisis counselors provided more than 40,000 free sessions to troubled New Yorkers in five months; the fire department sextupled the number of full-time counselors; employers and community centers offered therapy. In New Orleans, some people weren’t even delivered food and water for as many as five days. After the flood had been drained and the residents returned, the barely functioning city eliminated nearly a quarter of its in-patient psychiatric beds.