Does the United States Have PTSD?

PSYCHIATRIC VIEW ON THE NEWS

In his response to the latest mass murder in Oregon, President Obama noted that we have “become numb to this.”

As a psychiatrist, when I hear the word numb, I associate it to PTSD in a patient. Numbness is traditionally one of the typical emotional reactions to overwhelming trauma.

We also know that another hallmark of PTSD is that the sufferer can alternatively erupt in rage and anger, sometimes to kill others and/or oneself. We have seen that quite often in veterans of recent wars.

[[{"type":"media","view_mode":"media_crop","fid":"42087","attributes":{"alt":"PTSD","class":"media-image media-image-right","id":"media_crop_6931521876961","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4522","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right; width: 138px; height: 181px;","title":"©Optimarc/Shutterstock","typeof":"foaf:Image"}}]]When I worked in a medium-security prison, I saw so many Milwaukee inner city inmates who reported a sense of numbness to the ongoing violence in their communities. In my clinical work with them, the numbness had often been thought to be a sign of antisocial personality disorder (ASD). Once I got to know patients better, ASD seemed to not be true, not once they trusted you enough to tell you about the traumatic history of their lives, often coupled with substance abuse that numbed them further.

For the violence in our inner cities, which President Obama did not refer to, we have also become numb. Unless there is a police-related murder, these deaths are so routine that they are rarely covered in the media.

We as a nation seem to have become numb to a 14-year-and-counting War on Terrorism. Given the lack of a draft, many citizens do not feel the personal connection, as we did in the Viet Nam war.

We enthusiastically enjoy the most violent of sports-boxing and football-despite mounting evidence of how much brain damage occurs in participants.

Historically, our country was founded not only on the usual violence of any revolution, but on continuing internal violence, such as mass killings, murders, and abuse of African-American slaves and Native-Americans and a devastating Civil War. There are continuing internal cross-cultural conflicts and violence.

We know that other countries most like us-Canada, England, and Australia-have done much better at controlling guns, violence, and mass murders. Australia was even founded as a prison colony of England. Why have they succeeded?

What does this suggest to me as a psychiatrist? That we have a public mental health problem, if not epidemic. That there is an ethical priority for psychiatrists to respond to issues that can benefit community health.¹ That we collectively, perhaps in the Jungian sense of a collective unconscious, suffer the equivalent of PTSD. That we psychiatrists, in addition tohelping mentally ill persons vulnerable to homicide or suicide, must be part of the solution to these societal challenges.

Some would argue that human behavior is associated with climate instability. We have had rare wildfires, drought, and now the 1000-year floods in South Carolina. These natural disasters connect to human-to-human trauma and add to our collective numbness.

We as a country are superb in responding acutely to disasters.

Our fight and flight response kicks in, as well as our compassion. Psychiatrists have developed helpful disaster response teams. But after the crisis dissipates, what is to be done to prevent another, and another, and another?

References:

1. American Medical Association. AMA’s Code of Medical Ethics. http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics.page. Accessed October 6, 2015. Section 7 states: “A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.” Also see: Ethical Guidelines: https://psychresidency.ucsd.edu/my-residency/Documents/10.0%20Ethical%20Guidelines.pdf.