Day Two, Panel Four: The Psychological Impact of Covering War Crimes

Moderator/Discussant: Frank Smyth, Washington Representative, Committee to Protect Journalists

Frank M. Ochberg, M.D., founding Board member of the International Society for Traumatic Stress Studies, consultant to the F.B.I., U.S. Secret Service, and National Security Council

FRANK OCHBERG: Frank and I met last November and we've become colleagues and friends. I think I can smell the smell that'll bring you back to that reality. Proust tries to remind us how smells can bring us back to things that may have been lost for decades. I want to, in just a little bit of time, do what I can to begin an appreciation and an understanding of post-traumatic stress disorder. Hit a few high points, talk about some of the other major mental reactions that you may encounter as you cover extreme trauma.

Something in this chain of events that gets passed from these far corners of the world through the front line, witnesses for the rest of us, to you, then back to us as readers, I hope, I hope somehow eventually enlightens and helps us reduce human cruelty. We sure as hell haven't figured it out. And my field has been very, very late in coming to acknowledge the normal human and physiological reactions to extreme stress. There may be something about our biology and our culture that forces us to perpetuate violence and cruelty. And we find it in ourselves and we all struggle with it. Maybe something more about the new science of post-traumatic stress disorder will help. I hope so.

It comes historically. This new era comes out of not just the Vietnam War, but the women's movement and the attention that has been given to survivors of rape and incest and battering, which in some cultures is considered normal behavior. Rape and incest and battering. The numbers -- maybe our statistics friends could help us on this at some point -- they stagger me when I look at those numbers. And it wasn't until women got into leadership positions and the American Psychiatric Association and in universities and a few decades ago, I think the field began to make political changes and change its diagnoses and its approaches.

I got involved early in looking at trans-national terrorism. I became involved in some counter terrorist activity as the psychiatrist who worked with the NCS and the FBI hostage negotiation. And, if you recall, back at those times we did have an era in which there was a lot of attention in identifying with someone held hostage. What did that person feel and encounter? How was that person debriefed? What was true, what wasn't true?

Out of those experiences came the official medical diagnosis in 1980, “post-traumatic stress disorder.” It's a fairly simple diagnosis. If you've been exposed to the kind of life event that caused you, at the time, to feel terror or horror or to just feel paralyzed, at the time, and for at least a month afterwards, you've experienced among three categories of rather different reactions, you could be diagnosed as having PTSD. Those three different categories are as follows. First is, in one way or another without wanting to, you re-experience what you experienced. Now it could be just that in writing a novel about your experience, you recover what you originally went through. It could be that it's very dramatic. It has the power and intensity of a flashback or a hallucination. It could be that it simply as you'd rather not be thinking about that grave sight that you were at, but you find yourself thinking about it and you didn't intend to.

This first part of the diagnosis is patho-mnemonic, specific. It is the core of post-traumatic stress disorder. And because this happens to people who don't understand why it's happening, they often think they're going crazy. They don't understand this syndrome and understand that it eventually gets better. Although it could, because of everything around it, have you haunted with a life-shattering situation and not just a series of experiences that you have lived past. But it could be that you're moving on in your life, you have a chance to recover, and yet you're brought back to that scene and you've not only re-experienced the scene, but you doubt your sanity. And you think it's going to get worse and if it happens to you in older age, you may confuse it with Alzheimers or forms of dementia. So the opportunity that the media has to explain this to people who don't know about it, can be the first part of their recovery. It can give them hope, it can normalize the reaction, it can let them know that it is part of the universal human response to extreme stress.

Now the second part of the syndrome is almost the opposite. The second part are called the negative symptoms. And we had what was almost like a congressional hearing deciding what would go in and what would wouldn't go into these symptoms way back in the late 1970s and early 80s. People who studied holocaust survivors said over and over again we've seen that the person just feels they won't have a long life. So developing the sense that your life is foreshortened, a foreshortened future is part of that listed set of markers. But what I see over and over is the person says I'm a shadow of my former self. The Vietnam vets say I'm a survivor and they don't mean it the same way people in the crime victims movement mean it. “I'm a survivor, I'm proud, I'm not a victim anymore. I'm a survivor.” No, for them, they're like something out of T.S. Eliot. “I'm hollow, I'm stuffed, I'm empty. I'm just a survivor.” So it's a shift in sensation. You feel numb. You're not into personal relations. You feel detached. And in a sense of the meaning of your life, it has been seriously reduced. It's not quite the same thing as depression, but the same pathways that are involved in depression appear to be involved in this. And the same medication seems to help, the serotonin enhancers. It's the negative symptoms. It's either called numbing or avoidance or emotional anesthesia. So you have re-experiencing and you have this.

The last part is as though something has changed in the alarm system that triggers an adrenal response. You are far more easily aroused to experience fear. And you have the neurochemistry of an anxious person. And it needn't be related to triggers that resemble the traumatic event. In general, you have become a more anxious person. This interrupts concentration. It interrupts sleep. It destroys a sex life. It causes a measurable physiological marker, the “startle response.” A loud noise and you go -- I'm consulting at Columbine High School. The lights went out at Columbine High School last week. The secretary to the principal grabbed my leg and we were in a dark room. First I thought, “Oh, she's going to lead me out of the room,” Then I thought, “Oh, no, no. She's having a panic attack.” Then I said, “Well, I can understand it. It's Columbine. She's having a panic attack.” Then I said, “Holy Christ. It's Columbine. Something could be happening to me.” And rapidly, all these thoughts went through. I was triggered by her startled reaction, which was part of her post-traumatic stress disorder. And we finally rested when we saw the traffic lights were out too and it was a regional blackout.

PTSD, though, isn't the only reaction. When we've been confronted with human cruelty, we characteristically feel ashamed and belittled and stigmatized, maybe guilty. And that's not in the books on PTSD. I don't know why it is this way. Perhaps we feel like losers. Perhaps there's a certain literal or metaphorical sexual invasion of us. We have been violated. Something sacred about ourselves, something about our beliefs has been radically altered and we feel embarrassed. And with that embarrassment, we don't want to talk about what we've just gone through. So a victim syndrome. I consider this encounter with cruelty and a trauma syndrome as PTSD.

Sometimes the way we describe an encounter to ourselves may turn it more into a trauma syndrome than a victim syndrome. Let me explain this and I think where this may be critical for crimes of war as opposed to war itself. War itself, at least old wars, had a certain noble quality to them. And they might have been thought of as events that came with planetary revolution. Events of nature. But a
war of crime is a deliberate violation of the rule and violation of that individual. So there could be elements of shame and subjugation and of feeling dirty are different from the straight post-traumatic stress reaction.

In covering these issues, it's also important to pay attention to effacing and to a, I think it's individualized, but there are sequences of events. And early on there may be elements that have more to do with dissociation, of being in a trance or being in a feud. We have a new diagnosis now called acute stress disorder, which emphasizes that element. I wonder if this has adaptive value biologically. That at times in which sudden catastrophic events are happening, the masses will be dazed so that leaders of the tribe or the community can pull a flock in one direction or another. It isn't particularly adaptive if you're the one who is dazed. And those who are dazed turn out to be at a higher risk for a more difficult post-traumatic stress disorder later. Perhaps they've lost control of mental function. They doubt themselves later. They're more vulnerable to the rest of ATSD.

Other issues too, drinking too much, self-drugging, psycho-physiological problems, and from time to time, gross psychotic disorders. Let me not go into all of that. That's the outline of PTSD. I'll say just a few words about what my foundation is interested in now. We want to help with this network that we are creating here today. Interactions among those of us who've been learning about trauma from a medical, a mental health point of view and those of you who are the eyes and ears for the rest of humanity. Can we learn with each other and can we develop new ways of teaching new journalists? Can we have an award -- and we do now, $10,000 a year for the best newspaper writer on victims of violence. And some of the productions that we've seen should be eligible for this award. Currently, it's an American award and Australian award. We'll try to get it to the U.K. if our funds comes in. So the Dart Foundation, which you can reach at www.dartcenter.org, tells you about those services and those programs. The little handout that you have from me is a primer for journalists on PTSD and there's a Web site there that gives you access to other things that I've written.

Thank you.

Frank M. Ochberg, MD, Bio.
Founding Board Member of the International Society for Traumatic Stress Studies

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