Note: Mental Illness Trap I was posted on 1.27.2023. Additional discussions of PTSD were posted on 4.20, 4.27, and 5.5 2019.
Many people are eager to blame “mental health” on the rash of killings in schools, and elsewhere – anywhere we go from day to day. Many cases do indeed involve a perpetrator who is unstable, and some show warning signs of being a danger to themselves and others. A number of states have instituted “red flag” laws that allow families, health and social workers, psychologists, and law enforcement to intervene before someone showing signs of dysfunction actually carries out an attack. This strategy is fine, but unfortunately, the mental health argument usually focuses on the perpetrator, and ignores the mental-health consequences for victims and their families and friends after a trauma. Post-traumatic stress disorder (PTSD) can develop in all these people.
Traumatic experiences – whether we’re talking about the direct victim or friends and relatives who experience the trauma vicariously – have the potential to change everyone over the long run; the effects of trauma, to one degree or another, tend to be permanent. No one should expect to eliminate trauma effects. Yes, the effects may be subtle, but they are present nevertheless. We must be sensitive to victims who will carry the emotional baggage of a traumatic event for the rest of their lives.
Are these victims and those close to them mentally ill? They are certainly emotionally distressed but are not likely mentally ill. Unfortunately, when mental-health initiatives are directed at perpetrators, the victims who are troubled do not receive the message that their emotional reactions are quite normal and expected, not signs of mental illness. Instead, victims – especially the young ones – hear the false message that if they experience emotions like shame, anxiety, sadness, confusion, frustration, ambivalence, and fear, then they are mentally ill – not normal. This bogus and dangerous message can trigger despair, depression, and thoughts of suicide, especially in young people who already feel rejected, abandoned, and alone.
The key to coping with post-traumatic emotions is to acquire actions to deal with them in rational and confident ways. Is it not tragic, however, that too many people in our society – especially adolescents and young adults – have been protected from adversity by parents and other adults, with the unfortunate consequence being that they never learn how to deal with negative experiences and emotions? That inability makes them susceptible to the misleading statements about mental illness perpetrated by society.
Are you one of those with a somewhat unrealistic view of the world? Have you lived a relatively sheltered, stress-free life? Do you believe adversity and danger primarily affects others, not you? If so, psychologists know that – even when your trauma is vicarious, such as when a family member is the direct victim – you’re probably ill-prepared for processing stress and trauma, and being able to confront and meet challenges. Before you can deal with the effects of your trauma, you must challenge and modify your unrealistic view of reality.
Bonnie is in her late 20s, and has been briefly hospitalized psychiatrically twice. She would come in demoralized and depressed, and leave feeling somewhat better, but still with flat emotion. Psychotropic medications had little therapeutic benefit. In outpatient therapy, Bonnie was reluctant to offer much about her past, but eventually she described a car accident from years earlier that led to the deaths of others, and put Bonnie in the hospital in a coma. She was 17 at the time, and was tormented by some classmates who bullied her online. She kept herself isolated from her parents and siblings, and fit the profile of a confused, distraught, self-critical, and self-punishing adolescent, lost in a maze of conflicting emotions. One day she drove off in a rage, crying, and that’s when the accident occurred. When she finally came out of the coma, she had no memory of the accident, a deficit that remained years later. She does, however, remember going to jail because there was evidence she was to blame for the accident.
Ten years later, Bonnie remained ravaged with guilt, but failed to see how much so through a haze of denial and shame. She also did not understand that deep down she believed she didn’t deserve to live because she caused the death of others. It was nearly impossible for her to realize that although she could not change the past, that it was within her direct control to become a better person in other important ways. One reason her guilt was difficult to resolve was that she lacked specific memories of the accident, and the guilt was hard to clarify and discuss. Nevertheless, therapy slowly helped her see her self-defeating and self-destructive brought on by the guilt. It took months for her to see the connection between her guilt, shame, and depression. As she did, the motivation to punish herself decreased and she acknowledged it was time to accept what happened and move on with her life in more productive ways. These insights occurred very slowly because her guilt and shame were rooted deep in her mind.
She agreed to join a therapy group. Eventually she was able to talk about her trauma, and she learned that she was not judged for her previous misdeed. Over time, Bonnie’s mood and behavior became more positive, her outlook brightened, and she voiced optimistic and hopeful attitudes. She faced and accepted her guilt over the accident, which helped her reduce her shame about the event. Originally, when her guilt was linked to shame, she amplified, “Look at this terrible thing I did,” to, “I must be a terrible person.” These negative emotional states regularly produced social withdrawal, depression, self-punishment, and low-esteem. By understanding that these emotions were normal given her trauma, and she was not hopelessly “crazy,” she was able to become more sociable, hopeful, and constructive in her behaviors. Finally, she learned that she needed to forgive herself.
How many 16-year-old Bonnie’s are out there, not who have had a car accident but who have suffered other types of trauma: bullying, parental rejection, school shooting, abandonment, drugs – you name it. Post-traumatic stress comes in all sorts of disguises, and these victims of trauma need professional help, especially the ones who have been indulged and overprotected, and are ill-equipped to cope with stress brought on by trauma.