What You Can Change . . . And What You Can't*: The Complete Guide to Successful Self-Improvement (23 page)

Or Jonah could have done it.

K
ATE:
Rinsing isn’t enough. I’ve told you a hundred times: Dishwashers don’t scour plates
.

J
ONAH:
Yeah, I have to wash the dishes before you wash the dishes
.

K
ATE:
Can’t you just be a little help around here before you start complaining?

J
ONAH:
You don’t seem to realize that I’ve had a hard day at work. I don’t need this shit when I come home!

The crucial spot. His temper is flaring. Jonah should now use this as a signal to deploy his DESC skills.

J
ONAH
[describing]:
The last time we did the dishes we got into a fight
. [expressing]
This makes me feel sad and hopeless. It also makes me feel angry
. [specifying]
Next time we do the dishes, I want you to rub my shoulders while I scrape and rinse them
. [consequence]
If you don’t want to do this, I’ll just do the dishes alone next time
.

A final bit of advice, concerning fighting in front of your children: I am not naive enough to think that even if you take this chapter to heart, you will never again fight in front of your children. Fights happen. There is one solid piece of research on the subject of fighting in front of your children—if you must. It concerns resolution. Children who watch films of adults fighting are much less disturbed when the fight ends with a clear resolution. When you fight, go out of your way to resolve the fight, unambiguously and in front of your child.

10

Post-traumatic
Stress

I want to live so that my life cannot be ruined by a single phone call.

Federico Fellini,
La Dolce Vita

T
HIS IS
the saddest chapter of all.

“How’s your son, Tommy, doing?” inquired an old customer of Hector’s. Hector had sold him an insurance policy a few years before, and they hadn’t run into each other since. Hector burst into tears.
¹

Although it had been five years since that awful October evening, the memory and the pain were ever fresh. Tommy, fourteen, had been the center of Hector’s and Jodi’s lives. The family ate breakfast together every morning, and Hector and Jodi included Tommy in almost everything they did. Every Saturday was Tommy’s special day with Hector: just Tommy and Hector all day long
.

Norma Sue, Tommy’s seventeen-year-old cousin, was always in trouble in her hometown of Chicago, so her parents sent her to live with Hector and Jodi in their small Iowa town to straighten her out. Tommy was particularly enthused about helping Norma Sue, and tried to get her active in the church youth group
.

One Monday evening, Tommy persuaded Norma Sue to go to a youth-group meeting with him. She drove. About an hour later, Jodi dropped by her office and took a call from Hector. Hector said that there had been a small car accident, but that both kids were okay. To put her mind at ease, Jodi called the hospital and was told to come right over. Jodi went there and waited, and when Hector arrived with the police, she saw that he was hysterical. She knew immediately that Tommy was dead
.

The five years since have been an unending hell for Jodi and Hector
.
Jodi, formerly ebullient, has been suicidally depressed ever since. She has lost all motivation to do anything. She never went back to her office, and now barely keeps house. Once or twice a week she wakes up from terrifying nightmares, which often depict Tommy surrounded by “bad” kids, pleading with his mother to protect him. She relives that Monday evening every day of her life
.

Hector has barely hung on to his sales job. He used to be a regular member of the million-dollar club, but he hasn’t come close since Tommy died. Weekends are even worse for him because that was the time he always devoted to Tommy. Every time the phone rings, Hector almost jumps out of his skin. He can’t talk to anyone
—
especially Jodi
—
about Tommy because it would hurt too much
.

Last month, Hector moved out and Jodi filed for divorce
.

Tragedy used to be a part of everyone’s life—the human condition. Until this century in the West, more than half the population thought life was a vale of tears. Not so now. It is not unusual to go through an entire lifetime without tragedy. Bad things still happen to us all too frequently: Our stocks go down, our aged parents die, we don’t get the job we had hoped for, people we love reject us, we age and die. But we are usually prepared for many of these losses, or at least we know ways to soften the blow. Once in a while, however, the ancient human condition intrudes, and something irredeemably awful, something beyond ordinary human loss, occurs. We are then reminded how fragile the upholstered cubicles we dwell in really are.

So devastating and long-lasting are the effects of extraordinary loss that it has finally been given a name and a diagnostic category of its own:
post-traumatic stress disorder (PTSD)
. No jargon, no euphemism, no psychobabble, can camouflage that this is the saddest disorder of them all. Distress is universal. Many—but, assuredly, not all people—display the hallmarks of PTSD for months or years afterward:

• Reliving:
  The victim persistently relives the trauma in dreams or in intrusive flashbacks (or has the opposite reaction: He can’t recall the event). Not a day went by for years afterward when Hector and Jodi did not ruminate about Tommy’s death. They both repeatedly dreamed variations on Tommy’s death.
  

• Anxiety:
  The victim avoids anything connected with the trauma. He has difficulty falling asleep and staying asleep. He can’t concentrate. He startles easily. He becomes passive and continually anxious. Hector couldn’t bear to talk to anybody about Tommy, and he jumped whenever the phone rang.
  

• Numbness:
  The victim becomes numb to life. She may feel detached and estranged from people. She may lose the ability to love anybody. Jodi quit her job, Hector lost his ambition, and their marriage fell apart.
  

The worst of the common tragedies is, by all statistics, the death of a child. Each year in the United States, 150,000 people are killed accidentally. Accidents are the number one killer of children. Thus there are hundreds of thousands of parents in our country today bereaved by the worst loss of all. Unexpected death of a spouse is a close second.

Bereavement: Common lore tells us that it is difficult, but that time heals all wounds. Doesn’t it? Only some wounds, it turns out. When your spouse of many years dies, bereavement takes a predictable course: six months to two years of mourning, sadness, even depression, and an elevated risk of death yourself. And then, your life poorer, you pick up and go on. Not so for extraordinary losses.

It used to be thought that victims recovered briskly. Among the first psychiatric studies of the aftermath of disaster was one that focused on the Cocoanut Grove nightclub fire of 1942. Interviews with the survivors and the families of the dead led to an optimistic picture. An “uncomplicated grief reaction” was supposed to dissipate in four to six weeks.
²
This has remained the lore ever since. When people take longer than a few weeks to adjust after their lives have been devastated, it is considered “abnormal.” In order to qualify for a certified diagnosis of PTSD, the symptoms have to last at least one month.

Dr. Camille Wortman, a social psychologist, has single-handedly changed the lore. She went through the microfilm records of every auto fatality in Michigan between 1976 and 1979. She randomly chose thirty-nine people who had lost a spouse and forty-one couples who had lost a child. She interviewed them at length and compared them to matched controls.

The parents and the spouses were in decidedly poor shape four to seven years later: They were much more depressed than the controls, were less optimistic about the future, and did not feel good about their lives. They were more “worn-out,” “tense,” and “unhappy.” More of them had died than had the controls. While they had not differed from the controls in income before their child died, the bereaved parents now earned 25 percent less. Twenty percent were divorced (versus 2 percent of the controls). The bereaved people were just as bad off seven years later as four years later, so there did not seem to be a natural healing process at work. Almost everyone asked “Why me?” Sixty percent could find no answer to this wrenching question.
³

There are some clear cases of what counts as a loss “outside the normal range of human experience”: spending years in a concentration camp where you are forced to aid in the killing of fellow prisoners, watching your child be tortured, being the only survivor in your family of a collision with a truck, living through a catastrophic flood that decimates your community, being pinned down in a foxhole for days surrounded by corpses, being kidnapped and held hostage. Such horrific experiences routinely produce PTSD.

Dora, a Polish Jew, was sent to Auschwitz with her husband and three sons after the uprising in the Warsaw ghetto. Her husband and her baby perished in the first few hours, but she lived on until the end of the war, watching her two other sons worked to death; she survived by giving sexual favors to camp guards. Dora found her way after the war to distant relatives in Pittsburgh
.

An old lady now, she has not recovered. She has never worked, and she stays in her attic room listening to classical music most of the time. When she goes out, the sight of men in uniform—policemen, even mailmen—frightens her. She thinks constantly of her dead family and feels guilty that she lived and they died. Her contact with the present is minimal. Every night she dreams of her baby burning to death in an oven. It has been forty-five years of life in Auschwitz
.

Prisoners of war can show lifelong symptoms of PTSD. Forty years after captivity, 188 World War II POWs underwent diagnostic interviews in Minneapolis. Sixty-seven percent had suffered PTSD during some of the previous forty years. Of these, nearly 35 percent still had moderate or severe symptoms, and 40 percent still had mild symptoms.
⁴

If PTSD were only about the clear cases, like Dora’s and like the POWs’, it would be of interest only to specialists and to voyeurs. But PTSD, I believe, is much more widespread and is set off by more commonplace losses than the diagnostic criteria allow. I believe that the objective definition of “extraordinary” loss masks what takes place in the minds of the victims; what takes place does not reside in the objective awfulness of the event.

Bad things, though maybe not as objectively awful as the horrors above, happen to most of us. Some of us react to our losses with resilience. After a few weeks we go about our lives, look for a new family, a new job, a new country, or a new reason for living. Many others of us are more brittle. Major loss changes our way of looking at ourselves and the world forever. We find ourselves beyond consolation. Most people, living through what Dora did, would suffer PTSD. But many people endure the same symptoms when a child dies suddenly. Some people suffer it when they are mugged or raped. And a few surfer it when they are abandoned by a spouse or, merely, sued.

The Rape-Trauma Syndrome

Rape is distressingly frequent in our society. About 100,000 rapes are reported every year, and possibly seven times as many go unreported. As many as one out of every three to five women will be raped in her lifetime.
⁵
Rape is even more frequent in poorer societies. Using “extraordinary” as a criterion, rape, and the death of a child as well, would not qualify for PTSD. But it is clear that the death of a child usually, and rape sometimes, set off just the same symptoms as war, torture, and earthquake almost always do.

Ms. T., twenty-eight, was asleep in her apartment when she was awakened by a man with a knife. He told her not to turn oyer and look at him, and threatened to kill her if she fought. He then raped her and fled. Ms. T. reported the crime, accepted physical help and psychological counseling, and even volunteered for work at a rape-crisis hot line
.