What You Can Change . . . And What You Can't*: The Complete Guide to Successful Self-Improvement (48 page)

13
. See
chapter 8
of my
Learned Optimism
, on which this discussion of parental turmoil is based. Three other important references are J. Wallerstein and S. Blakeslee,
Second Chances: Men, Women, and Children a Decade After Divorce
(New York: Ticknor & Fields, 1989) (but see R. Forehand, “Parental Divorce and Adolescent Maladjustment: Scientific Inquiry vs. Public Information,”
Behaviour Research and Therapy
30 [1992]: 319–28, for a critique of such studies as Wallerstein and Blakeslee’s); E. Hetherington, M. Cox, and C. Roger, “Effects of Divorce on Parents and Children,” in M. E. Lamb, ed.,
Nontraditional Families
(Hillside, N.J.: Erlbaum, 1982); and E. Cummings, D. Vogel, J. Cummings, and M. El-Sheikh, “Children’s Responses to Different Forms of Expression of Anger Between Adults,”
Child Development
60 (1989): 1392–1404.

14
. S. Feshbach, “The Catharsis Hypothesis and Some Consequences of Interaction with Aggression and Neutral Play Objects,”
Journal of Personality
24 (1956): 449–62; L. Berkowitz, “Experimental Investigations of Hostility Catharsis,”
Journal of Consulting and Clinical Psychology
35 (1970): 1–7. Carol Tavris’s discussion of the catharsis view in her excellent book
Anger: The Misunderstood Emotion
(New York: Touchstone, 1989) is particularly lucid.

15
. Raymond Novaco,
Anger Control
(Lexington, Mass.: D. C. Heath, 1975), 52–67. This is a good book for the professional, detailing one small-scale outcome study and a variety of cognitive-behavioral techniques for controlling anger.

16
. This example is from L. Powell and C. Thoreson, “Modifying the Type A Pattern: A Small Group Treatment Approach,” in J. A. Blumenthal and D. C. McKee, eds.,
Applications in Behavioral Medicine and Health Psychology: A Clinician’s Source Book
(Sarasota, Fla.: Professional Resource Exchange, 1987), 171–207.

17
. Novaco,
Anger Control
, 8–12. See also A. Goldstein and H. Keller,
Aggressive Behavior: Assessment and Intervention
(New York: Pergamon, 1987), 139–44.

Several investigators are presently developing new strategies for anger control. These are summarized in D. Golcman, “Strategies for Lifting Spirits Are Emerging from Studies,”
New York Times
, 30 December 1992, C6.

18
. Sharon Bower,
Assert Yourself
(Boston: Addison-Wesley, 1975).

CHAPTER
10
Post-traumatic Stress

1
. The case of Hector and Jodi is adapted and modified to protect the privacy of the family. The case comes from the files of Dr. Camille Wortman, the leading researcher on the long-term consequences of bereavement.

2
. E. Lindemann, “The Symptomatology and Management of Acute Grief,”
American Journal of Psychiatry
101 (1944): 141–48.

3
. D. Lehman, C. Wortman, and A. Williams, “Long-term Effects of Losing a Spouse or Child in a Motor Vehicle Crash,”
Journal of Personality and Social Psychology
52 (1987): 218–31.

4
. J. Kluznik, N. Speed, C. Van Valkenberg, and R. Magraw, “Forty-Year Follow-up of United States Prisoners of War,”
American Journal of Psychiatry
143 (1986): 1443–45.

5
. Reliable statistics for unreported rape are hard to get, and increasingly they are becoming ideologically obfuscated. L. Gise and P. Paddison, “Rape, Sexual Abuse, and Its Victims,”
Psychiatric Clinics of North America 11
(1988): 629–48, make the one-in-three lifetime guess.

The official diagnostic criteria for PTSD are now softening, particularly in response to the “Rape Trauma Syndrome.” No longer will the criteria include such language as “beyond the ordinary range of human loss.”
DSM-4’s
description of a qualifying event will probably be “actual or threatened death or injury, or a threat to the physical integrity of oneself or others.” See
DSM-4 Options Book
(Washington, D.C.: American Psychiatric Association, 1991), H-17.

6
. This case is adapted from S. Bowie, D. Silverman, S. Kalick, and S. Edbril, “Blitz Rape and Confidence Rape: Implications for Clinical Intervention,”
American Journal of Psychotherapy
44 (1990): 180–88. They distinguish between a blitz rape, which involves an unknown assailant attacking out of the blue, and a confidence rape, which involves someone you know. Their data is based on one thousand rape victims. Unfortunately, they do not tell us if the prognoses for PTSD and recovery differ with the two kinds of rapes.

7
. B. Rothbaum, E. Foa, D. Riggs, T. Murdock, and W. Walsh, “A Prospective Examination of Post-Traumatic Stress Disorder in Rape Victims,”
Journal of Traumatic Stress
5 (1992): 455–75.

8
. The classic modern paper about reaction to rape, its typology, and its duration is A. Burgess and L. Holmstrom, “Adaptive Strategies and Recovery from Rape,”
American Journal of Psychiatry
136 (1979): 1278–82. B. Rothbaum et al., “A Prospective Examination of Post-Traumatic Stress Disorder in Rape Victims,” present the most complete picture of the sequelae in the first three months following rape. S. Girelli, P. Resick, S. Marhoefer-Dvorak, and C. Hutter, “Subjective Distress and Violence During Rape: The Effects on Long-term Fear,”
Violence and Victims
1 (1986): 35–46, report prognosis to be a function of distress, not violence. D. Kilpatrick, B. Saunders, A. Amick-McMullan, et al., “Victim and Crime Factors Associated with the Development of Crime-Related Post-Traumatic Stress Disorder,”
Behavior Therapy
20 (1989): 199–214, in contrast, report that life threat and violence best predict chronic PTSD.

D. Kilpatrick, B. Saunders, L. Veronen, C. Best, and J. Von, “Criminal Victimization: Lifetime Prevalence, Reporting to Police, and Psychological Impact,”
Crime and Delinquency
33 (1987): 479–89, report the seventeen-year follow-up.

9
. A. Feinstein and R. Dolan, “Predictors of Post-Traumatic Stress Disorder Following Physical Trauma: An Examination of the Stressor Criterion,”
Psychological Medicine
21 (1991): 85–91.

10
. L. Weisaeth, “A Study of Behavioural Responses to Industrial Disaster,”
Acta Psychiatrica Scandinavia
80 (1989): 13–24; A. McFarlane, “The Aetiology of Post-Traumatic Morbidity: Predisposing, Precipitating, and Perpetuating Factors,”
British Journal of Psychiatry
154 (1989): 1221–28; Z. Solomon, M. Kotler, and M. Mikulincer, “Combat-Related Posttraumatic Stress Disorder Among Second-Generation Holocaust Survivors: Preliminary Findings,”
American Journal of Psychiatry
145 (1988): 865–68; Z. Solomon, B. Oppenheimer, Y. Elizur, M. Waysman, “Exposure to Recurrent Combat Stress: Can Successful Coping in a Second War Heal Combat-Related PTSD from the Past?”
Journal of Anxiety Disorders
4 (1990): 141–45; U. Malt and L. Weisaeth, “Disaster Psychiatry and Traumatic Stress Studies in Norway,”
Acta Psychiatrica Scandinavia
80 (1989): 7–12.

11
. T. Yager, R. Laufer, and M. Gallops, “Some Problems Associated with War Experience in Men of the Vietnam Generation,”
Archives of General Psychiatry
41 (1984): 327–33, present grim statistics on the aftermath of the Vietnam War for veterans. These authors are not the skeptics.

12
. K. Erikson,
Everything in Its Path: Destruction of Community in the Buffalo Creek Flood
(New York: Simon and Schuster, 1976), movingly narrates the destruction of an Appalachian community and the plight of the dispossessed survivors. What Erikson fails to make clear, however, is that the survivors who so wrenchingly told him their awful stories were in the middle of suing the Pittston Company for the ruin of their lives and the dissolution of their community.

13
. J. Frank, T. Kosten, E. Giller, and E. Dan, “A Randomized Clinical Trial of Phenelzine and Imipramine for Posttraumatic Stress Disorder,”
American Journal of Psychiatry
145 (1988): 1289–91; J. Davidson, H. Kudler, R. Smith, et al., “Treatment of PTSD with Amitriptyline and Placebo,”
Archives of General Psychiatry
47 (1990): 250–60. For a review of twenty drug studies for PTSD, see M. Friedman, “Toward Rational Pharmacotherapy for Posttraumatic Stress Disorder: An Interim Report,”
American Journal of Psychiatry
145 (1988): 281–85.

14
. James Pennebaker,
Opening Up
(New York: Morrow, 1990), 37–51, 94–97.1 recommend this book to all students of PTSD.

15
. E. Foa, B. Rothbaum, D. Riggs, and T. Murdock, “Treatment of Post-Traumatic Stress Disorder in Rape Victims,”
Journal of Consulting and Clinical Psychology
59 (1991): 715–23.

16
. Foa et al., “Treatment of Post-Traumatic Stress Disorder in Rape Victims.” Other studies that suggest some relief produced by cognitive and behavioral treatment of PTSD are E. Frank, B. Anderson, B. Stewart, C. Dacu, et al., “Efficacy of Cognitive Behavior Therapy and Systematic Desensitization in the Treatment of Rape Trauma,”
Behavior Therapy
19 (1988): 403–20; and P. Resick, C. Jordan, S. Girelli, C. Hutter, et al., “A Comparative Outcome Study of Behavioral Group Therapy for Sexual Assault Victims,”
Behavior Therapy
19 (1988): 385–401.

An easy-to-follow manual for such exposure therapy is H. Moore,
Traumatic Incident Reduction: A Cognitive-Emotional Resolution of the Post-Traumatic Stress Disorder (PTSD)
(Clearwater, Fla., 1991). Patients are cycled repeatedly through a mental viewing of the precipitating incident, until the response becomes “lighter.” Using TIR, Moore reports dramatic improvement in a brief time, but what is needed is a well-controlled outcome test of these procedures.

17
. Edna Foa, personal communication, 18 July 1992. Foa is a professor at the Medical College of Pennsylvania, Department of Psychiatry, Center for the Treatment and Study of Anxiety. Because this is the pioneering center in the treatment of rape, and because so few centers are presently treating rape effectively, I include the center’s phone number: (215) 842–4010.

The study is mentioned in E. Foa and D. Riggs’s comprehensive “Post-Traumatic Stress Disorder in Rape Victims,”
American Psychiatric Press Review of Psychiatry
12 (1992): 273–303. See also P. Resick and M. Schnicke, “Cognitive Processing Therapy for Sexual Assault Survivors,”
Journal of Consulting and Clinical Psychology
60 (1992): 748–56.

CHAPTER
11
Sex

1
. Sexologists refer to these layers as
gender
identity,
gender
role, and the like. I find the word
gender
in such usage unpalatable. Pronouns, but little else, can be properly said to have gender. This is more than a grammarian’s reservation, however:
Gender
in place of
sex
is a desiccating word, a eunuch word. Like the
id
of Freud’s translators in place of his original
das Es, gender
dries up the vital fluids that pulsate through erotic life.

John Money, a modern pioneer in research on sexuality, is most responsible for introducing
gender
to mean more than what pronouns have. Underlying his attempt is the distinction between sex—your genital configuration—and gender—your status as male and female, a much broader idea than what is dictated by your genitals. As laudable as this distinction may be, sexology has become a field with impenetrable jargon (“Let’s do it, let’s fall in limerence”). For a history and apologia for some of this jargon, see J. Money, “The Concept of Gender Identity Disorder in Childhood and Adolescence After 37 Years.” Paper presented at a conference on gender identity and development, St. George’s Hospital, London, March 1992.

2
. D. Barlow, G. Abel, and E. Blanchard, “Gender Identity Change in a Transsexual: An Exorcism,”
Archives of Sexual Behavior
6 (1977): 387–95.

3
. In the only well-documented report of psychotherapy changing sexual identity that I can find, three yeoman behavior therapists attempted very intensive therapy to change, piece by piece, the feminine motor behaviors, role behaviors, masturbation, and fantasies in sequence over the course of many months. Three transsexual men were so treated. In only one of the three cases was clear long-term success obtained. See D. Barlow, G. Abel, and E. Blanchard, “Gender Identity Change in Transsexuals,”
Archives of General Psychiatry
36 (1979): 1001–7.