When PTSD Misses The P, Ctd


by Chris Bodenner

A reader writes:

Some good points made here. But this is also a good time to point out that PTSD is not a simple label for something that happens after trauma. The symptoms described with PTSD are really only problems after the fact. Fight or flight, hypervigilance, shutting off emotions and leaving the body – these are techniques the brain uses to protect you in the moment. I have PTSD and have had this explained to me over and over: your reactions were normal, and more importantly, they were useful at the time. You need to be able to shut down, to run, to fight, to know when danger is coming. These things become a problem later, when the danger is gone, but your body and brain can't let it go.

So if someone's still in danger – yeah, they probably need someone to talk to. But they're going to need more once the danger has passed.

Another writes:

You'd be remiss not to mention the work of Emile Durkheim, who besides having had a stellar mustache, was one of the founders of modern sociology. His 1897 book, Suicide, is widely considered to be the first empirical sociological study. Durkheim identified four types of socially significant suicides.

Egoistic and altruistic suicides relate to social integration – egoistic suicides result from the alienation resulting from "excessive individuation" and lack of social support (think of a lonely single man or elderly person), while altruistic suicides result from being so integrated that we feel our roles and values compel us to give up our lives (think of honor suicides or a parent dying to save their child). Anomic and fatalistic suicides relate to our individual positions in society – anomic suicides occur when social and/or economic upheaval falls on someone so heavily that they lose their moorings and become incapable of knowing or understanding how to fit in, act, and derive meaning (this category would include the hypothetical Indian farmer), while fatalistic suicides occur when social constraints are so oppressive that the person would rather die than continue living (think of a prison suicide or the suicide at the end of Dead Poet's Society).

These four categories may not cover every suicide, and mental illness is certainly a factor in many cases, but Durkheim's work was the first of many to demonstrate that social circumstances shouldn't just be thought of as "mediating variables" dwarfed by the causal monolith of mental illness. Rather, they should be seen as independent variables that explain significant statistical variance in their own right.

(Photo: Dan Magoon, 30, a U.S. Army veteran and Boston firefighter, has served three tours of duty in Iraq and Afghanistan and been diagnosed with PTSD. By Stan Grossfeld/The Boston Globe via Getty Images)