The impact of traumatic events also depends to some degree on the resilience of
the affected person. While studies of combat veterans in the Second World War
have shown that every man had his “breaking point,” some “broke”
more easily than others. Only a small minority of exceptional people appear to
be relatively invulnerable in extreme situations. Studies of diverse populations
have reached similar conclusions: stress-resistant individuals appear to be those
with high sociability, a thoughtful and active coping style, and a strong perception
of their ability to control their destiny.
For example, when a large group of
children were followed from birth until adulthood, roughly one child in ten showed
an unusual capacity to withstand an adverse early environment. These children
were characterized by an alert, active temperament, unusual sociability and skill
in communicating with others, and a strong sense of being able to affect their
own destiny, which psychologists call “internal locus of control.”
Similar capacities have been found in people who show particular resistance to
illness or hardiness in the face of ordinary life stresses.
stressful events, highly resilient people are able to make use of any opportunity
for purposeful action in concert with others, while ordinary people are more easily
paralyzed or isolated by terror. The capacity to preserve social connection and
active coping strategies, even in the face of extremity, seems to protect people
to some degree against the later development of post-traumatic syndromes. For
example, among survivors of a disaster at sea, the men who had managed to escape
by cooperating with others showed relatively little evidence of post-traumatic
stress disorder afterward. By contrast, those who had “frozen” and
dissociated tended to become more symptomatic later. Highly symptomatic as well
were the “Rambos,” men who had plunged into impulsive, isolated action
and had not affiliated with others.
A study of ten
Vietnam veterans who did not develop post-traumatic stress disorder,
in spite of heavy combat exposure, showed once again the characteristic triad
of active, task-oriented coping strategies, strong sociability, and internal locus
of control. These extraordinary men had consciously focused on preserving their
calm, their judgment, their connection with others, their moral values, and their
sense of meaning, even in the most chaotic battlefield conditions.
the war as “a dangerous challenge to be met effectively while trying to
stay alive,” rather than as an opportunity to prove their manhood or a situation
of helpless victimization. They struggled to construct some reasonable purpose
for the actions in which they were engaged and to communicate this understanding
to others. They showed a high degree of responsibility for the protection of others
as well as themselves, avoiding unnecessary risks and on occasion challenging
orders that they believed to be ill-advised.
They accepted fear in themselves
and others, but strove to overcome it by preparing themselves for danger as well
as they could. They also avoided giving in to rage, which they viewed as dangerous
to survival. In a demoralized army that fostered atrocities, none of these men
expressed hatred or vengefulness toward the enemy, and none engaged in rape, torture,
murder of civilians or prisoners, or mutilation of the dead.
experiences of women who have encountered a rapist suggest that the same resilient
characteristics are protective to some degree. The women who remained calm, used
many active strategies, and fought to the best of their ability were not only
more likely to be successful in thwarting the rape attempt but also less likely
to suffer severe distress symptoms even if their efforts ultimately failed.
contrast, the women -who were immobilized by terror and submitted without a struggle
were more likely not only to be raped but also to be highly self-critical and
depressed in the aftermath. Women’s generally high sociability, however,
was often a liability rather than an asset during a rape attempt. Many women tried
to appeal to the humanity of the rapist or to establish some form of empathic
connection with him. These efforts were almost universally futile.
highly resilient people have the best chance of surviving relatively
unscathed, no personal attribute of the victim is sufficient in itself to offer
reliable protection. The most important factor universally cited by survivors
is good luck. Many are keenly aware that the traumatic event could have been far
worse and that they might well have “broken” if fate had not spared
them. Sometimes survivors attribute their survival to the image of a connection
that they managed to preserve, even in extremity, though they are well aware that
this connection was fragile and could easily have been destroyed. A young man
who survived attempted murder describes the role of such a connection:
was lucky in a lot of ways. At least they didn’t rape me. I don’t
think I could have lived through that. After they stabbed me and left me for dead,
I suddenly had a very powerful image of my father. I realized I couldn’t
die yet because it would cause him too much grief. I had to reconcile my relationship
with him. Once I resolved to live, an amazing thing happened. I actually visualized
the knot around my wrists, even though my hands were tied behind my back. I untied
myself and crawled into the hallway. The neighbors found me just in time. A few
minutes more and it would have been too late. I felt that I had been given a second
chance at life.”
- Herman M.D., Judith Lewis, “Trauma and Recover”,
Basic Books: New York, 1992.
“bush vets” live hidden in the jungle on the island of Hawaii. PTSD
counselors estimate there are several hundred of them, living in tents or makeshift
“hooches,” shelters like they made for themselves during the Vietnam
Some simply want to be left alone. Their PTSD symptoms are so severe
that they cannot live among other people. For many the war has never ended; they
still carry rifles and set booby traps around their camps. Other bush vets have
settled in remote and isolated areas of Washington State, Maine, and Texas. They
continue to be emotional hostages of a war that ended 30 years ago.
cause mental suffering to all of the people this form of violence touches. Except
for prisoners of war and concentration camp survivors, combat veterans seem to
be the most affected by PTSD. As a general rule, the more combat a veteran was
exposed to and the more intense that combat was, the more likely the former soldier
is to suffer from PTSD. One Veterans Administration psychiatrist has called PTSD
an occupational hazard of war.
Several factors make
wars especially traumatic to the soldiers who fight them:
Soldiers are separated from their homes and families. Those who fight in foreign
countries are faced with a different culture and language.
• For the
most part, soldiers are young men who are still in the process of learning coping
• During a war, especially in a battle zone, the threat of being
killed or wounded is always present.
• Battlefield conditions are physically
stressing. Often soldiers march for days in extreme temperatures. Food and water
may be scarce, and sleep scarcer. All this marching takes place while carrying
a 40-pound pack.
• Military training encourages soldiers to hate the
enemy and teaches those who will fight wars to take out their anger at the enemy
by trying to kill them. It discourages compassion and caring.
involves seeing dying and wounded people up close. Many times soldiers saw the
mutilated bodies of their friends, but to survive had to stuff their anger and
• A situation of killing another person or being killed
is perhaps the most difficult one in which a moral human being can find him- or
herself. Most us have been taught from childhood that killing is wrong, yet we
have an urge for self-preservation.
An estimated 15 percent
of the soldiers who were in Vietnam have PTSD today.
- Porterfield, Kay Marie,
“Straight Talk About… Post Traumatic Stress Disorder”, Facts
on File: New York, 1996
Reflection Exercise #3
The preceding section contained information
about factors that can influence the severity of PTSD. Write three case study
examples regarding how you might use the content of this section in your practice.
According to Porterfield, what percent of Vietnam soldiers have PTSD
today? Record the letter of the correct answer the .