January 3, 2001

Sloppy Science Justifies Posttraumatic Stress Disorder
by Ilana Mercer

If I were to tell you that the incidence of stress-related disorders among war veterans, civilians in war zones, Israeli children subject to bombardments, and Holocaust survivors, is not significantly higher than that in comparable populations, would you believe me? Of course you wouldn't. The specter of the ubiquitous crisis-intervention team descending on a community following a tragedy doesn't help my case. The common perception that there exists a direct connection between extreme events and disordered behavior is firmly ensconced across our communities, much like the grief-debriefing protocol administered by intrusive strangers.

The murder in November of Samer Jaber at Lester B. Pearson High School in Calgary, Alberta was the last tragic event to flush out this macabre lot. The teams also lay in wait at William Aberhart High in March, when two boys from Calgary drowned off the coast of northern California while on a school field trip. Not content to wait until the bereaved returned home, some members of the Calgary Board of Education crisis team actually flew to California to counsel the mourners.

The Psychiatric Diagnostic and Statistical Manual stipulates that merely hearing about a "toxic" event may cause damage. Small wonder then that intervention has become an imperative.

Most of the data supporting these flawed assumptions are derived from biased clinical samples and rely on controversial self-reports. A patient presenting for treatment is already unrepresentative of the general population. She tells of an event or a person which she implicates in her symptoms. The clinician then erroneously concludes there is a causal relationship between the event and the patient's symptoms. This post hoc or backward reasoning contaminates most of the studies on Posttraumatic Stress Disorder (PTSD).

Controlled studies show that well functioning individuals tend to report as many pathological experiences as do people who don't function well. The same flawed reasoning must lead us to conclude that their trauma caused their successes.

All told, the incidence of "toxic" events in the lives of people in western democracies is very high. In Third World countries it is virtually universal. Paradoxically, the lifetime prevalence of PTSD is very low. "Very few directly exposed individuals develop distress disorders", writes Marilyn Bowman, professor of psychology at Simon Fraser University, B.C., and an expert on the subject of PTSD.

What am I missing here?  "Toxic" events are rife in the lives of people, yet stress-attributed disorders are not common?

Clearly the "toxic" event in and of itself doesn't cause PTSD. In her book on individual differences in PTSD and in a 1999 paper in the Canadian Journal of Psychiatry, Professor Bowman demonstrates that whether those exposed to traumatic events will suffer some mental repercussions is determined by certain stable temperamental styles, chief of which is neuroticism. Another good predictor of PTSD is a history of psychiatric and personality disorders.

Despite the evidence, mental health professionals continue to expand their jurisdiction. Tooled up with Freudian trickery like denial and repression they can claim that if you are not "venting" you are in denial. If you are stoical, you are likely "repressing". Evidence that contradicts the clinician's theory is enlisted as evidence for the correctness of the theory; every behavior the posttrauma individual shows--adaptive or not--is said to be a consequence of the trauma and proof of it.

On a sinister note, to give vent is to be automatically bestowed with a moral virtue, which helps explain the camera-friendly grief chic displayed by people many times removed from a tragedy.

Therapy itself is based on the premise that "expression of negative feelings is essential". Again, the evidence indicates that denial more often confers an adaptive benefit. Individuals given to emotionality fare worse than people with a stiff upper lip. Clinical outcomes are in fact improved when therapy focuses instead on problem solving strategies.

The pressure from many PTSD-advocacy groups notwithstanding, the American Psychological Association's clinical division reports that zero out of 255 treatments for PTSD "meet criteria as well established". Efficacy evidence for the treatments is indeed scant, if non-existent.

No surprise here. The faulty assumptions underlying this clinical diagnosis jibe with a general emphasis on subjectivity and relativism in psychological research and the culture at large. There has been a shift away from objective inquiry towards a fascination with the grotesquely emotional and the histrionic.

Bowman contends that we have regressed to an unenlightened, premodern---not postmodern---era, paralleled in some of the less evolved periods in the history of Western civilization. I'd say that chimeras such as satanic ritual abuse, repressed memory therapy, and multiple personality disorder, which not so long ago received the nod from too many mainstream mental health professionals, bear this out.

© 2001 by Ilana Mercer
Published previously in the Calgary Herald.

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