Jewish World Review July 11, 2002 / 2 Menachem-Av 5762



Preventing future attacks



By Dr. Abraham Twerski, M.D.

http://www.jewishworldreview.com | The World Trade Center was a trauma of monumental proportions. The number of lives lost and the number of families devastated may be calculated, but the far reaching consequences are incalculable. The experience on the country has been shattering, psychologically and economically. The global scope of terrorism and the relatively feeble ways to prevent further attacks is unnerving.

But for all its immense magnitude, the World Trade Center was a single trauma. There is, of course, the fear of further attacks. But people affected by this catastrophe were not alone. Many shared in the tragedy, and the continuing anxiety is also widely shared. Support for those affected was effluent. When the trauma affects an individual, and especially if it remains concealed, the comfort of sharing is absent. If the individual trauma is repetitive, the effects on the victim may be profound.

Domestic abuse, whether spousal or child, and molestation are examples of chronic, individual trauma that is frequently concealed. The characteristics of intense fear, sense of helplessness and loss of control are all present. The victim frequently fears disclosure, and has little or no support. Where the parent is the abuser, it is further complicated by the fact that the perpetrator is the one to whom a child normally looks for protection. This is the ultimate breach of trust. The victim is essentially a captive.

The perpetrator of abuse and molestation is generally power-crazy, exerting tyrannical control over the victim. Ironically, the perpetrator expects not only absolute obedience but also love. The battering husband demands that the wife relinquish all other relationships and essentially worship him. Abusive parents and spouses instill fear into their victims and crush every trace of autonomy.

In addition to the fear of the perpetrator, the victim of childhood molestation feels shame and guilt, and is afraid of the repercussions if he or she were to tell the parents. The sense of helplessness, along with the shame and guilt, may crush every bit of self-esteem that the child has. The emotional and physical symptoms of PTSD (Post Traumatic Stress Disorder) may compromise the child's schoolwork and socialization which further depresses the child. The concealment of the molestation precludes treatment, and the variety of symptoms that may persist well into adulthood can result in the victim being given any one of many psychiatric diagnoses. Treatment that is appropriate for all of these diagnoses is likely to be ineffectual.

Just as we live in the fear that there will be more terrorist attacks, the victim of abuse or molestation fears that these will recur. We may be somewhat comforted by the war against terrorism that the United States is waging and by the increased alertness and intelligence to ward off future attacks. How effective these are may be questionable, but at least we are doing something. The victims of abuse do not have even this modicum of comfort. They are totally helpless, completely at the mercy of the perpetrator. They may lose the will to live.

The intrusive symptoms of PTSD following a single episode tend to wane with time. Those of chronic trauma may persist for years and decades. A study comparing soldiers who had suffered wartime combat trauma to those who had been prisoners of war showed that thirty-five years after their liberation, the majority of the latter still had nightmares, persistent flashbacks and other symptoms of PTSD (G. Goldstein et al, "Survivors of Imprisonment in the Pacific Theater During WW II," American Journal of Psychiatry 144 [1987]: 1210-13).

Victims of chronic trauma adopt an attitude of passivity and fatalism. They see any action on their part as having serious consequences. They dare not make a mistake. They are cut off from meaningful communication with others, and turn inward to find relief. They do this by voluntary thought suppression, minimization and frank denial. They may live in a kind of trance state, functioning very much like robots. They may not complain because in their denial of reality they see nothing to complain about. Furthermore, the abuser threatens them with serious harm if they reveal his behavior to anyone.

Victims of spouse abuse may develop a total dependence upon the all-powerful abuser. Although living in terror of his anger, an abused wife may see her husband as a source of strength and guidance. She may suppress her feelings as proof of her loyalty to him.

Abused children who leave the home after they have grown up, adults who were victims of molestation as children and women who leave an abusive marriage are not able to put the past behind them. They may continue to live a passive life in which they feel powerless or may have outbursts of rage. They may feel that the Creator abandoned them or that they deserved to be punished. Victims of childhood molestation may not be able to have a healthy marriage. Intimate relationships may be fraught with terror.

It is little wonder that victims of chronic trauma become seriously depressed. Not only are they tormented by symptoms of anxiety, insomnia, nightmares and a variety of bodily aches and pains, but they may become totally apathetic. The only feelings that may remain are guilt and shame. Some may look back on their life before the abuse and say, "I am no longer that person." Some may even say, "I am no longer a person."

The government should do all it can to prevent terrorist attacks. The community -- every facet of it, religious institutions, school, and family -- should do all it can to prevent chronic trauma. Becoming sensitive to the needs of those suffering from chronic trauma and translating that sensitivity into acts and deeds of compassion is something each of us can do to help the healing process.

Previously:

American Spirituality
Trust
Post Traumatic Stress Disorder (PTSD): A very real condition
Helping our kids deal with trauma
The Creator helps those who help themselves
Knowing what to expect
Psychological fallout in the shadow of terrorism
Self-esteem in the face of world terrorism


Abraham J. Twerski, M.D. is a psychiatrist and ordained rabbi. He is the founder of the Gateway Rehabilitation Center in Pittsburgh, a leading center for addiction treatment. An Associate Professor of Psychiatry at the University of Pittsburgh School of Medicine, he is a prolific author, with some 30 books to his credit. He has recently launched a new 12 step program for self esteem development www.12steps2selfesteem.com Send your comments by clicking here.

© 2002, Abraham J. Twerski, M.D.