Did John Wayne ever have PTSD? Toughness and Trauma

Are there certain types of people who do better at handling traumatic events than others?  Almost certainly – as discussed earlier on this blog, a variety of differences in things such as emotional expressivity and physiological reactivity can predict people’s responses to traumatic events.  But that’s not the interesting question.  After all, there are individual differences in almost every psychological phenomenon you can find.  The interesting question (at least to me) is this: is pop culture accurate as to what kind of person can best cope with traumatic events?  Is there a kernel of truth to the idea of “toughness?”  Does the stereotypical image of a rough, tough, macho man (or woman) who can eat nails and spit bullets have any relevance to the actual psychological predictors that can help predict a healthy response to a traumatic event?   Some insight on this question comes from a chapter written by Patricia Watson and colleagues published in the book “Interventions following mass violence and disasters: Strategies for mental health practice”  (Ritchie, Watson, & Friedman, 2006). Watson et al’s chapter looks at what predicts healthy resilience following disasters and mass traumas.  As a part of that, they brush up against many of the things that characterize a traditional tough-guy/gal, and paint an interesting picture of whether Hollywood got it right.  Let’s see how the image of a tough person holds up by looking at the research behind some traditional characteristics that show up in “tough” characters on TV and in movies:

1.    A tough guy/gal is capable, and knows how to handle any event. This type of confidence is referred to as “coping self-efficacy,” a relatively fancy term that basically means that people have a perception of themselves as able to effectively handle stressful or negative events.  If someone believes that they can appropriately handle anything life throws at them, they’re much more likely to recover from any specific stressful event.  Whether it’s through building machines like MacGuyver or just gunning down anyone who gets in her way like Vazquez from the movie Aliens, the traditional tough-guy/gal can handle anything that comes their way – and this means that they will probably recover well from a traumatic event.

2.    A tough guy/gal started out green and “toughened up.” The research on this suggests this can be true.  Repeated exposure to challenges or stressors, if followed by good recovery periods, can help to keep the body’s system used to responding to and recovering from stressful events .  This can reduce long-term distress.  Importantly, however, this only works if the stressful event is something that does not itself cause long-term distress.  Situations which included loss, or emphasize that the person is not in control of their life can be bad, and can weaken instead of improve people’s overall resilience.

3.    A tough guy/gal is fit. Physical fitness is important for every kind of health – including mental health!  People who are in good shape are both more likely to have had repeated demonstrations of their ability to handle challenging situations (through the challenging process of getting fit) and are also more likely be able to respond in a healthy fashion to the physiological response to stressors.

4.    A tough guy/gal is a loner, who works best alone and broods over their past with a glass of straight whisky. Uh-oh.  Now, our tough guy/gal has a serious problem.  This pattern of characteristics that is so popular in our images of tough heroes that it has become a cultural stereotype is almost exactly the opposite of the best way to respond to a traumatic event.  Research consistently shows, over and over again, that the people who recover best from traumatic events are people who seek help from others, and build large social networks that provide critical social support.  Talking to others about the traumatic event (when they want to), and spending time with others in healthy, positive social interactions, helps to support healthy coping strategies.  This allows people to see themselves in a positive light, improves perceptions of mastery and helps with constructing a narrative of the traumatic event that provides meaning, an important predictor in recovery.  Moreover, using alcohol as a way of coping with a traumatic event is a bad idea – it does not contribute to long-term mental health, may exacerbate feeling badly, and can easily lead to more significant problems down the road.

So overall, what does this suggest about our images of toughness?  There are some good ideas there.  Physical fitness, self-confidence and mastery, and a history of successfully managed stressful events can all help to improve response to traumatic events, and someone who works to develop those traits will probably show more healthy long-term responses to trauma than those without them.  But the image that often goes with those traits in popular culture, of a person who holds themselves separate from the rest of the world and works as a “lone wolf”… well, it’s a powerful image and one that is tempting to many people.  But the research is clear: lone wolves don’t work as well as those who have a pack.  Social engagement and positive social interactions are one of the best ways to recover from a traumatic event.  If you define toughness as the ability to overcome anything that life throws at you, then the toughest person in the room is not likely to be the Indiana Jones lookalike brooding alone at the end of the bar.  It’s probably the person surrounded by her friends, and having a positive, cheerful time.

Are there certain types of people who do better at handling traumatic events than others?  Almost certainly – as

discussed earlier on this blog, (http://beyondfearblog.wordpress.com/2009/08/19/gender-and-ptsd) a variety of

differences in things such as emotional expressivity and physiological reactivity can predict people’s responses

to traumatic events.  But that’s not the interesting question.  After all, there are individual differences in

almost every psychological phenomenon you can find.  The interesting question (at least to me) is this: is pop

culture accurate as to what kind of person can best cope with traumatic events?  Is there a kernel of truth to

the idea of “toughness?”  Does the stereotypical image of a rough, tough, macho man (or woman) who can eat nails

and spit bullets have any relevance to the actual psychological predictors that can help predict a healthy

response to a traumatic event?   Some insight on this question comes from a chapter written by Patricia Watson

and colleagues published in the book “Interventions following mass violence and disasters: Strategies for mental

health practice”

(http://www.amazon.com/Interventions-Following-Mass-Violence-Disasters/dp/1593852568/ref=ed_oe_h) (Ritchie,

Watson, & Friedman, 2006).
Watson et al’s chapter looks at what predicts healthy resilience following disasters and mass traumas.  As a

part of that, they brush up against many of the things that characterize a traditional tough-guy/gal, and paint

an interesting picture of whether Hollywood got it right.  Let’s see how the image of a tough person holds up by

looking at the research behind some traditional characteristics that show up in “tough” characters on TV and in

movies:
1.    A tough guy/gal is capable, and knows how to handle any event.  This type of confidence is referred to

as “coping self-efficacy,” a relatively fancy term that basically means that people have a perception of

themselves as able to effectively handle stressful or negative events.  If someone believes that they can

appropriately handle anything life throws at them, they’re much more likely to recover from any specific

stressful event.  Whether it’s through building machines like MacGuyver or just gunning down anyone who gets in

her way like Vazquez from the movie Aliens, the traditional tough-guy/gal can handle anything that comes their

way – and this means that they will probably recover well from a traumatic event.
2.    A tough guy/gal started out green and “toughened up.”  The research on this suggests this can be true.

Repeated exposure to challenges or stressors, if followed by good recovery periods, can help to keep the body’s

system used to responding to and recovering from stressful events .  This can reduce long-term distress.

Importantly, however, this only works if the stressful event is something that does not itself cause long-term

distress.  Situations which included loss, or emphasize that the person is not in control of their life can be

bad, and can weaken instead of improve people’s overall resilience.
3.    A tough guy/gal is fit.  Physical fitness is important for every kind of health – including mental

health!  People who are in good shape are both more likely to have had repeated demonstrations of their ability

to handle challenging situations (through the challenging process of getting fit) and are also more likely be

able to respond in a healthy fashion to the physiological response to stressors.
4.    A tough guy/gal is a loner, who works best alone and broods over their past with a glass of straight

whisky.   Uh-oh.  Now, our tough guy/gal has a serious problem.  This pattern of characteristics that is so

popular in our images of tough heroes that it has become a cultural stereotype is almost exactly the opposite of

the best way to respond to a traumatic event.  Research consistently shows, over and over again, that the people

who recover best from traumatic events are people who seek help from others, and build large social networks

that provide critical social support.  Talking to others about the traumatic event (when they want to), and

spending time with others in healthy, positive social interactions, helps to support healthy coping strategies.

This allows people to see themselves in a positive light, improves perceptions of mastery and helps with

constructing a narrative of the traumatic event that provides meaning, an important predictor in recovery

(http://beyondfearblog.wordpress.com/2009/06/29/can-political-commitment-protect-people-from-ptsd/).  Moreover,

using alcohol as a way of coping with a traumatic event is a bad idea – it does not contribute to long-term

mental health, may exacerbate feeling badly, and can easily lead to more significant problems down the road.
So overall, what does this suggest about our images of toughness?  There are some good ideas there.  Physical

fitness, self-confidence and mastery, and a history of successfully managed stressful events can all help to

improve response to traumatic events, and someone who works to develop those traits will probably show more

healthy long-term responses to trauma than those without them.  But the image that often goes with those traits

in popular culture, of a person who holds themselves separate from the rest of the world and works as a “lone

wolf”… well, it’s a powerful image and one that is tempting to many people.  But the research is clear: lone

wolves don’t work as well as those who have a pack.  Social engagement and positive social interactions are one

of the best ways to recover from a traumatic event.  If you define toughness as the ability to overcome anything

that life throws at you, then the toughest person in the room is not likely to be the Indiana Jones lookalike

brooding alone at the end of the bar.  It’s probably the person surrounded by her friends, and having a

positive, cheerful time.

Can political commitment protect people from PTSD?

On Friday, June 19th, the Ayatollah Khamenei made it clear that the Iranian government and citizen militias  would not shy away from using violence to put down the protests occurring in the country.  Although the protests had already been met with some violent responses, this was widely perceived as an announcement that the enforcement would be stepped up and that protestors would face much fiercer response.

From what we can see of the response to this speech, it’s clear that many of these protestors received this message with sadness, deep concern, and fear, but that their commitment to their movement did not waiver.  Throughout the past week, their fears have been validated.  Pictures and videos from Iran have shown the force being used against these protestors.  Brutal videos of young people dying in the streets of Tehran have stood testament to the violence that they are experiencing.  The impact of these experiences appeared in the short term to be to strengthen the movement rather than weaken it.  The deaths of those killed in the violence are quickly becoming symbols of the movement, statements that reinforce the protestors’ belief that they are fighting for what is right.

These protestors in Iran are demanding that the government live up to its promises of democracy.  This movement may have lasting impact on the political system inside Iran or internationally, but it’s too early in the process to tell.  However, it’s guaranteed to have a lasting impact on the people of Tehran who witness this violence.  Will the protestors on the street, facing brutal opposition and witnessing traumatic events, suffer the long-term effects of PTSD?  It’s certain that some will, but it’s also likely that most will not.  Research on the pathways that lead to PTSD suggest an interesting relationship between political commitment and traumatic events.

Metin Başoğlu, a researcher who studies the psychological impact of torture, conducted one of the best studies on this phenomenon when he and his colleagues compared Turkish prisoners arrested and tortured because of their commitment to political movements with prisoners arrested and tortured for non-political crimes (Başoğlu et al, 1997).  They found that even after accounting for the effects of education, socioeconomic status, and other effects, political prisoners suffered significantly less PTSD.  This is consistent with anecdotal reports from an Israeli colleague working in Gaza, who once told me that the people he worked with who truly, passionately believed in their cause – whether Palestinian or Israeli – may have experienced more traumatic events than others but “just don’t get PTSD.”

Why is this?  There is no certain conclusion that is accepted by all researchers, but one likely explanation has to do with *why* traumatic events cause PTSD.  Among the many physiological and psychological changes caused by threatening events, one has to do with people’s perceptions of the world.  Most people believe that the world is, overall, a fairly safe place filled with people who are on balance kind, that bad things are unlikely to occur, and that we have control over our own lives and experiences.  Traumatic events shatter this perception, and force people to very quickly assimilate a new worldview in which terrible things, uncontrollable things can happen (Foa, Steketee,  & Rothbaum, 1989). This adjustment can be difficult for many people, and can contribute to the post-trauamatic distress leading to the symptoms of PTSD.   For people committed to a political perspective and particularly for those who are activists working in oppressive regimes, however, it’s often the case that they do not have such a rosy worldview.  People committed to political activism by definition see some flaw or problem in the system or the group that they are working against.  To many activists, it is easy to see the group they are working against as cruel or uncaring or unwilling to acknowledge the harm that they do – and this is even easier when this belief is validated by violence used against the activists.  Because of their beliefs, the idea that the group the activists are working against might use violence is not a shock to their perspective, and when they experience torture or violence directed against their allies, it can serve to reinforce their beliefs that the opposing group is mistaken or evil.  This does not cause a significant change in their beliefs about the world, and hence may reduce the shock of their traumatic experiences by reducing that aspect of the impact of a traumatic event.

Does this mean that this kind of political commitment is a positive?  Not necessarily – the kind of commitment that leads someone to believe that those who disagree are evil enough that they might use force also makes it easy to demonize and ostracize the other perspective.  When the conflict is not at the point of direct violent conflict, and there is the possibility of collective problem solving, this kind of hardening of political perspectives can easily contribute to a cycle of extremism that makes it difficult for groups to come together to collectively solve problems (Seyle & Newman, 2006).  So what’s good for the individual might not be so good for society.  On the other hand, this is good news for those who stand up to oppressive regimes to demand their rights, and who take their experiences of violence and threats and turn them into increased justification for what they are fighting for.  This commitment, strengthened by the terrible events they undergo, may be the best thing for their mental health in the long run.