International Handbook of Clinical Hypnosis - E-Lib FK UWKS

144 INTERNATIONAL HANDBOOK OF CLINICAL HYPNOSIS
gical trauma in relation to that. Firearms are the leading cause of death for young
people in Texas. Physical trauma is a major cause of mortality and morbidity in the
United States and that means that psychological syndromes which accompany
trauma are a very prevalent part of our collective psychological experience. There
are estimates that 12 million adult women have been raped in the United States and
another 10 million have been victims of aggravated assault. Bowners, O'Gorman
et al., 1991; Browne, 1993; Koss, 1993a, b; Koss, Heise et al., 1994). Edna Foa's
work Foa & Riggs, 1993), and that of others, suggests that some two-thirds of
women who have been raped develop post-traumatic stress disorder, 45% have the
disorder 3 months later, and among all rape victims regardless of time since the
trauma, 15% suffer PTSD. It can be, it isn' t always, but it can be a lifelong
disorder. Similarly studies of Vietnam era veterans indicate that somewhere between
15 and 25% of veterans suffer from post-traumatic stress disorder Keane &
Fairbank, 1983). This is a huge proportion of the population. While the majority of
people who have been through terrible trauma do not get post-traumatic stress
disorder, a substantial minority do. This compels us to understand the phenomenology
as a ®rst step to diagnosis and treatment.
A BRIEF HISTORY OF PTSD
There has been a tendency to slip into one of two mistaken extremes in regard to
PTSD. One is a cynical attitude which implies that most patients are making up
their symptoms for secondary gain. An example is a case in which an armored car
driver was shot in the chest three times during a robbery. His two colleagues were
killed as they were walking out of an elevator. The company he worked for objected
to providing treatment for post-traumatic stress disorder. This was not some fantasy
of childhood sexual abuse: he took three bullets in the chest and saw two of his
friends die and yet there was doubt that he had genuine psychiatric symptoms
afterwards. One of our professional responsibilities is to have the kind of educated
empathy to understand what it is like to go through this and be able to articulate
that. Post-traumatic symptoms often involve considerable and frequently inappropriate)
guilt about imagined or real lapses during the traumatic event. This can
generalize into a sense of shame, reducing the willingness of patients with PTSD to
talk about their symptoms.
On the other hand, there is a victimology approach that can allow people to evade
responsibility for all aspects of their lives because they have been victimized. For
example, some patients with an axis II antisocial personality disorder may be
looking for an excuse to blame everybody else for their problems in living.
The concept of post-traumatic stress disorder has had a rather checkered history.
It has tended to emerge largely in the aftermath of war. During and after World War
I there was discussion of `shell shock'. The treatment then infantilized patients by
removing those who could not function in combat as far from it as possible. They