Surviving Trauma and Tragedy

Lessons for Future Physicians Mike Walter
Mike Walter Post-traumatic stress disorder is a growing serious health issue in this country, so there is a tremendous need for people entering the field of medicine to really recognize the invisible wounds of PTSD and no one knows this issue better than the international expert in the field who’s going to join me in just a moment. Frank Ochberg, he’s been a trailblazer in the field of PTSD for years, he’s a clinical professor in psychiatry at MSU, he’s a former mental health director for the State of Michigan. Ochberg was the editor of the first treatment text on, ah, PTSD. He was on the team that wrote and revised the diagnosis of PTSD; he’s often called on to help in major disasters, the tsunamini, the tsunami rather in Southeast Asia and the tragedy in Columbine. Frank is here with us now. First and foremost though, Frank is a teacher and that’s why he has come up with this unique program where he partners medical students like yourself with people who’ve grappled with the issue of PTSD. Frank, welcome, let’s talk ah, first of all about PTSD and, you know, some people might say, well, you know, what are the symptoms? What are some things that you’ll see in somebody who’s suffering from this?
01:35 Frank M. Ochberg, MD
Frank M. Ochberg The first thing is to give the diagnosis you have to know that a person has lived through an extraordinary event, and at the time of the event they felt terrified or horrified or utterly helpless. And, and we’re not talking about the kind of events that are ordinarily stressful uhm, like, like going through the death of a loved one, the normal, natural death, there has to be something about the sight and sounds and, and, and the smell of it all that gets lodged deep within you. And then, for at least a month and sometimes for years and, and sometimes for a lifetime, you have three different sets of symptoms. The first is a problem with memory. Now, we, we don’t know that much about how normal memory works. It’s, it’s lodged all over the brain, you can dial up a memory sometimes with difficulty, but these traumatic memories come back when you don’t want them to and sometimes they are so intense that you think it’s happening now, you don’t have a time sense. And for the soldier the smell of the battlefield is right there even though it’s a year later. For the woman walking into an elevator or a parking lot, it’s the scene of an abduction and a rape at, at gun point and it feels like it’s now. It, it wakes you up at night ah, so there are nightmares, there are flashbacks, and sometimes there’s just a vague feeling, you can’t put your finger on it. It’s a very subtle and it takes a while to remember, “Oh my God, it’s that time of year. I’m dealing with the feelings of being shot in my front yard at 11 o’clock at night;” uhm, that’s one set of problems. The, the second in, in a way is almost the opposite, you, you have emotional anesthesia, you’re feeling numb. I, I was part of a team that interviewed dozens of Michigan Vietnam veterans, 12, 13, 14, years afterward and, and I would say things like, “I, I know I love my daughter , Doc, I just don’t feel it the way I should,” so there’s an experience of a lack of feeling across the board. And, and, and people change the way they live, they, they avoid doing things that used to be a source of pleasure or, or a source of social interaction and they are avoidant and withdrawn and, and, and they know it. And sometimes with encouragement they want to come out of that and sometimes they would rather be left alone so, so you become marginalized. And the last part is, ah, you can think of it metaphorically as having too much adrenaline. Ah, you know, the, the ah, sympathetic nervous system responses aren’t all about adrenaline per se, but because of this lowered threshold for anxious arousal, you don’t sleep well, you’re irritable, you don’t concentrate, ah, you’re not necessarily paranoid but you’re very, very vigilant and on the look out for danger and not necessarily when something triggers a reminder of the original event. Those three clusters of problem; the episodic re-experiencing of the original event, the numbing and the avoidance, and the anxious arousal, RPTSD.
05:20 Mike Walter And, and Frank, one of the things that’s ah, interesting and, and one of the reasons why you’ve put this together is by the time somebody gets to you they’ve gone through so many phases, haven’t they? They’ve seen maybe perhaps a social worker, police officer… (crosstalk)
05:35 Frank M. Ochberg Yeah.
Mike Walter …maybe somebody in the ER or a doctor, (crosstalk)
Frank M. Ochberg Uh hmm.
Mike Walter every step of the way someone could intervene to help to get them to your stage and, and how they handle that situation could have a bearing on how well these people respond to.
05:45 Frank M. Ochberg A, a, absolutely, there is a condition in the victim field called the second wound. And, and it, it’s a psychological wound that comes from disrespect, ah, often when we have to do our jobs we’re in a hurry and, ah, if there’s one thing I remember from my bedside manner medical education, it was when you’re dealing with someone who’s seriously hurt or ill, for God’s sake sit down, but we’re standing up, we’re at a bedside or we’re doing a quick consultation. And, and here when a person has been robbed of dignity, we may not give them the dignity and the time that they need. And there are insurance claims adjusters, there are detectives when it’s a violent crime, there are nosy neighbors so you have to tell your story and telling the story makes such a difference when it’s told in the right circumstance. I think many of the people you’re gonna meet have told their stories first to their family doctors, and you’re gonna hear some very, very positive experiences of how the family doctor started the course of, of personal and, and of almost spiritually reconstruction so the, these stories are, are precious stories.
07:05 Mike Walter They’re precious stories and each story is unique, each patient is unique and each one kind of hits different stages at different times, so how do you guide them through and, and, how do you start them out ah, perhaps as, as a victim get them on the road to being a survivor?
07:20 Frank M. Ochberg You know, it’s, it’s different for me having become a specialist and having heard, by now, literally thousands of, of extreme stories or, or people like yourselves in the, ah, in medical school and, and ready to be a doctor just, ah, a year or two from now. I, I, I think it’s important to be honest and, and not to pretend to have answers or to have a, a, a kind of, ah, calm and aplomb when, when it isn’t there. It, it wouldn’t hurt to say, you know, “This is, this is even scary for me.” Ah, I, as you know, Mike, I, I train journalists now as well as doctors and police and, and for journalists who are expected to cover a crime and to talk to the parents of murdered children when they’re still such young journalist. The professional has a certain amount of fear and, and, and awkwardness. Ah, I wrote a little bit about themes of, of doing therapy with normal people who’ve had these abnormal events and I recommend a, a form of collegiality. We’re, we’re in this to learn together and, and to listen together. And, obviously, we, we doctors have certain skills and authorities; we, we can treat symptoms with medication and, and we’ll get into that. It, it, it’s good to be assured about your use of the tools of the trade, but when it comes to dealing with human cruelty we’re, we’re all novices. As a species, we don’t do that well in limiting our cruel behavior.
09:00 Mike Walter So, we’re just about ready to bring one of our guests up, but one of the things I’d like you to touch on for our people who are sitting out here today is, in my field as a journalist, ah, we’re, we’re to subjected to, ah, vicious scenes of ah, of just enormous violence and trauma, ah, I wouldn’t say on a daily basis but a, a healthy dose of it. Now, these people are gonna end up in, in, perhaps, hospitals, ERs… (crosstalk)
09:25 Frank M. Ochberg Uh-hmm.
Mike Walter …where they’re gonna see trauma again and again… (crosstalk)
09:30 Frank M. Ochberg Uh-hmm.
Mike Walter …and again. And there has an impact to, ah, being exposed to it, it kind of hardens you. Talk to me about the resiliency, ah, and some of the things that they may also encounter as they enter this field.
09:40 Frank M. Ochberg Well, you know, the best protection against something called compassion fatigue which is when we inherit the feelings of those that we care about and we find ourselves feeling demoralized or anxious. I, I have a ah, friend who described that he was having the dreams of his Vietnam veterans and they weren’t his experiences but in a secondary way his unconscious was giving him this kind of a dose. I, I think the best thing we can do is to do our jobs and be proud that we do our jobs well and sometimes it’s, it’s to talk about what we do. Ah, my wife knows what I encounter, ah, there are things that we have to be very discreet about and we have laws that protect confidentiality and privacy, but in a way you can learn to share experiences with colleagues and with, with close ones and to feel very, very good about having the opportunity to help. We, we, we do get desensitized as physicians. In, in the mental health field there are four core disciplines: psychology, social work, nursing, and psychiatry. And I think the psychiatrist and the nurses have an advantage because we’ve scrubbed in on surgery, we’ve delivered babies, we, we know the human body in its parts. Ah, you lose a little bit of that as you, as you grow up, get older, and perhaps get away from it and then you’re just as vulnerable as the next person to scenes of, ah, of human destruction. But I, I don’t want to overstate that this is going to be damaging, I, I have had a long and very, very fulfilling career working with people who’ve taught me about their resilience and I guess I pick up some of that as well.
11:35 Mike Walter We’re gonna hear some of those stories in just a moment. Now, when you mentioned post-traumatic stress disorder, awful lot of people think of the soldier returning from war who’s, as you mentioned, seen the horrors of war. Most people just think of those soldiers returning from the battlefield and reliving the horrors, ah, in these nightmares that Frank alluded to but this isn’t something that just effects returning vets. Linda Harkness was doing something so routine that we’ve all done it from time to time. Linda went grocery shopping, she returned with her groceries, but she also came back grappling with post-traumatic stress disorder. We want to invite Linda up here on stage to tell us her story.
12:10 Surviving Trauma and Tragedy: Lessons for Future Physicians Linda Harkness
Linda Harkness At that time I was married, I was the mother of three small children , and I was pregnant with my fourth child, I’m about five months pregnant. And I simply went grocery shopping, you know, get groceries for the family, did my shopping, came out to the car, I was loading, ah, things into the car and a man came up and stuck a gun in my ribs and, ah, ordered me to get in the car, ah, which we did, and I basically think his intent was to rob and, unfortunately, I had already spent all my money. He was very angry with me, I don’t know if it’s just because that’s how rapists are when they were angry, he was also very controlling. We drove off to a remote area and there he, ah, raped me but not just rape me, it was very cruel. Ah, he did many very humiliating things, threatened my life, threatened the life of my unborn child, used the barrel of the gun and in an unorthodox manner ah, caused some severe injury, caused me to bleed pretty profusely, and ah, he drove back to the parking lot that I was abducted from, got out of the car, and ran away. I, myself, was in shock by this point. I, during the incident, felt he was going to kill me, you know, I thought my life was over. And, ah, I drove off, drove out of the parking lot but you, if you ask me I couldn’t tell you where I was for the next couple of hours. I drove around, I don’t know where I went, I couldn’t tell you where I was, I finally ended up at home, ah, my husband wasn’t concerned about where I was, I think, he thought I just went on a longer shopping spree than I had planned, but I didn’t say anything to him about what had happened. I, ah, as I said, I was in a state of shock and deep inside I really did just wanna die, I was so humiliated by what had happened and I went up to bed, still bleeding profusely. The next morning I was concerned about the baby, uhm, didn’t really sleep through the night either, I tossed and turned all night. So I did get a hold of my obstetrician because I was worried about the welfare of the child, went in to see my obstetrician , and didn’t really tell him the whole story at first either. But when he did his examinations, he could tell there was something more going on than what I was revealing to him so continued to question and question and question. Finally, I did admit to him what had happened and he was very understanding. He ah, encouraged me to let my husband know, encouraged me to, to, uhm, talk with the local law enforcement, so I did go home, I did not until in the evening speak with my husband about it, and his reaction was that he immediately called the police. He didn’t give me a choice in that and, and one thing that was very prominent in my mind is, you know, when you go through an experience like that, control over even your own self is completely taken away. So for him to do that was, was not a good thing for me ’cause, again, somebody was taking control away from me. I did speak with the police, uhm, I went in and made a report but, unfortunately, because of the time that had gone by, because of the fact that I had washed and washed and washed myself, showered and bathed and washed and scrubbed, there wasn’t too much evidence there, ah, so they didn’t really follow up right away on things because of, you know, other than taking the report. Now, the person that did this to me was caught a couple of years later because it was something that he continued to do; in fact, he had murdered two people. He had done a lot of damage to a group of women who worked in a travel agency and ah, very similar things, had actually raped all three of those women. My life really changed the day that incident happened. My outlook on life, my philosophy, how I looked at things, the entire, my entire life was over. One thing it did is it really made me take a, be, become more aware of my basic human rights. And as I said, the way my husband reacted to this rather than being supportive of me, he handled it the way he wanted to handle it and it, it really made me realized that the relationship I had with him was, in itself, abusive. Ah, he did not seek any counseling afterwards, I did. He turned to drugs, alcohol, he became more controlling, more abusive toward me to the point not just emotional but very physical. He also torn, turned toward the children and became more abusive with them, ah, his anger, he did not deal with. I, on the other hand, did seek counseling. The medical doctor who I had spoken with first was highly responsible for that. Unfortunately, the first therapist I, I had gone to was not trained well in uhm, victims of rape. She, she was a good listener, the big mistake she made and this is something that, ah, at this day and age ah, was very prominent in, in healthcare is I didn’t have insurance that would cover psychology. And so, she said she would work with me with that until I could find some way to fund it, so we were working with the insurance companies in trying to find funding for that. She turned me into a collection agency about six weeks after I had seen her, so that completely took the trust out of the relationship at that point. Ah, in between that time I had actually met Dr. Ochberg at a, a, a local women’s commission meeting and, ah, he referred me to somebody who would not, wasn’t not only a great help to me but, ah, ah, was willing to help with, to be patient with, with the money part of it too. But what was different about this woman is she had good training in, ah, sexual assault. She was able to tell me, and that’s the one thing I didn’t feel like a normal person anymore, you know, the sleeplessness, ah, the memories that kept, kept coming back, I, I really felt that there was something majorly wrong which there was, that’s not normal to go through an experience like that but my whole life was torn apart. I’m trying to watch and take care of three small children and yet my mind is wandering constantly and ah, she was able to let me know, “Actually, you are normal. What you’re experiencing is very normal for somebody who’s gone through a traumatic event like that.” And that, that was one thing that I really needed to hear is that, that was normal. Well, the marriage end up in the long run, breaking up; I ended up divorcing him because the abuse kept escalating so I left him.
20:10 Mike Walter You know, you mentioned ah, going upstairs and just not wanting to tell your husband or tell anyone, you were just kind of in your own little world there, and how intrusive were these memories when you try to… (crosstalk)
20:20 Linda Harkness Oh, I… (crosstalk)
Mike Walter …go to sleep?
Linda Harkness …didn’t get any sleep that night. It was, you know, tossing and turning and, and then I began thinking about the baby because I was thinking about myself at first. I felt I was in shock and how could somebody do this to me? I’ve never done anything, harm to anyone in my life. Why would somebody do this that didn’t even know me, you know, and ah, basically… (crosstalk)
20:40 Frank M. Ochberg And let me point out that right away it’s not post-traumatic stress disorder. You, you don’t make the diagnosis until this kind of symptoms persist for at least a month, but there is an acute stress disorder and there’s an immediate reaction and sometimes you’re all going to have to make decisions, do I medicate? Do I tranquilize? Do I get sleeping pills? And often, it’s a good idea to help a person with temporary symptomatic relief but, but not to transform them in their mind into a mental cripple. Ah, it, it, as, as Linda tells the story, she got some sympathetic professional care, some arrogant and, and, and terrible reaction from, from her spouse . Ah, you know, but look she not only went on to become a nurse, she’s, she’s now a, ah, is, is not a professor yet but, but an instructor… (crosstalk)
21:40 Linda Harkness Facilitator.
21:45 Frank M. Ochberg …and, and one of the most heightening long-term outcomes is the people who go through this become effective altruists; ah, their real goal is to reach the point where you help other people.
21:55 Mike Walter And, Frank, another interesting point and I want you to piggyback off of this. She went to her doctor and in this field there, there are pressures to kind of move three people through and yet this guy took the time to really draw out her story and to help her. It’s interesting, here’s somebody who came to her aid and was very helpful… (crosstalk) Frank M. Ochberg Uh hmm.
22:15 Mike Walter …and then she has the, the flip side. She has someone that she worked with who turns her into a collection agency so, so much of what they do is gonna really have an impact on, on their recovery in the sense to, isn’t it?
22:25 Frank M. Ochberg You know, you, you figure it out sometimes 20, 30 years later in a professional life. I, I did something when I was a young doctor and it, it made a huge difference. I mean, for Linda, that obstetrician pulled that out of you and, and he didn’t do it in an aggressive way… (crosstalk)
22:45 Linda Harkness Hmm.
Frank M. Ochberg …but he was persistent.
Linda Harkness He was very gentle but very persistent because he knew there was something more missing.
22:50 Mike Walter And what happens to Linda if she walks out of that office and he doesn’t do that? How much longer do you… (crosstalk)
22:55 Linda Harkness Oh, I’d still been a lost soul, I think, for quite a while.
Mike Walter So it makes a tremendous impact?
23:00 Linda Harkness Hmm. You know I didn’t have my husband to turn to, you know, because I didn’t tell him. I mean, the whole dynamics is different in every case but the whole dynamics of it is he really set me on to a road to wellness and survivorship just by him taking that little extra time.
23:15 Frank M. Ochberg Yeah, just a, just a quickie. This may be the only chance we have in medical school to mention a few things that when I used to teach about sexual assault, often the, the men in the audience didn’t appreciate the statistics that the women knew that, ah, rape for a woman in America it’s a, it’s, it’s about a 25 percent chance. So guys, we’re talking about our moms and our daughters and our sisters, we’re not talking about some archetype out there of a person who is leading a loose life. We’re one in four and when you add to that the kind of sexual abuse and coercion that exist that’s short of penetration, we’re talking about a majority experience by a gender of our own. So letting this sink in and Linda as a colleague, I met her as a colleague, not as a patient, and it, it takes a tremendous amount of guts and candor and maturity to tell this story.
24:20 Mike Walter And we wanna thank you for doing that, Linda, so we appreciate it.
Linda Harkness Uh hmm.
Mike Walter Each person here today is going to tell you their own nightmarish tale of what happened to them. When I first met Art Austin, he told me that one of the toughest things for him in his ordeal was returning to work. His co-workers and his friends were uncomfortable around him, they didn’t know what to say and you may understand why after you hear his story.
24:45 Surviving Trauma and Tragedy: Lessons for Future Physicians
Mike Walter Let’s begin at the beginning, what happened with you?
24:50 Art Austin
Art Austin On January 28th, uhm, 1998 uhm, was the turning point in my life, uhm, my fiancée and I had went and got dinner and, and brought it back home and we’re eating and we had, she had her granddaughter with her and put her to bed and we ate. She had went, went to take a shower when the doorbell ring in my house and, of course, I have a little dog and he barks and, ah, so I go at the door and ah, there’s a young lady standing in my driveway and she wanted to see my son . She didn’t actually give me a name but just they knew he was there because his car was there, so, I called for him, he’s down in the basement watching TV and he asked me who it was. I told him I didn’t really know and as I come back up and I said, I asked her name again, she still wouldn’t say, what she just said, “Tell him to come up.” So I go back and I tell him and he doesn’t, he says, “I’m not coming up,” he didn’t come up so I go back to the door. As I get back to my front door, uhm, the whole door just burst open with three angry young men, all with guns. Ah, they backed me up, cornered me and turned me around, took me to my living area where I had my TV and kind of like a family room, threw me to the floor, face down into the carpet, ah, I had a gun right behind my head and told me to tell him to come up. And I yelled for him to come up, of course, my voice sounded a little muffled with my face right into the carpet so he kept, he knew something because he heard all the noise and my dog barked, and so, so he must had knew something. So I, ah, kept yelling for him, he didn’t come and they, ah, kept nudging me in the back of the head with this gun and, ah, one was standing at the door and, ah, all of the sudden, ah, my fiancée comes out of the shower, she’s just got a towel on her ’cause she heard the noise while she was in there drying off, and she comes in, they grabbed her and threw her down ah, right, not next to me, but we were kind of like in a L-shaped position on the floor.
27:10 Art Austin So I called for him again and then he, he still wouldn’t come up and then all of the sudden they heard some glass break and he had jumped up out, I guess, and went, he had went out of the basement window. So at that time they jumped up off of me, I still laid there and the other two guys went out to try to see where he went and ah, the other guy stood there and he said, “Well, somebody’s got to go.” That’s just the way he said it. And so he, his gun was going off in my kitchen and in my family room and then, ah, he rattled off probably about seven shots. Ah, the five of them was in my fiancée , ah, I go to the door and that’s where they’re going and I don’t even know where they parked, where they ran to, and, ah, then of course the police and everybody there, and the media’s there and, ah, I was just kind of, you know, just kind of stunned, ah, you know, with all this attention that I was receiving that I didn’t want. And so they just took and, ah, the police came like I said and then, ah, ah, I went through that with them, you know, they have to do their investigating, I was booted out of my house for that night. I couldn’t get back in till the next day ’cause they had to do all their finger printing and everything but me being a, you know, being a man, I’m supposed to be strong that’s the way I felt but I was pretty weak. Ah, I had to go back over to the house the next day, and unfortunately I had a couple of friends that come and do the cleanup for me and ah, I wasn’t able to stay there, I wasn’t able to sleep there for quite some time. Ah, I stayed in my mom’s house which she lives on the other side of town and then, uhm, when I would go over there during the day I would let my dog out and I’d stay there during the day, it was fine, at night time and if it, you know, if anybody came to my doorbell from that time on it was just like, you know, I, my whole body would just kind of just, I could just feel the anxiety, ah, you know, just, it’s just, yeah, I get real nervous. And so then, ah, one of my co-workers at work ah, she does a lot in this area, she has a lot of hats that she wears, but this is one of the areas that she works at, she’s the one that set me up with a therapist but didn’t, before I went to the therapist I had went to see my medical physician , I just called and said I need to come in. And he spoke with me and he knew the situation because of all the coverage and stuff and, ah, he’s very compassionate, you know, of a, being him and I about the same age and, ah, it, I saw him a couple of three other times before I actually saw the therapist and I felt comfortable, you know, with him. I didn’t even have to even make an appointment, I’d just call and he would fit me in ah, and we would speak, uhm, in his office. Uhm, ah, the lady from work, a co-worker , she did set me up with a therapist, I did go see a therapist, ah, that was fine. Uhm, him and I connected somewhat we did but, ah, I actually felt a little better speaking with my doctor . I, I just felt, you know, that comfort zone with him, uhm… (crosstalk)
30:25 Mike Walter Is it because you had the relationship with him, you feel like (inaudible )? (crosstalk)
30:31 Art Austin Yeah, I’ve been a patient of his for quite some time, so he knew me and knew who I was ah, it was just, you know, the him knowing me and ah, I could feel that, ah, it hurt him, I think, it hurt him as well. He had met my fiancée , ah, I didn’t take him, I, and I wasn’t on any medication, he kept trying to me, I just thought I would get through it. You know, PTSD was not something I’d, it even come across my mind. But as it came out that’s, you know, what I was suffering with.
31:05 Mike Walter Was the toughest part for you the anxiety, you mentioned that ringing of the doorbell, which I imagine every time it was (inaudible )… (crosstalk)
31:11 Art Austin Every bell, yes.
Mike Walter Was there the numbing that Frank talked about as well where you just felt like you were in a fog?
31:15 Art Austin Yeah. Yeah, you, you do feel that and you just, ah, ah, you have those flashes right then, you know, you, you wanna look out and see what’s going on, of course, I don’t go, I don’t go to the door and just open it up like I did then because I was a pretty trusting person then. You know, it wasn’t that late, it was only like nine o’clock or ten to nine or something like that so… (crosstalk)
31:30 Frank M. Ochberg Ah, ah, Art and I met, uhm, maybe it was about a year after… (crosstalk)
31:35 Art Austin Yeah, uh-hmm.
Frank M. Ochberg …this happened ’cause Art became a member of the Michigan Victim Alliance helping other people, and I served as an advisor to that group. And I went over and went with her into the house, ah, you know, you got of a kind of a eerie feeling, (crosstalk)
31:50 Art Austin Uh-huh.
Frank M. Ochberg being in the house that’s been a murder scene… (crosstalk)
31:55 Art Austin Yeah.
Frank M. Ochberg …and, and I wondered, ah, for a long time whether you should live there but I think, I think you wanted to claim that as your own and I’ll not let that… (crosstalk)
32:00 Art Austin Well, initially my first thought was I was gonna have to get out of there, ah, and that I, I was certain I was never gonna be able to sleep there again, uhm, and it took a long time that I actually could do that. As a matter of fact, I think, the first night that I stayed there… (crosstalk)
32:20 Frank M. Ochberg Yeah.
Art Austin …I actually didn’t go to bed. I think I just sat up on the couch… (crosstalk)
Frank M. Ochberg Yeah.
Art Austin …and kind of dozed off… (crosstalk)
Frank M. Ochberg Yeah.
Art Austin …I was, I guess, I was still… (crosstalk)
32:25 Frank M. Ochberg Yeah?
Art Austin …thinking that door, you know, you know, right? I just got to be more aware of, you know, of my surroundings and that doorbell ringing, and my dog barking and it’s just… (crosstalk)
32:35 Frank M. Ochberg Yeah, your… (crosstalk)
Art Austin …you know.
Frank M. Ochberg …body, body doesn’t forget.
Art Austin No.
Frank M. Ochberg What I did end up doing which was helpful was prescribing Desyrel, trazodone, because years and years later, I think still now… (crosstalk)
32:45 Art Austin Yeah.
Frank M. Ochberg Art has… (crosstalk)
Art Austin Correct.
Frank M. Ochberg …a particular pattern and I’ve seen this, I, I saw this a lot at Columbine when I went out to help teachers and administrators after there, you wake up at about 2 A.M. and you don’t fall asleep again.
32:55 Art Austin That’s right.
Frank M. Ochberg So it’s late insomnia, not early insomnia, and, ah, trazodone was developed and marketed as an antidepressant. It isn’t worth a darn as an antidepressant but it’s very, very good for late insomnia and because it’s of the antidepressant class rather than a benzodiazepine, you don’t have the tolerance, uhm, you don’t get addicted to it… (crosstalk)
33:25 Art Austin Uh-huh.
Frank M. Ochberg …but you may need it to help with sleep for years and years… (crosstalk)
33:30 Art Austin Yes.
Frank M. Ochberg …and I think it’s been, it’s been useful for you.
Art Austin Yes.
Mike Walter Let me ask a, a question ’cause… (crosstalk)
33:35 Frank M. Ochberg Yeah.
Mike Walter …you brought up the word “reclaim”… (crosstalk)
Frank M. Ochberg Yeah.
Mike Walter …and Linda brought up the word “power”… (crosstalk)
Frank M. Ochberg Yeah.
Mike Walter …and power stripped and… (crosstalk)
33:40 Frank M. Ochberg Oh.
Mike Walter …reclaiming, it, it seems so important.
Frank M. Ochberg Yeah.
Mike Walter Talk a little bit about that and talk to me as well, if, if you will, after he’s done about the importance of, of those two words: reclaiming and power, so you’ve got some time to think about it. Frank?
33:50 Frank M. Ochberg Well, think about the word “victim” and nobody wants to use the word “victim,” it’s, it’s not something that in our language and our culture is as honorable as, as it ought to be. You’ve, you’ve had things taken away from you, primarily, your, your dignity and we don’t have rituals to celebrate someone’s survival. If you die, you get a wake, you get a funeral, the whole community comes out and celebrates you. You get raped, do you think that there’s any kind of cultural ritual to restore to you your rights and, and, and the community respect for you who are innocent? So there is something about our culture and perhaps about ourselves that brings shame into this status of losing a human interaction and we’ve got to work hard to change that. Ah, whether you consider it control or dignity or, or just peer relationship that’s, that’s what it’s all about and that’s what I think post-traumatic therapy is all about, it’s reminding somebody you’re human even though you haven’t been treated in a very humane way.
35:00 Mike Walter Art, thoughts?
Art Austin Oh, as far as the power?
Mike Walter Reclaiming. So much ah, so much has been taken from you, that’s a big step forward for you, isn’t it?
35:05 Art Austin Yes. Ah, to get your life back on track, ah, and getting back to the, the mainstream of working, going to work, ah, it was very hard, ah, that I was off work for like six, six months before I actually went back to work. Ah, I felt comfortable enough to go back, ah, you know, you, and you got people at work, you know, they kind of, they want to stay away from you and, ah, you know, they speak, you know, the guys that, you know, you normally talk to on a daily basis they speak but it’s, you know, they kind of but I was comfortable at that point. Ah, seeing my doctors and being able to speak about it and that would make them feel better. Ah, I do… (crosstalk)
35:50 Mike Walter And you really need somebody to, to I mean, that doctor made such a difference for you.
35:55 Art Austin Yeah, oh, yeah, he’s, he’s a, he’s still in my life and we talk. Ah, he doesn’t bring it up, if I say something to him then, you know, he’ll say but… (crosstalk)
36:05 Mike Walter Uh hmm.
Art Austin …he doesn’t bring it up.
Mike Walter Art, again, thank you for coming in… (crosstalk)
36:10 Art Austin Yeah.
Mike Walter …and sharing your stories.
Art Austin Thank you.
Mike Walter They’re very powerful.
Art Austin Uh-huh.
Surviving Trauma and Tragedy: Lessons for Future Physicians
Mike Walter Tell us what happened on that day, November 10th, 2001.
36:15 Brant & Sue Krauss
Brant Krauss Well, we did, uhm, our son lived in Lansing, obviously, he lived with two other people. Uhm, they had a visitor staying at the house, they come in from Colorado who used to be staying at the same home at the time before our son moved in. We uhm, were planning a little family get-together that next day. Ah, unfortunately, our son , where he lived they had no telephone in the house, he had no cell phone so, and he being a 20-year-old would have this tendency to either have a case of selective hearing or short-term memory loss and we just felt we need to go visit him and remind him of the dinner the next day. And so I took my wife and my youngest daughter and myself, we decided to go and get a bite to eat and we did, we went back to the home, on our way home, and it was around, and I remember the time very vividly, it was roughly around 8:43 that night. Ah, I parked the van out front, I went to the front door, there was a sign at the front door of the home, it said, “Please go to the back.” The reason being at the time is they were doing some remodeling and there was a large roll of carpet that was in the front doorway or in the foyer and the door, front door. And anyway, she couldn’t get in the front so I went around back, knocked, and as I was walking up the driveway I could hear some noise in the house and I thought maybe they were having a little party or whatever it might be. Ah, I knocked on the door and immediately someone said, “Come on in,” which I’m always uncomfortable with that, I don’t like to come in unless someone’s at the door to bring me in. Well, finally after a few seconds, my son came running to the door, ah, said hello as soon as he, uhm, said his greeting I could tell he’d been drinking. Uhm, I reminded him of the day, we were gonna, the next day we were gonna have our dinner, and then I proceeded to get into the normal father-son lecture about drinking and the problems it can create for young people and so on. After about five minutes of doing this, he did something I’d never had him do before and I still it’s just, it’s just burned into my memory that he stuck his hand out, shook my hand and said, “Dad, thank you for caring.” And at that point I told him, “You don’t understand really how many people really do care about you,” at that point we parted ways. Ah, based on the police reports afterwards, by the time I had gotten into the van it was in this, in, in the van itself and departing it was about the time another party in the house began to attack our son . We went home that night, I was downstairs watching TV and my wife was upstairs and I got a phone call around 10 o’clock and she took the phone call and I could hear some of her conversation and it was not, it didn’t sound good and sometimes you have that gut feeling that there’s something wrong. So I bolted upstairs, she immediately handed me the phone and said, “Here, you talk to them, I don’t know what, I can’t understand what she’s talking about.” Uhm, I proceeded to talk to the young lady who was a neighbor of our son and she kept repeating, “Alex isn’t breathing, there’s something wrong. Alex isn’t breathing.” And I just was, couldn’t quite figure out what she got, you know, if it was a joke or what and then a few seconds later also there was another voice that came on the phone and it was the a, a Lansing police officer and he proceeded to inform me that, he said, “We don’t normally do this. This is not a normal procedure but under the circumstances I, I hate to tell you this but your son has been killed.” And it was at that moment that, as far as I’m concerned, the world that our family had worked so hard to build all those years came crumbling down around us.
40:10 Mike Walter Hmm. and, Sue, ah, taking that call, what’s racing through your mind during all of those times?
40:20 Sue Krauss When I first answered the phone, of course, it was so confusing and, and then, it was just once I gave the phone to him and I knew something was seriously wrong but it was disbelief. I just, it still seemed like it was a bad joke or something. And uhm, we hanged up the phone and we really just looked at each other and said, “What do we do?” We didn’t know what to do. And should we call somebody, should we not? It was just very confusing. He had gone to pick up our daughter at Michigan State here, she lived out here. And, ah, my other daughter and I waited for the police to come in. I really, I think in the back of my mind, thought when he gets serious he’s gonna tell me everything is okay, that Alex is fine and, and, ah, I waited on the front porch, I remember in my bare feet, it was very cold and, and they pulled up with the police advocates and the policemen and he just kind of shook his head and hugged me. And ah, I knew then it was real, but you still have that feeling of disbelief and then the despair took over and just the total, just despair. And, ah, for, for the next week really when you’re preparing for a funeral and it’s, ah, just so, so much to do when, they’re kind of in a fog, you remember it but you’re in a fog. And, uhm, from that point, I, and I really never thought about the perpetrator except that we wanted them caught which he was. Uhm, but, ah, from that point on, it was just really about my son . I was just, just the emptiness that you feel is so unbelievable. And, uhm, we, of course, for the first three weeks really you’re consumed with things that you have to be doing and after that, different symptoms started to, to set in; emotional, physical, spiritual. Things really change. And I, initially, my family called, our family doctor to get me something. I didn’t wanna take anything because I felt like I probably might miss something and, ah, but they did. She prescribed me Xanax which now it was a godsend to help me get through that time. But, ah, then we, uhm, we, ah, ah, ah, the mother, or the head of parents of murdered children told us about Frank and it took a little while. We made contact with Frank and set up an appointment to see him. And a little time had passed from our son’s death to that point. And now, I was starting, not only to feel the total emptiness and grief, but I could not, as days went on, we learned more and more about how our son actually died, the actual wounds and he was stabbed multiple times, and we did find out that he was nearly beheaded… (crosstalk)
43:30 Mike Walter Uh-huh.
Sue Krauss And that those thoughts kept running through my mind, all the time I could not stop thinking about that. And that was just eating me up. And then in turn, I started after six weeks or so getting really angry and thinking about what I could do to the perpetrator, and that scared me because I am not that kind of person and I would have thoughts of really hurting him.
44:00 Mike Walter Frank, let me draw you in here because up to this point, we have individual stories. But now, you’re, you’re, you’re talking about a couple… (crosstalk)
44:05 Frank M. Ochberg Yeah.
Mike Walter …and you had a chance to work with both them… (crosstalk)
44:10 Frank M. Ochberg Yeah. Yeah.
Mike Walter And each one comes at it differently… (crosstalk)
Frank M. Ochberg Yeah.
Mike Walter …and so, you have to approach each patient differently.
44:15 Frank M. Ochberg Ab, absolutely. And in this case, uhm, I, I just recently reread my notes. The, the murder happened in November and we were together in December before Christmas. Uhm, and Brant and Sue would sit about as close as they are now often touching and it was, ah, a couch in, in my office. I have never worked with a couple who were as supportive of one another, ah, ah, as they were. I mean I, I go home and I’d be taken through your trauma and your tragedy, but it was so uplifting for me to see the, the connection that they had. Well, often, as a therapist, you’re trying hard to help a connection happen or to create pseudo family because the violence takes place within the family and you introduce one person to somebody else. They had their network and they both had good, strong, extended families , and for them, the church was a tremendous resource. I, I’m not a religious person but I had so much respect for the communities that they were parts of. Now, I thought I would work mostly with both of them together. But somewhere along the way when a person has flashbacks, I feel you have to work on the flashback and I actually cut down the light in the office, I do something that’s semi-hypnotic. I count out loud to a hundred while the person voluntarily, when they are ready silently relives the worst of the experience. And when they get to the end of that 100, they feel that they’ve taken themselves through it, that they developed a certain amount of mastery over the internal traumatic memory. And, and I learned that this was correct for Sue but not for Brant. Brant didn’t have flashbacks. He had his feelings or he was not ah, in any way indifferent, quite the opposite. But for Sue, she had that element of the post-traumatic stress syndrome. And, and I would say in a case like this, it’s usually about 50-50; sometimes, it’s the male, sometimes, it’s the female. They didn’t see the death, but, by the time they had gone to the court and going through the police reports, they knew what happened. I got, by the way, I got asked as an expert, does that qualify for PTSD? You bet, it does.
46:40 Mike Walter Uh-huh.
Frank M. Ochberg You have lived through it whether you were an eyewitness or not.
46:45 Mike Walter Well, let me ask you about that because you touched on it. Ah, I think we’ve heard Art’s story and Linda’s experiencing it. It’s so visceral, it’s so horrible… (crosstalk)
46:55 Frank M. Ochberg Uh-huh.
Mike Walter And yet, I think, our minds and our imagination, the fact that you weren’t there and reading it and knowing it and playing it through your mind in some ways, it’s almost worst. I mean we can be so vivid.
47:05 Sue Krauss Right. I, it really was. And we had a female in the house that was actually the first to find Alex and she was describing the gurgling noise and… (crosstalk)
47:15 Mike Walter Uh-huh.
47:20 Sue Krauss …that, just all of that keeps coming back to you but not having been there. I mean, I can’t imagine that I, uhm, that I thought about it worst than it was, but it’s, you just, your mind just runs away and you’re constantly thinking about all those details and… (crosstalk)
47:35 Mike Walter Let’s talk about it as a couple because I would think, at some point, you’re really taking it hard. He’s trying to buck you up. But then, maybe another moment, he is the one that and it, it try and find an equilibrium there as a couple one. Both of you are going through this horrid experience. Ah, how tough was that?
47:55 Brant Krauss Well, you know, from my standpoint, it was bad enough the initial shock of what happened to Alex, you know. And then we had to relive the experience all over again six months later. Uhm, my issue is that I deal with it, and everyday I think of Alex. I mean, I just can’t getting them out of my mind. There’s things I always think about, always good things, but every once in a while, there’s bad things that, you know, I think about what if we had done this, what if we had done that. But if we just stop there before we went to dinner rather than after, uhm, there’s always that doubt, you know, what could I have done differently to help him. What if had, what if I had gone in the house when he said come on in. And then, I think, well, maybe I might have been a victim too, that I might have been in a situation my son was in also ’cause the man was ready, he was waiting for him when he turned around and walked back into that kitchen of that house and proceeded to attack and just drove him into the front room and the other images, that front door where that carpet was, it was an avenue of escape our son could not take advantage of ’cause he couldn’t get the door open. Whether he would have survived or not, we’ll never know. But that doubt also runs through my mind. But we talk about it a lot as a couple, you know.
49:05 Frank M. Ochberg And, and I think it’s fair to say that a survivor then takes on a role of helping others in the family. I ended up seeing both of their daughters, but you can imagine that the parents are very, very concerned about the impact of this on, on teenage daughters. And each one was caring for the other as well. There’s something called the caregiver burden, and, and that is the amount of stress and distress that a family member has dealing not just with PTSD but, but with any major health or social problem. So, they had their person who direct problems and their caregiver burdens.
49:45 Mike Walter Uh hmm.
Frank M. Ochberg That, what an example of, of, of dealing with this in an inspirational way.
49:50 Mike Walter And again, ah, I know you told me before this broadcast that, ah, that the hole is always there in your heart.
50:00 Sue Krauss Uh hmm.
Mike Walter They get smaller but it’s always there.
Brant Krauss It will never, never go away.
50:05 Surviving Trauma and Tragedy: Lessons for Future Physicians
Mike Walter You know what’s unique about, ah, your story is Dan experienced it, and yet a lot of his memory of the, the night that had happened, ah, is kind of by the wayside. So, you really kind of take the lead in telling your stories, so why don’t you tell us what happened?
50:20 Dan & Pat Anderson
Pat Anderson Well, it was in the middle of the night on, ah, July 7th 1985. Our dog wanted out and, ah, our son let him out. He, my son and I was watching, uhm, a late movie which we never did. This was about one o’clock in the morning. And my son came back to the living room and he says, “Mom, the dog is acting crazy.” So, I think someone is out there under the bushes. I said, “Get her in here”, so she came back in. He says, “Yes, there’s a man under the bushes under your bedroom window.” And so I went to the, I went and woke Dan up. And I went to the phone to call the police. Dan grabbed the flashlight and went out to see what was going on, and he asked the man what he was doing, and he pulled a sawed-off shotgun out of his jacket and shot Dan on the side. Of course, ambulance, police cars, fire trucks, everything came. After a long period of time, Dan was rushed to the hospital where he spent the next two and a half months in intensive care, three months in the hospital altogether. Each day was a new nightmare. Uhm, I never knew when I got up in the morning to go to the hospital if Dan was going to be alive. The doctors said they didn’t know if they could pull him through, there were so much damage. I mean, you can imagine, ah, shotgun through the stomach. Everything was involved. It was a nightmare for everyone, and thank God Dan did survive it. But this is 21 years later and Dan is still having surgeries. Dan is still having illnesses from it; he’s in, in and out of the hospital all the time.
52:10 Mike Walter So I had a chance to talk to Dan just last night, and, and you mentioned to me you just recently had a nightmare about this incident. And, and you said it never goes away. Talk to me about that because for a long period of time, you can even remember some of the details. And it was crystal clear for you (inaudible ).
52:27 Dan Anderson It was, it was, uhm, reliving the incidents completely, you know, just exactly like the, the night that had happened. And I have never had one of those before and I was just about within the last year so that’s about 21 years later.
52:40 Mike Walter All right. You were saying to me that you feel as though this man had been good step forward having this dream in a sense?
52:45 Dan Anderson Ah, I kinda think so. Ah, it’s interesting because, ah, I believe that, that these things are step forward in, ah, helping the healing.
53:00 Mike Walter What were some triggers for you? What about, I mean, and, and, I guess, living was a nightmare. I mean, not just… (crosstalk)
53:10 Pat Anderson It was.
Mike Walter …going to sleep and having, ah, nightmares. I mean, going through that whole period, the numbing effect, talk to me about some of those symptoms that you saw on yourself.
53:15 Pat Anderson Well, our son and myself, we did not stay in our own home the first week, we stayed in my parents . Ah, even though I’ve been told by the police that the day after this happened, the felon was picked up. But I still was very uncomfortable being in that house. And finally, we did go home and that again was another nightmare. Neither one of us slept well. Ah, our son who was, you know, adult, he slept on a quilt on a floor of my bedroom because he was afraid to be in the front of the house where his bedroom was for a fear this guy’s family will come and get him… (crosstalk)
54:00 Mike Walter Uh hmm.
54:05 Pat Anderson …or shoot him because he was the only eyewitness. Uhm, for a long time, ah, after that, after Dan did finally get home from the hospital, ah, he closed the house up like a tomb at night. But as soon as he started getting a little bit dusk, the drapes were closed and, ah, extra lights were shut off so people couldn’t see in. He made sure the doors were, you know, locked, ah, became very paranoid and we both were.
54:35 Frank M. Ochberg I can mention just a, a few things. It’s very rare for a surgeon to make a referral to a psychiatrist. Let me ask you, how many of you that think you’re gonna go into surgery? Oh, we got about a quarter of the class. The only reason Jim McGillicuddy referred Dan to me is because Jim and I went on a raft trip together. I don’t, I don’t think he refers to psychiatrist. There is something about surgeons and psychiatrists, we can be friends but, ah, we’re cut from different cloth. I’m very glad that Jim referred Dan to me. For some reasons, I don’t have that much to do with medicine. Dan was a state employee. There were, there were certain accommodations that he needed on the job. He was doing some technical work and it was difficult to keep up. I needed, at one point I believe, to write some letters that help with ah, either medical leave. I believe what happens is he only have so much leave, and then you’re on your own and we, we had to, we had to stretch that. So, the doctor ends up having a certain amount of authority to deal with the work and the financial situation of some of your patients. And I had, ah, a little bit of clout at that time in addition to being, ah, a physician and that, that was a view. So, at least, I could understand that, that to mention. These two people were, were different in the way that sometimes the victim and the co-victim are different. Pat had a lot anger. You never went to become a death penalty advocate but she might have been close. Dan, on the other hand, had a lot of forgiveness and, and sometimes when you’ve almost lost your life but you haven’t, you’re in a position where you say, as Dan did, the last thing I wanna do is impose a death sentence on somebody else. So, his, his spirit became one that was focused on health and healing and not on vengeance against the perpetrator. But those who watch our loved ones go through this, we have a lot anger. Ah, and then, and all of that is rational too. I, I just ended up witnessing and watching. Also, I had a chance to send Dan at one point down to Detroit Receiving Hospital because he had a bone infection that was a result of the blast to the abdomen and it never fully healed, and we just didn’t have the resources and the experience in the Lansing area. So, the ah, surgeons at, uhm, Detroit Receiving helped him with that problem and it was, ah, it was a good break for him.
57:05 Mike Walter You know, what’s interesting is, ah, when so many of us, ah, debate these issues in the abstract but then to be faced, ah, with it… (crosstalk)
57:15 Frank M. Ochberg Yeah.
Mike Walter …ah, and then half one point of view and another, it’s, it’s really unique. Well, let me ask you, ah, since you’ve worked with them, you’ve worked with a lot of these people here today, they talked about this and, and it’s, it’s been two decades now… (crosstalk)
57:25 Frank M. Ochberg Yeah.
Mike Walter What are the strides? What are the things you’ve seen in terms of, ah, the acceptance of PTSD in terms of the medical community recognizing that this really is an issue, the treatment of it?
57:35 Frank M. Ochberg We, we, we still have a long way to go. I, I, I think, ah, the whole world is in denial and they were in denial about our troops in Iraq right now. Ah, the rates of PTSD coming out of that war are gonna be high. And the administration is downplaying , ah, just the amount of emotional injury to those who were, ah, serving in the front lines. Whatever we think about the war, we have to be ready to help those who are the, the combatants. Ah, I went through that in the Vietnam era when it took me awhile to realize that the warrior was not responsible for the war. So, I, I think we still have a lot to learn although the diagnosis is generally known. When I started, ah, lecturing about PTSD, there’d be one person in an audience like this who would, who would heard about it. Ah, but you have emergency rooms where a PTSD diagnosis was given once or twice a year. They actually underreport PTSD in hospitals across the country, ah, because they don’t believe in it, or perhaps, they don’t have the staff to deal with the disorder, so they’d rather downplay the incidents and the prevalence. PTSD is real. It’s a medical diagnosis. It affects the brain. You can see it on a PET scan. A, uhm, a trauma, memory lights up in a different way from autobiographical memory. We, we owe it to these people to help them recover their normal memory and not be plague with trauma memories for two decades.
59:05 Surviving Trauma and Tragedy: Lessons For Future Physicians
Mike Walter Let’s open it up and bring everybody back up here on stage and we’ll give you an opportunity to ask them questions as well.
59:15 My question was just how often do you, as a psychiatrist, Dr. Ochberg, encounter a couple as supportive of each other ’cause I have heard sometimes when couples go through very severe trauma such as this it often erodes their relationship?
59:30 Frank M. Ochberg It, it, it’s a good question. And back when I was a resident which was Stanford in the ’60s, we were told that the divorce rate from prolonged ah, traumatic exposure like being the parents of a leukemia child was up around 70 percent. And sometimes, the big difference is that one partner is a talker and the other partner is the silent type. And it’s hard to be compatible when on the one hand you really wanna tell the story. You, you you have a need to share and to get a reaction and if you’re of the other disposition, you really want the privacy, ah, and you don’t want to be asked questions, and you, you don’t want your feelings to be exposed when, when you don’t have control over your feelings yourself. So that can be a, a very disruptive situation. Ah, I stayed with a couple who were both teachers at Columbine; one was in the school in which the shooting took place, and the other was the wrestling coach at the school where the kids ah, ended up graduating that year and they were a very supportive couple. They reminded me ah, somewhat of, of the, the Krausses. But ah, at one point he says to me, “Frank, when is she gonna get over it?” He, he, he wanted to stop listening, but he really wanted to be very supportive to his, his wife at, at the same time. Uhm, I think Dan and Pat had been have been an extremely supportive couple, but they, they seldom were with me at the same time, so I didn’t have the chance to witness that emotional and, and physical connection. So, it’s, it’s been relatively rare in my experience. I wouldn’t offer a percentage to say that 10 percent of the time you see and 90 percent of the time you don’t. But I, I was struck by it when I, when I did see it. Mike Walter You know what’s interesting, Frank, you started to talk, he looked at her, they both smiled at one another, he grabbed his hand there, that support is still very much evident today.
01:01:40 Frank M. Ochberg Right.
Mike Walter One of the two of you more of the talker and the other one, you are the talker and did it, did it create any kind of stress at any point too?
01:01:45 Sue Krauss It really didn’t. Uhm, I needed to talk about our son all the time, I just want to talk about, even to Frank, just, anybody that would listen. Every, I just want to talk about him constantly and Brant is more of a listener, so he was, I mean, he would interject things sometimes. Well obviously at Frank’s office… (crosstalk)
01:02:10 Frank M. Ochberg Yeah.
Sue Krauss But uhm, I’m the one that’s always needed to talk more so, but ah, he was always very supportive and just, we were always, it just seem like we were on the right clock or something. When I needed him, he was there. When he needed me I was able to offer him that support. So, we were lucky that way. That we just always kind of around the same page so.
01:02:35 Brant Krauss Well, after this, just before this happened to our son , I had left the job I had been previously employed at and fortunately as a family we had circumstances where once this incident happened, it, like I said our world that we had built and worked so hard to build they crumbled right around us at that time. So, I sort of look at, sort of we had to rebuild what we had, which I think we’ve done a good job but it’s still, it’s gonna be a forever project. I decided to retire at that point ah, which I did, which allowed me to spend a lot of time with this wonderful woman and so we, we’ve shared a lot of time together. Uhm, we are best friends and we’re gonna be on our 29th wedding anniversary coming up and it’s been 29 wonderful years, and we’ve had a big bump on the road but we’re survivors and we’ll get through it.
01:03:35 Frank M. Ochberg Mike, there’s a question over there?
Mike Walter Yes.
My question is for Linda. I was wondering if and how your experience affected your relationship with your children especially uhm, your fourth, the one you’re pregnant with at the time of your ordeal?
01:03:50 Linda Harkness As I was also always so fearful up until the time that he was born, you know, if he was gonna be okay, ah, it turned out he was okay.
01:03:55 Frank M. Ochberg Linda, I really liked that question now, and here’s someone who’s gonna be a physician, and she realizes her patient is pregnant and is the mother of three children . So, I’ve got to be thinking about the relationship that that mom has to her kids, her ability to care for those kids. I, I, I assume that that’s in the back of your mind and that when some woman is your patient, you’re gonna be thinking about her role in the family and not just her, her medical symptoms.
01:04:35 Linda Harkness And I, I think I have to say it’s those children that really kept me going, instead of sinking it. You know, I guess my philosophy was that if I sunk, those children are gonna go under too because I was really the only one that they had. And that was really, that test, it was a test, because I still had that numbing feeling but I was, I made sure that all their, their needs were met in some way or the other. So, that, that was very helpful for me in getting through the situations.
01:05:05 Mike Walter You have a question?
Matt Uhm, first of all, I’d like to really thank all of, all these speakers for coming to speak to us. I really, really admire your courage and your strength in dealing with the things you’ve dealt with. And sort of along those lines, I sort of assuming that those, that, that the speakers you’ve heard today sort of represent the, sort of all-stars, the, the patients who has have, you know, have done the best with, uhm, with what, what they’ve been dealt. Uhm, and I’m so, my question is really for Dr. Ochberg, what, what is sort of the flipside, how do, ah, how do patients deal less well with this sort of thing?
01:05:40 Frank M. Ochberg Well, first, there’s the trauma and for some people the trauma is loss of limbs or sight or spouse, child. There, there’s dealing with death. And of course not everybody deals in a effective way, coping, mastering and reaching the point where you can help other people. If the physical wounds are painful and are disabling, that’s, that’s a, a major part of life. If the emotional wounds are disabling and constitute major depression, post-traumatic stress disorder, let me say, by the way, that there’s a slightly higher prevalence of major depression after these events than there is of PTSD. The technical confines of the PTSD diagnosis make it a little bit harder to give that diagnosis than, than depression. So, there are those limitations. But I, I think the saddest of all is a cultural event that here where we really need one another, and it takes a village, there, there often isn’t that village. And they, the sadness and the loss is, is quite profound. I’ve reviewed articles as an editor and I’m astounded to see the incidents of PTSD and certain catchment areas in American cities is over 70 percent. Why you don’t even, you don’t even begin to think about handling those problems as a public official because you’re dealing with poverty and crime and a whole range of, of other social ah, social losses. But let’s make it clear, there’s a lot that we can do and the opportunity to work with people who may not be all-stars but they are scoring, they are coping, they are prevailing is, is very compelling. And after you’ve been at this for a while, you, you do get a sense of a person’s best opportunity for growth. There is a concept now, post-traumatic growth, and there are scholars who are looking at it. I, I think with that orientation you get beyond symptom management and you ask yourself, what might this family do? What might this mom and child do a year after the rape, two years afterward? And, and remember we’re talking about circumstances that are rather prevalent in our culture. Gunshot wound to the abdomen may not be that prevalent, but rape is. The most common kind of PTSD cause, you may say, is a car crash. And a lot of adolescents are involved or in a car when another adolescent dies. The exposure to the car crash is the one that most journalists end up saying, so we’re, we’re dealing with common enough events. It’s a good… (crosstalk)
01:09:00 Mike Walter Yeah. Frank… (crosstalk)
Frank M. Ochberg It’s a good, it’s a good question though, to think about those who are not the thrivers ah, and who have significant loss.
01:09:10 Mike Walter Frank, and I know I want to get to their questions again, but ah, one thing we really haven’t talked about is stigma. I know in my profession… (crosstalk)
01:09:15 Frank M. Ochberg Uh hmm.
Mike Walter …the fact that you’d acknowledge this, I really need help, most of us won’t do that. I think people in, in ah, police work ah, and even ah, the sex difference, you know, you got men and women… (crosstalk)
01:09:25 Frank M. Ochberg Uh hmm.
Mike Walter …and talking to Brant and Art, they were saying we’re expected to be stoic and, and buck up and, you know, be tough. Uhm, talk to me about the stigma of just, you know… (crosstalk)
01:09:35 Frank M. Ochberg We’re still fighting stigma. And, and anybody who is a role model who has a star quality, whether they are a politician, ah, actor or actress, ah, who’s willing to come out and say, “I have post-traumatic stress disorder” or “I had depression and here’s how I dealt with it.” It’s a, it’s a godsend. I, I was just on a panel with a former quarterback for the Detroit Lions, uhm, Eric Hipple. Eric Hipple had major depression. His son inherited it and committed suicide, and that man is out there as an inspirational speaker. Ah, the head of ah, CNN International, Chris Kramer, had post-traumatic stress disorder after being held hostage in an embassy siege, and he talks about it in a very compelling way. So, I, I don’t think we’re gonna defeat stigma until we have enough people who are, are role models, and they speak about having the disorder, dealing with the disorder and holding their head up high.
01:10:35 Mike Walter Okay.
I want to thank you all for coming here, uhm, as Matt did. Uhm, my question deals with, a few of you mentioned, uhm, you find it difficult to talk to your physician about this. Uhm, I was wondering, after you’ve started talking about it, was that, was just talking about it enough or did you have to fend other forms of catharsis, other, another way to form ah, to form a voice, to regain your voice?
01:10:55 Art Austin I can’t say that I, ah, my physician, it was hard for me to, to ah, to speak with him about it because I went to him, that’s what I, you know, to speak to him and he was open enough to, ah, to listen. He was more, you know, caring, ah, made suggestions of other avenues, ah, that I could do. Ah, the medication, ah, but, ah, no, he was, ah, it was, it was easy for me and I think it was fairly easy for him, of course, there was other doctors that may not be as receptive to, to doing that.
01:11:40 Sue Krauss Uhm, I also went to my family docto r who’s not initially after the incident happened a few months down the road, and I wasn’t gonna tell her what happened and, and I did. And I was so thankful that I did because, and this was just, my general family doctor . Uhm, she, she sat and listened and she probably spent 30 to 40 minutes with me, and she cried with me. And ever since that day, she, when I come in, she pays that little extra bit of attention to me, she never rushes me, she always asks how I’m doing, and she’s just been very, very compassionate, and I will never forget that, that she’s done that for me.
01:12:25 Mike Walter And you mentioned you weren’t going to tell her, why, why was that? Why didn’t you want to share?
01:12:30 Sue Krauss No, I wasn’t in when I went for my yearly with the gynecologist, I didn’t tell her and the following year I did and she was very shocked that I hadn’t but it was, ah, I’m not really sure why I didn’t tell her and, uhm, you know, I had had so many physical symptoms coming out because of what had happened that she, she really was very compassionate also and wish that I had told her upfront. And to be honest, I’m not quite sure why I didn’t confide in her… (crosstalk)
01:13:00 Mike Walter Uh hmm.
Sue Krauss …right off the bat. But both of them since then have just been awesome. And they are always, they always go the little extra mile with me now. And I appreciate that more than I can say.
01:13:10 My question is for Dr. Ochberg. Uhm, you spoke about acute stress disorder in the month immediately following the trauma. And I’m just wondering how do you discern between acute stress disorder and a normal healthy reaction to what is a horrifying thing to happen to someone? And also, at what point do you decide to, with a patient to give them medication because so many of the speakers spoke about, you know, the doctor really wanted to give me something. Is that something that we should just do as physician, physicians or should we be very careful on deciding, you know, who and what to medicate with?
01:13:45 Frank M. Ochberg Well, these are, these are both questions. Ah, in, in psychiatry, there is the diagnostic and statistical manual and it gets revised every so many years. And in the beginning, we formulated the concept of post-traumatic stress and then a group who are primarily research-oriented brought the diagnosis of acute stress disorder into the, the DSM IV. Ah, you give that diagnosis when you see between a few days and, ah, and a few weeks, ah, symptoms that are almost the same as PTSD to the point where they are debilitating someone. They’re interfering significantly with their work, with their home life, with their school life. And in the acute stress disorder, you also look for something called dissociation. And, and that means the person acts or feels as though they’re in a trance. And now a trance state may be somewhat protective. The reality is pretty grim, so feeling as though you’re in a play or you’re being moved about by strings coming from one high. Ah, that may be a form of protection against anxiety. It, it’s ultimately not a healthy condition. So, so you look for those elements. And, and if you read the, the DSM, the diagnostic criteria are there, and perhaps you’d be examined on it. I, I, I don’t know that the concept is all that important because as a physician, if you know that something is going terribly wrong in your patient’s life, and you encourage them to share that with you. Then you’re on a lookout for the whole range of, of other things they can go wrong. PTSD by, is by no means the only one. There’s, there’s, ah, a higher risk of all of the psychophysiological disorders. So, you, you stay on the lookout for that. Ah, alcoholism, self-medication, drug abuse, that’s there and, and forms of personal alienation. So, you, you pay close attention to all of that. You try to, you try to modulate, facilitate. Ah, as far as when to use medication, the only thing I would suggest is don’t do it the way Linda’s husband would have done it, “Here, take this. I’m insisting. This is what you need. “Listen and collaborate and allow someone to make an informed choice. So, if they haven’t slept for a week and that sleeping pattern is disrupted, ah, what is wrong of taking the risk of prescribing Ambien or, or whatever you are comfortable with and saying, “I don’t want you to get hook on this. But, this will, this will help you fall asleep.” And if they’re waking up early like Art then you have something to deal with the other end of the sleep spectrum. Ah, it’s gonna take a month for the SSRIs to work. So, you may need to give a little lecture about it. What, what I often do is say, “This is like insulin for a diabetic.” This isn’t going to help you if you’re normal and wanna feel better. There, there is no black market for Celexa, it’s not an upper. But if your uhm, brain chemistry has been depleted with all that you went through, and this is gonna help you on nor, normal neurotransmission to the job of regulating your mood, it’s worth a shot. Ah, and you explain the side effects and you say it’s gonna take a while. So, I, I would, I would use the approach of being collegial, of normalizing these reactions. You’re going through what are a set of normal responses to something horrible that happened. Ah, and everybody is different. Ah, you may take a family history to find out what medication worked with other family members because, ah, you wanna be lucky the first time and if you find out that, ah, as I have found out in one family, the family all response to Wellbutrin and not to Celexa and it’s in three generations. It, it start with the Wellbutrin. So, so you engage in the conversation and in the choice and you’re doing symptom management, there is no one medication that is currently prescribed for PTSD all the time.
01:18:25 Mike Walter Frank, thank you. I thank all of you and I’d also, as we close today, I’d like to thank all of you sitting out here today and for being so engaged, your thoughtful questions and, ah, and I, and I really wanna take sometime to thank Frank for his vision to, to actually bring these people together to, ah, come up here and talk to you about what they’ve ah, faced and what they’ve gone through. You know, there’s a great saying about teaching, the teaching profession then. A mediocre teacher tells and of course the, ah, the good teacher explains, the superior teacher actually demonstrates, and an excellent teacher inspires and I think, ah, Frank has shown that he is, ah, a superior teacher because by bringing all these people here today has demonstrated to you, ah, what happens when someone grapples with PTSD. He has also proven that he’s a great teacher because hopefully, he has inspired you to go out there and make a huge difference as you’ll embark in your careers in medical profession. Careers that will obviously make a huge difference for people dealing with this issue. I’d also like to thank Keith ah, Etheridge, he is the executive director of the Michigan Victims Alliance, and, of course, we have all of these people are members of the MVA. Without Keith’s help, ah, we wouldn’t have been able to put this program together. Finally, I’d like to thank our panel, ah, for their courage, their conviction, and their commitment for this program. Ah, you probably all heard the saying when it gets dark enough, you can see the stars and those stars are seated right here. Uhm, they are obviously lighting the way for future generations of medical professionals. You know, I think everyone of them would tell you that what’s important to them is coming up here and sharing their stories so that they can help others who will face the same issue in their lives. And the best way to do that is to talk to you and to help you so when you confront something like this, you can make a difference as well. They are survivors. They are not victims. They are brave survivors. And again, they are helping people who will face the same issues in the future so I wanna thank them as well. You guys have been just absolutely terrific. I’m Mike Walter and I wanna thank all of you for joining us today. Thanks again.
01:20:35 [sil.]
01:20:40 I expected to hear stories about people with post-traumatic stress disorder and who had been through some really traumatic things in their lives but I had no idea really. And I, I didn’t know that their stories were going to be as complicated as they were and just were they’re reminding me that people have so many different things going on in their lives. And when you look at the person, you’ll never really know, that’s, that’s what that really reminded me of.
01:21:05 A lot of times we actually could probably read the same information out of the textbook and when you have someone telling the story themselves, it kind of comes alive for you in a way that the next time or the first time maybe you’re, you’re with the patient with a similar story or, uhm, you can kind of relate and think back to today.
01:21:20 It makes you feel closer to the issue when you can actually put a story with the faces and really hear it because we’ve been studying it for so long in our books and it’s, those are just stories and those are just vignettes. But when you can actually see the people and you actually hear the stories and they’re not just acting and if something that’s real, it just makes you feel closer.
01:21:40 I have had some, ah, mental health training in the past and I haven’t really been exposed to, to trauma victims for PTSD, uhm, people suffering from PTSD. And I would like to get more involved and hear more stories so that (inaudible ) better skilled when I move into practice eventually
01:21:56 I was really impressed with the whole panel, how they were able to take such an, a traumatic event and really turned it around and make it useful and helpful to others.