According to the National Institutes of Health, the majority of individuals experience several traumatic events in their lifetimes, but do they all develop post-traumatic stress disorder (PTSD)? If you question the general populace or the media, they would indicate that PTSD is extremely common. Although it varies by sub-population, for the general populace, 13 and above, the rate of diagnosed PTSD is 4 percent to 8 percent. It is highest in women, ±33 percent, who have been raped, and ≈15 percent in veterans. The latter may be an underestimate as many veterans likely never receive a formal diagnosis.
Different definitions of trauma and PTSD exist among mental health organizations, federal agencies, and practitioners. Some PTSD experts contend that trauma underlies as much as 80 percent of all psychiatric pathology, while others are skeptical of this assertion, believing it a gross overestimate, and that in the majority of instances, trauma is integrated into an individual’s personality, rather than creating mental illness. As historically some psychiatric diagnoses have waxed and waned in popularity (i.e., ADHD), the latter perspective is likely correct.
Dr. Lara Friedenfelds researched miscarriage in the U.S., from the 17th-century colonies until the present, and how this event evolved from an almost welcomed experience to one of (sometimes overwhelming) grief and mourning. She attributed the change to evolution in social and technological factors, and a similar argument could be made for PTSD.
Until relatively recently, violent death was both a common and accepted norm, which ended gradually as society changed, technology advanced, and civilian deaths lessened between the mid-19th and mid-20th centuries. During this century, surgical advances increased survival rates, people migrated from farms to cities decreasing agrarian accidents while increasing medical access, and exposure to trauma decreased. Although, in the last ±30 years, because of the internet, increased firearm access, and other social changes, violence and exposure to it have increased.
Two constant factors among PTSD definitions are that an individual must perceive a traumatic event as physically and psychologically threatening for morbidity to develop. While trauma research and its effects are still in their infancy, it is known that an individual’s personality determines what is interpreted as traumatic and whether a disorder develops. Biological females appear more susceptible, in part due to genetics, but also resulting from continuing traditional feminine socialization.
There are other social influences as well. Primary is one’s family of origin, which can be either protective or detrimental. Although parents may argue occasionally, and a child witnesses these disputes, of themselves they are not traumatic if there is no violence, and the parents also demonstrate successful resolution. Conversely, frequent arguing without resolution, physical or sexual violence, or having distant or unresponsive parents can be traumatic. Recently, researchers have indicated that home life may well be the major cause of lifelong trauma effects, both physical and psychological, while witnessing or involvement in subsequent violence only magnifies the already existing trauma, rather than causing it.
There are other influential social factors, not all of which are controllable, and even a healthy family may be an insufficient counterweight. There is the internet, and despite the surgeon general’s warning, it is not an absolute evil, as therapy delivered over this medium, positive “nudges” regarding oneself and behaviors, and other aspects can be positive. Texts, emails, and computer games are also influential, though they too may be of either valence.
A major concern is the school environment. If one accepted the media version of mass school shootings, they are frequent, and the primary cause of anxiety, depression, and trauma among K-12 students. Statistics relate a dramatically different story, as they comprised ±1.5 percent of all mass shootings, and 0.0002 percent (2/10,000) of all murders from these shootings, between 1997 and 2022. Yet, parents and school systems react as if the media interpretation were correct.
More influential on children’s emotions are a school’s “active shooter” drills, and post-shooting actions. Research on drill effects is just appearing in professional journals, and those including mock bodies, fake blood, and armed officers are the most traumatic for students. But even those that only involve youth pushing bookcases to block ingress to classrooms generate student anxiety. Gun-bearing school resource officers even affect some children negatively. What would be the effect on them, especially younger children, if states approve armed teachers? If gun-toting police are disconcerting, there is no reason to believe that pistol-packing faculty would be less so!
And then the after-event response of grief counselors flooding a school, and teachers and staff constantly inquiring if a child is OK communicates the message that a child should not feel OK, and that if they do, that is abnormal! And when symptoms can occur months to years after an event, is concern that dwindles within a few weeks sufficient? Present evidence indicates that rather than dwelling on an event and negative feelings, it can be more helpful to acknowledge these but quickly transition to, and emphasize, the commonality of traumatic events, how to integrate them into one’s life, present examples of people who rose above trauma, and look toward and plan for a positive future. Ideally, mental health professionals should be available long-term, in-school, either online, or in-person for individual or group therapy. Funding is available through a number of sources, and need not negatively affect a school system’s budget.
M. Bennet Broner is a medical ethicist.
