In her book, "Within Our Reach," former first lady Rosalynn Carter shares insights she gained during her 35 years of work in the mental health field and issues a call to end discrimination against people with mental illnesses. In this excerpt, she writes about her own experience with post-traumatic stress disorder.
Chapter five: When disaster strikes One day many, many years ago in Plains, I was taking the babysitter home. We had a station wagon back then, and Carrie Lee, the babysitter, was in the backseat with the baby, Jeff, who was about two at the time. This was long before seat belts even existed. All of a sudden I heard a loud crash and found myself frantically trying to hold onto the back of my seat as the car turned over in the air. I remember Carrie Lee screaming as she, too, scrambled to grab onto something. Someone had struck our car from the rear. It flipped completely over and landed sitting upright, facing in the opposite direction. Carrie Lee was not hurt, but she was still screaming. I didn’t hear the baby at all. It was one of the worst moments of my life. Fortunately Jeff had been held in place by the spare tire. It had come out of the floor in the back part of the vehicle and kept him safe. He thought it was fun.
Someone took me to our business office in town, where Jimmy was meeting with a customer. “I just totaled the car,” I said in a trembling voice. I was shaking all over. He just said, “Where is it?” I told him, and on the way to get it, he dropped me off at home. He took care of everything, and I never saw the car again.
It was a miracle that no one was hurt. Carrie Lee had a tiny scratch just above her ankle that was not even deep enough to bleed, but I think we were both affected by the accident. I knew nothing about the psychological problems trauma can cause or about post-traumatic stress disorder (PTSD) back then, but for months afterward, I would begin to shake every time I picked up a newspaper. There were always reports of traffic accidents. I don’t think I had noticed before that people could die just by running off the road into a ditch. After my own terrifying experience, whenever I saw the headline of an article about an accident, my heart raced. I became sweaty and shook all over, and it was a very long time before I could make myself drive past the place where my accident occurred.
Fortunately, Carrie Lee, Jeff, and I suffered no long-term or permanent consequences. We were so lucky. Since then I have been no stranger to trauma and catastrophic events. Through our work at The Carter Center over the past twenty-five years, Jimmy and I have traveled to more than sixty-five countries, and in too many instances, we have witnessed the devastating impacts of war and violence on innocent victims. I shall never forget the day in 1995 when we visited a refugee camp in the Sudan. Thousands of people were huddled in masses on the ground, sitting or lying down, waiting for help. At a distance we could see a patch of blue—a makeshift tent made from a large sheet of plastic supported by sticks. It served as a health clinic for people who had come from far and near. A civil war had been raging in the country, and this was the first time in thirteen years that these people had had any health care at all.
As we stood looking at the site, we were overcome by the magnitude of the suffering. After taking a moment or two to regain our composure, we began walking through the masses in the direction of the blue tent. People were weak and sick, hollow eyed from hunger, staring into space, some shedding tears and others moaning. There was an occasional whimper from a child, but mostly it was eerily quiet, as though the people had no strength left with which to cry out. One little boy sobbed softly to me, “Mina, mina, mina.” He was trying to tell me that he had stepped on a land mine. He had only one leg. My heart skipped a beat.
Seeing the children was the hardest for me.
As Jimmy and I walked among the people, we held babies and cuddled other small children, many with distended stomachs—a sign of starvation. I picked up one infant whose little arms fell limp at her sides. She was too weak to lift them. The doctor told me that she had malaria and would not live through the day. I could tell by the look in her mother’s eyes that she already knew.
When we left the area, we were drained both physically and emotionally by the heat and the suffering and the shocking evidence of severe trauma that we had witnessed.
As I reflect on the anguish we saw that day, it gives me a renewed sense of urgency about the importance of providing help and support to victims of trauma—both children and adults. Its impact is so pervasive in our world, where violence, physical and mental abuse, poverty, natural disasters, and war continue to inflict pain on people of all ages.
What is trauma?
Each of us throughout our lifetime will experience traumatic events. It might be a discrete occurrence, like a car accident, a mugging, a fire, or a medical emergency that affects us personally. Trauma can also be a continuing presence in one’s life. Child abuse, domestic violence, chronic illness—all can have persistent and harmful impacts. Train wrecks, plane crashes, bombings, floods, tornados, and earthquakes can be emotionally devastating. Disaster and catastrophe have been a part of the human condition forever. It is only recently, however, that we have begun to understand the significant mental health consequences of exposure to trauma.
Fortunately, most people who are exposed to terrifying ordeals do recover and go on with their lives. They may, like me after the car accident, experience symptoms of anxiety for some period of time, but eventually these subside and there are no lasting effects. For reasons we do not fully comprehend, others are not so fortunate.
We have learned much in the last twenty-five years about the effects of trauma on children, victims of natural disasters, and casualties of war, both military and civilian. We have begun to identify the factors that can influence how individuals respond to stress and whether or not they experience PTSD. Equally important, in the past decade both public officials and leaders in numerous disaster-relief organizations have made significant progress in developing more effective emergency response procedures. Yet despite these gains, it seems to me that we are losing ground in our fight to overcome the devastating consequences of trauma.
The impact of PTSD
For some who are involved in a catastrophe or traumatic event, as well as some who witness it, healing can be elusive. PTSD affects about 3.5 percent of American adults and can occur at any age, including in children. For millions, it can be accompanied by serious psychological problems: depression, substance abuse, or other anxiety disorders. Failure in school, criminal behavior, and even suicide can also result. There is some evidence that susceptibility to PTSD may run in families or is otherwise mediated by genetics. New research into what’s happening at the genetic and brain-structure levels may hold some answers. In fact, unrecognized PTSD is common and can be an important contributor to severe depression.
People with PTSD may startle easily and in an exaggerated way and become emotionally numb and withdrawn or extremely vigilant about potential danger. Depending on the severity of the trauma, they may lose interest in activities they usually enjoy; have trouble feeling affectionate; experience panic; be irritable; or engage in angry, aggressive, or violent outbursts. They may avoid situations that remind them of the original trauma, or they may become obsessed with them. If they become depressed, they can also experience all of the symptoms attendant with that disorder. Most people with PTSD have flashbacks, and they can also have nightmares.
PTSD can develop after a terrifying ordeal that involves physical harm or the threat of physical harm to oneself, a loved one, or even a stranger. Natural and man-made disasters and a variety of random, more personal events such as robbery or rape can trigger it. In fact, PTSD seems to be worse if the harm was deliberately inflicted by another person rather than resulting from some natural disaster. When you think about it, it is easy to understand. Most of us have a harder time digesting that another person may have wanted to harm us or has no regard for us. This can undermine our faith in humanity and leave us feeling suspicious and isolated. In addition, a natural disaster is often experienced within a community, leaving many people struggling with the same issues at the same time. In such situations, the residents of the community support one another with a “we’re all in this together” mentality. The aftermath of sexual assault, on the other hand, is often suffered in silence and alone, with victims possibly feeling stigmatized or mistakenly believing that they are somehow to blame for the crime perpetrated against them.
PTSD may emerge shortly after exposure to a traumatic event, or it may take months or even years before symptoms are obvious and a diagnosis is possible. No matter when it arises, for the afflicted and their families, the consequences are often devastating.
Reprinted from "Within Our Reach: Ending the Mental Health Crisis" by Rosalynn Carter. (c) 2010 by Rosalynn Carter. By permission of Rodale, Inc.