Denial (32 page)

My goal in writing this book is to help not only the millions of women and men who have been raped or tortured but the soldiers who risk their lives on our behalf, returning with psychic wounds so excruciating that both they and we cannot bear to admit that these wounds exist. Denial is almost irresistibly seductive, not only for victims who seek to forget the traumatic event but also for those who observe the pain of others and find it easier to ignore or “forget.” In the long run, denial corrodes integrity—both of individuals and of society. We impose a terrible cost on the psychically wounded by colluding in their denial.

1. Catharine A. MacKinnon, “Women's September 11th: Rethinking the International Law of Conflict,” Harvard International Law Journal 47, no. 1 (Winter 2006): 25.

2. The “walking corpses” is Bruno Bettelheim's term in
The Informed Heart
(New York: Free Press, 1960), p. 151. Psychiatrist and author Henry Krystal “affirms that psychogenic death can occur if the victim of catastrophic trauma completely surrenders to the situation in which no action is perceived as possible. If this surrender occurs, he/she falls into a state of immobility (catatonia), and abandons all life-preserving activity. He calls this a ‘potential psychological “self-destruct” mechanism' and affirms that, once the process of total surrender starts it is no longer voluntarily terminable but may only be stopped by the intervention of an outside caretaker, and that, if this does not happen, the victim will die.” Krystal cited in Carole Beebe Tarantelli, “Life within Death: Towards a Metapsychology of Catastrophic Psychic Trauma,”
International Journal of Psychoanalysis
84 (January 2003): 915–28.

3. Primo Levi,
The Drowned and the Saved
(New York: Simon & Schuster, 1988), 79; cited in Tarantelli, “Life within Death.”

4. Feminists argue about whether rape is a form of sex. See, for example, Susan Brownmiller,
Against our will: Men, Women, and Rape
(New York: Simon and Schuster, 1975); Catherine A. MacKinnon, “Sexuality, Pornography, and Method: ‘Pleasure Under Patriarchy'” Ethics, Vol. 99, No. 2 (Jan., 1989), pp. 314–346; and Camille Paglia,
Vamps and Tramps: New Essays
(New York: Viking, 1994). It didn't feel like sex to me, maybe because the gun and the imminence of death were so central to my experience.

5. http://www.thedoctorwillseeyounow.com/articles/behavior/ptsd_4/

6. Tim O'Brien,
The Things They Carried
(New York: Houghton Mifflin, 1990).

7. Gottfried Leibniz's answer to the question of why God would allow a natural order that involved so much innocent suffering was that man brought such natural evils upon himself: natural evil was collective punishment for moral evil, including but not limited to the Fall. A massive earthquake that destroyed the city of Lisbon in 1755 evoked a reaction among Enlightenment philosophers and theologians similar to that of their twentieth-century counterparts to Auschwitz, Susan Neiman explains in
Evil in Modern Thought: An Alternative History of Philosophy
(Prince ton, N.J.: Prince ton University Press, 2002), 1–57. Jean-Jacques Rousseau would reject Leibniz's view, ushering in a more modern conception of evil. Innocent suffering was not punishment for sin, but a symptom of ignorance. In regard to the earthquake at Lisbon, for example, it made no sense for humans to live in large cities where they were vulnerable to earthquakes. Interestingly, psychiatrists are seeing new links between suffering and sin today, as we shall see.

8. Sue Grand,
The Reproduction of Evil: A Clinical and Cultural Perspective
(Hillsdale, N.J.: Analytic Press, 2000). Victims of repeated abuse, or children who live in violent neighborhoods or war zones,
may experience PTSD; see Tener Goodwin Veenema and Kathryn Schroeder-Bruce, “The Aftermath of Violence: Children, Disaster, and Posttraumatic Stress Disorder,”
Journal of Pediatric Health Care
16, no. 5 (September–October 2002): 235–44.

9. Shakespeare's Richard III, for example, attributes his determination to become “a villain” (morally evil) to his having been “cheated of feature by dissembling nature” (natural evil). This might be a good example of how victimization—including by fate—can be used to justify moral wrongs. Derek Summerfield observes that “the pro-file of post-traumatic stress disorder has risen spectacularly, and it has become the means by which people seek victim status and its associated moral high ground in pursuit of recognition and compensation.” Summerfield, “The Invention of Post-traumatic Stress Disorder and the Social Usefulness of a Psychiatric Category,”
British Medical Journal
322 (January 2001): 95–98.
Judith Lewis Herman, a leading authority on trauma, reminds us that it is important not to subscribe to the belief that traumatized victims inevitably become evil, since that would involve “blaming the victim,” which is morally wrong. Herman points out that there is a popular literature of the “cycle of abuse” theory. Herman states that this theory is not empirically valid, explaining that “its most glaring weakness is its inability to explain the virtual male monopoly on this type of behavior. Since girls are sexually victimized at least twice to three times more commonly than boys, this theory would predict a female rather than a male majority of sex offenders.” Herman, “Considering Sex Offenders: A Model of Addiction,”
Journal of Women in Culture and Society
13, no. 4 (Summer 1988): 703–4.

10. Some studies suggest that PTSD may be at least partly heritable. Adult children of Holocaust survivors are at greater risk for PTSD—perhaps because they are more likely to expose themselves to traumatic events through life choices, or because susceptibility to PTSD is heritable. See R. Yehuda et al., “The Cortisol and Glucocorticoid Receptor Response to Low Dose Dexamethasone Administration in
Aging Combat Veterans and Holocaust Survivors With and Without PTSD,”
Biological Psychiatry
52, no. 5 (September 2002): 393–403; M. B. Stein, K. L. Jang, and S. Taylor, “Genetic and Environmental Influences on Trauma Exposure and Posttraumatic Stress Disorder Symptoms: A Twin Study,”
American Journal of Psychiatry
159, no. 10 (October 2002): 1675–81.

11. Judith Herman reports that the majority of trauma victims do not become perpetrators, but that trauma appears to amplify common gender stereotypes among victims of childhood abuse. Men are more likely to take out their aggression on others, while women are more likely to injure themselves or to be victimized again. Judith Lewis Herman,
Trauma and Recovery
(New York: Basic Books, 1992), 113. For adolescent males, exposure to violence and victimization is “strongly associated with externalizing problem behaviors such as delinquency, while adolescent females exposed to violence and victimization are more likely to exhibit internalizing symptoms,” according to Z. T. McGee et al., “Urban Stress and Mental Health among African-American Youth: Assessing the Link between Exposure to Violence, Problem Behavior, and Coping Strategies,”
Journal of Cultural Diversity
8, no. 3 (Fall 2001): 94–104. A 1999 study showed that male Vietnam veterans seeking inpatient treatment for PTSD were more likely to exhibit violent behavior than a mixed diagnostic group of inpatients without PTSD: M. McFall et al., “Analysis of Violent Behavior in Vietnam Combat Veteran Psychiatric Inpatients with Posttraumatic Stress Disorder,”
Journal of Traumatic Stress
12, no. 3 (July 1999): 501–17. Combat exposure was found to have an independent positive association with interpersonal violence, when controlling for PTSD among combat veterans. F. C. Beckham et al., “Interpersonal Violence and Its Correlates in Vietnam Veterans with Chronic Posttraumatic Stress Disorder,”
Journal of Clinical Psychology
53, no. 8 (December 1997): 859–69. Dr. Jerrold Post argues that PTSD, secondary to living in a Palestinian refugee camp, could play a role in the creation of a terrorist. Post, “Terrorist on Trial:
The Context of Political Crime,”
Journal of the American Academy of Psychiatry Law
28, no. 4 (2000): 489.

12. I will not be able to answer this question here. First, I no longer feel safe interviewing terrorists in the field. Second, even if I did, it would be difficult to pose such a question to terrorists (it would be too humiliating to them). To address the question empirically would require surveying a random sample of terrorists as well as controls. We would need to know the relative frequency of humiliation (sexual or otherwise) in the general population as well as in the terrorist population. It would also be interesting to understand the frequency of post-traumatic stress disorder among terrorists and controls, and to ask terrorists about possible connections between their experience of trauma and their choice of career. This sort of study would be very difficult to carry out. But perhaps someday it will be possible.

13. William Nash, “PTSD 101,” course transcript for Combat Stress Injuries, Department of Veterans Affairs, National Center for PTSD. This is an excellent, humane description of the psychological impact of war, available at www.ncptsd.va.gov.

14. Ibid.

15. Benedict Carey, “Mental Stress Training Is Planned for U.S. Soldiers,”
New York Times
, August 17, 2009.

16. Lisa H. Jaycox and Terri Tanielian, eds.,
Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery
(Santa Monica, Calif.: Rand, 2008), available at http://www.rand.org/pubs/monographs/MG720/. The 30 percent figure is from Ann Scott Tyson, “Military Diagnosing More Post-Traumatic Stress,”
Washington Post
, May 28, 2008.

17. James Hosek, Jennifer Kavanagh, and Laura Miller,
How Deployments Affect Service Members
(Santa Monica, Calif.: Rand, 2006); Jaycox and Tanielian,
Invisible Wounds
.

18. Amy Belasco, “The Cost of Iraq, Afghanistan, and Other Global War on Terror Operations Since 9-11,” Congressional Research Service
report for Congress, June 28, 2007; Jaycox and Taneilian,
Invisible Wounds
.

19. Tyson, “Military Diagnosing.”

20. Jaycox and Tanielian,
Invisible Wounds
.

21. Jonathan Shay has written about this issue extensively; see, for example,
Achilles in Vietnam
(New York: Scribner, 1994).

I would like to thank Jason Epstein for proposing that I write this book. It took me some time to understand that the subject would be of interest to others, but Jason was right, as usual. I would not have had the courage to start, or finish, without the early and continuing support of Jerry Fromm, Howard Gardner, Hillary Chute, James Gilligan, Jack Goldsmith, Robert J. Lifton, Catherine MacKinnon, Julia Moore, Louise Richardson, Ed Shapiro, and Ben Wittes. My sister, Sara Stern Fishman, revisited the terrors described in this book with me. I am sorry that in writing this book, I inadvertently exposed her to the memory of these horrors, and I am grateful, as always, to have her hand to hold.

I am deeply grateful to my agent, Martha Kaplan, who intuited there was a book in this material, long before there was empirical evidence, and for her constant encouragement. Martha holds you up when you most need holding. I thank my editors at Ecco, Dan Halpern and Ginny Smith. Ginny's probing questions, delivered with grace, make clear that she will go far as an editor. Ben Wittes and Dan Halpern both insisted that I cease hiding behind policy prescriptions and simply tell the story.

The book was supported by grants from the Guggenheim Foundation and the Women and Public Policy Program at the Kennedy School of Government. I benefitted also from residencies at the Erik Erikson Institute, MacDowell Colony, and Yaddo. I am deeply grateful for the support of these organizations and the individuals involved. The Erik Erikson Institute offered me an opportunity to present chapters in draft. I learned a great deal from the comments of participants. I am grateful, too, for the time I was able to spend writing in silence on the fifth floor of the Boston Athenaeum.

Barbara Pizer, my very dear friend, was the kind of reader writers dream about. She knew how to read, not just my words, but also my intentions. She persuaded me that I had it in me to go further, both in life and on the page.

A number of government officials helped by digging up documents in archives or sharing their memories. I would like especially to thank Paul Macone, who is already a hero in Concord, Massachusetts, but deserves to be much more widely known. His integrity, diligence, and sensitivity make him a model public official.

I have been assisted by extraordinary research assistants. Jack McGuire is a world-class sleuth. He didn't just find documents for me, but people whom no one else could find. I would also like to thank Desmond O'Reilly. I am in awe of Desmond's determination, strength, and faith. I would like also to thank Brooke McConnell.

My dear husband, Chet Atkins, learned to recognize when terror was influencing my actions, long before I understood to recognize this feeling myself. He drove me to every interview, and listened to every word. This book, in many ways, is a testament to my desire, inspired by him, to learn to love.

This book is written for victims—raped or traumatized or terrorized—many of whom outsiders may not recognize under their soldiers' uniforms or courageous façades, but who may recognize themselves in the pages that follow. I hope this book provides comfort and hope.