Mary Wakefield

For some girls, therapy does more harm than good

13 January 2018

9:00 AM

13 January 2018

9:00 AM

In the churchyard by the church near my grandmother’s house, there’s a tombstone with an inscription that’s haunted me since I was a child. It marks the grave of a woman called Elizabeth who died, as I remember, in the 1920s. Elizabeth married young, had five babies in five years, then died well before she reached 30. The epitaph on her stone: ‘She did her duty.’

I often find myself thinking about Elizabeth and how different her cold and stoic age was to ours. I thought of her late last year as a slew of research revealed that an astonishing number of women, more than one in ten, screen positive for PTSD (post-traumatic stress disorder). We associate PTSD with soldiers back from some grisly frontline but as it turns out, twice as many women as men display symptoms: flashbacks, disassociation, unmanageable anxiety. This isn’t self-indulgent self-diagnosis; it’s real suffering.

Women can be shell-shocked by life. It’s surprising — and it’s not. Consider Elizabeth. All sorts of recent studies show that giving birth, even to a healthy baby, can be traumatising. Most new mothers wobble like light aircraft in turbulence, then stabilise and carry on. A number nosedive. More than 8 per cent of mothers in America and in Canada develop PTSD after childbirth. Then on top of the ordinary grind there’s life’s sucker punches: losing a child; losing a spouse; miscarriage; abortion (much though we celebrate it); serious accidents; sexual abuse.

These things happen to men too — but they happen more often to women and it’s a fact that, for the most part, men and women react differently to traumatic events. A prison chaplain once told me that when male convicts are stressed they become aggressive. They lash out and feel better. Women hurt themselves.

If it’s not altogether surprising that some women are weighed down by life, there is another statistic that does seem strange. The PTSD chart in this country has a spike. Our younger women suffer disproportionately and increasingly. The number of English girls between 16 and 24 who screened positive for PTSD trebled in the seven years from 2007 to 2014, and it’s rising every year. It’s sad but it’s also curious. Life delivers shocks but surely these come with increasing frequency as the years go by. Why so traumatised, so young?

The usual suspect is the internet. Teen girls seem trapped in a near-inescapable bubble of constant carping and comparing. It’s also a fact that girls who use the most social media are the most likely to experience depression. But which came first: the blues or the ill-advised retreat online?

I hope for all our sakes that there are serious scientists doing serious studies on this. I hope they are also investigating another maybe more controversial theory that’s been raised in recent years.

In 2004, George A. Bonanno, a professor of clinical psychology at Columbia University, wrote an interesting and optimistic paper on how we all cope with life’s horrors. Bonanno is perhaps the world’s foremost expert on the science of trauma and bereavement, but seems a jolly soul even so. His paper was called ‘Loss, Trauma and Human Resilience’, subtitled: ‘Have we underestimated the human capacity to thrive after extremely adverse events?’ Bonanno’s answer was yes, probably.

He looks at some of those same stats about the prevalence of PTSD, but his view is from a different angle. Bonanno agrees that a decent percentage of us, and especially women, require treatment for PTSD. But what’s really incredible, he says, is how many of us just roll with the punches. He divides people into three main groups: the sufferers (the 10 per cent of women, let’s say, and 6 per cent of men who really go under); the Teflon-coated Tiggers of the world and then the middle group of people, who stagger when life whacks them, display some of the symptoms of PTSD, then recover.

What is particularly interesting is Bonanno’s suggestion that therapy, counselling or ‘grief work’ can interfere with the progress of those who would, if left alone, make a natural recovery. He writes: ‘Whereas genuinely traumatised individuals were once doubted as malingerers, the pendulum has swung so far in the opposite direction that many practitioners believe all individuals exposed to violent or life-threatening events should be offered and would benefit from some sort of intervention.’ But, he says, ‘growing evidence shows global applications of psychological debriefing are ineffective and can impede natural recovery processes’.

In the 14 years since Bonanno’s paper, the mania for psychological debriefing and counselling has expanded across the West, propelled both by risk aversion and by genuine compassion. In the 1980s, state-sponsored counselling was just for medics who’d witnessed unimaginable horrors. By 9/11, Bonanno points out, it was considered an appropriate ‘blanket intervention for all exposed individuals’. Come 2018, a wolf-whistle can be grounds for therapy. That stern age which decided Elizabeth had done her duty is long gone.

Twice last year I reported a bike stolen to the Met and though no thief was pursued, both times I was offered trauma counselling. Our western universities are ever keener on therapy for all. As this magazine has so often described, campus madness both in America and here has meant several works of great literature have been considered psychologically damaging.

I’ve thought all this is silly and paid it little mind. But what if our caring culture, the one that finally (and rightly) takes real PTSD seriously, is simultaneously undermining the natural resilience of kids? What if we’ve created a ‘grief work’ trap, encouraging girls and boys to see ordinary blues as a problem, urging them to seek help which then keeps them from recovery?

We hear more about the placebo effect every day. Just the thought that you’ve been given a cure is often enough to effect one. Perhaps there’s a reverse placebo effect too. If we tell our young their ordinary, difficult emotions are disordered, they’ll become so.

Bonanno’s pendulum swings, but rarely settles. How can we ensure that the 10 per cent who need help are treated, while preserving enough old-fashioned grit to chivvy the others on? It’s a terrible dilemma.

Mary Wakefield talks to Isabel Hardman about PTSD.

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