The mental health crisis that wasn't: how the trauma industry exploited 9/11

Reason, August-Sept, 2005 by Sally Satel, Christina Hoff Sommers

The instructor peppered us with a series of half-truths and outright misstatements. We were told, for example, that PTSD "rarely goes away by itself," that there are no factors that predispose a person to develop PTSD, and that people who "hold it in do worse" all untrue statements. The course manual stated that debriefing compensates for "the failure of the [victim's] usual coping strategies." Moreover, unless psychological debriefing took place soon after the crisis, a "trauma membrane" would form around the victim and "thicken" so that he would no longer be receptive to help. (Ironically, the psychiatrist Jacob Lindy, who treated survivors of the devastating Beverly Hills Supper Club fire outside Cincinnati in 1977, coined the term trauma membrane to describe not a debriefing-resistant cocoon but a small network of trusted friends who buffer the victim from additional stress. A properly functioning trauma membrane, in Lindy's sense, might well act to keep debriefers away.)

We also learned how to conduct a psychological debriefing by breaking up into groups of eight. Each group was provided its own tragic scenario. In ours, we were supposed to be telemarketers busy on the phones one morning when an employee's drunk and jealous ex-husband burst into the work area with a gun and shot one of us in the shoulder. After the injured worker was taken away in an ambulance, the rest of us gathered to be debriefed by our eighth colleague, who was assigned the role of an outside debriefer. Following the directions in our course manual, the role-playing debriefer encouraged us to talk about how scared we were, rehashing in the most graphic language how the blood had spurted from our colleague's wound, how we had panicked and had thought we would all be killed. This was our "opportunity for catharsis, an opportunity to verbalize trauma," said the manual.

First, Do No Harm

Such opportunities are precisely what the 19 psychologists' open letter warned about when it spoke of therapists "descending on disaster scenes with well-intentioned but misguided efforts." And with good reason. Research shows these efforts at debriefing to be ineffective in preventing the development of PTSD or related symptoms, and, at times, to actually be harmful.

Most random-assignment studies of individuals who have suffered accidents, assaults, or burns show the same degree of improvement, whether patients were debriefed in a one-on-one session by a therapist or instead received general support or no intervention at all. Two such studies, however, found that debriefing actually impeded recovery. In one, debriefed burn victims were three times as likely as the control group to develop PTSD after one year. In the other study, a three-year follow-up of car accident victims, anxiety, level of functioning, physical pain, and degree of preoccupation with the accident improved more slowly in the debriefed patients than in the control group.

Britain's National Health Service, the North Atlantic Treaty Organization, and the World Health Organization all cautioned against the use of debriefing as possibly harmful. In the fall of 2002, the National Institute of Mental Health (NIMH), in collaboration with the Red Cross and the U.S. Departments of Defense, Justice, and Veterans Affairs, released a report on psychological interventions in the wake of disaster. "A sensible working principle in the immediate [aftermath] is to expect normal recovery," said the report.