Americans as Survivors
http://www.100md.com
《新英格兰医药杂志》
To the Editor: Dr. Lifton writes in his thought-provoking article (June 2 issue) that "physicians have always been concerned with how people survive trauma," arguing that survivors of mass trauma, such as the Vietnam and Iraq wars and the attacks on September 11, 2001, had "collective psychological responses" and that their "psyches have often been decimated."1 This proposition is not supported by studies that were conducted after these events or by data on similar events in other countries. Studies aimed at documenting the consequences of mass trauma suggest that most exposed persons manifest impressive resilience or quick recovery from their initial responses to the trauma. Post-traumatic stress disorder (PTSD) developed in only a minority of those exposed to combat in Vietnam,2 Iraq, and Afghanistan.3 Similar findings emerged in studies conducted after September 114 and in research on Israeli survivors of combat5 and terrorism.6
The awareness that exposure to trauma may result in elevated rates of post-trauma reactions is important. However, physicians concerned with how people survive trauma can be reassured that the majority of the population is most likely to demonstrate psychological resilience, rather than psychopathology.
Yuval Neria, Ph.D.
Raz Gross, M.D., M.P.H.
Columbia University
New York, NY 10032
ny126@columbia.edu
References
Lifton RJ. Americans as survivors. N Engl J Med 2005;352:2263-2265.
Dohrenwend BP, Neria Y, Turner JB, et al. Positive tertiary appraisals and posttraumatic stress disorder in U.S. male veterans of the war in Vietnam: the roles of positive affirmation, positive reformulation, and defensive denial. J Consult Clin Psychol 2004;72:417-433.
Hoge CW, Castro CA, Messer SC, McGurk D, Cotting DI, Koffman RL. Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Engl J Med 2004;351:13-22.
Schlenger WE, Caddell JM, Ebert L, et al. Psychological reactions to terrorist attacks: findings from the National Study of Americans' Reactions to September 11. JAMA 2002;288:581-588.
Neria Y, Solomon Z, Ginzburg K, Dekel R, Enoch D, Ohry A. Posttraumatic residues of captivity: a follow-up of Israeli ex-prisoners of war. J Clin Psychiatry 2000;61:39-46.
Bleich A, Gelkopf M, Solomon Z. Exposure to terrorism, stress-related mental health symptoms, and coping behaviors among a nationally representative sample in Israel. JAMA 2003;290:612-620.
Dr. Lifton replies: In studies of survivors of war and the Holocaust — and in more general observations on the psychology of the self — I, too, have been impressed by the human capacity for resilience.1,2 Much of my article was about that capacity, as manifested among survivors seeking illumination from their experience. But we best understand our species by recognizing not only our resilience but also our vulnerability. This vulnerability was greatest among those I spoke of as immediate survivors (of combat in Vietnam or Iraq or of proximity to the targets on September 11, 2001), and it is evident in most studies of severe trauma. Though responses vary, many survivors experience profound psychological effects. Hoge et al., whose article is cited by Drs. Neria and Gross, reported a prevalence of PTSD of 12.7 percent among U.S. troops in Iraq after they had been in three to five firefights and of 19.3 percent after more than five.3 The authors called this a conservative estimate, which did not take into account the severely wounded; they recommended broader screening for PTSD.
Our awareness of human resilience should not cloud our recognition of the assaults on the psyche brought about by war and other forms of exposure to mass killing and dying.
Robert Jay Lifton, M.D.
Harvard Medical School
Boston, MA 02115
References
Lifton RJ. The protean self: human resilience in an age of fragmentation. Chicago: University of Chicago Press, 1999.
Lifton RJ. Death in life: survivors of Hiroshima. Chapel Hill: University of North Carolina Press, 1991.
Hoge CW, Castro CA, Messer SC, McGurk D, Cotting DI, Koffman RL. Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Engl J Med 2004;351:13-22.
The awareness that exposure to trauma may result in elevated rates of post-trauma reactions is important. However, physicians concerned with how people survive trauma can be reassured that the majority of the population is most likely to demonstrate psychological resilience, rather than psychopathology.
Yuval Neria, Ph.D.
Raz Gross, M.D., M.P.H.
Columbia University
New York, NY 10032
ny126@columbia.edu
References
Lifton RJ. Americans as survivors. N Engl J Med 2005;352:2263-2265.
Dohrenwend BP, Neria Y, Turner JB, et al. Positive tertiary appraisals and posttraumatic stress disorder in U.S. male veterans of the war in Vietnam: the roles of positive affirmation, positive reformulation, and defensive denial. J Consult Clin Psychol 2004;72:417-433.
Hoge CW, Castro CA, Messer SC, McGurk D, Cotting DI, Koffman RL. Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Engl J Med 2004;351:13-22.
Schlenger WE, Caddell JM, Ebert L, et al. Psychological reactions to terrorist attacks: findings from the National Study of Americans' Reactions to September 11. JAMA 2002;288:581-588.
Neria Y, Solomon Z, Ginzburg K, Dekel R, Enoch D, Ohry A. Posttraumatic residues of captivity: a follow-up of Israeli ex-prisoners of war. J Clin Psychiatry 2000;61:39-46.
Bleich A, Gelkopf M, Solomon Z. Exposure to terrorism, stress-related mental health symptoms, and coping behaviors among a nationally representative sample in Israel. JAMA 2003;290:612-620.
Dr. Lifton replies: In studies of survivors of war and the Holocaust — and in more general observations on the psychology of the self — I, too, have been impressed by the human capacity for resilience.1,2 Much of my article was about that capacity, as manifested among survivors seeking illumination from their experience. But we best understand our species by recognizing not only our resilience but also our vulnerability. This vulnerability was greatest among those I spoke of as immediate survivors (of combat in Vietnam or Iraq or of proximity to the targets on September 11, 2001), and it is evident in most studies of severe trauma. Though responses vary, many survivors experience profound psychological effects. Hoge et al., whose article is cited by Drs. Neria and Gross, reported a prevalence of PTSD of 12.7 percent among U.S. troops in Iraq after they had been in three to five firefights and of 19.3 percent after more than five.3 The authors called this a conservative estimate, which did not take into account the severely wounded; they recommended broader screening for PTSD.
Our awareness of human resilience should not cloud our recognition of the assaults on the psyche brought about by war and other forms of exposure to mass killing and dying.
Robert Jay Lifton, M.D.
Harvard Medical School
Boston, MA 02115
References
Lifton RJ. The protean self: human resilience in an age of fragmentation. Chicago: University of Chicago Press, 1999.
Lifton RJ. Death in life: survivors of Hiroshima. Chapel Hill: University of North Carolina Press, 1991.
Hoge CW, Castro CA, Messer SC, McGurk D, Cotting DI, Koffman RL. Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Engl J Med 2004;351:13-22.