Posttraumatic Symptoms and the Complexity of Responses to Trauma
Authors: Jerome Kroll
Journal: JAMA (2003)

SEVERAL ARTICLES IN THIS ISSUE OF THE JOURNAL HIGHlight the increasing appreciation of the complexity, ubiquity, and inescapability of both personal and indirect exposure to trauma and violence. Trauma, variously defined, is an integral part of the human condition. Most of the world has already known this, in many cases firsthand. Whatever illusions of a tranquil life the more fortunate segments of US society may have had prior to the 1995 Oklahoma City bombing and the September 11 terrorist attacks, a different awareness of individual and collective vulnerability has been instilled in the US consciousness. This awareness has been expanded to consider the psychological consequences of the “routine” violence that occurs daily in less dramatic form—routine and less dramatic, that is, except for those most immediately affected. Several articles in this theme issue of THE JOURNAL examine responses to different forms of exposure to trauma; what they share is recognition of the long-term consequences of experiences of violence in terms of individual morbidity and social cost. Two articles report the effects of political violence and forced emigration of Central American refugees, one group in Chiapas, Mexico, and the other group in the United States. Two other studies examine the circumstances of children exposed to violence, one study reporting on a school intervention program to reduce the effects of ongoing neighborhood violence on sixth-grade children in Los Angeles, Calif, and the other study reporting a brief screening instrument to assess risk of development of psychological sequelae (posttraumatic stress symptoms) from the effects of motor vehicle crashes on the children injured. A fifth study reports the results of a telephone survey of the effects of 19 months of terrorism on a nationally representative sample of Israeli citizens. All 5 studies used careful design, data gathering, and analysis, and they represent considerable theoretical and field effort to measure and control for the enormous complexities of human experiences and responses. The violence and genocide and the uprooting and resettlement of whole populations throughout the world in the 20th and 21st centuries increasingly shown as they happen by the news media; the high-profile domestic exposure of childhood abuse in its various forms; and the awareness of the psychological effects of the Vietnam War on all exposed to it have made posttraumatic stress disorder (PTSD) a familiar concept. This familiarity has had both beneficial and deleterious effects for health care professionals and the general public. The benefits are those exemplified in 5 articles in this issue of THE JOURNAL, namely, recognition that the effects of trauma do not disappear just because broken bones are mended, that children are deeply affected by exposure to violence, that collections of peoples and their cultures are irrevocably altered by exposure to violence and subsequent uprooting, and that the consequences of all types of trauma constitute important arenas for health care assessment and intervention. On the other hand, PTSD, like many other constructs, has been incorporated into social awareness in a simplified and exploitative manner that claims too expanded a territory and too broadened an explanatory principle. Not every ill that befalls a person is, or results in, PTSD and, conversely, many of the ills and sufferings that do befall persons cause much more than PTSD.