Women's Mental Health in Primary Care

By Kathryn J. Zerbe | Go to book overview

Chapter 6
Trauma and Violence

At the outbreak of World War II, the poet W. H. Auden captured in one short stanza a horrifying but indisputable hallmark of the residual effects of trauma and violence:

I and the public know what all school children learn.
Those to whom evil is done do evil in return.

(From September 1, 1939, p. 57)

Psychological trauma is a formidable clinical and societal problem. It tends to repeat itself from generation to generation because its victims defensively reenact the evil that has been done to them by vicariously or overtly repeating it with those they hold most dear, especially significant others and children (Davidson, 1993; Plakun, 1998). The distress of the traumatized patient is palpable, manifesting itself in a range of feelings, from anger to depression, and in a range of psychological defenses, such as aggressive outbursts, verbal provocation, disavowal (e.g., "This never really happened to me"), and guilt feelings. Posttraumatic stress disorder (PTSD) is one of the most commonly discussed psychiatric syndromes in the popular press. Women and men are increasingly open about the damaging effects of inappropriately sexualized and abusive relationships, and the mass media take us into the lives of people who have survived natural and manmade disasters. Rarely does a day go by without some reference to the painful effects of trauma on people's lives and how they attempt to navigate away from it or adapt to its consequences. Moreover, increasingly in our society, violence is moving out of the home and into the schoolyard, workplace, and neighborhood. No one is immune to the impact of trauma and its potentially devastating effects, and no physician can avoid seeing its ravages in practice.

Trauma's victims are often debilitated because their capacity to cope is overwhelmed. What is particularly beguiling to clinicians is the fact that no two persons handle overwhelming stress in the same way (Tables 6-1 and 6-2). Whether a woman develops psychiatric symptoms within days, months, or even years—or not at all—after a traumatic event depends on her characteristics, her psychological health before the trauma, her age, the unique personal meaning she attaches to the event, and her support system during recovery.

In the course of a lifetime few escape traumatic events, but often victims are left to deal with the psychological consequences alone. Overwhelming rage and a sense of helplessness are the most common responses, but they erupt particularly when a catastrophe comes out of the blue, is experienced as malevolent and random, or takes the life of a loved one. For example, Susan Cohen is the mother of 20-year-old Theo Cohen, who was murdered when terrorists blew up Pan Am Flight 103 over Lockerbie, Scotland, on December 21, 1988. Mrs.

-139-

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Women's Mental Health in Primary Care
Table of contents

Table of contents

  • Women's Mental Health in Primary Care *
  • Preface vii
  • Acknowledgments xi
  • Contents *
  • Chapter 1 - Anxiety Disorders 1
  • Chapter 2 - Depression 31
  • Chapter 3 - Bipolar Disorder 55
  • Chapter 4 - Misuse of Substances 73
  • Chapter 5 - Eating Disorders 109
  • Chapter 6 - Trauma and Violence 139
  • Chapter 7 - Insomnia 165
  • Chapter 8 - Somatization 181
  • Chapter 9 - Catastrophic Loss and Bereavement 199
  • Chapter 10 - Major Medical Illness 219
  • Chapter 11 - Menstruation, Pregnancy, and Menopause 247
  • Chapter 12 - Psychosis 273
  • Chapter 13 - Sexuality and Intimacy 291
  • Chapter 14 - The Older Patient 319
  • Afterword 347
  • General Resources for Patients 350
  • Index 353
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