Road Warfare Takes a Toll on Survivors
Post-traumatic stress disorder has long been recognized as a syndrome afflicting battle-scarred soldiers, sexual assault victims and survivors of catastrophic natural disasters. But it has been only in the last decade that it has been linked to an occurrence so common as to be considered routine: motor vehicle accidents.
Researchers, in fact, now believe that by virtue of their very frequency, serious car crashes are the leading--and most overlooked--cause of the disorder in the general population.
Recent studies have put the number of people at risk of developing post-traumatic stress after an accident in the hundreds of thousands, or 25% of the 3 million Americans injured in collisions each year.
“There was a bit of a notion when the disorder was introduced to the professional world that it had to be something outside of the range of normal experience to count as a stressor,” said Edward B. Blanchard, coauthor of the book “After the Crash: Assessment and Treatment of Motor Vehicle Accident Survivors.” “People have come to realize that, when there is a noticeable threat to life or limb, and you are frightened by it, that is enough to lead to PTSD.”
Post-traumatic stress disorder is a psychiatric condition whose symptoms include re-experiencing a life-threatening event through mental flashbacks; intrusive thoughts or nightmares; a psychic “numbing” that presents itself as diminished interest in people and activities, as well as in efforts to avoid situations that arouse memories of the trauma; and increased irritability, fearfulness and difficulty concentrating.
While it is normal for someone who has been in an accident to exhibit one or more signs of the disorder, people who fully develop the condition continue to be tormented by anxiety long after their physical injuries have healed. To be diagnosed with the disorder, a patient must usually have symptoms that persist for three months or more.
“Let’s say the immediacy of the situation is dissipated. You got your new car. You got the attorney. And yet you notice you don’t feel any better than at the time of the accident. In fact you may feel worse,” said C. Scott Saunders, co-director of the UCLA Trauma Psychiatry Service, which evaluates and treats patients suffering from the disorder. “Whenever you are caused to remember the accident, it will be fresh and vivid, like it was yesterday. That is your first clue.”
The mental anguish that sufferers experience can strain personal relationships and cause difficulties on the job. Another frequent by-product is difficulty getting back behind the wheel of a car, or even riding as a passenger.
According to Saunders, it is very common for his patients to drive slowly in the left-hand lane of the freeway to minimize their exposure to other vehicles, to freeze when they hear fire engines or ambulances or to go miles out of their way to avoid road conditions similar to the ones they encountered during their accident.
California Highway Patrol statistics show the stunning frequency of serious car accidents. During 2000, the last year for which data are available, 303,023 Californians--one in every 114 residents--were injured in collisions. (In Los Angeles County, the figure was one in every 109 people.)
That means that, if the one-quarter measure that Blanchard and other researchers use to predict the prevalence of post-traumatic stress disorder is accurate, 75,755 new crash-related cases would have developed statewide that year.
According to UCLA’s Saunders, who began his career by treating Vietnam War veterans, car accident survivors constitute the single largest category of post-traumatic stress patients he has treated. Interestingly, though, half of them weren’t even seriously injured in their crashes.
“The odd thing about a motor vehicle accident is, it isn’t what happened, per se,” Saunders said. “What matters is that, in the course of those events, you believed there was no way you were going to survive. You needed to have the moment of feeling helpless as you met what seemed obvious to you as the face of death. You can be in a horrific accident and if you were taking evasive measures, had a good idea of what was happening and never reached that point of hopelessness, you won’t develop PTSD.”
In fact, his patients who walked away with only bumps and bruises are often the ones who suffer the most because their psychological pain seems out of proportion to the event.
“A person who is devastated by PTSD can begin to wonder if he is losing his mind because he tells himself, ‘It can’t be that little auto accident that caused me to change the course of my life forever,’ ” he said.
While clinicians used to think that children’s emotional immaturity afforded them immunity from the psychological trauma of a traffic accident, recent research has shown that they are just as vulnerable as adults, perhaps even more so.
Robert Pynoos, a nationally recognized child psychiatrist who directs the UCLA trauma center along with Saunders, said it is easy for adults to overlook the traumas that children experience “as if they didn’t appraise the threat for what it was.”
At the same time, he thinks that, since children do not know how to drive, their sense of helplessness may actually be greater.
Although many psychiatrists believe that the disorder often goes undiagnosed in children and adults, some clinicians believe the number of people at risk of developing it has been overestimated in recent studies. Mark Levy, a forensic psychiatrist who teaches at UC San Francisco, said the promise of multimillion-dollar pain and suffering awards has prompted personal injury lawyers to seek post-traumatic stress diagnoses for their clients.
“It’s a fairly new idea that PTSD is in the 25% incidence range, so for auto accidents I would think it is an inflated figure driven by compensation and the plaintiff’s bar,” Levy said. “The fact that someone was shook up or even had some symptoms doesn’t mean they have PTSD.”
According to Blanchard, many, or even most of the patients with post-traumatic stress resulting from traffic accidents, will get over it on their own, usually within six months. For the rest, intensive psychological therapy may be required.
Treatment methods include encouraging patients to confront their fears in a safe environment, helping them counteract their catastrophic thoughts with healthier ones and teaching them relaxation techniques.
In the case of people who have been scared off from driving, that might also mean easing them step-by-step into the driver’s seat, starting with simply sitting in a car and working their way toward putting the key into the ignition and driving around the block.
“Getting back behind the wheel is a very hard thing, but it is a good thing,” Blanchard said.
