• The hellish week that traumatized -- and bonded -- Americans

    Charles Krupa / AP

    A woman carries a girl from their home as a SWAT team searching for a suspect in the Boston Marathon bombings enters the building in Watertown, Mass., Friday, That was part of what turned out to be a chaotic week in the U.S.

    By Bill Briggs and JoNel Aleccia, NBC News

    Americans found their resilience pushed to the limit  this week – and they still don’t know what’s coming next.

    When the Boston Police Department tweeted "CAPTURED!!!" Friday night, signaling the apprehension of the second suspect in the bombing blasts that devastated that city's famous marathon, their elation was echoed by people across the nation who clapped, cheered, pinged, Facebooked and tweeted their own relief that, finally, there was an end to the manhunt -- and a hellish span of days.

    Even though that siege has passed, the impact of collective crisis fatigue may well linger, experts say.

    The U.S. already had endured Monday’s deadly attack, Tuesday’s poison letters and the Wednesday Texas fertilizer plant explosion that has left a still-untold number of people dead, 60 missing and 200 injured. Thursday and Friday saw a late-night shootout and a day-long lockdown that resulted in the death of Tamerlan Tsarnaev, 26, and the capture of his 19-year-old brother, Dzhokhar. 

    “All in all, this has been a tough week,” said President Barack Obama, addressing the nation Friday night. “But we’ve seen the character of our country once more.”

    Through its long history, America has weathered its share of the disturbing and the traumatic -- political assassinations, civil and international wars, school massacres, Pearl Harbor, the 9/11 attacks. But few in this generation can cite a single Monday-through-Friday series so jam-packed with frightful, breaking-news bulletins.

    “For the first time in a long time, we’re really being challenged now on our home turf,"  said Marleen Wong, a professor and associate dean of the University of Southern California school of social work. She compared the condensed spate of sadness to the 1960s assassinations of President John Kennedy, his brother Robert, and Martin Luther King, though she admits those murders spanned five years.


    Sure, it's a lot to take. But when do we hit our bad-news breaking point? 

    "If there’s another IED in another city, then we’re really going to have a problem. That’s what concerns me. We might then be crossing some kind of new line," said Bart Rossi, a New Jersey psychologist and author of "The New-New American Life Style: Post September 11, 2001, A Psychologist’s Perspective." "We're talking about some heavy issues here." 

    Already, he expects that many Americans are purposely avoiding crowds and staying home, fearful that another mass-casualty is looming. He estimates that in about one month, those same people will resume their normal routines — if all remains relatively quiet.

    "If you put a number on our national anxiety it's a 6 or 7 or maybe trending toward an 8," Rossi said. "We’re so frustrated and angry. If something else happens, it might go up to a 9 or a 10, where we’re all just really overwhelmed and overwrought."

    That’s true even though the actual risk of harm is very small, even for those who were confined in the immediate area of Watertown, Mass., where Dzhokhar Tsarnaev was believed to be trapped for most of Friday.

    “The risk is statistically infinitesimal,” said David Ropeik, a Harvard University instructor, author and consultant in risk communication. “And greater emotionally.”

    Terrorism is effective precisely because of the emotions it evokes and the stress that triggers a flight-or-fight response that suppresses reason and makes people more instinctive, Ropeik said.

    “What terrorism is, is random, violent madness that makes us all feel vulnerable,” he said. “The unpredictable, unpreventable, could-happen-to-anyone-anywhere-anytime, they-are-living-among-us crimes always scare us.”

    And it's not like Americans have been dancing lately through a landscape of easy years. The nation has weathered two wars — one still active — and the nasty aftermath of those conflicts, a bad economy, and an adversarial political environment: not traumatic for most yet exhausting and grinding for many. Since last summer, we've mourned dozens lost in the Aurora theater massacre, Superstorm Sandy and the Newtown school slaughter.

    "These are times that really reinforce our values and the things we hold dear: the ability to live in peace," Wong said. 

    "But on the other hand, I hear messages not just from leaders but also from people, from athletic teams, from runners — from people who have expressed the idea that you can try to hurt Americans, but we’re not afraid, we’re going to respond, we’re going to keep going, we’re going to prevail.

    "It really demonstrates the courage of Americans in a way that reminds me of Britain during World War II when the bombs were falling every day in London and their leader, Winston Churchill, stood up and described what the English spirit is all about," Wong said. In similar fashion, some have demonstrated heroic and defiant actions this week — like the Boston hockey crowd belting out the National Anthem on Wednesday night.

    "I saw that. It was so wonderful. It made me cry," Wong said. "We will be together, and we’ll get through it."

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  • PTSD may strike marathoners, bystanders in Boston blasts

    Slideshow: Boston Marathon explosions

    Charles Krupa / AP

    See images from the scene of the explosions.

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    By Bill Briggs, NBC News contributor

    Cops called the twin bombs “IEDs” and a Boston ER doctor said the wounds included “traumatic amputations” normally seen on Iraq battlefields, but now another combat comparison has emerged: Some civilian survivors of the terror attack will suffer PTSD as a result of Monday’s carnage.

    A number of the bystanders, runners and public-safety personnel near the blasts — those close enough to see, hear and feel the detonations, those who witnessed or aided the wounded, and the injured themselves — now have a higher risk for developing the same anxiety symptoms known to affect tens of thousands of Iraq and Afghanistan veterans, said a leading expert on Post Traumatic Stress Disorder.


    “Absolutely. To be precise, it is called Acute Stress Disorder at the beginning and usually involves some or all of the symptoms of PTSD. If it lasts more than a month, and has enough symptoms, it is then described as PTSD,” said Dr. Harry Croft, a San Antonio-based psychiatrist who has talked with more than 7,000 veterans diagnosed with PTSD.

    Common PTSD symptoms include an inability to sleep, nightmares, a craving for isolation and a disquiet when in crowds. Following a decade of wars, experts like Croft have developed a keener understanding of these side effects.

    “We know that for some people intensive debriefing after a trauma does not help, and may worsen symptoms in the long run. But getting survivors to safety, helping them understand what has happened, helping them talk — or be quiet but around others — may be of great value,” Croft said. “Mental health professionals are (now) better trained in handling the emotional needs of survivors and passers-by.”

    The earlier symptoms to emerge often include a sense of disbelief — in which the event doesn’t seem real — and either no emotion or gushes of emotion, including sadness, fear, anger, Croft said. Typically, people with PTSD have either recurrent memories of the event, or no memory at all. People may discover they are easily startled or abnormally agitated.

    Investigators say pressure cookers packed with shrapnel were used in the Boston attack. NBC News' Jay Gray reports.

    Civilians more susceptible?
    How prevalent is PTSD among people who have witnessed or were wounded in a sudden and violent situation? The figure most commonly cited by experts is 20 percent, although that rate is known to vary widely among civilians and can depend on the severity of the event, Croft said, adding: "Long term, the amount of PTSD is greater with man-made traumas as opposed to those caused by hurricanes, floods and fires.”

    Civilians are “probably” more susceptible to PTSD than military members, he said. 

    Veteran Brennan Mullaney, 30, an Army veteran who witnessed some explosions during two tours of Iraq, was between mile marker 24 and 25 when the blasts occurred. He lives in Boston and goes to graduate school at Tufts University. He did not hear the concussions and was not allowed by authorities to get close enough to help the injured.

    “My initial concern was with civilians who haven’t witnessed scenes like that,” Mullaney said. “So many of us who have spent time deployed — and I’m not trying to overlook the severity of what transpired yesterday — but we’ve seen it before. It’s infinitively more horrific and disturbing when you see it in your hometown.”

    He knows of several Tufts students who were far closer to the finish line when the bombs were detonated and he already has offered to talk with those runners about some side effects they're perhaps feeling two days later.

    Three died in the bomb blasts at the Boston Marathon including 8-year-old Martin Richard, the youngest victim, who was remembered by neighbors who left flowers and candles at his family's home. NBC's Katy Tur reports.

    “Maybe my experience can help them through that. Veterans have been sloughing [PTSD] off for years. The better way is to talk to someone about it. It’s a process. You can talk to them, be empathetic. You can tell them: 'It’s tough; you’re going to have those visions of what you saw for days to come,'” Mullaney said. “How you synthesize that information, [how you] manage and process that, is going to be a big determination in whether that thought re-entering your mind is entirely a negative thing or if there is some type of silver lining to it.

    “My share of what I saw in Iraq was probably less than a lot of guys who played combat roles. Yes, I did see some explosions and some aftermath of what that looks like,” Mullaney said. “A lot of times, we didn’t know the people who were hurt or killed. They were Iraqis — a father, mother, a son. They were people, and that human feeling [about them] is there, whether you’re in war zone or whether you’re home and it’s a fellow American.” 

    Related:

    Inside a bomb investigation: the hunt for forensic clues

    'Adorable' boy, 8 mourned after Boston Marathon blasts

    Woman killed, 29, was 'daughter every father dreamed of'

    Who is the man in the hat at the finish line?

  • Mass traumas ripple across towns — and time

    The massacre at Sandy Hook Elementary School shook everyone in Newtown, Conn., including the first responders, who will be undergoing counseling. NBC's Anne Thompson reports.

    By Bill Briggs, NBC News contributor

    A serial tragedy — like Friday's mass shooting at Sandy Hook Elementary School in Newtown, Conn., that left 20 children dead — is like “a big rock thrown in a pond,” grief experts say, casting emotional ringlets that drench those closest to the bloodshed in life-changing despair and bathe entire communities and even distant observers in sorrow.

    "What happens after that rock lands in the pond? The waves circulate out from ground zero. There are the victims. And these (at Sandy Hook Elementary School) are babies, so unbelievably sad,” said Dr. Jeff Dolgan, chief psychologist at Children's Hospital in Denver. “Some people are not even directly touched by the trauma but are in fact traumatized — think about the other kids at the school, the administrators at the school, the first responders, the caregivers. Then the waves radiate out from the school into the community."

    Those ripples may initially unite a town in candlelight and song then splinter it into a torrent of blame and lawsuits, as happened after the Columbine High School shootings in 1999 that killed 12 students and one teacher and injured 24 others.

    "At Columbine, the impact was very widely felt. I talked to the people who were dealing with the fatalities at the hospitals. They had caregiver trauma. They did everything they could with the influx of severely injured but felt inadequate to the task,” he added.

    After the Columbine massacre, Dolgan and his colleagues aligned with mental health experts in Jefferson County, Colo., launching a hotline where local parents could call for advice on soothing their own kids' anxieties. On Friday, Dolgan urged the parents in Newtown to similarly band together.

    “This is a neighborhood elementary school and the parents there hopefully are tight-knit. Once you have the care done, I hope the parents are supportive of one another and work with one another,” Dolgan said. “I hope parents team up and, in time, do get-togethers.”

    Dolgan witnessed firsthand how some Columbine families looked initially to condemn and penalize neighboring families and local law enforcement officers for the deaths in their school. The families of more than 30 Columbine victims sued the parents of the two killers, also Columbine students, eventually settling for $2.53 million. The families of 17 Columbine victims also sued the Jefferson County sheriff’s department; one of those victims settled in 2004 for $117,500.

    President Obama addressed the nation in an emotionally charged speech Friday, wiping away tears as he expressed sympathy for the families of the victims killed in the Sandy Hook Elementary School massacre.

    Many of the Columbine families, Dolgan agreed, were likely seeking outlets to vent their anger at the tragic event, and at the murders.

    “But who are you going to blame? The first responders? No. (Columbine principal Frank) DeAngelis? No. The school security? No,” Dolgan said. “In time, there was more healing and the parents came together. But initially, no, there were some fractious qualities.”

    While heartache and fury may engulf a town after a mass killing, such serial traumas psychologically damage those closest to the suffering on a far deeper level than they do people who were merely in the vicinity, who were, perhaps, close enough to hear the gunfire but not see the deaths, science has found. 

    Among 1,000 students who were on campus at Dawson College in Montreal in 2006 when a man shot and wounded 19 people, killing one, about one-third were found to be dealing with some form of mental illness within 18 months of that tragedy, according to a paper published in 2009. 

    “The most common form was clinical depression – which affected 12 percent or 1 in 8. That is about three times higher than would be expected in a normal population,” said Dr. Warren Steiner, head of the department of psychiatry at McGill University Health Centre in Montreal, and one of the paper's authors.

    “The next highest was substance abuse — drug or alcohol — which affected about 10 percent, people who were self-treating their own anxieties. That’s about three times higher than you would see in the normal population,” Steiner said.

    The precise proximity of the survivors to the violence that day directly affected their mental health later, the research team learned. They divided the 1,000 students into four groups based on their “level of exposure.” Those who had witnessed the shootings received the “highest” exposure score, followed by those who only heard gunfire, followed by those who locked themselves into classrooms without knowing if they were next, followed by those who were on campus but unaware of the attacks.

    Slideshow: Connecticut school massacre

    Michelle Mcloughlin / Reuters

    The second deadliest school shooting in U.S. history sent crying children spilling into the school parking lot as frightened parents waited for word on their loved ones.

    Launch slideshow

    “There was a direct correlation between the level of exposure to the shootings and the development of mental illness. It’s common sense, but it had never been proven before,” Steiner said.

    For those who viewed the killings, or who had held a wounded classmate in their arms, post-traumatic stress disorder was the most commonly diagnosed illness, followed by depression and then alcohol dependency. 

    But while the mass traumas at Columbine and Dawson College soaked each community in immediate anguish -- and, eventually, imbued those closest to the gunfire with psychological turmoil -- they continue to resonate in the Denver area and in Montreal, the psychologists said.

    Memories of each are rekindled after the news of other serial shootings, including the 32 people who were shot and killed at Virginia Tech in 2007, the 13 people who were shot and killed at Fort Hood in 2009, and the 70 moviegoers who were shot — 12 fatally — in Aurora, Colo. on July 20.

    “You hear about another one, and there’s the reflex of anxiety,” Steiner said. “I guarantee everyone who was at Dawson will hear the news this evening and they will have flashbacks and disturbing memories, PTSD-like symptoms from what happened to them.

    “It goes on for a generation, no doubt about that,” Steiner said.

    Dolgan agreed that the shelf-life of a local mass tragedy sticks with a community for several decades, and isn't simply shaken by the passing of time.

    “No, no,” Dolgan said. “This is very long-lived.”

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  • PTSD may be overdiagnosed, but PTSD deniers are 'wrong,' psychologists say


    By Bill Briggs, NBC News contributor

    Why do some people reject the existence of PTSD?

    The topic is touchy. Even asking the question is slammed as irresponsible.

    “Why on Earth would you try to put out something that states combat PTSD isn't a true affliction? Or even try to debunk it? Or to put questions into the minds of society? In the first 155 days of 2012, we lost 154 men,” Amy Cotta, an author and the mother of a Marine wrote in an email to NBC News. Her message arrived minutes after she learned NBC News was seeking to interview a PTSD denier.

    Despite exhaustive scientific studies that have explored the symptoms, causes, diagnoses, and prevalence of post-traumatic stress disorder, hardcore skeptics remain.

    They exist within the military, where some leaders openly call PTSD a mental weakness, according to mental health advocates. David Weidman, who did two tours in Afghanistan and was diagnosed with PTSD, said all of his senior non-commissioned officers advised him not to seek treatment, instead suggesting he “just put your head down and keep going” in order to maintain any chance at a promotion.

    They exist within the veteran community. Kevin R.C. “Hognose” O’Brien, who operates a blog called “WeaponsMan” and identifies himself as “a former Special Forces weapons man,” wrote in July that PTSD was a “quack” diagnosis, “invented” to clump “any odd and many normal behaviors.” He added: “If a vet is wound up tight? PTSD! If he or she is calm? Hypercontrolling due to PTSD! Lose weight, gain weight, maintain weight, those are all PTSD markers. Get in fights? PTSD, natch. And avoid fights? Well, clearly it's .... are you starting to get the idea?” O’Brien declined to be interviewed for this story.

    And they exist within medicine. In late September, Washington, D.C. psychiatrist Dr. Joseph Tarantolo authored an op-ed piece titled: “PTSD, The Grand Scapegoat.” In it, Tarantolo described PTSD as a “pseudo-diagnosis” and held that “the PTSDer gets an enormous amount of pseudo-sympathy.” On Friday, Tarantolo’s voicemail message said he was out of the country on vacation.

    To Afghanistan veteran Weidman, most people who so stridently dismiss PTSD have simply failed to read the available scientific literature on the subject and are, he said, “uneducated.”

    But Weidman acknowledged that different people possess varying degrees of mental “resiliency,” underscoring the slippery nature of diagnosing anxiety disorders. That means, he added, that if an entire platoon collectively endures the same moment of extreme combat violence, not every platoon member will ultimately feel the symptoms of post-traumatic stress. According to the Mayo Clinic, those signs can include “flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event.”

    “There are people who can experience something who have no side effects. It could be that person (who ends up being a denier),” said Weidman, a student at Penn State-Lehigh Valley. “Or it could be the person who is extremely uneducated and chauvinistic, who says a guy who gets diagnosed with PTSD ‘is not being a man.’ You’re going to have a perfect storm within the individual who’s going to be that outlier, who says: ‘It doesn’t exist.’

    “Or, it could be the person who actually has post-traumatic stress, who is not seeking help, who is more living up to society’s ideal male image of being strong and being resilient,” he added. “Those people going to make even more noise.”

    Mental health experts say the occasional repudiation of PTSD is merely an extension of the larger societal taint associated with anxiety or mood disorders.

    Click here for more military-related coverage from NBC News.

    “It comes back down to the stigma of mental illness,” said Jean Teichroew, spokeswoman for the Anxiety and Depression Association of America. “Military members also are afraid to speak out because it’s seen as a weakness. The VA has programs to try to combat that, too. But when you have a sergeant who doesn’t think you should be afraid of a bomb going off near you or seeing a dead body, that’s another issue.”

    Still, the rate of diagnosed PTSD cases among Iraq and Afghanistan veterans is higher than the rate of cases associated with men and women who served in past conflicts. That abrupt spike has sparked an ongoing debate within American and British academia as to how common PTSD truly is among military personnel and veterans.

    “The suffering of people with PTSD is very real whether we label it an ‘anxiety disorder’ or not. As for the skeptics, some of them may believe that a proportion of veterans without the disorder may report symptoms to secure service-connected disability compensation payments for PTSD,” said Harvard University psychology professor Richard J. McNally. He has penned more then 320 publications on anxiety disorders, including PTSD.

    “According to (Department of Veterans Affairs) data reported late last spring, 45 percent of all veterans from Iraq and Afghanistan have applied for service-connected disability compensation, and 31 percent have secured it already. This figure includes all forms of medical problems, however, not just PTSD," McNally said. "The percentage of veterans of World War II and Vietnam who obtained disability compensation is 11 percent and 16 percent, respectively.”

    In 2011, the VA listed the three most common service-connected disabilities among veterans receiving federal compensation that year: tinnitus (ringing in the ears) at 10.9 percent, hearing loss at 7.5 percent, and PTSD at 5.3 percent.

    Is PTSD being over-diagnosed in post-9/11 veterans?

    “Yes. I think it is,” said Simon Wessely, vice dean of academic psychiatry at King’s College in London. “I think that despite the formal criteria, there is a confusion sometimes (about) the normal emotional responses to war — my father still has nightmares about his World War II service in Royal Navy and he is 87, but he doesn't have PTSD.

    “I also think that, for example, depression often gets under diagnosed, and substance misuse also,” Wessely said. “Our evidence also shows, for example, that quite often the triggers for what becomes labeled as PTSD is not combat exposure but actually a reflection of problems back home. It is important that we remember that not every mental health problem in theater is PTSD."

    Despite the loose diagnoses or cases of outright PTSD fraud, to those in medicine and the military (post and present) who deny PTSD altogether, Wessely offers three final words: “They are wrong.”

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