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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.

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.

“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.” 

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josephnicolosi.com

Joseph Nicolosi of Encino, Calif. has been practicing sexual orientation change therapy for 25 years.

They’ve been dismissed as quacks, homophobes and in denial, but therapists who counsel patients on shedding their gay feelings insist that their work is needed.

“If a person wants to be gay, and thinks he is gay, then that’s perfectly fine,” said Joseph Nicolosi, who founded a so-called "reparative" therapy practice in Encino, Calif. “I want to be available for those who want to change.”

In recent months, Nicolosi and his colleagues have come under fire for their position that people can diminish gay feelings through therapy, a process referred to as "sexual orientation change effort" by the American Psychological Association.

• Last week, four men who underwent conversion therapy sued their New Jersey provider, saying they were shamed and falsely led to believe they could be “cured” of being gay. 
• In California, Governor Jerry Brown signed a law that bans the use of sexual orientation change effort on minors. The ban, supposed to take effect on Jan. 1, was put on hold by a judge Monday, but only for three California therapists who challenged the law.
• Psychiatrist Robert Spitzer, a leader in psychiatry in the 20th century, apologized in May for publishing an article saying that conversion therapy was possible for motivated patients. Exodus International, a nonprofit for ex-gay Christians, came out weeks later saying they don’t recommend “therapies that make changing sexual orientation a main focus.”

But Nicolosi, who has been in practice for 25 years and who coined the term "reparative," stands firm: “We need to understand there’s a lot of mystery about human sexuality. You can’t say gay once, gay always.” 

Conversion therapy draws on Sigmund Freud’s theory that all people are born bisexual and that some become gay because of their upbringing, which he wrote about in Three Essays on the Theory of Sexuality. Many therapists offered some form of sexual orientation change therapy until around 1973, when homosexuality was removed from the psychiatric guide to mental disorders, according to the American Psychological Association.

In a 2009 resolution, the association stated that therapists who persist with such therapies appeared to be part of the broader “conservative political movements that have supported the stigmatization of homosexuality on political or religious grounds.”

Psychology can acknowledge different viewpoints, the resolution says, but such therapies contradict rigorous studies. “Belief in the hope of sexual orientation change followed by the failure of the treatment was identified as a significant cause of distress and negative self-image.”   

Related: Four men sue New Jersey organization over ‘gay conversion therapy’

David Pickup, a licensed therapist in Glendale, Calif. who trained with Nicolosi, went through sexual orientation change therapy in his early 30s. Pickup, 56, believes he was attracted to men because he was molested several times by a high school student when he was five. He describes himself as a “typically religious, conservative guy."

Rich Pedroncelli / AP file

David Pickup, a "reparative" therapist in California, urged state lawmakers to reject a bill banning the controversial form of psychotherapy for minors.

“I had challenges with homosexual feelings but never identified being gay for me was innate or inborn,” he said. “I never lived the gay lifestyle. I just had sexual experiences.”

Pickup is quick to differentiate himself from those who practice aversion therapy, which tries to eliminate a behavior or desire by associating it with pain. Those who were sued in New Jersey were accused of shaming patients and forcing them to strip off their clothes in group sessions. 

“I can say this: I don’t do oranges therapy, and I don’t do naked therapy,” Pickup said. (In the New Jersey lawsuit, one of the young men said oranges were used to represent testicles.) Rather, he said, his practice is focused on talk therapy and working through a client's issues.  

Pickup is not married. “I’m still looking,” he said. His friends are straight, for the most part, he said, although he remains close to a gay man from his past. He said they are like brothers, even though they disagree on matters of sexuality.

Both Nicolosi and Pickup belong to NARTH -- National Association for Research and Therapy of Homosexuality -- which includes about 350 therapists, according to its vice president, David Pruden. Unlike Nicolosi and Pickup, Pruden said most of those therapists have just a few gay clients within a larger practice.

“People get the idea that someone comes in and we say, ‘How do you feel about that?’ and then, ‘We’re going to fix that,’” Pruden said. “You really don’t. What you really do is treat them like any other client that is distressed about anything, and you work on distress.”

Through talk therapy, he said, some clients say their same-sex attractions are diminished.

Most of Nicolosi's clients are men from conservative, religious backgrounds, he said. About 40 percent are teens, and about half of them, sent by their parents, say they don’t want to change or are confused.

“We say, fine, you want to be gay, but are you curious in understanding why you’re gay?” Nicolosi said.

Nicolosi's theory is that men are attracted to other men because of how they were raised. He bases this notion on conversations he had early in his career with gay men.

“As I listened to these men, I started to hear common themes of their childhood,” Nicolosi said. “Overinvolved, intrusive mother, distanced, detached or hostile father, so that the boy did not bond with the father. That became the foundation of the understanding. I looked into the literature. I saw that there was an entire tradition of psychoanalytic understanding.”

So why not accept that his patients might be gay?

Knowing the reason for their same-sex attraction is consoling to patients, Nicolosi said. “They’re no longer weirdos or perverts or degenerates or whatever. Now they realize that their same-sex attraction is an attempt to repair a sense of not belonging to men.”

On his website, Nicolosi has transcribed some of these conversations. In many, the men describe wanting a “normal life.”

One man, married 31 years, told Nicolosi: “I wanted what most everybody wants — I wanted family, security. I wanted to grow old together with somebody that I was committed to. I wanted children, a house, a job, and a picket fence, all of those things — the American dream. And I couldn’t have that with homosexuality.”

In some places, gay couples can enjoy much of what Opp desired: Same-sex marriage is legal in nine states, and same-sex couples can adopt children together in all U.S. states except Mississippi and Utah. 

“Gay marriage doesn’t cut it for this clientele,” Nicolosi said. “They want a woman. They want a male-female relationship. They don’t want to be living with a guy in a marriage. That’s too radical for them.”

Some patients take years to feel less gay; others never do, he said.

“Some can walk away and say they have no homosexual attraction, period,” he said. “That’s rather rare. A lot of them say, ‘My homosexuality comes up rarely and not really strongly. It’s something that I can dismiss.’”

NARTH’s Pruden said fewer patients are seeking to change their sexual orientation these days because society has become more accepting.

“Once people felt less shamed – and I think that’s really positive – there was less a feeling that they couldn’t talk about it,” Pruden said. But those who do want to minimize those feelings, Pruden said, “deserve to have their needs met as well.”

“To say to them, we’re not willing to walk alongside you in your journey feels to me as cruel as the other extremes we used to be at, when people were hurt for saying, ‘I’m gay, and I’m OK with that,’” Pruden said. “In a sense it’s a pro-choice movement – people should have the right to deal with this.”

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A conservative legal defense group is suing to try to block a new law in California that will ban therapies that aim to “cure” gay teens.

The Pacific Justice Institute filed the lawsuit on Monday in federal court in Sacramento on behalf of a marriage and family therapist, a psychiatrist and a man studying to become a mental health professional. It names as defendants Gov. Gerry Brown and a host of other state officials.

Brown on Sunday signed SB 1172, a bill sponsored by state Sen. Ted Lieu, D-Torrance, that would prohibit therapists from administering “sexual orientation change therapy” to gay and lesbian children under 18.  California became the first state in the nation to crack down on “gay cures” for minors.

Brown and Lieu said such “gay conversion” therapies are not based on science and in some cases have driven teens to commit suicide.

The law is scheduled to take effect Jan. 1.

“Of all the freedom-killing bills we have seen in our Legislature the last several years, this is among the worst,” Brad Dacus, president of the Pacific Justice Institute, said in a statement. “This outrageous bill makes no exceptions for young victims of sexual abuse who are plagued with unwanted same-sex attraction, nor does it respect the consciences of mental health professionals who work in a church. We are filing suit to defend families, children and religious freedom. This unprecedented bill is outrageously unconstitutional.”

The lawsuit states:

“The statute materially interferes with the plaintiff mental health professionals’ exercise of their independent professional judgment in providing treatment to minors who have unwanted same sex behaviors or attractions. As such, the statute requires the plaintiff mental health professionals to discriminate against minors who are gay, lesbian, bisexual or questioning youth. This is in violation of these plaintiff mental health professionals’ obligations under the rules of professional ethics to provide treatment to persons regardless of their sexual orientation.”

Lieu, a  former prosecutor, called the lawsuit "frivolous."

"Under the plaintiffs' argument, the First Amendment would shield therapists and psychiatrists from medical malpractice and psychological abuse claims simply because they use speech in practicing their medicine. That is a novel and frivolous view of the First Amendment.”

Kate Kendell, executive director of the National Center for Lesbian Rights, also said the lawsuit is meritless. “This lawsuit is a desperate, last-ditch effort to defend the indefensible,’’ Kendell told The Los Angeles Times.

The National Association for Research & Therapy of Homosexuality, or NARTH, a group of therapists who believe sexual orientation can be changed, has also said it plans to file a lawsuit to block implementation of the law.

Previous story:
California becomes first state in nation to ban 'gay cure' therapy for children

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