Popularly known for his role as a doctor on television's top-rated drama, ER, Noah Wyle has put his bedside manner to the test by helping real trauma victims.
Noah Wyle is not a doctor. Nor is he a psychologist. And he's not suffering from a mental illness. But he has seen, firsthand, the face of one poignant and prevalent disorder, and it was enough to spur him into action.
"There isn't a face—it's every face," Wyle responds when I ask him to describe the face of post-traumatic stress disorder, or PTSD, a debilitating condition that some people develop after experiencing or witnessing an extremely traumatic event. The young actor and star of NBC's ER had flown to New York City the day before to speak out about recognizing and treating the disorder. And these days, everyone is listening.
When terrorists attacked the country on September 11, naturally our first concern was rescuing victims, particularly those who might be alive amid the World Trade Center rubble. Soon, however, it became apparent that not only had few survived the collapse but that there was another population of survivors to worry about: those left to grapple with memories of the tragedy. Mental health practitioners rushed to Ground Zero to aid those on the front lines—firefighters, police officers, even journalists covering the story—and soon many were predicting an epidemic of PTSD.
The disorder is by no means a new one. It was first described during the Civil War as "irritable heart" by an army surgeon treating soldiers displaying symptoms including chest pains, disturbed sleep, depression and irritability. Many refer to it as "combat fatigue" or "shell shock," and it's often associated with war veterans.
But PTSD isn't always a result of an act of war or terrorism. In fact, some of the most common traumas that lead to the disorder include being raped, being sexually or physically assaulted and experiencing the sudden, unexpected death of a loved one. About 20 percent of people who experience an extreme trauma will develop the disorder, according to one study published in the Journal of Consulting Clinical Psychology, and women seem twice as susceptible to PTSD, most likely because they are more often victims of rape, sexual assault and child abuse.
Women also make up the majority of PTSD sufferers with whom Wyle has come into contact. In 1999, Wyle spent three weeks in a Macedonian refugee camp during the war in Kosovo with Doctors of the World, a nonprofit organization that provides medical care to the needy and had approached him about doing charity work.
"I was supposed to be there in an observing capacity so that I could speak intelligently about their work," Wyle admits. "But a bus would pull up with 600 people in it and women were handing their kids to me, people were running for ambulances and medical supplies, and I'm there just to watch? I don't think so." Of the camp's 10,000 refugees, most were women and many of them had witnessed the murder of their husbands or confided they had been sexually assaulted.
"There was a certain hollowness in their eyes, a certain manic behavior," Wyle says. "I would see women scrubbing the wash, the same patch of a piece of clothing, for two or three hours. They were trying to get back into some routine of normal life, but in the refugee camp nothing was familiar." This kind of behavior is typical of a PTSD sufferer and falls into one of three sets of diagnostic symptoms associated with the disorder: avoiding reminders of the traumatic event.
"PTSD is stimulus-driven," explains Matthew Friedman, M.D., Ph.D., the executive director of the Department of Veterans' Affairs National Center for PTSD and a psychiatry and pharmacology professor at Dartmouth Medical School. "Stimuli that resemble the trauma are going to bring that trauma back to the victims. So part of PTSD involves numbing, emotional shutdown and avoidance." The second set of symptoms focuses on sufferers' tendency to continually relive the event, both while sleeping in the form of nightmares and while awake, when flashbacks occur. These images cause extreme emotional or physical reactions, including shaking, chills, heart palpitations and panic. The final set concentrates on hyper-arousal, as victims are prone to irritability, sudden anger, startling easily or being unable to concentrate.
How an individual responds to a traumatic event depends, in part, on what he or she brings to the table, Friedman points out. For instance, people who have experienced a prior trauma, have a family history of psychiatric problems or grew up in a disruptive household or with abusive parents are at greater risk for developing symptoms. Amount of social support and degree of resiliency—which has both a genetic and experiential component—also play important roles.
"Most of us were impacted by September 11," says Ray Monsour Scurfield, D.S.W., L.C.S.W., an assistant professor of social work at the University of Southern Mississippi. "But after a few months, it started taking somewhat of a backseat for some people and less of a backseat for others. The key is questioning whether a person feels their memories are beyond their control. If they're wallowing in isolation and denial and painful memories—if they're a prisoner to them—it's time to seek help."
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