This psychological imprisonment is something Wyle likens to piecing together jigsaw puzzles. "If you do the same puzzle every day, you get the same picture every day because you've got the same pieces," he says. "But if you wake up one morning and something traumatic happens, when you put your pieces together, nothing fits right. And when you do get them to fit it makes a different picture, one somewhat grotesque. Ultimately, you just want your picture to look like it always did, but it's never going to look that way again."
After witnessing the refugees' anguish, Wyle knew he wanted to do more to help victims of trauma and violence. So when he returned to the U.S. he began working with Human Rights Watch, a human rights advocacy group. Then Dr. Carter, the character he plays on ER, was stabbed on the show, and Wyle found himself portraying many of the symptoms he'd witnessed in Macedonia. That's when Moving Past Trauma (MPT), a community outreach program that works to increase awareness about and treatment of PTSD, asked him to be one of their spokesmen. He agreed and soon began working with Kellie Greene, another program spokeswoman.
What's noteworthy about Greene is that she's also a PTSD survivor, though by looking at her today one would never guess that there was a time when she was afraid to step foot outside of her apartment. She's now energetic, outgoing, constantly smiling and seems ready and able to take on the world. But on January 18, 1994, Greene was attacked and brutally raped by a stranger who had followed her home. She was traumatized and subsequently unable to concentrate or make simple decisions. She also began isolating herself from her family and friends and was plagued by nightmares and flashbacks of her rape.
"Flashbacks are powerful and very frightening," Greene tells me the same morning I meet Wyle. The two were scheduled to speak throughout the day at several venues including The Today Show and the YWCA, which helped launch MPT's program. "You go back to the moment the trauma was happening and re-experience it; your body has all of the senses of it reoccurring." Her symptoms were unrelenting for about six months, until one night she found herself sobbing uncontrollably in the shower and contemplating suicide. Greene called her mother for help, who made an appointment for her with a psychiatrist the next morning.
"I told him everything I was going through, and then he opened a book and read all of my symptoms back to me," Greene says. "He said, 'It's post-traumatic stress disorder,' and just having him validate it calmed me down." She was prescribed Zoloft, an antidepressant and selective serotonin re-uptake inhibitor (SSRI), to help assuage her symptoms. Zoloft and Paxil, also an antidepressant and SSRI, were the only two drugs that had been approved by the FDA for treating PTSD in 2002. Greene's psychiatrist then worked with her for six months using cognitive restructuring—a form of cognitive behavioral therapy—along with teaching her breathing exercises that helped alleviate her panic attacks.
"The classic principle that applies to almost every PTSD therapy is therapeutic re-experiencing of an aspect of the original trauma," explains Scurfield. "The person has to learn to master the memory and be able to revisit the trauma in a way that's not overwhelming." Fortunately, the rate of recovery from PTSD is high—particularly if recognized early on—and there are numerous types of therapy for treating it. But because this field of research is relatively new, there is little empirical evidence confirming what works best and for whom.
"The evidence suggests that cognitive behavioral treatments are most effective for PTSD," Friedman says. "But a large number of people in treatment receive two types of treatment, maybe even more." The most typical combination is some form of psychotherapy plus pharmacotherapy, one that seems to have done the trick for Greene.
"I feel really good today," Greene now says. Fully recovered, she devotes her time to promoting awareness of PTSD. She began speaking publicly about her own experiences seven years ago when she joined the speakers' bureau of the Rape, Abuse & Incest National Network. She also formed her own organization, Speaking Out About Rape, where she works daily with other rape survivors.
"It was difficult at first to talk in front of a large group because the wounds were so fresh," Greene confesses. "But by sharing my experience, it was no longer a random act of violence; it had a purpose." That purpose has taken on added meaning since the events of September 11, which Greene watched unfold on television.
"I could really identify with what firefighters were feeling," she says. "I knew the dark place that these people were going to go in the months that followed. It's hell." Wyle, too, had a strong personal response to the attack. He observed the aftermath while in Los Angeles after his mother called and told him to turn on his television.
"I was shocked when I saw one shot of a thousand people walking across the Brooklyn Bridge; it looked just like a thousand refugees going across the border from Kosovo to Macedonia," Wyle says. "I was pretty dedicated [to MPT] before the attack, but if anything, I feel validated in that what we were talking about before was timely and important."
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