These are averages. With more severe trauma, such as repeated and intense childhood sexual abuse, as opposed to one occurrence, the PTSD rates rise. In the aftermath of September 11, 2001, the general PTSD rate in New York City was 6–8 percent; but if persons had been physically injured during the attack, it was 26 percent. Among Vietnam veterans, chronic PTSD appears to be present in 9 percent; in those with the most combat exposure, it is 28 percent. Studies rarely find full PTSD present in more than one-third of any sample, even with the most severe trauma. Milder PTSD symptoms that may not meet the full definition (“subsyndromal” PTSD) occur, but still only in a minority. For instance, after September 11, 2001, with syndromal PTSD present in 6–8 percent of the population, subsyndromal PTSD symptoms were found in another 17 percent. (S. Galea et al., “Psychological Sequelae of the September 11 Terrorist Attacks in New York City,” New England Journal of Medicine 346 [2002]: 982–987.) In sum, with typical traumas, even under the worst conditions, at least one-third of persons have no PTSD symptoms at all—ever. (G. A. Bonanno and A. D. Mancini, “The Human Capacity to Thrive in the Face of Potential Trauma,” Pediatrics 121 [2008]: 369–375.)
The same holds in the absolute human trauma—death. Each of us must face the deaths of loved ones, and, eventually, ourselves. Grief after the death of a beloved person is a universal human experience. Chronic grief, however—a grief of such severity that it involves long-term depression and PTSD-like symptoms—only happens in about 10 percent of persons. (W. Middleton, P. Burnett, B. Raphael, and N. Martinek, “The Bereavement Response: A Cluster Analysis,” British Journal of Psychiatry 169 [1996]: 167–171.) Even when a death is unexpected and especially painful, chronic PTSD-like grief does not occur in most persons.
122 Bonanno identifies four major types: George A. Bonanno, “Loss, Trauma, and Human Resilience,” American Psychologist 59 (2004): 20–28.
122 they recovered repressed memories: This is what Freud’s first patient famously called “the talking cure”—a staple of Freudian dogma. All sorts of unconscious emotions exist within us, some related to childhood trauma; our current neuroses, anxieties, and depressive symptoms flow from those repressed unconscious emotions. This view has not been without controversy: feminists later attacked Freud for repressing the theory of repression, fearing the consequences of revealing the sexual abuse of young girls in a male-dominated Victorian world; others see the whole concept of repression as a fabrication, mere suggestion by psychotherapists with their own ideologies (sometimes fantastically so, as in the theory of sexual abuse by aliens from outer space). The repressed memory debate has led to lawsuits and delirium, with some probable unjust accusations, and some legitimate cases dismissed as unprovable.
123 Similarly, in Gulf War veterans: P. B. Sutker et al., “War Zone Stress, Personal Resources, and PTSD in Persian Gulf War Returnees,” Journal of Abnormal Psychology 104 (1995): 444–452.
124 strong social supports: Michael Rutter, “Resilience in the Face of Adversity: Protective Factors and Resistance to Psychiatric Disorder,” British Journal of Psychiatry 147 (1985): 598–611.
124 Some psychologists call this “ordinary magic”: Masten, “Ordinary Magic: Resilience Processes in Development.”
124 Similarly, in studies on World War II veterans: K. A. Lee, G. E. Vaillant, W. C. Torrey, and G. H. Elder, “A 50-Year Prospective Study of the Psychological Sequelae of World War II Combat,” American Journal of Psychiatry 152 (1995): 516–522.
124 In an uncommon project: Stephan Collishaw et al., “Resilience to Adult Psychopathology Following Childhood Maltreatment, Child Abuse and Neglect 31 (2007): 211–229.
124 psychologist Dean Keith Simonton found: Dean Keith Simonton, Greatness: Who Makes History and Why (New York: Guilford, 1994).
125 are usually set by age three or so: A. Caspi and P. A. Silva, “Temperamental Qualities at Age Three Predict Personality Traits in Young Adulthood,” Child Development 66 (1995): 486–498.
125 Adults who have higher neuroticism scores experience more PTSD: Lee et al., “A 50-Year Prospective Study.”
125 one study examined . . . terrorist attacks in Russia: V. S. Yastrebov, “PTSD After-effects of Terrorist Attack Victims,” in The Integration and Management of Traumatized People After Terrorist Attacks, ed. S. Begec, 100–107 (Amsterdam: IOS Press, 2007).
126 study of forty-six college students: Barbara L. Frederickson, Michael M. Tugade, Christian E. Waugh, and Gregory R. Larkin, “What Good Are Positive Emotions in Crisis? A Prospective Study of Resilience and Emotions Following the Terrorist Attacks on the United States on September 11th, 2001,” Journal of Personality and Social Psychology 84 (2003): 365–376.
126 in young adults with childhood sexual abuse: Bonanno, “Loss, Trauma, and Human Resilience.”
126 Genetic studies with identical versus fraternal twins: Kenneth Kendler and Carol Prescott, Genes, Environment and Psychopathology (New York: Guilford, 2006).
126 George Vaillant . . . concluded: George Vaillant, Adaptation to Life (Boston: Little, Brown, 1977).
127 followed children of the Great Depression: Rutter, “Implications of Resilience Concepts for Scientific Understanding.”
127 a project . . . with which I was associated, at Massachusetts General Hospital: Mark H. Pollack et al., “Persistent Posttraumatic Stress Disorder Following September 11 in Patients with Bipolar Disorder,” Journal of Clinical Psychiatry 67 (2006): 394–399.
127 a study of well-being in two thousand adults: M. D. Seery, E. A. Holman, and R. C. Silver, “Whatever Does Not Kill Us: Cumulative Lifetime Adversity, Vulnerability, and Resilience,” Journal of Personality and Social Psychology 99 (2010): 1025–1041.
127 in seventy-eight women who had experienced a serious life event: Allison S. Troy, Frank H. Wilhelm, Amanda J. Shallcross, and Iris B. Mauss, “Seeing the Silver Lining: Cognitive Reappraisal Ability Moderates the Relationship Between Stress and Depressive Symptoms,” Emotion 10 (2010): 783–795.
128 Resilience grows out of exposure to . . . risk: Rutter, “Implications of Resilience Concepts.”
CHAPTER 10. A FIRST-CLASS TEMPERAMENT: ROOSEVELT
130 “Get down, you fool!”: Alexander Woollcott, “Get Down, You Fool,” Atlantic Monthly 161 (1938): 169–173.
131 “blow your trumpet” and “give the order to charge”: G. Edward White, Justice Oliver Wendell Holmes: Law and the Inner Self (New York: Oxford University Press, 1995), 470.
131 “A second-class intellect, but a first-rate temperament”: The aide thought Holmes was referring to FDR, and this is the standard view; but some historians now claim the statement referred to Theodore Roosevelt. Paul Boller, Not So! Popular Myths About Americans from Columbus to Clinton (New York: Oxford University Press, 1996), 102–103. This phrase has been repeated in various combinations: “second-rate mind,” “second-class mind,” “first-class temperament.” The most commonly cited original usage appears to be what is in the text, and the original source was the aide, Thomas Corcoran, who reported it verbally afterward.
131 FDR’s first-rate temperament . . . was hyperthymic: In what follows I describe symptom evidence for hyperthymia, but I did not come across in my research evidence for full manic episodes or for clinical depressive episodes. The closest evidence for a possible clinical depression comes toward the end of FDR’s life, when he had suffered from severe hypertension for years and was about to die of a massive stroke. Alen Salerian, an FBI psychiatric consultant, has suggested that Roosevelt might have been clinically depressed during the Yalta conference in 1945. David Owen, reviewing medical records of the time, could not confirm this impression. In any case, depression at that time would most likely be attributable to Roosevelt’s cerebrovascular disease, especially since there is no evidence of a prior pattern of depressive episodes throughout his life. David Owen, In Sickness and in Power: Illnesses in Heads of Government During the Last 100 Years (Westport, CT: Praeger, 2008), 47.
131 “Obviously that man has never had
indigestion”: John Gunther, Roosevelt in Retrospect (New York: Harper and Brothers, 1950), 23.
131 the State Department asked him to brief the president: Ibid., 24–28.
132 “FDR’s extreme loquaciousness”: Ibid., 55.
132 “My own method”: Ibid.
132 “The simplest way to get at the President”: Ibid.
132 “asking somebody who had never been in Latin America”: Ibid., 56.
132 after Pearl Harbor: Ibid., 31.
132 “His vitality was . . . practically unlimited”: Ibid., 63.
132 he made 399 trips by rail: Ibid., 139.
132 “The Roosevelt family is completely superhuman”: Marion Elizabeth Rodgers, Mencken: The American Iconoclast (New York: Oxford University Press, 2005), 434.
133 TR needed only six hours’ sleep: Gunther, Roosevelt in Retrospect, 8.
133 he had only two sleepless nights: Ibid., 32.
133 “He was often restless”: Ibid., 33.
133 He spent about a quarter of the working day on the telephone: Ibid., 125.
133 “You know, a man will do a lot of right things”: Ibid., 130.
133 “incurably sociable”: Frances Perkins, The Roosevelt I Knew (New York: Viking Press, 1946).
134 “It was here that Roosevelt was irresistible”: Robert H. Jackson, That Man: An Insider’s Portrait of Franklin D. Roosevelt (New York: Oxford University Press, 2003), 135.
134 “[Wilson] refused to see most of them”: Ibid., 135–136.
134 “There was always considerable conflict”: Ibid., 111.
135 “Roosevelt certainly was not accomplished as an administrator”: Ibid., 111.
135 not “a careful, direct-line administrator”: Perkins, The Roosevelt I Knew, 384.
135 “Mr. President, you know you’ve got to let the cattle graze”: Ibid., 135.
136 why not just shoot forty-nine thousand instead?: Jackson, That Man, 149.
136 “My fellow immigrants . . . ”: Gunther, Roosevelt in Retrospect, 67.
136 about 60 to 80 percent of newspapers opposed him: Graham J. White, FDR and the Press (Chicago: University of Chicago Press, 1979), 70.
136 “You know, we had to buy that fucking paper”: Robert Dallek, An Unfinished Life: John F. Kennedy (Boston: Little, Brown, 2003), 172.
137 almost a thousand press conferences in all: Gunther, Roosevelt in Retrospect, 134–136.
137 “Innovations never frightened him”: Ibid., 64–66.
137 He loved to read: Ibid., 118–119.
137 After Yalta, FDR was headed to Saudi Arabia: Perkins, The Roosevelt I Knew, 88–89.
138 “You sometimes find something pretty good in the lunatic fringe”: Gunther, Roosevelt in Retrospect, 115.
138 once writing a memorandum: Ibid., 115.
138 “That fellow in the White House”: Ibid., 115.
138 “Mr. President, are you a Communist?”: Perkins, The Roosevelt I Knew, 330.
139 Roosevelt . . . read some of Kierkegaard’s works: Ibid., 146–148.
139 FDR scribbled . . . China’s coastal contours: Jackson, That Man, 13.
139 Family history provides some evidence: Gunther, Roosevelt in Retrospect, 156–161.
140 in some genetic studies of bipolar disorder: Sermin Kesebira, Simavi Vahipa, Fisun Akdeniza, Zeki Yüncüa, Müge Alkana, and Hagop Akiskal, “Affective Temperaments as Measured by TEMPS-A in Patients with Bipolar I Disorder and Their First-Degree Relatives: A Controlled Study,” Journal of Affective Disorders 85 (2005): 127–133. S. G. Simpson, S. E. Folstein, D. A. Meyers, F. J. McMahon, D. M. Brusco, and J. R. DePaulo Jr., “Bipolar II: The Most Common Bipolar Phenotype?” American Journal of Psychiatry 150 (1993): 901–903.
140 “I have one wish for you”: Gunther, Roosevelt in Retrospect, 168.
141 “It’s ridiculous to tell me”: Ibid., 238.
141 he fell, or almost fell, about five times: Ibid., 236.
142 the “ultimate humility”: Perkins, The Roosevelt I Knew, 44–45.
142 “When he reached the top”: Gunther, Roosevelt in Retrospect, 267–268.
142 was the worst aspect of his disability: Ibid., 236.
142 “an untried rather flippant young man”: Ibid., 242
142 Roosevelt was disciplined by his illness: Jackson, That Man, 171.
143 “Roosevelt underwent a spiritual transformation”: Perkins, The Roosevelt I Knew, 29.
143 “This is the Happy Warrior”: Gunther, Roosevelt in Retrospect, 245–250.
144 “A governor does not have to be an acrobat”: Ibid., 253.
144 “Ten years ago, Governor Roosevelt suffered an attack”: Ibid., 266.
144 “nothing in human judgment is final”: Perkins, The Roosevelt I Knew, 164.
145 “recovery was not enough”: Gunther, Roosevelt in Retrospect, 289.
145 a government “that cannot take care of its old”: Ibid., 289.
145 “We can’t sell the United States short in 1980”: Perkins, The Roosevelt I Knew, 294.
145 “Isn’t this Socialism?”: Ibid., 299.
145 FDR did not take a class with James: At my request, my colleague at Harvard Dr. Eugene Taylor examined the registrar’s records there for Roosevelt’s college years of 1900–1904 and documented that Roosevelt was never a student in a class taught by William James.
146 “the greatest political personality of the century”: John Kenneth Galbraith, Name Dropping (Boston: Houghton Mifflin, 1999), 43.
146 “He would certainly have been President”: Gunther, Roosevelt in Retrospect, 243.
CHAPTER 11. SICKNESS IN CAMELOT: KENNEDY
147 “If that crazy Muckers club had been mine”: Christopher Matthews, Kennedy and Nixon: The Rivalry That Shaped Postwar America (New York: Simon and Schuster, 1996), 23.
147 “I do not think it particularly helpful”: January 22, 1963, JFK Presidential Archives, Box 1, Choate School Archives.
148 an IQ of 119: Robert Dallek, An Unfinished Life: John F. Kennedy (Boston: Little, Brown, 2003), 33.
148 “a very able boy”: James N. Giglio, “Growing Up Kennedy: The Role of Medical Ailments in the Life of JFK, 1920–1957,” Journal of Family History 31 (2006): 362.
148 At age thirteen he was hospitalized: Giglio, “Growing Up Kennedy,” 361. Dallek, An Unfinished Life, 34.
148 Robert joked that if a mosquito bit Jack: Arthur Schlesinger, Robert Kennedy and His Times (Boston: Houghton Mifflin, 2002), 13.
148 At age seventeen, he had his worst infection ever: Giglio, “Growing Up Kennedy,” 361. Nigel Hamilton, JFK: Reckless Youth (New York: Random House, 1993), 101–105. Dallek, An Unfinished Life, 35.
149 He was diagnosed with fatal leukemia: Dallek, An Unfinished Life, 77. Giglio, “Growing Up Kennedy,” 363.
149 His father, unwilling to accept this death sentence: Joseph P. Kennedy to George St. John, September 15, 1934: “About the early part of the summer we sent Jack to Mayo’s and he remained there a month. A thorough investigation of his physical condition . . . unable to find the cause of Jack’s illness during the winter. If there is the slightest tendency to a relapse he would have to be taken out of school for a year.” JFK Presidential Archives, JFK Personal Papers, Box 1. They had discovered that he had many allergies—to “animal hair, house dust, and certain foods, including lamb, pork, and to a lesser extent, whole milk, beef, and various grains.” Giglio, “Growing Up Kennedy,” 363.
149 a month of testing at the Mayo Clinic: Dallek, An Unfinished Life, 73.
149 “they have not found out anything as yet”: Giglio, “Growing Up Kennedy,” 365.
149 “Joe’s blood count was 9400”: Ibid.
149 “one of the things I am a little disturbed about”: Ibid., 367.
149 “One thing I want to be sure of”: Ibid., 368.
150 Kennedy fended off lifelong whispers of hypochondriasis: In the oral history interview between Kennedy’s close adviser Ted Sorensen and Kennedy’s personal White House physician, Janet Travell, Sorensen
asks, “Did you ever feel that he complained, or did not complain but suggested maladies that perhaps weren’t something he had—that he had any tendencies toward being hypochondriac?” Travell responds, “Oh, no, he was the opposite of a hypochondriac. It was difficult to get him to state his complaints, unless they were very acute.” (JFK Presidential Archives, Oral History Collection, interview of Janet Travell by Ted Sorensen, January 20, 1966.) The association of ulcers and colitis (today called irritable bowel syndrome) with psychiatric or emotional causes is now, perhaps paradoxically, less strongly held than it was in the 1930s. Peptic ulcer disease, long considered a classic psychosomatic illness, is due in many persons to a previously unrecognized bacterial infection, and treatable with an antibiotic. Irritable bowel syndrome seems more common in those with psychiatric conditions, like depression, and improves somewhat with antidepressants, but it also occurs in persons without psychiatric diagnoses and improves with nonpsychiatric medications too. It is important to note that an autoimmune inflammatory disease of the bowel called celiac disease can mimic irritable bowel syndrome and is often misdiagnosed.
We cannot know for sure the cause of John Kennedy’s lifelong gastrointestinal illness; perhaps it was partly psychosomatic and due to his nervous and anxious and active temperament; partly, or even fully, it might have been part of a larger autoimmune disorder, which manifested a bit in his allergies, more in his irritable bowel syndrome, and even more, soon thereafter, in his near-fatal Addison’s disease.
150 evidence of hyperthymia: Hamilton, Reckless Youth, 131–133. Long before he took steroids, he was seen as extremely sociable, charismatic, and energetic, getting elected by his peers “most likely to succeed,” which was, as Hamilton notes, “a complete travesty of his record at Choate.”
150 visiting prostitutes and probably contracting venereal diseases: Ibid., 153–158, 341–342.
A First-Rate Madness Page 30