Mrs. Dalloway, by Virginia Woolf

Mrs. Dalloway, by Virginia Woolf
Narrated by Juliet Stevenson

Spoilers below.

This experimental book takes place in one day in June 1923, as Clarissa Dalloway prepares for and then gives a very successful high society party. In parallel, we follow the story of Septimus Smith, who has shell shock after witnessing the death of his friend during the war.

This was a very difficult book to listen to in audio, and I suspect it is equally difficult to read. The problem is that it is omniscient stream-of-thought and since it jumps around from character to character it is not always clear who is doing the thinking. You have to guess from context which person is thinking, and even after you’ve guessed that it’s not always clear (due to pronouns without antecedents) whether one character is thinking, or the other character is thinking about the first character. I had to read a description of the plot before I was able to get a clear version of the story, and after that my listening went much more smoothly, and I was able to understand what was going on.

There are a lot of ways to analyze this book. I could analyze the (paleo)modernist philosophy which rejects realism and rewrites, parodies, and incorporates ancient classical literature. (For a definition of paleomodernism, check out lecture 1 summary of the Literary Modernist Teaching Company course). But I’m not yet comfortable enough with the philosophy to give an accurate interpretation. (This month is dedicated to modernist literature for the Reluctant Romantic Challenge, hosted by Katie at Doing Dewey; however, I have not yet learned enough about the genre. This is my first modernist review.)

Another way of analyzing Mrs. Dalloway is more straightforward. Clarissa and Septimus are parallel characters who respond to their predicament with opposite actions. They are both very lonely and isolated people. Clarissa is lonely despite being surrounded by people. She recognizes the false sincerity of the friends she invites to her party. Her husband is unable to tell her he loves her. Her daughter is being “stolen away” by a religious fanatic. (That’s one thing I do know about modernism, they often reject religion.) During the course of the day, three former flames, all rejected by her, appear – seemingly out of nowhere. She spends a lot of time thinking about why she rejected them. In fact, she seems quite obsessed with the past and ignores the present.

Septimus, on the other hand, feels isolated because he is suffering from a severe form of “shell shock” (now called PTSD) after losing a friend in the war. He, likewise focuses more on the past than on the present. Unlike Clarissa, who rejected people who could have been too consuming or controlling and thus ended up with insipid people in her life, Septimus is surrounded by control – mainly by his doctors who don’t understand what is wrong with him. Another difference is that Septimus commits suicide at the end. Although Clarissa has contemplated suicide, when she hears about the suicide of this young stranger, she realizes how much she loves life despite the loneliness.

I imagine this contrast of parallel characters appears frequently in ancient classical literature, though I can’t think of specific examples since this, too, is a genre I am woefully under-read in.

Evil Hours, by David J. Morris

The Evil Hours, by David J. Morris
Narrated by Michael Chamberlain

In this important work, Morris traces the history of what we now call post-traumatic stress disorder (PTSD), even back into the ancient days. He begins the book with his own experiences with PTSD. He experienced many traumatic events when he was a war journalist in Iraq, most notably “the time he was blown up.” He remembers shortly before, one of the men asked him tentatively “Have you ever been blown up, sir?” Although the rest of the group chastised the man, it was too late. Morris had been “cursed.” When he was “blown up,” one of the men turned to him and yelled “What are you doing here?! We all want to go home and you’re here voluntarily?! What are you doing here?” Morris couldn’t answer that question. He understood that this moment had torn a rift between himself and this angry soldier – because Morris had chosen to put himself in danger. To be honest, I’ve often felt that way about war correspondents. Not that they deserve PTSD, no one deserves that. But if they repeatedly and purposely put themselves in danger, something will eventually happen.

In his book, Morris discusses not only his own PTSD & the history of PTSD, he talks about how PTSD affects the lives of its sufferers. He also discusses the major treatments for PTSD, many of which he has tried out himself. He apparently interviewed quite a few people for the book – at least he claims he did – though those interviews are generally chiseled down into two or three sentence mentions.

One point that Morris brought up about “PTSD” in ancient culture is his suggesting that Epic of Gilgamesh and The Odyssey could be interpreted as allegories for PTSD. This was a fascinating new way to interpret an epic that I have been spending a lot of time thinking about lately (Gilgamesh, of course). The way he interpreted it, travel is good for the war-ravaged brain – seeing new places and having new experiences can release the trauma so that you can eventually return home to your life. I interpret it differently. I say that the voyage itself is in the mind. The voyage itself is the PTSD. Gilgamesh’s desperate hunts for immortality – whether by glory, by physical longevity, or by wisdom – they’re different stages in his growth and healing from a trauma. I’d have to think about it more, but it’s definitely workable.

Morris also had an interesting section on treatments. The first he discussed was one that is highly lauded as the most successful treatment for PTSD: prolonged exposure (PE). In PE, the patient is made to relive his trauma in exact detail over and over. The theory is that after reliving it so many times, the mind becomes immune to the trauma, and is able to move on. This treatment has fantastic success rates. Problem is, the “success rates” of these studies don’t generally include people who drop out of treatment. And most people drop out of treatment because it makes their symptoms worse (at least at first). So is this a highly successful therapy? Or a potentially harmful one? Morris dropped out of PE because he became much, much worse. Morris also tried a form of cognitive behavioral therapy which worked out much better for him – though Morris thought the idea of meshing out his cognitive distortions to be pointless and annoying. Morris also briefly talked about antidepressants. He pointed out that there is no proof that antidepressants have any effect at all on the symptoms of PTSD, but they might help the depression and suicidal ideation that often accompany PTSD.

One thing that disappointed me is that this is not a book about PTSD in general – it is a book about PTSD in military. PTSD is suffered more by women than by men. Most Americans with PTSD are women who have been raped or beaten or otherwise traumatized during a non-war setting. One review I read said “rape is also discussed extensively.” It wasn’t. Rape got a side comment every once in a while – generally in the form of a quote from Alice Sebold’s memoir. However, most of the research on PTSD, and Morris’ own personal experience with PTSD, is military-related, therefore it is understandable that he would focus on military PTSD.

The book also tended to wander and get a bit dull at times. And every once in a while there was a little touch of ignorance that the snobby intellectual will cringe at. Such as saying “as soon as I left PE, my stress almost mathematically declined.” That sentence is meaningless. Every decline can be modeled mathematically. I suppose he meant “exponentially declined.” But…sorry….I know….I’m a snob.

In the end, I thought this was a good book that could have been an amazing book if he had taken that extra step to include womens’ experiences a little more. Women are the majority of the sufferers of PTSD in the US, and a great journalist would certainly have the resources to look into this subject as well.

A generous 4 stars for important content and good personal tie-ins

Post Traumatic Stress Syndrome – the Basics

I think we all have some idea of what we think PTSD is, but it turns out PTSD isn’t as clear-cut as I thought.

Apparently, when PTSD was first introduced into the DSM, the diagnostic criteria required a traumatic event “outside the range of usual human experience” that would cause “significant symptoms of distress in almost anyone.” That fits pretty well with my own perception of PTSD. Rape, war, torture, violent experiences…these all fit into that description. PTSD is a normal response to an abnormal stressor.

However, in the DSM-IV, the nature of the “traumatic event” broadened drastically, and a requisite response was “intense fear, helplessness, or horror.” So in the DSM-IV, PTSD was a pathological response to a potentially less extreme stressor. Someone could be diagnosed with PTSD if they experienced “intense horror or helplessness” after watching a scary TV show or upon being diagnosed with a terminal illness.

Although I don’t wish to undermine the intense stress that someone with pathological responses may feel, I think this definition undermines the intensely awful experience that someone with PTSD (in my mind) has encountered. The statistics agree with my assessment of these criteria: in a community survey, 89.6% of people reported that they had been exposed to a traumatic event and had responses that could potentially qualify them for a PTSD diagnosis.

Luckily, the DSM-5 tightened the traumatic event criteria again, and broadened the range of response to the traumatic event. Now, the traumatic event must occur directly to the subject, and they can exhibit other pathological responses besides “intense fear, helplessness, or horror.”

To be diagnosed with PTSD by DSM-5 standards, a person must be exposed to “actual or threatened death, serious injury, or sexual violence.” They must exhibit one of the following symptoms: intrusive distressing memories of the event, distressing dreams reliving the event, dissociative reactions, intense psychological distress at cues that remind the person of the event, or marked physiological reactions to cues that remind the person of the event. Additionally, the person must persistently avoid stimuli associated with the traumatic event, have negative alterations in cognitions and moods associated with the event (e.g. distorted cognitions about the cause or consequences of the event), and alterations in arousal and reactivity (e.g. hypervigilance or angry outbursts).

In general, people respond to trauma with decreasing pathological symptoms. In order to be diagnosed with PTSD, the patient must have experienced these negative responses for more than 1 month, otherwise they are experiencing “acute stress disorder.”

Despite the common association of PTSD with war veterans, PTSD is actually more common in women than in men – and the traumatic events are more often domestic violence or rape than war. However, a great deal of money and time has gone into research of PTSD in war veterans.

During WWI, symptoms of PTSD were called “shell shock,” and were thought to be caused by brain hemorrhages. However, this belief slowly subsided as doctors realized that the symptoms presented themselves regardless of injury. By WWII, traumatic reactions were known as “operational fatigue” and “war neuroses,” before the terminology finally settled on “combat fatigue” during the Korean and Vietnam wars. A rigorous longitudinal study of PTSD by Smith et. al. in 2008 found that 4.3% of military personnel deployed to Iraq or Afghanistan had PTSD. Of those, the rate was higher (7.8%) in those that had experienced combat compared to those who hadn’t (1.4%). An issue that is (rightfully!) getting much attention lately is the high rate of soldier suicide. Between 2005 and 2009, more than 1,100 soldiers took their own lives – generally with a gun.

There are several risk factors that increase the likelihood of PTSD – being female, lower social support, neuroticism, preexisting depression or anxiety, family history of depression, substance abuse, lower socioeconomic status, and race/ethnicity. (Apparently, compared to whites, African Americans and Hispanics who were evacuated from the World Trade Center in 2001 were more likely to get PTSD.) There is also a genetic factor that increases susceptibility to PTSD. Preliminary studies suggest that people with a particular form of the serotonin transporter gene may be more susceptible to PTSD than those with the “normal” form of this gene.

On the other hand, there is at least one factor that promotes resilience to traumatic events: intelligence. It’s possible that people with higher intelligence are better able to make “sense” of the event by viewing it as a larger whole. Or an intelligent person may be better able to recognize and buffer cognitive distortions such as “I deserved that,” “why should I have lived when they died?” and “If I had only done _______, this wouldn’t have happened.”

Researchers have come up with several ways to decrease likelihood of succumbing to PTSD after a traumatic event.

Stress-inoculation training has proved successful with members of the Armed Forces. Soldiers can be exposed, through virtual reality, to the types of stressors that might occur during deployment. Thus they are better able to deal with the trauma when exposed to the events in real life.

Debriefing after a traumatic event can also be helpful. This allows the victim to process the event in a safe environment, before the details become internalized.

Interestingly, one study showed that subjects who were exposed to a highly disturbing film were less likely to report flashbacks if they played Tetris for 10 minutes after the film than if they sat quietly for those 10 minutes. This team of researchers also showed that simply being distracted after the disturbing video was not enough to decrease flashbacks, and that doing a verbal task actually increased the number of flashbacks. So, apparently, visio-spacial tasks decrease the likelihood of intrusive flashbacks if performed immediately after the traumatic event. I’m not sure this information is particularly useful, but it’s interesting.

As of yet, there isn’t a highly successful way to “cure” people with PTSD. Cognitive behavioral therapy, which helps the victims recognize cognitive distortions (e.g. “I deserved that,” “why should I have lived when they died?” and “If I had only done _______, this wouldn’t have happened.”), can be helpful in reducing anxiety. Antidepressant medications can alleviate some of the depression and anxiety experienced by victims.

One up-and-coming treatment has shown promising results. Someone with PTSD can undergo prolonged exposure to the traumatic events. They can do this through repeatedly reliving the events out loud, or even by re-experiencing them through virtual reality. Unfortunately, many PTSD vitimcs drop out of such treatments because reliving the events is too difficult. However, this treatment method has proven very helpful to people who complete the process, and I hope that work in this area continues.

This is a series of posts summarizing what I’m learning in my Abnormal Psychology course. Much of the information provided comes from reading my James N. Butcher’s textbook Abnormal Psychology. To read the other posts, follow these links:

The Definition of Abnormal
A History of Abnormal Psychology
Abnormal Psychology in Contemporary Society
Contemporary Viewpoints on Treating Mental Illness – Biology
Contemporary Viewpoints on Treating Mental Illness – Psychology
Frontline: New Asylums
Brave New Films: This is Crazy
Clinical Mental Health Diagnosis: Biological Assessment
Clinical Mental Health Diagnosis: Psychological Assessment
Does the DSM Encourage Overmedication?
Post Traumatic Stress Syndrome – The Basics
Panic Disorder
Obsessive Compulsive Disorder
Hoarding and Body Dysmorphic Disorders
Depression – an Overview
Personality Disorders – Clusters and Dimensions
Personality Disorders – Cluster A
Personality Disorders – Cluster B
Personality Disorders – Cluster C
Biological Effects of Stress on Your Body
Somatic Symptom and Related Disorders
Dissociative Disorders
Borderline Personality Disorder
Dialectical Behavioral Therapy
Paraphilic Disorders
Gender Dysphoria – Homosexuality and Transgender
Anxiety Disorders
Bipolar Disorder – The Basics
Suicide – An Overview

References:

Butcher, James N. Hooley, Jill M. Mineka, Susan. (2014) Chapter 5: Stress and Physical and Mental Health. Abnormal Psychology, sixteenth edition (pp. 129-161). Pearson Education Inc.