Monday Morning Crisis Quarterback

Much of the cable news business has been obsessed, over the last few weeks, with the murder trial of the mother accused of killing Caylee Anthony. It was a very highly publicized case when it first broke, and the trial has had lots of salacious details and conspiracy theories to keep Nancy Grace and the like buys for the foreseeable future.

Branching off in a different direction, CNN.com ran a piece yesterday about the symptoms often experienced by jurors following these trials. According to the article, some jurors in murder trials,

report symptoms reminiscent of post-traumatic stress disorder, such as flashbacks and intrusive thoughts. Whether you're in the courtroom or at home watching TV, repeated exposure to the details of a horrific events can lead to a phenomenon called vicarious traumatization -- you're so connected to a tragedy that you feel emotional trauma as if you'd been directly involved.

To those of us in the trauma biz, this is not a particularly surprising phenomenon. In fact, it's so accepted that people hearing about trauma can themselves be traumatized that every training or workshop you go to through the International Critical Incident Stress Foundation includes a warning about the level of distress you can expect to experience. I don't know anyone who has been to significant numbers of these things (including myself) who hasn't found themselves unexpectedly upset by a role play or case study. Jurors have it worse, because they aren't just pretending something happened -- it really did.

What should we call what is going on with these jurors? The Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision (DSM-IV,TR) is the bible by which mental illness is diagnosed. As the article states, these jurors have some of the symptoms of PTSD -- some of them may have all of them. has two relevant diagnoses listed as "official" psychological disorders that occur following trauma. But do they have PTSD?

By current standards, they can't. In order to have PTSD, the person must have

experienced, witnessed or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.

Most (but not all) diagnosticians would say that being on the jury in a grisly murder trial does not meet the threshold of being "confronted" with the event.

It just so happens, however, that the DSM is undergoing revision as we speak. The proposed guidelines for PTSD in the DSM-V define traumatic exposure as follows:

The person was exposed to one or more of the following event(s): death or threatened death, actual or threatened serious injury, or actual or threatened sexual violation, in one or more of the following ways:

1. Experiencing the event(s) him/herself
   
2. Witnessing, in person, the event(s) as they occurred to others
   
3. Learning that the event(s) occurred to a close relative or close friend; in such cases, the actual or threatened death must have been violent or accidental
   
4. Experiencing repeated or extreme exposure to aversive details of the event(s) (e.g., first responders collecting body parts; police officers repeatedly exposed to details of child abuse); this does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.
   

The jurors would most likely come under #4 in this definition. Their work, for the duration of their jury duty, is serving on the jury. They experience repeated or extreme exposure to aversive details of the murders. When the new manual comes out, they'll be eligible for a PTSD diagnosis.

This raises two important points. First of all, it's absurd to think that what actually is going on for these people will miraculously change because a new book is published. This is somewhat like deciding that in order to be diagnosed with a cold, you now have to have a stuffy nose and a cough, whereas before you just needed the nose. Unlike a virus, bacterial infection or broken bone, there is no way to objectively define a mental illness. We classify disorders by symptoms, and every now and then we decide to reclassify. We pretend we're defining an actual thing, but really we're just describing what we see in people that have the thing.

The second, and perhaps more important point, is that most of these jurors will not have PTSD under the new definition, either. In addition to describing the symptoms and the definition of traumatic exposure, both the old and new guidelines require that the person experience

clinically significant distress or impairment in social, occupational, or other important areas of functioning. 

This would mean that, for an extended period of time, their symptoms significantly interfere with their ability to love, work, have friends, care for children, etc. Thankfully, even those with symptoms will mostly not reach this threshold.

Just because they don't and won't have PTSD, however, doesn't mean they don't need or deserve support. One of the most helpful things courts could do is, following a grisly trial, sit the jury down and tell them they may have a rough time for a while. That way, if and when the symptoms come, people won't add thinking they're going crazy to their stress. I think it's the least we can do for those whose misfortune was simply to be civic-minded and conscientious enough to show up for jury duty, and fair enough to be chosen to hear the case.

In my household, we talk about two kinds of severe weather warnings: Mr. Brown warnings and Parcheesi board warnings. Mr. Brown warnings are for severe thunderstorms, a reference to the Dr. Seuss book Mr. Brown Can Moo! Can You? which says, "Boom, boom, boom, Mr. Brown is a wonder. Boom, boom, boom, Mr. Brown makes thunder." Parcheesi warnings are for tornadoes. These come from something I'm relatively sure my sister made up (although she will correct me if I'm wrong). Right before Hurricane Bob was due to hit New England in the early 1990's, she said, "Hang onto your Parcheesi boards. It's gonna blow."

Last weekend, we had a major family event on Saturday night. On Sunday morning, all of the out of town guests were invited for brunch, and a bunch of them stayed throughout the day. There were 14 people at my house. About midday, we learned that our area was under a tornado watch. This is not such a big deal in Southeast Michigan. It happens pretty frequently, and doesn't usually progress to a tornado warning. Even when it does, however, we don't get too upset. While tornadoes are not unheard of in this neck of the woods, the number of warnings far outstrips the number of actual tornadoes, so we have a plan and a safe room in the basement, but we try to keep things fairly calm. My husband and I discussed the fact that our usual safe room won't hold 14 people, and decided that the room next to it is almost as safe and we would use that if necessary.

A little after 5 PM on Sunday, a Parcheesi warning was issued for our county. We are on the eastern end, so we knew we had some time. I calmly invited our guests to join us in our luxurious basement, bring something to do, and carry down a chair if they preferred not to sit on the floor. At my sister-in-law's request, we brought down a guitar, and for the next hour we all sat around, noses in computers and cell phones, while my mom, my daughter and I passed the guitar around and led the group in various folk songs. A good time was had by all.

When it was over and everyone had posted about it on Facebook, I was somewhat taken aback by the comments we got from friends and family elsewhere. "Was it scary?" "That's disturbing." "How horrible." My sister-in-law praised my calmness, and said she was handling the panic, quietly, for all of us. I explained that I preferred to save my panic for when a tornado actually hits our house.

The bulk of these visiting relations are from Massachusetts, where I grew up. In the 17 years I lived there full time, I can remember no more than three tornado warnings. We would go down to the basement and wait it out, and I remember distinctly one time asking schoolmates what they had done during a warning and them saying things like, "We just hung out and hoped a tornado didn't come." They had no plan at all.

Last night, however, the central and western parts of Massachusetts were slammed by tornadoes, causing major damage in 19 or 20 towns. At least four people died. My family, living as they do in the eastern part of the state, just got a spectacular lightning show.

Meanwhile, in Missouri last week, reports indicate that a lot of people didn't take cover during the Tornado that hit Joplin until they could see the tornado bearing down on them. The sirens go off so often around there, people don't always pay attention anymore.

This is the difficulty of disaster warning systems. You want a system that people will pay attention to and that warns of any disaster that is actually going to hit. But these two goals can be at odds. Any system that catches all the tornadoes that actually hit will also catch a lot of storms that could produce tornadoes but don't. And as long as that's the case, people in areas where those storms are fairly common will not see a tornado warning as being sufficient reason to take cover. Meanwhile, people in areas where such a thing is very unusual will take it seriously, but won't have a plan because they generally don't need one. Locations like ours, in fact, are in some ways ideal. We get enough warnings that we have a plan, but not so many that we don't take it seriously.

You've heard me say many times in this space that we live our lives by
what is likely, not what is possible. We take risks all day long based on the probability that something bad will happen to us, how bad that thing would be, and how disruptive it is to our lives to not take those risks. If a tornado hits near you, it's easy to say, in hindsight, you should have taken cover. It's not as easy to say, for someone else, that taking cover every time the warning goes out is always the absolute right thing to do. It is always the safe thing to do, but "right" depends on how much of a pain it is and how likely the tornado is to actually hit where you are, so everyone will come to his or her own conclusions.

In my household, however, when the siren goes off or the warning comes onto the radio or TV, we'll continue to hold onto our Parcheesis boards. Thanks for asking.