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.