Five Case Studies

Case Study #1 Subject Name: Robert Sex, Age and Marital Status: Male, 19, single Occupation: College Student, summer lifeguard Personal Background: Upper middle class family, parents never divorced, 1 brother and 1 sister. Raised in and remains active in L.D.S. church. The Incident: Robert has worked for 3 summers as a lifeguard at the Desert Shores Community Association Lagoon Pool, and is now lifeguard supervisor. The Lagoon, as it is known, is a naturally shaped, concrete lined and sand covered swimming pool designed to look like a tropical lagoon. It is irregular in shape, surrounded by palm trees and includes a beach around the swimming area as well as a large picnic and recreation area that will accommodate a large crowd of members. On Sunday of Memorial Day Weekend, 1998 there were approximately 1,500+ members at the Lagoon, enjoying a picnic and family swimming. As described by Robert, there were so many people in the lagoon you could barely see the water. With 3 lifeguard stands, and several lifeguards on duty and rotating time on the stands, plus those not on the stands working the crowd, Robert felt that even though things were busy they were under control. At the appropriate time Robert approached a stand to relieve another guard, Tyler. Robert climbed up into the stand, sat down, began scanning the water and crowd, and immediately saw a child floating face up about a foot beneath the surface of the water. He jumped from the stand, entered the water, pulled the child out and observed that her skin was white, her lips blue, her eyes rolled back in her head. There was no respiration and no pulse. He immediately began CPR, thinking to himself: "She’s dead" and "what if she’s dead" and other thoughts about the consequences of a drowning. He worked on the child for what he estimated to be 3 minutes with no response, then the child coughed but failed to breath. He continued working and after about another 30 seconds the child began to cough, cry and breath. Her color began to return as the paramedics arrived and took the child away to be checked at the hospital. The parents had been standing at Robert’s side the entire time he was working on resuscitating the child. The

no one. 4) Some sense of hypervigilance in the workplace and in non-working circumstances. were revealed: 1) Nightmares about the event in which the rescue effort was unsuccessful were experienced. whereas prior to the incident they had engaged in sex about once a week. including elevated heart beat.. though subject was not consciously aware of it until the interview. At the time of contact he indicated a willingness to discuss the event and an appointment was made for the following day for a interview.T. containing questions considered pertinent to the diagnosis of P. conversational interview of approximately one hour in length was held. symptomatic of P. 3) Some sense of detachment and estrangement occurred. Less violent cued responses to event familiar stimuli. At the interview the subject realized he had not had sex with his girlfriend since the incident occurred. Both were extremely violent and traumatic. continued for another 2 to 3 weeks. 2) Numerous spontaneous daytime flashbacks/daydreams with a pattern similar to the nightmares were experienced. 5) In the course of the interview it became clear Robert was to some extent blaming himself for the near reported there was no brain damage and no broken ribs (common as a result of CPR).S. asked him to recount his . there was also a greater closeness with parents involving much greater daily communications. including closest family. an informal.S.T.. even debriefed him and asked him to recount the event. In fact. the second on the following night. Response to Event: I interviewed Robert approximately 7 weeks after the event occurred. Using a standard interview outline. that he might benefit from any type of counseling.D. In the course of that interview the following occurrences. He has not yet realized that he was not in a position to observe the victim at the time she actually went under water and that it was his assumption of active lifeguarding when he relieved Tyler that actually resulted in the saving of the child. the first occurred on the third night after the event. Follow-up Activities: There was no suggestion by anyone involved with Robert in the workplace or among his family or among all those he came in contact with as a result of the event.D. And no one. But. These were numerous and recurring during the subsequent week. including the employer.

personal reactions and experience. lost biological father in accident as toddler. Other interviews revolved around the human interest aspects of the event as a newsworthy item but paid no attention to any trauma he experienced.S. His stepfather. Rather than asking about his feelings. is a loving and . church but left the church a number of years ago. His younger life was marred by the tragic death of his father in an explosion when he was a toddler. parents never divorced. president of the student body and an athlete. Raised in L. Summary: Robert experienced a traumatic event with a happy ending. By DSM-IV standards it is questionable if he actually developed P. though his mother remarried happily and ultimately relocated to the town where John grew up. John had known Allan Evans since boyhood. At the close of the interview. the victim did not drown.T. married (age 24. brothers and sisters. in as much as active symptoms appear to have continued barely 4 weeks.. The Incident: September 16.S.D. It is more likely he only experienced many of the diagnostic symptoms of the disorder. the general inquiry was "Are you doing ok?" or something similar. at time of incident) Occupation: Landscape Contractor/Supervisor Personal Background: Upper middle class family. single. for a full month after the event he experienced active symptoms that upset him and upset his life and work and social habits. Utah. 1995. though being 2 years older they were not good friends in public school. mother remarried happily. 27. His lack of sexual activity continued even longer than a month. Nevertheless. John was a leader in High School. Salt Lake City. or the event. after I thanked him for his time. Age and Marital Status: Male. he thanked me for listening to him.D. Case Study #2 Subject Name: John Sex. who he considers his father.

His desires for social normalcy prevailed at this time. his bond with Allan seems as strong a relationship of platonic love as I’ve ever encountered. his athletic ability. Attending State University John’s life was.m. at age 10.U. made his first attempt at suicide. and working hard at their jobs during the day. doing everything together. and sharing together the burden of John’s problems. he accepted a job. John and Karen settled in Salt Lake City. Allan was. During his college years his acquaintance with Allan Evans blossomed into an all encompassing and truly great friendship. Allan moved to Salt Lake City on Labor Day weekend. prior to transferring to a Club Med in Mexico. and neither he nor his wife are active in the L. When John arrived at the Club Med in Mexico and told the staff about Allan -. going everywhere together. his desire for social normalcy conflicting with his Mormon upbringing. Allan asked John to see if he could get him a job. subject to profound depression and had. the final prescription being for Zoloft which he never took. At home. and his mother is described as a very loving person as well. life in paradise was to come to an end. But. a bit confused. returned to the states to resume a life a bit less fantasy filled. He was. joining the same company John was working for and living with John and Karen as their roommate in their 2 bedroom apartment. And. had over the years been in thus far unproductive psychotherapy and had been prescribed various anti-depressants. A good. Karen. and had been since childhood. confusion brings strife. faith today. Following that. In the spring of 1995 all 3. evenings on the town having too much to drink sometimes. John working for a landscaping company. seriously manic-depressive. But. The good life continued briefly. with Club Med and over a 2 year period worked in the Caribbean and Mexico. John knew he needed to go home. doing everything together. Karen. at times. Finally. But it all came to an end the night of September 15th. The three became inseparable. The two became true bosom buddies. at no time did Allan share his burdens with John. fun time. But. John and Karen went to bed -. partying but not to excess. as well as for writing bad checks. working as a greenskeeper at a local private golf club. he experienced arrest and serious penalty for D. his charm. but it appeared to be a good healthy young adult life. Allan was playing host. During the ensuing months the friendship grew stronger and now included the friendship of John’s then fiancée. As described by John.S. but by about 2:00 a.they . there was a visit to a bar -more drinks and a few games of pool.I. and he did. So he and Karen left -. and Allan. and future wife. He’d had too much to drink. Everyone was having fun. caring deeply for his family. At the time John left his home town to work at Club Med he and Allan remained in close contact and when John visited home in the fall of 1994. After visiting at home. There was a bar-b-q at the home of John and Allan’s boss. Karen for Nordstrom department stores. in an effort to extricate himself and set himself on a new track. unknown to John. John.Allan said he’d catch a ride with someone else. his rock climbing skills which could be utilized in the resort’s recreation program -they told John they’d hire Allan and within a week Allan was in Mexico and at work.sacrificing man.his good looks.D. with his parents’ blessing. after a summer at home.

blowing his brains out and leaving me behind to find him and deal with this. 911 dispatches help immediately upon hearing of the presence of a gun. awaking at some point to go to the bathroom. the fear of blame. dead. Conversations with a coroner’s assistant ensue. Karen.5 hours). a call to 911. A good. you look good. The authorities ask them not to contact anyone until they can contact Allan’s family. He turns. John.John hears the sirens as they approach. notices Allan’s bedroom light is on. Karen is working with the coffee. tell what they know. disbelief. and for the first time spotting the gun in Allan’s lap. John and Karen are questioned. Arrival of an emergency crew from only 4 blocks away -. John said he sleeps incredibly soundly. a man I loved as much or more than any brother. etc. blood pooled around his head. though fears on John’s part they might blame him. John says: Allan is dead. I want you to know we don’t blame you for any of this. and John gets up. Tell me how sorry you are for me. but Allan’s father greets John with love and concern: "John. followed by Karen. He needs to talk to someone. good. compassionate crew." Relief. goes to the kitchen. He tells the emergency crew he wants to be with his mommy. Question from 911: Are you sure he’s dead? A return to the bedroom. He finds Allan lying on the floor beyond the bed. Next step: Get home to be near Allan’s family and his own. What if they think he shot Allan? The body is removed within about 30 minutes. semi-hysterical feelings. goes to peek in. not seeing John. Arrival in the home town on Saturday evening.a brief telephone conversation with an uncle as they pass through an Idaho town." John is internally outraged: "Don’t tell me you’re glad to see me and I look good."I can handle this. but then enormous emotional chaos when Allan’s father tells John he wants him to be the one to contact the boys’ mutual friends. also a call to a cleaning company to clean up the brains and blood. the necessary visit to Allan’s parents home. says: Don’t joke. Response to Event: John was interviewed nearly 3 years after the event. some clarity of thought -. fraternity brothers. But then she turns and sees him and knows things are bad and John is not joking. What if Allan’s family blame him? What if they hold him responsible for Allan’s death? A mostly wordless drive home (6. His memories and emotions are vivid and raw: Shock. His parents come out to greet them: "John. Shock. an $800 quote. Karen. seeing Allan’s light still on through his cracked door. She heads to the kitchen to make coffee." -. ghostly white. John consents and spends several hours on the phone. he made it home! She goes back to bed. John calls his sister anyway. Morning: John and Karen awake. 1989).were out like lights. Then. The Dance has ended (Arata/Brooks. share a few thoughts. Make me feel something other than the horror I feel about my best friend. then spends several hours meeting and talking to friends and acquaintances . this isn’t funny.

There was anger. While there is no desire to return to the location of the event. normalcy returned. . While there was some temporary loss of appetite. Cues easily set traumatic memories in motion. which persists to now. But today John feels strongly he has a significant stomach ulcer as a result of the ongoing traumatic stress. songs. John is closer now than ever to his wife Karen. but they are lesser now. fear of taking his own life in response to being unable to get past this. There is no real change in his relationship with his parents. but Allan’s presence in dreams that are not unpleasant also occurs with some regularity. Included in his feelings is a real. There were strong nightmares at first. and his temperament which is by nature solid and easy going could drift to volatility without great self control. Persistent sleep problems aggravate his emotions. who shared the actual event and shared for a time some of the friendship. discusses how they rely on each other for ongoing support. his memories are vivid and include exceptional detail. Karen. There is a strong sense of wanting to be done with this. His friends were open about the incident at the time. Mental images are incredibly strong and fear of disaster lurks behind every event. Initially there were intense sleep disturbances. They said he looked good and were glad he was all right which was nice but. and a fear of consequences. Never a day passes without an incident of some sort. at some who failed to respond appropriately to the incident and John’s feelings. in his opinion. But he feels stronger than ever feelings of love and closeness to his wife. now occasional nightmares. Triggered by sounds. not appropriate considering what he had just experienced. But John had already left college and many of the old relationships were dwindling at that time so no real change with most. if he doesn’t get over this.Follow-up Activities: John experiences constant reminders on a daily basis. and repeatedly vocalized. curious and loving. though still exist. he loves them very much though appears confused a bit. Among the residual emotions are a strong sense of feelings of estrangement from people who won’t recognize the severity of his emotions or the magnitude of the event. situations of familiarity they are strongly emotional and result in feelings of detachment as well as emotional response through crying. even now 3 years later. including thoughts of suicide. John remains close with his parents even though his immediate response was that his parents didn’t respond properly to him at the immediate time of the event. but he welcomed opportunity to talk with me.

The same horrors faced and lived together need to be exorcised from their daily lives through the intervention of a third party on whom they can unload. though. intelligent. He describes a relationship with Karen that concerns me in only one respect: His dependence on her. of pioneer. Summary: John is a strong. Age and Marital Status: Female. John said it seemed strange to have them say that. suffering chronic P. When Allan was alive they were Allan’s parents and he viewed them as such and had no closeness with them at all. limited involvement in Episcopal church The Incident: Martha had married Bill over 5 years before the incident. but now he now talks with them as he never did when Allan was alive. may be more burden than either of them is equipped to bear. He is. at an intense level. a happy and settled young couple. His love for his wife is a godsend and I’d love to meet her at some time. married Occupation: Rancher Personal Background: Upper middle class family. 60 now) . parents divorced. and her possible reciprocal dependence. self sufficient stock. It is incredible to me that my conversation with him was the first thorough emotional debriefing he has had since the suicide.T. at the time. and that no one. intervened with some level of force urging them to seek therapeutic help. I feel deep concern for him. With ample landholdings passed to . or another Psychiatrist who was involved in helping John and Karen extricate themselves from the lease on the apartment where the suicide occurred. 20 (at time of event. Case Study #3 Subject Name: Martha Sex. including Allan’s father who is a mental health professional. They were. and feel an intense need to help him find assistance for both himself and Karen.Allan’s parents told John they were going to sort of "adopt" him in Allan’s absence. clear thinking and well spoken young man who has experienced a personal horror no one should have to experience.D.S. without question.

Alan. is that at this point there is no end: There has been no closure yet. Kay. and the final . The impact of the event on Martha. Bill. came without surprise and was welcomed with thoughts of several more children to come. falling just after the death of one’s spouse (presuming a happy marriage). Summary: The death of one’s own child is perhaps the second most emotionally traumatic event that can be experienced. This can’t possibly be happening. It was morning. Martha suddenly started. with his military service and college behind him. Martha heads for the door. only in her own mind. Only idiots leave guns where children can reach them. time to load the 3 children into the truck and go to town. She hasn’t done that with anyone else before. Martha was busy. they were financially secure and Bill. disbelief: "This isn’t real. Alan and Rick loaded themselves into the truck. had settled in to be a Montana rancher for the rest of his life. coupled with those of mothering 3 small children. playing. It’s not a toy. from beginning to end. She and Bill were hunters and there was still a rifle hanging in the truck. Follow-up Activities: This event which occurred over 40 years ago evokes such strong memories and responses Martha has difficulty recounting them. I am unable to locate source materials that rank the witnessing by a parent of the death of one’s child as the result of the sudden and violent accidental actions of another of one’s children. We’re always so careful with guns. ultimately work her way through the entire event with inability to respond to the horror witnessed. grabbing Kay. Better tell the boys to keep their hands off. Rick pulls the trigger. A quick adjustment to the diaper. But what she hasn’t realized yet. were just about enough to wear her down at times. she says. Working away. Rick. from beginning to end. concerned with an oversight on her part. The next child Rick was welcomed equally enthusiastically and he was followed shortly by a daughter. As Martha was readying baby Kay for the trip. There was a lot to do on a ranch and the demands of ranch life.Bill by his maternal family. Kay. But she’s interrupted: She sees Rick pointing the gun at Alan. pushing it open and simultaneously beginning a call to the boys: Hands off the gun. She will." An overwhelming anguish engulfs Martha -. The oldest child. and then in a deadly game. somewhat preoccupied. Response to Event: Shock. time to get going. The process is one of going very slowly and allowing for a lot of breathing time. She says she’ll recount it all.

no real classroom work.T. a post. But. Age and Marital Status: Male. This school has no lunch period. Last one there is a loser! Into the car. And. has it good. Yes. hits a sign. single Occupation: High School Junior Personal Background: Middle class Hispanic family.child to be born in the future. His family has done well. it veers to the right from the road. returning before getting caught during the schools nutrition break seems like a fun and exciting adventure. he paid for some of it. all in all. remains to be explored. in any capacity. Let’s escape briefly during the 10 minute nutrition break. and the freedom from responsibility of school and the ensuing play time is eagerly anticipated. But. Ron loses control of the car. thirsty and restless. been sort of boring with little to engage the interest of the young men who are such good friends. Silence broken by creaking sounds. a quick exit from the parking lot. in fact. hissing sounds. member of Roman Catholic Church. The morning has. . 17. and then a mad race down the street to the main artery that leads to the 7-11. floor the gas pedal. and in an attempt to correct and prevent more damage. no assignments to be dealt with at night. Carl. well enough in fact for Ron to be driving a late model convertible.S. attends church though not regularly The Incident: It is the last week of school. The signal indicates dismissal for the nutrition break and the three race for Ron’s car. But. There’ll be a little work. Case Study #4 Subject Name: Tim Sex. life is good and the summer stretches ahead. the school’s offering of snacks does not tempt: A daring foray to the nearest 711 to grab some junk food. the interview to this point. something happens. Entry onto the main street. suggested any kind of counseling.m. Tim’s good friend. dripping sounds. Ron. but mostly the car came to him from loving parents. is revealing symptoms of chronic P.m. In jumping ahead. and releases at just after 1 p.D. a winding down of the activities of the past year. Let’s go! And then. the day has been fun -. the morning is dragging. Ron overcorrects. one significant fact has been discovered: At no time has any person. the boys are hungry. School begins at 7 a. whirring sounds. the car rolls and then it is over.

He has been advised. and its ramifications and believe. one child. at some level. The attorney is seeking damages based on lingering physical symptoms. And. p. Response to Event: Tim simply would not talk much about the event at this point. no school counselor. 30. at present. age 2 .T. July 1996. it may be greed. to date. 4) . Tim.S.D. to further a lawsuit seeking damages as a result of the accident. no one has suggested counseling: no priest. I hope Tim will receive some counseling. I have. by his family’s attorney to have no detailed discussion beyond the actual event with me. Follow-up Activities: This event which occurred only 3 months ago is far from closed. Tim has not been counseled. explained P. in any way. Tim and the other passenger are injured but will recover. Harvard Mental Health Letter. While my discussions with Tim and his family are not intended.S. Age and Marital Status: Female. based on their guarded responses. experience extraordinarily traumatic accidents with an incidence that is mind boggling. no physician. constrained from doing so. Legal action against Ron’s family’s insurance carrier is pending.S. and the attorney’s interest in potential gain through a P.D.T. page 8. Most of the actual physical events of the accident are a jumble of thoughts. I am asking the attorney to reconsider. married happily. Summary: I intend to stay in touch with Tim’s family and hope to complete this study. that will ultimately get Tim some therapeutic help.D. at this time. and hundreds of other young people. most of these details are remembered later. Tim lost consciousness at some point in the accident. The aftermath: Ron lies dead. that Tim is suffering P. in discussion with Tim’s family. And yet. the emotional symptoms being. He appears eager to talk with me but is. diagnosis.But. not even the lawyer prior to my introduction to the scene. through a haze.T. Case Study #5 Subject Name: Lisa Sex. immaterial to that case (see footnote.

Several months pass. Success. She was hospitalized and examination revealed a fetus in distress. She was heavy set already. More children would be in order soon. within 3 weeks there are problems: Spotting of blood again. Lisa and Aaron decide that this child will not be slighted: They take the body back to the mid-west for burial in a family plot. there were early and unexpected contractions. Now life can continue. But. suffering mongolism. After 24 hours delay a decision to induce and force the delivery. Lisa’s physician declares her healthy and fully recovered and Lisa and Aaron decide to once again let nature take its course. Lisa and her husband were delighted. How can this be happening again? Is everything ok? Am I going to lose this baby too? A rush to the doctor who confirms her worst fears: The fetus has died. But. The doctors are aware of it. no church involvement The Incident: Lisa’s first pregnancy was uneventful and the baby boy arrived without incident. At any sign of troubles Rhogam has been administered to Lisa to assure she is not sensitized. Perhaps she’ll become pregnant again. has 1 brother. and the results of the delivery devastating: A baby boy. Within 48 hours Lisa’s body spontaneously expels the dead fetus. Then. Sensitization inevitably results in the near impossibility to bear more . something not quite right. at birth. That plus chasing around a toddler. Due in December. and the burden of the pregnancy was wearing on her. the baby would come in the fall. upon examination the doctor declared everything ok and the pregnancy continued. But. Then the most devastating revelation: Lisa and Aaron have an Rh incompatibility problem. Lisa sensed. unexpectedly. Aaron’s job was a good one. A full funeral is conducted at a funeral parlor with the family and close friends attending. There is a great sense of loss. But. Before Aaron junior’s first birthday there was good news: Lisa was pregnant again. Life was good. There was. Absolute emotional panic ensues. Something was definitely wrong. by November Lisa was ready. within 24 hours reality prevailed: Lisa and Aaron sadly agreed to disconnect life support and the baby died within minutes.Occupation: Homemaker Personal Background: from a middle class family with whom she maintains close contact. The pregnancy proceeded without notable incident. and they had no financial or other worries. The delivery was not good. another pregnancy is confirmed. a heartbeat. brain dead but with. the contractions didn’t feel normal. Life support was begun. a mourning for this child that was given a name. There was one scare: A little blood spotting on Lisa’s underwear.

Lisa is suffering. hasn’t said a word to her about her psychological condition. It may be impossible for Lisa to bear additional children. The answer to my . at some point. her parents are deeply moved by her plight but are unequipped to assist her. Intra-uterine blood transfusions can be done. in late July 1998. The pregnancy might be aborted through the transfusion process. The event which occurred is ongoing. I made an earnest effort to determine if there was.D. to encourage Lisa. I intend. one things that is certain is that to date.S.D. or the transfusion might produce a damaged baby. probably during the pregnancy with the full term Mongoloid child. Summary Note As my research on this subject progressed and in particular as I discovered that among my five case studies there had been no effort at. Sleeplessness. though how long the suffering will continue is uncertain. hallucinations of death of her other child. that allowed mixing of fetal and maternal blood. or direction to. disbelief and the search for a medical procedure to assist in the successful delivery of another child. and resulted in her sensitization. no one has suggested counseling: there is no clergy in Lisa’s life. And this event occurred only 3 weeks ago. the reality of the recent miscarriage still being assimilated. and the uncertainty about her childbearing future being a major preoccupation. her physician.T. But. Response to Event: Anger.T. there was a rupture. in the public domain. But. if I perceive continuing problems. Summary: I have regular contact with Lisa and Aaron and I will be able to follow their progress through this event. and probably Aaron. counseling. symptoms begin to emerge. edginess. and a myriad of P. dreams.S. But there is uncertainty and there are absolutely no guarantees of success. however small. grief. any method of support readily available to individuals exposed to individual traumatic events who are suffering from P. His concerns are entirely physiological in nature. subsequent to Aaron junior’s birth. overprotectiveness. to seek counseling from some source.children. and the person who should be concerned with her mental condition. and have been successful.

comparable to Alcoholics Anonymous or Compassionate Friends will emerge. be a readily available volunteer support group for sufferers of P. particularly police officers and emergency medical technicians.S.unlv. I hope so and I intend to work to that end. who are frequently first on the scene of serious accidents be encouraged to offer. is based in British Columbia. cases.D. a referral card directing the potential P. at this time.S. raises a serious question: With so many minds at stake. the statistics of traumatic incident. is there not great logic in seeking and assisting in the establishment of voluntary support groups? Perhaps continued study and better education about and understanding of P. various Internet search engines) has revealed only one organized support group dealing with victims of Post Traumatic Stress Disorder. and a more complete presentation to the public of a clear picture of the problems and needs of sufferers and potential sufferers. Given that study.V. There are no support groups devoted to the victims.T. but a search of every source I have been able to access (U. shouldn’t there. and so much potential and actual counter-productive social dysfunction resulting from the disorder. be aware of the need for assistance? Shouldn’t they at least suggest seeking counseling? Recognizing the passage from history of the years of generous government funding to provide even marginally adequate public mental health services. Las Vegas-Clark County Library System.D.S. may not be present at the time of the occurrence.? And shouldn’t public employees. Don Stewart 2002 . Canada.S. even though P.T.D.L. and review of. Department of Sociology at the University of Nevada http://faculty. a return to.S. That organization.T.question.D. Library.T.D. out of simple human compassion and concern. in its infancy.D. and the probable correlation between those statistics and the development of P.T. is no. within the general public is I would like to be proved wrong. sufferers had no readily available suggestions for treatment.htm .S.N. But. perhaps a nationwide network of volunteer support groups. The State of Nevada Mental Hygiene Division provides some limited crisis intervention services and also provides counseling on a group and individual basis on a case by case basis but when quizzed about P.T. recognizing that traumatic incident has occurred. victim to a source of help? Shouldn’t physicians. at a minimum.