Post Traumatic Stress Disorder (PTSD) is a Psychiatric syndrome characterized by behaviors such as poor sleep, frequent nightmares, “flashbacks” (a vivid reliving of traumatic events), intrusive memories of said events, social isolation, difficult relationships at home and work, problems relating to authority, hypervigilance, mood swings and/or episodes of irrational or excessive anger. PTSD clients also commonly have a foreshortened sense of survival and exhibit signs of a hyperactive nervous system such as “nervous tics,” tremors, chronic motor restlessness, etc. [1][2] And, by definition, PTSD is caused by exposure to a trauma that the individual finds severe or overwhelming. Or is it?

The truth is that PTSD can be a sort of “infectious” psychiatric problem passed on to others, especially close family members. [3][4] The old Biblical maxim about the sins of the fathers being passed down to the third or fourth generation is true, in a sense, because it can take three or four generations for the effects of trauma to dilute out in a family. [5]

Our diagnostic texts are not fully cognizant of this butat least the therapeutic community is responding. The Holocaust Survivor’s projects in New York have treated the children of survivors for many years and are now seeing some grandchildren.[6][7] The Alanon Adult Children of Alcoholics program now includes adult grandchildren. (Sadly, our own US Veteran’s Administration is not making any concerted effort to help children of PTSD vets., even those with service connected disabilities for the syndrome.)

It can be fascinating to treat the second generation “G2’s”, though. One of the things which especially strikes me is how common it is, at least in my patient population, for the G2 to actually experience nightmares or flashback like events, reliving the trauma of their family member.

I personally recall a case of a young woman in her late 20’s who practically turned into a Vietnam veteran herself after her husband’s suicide. She took to wearing pieces of Army uniforms, using GI slang, and quickly progressed to having vivid nightmares of being in combat herself. (This was an individual with no military experience or even military background at all.) She even quit a secretarial job to work as a laborer in a Government warehouse so she could be around “other veterans.”

And, early on in my career, I saw the young adult son of two Holocaust survivors. He had suffered bouts of severe depression for years and had finally gone totally psychotic with delusions that he was some sort of red blood corpuscle and there were bad white corpuscles trying to ferret him out and totally destroy him. It doesn't take Freud to see the symbolism there. Interestingly, his psychosis had a very minimal response to the best treatment available at that time, Haloperidol and Lithium, even though this typically is still an effective combination.

Cross generational PTSD is becoming a common theme in current fiction. Pat Convoy’s novel “Beach Music” portrayed a young Jewish woman, Shyla, who was the child of two Holocaust survivors. She suffered progressively worsening bouts of depression and finally committed suicide. Also, the film “Coming Home” starring Bruce Willis does an excellent job of portraying a young woman whose father got killed in Vietnam and her battle with severe emotional constriction and detachment.

How is the “infection” transmitted, so to speak? One all too common way is through child abuse. Adults with PTSD have a higher than average incidence of alcohol use [8][9], affecting up to 60% of men presenting for treatment of Vietnam related PTSD in one study, [10] and can be prone to sudden, irrational rages. Obviously this is a high risk situation. And this creates much confusion for adult children trying to sort out their lives or help others do the same because it can be very difficult to separate the effects of the direct abuse as a first generation (G1) survivor from the effects of being a second generation G2.

A friend who reviewed this article, Dr. Russell Davis, pointed out that this situation quickly gets more confusing because of the tendency of some abuse survivors to identify with their abusers, thereby achieving some degree of control over both their anger and their feelings of fear and helplessness. Needless to say, this complicates the problem of unraveling G1 from G2 effects even further.[11]

Another more subtle “hand me down” situation are parents who tell “gory stories,” describing their trauma in graphic detail around the children. There is always a “judgment call” element here but PTSD parents must take care to not give their children more than they can handle. While it may be appropriate to tell a teenager about a buddy who died in combat, it would be best to simply tell a younger child that daddy sometimes gets sad about some things that happened in the war. And there is never any justification for detailed descriptive accounts with your kids. Save it for a therapy group.

There are pure G2’s, persons who suffer purely from the indirect effects of their parent’s experiences. Again, I refer you back to the Conrad novel, “Beach Music.” Shyla had a perfect childhood, all that a girl could ask. Her parents were financially secure and gave her most enough of what she wanted but not enough to spoil her. They attended to her every physical need, almost compulsively. They kept a perfect home, never drinking to excess and never, ever having even a minor argument.

But, emotionally, there was nothing there. Her mother was riddled with fear and obsessed with the gold coins she had kept hidden to help her survive the war. Shyla’s father was overwhelmed with guilt about collaborating with the Nazis but still losing his first family in the camps. He was an urbane and polite man but he was beyond emotionally constricted; he was totally shut down. So, the lack of emotional nurturance and feedback is a major part of the G2’s problem.[12]

Another major issue is blaming oneself for the G1 parent’s changes in mood, commonly seen in younger children. All they see is that their parent sometimes gets very sad or angry and, with the typical narcissism of childhood, they assume it’s all their fault. These childhood misperceptions often carry over into feelings of chronic inadequacy in adulthood.

Many G1 parents try so hard to create a “perfect” life for their children that they smother them with excessive expectations or respond to normal adolescent anger and attempts at differentiation with, “How could you? You’ve had it so easy. After all we’ve done for you....”

What to do about the G2 syndrome is beyond the scope of the present article. Let me just say, if you think you are a G2, get help and find a therapist who is familiar with PTSD. Antidepressants and anxiolytic drugs can be helpful, even life saving, but do not get trapped in a misdiagnosis like “panic disorder” or “recurrent biological depression.” You need someone to talk to.

And how do you know if you may be a G2? Well, the first step is to review the symptom checklist at the start of this article. How many do you have? And pay special attention to looking for “second hand” phenomena. If daddy was a combat veteran, do you have “crazy” dreams, fantasies and even flashbacks like you were in combat yourself? If your mother is a rape survivor, do you also jump whenever someone walks up behind you?

Whether you are the client or the therapist, I believe the most important diagnostic tool is an accurate family history. Is one of the parents a combat veteran? (Remember here that women in wars before Desert Storm were often assigned to medical duties, which means an especially high risk for PTSD.) Was one parent or both of them physically or sexually abused? Are any of the grandparents excessive drinkers or were they when their children were young?

If you think you may be a G2, gathering this information may require a frank talk with your parents. In other words, don’t trust your memory because many families have their “little secrets”. I recommend talking to each parent separately here. And, of course, show sensitivity for their feelings and possible pain. But is okay to ask, “Were you abused?” or “What happened to you in the war?” In fact, you have a right to know.

Remember, you don’t want to necessarily take “No” for an answer. Did you receive a basic “No” with perhaps a touch of indignation? Or did you receive an angry “How could you think such a thing?” Here, especially, close contact with an experienced PTSD therapist is essential. False accusations and even false memories occur and it takes a real pro to sort things out. [13]

Finally, don’t give up hope. More and more work is being done almost daily on treating second generation PTSD and the tools you need to help yourself or your client recover are out there. And, just being aware of the problem is more than half the battle. G2’s have a tendency to feel responsible for their parent’s problems and, it can seem, the problems of the whole world. Just knowing what they are dealing with can give an empowering sense of “It wasn’t my fault” and this is where healing begins.

Notes:

1: Kaplan, H.I. & Sadock B.J., Pocket Handbook of Clinical Psychiatry, Williams and Williams, Baltimore, 1990. p. 99.

2: Dave Baldwin’s Trauma Pages, http://www.trauma-pages.com/. (This site contains an excellent discussion of PTSD characteristics.)

3: Beckham, J.C.; Braxton L.E.; Kudler, H.S.; Feldman, M.E.; Lytle, B.L.; Palmer, S. Journal of Clinical Psychology, 1997 Dec; Minnesota Multiphasic Personality Inventory Profiles of Vietnam Combat Veterans With Posttraumatic Stress Disorder and Their Children.

4: Motta, R.W.; Joseph, J.M.; Rose, R.D.; Suozzi, J.M.; Leiderman, L.J. Journal of Clinical Psychology, 1997 Dec; Secondary Trauma: Assessing Inter-generational Transmission of War Experiences With a Modified Stroop Procedure.

5: Exodus 24:7

6: Solomon, Z.; Kotler, M.; Mikulincer, M.; American Journal of Psychiatry 1988 Jul; Combat-related Posttraumatic Stress Disorder Among Second-Generation Holocaust Survivors: Preliminary Findings.

7: Reifman, A., et.al., American Journal of Psychiatry, 1998 June; Relationship Between Posttraumatic Stress Disorder Characteristics of Holocaust Survivors and Their Adult Offspring.

8: Reifman, A.; Windle, M.; Journal of Trauma and Stress,1996 Jul; Vietnam Combat Exposure and Recent Drug Use: a National Study.

9: Stewart, S.H., Psychological Bulletin, 1996 Jul; Alcohol Abuse in Individuals Exposed to Trauma: a Critical Review.

10: Recent Developments in Alcoholism, 1988; The Interrelationship of Substance Abuse and Posttraumatic Stress Disorder. Epidemiological and Clinical Considerations. Keane, T.M.; Gerardi, R.J.; Lyons, J.A.; Wolfe,J.

11: Russell C. Davis, PhD; Personal communication, July 4, 1998. (Dr. Davis’ practice deals heavily with Critical Event Debriefing of disaster scene first responders, such as Police Officers, Firemen and EMTs.)

12: Conroy, P., Beach Music, Nan A. Talese Imprint of Doubleday, New York, 1995. (See especially Shyla’s father’s discussion of his inability to love his family at the bottom of p. 520.)

13: What’s New, Critical Issues in Trauma, http://www.istss.com/critical.html (This site contains an introductory discussion of childhood trauma and memory with chances to learn more.)

10/08/98