That Which Does Not Kill Us: PW Talks with John Rich

by Parul Sehgal — Publishers Weekly, 11/2/2009

Physician Rich investigates how powerfully—and frequently—post-traumatic stress disorders influence the lives of young African-American men who’ve survived a violent assault in Wrong Place, Wrong Time (Reviews, Oct. 5).

What was the impetus for the project?

Working at Boston City Hospital, I’d see so many young people in pain, so many young people who were angry, and I realized that our day-to-day hospital discourse didn’t have a place for them—other than as victims of violence. When I’d sit opposite these young people—who, if you saw their lives written up, might seem menacing—they weren’t menacing at all. Their distress was really close to the surface. I began thinking that there’s a disconnect, even in my own mind, in my own deeply held assumptions as an African-American man. I thought it was important to go on a journey of understanding: what’s it like from their perspective? And how might that inform what I might do as a physician?

You write that many of your subjects exhibit the same post-traumatic stress disorders as war veterans and rape victims. What behaviors have you seen specifically?

They face all the stereotypical symptoms: intrusive nightmares and flashbacks. I remember a young man who was in the hospital who got so anxious that it seemed he was having a psychotic break. But when a clinician talked to him, it became apparent that seeing other young men (many of whom dress in similar garb) prompted a flashback, and he was re-enacting what had happened to him. Depression, isolation and avoiding any place that might activate this hypervigilant mode is also very common. But the one symptom that was most striking to me is the loss of the ability to feel that I discuss in David’s case. When David and his cousin were shot, David felt both fear and incredible love for his cousin—and those are the very feelings that have become unavailable to him. To the outside world, he may seem remorseless, but he’s wounded. Lacking real access to health care, these young men might do what’s in their environment: they might smoke a lot of marijuana, which can cut off other opportunities. It becomes a vicious cycle.

You write that the experience transformed you. As a practicing physician, how have you changed?

I’ve come to understand why trauma is such a critical part of what we have to address. Trauma changes the body; it changes behavior and in the social context of poverty and violence, it may be the real thing we have to deal with. If in fact our jails are filled with young people who are deeply traumatized—and I’m not making excuses, merely providing explanation—then our imperative ought to be to make sure that they get the care and treatment they need rather than to strip it away as part of punishment. If we don’t understand trauma as the central problem, then our policies will undermine the ultimate goals we say we want. If I’ve been changed, it’s been to replace the question “What’s wrong with this person?” with “What happened to this person?”

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