The Nobel Prize for Psychological Health

On October 10th of this year, 17-year-old Malala Yousafzai became the youngest ever recipient of the Nobel Peace Prize. When she was 11 years old, Malala began speaking against the Taliban’s movement to ban girls from attending school in Pakistan, despite continual death threats against her and her father. Malala continued to travel in dangerous wartime conditions to go to school even when only 10% of her fellow students were in attendance. After several years of garnering worldwide attention for girls’ educational rights, the Taliban attempted to assassinate 15-year-old Malala. The assassins boarded her school bus and threatened to kill every passenger unless Malala identified herself. Malala stood up and was shot in the head. After stabilizing from critical condition and removal of the bullet near her spinal cord, Malala was transferred to a hospital in England to recover from infections, restore hearing loss, and reconstruct her skull. Malala remained in England with her family to continue her education and rehabilitation. Despite criticism from other Pakistani people that she is making their country look bad and perpetrating Western agendas, Malala resumed her fight for educational freedom. And the rest, as they say, is history.

One of the jurors who disagreed with the award stated, “This is not for fine people who have done nice things and are glad to receive it. All of that is irrelevant. What Nobel wanted was a prize that promoted global disarmament.” Access to education is a very necessary step toward global disarmament, dummy.

After reading that…intriguing(?)…opinion, my first reaction to learning of Malala’s story was my God, that poor girl must be traumatized for life. I imagined her as a withdrawn girl who awakened every 20 minutes at night in a cold sweat. A girl who could not board a bus without her knees shaking and heart pounding. A girl who moved through her days with that gun perpetually pointed at her head. A girl with PTSD.

But reports claim that she has recovered tremendously well. Although we may be unaware of what scars remain, the fact that she has continued her work with such fervency since her assassination attempt indicate that she may not be suffering from the devastating injuries that physical and psychological trauma can imprint on a person.

As a PTSD researcher, one of the most important questions in my mind has always been this:

After experiencing a traumatic event, why do some people develop lasting debilitating stress, fear, and arousal responses, while other people who experienced the exact same event recover quickly?

The fact that some people can essentially be fine after getting shot in the head fuels the stigma that people who do go on to develop long-lasting psychological problems like those associated with PTSD (anxiety, fear, aggression, sleep problems, exaggerated startle, dissociative flashback episodes, hypervigilance, emotional problems, etc.) are weak or over-reacting (see Mental Illness Awareness Week post #1). “Other people have been through so much worse and came out fine,” may be the least helpful statement that can be made in the aftermath of trauma.

One of the most important activism issues to address is the “get over it” responses that have stigmatized PTSD for decades. Traumatic stress can physically injure the brain, and when not intervened properly, these injuries are not easily reversible. Some people, for a combination of currently elusive reasons, are more vulnerable to the effects of traumatic stress, while others are resilient. While there are genetic and environmental factors that influence the risk for developing PTSD after trauma, the single greatest risk factor is lack of social support. With the proper social support immediately following trauma, the likelihood of recovery is exponentially greater. When you have people telling you to “get over it” or that “everybody has nightmares, no big deal” you retreat into yourself and do not continue to seek support. Traumatic memories can get stored improperly in the brain in a way that they lack narrative context, so when reminded of those memories, a person may just feel them as a flood of emotions or flashes of visualizations that are completely overwhelming as if the trauma was happening all over again. But when you consciously give narrative context to what you see and feel by talking about it in detail (i.e. social support), those memories may eventually be associated and stored with that narrative context. Then, when you get reminded of a traumatic event, you remember it as you do most other memories, as a chronicle of what happened without the overwhelming emotions and fear.

One popular “science” magazine hailed Malala for her resiliency:

“If there was a Nobel Prize for Psychological Health, Malala Yousafzai would have won it too.” 

Psychological health is not a prize to be won; it is a basic human need. I am so happy for Malala that she had the social support, healthcare accessibility, and biological characteristics to facilitate her physical and emotional resilience to trauma, but for so many people, those conditions are simply not there—and that makes them what? Losers? As many as 1 in 10 women suffers with PTSD. That is far too many.

I can’t help but think of all those other people on the bus—each one of them should have been taken to the hospital right along with Malala. There might not be a physical hole in the head, but that kind of extreme stress—where your own life is threatened and then you watch the blatant assassination of a comrade—can do just as much, if not more, damage to the brain as a gunshot wound. Everybody who has experienced trauma deserves (and needs) to have their experience validated—that it was scary, that it was painful, and that it may feel that way for a long time (or not if you’re more resilient or less susceptible to brain inuries), but it can get better.

Read more about this year’s Nobel Peace Prize laureates here.