Surviving PTSD: A Q&A with Virginia Eubanks

Virginia Eubanks, in glasses and a blue jacket, speaks at a microphone at a podium
Virginia Eubanks, speaking in Utrecht, Netherlands, in 2019. (Photo: "Privacyrede 2019 met Virginia Eubanks" by Sebastiaan ter Burg, licensed under CC BY 2.0)

ALBANY, N.Y. (July 7, 2022) — Virginia Eubanks is an associate professor of political science and investigative journalist whose 20-plus year research into technology and social justice has resulted in the books Automating Inequality: How High-Tech Tools Profile, Police; and Punish the Poor; and Digital Dead End: Fighting for Social Justice in the Information Age.

This week Eubanks published a personal essay in The New York Times Magazine, available online now and in print on Sunday, about community violence, PTSD and caregiving, all stemming from a brutal attack on her partner in 2015. She is working on a memoir about the experience.

PTSD is far more than a combat condition — nearly 11 million people in the United States suffer from it. What have you learned about non-wartime PTSD, and the efforts understand and treat it?

We tend to believe that PTSD primarily impacts male soldiers. While it is crucial to address combat-related trauma — and the Department of Veterans Affairs (VA) does the lion’s share of PTSD research in this country — most people with PTSD aren’t military, or male.

In fact, less than 25 percent of PTSD cases stem from military service, according to a 2006 National Comorbidity Survey—Replication, which found 1.8 percent of men and 5.2 percent of women had PTSD in the 12 months prior to taking the survey. The most common cause of PTSD in men was combat; the most common cause in women was rape and sexual assault.

Sexual violence is also more likely to result in PTSD than combat. The VA estimates the prevalence of combat-related PTSD since Vietnam at between 2 percent and 17 percent, but more than 41 percent of victims of rape or sexual assault develop PTSD within a year of their attack. A conservative estimate from the Bureau of Justice statistics put the number of rapes and sexual assaults at half a million in 2019. If 41 percent of those victims developed PTSD, that’s 191,000 people — roughly the same number as total active combat deployments that year.

If you develop PTSD serving your country, we absolutely have a collective obligation to provide the support and resources you — and your family — need to heal. But don’t we also owe something to survivors of rape, sexual assault and community violence?

What’s one thing you wished others knew about PTSD?

One of the most useful concepts I learned in my research is the “window of tolerance,” the mental range in which you function more or less normally and can adjust to stresses. Trauma shrinks your window of tolerance so that you lose resilience, mental clarity and emotional regulation more easily. 

For me, the key insight is that there are two ways we react when we are pushed out of our window of tolerance. We can become hyperaroused, going into flight or fight mode — anxious, enraged or overwhelmed. But we can also become hypoaroused, going into freeze mode — numbed or withdrawn.

Hyperarousal matches the cultural picture we have of PTSD, but we don’t always recognize the avoidance and withdrawal of hypoarousal as danger signs. I fear too many people don’t get treatment and continue to suffer because this less explosive reaction to trauma doesn’t look like what we expect from post-traumatic stress.

You write about the “broken healthcare system” and the exhausting amount of paperwork, phone calls, rejections and follow-ups that caregivers deal with in both emergencies and chronic conditions. What can be done to make the system more accessible and flexible?  

In many ways, Jason and I had the best-case scenario version of PTSD. I’m an academic and an investigative journalist, and I spent many years as a welfare rights organizer, so I know how to research and navigate complex systems. Jason immediately sought treatment and we had tons of support from friends and family. And yet, almost four years after the attacks, we reached this moment we call “The Reckoning,” when we desperately tried — and failed — to get Jason an in-patient bed in a behavioral health crisis center.

Even before Covid, budget cuts and rising demand created shortages of both psychiatric beds and providers. This problem is particularly acute in nonmetropolitan areas — if you are seeking emergency mental healthcare outside a major city, too often you are out of luck. If you take that terrifying step of going to the hospital and asking for in-patient behavioral health treatment, there should be enough capacity to accommodate you.

We also need investment in community-based mental health services to keep mental health conditions from becoming crises. Without this, the labor of care falls to friends and family, who are often underprepared, overextended and terrified. Or, in the worst-case scenario, people in mental health crisis end up in prisons and jails.

This is why we need to expand access to resources like the Program of Comprehensive Assistance for Family Caregivers (PCAFC) both in and beyond the VA. The PCAFC provides 37,000 families of seriously wounded veterans with healthcare, training and a small monthly stipend to support their caring labor. We need a parallel program for the caregivers of people recovering from rape, community violence or natural disaster.

What would have helped Jason and me most directly is early and comprehensive support after the first attack. He had obviously been the victim of a savage beating. His jaw was broken in three places, one of his eye sockets was broken, one of his cheekbones. He had been unconscious for a significant length of time. We should have — at the very least — received a pile of brochures about PTSD, traumatic brain injury and the challenges of caregiving. Early intervention leads to much better outcomes for both PTSD and TBI. And more practical support would have helped me help Jason more effectively. We should have been assigned a social worker to help manage the crisis and access community resources.

The good news is that there are resources available for caregivers, for example, the NYS Department of Health caregiver guide and caregiver training and support groups. But I didn’t learn about them until a New York Times Magazine factchecker found them, almost seven years after the first attack. And I’m a professional researcher!

One of the most difficult things about my experience as Jason’s partner was feeling like I had to invent a makeshift mental health system from scratch, during the scariest time of my life. I believe the lack of support and intense feelings of helplessness contributed to the mild case of PTSD I developed myself.

As a scholar, professor and investigative journalist, what was it like to tell a story so personal?

The essay started as a love letter to Jason. Over time, it became a love letter to myself.

Writing it has been both a deeply strange and a weirdly useful process. I am, essentially, reporting on my own life. Because of the cognitive impacts of trauma, neither Jason nor I have perfect recall of the most difficult parts of our experience. That meant that I had to investigate us — interview friends and family, record and transcribe our couple’s therapy sessions, dig around in the clinical literature.

In the end, the essay was helpful for our healing. In dozens of conversations about it, Jason and I unearthed and defused emotional landmines we might have otherwise been tempted to leave buried. We stretched ourselves — sometimes painfully — to see this experience from each other’s point of view. Sharing early versions of the essay with therapists, family and friends has helped weave us back into our community.

Being this vulnerable in public, though, inviting scrutiny of the most difficult times of my life, feels like a risky choice. I almost chickened out many, many times. But then I’d remember how alone I felt when I was going through the worst of it, how desperately I searched for resources on caregiving for someone with PTSD. I found almost nothing — and ended up buying a bunch of manuals on open water lifesaving. That felt closest to what I was doing: pulling Jason out of choppy seas again and again, or treading water just out of reach, watching him go down.

I wanted people like me to feel less alone. If there are 11 million people living with PTSD in the U.S. right now, there are probably 11 million of me out there, too. During my worst times, I desperately needed one story that said, “This is so hard. If you want to stay, that’s OK. If you want to leave, that’s OK.” I needed to feel seen. I needed to feel like I had options. I needed to feel like I had fellow travelers.

That’s what I hope the essay accomplishes.