In the fall of 2010, reporter Mac McClelland was sent to Haiti to cover the country’s recovery nine months after the island’s devastating 7.0 earthquake, which affected 3.5 million of Haiti’s residents. McClelland arrived in Haiti after spending four months in New Orleans covering the Deepwater Horizon oil spill. So she was no stranger to disaster scenes. But the post-quake squalor of Port au Prince, Haiti’s capital, shocked her. Driving from the airport to her hotel, she was confronted with miles of displacement camps, tent cities where thousands of Haitians, many of them children, lived in subhuman conditions, without running water or toilets. There was not enough food and water or security. Violence, especially sexual violence against women and children, was rampant. On her first day of reporting, McClelland witnessed an act of sexual violence so shocking that she found herself dissociating, her conscious mind leaving her body and watching the scene from afar.
This instance of dissociation would change McClelland’s life, although she didn’t realize it at the time: “In the moment, though it was extremely disconcerting, I didn’t have time to think or worry about it.” Instead, McClelland continued her reporting trip, during which she began to exhibit strange symptoms: she felt buzzed and shaky; parts of her body went numb and seemed to disappear; and most disconcerting, she found herself crying uncontrollably for hours at a stretch. Eventually McClelland heeded a friend’s advice and ended her reporting trip early. But at home, things only got worse. Desperate, McClelland visited her old therapist, who told her that she seemed to be exhibiting symptoms of PTSD. McClelland told her therapist that sounded “absurd” and that PTSD was “for veterans”, not reporters, mere witnesses.
Irritable Hearts is the story of what happens after this “absurd” diagnosis. It’s a memory of recovery, a thoughtful and well-researched record of one woman’s experience with a subtle and often terrifying condition. McClelland delves into the history of PTSD as well as her health history, her romantic and familial attachments, her career ambitions, and her childhood. With the help of her therapist, she learns to stop seeing her breakdown as sign of weakness: “My symptoms were not a dysfunction, but an adaptation to some very dysfunctional situations, situations I hadn’t fully processed. Trauma had been perpetrated upon my body, and lived in my body. It was my body reacting to trauma.”
Post-traumatic stress disorder, or PTSD, is most commonly associated with soldiers. But war experience is actually not the most common cause of PTSD. Instead it is violence against women, the subject McClelland was immersed in and what she witnessed just before her dissociative episode. In her research into the history of PTSD, McClelland was startled to learn that Sigmund Freud himself made a link between sexual abuse and PTSD-like symptoms. After hundreds of interviews, Freud found that most of his female patients, the ones so famously plagued by “hysteria,” were victims of sexual abuse. His theory was that their symptoms were the body’s natural response to trauma.
This wasn’t something anyone wanted to hear in the late 19th century and unfortunately it’s still an uncomfortable subject for the public to explore. McClelland learned of this discomfort first hand in 2011, when she published a personal essay about her experience with PTSD. The essay detailed her sexual difficulties in the wake of her diagnosis and the counter-intuitive treatment she’d found comforting: violent sex with an ex-boyfriend. I first became aware of McClelland through this piece and no doubt many others did as well. The essay got a big response online, much of it positive, but in the way of so many online debates, the negative was really, really negative. McClelland was labeled narcissistic for writing frankly and unabashedly about her sex life. Her status as a victim was also questioned, and critics accused her of exaggeration and self-glorification. Some even labeled her a colonist. A second backlash questioned her reporting and ethics.
The comments gave voice to McClelland’s worst fear: that she didn’t, somehow, deserve to have PTSD, that a tougher person, a stronger person, would have been able to witness something horrible and recover quickly, that a better reporter would not be so vulnerable to other people’s suffering. McClelland’s symptoms got worse in the wake of the essay’s publication: “I found it impossible not to feel attacked. And sorry for myself. My sorrow extended far beyond my own suffering…[I felt] sorrow for anyone who’d been traumatized and now heard trauma called narcissistic or weak because of me.”
The thing is, McClelland is an unusually compassionate and strong person. This came across to me in her essay and it comes across again and again in her memoir. Even as McClelland spends much of the book detailing her mood swings and crying jags, what emerges is a portrait of a capable, independent, and resilient woman. She’s the kind of person who, when she finds herself unexpectedly saddled with thousands of dollars of debt (thanks to her father, who secretly took out loans in her name), does not wallow in misery but instead works three jobs until the debt is paid off. She’s the kind of person who decided, a few months out of grad school, that she would write a book about the Burmese refugee situation, and then four years later, published that book; she’s the kind of person who, after spending four months reporting on one of the worst man-made natural disasters, accepted a reporting assignment to Haiti. If McClellan has a fatal flaw, it’s that she doesn’t know her limits. That’s the lesson that PTSD eventually teaches her, by forcing her to pay attention to her body’s self-protective defense mechanisms.
One of the positive results of the controversy surrounding McClelland’s article was that a number of sufferers of PTSD wrote her notes of support. McClelland includes several of them in Irritable Hearts and they are a dispiriting reminder of how mental illness is still a taboo subject in the U.S. Through these letters, McClelland is introduced to a community of PTSD sufferers, many of them veterans of the wars in Iraq and Afghanistan. If there’s anyone who can understand McClelland’s shame for not being “tough enough,” it’s veterans. As one marine, Chris, writes to her: “Marines are a rare breed. We don’t ask for help when we need it. That’s why I have lost 6 of my buddies to suicide after we got back to the States.” After meeting Chris in person and hearing about his experiences first-hand, McClelland feels sheepish bringing up her own trauma, as a witness. But McClelland soon learns that within the PTSD community, people don’t tend to compare traumas:
He wasn’t interested in saying to me, “What happened to you is not that big of a deal”…Any more than Chris would say to an earthquake survivor, “You know what’s really awful? War.”…This atrocity hierarchy, which one’s nervous system is unfortunately unaware of, is imposed on traumatized people by non-traumatized people.
This gap in understanding between the traumatized and non-traumatized, and more generally, the mentally healthy and the mentally ill, comes up often in McClelland’s reporting. Americans simply don’t have a way of talking or even thinking about mental illness without attaching stigma to it. We blame those with mental illness in a way that we don’t blame people with bodily illnesses, and in fact we don’t even specify “bodily” illness, so that the modifier “mental” is a way of putting it into a different category, one that doesn’t require as much sympathy or support. Certainly our healthcare system treats mental illness in this way, requiring people to jump through hoops and/or pay huge deductibles before supplying the bare minimum of care. McClelland describes her efforts to have her PTSD recognized by her insurance provider, but doesn’t lose sight of the fact that she’s lucky to have enough savings to cover the cost of her treatments until she receives coverage. Many of the people she interviews are not as fortunate.
I’ve neglected so far to mention the love story woven through Irritable Hearts, and which provides the subtitle: A PTSD Love Story. In a chance meeting that seems, in retrospect, fated, McClelland kisses a French soldier on her first night in Haiti. The soldier, Nico, has his own psychological baggage and is unfazed when McClelland begins to behave erratically. The two embark on a long-distance love affair, even though little about their pairing makes sense. He’s a lot younger than her, barely speaks English, and is stationed thousands of miles away. She’s recently divorced and in the throes of a personal and mental breakdown. Yet their connection is strong. At one point they break up but promise not to marry other people until they’ve seen each other again. They want to be together but, as if in some kind of perverse romantic comedy, there are a lot of obstacles.
One of the biggest obstacles is that McClelland can no longer enjoy sex. She undergoes somatic therapy, a kind of intense talk therapy that incorporates touch. A therapy that acknowledges and works with PTSD’s physical symptoms seems like a sensible course of treatment, yet most veterans still receive cognitive therapies, which can sometimes re-traumatize patients. For McClelland, somatic therapy was the only thing that worked: “My symptoms were in my body; my fears were for my body…I’d had to accept that I wasn’t going to be able to rationalize my way out of it. Believe me. I’d tried.”
McClelland’s writing about sex, about her body, and about her relationships is fearless and revealing. I imagine that a lot of people suffering in the wake of trauma will find this memoir comforting because McClelland does get better, and at the same time, she doesn’t gloss over the time and patience that healing requires. If I haven’t written much about McClelland’s relationship with Nico, the soldier who eventually becomes her husband, it’s only because it’s difficult to summarize. Love is simple, but people are complicated, and McClelland explores this dilemma as she describes the ups and downs of dating while mentally ill. What struck me most about McClelland’s portrayal of her relationship with Nico was just how hard she was willing to fight for it. She wants to love and be loved, she wants to do meaningful work, she wants to “feel herself in the world”. As her therapist observes, “You’re so hungry to get better.” It’s hard not to root for a narrator like that.