534 TREATMENT OF SPECIFIC ANXIETY DISORDERS
of law. He believed that personal threat or danger could be minimized through caution,
discipline, and resourcefulness. He held to a personal code of morality and believed in
the dignity and fairness of humanity. Edward’s self-view was of a strong, confident,
hard- working individual who treated others fairly and expected the same in return. All
of these fundamental beliefs about himself, the world, and the inherent good and dig-
nity of humanity were shattered in Rwanda.
There was no single, specific traumatic event that elicited Edward’s PTSD. Rather
it was multiple experiences of threat to personal safety such as clearing land mines in
Bosnia or being threatened at gun point when passing through road checks in Rwanda.
It was witnessing the tragedy of war such as being confronted with masses of starving
and frightened Rwandans, coming across mass graves, churches crowded with dead
civilians, and rivers filled with dead floating bodies. However, one of the most promi-
nent experiences was the disappearance of children from an orphanage he had visited,
especially a 5-year-old Rwandan girl who had befriended him. At the time of these
experiences, Edward suppressed his emotions, using humor and a superficial bravado
to distance himself from the circumstances. Though feeling shock and disgust by what
he witnessed, he soon became numb and dissociated himself from these repeated expe-
riences. He treated threats to his personal safety as “just doing my job” and when he
returned home there was no acknowledgment of what he had seen or experienced. He
was expected to slip back into his normal life and work routine as if nothing had hap-
pened.
Edward’s Trauma Memory Narrative focused on what he remembered about the
day his convoy arrived at the orphanage and the little girl’s absence along with that of
dozens of other sick and injured children. Edward could only remember aspects of that
day that confirmed his assumption that she had been murdered. He was unable to recall
aspects of the experience that would suggest other reasons for the little girl’s absence
from the orphanage. His recall was mainly driven by strong feelings of rage, sadness,
and guilt for what he assumed was the brutal death of the little girl. He experienced
fragments of the memory in which he had intrusive images of the little girl and a gorilla
dressed in an RPA uniform. These images could occur spontaneously or be triggered by
certain external reminders of Rwanda such as being in a crowded store or on a certain
section of highway on his way to work. His main emotional response to the intrusions
was anxiety, anger, and guilt.
Edward had a strong sense of self-blame for Rwanda. He believed that as a UN
peacekeeper he did not do enough to stop the genocide and he blamed himself for not
protecting the little girl. He believed that the genocide had permanently changed his
beliefs and attitudes about himself, the world, and other people. He concluded that he
would never be able to get over its effects, that it had permanently scarred him. Edward
believed that danger to himself and his loved ones was much more likely and that he was
left a weak, vulnerable person. He must remain vigilant and onguard, especially when
around other people. He believed he had utterly failed himself and that his future looked
bleak and unfulfilling as he tried to struggle with the guilt and anger of his war- related
experiences. He stated, “I cannot plan ahead; I have lost all control of my life.” His pre-
dominant view of himself was that of a guilty, worthless, and empty individual with no
interest, no energy, very limited ability, and no future. In other words he suffered from
what Ehlers and Clark (2000) called “mental defeat.”