Randy’s boss put him on probation. When it happened, he was
so shocked he went numb. It was so unfair, but there was nothing
he could do about it. Later in the day he had a panic attack,
and he had nightmares about it that night. The next day, Randy
could barely get out of bed. Just waiting for the bus to work he
got so nauseous that he had to go home. His doctor authorized
a two-week stress leave, but Randy didn’t feel any better at the
end of that time. He knew he’d have to go back to the same
difficult and painful situation. After a few weeks, at his doctor’s
suggestion, Randy went to see a therapist, who diagnosed him
as having PTSD. It’s been three months now, and the stress
leave has turned into a long-term disability that, conveniently
enough, gives Randy enough time to look for another job.The stresses of the job search were too much for Randy as well. His dis-
ability continued, finally turning into major depression. Once you start
running, it’s hard to stop.
It has been my experience that stress leaves for fear disorders that
last more than a couple of weeks do more harm than good. There are
individual exceptions, of course, but few of them. Doctors’ excuses should
be for a limited duration and with a clear understanding of the criteria for
going back. This is difficult advice to follow, even for doctors. It’s hard to
say no to a person who is clearly in distress. I’m sometimes drawn into
writing notes for the third and fourth week, even though I usually regret
it later.
For fear disorders at work there are more appropriate accommodations
than extended leave, like allowing time off for therapy, or to use control
strategies like exercise or relaxation. Eventually Randy did stop running.
We’ll discuss his case in the section on depression.
The issue of secondary gain with the delayed form of PTSD are so
complex and tricky as to be outside the scope of this book. Sometimes the
legal and political issues overwhelm the psychological. I believe that in
delayed PTSD the problems that create the delay—perhaps dissociative
conditions or personality disorders—often need more treatment than the
PTSD itself.
The Psychology of Fear ❧ 111