After cheating death, the real challenge of living begins

Jan. 4, 2011, 1:48 PM UTC / Source: Self

By Jennifer Wolff Perrine

When Julia Ferganchick learned storms had delayed her connecting flight from Dallas to Little Rock, Arkansas, she found a seat at an airport bar and ordered a Bloody Mary. The 30-year-old writing and rhetoric professor had just spent Memorial Day weekend on Coronado Island, off the coast of San Diego. She was eager to return home to start the summer semester at the University of Arkansas, where she had applied for tenure. Now she was irritated; the bad weather would push her arrival close to midnight.

Two hours and 12 minutes behind schedule, American Airlines flight 1420 took off. Once above the clouds, the flight was relatively smooth, but as it neared Little Rock, they flew into lightning and severe thunderstorms. “Quite a light show off the left-hand side of the aircraft,” the pilot announced. “I’m going to have to slightly overfly the airport in order to turn back around to land.” As the plane circled and dipped, it jolted in the wind. “I knew—all of us knew—that this wasn’t the feeling of a plane touching down,” Ferganchick says.

The McDonnell Douglas MD-82 slammed into the ground going 184 miles an hour, careening off the end of the runway into a flood plain, where it smashed into a steel light stanchion and split in two just four rows behind Ferganchick’s seat. Her seat belt kept her torso in place, but the impact ripped her blue clogs from her feet and wrenched her back so badly she herniated a disk in her spine. Still, she was alive. And as fire enveloped the cabin, she could see a way out, through a jagged gash in the plane’s ceiling. Ferganchick clawed her way over mangled seats and carry-on bags until she found herself in the open air in the middle of a hailstorm, standing barefoot atop a plane that seemed ready to explode.

That night, June 1, 1999, Ferganchick became a hero. At the scene of a disaster that killed 11 people, she jumped from the top of the plane and raced to help those around her. Amid the flaming debris and falling ice, she saw a man whose leg had been nearly torn from his body. She pressed together two pieces of his limb, stanching the bleeding until the rescue crew could arrive.

Surviving physically, but a long road to mental recovery
The debris was eventually cleared, and the news cameras moved on to the next disaster. Yet Ferganchick’s tale of survival was only beginning: She was at the doorstep of a decade-long struggle—including blackouts, a suicide attempt and a stay in a mental hospital—before she found happiness and even a sense of gratitude for what had happened. She had survived relatively unscathed on the outside. Mentally, she says, “I didn’t even get off the plane.”

What happens on the day after the worst day of your life? Although being in an airplane crash is exceedingly rare, traumatic experiences are not: Half of all Americans will face one, reports the American Psychological Association in Washington, D.C. And women are more likely to be injured nonfatally in a car crash than men, according to 2008 data from the Centers for Disease Control and Prevention in Atlanta. We read about the devastation every day, but not what happens next. “Most of the traumatic aftermath of these tragedies doesn’t make it to the press,” says Carolyn Coarsey, Ph.D., a psychotherapist in Atlanta and cofounder of the Family Assistance Foundation, a nonprofit organization dedicated to improving corporate disaster response. “Anyone who lives through something like this returns to a life that is totally different.”

Some never recover. But most do. In fact, nearly two thirds of trauma victims, even those who had extreme pain, say they ultimately benefited from the aftermath of their experience, according to the research of Richard G. Tedeschi, Ph.D., professor of psychology at the University of North Carolina at Charlotte. Tedeschi and his colleagues have tracked outcomes for people who survived accidents and other traumas, such as life-threatening illnesses or the death of a child, and identified a phenomenon they call post-traumatic growth: Some survivors grow closer to people they love; others develop a sense of personal strength or appreciation for life. Still others deepen their spiritual beliefs or change their career and life goals. Women are more likely than men to report these benefits, and even those who are most impaired at first can find their way, as Ferganchick did, to feeling enriched by their ordeal.

What can these women teach the rest of us? As researchers learn more about what makes people resilient, they hope to develop therapies that could lessen negative responses and promote post-traumatic growth instead. “It’s not about getting over it‚ it’s about processing it in the most meaningful way,” Tedeschi says. “You still have your fears and grief and suffering, but you have made your suffering meaningful. If you can learn to do that, you can get through the bad stuff in life and find value in the struggle.”

Within a month after the crash of flight 1420, Ferganchick’s doctor had diagnosed her with severe post-traumatic stress disorder (PTSD). “I was afraid and depressed all the time,” Ferganchick says. “I couldn’t focus on anything, and I couldn’t maintain relationships with my friends and family because I was always agitated and argumentative.” Her already rocky marriage sped toward its end. She even contemplated suicide. One night, unable to sleep, she took a small handful of Xanax her doctor had prescribed. When she felt woozy and realized what she’d done, she called her estranged husband, who sent an ambulance. “I didn’t want to die,” she says, “I just wanted to stop hurting inside. I had stopped seeing any way to escape from the constant panic and fear.”

After taking a leave of absence from her professorship to recover from the crash, Ferganchick returned to teaching in August 2000. But the pressure proved overwhelming. She started blacking out, showing up at her office not knowing how she got there and getting return calls from people she didn’t recall phoning. “A family friend described me as like a ghost, almost like he could put a hand through me‚” she recalls. “There was no person left.”

In October, she got into a fender bender but had no recollection of stepping into her car. She handed her cell phone to the man she hit and asked him to dial any number in it to get her help. Later that morning, she admitted herself into a mental hospital.

A primary risk factor for PTSD is being a woman
Between 6 percent and 9 percent of people who have experienced or witnessed a life-threatening accident will develop PTSD. That most won’t is an astonishing testament to the sturdiness of the human mind. And studies are shedding light on why some accident survivors fall apart while others seem to bounce back more quickly. One of the primary risk factors for PTSD is simply being a woman, according to a large research review by David F. Tolin, Ph.D., director of the Anxiety Disorders Center at The Institute of Living, a psychiatric hospital in Hartford, Connecticut. “There is speculation that men are underreporting anxiety, because they are taught from an early age that being sad and anxious is unacceptable,” Tolin theorizes. “However, when you expose people with PTSD to visuals or sounds that remind them of their trauma, women do show more signs of physiological arousal, such as a higher heart rate. One possibility is that women’s brain hormones make them more vulnerable to PTSD.” One in 10 women has also experienced some kind of sexual assault, and that history often makes recovering from another trauma more difficult, Tolin adds.

How someone copes also depends on her mental health before the accident: Was she already depressed or anxious? How strong was her social support? Did she have any other traumas in her past, and how well had she dealt with them? Ferganchick’s family ties were strong, she had a loyal circle of friends, and she loved teaching. But a few months before the crash, her marriage had begun to unravel, and she was taking anti-depressants. The crash’s aftermath also recalled an assault during her childhood, conjuring familiar feelings of hurt and helplessness. “Dealing with the plane crash forced me to confront all of my troubles as a whole human being,” she says.

There is also wide variation in people’s recovery depending on the intensity of the accident they survive, says Joseph C. Napoli, M.D., a psychiatrist in Fort Lee, New Jersey, and codirector of Resiliency, a crisis-response consulting firm. “We call it the dose response curve,” Dr. Napoli says. “The larger the dose of trauma, the more likely they will develop PTSD.” Events that are shocking (a collision, an assault) are more likely to trigger PTSD than those that are gradual (losing a friend to cancer). The less control a survivor felt during the event, the greater her struggles may be. And multiple traumas have the potential to wreak havoc on even the strongest among us.

Heather Reidt, a 38-year-old nurse in Grand Rapids, Michigan, found this to be true as she strived to rebound from two accidents barely two years apart. The first occurred on her 34th birthday: On August 27, 2006, Reidt and two friends were walking home after celebrating over dinner in Kalamazoo. A burgundy SUV‚Äîa drunk driver at the wheel‚Äîjumped the sidewalk and hit her from behind, slamming her head through its windshield, then catapulting her over its hood. The driver fled as Reidt lay motionless on the pavement, her purse, shoes and lipstick scattered across the lawns.

Reidt suffered a broken pelvis and nerve damage in her brain that caused long-lasting double vision. Yet losing consciousness spared her from being haunted by graphic visions of the accident. And she felt strangely protected, as if now she’d had her share of trauma. “Whenever I got anxious about getting into a car,” she says, “I told myself, Lightning doesn’t strike twice.”

But on Thanksgiving weekend in 2008, Reidt was at the wheel of her own SUV when another car collided with her head-on. This time, she watched the car approach and her windshield shatter. Although she escaped with no new injuries, Reidt’s more vivid memories of the second crash seemed to increase her traumatic “dose.” She lost sleep and obsessively worried about the safety of her family and friends —fears that seemed justified when her father was killed in a car accident five months later. “It was unbelievable, almost too much,” she says.

Early treatment essential to recovery
In the face of high doses of trauma, and especially if there are signs of post-traumatic stress, early treatment is essential, Dr. Napoli says. The first step is making survivors feel safe; therapists might work with a victim of a highway pileup on a plan for when they can drive again, first on side streets, then the interstate. Reidt focused on her physical recovery after her first accident; after her second, she realized she needed therapeutic solace. And after her father’s death— period in which she lost 25 pounds—she began taking antidepressants as well. “I had no appetite,” she says. “I was always anxious and couldn’t sleep. I don’t want to live my life being constantly scared. People don’t realize how life-changing accidents can be. Friends told me, “You look great. Why can’t you move on?” But it’s like a part of me died, and I had to start life all over again.”

Starting over may be easier for some of us: Studies show individuals who are more extroverted, optimistic and open to new experiences are most likely to experience post-traumatic growth. But resiliency is a skill we can enhance. Simply talking about the trauma helps, Tedeschi says. “Some survivors can’t believe what happened. They may need to retell the story over and over to make it real, and to work it into the overall narrative of their life. Discussing how life has changed in the aftermath can be even more important.”

These thoughts can be difficult to listen to, he adds, but survivors do better when they can find “expert companions”— well-informed therapist, friend or family member—who will listen without necessarily trying to solve the problem. Sometimes therapists will role-play with survivors to help them disclose difficult truths, practicing interactions with people they want to share their experience with, those they want to keep it from and those somewhere in between.

Valerie Gaus cannot count the times she’s revisited the day she nearly died. In August 1996, the psychologist was crossing a New York City street on her way to work when a box truck pulled forward to turn the corner and struck her. “It’s almost embarrassing telling the story—how could I have not seen this massive truck coming toward me?” says Gaus, 47. “The instant I realized it was there, I was under it.”

Gaus remained conscious as the right side of her face was pulverized, leaving her eyeball dangling from its socket. She spent roughly six hours in the ER without painkillers while doctors checked for neurological damage, then underwent a nine-hour operation to reconstruct her shattered cheek, jaw and eye socket.

For weeks, Gaus relived the accident. “I’d see myself being run over, my head getting smashed like roadkill,” she remembers. “I didn’t know how I didn’t die, so I played the scene over in my head in so many different ways to figure it out.” Memories of her time in the ER proved even more persistent. “That was my trauma,” she says. “I screamed the whole time. Every day for five years, I flashed back to those moments.” Some people might have tried to banish these ghastly visions, but Gaus knew they were normal, even healthy. “Had I not been trained in psychology, I might have thought I was losing my mind,” she says. “What I saw was horrifying, but it didn’t mean I was insane. Letting myself feel what happened helped me become unstuck from it.”

Story: Trapped but still sane: Survivors of disaster speak out

Still, Gaus felt disconnected from everyone she knew, many of whom seemed to want to stop her from telling her story. She filled the void by running a 12-week group therapy program for survivors of motor vehicle accidents at Long Island University’s C.W. Post Campus. “What everyone had in common was isolation,” she says. “Even with the support of family and friends, we have no one who understands what we went through. Car accidents in particular encourage others to want you to get over it. Riding in a car is such a mundane and necessary thing; no one wants to be reminded of the danger.”

To help her clients move beyond their trauma, Gaus turned to cognitive-behavioral techniques, including exposure therapy, which encourages survivors to recall their experience in the minutest detail. “Sometimes the more trauma victims avoid their memories, the more intrusive those memories become,” Gaus says. She had her patients write a meticulous narrative of their accident, review it with the group and add nuances they might have left out, then reread it every day. A 2010 study by Dutch researchers from Leiden University in the Journal of Traumatic Stress found that survivors who underwent exposure therapy had a reduction in PTSD and more signs of post-traumatic growth than they did before the treatment. “Fear decreases if you are exposed to a frightening event repeatedly without severe consequences” explains Muriel Hagenaars, lead researcher on the study. “With time and context, memories that were vivid and uncontrollable become part of your normal autobiography.”

After her release from the psychiatric hospital in January 2001, Ferganchick applied for a second leave of absence from her teaching position. She was given permanent disability instead. “I lost my sense of stability from the crash, my identity when I lost my job and my family through divorce,” she says. “All my lifelines were ripped away.” She was plagued by guilt. “People said that God must have a special plan for me. That just crushed me. There was nothing more special about me than the people who died.”

For several years, she struggled to pull her life back together, first pouring her energy into a new teaching job, then trying to find a new partner to love and marry. She went on and off antidepressants, antipsychotics, antianxiety drugs and sleeping pills. But it wasn’t until about five years after the crash, when a friend took her to a lecture by a Buddhist monk, that her life turned in a direction she was comfortable heading. “The monk talked about how we create our own world with our mind, and it dawned on me that I continued to suffer because I felt so out of control,” she says. “What I needed to realize—and what Buddhism teaches—is that no one has control of the present, but that you can control the future by practicing kindness and nonviolence today.” After the lecture, Ferganchick delved into the study of meditation and Eastern religion, and eventually she changed careers and became a meditation instructor.

Turning to hobbies and other outlets gives post-trauma purpose
Whether survivors turn to religion, volunteering, athletics or another outlet, psychologists say taking action and finding positive passions as Ferganchick did can spur post-traumatic growth. Others show growth by transforming their trauma into service, speaking in the community, serving as a witness in court or lobbying for laws that would prevent similar accidents. Coming to terms with the loss of control is also key to creating a more fulfilling life after trauma, says Ken Reinhard, Ph.D., director of the Anxiety Disorders Clinic for the Veteran’s Administration Hudson Valley Health Care System in Montrose, New York. “There’s a bottom line that life is dangerous and there are no guarantees. Once you realize that you can’t control everything, you find the things you can control. It makes people more mindful of how they want to live.”

Heather Reidt is now four years away from her first accident, two years away from her second and 20 months from her father’s death. Although she says she sometimes feels “depressed, overwhelmed and sad,” she’s put back on some of the weight she had lost and moved off of antidepressants, and she feels stronger. She works out at the gym and runs despite her chronic hip injury. She has switched from nursing in a chaotic emergency room to serving as a hospice care case manager. And she founded a support group, Helping Others Peacefully Evolve (HOPE), which has aided victims of auto accidents as well as those of fires, burglaries and sexual assault. “The group gives me a purpose at times when I feel I don’t have one,” she says. “There is a time and a place to put yourself aside, and despite what I’ve been through, it’s important that I do that.”

Valerie Gaus calls her accident her “birthday”: She is happier and less of a workaholic today. But her recovery is still a work in progress. She flinches at the sound of diesel engines and when anyone approaches her from behind. When she became pregnant three years ago, she dreaded the possibility of again lying awake on a hospital gurney; her obstetrician scheduled a C-section in part so she could cope better during the delivery. And after her son, Gabriel, arrived, she fixated on gruesome threats like crib death. “Every parent has fears, but because of my accident, my fears had an extra dimension to them,” she says. In anxious moments, she turns to her yoga training: “I bring myself into the present and experience Gabriel in the moment. I smell his hair, feel his skin. I focus on what is happening right then because he is right there in my arms. Safe.”

Last year, Ferganchick marked her 10th anniversary of being a plane-crash survivor by taking a 10,000-mile motorcycle ride with her mother, visiting the memorial for flight 1420 as well as the Oklahoma City bombing site and the Trail of Tears. “The crash still seems so recent, like a mountain that is far away but that you can see clearly, because it’s so huge,” she says.

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Sometimes she thinks back to that night in the Dallas airport when she felt so frustrated. “Had I known what I was actually waiting for, I would have enjoyed my time so differently, she says. ‚I get sad when I see people obsessing over little things or yelling at each other over something petty. We spend so much time being unhappy, but any moment could be our last. Would I wish what happened to me on anyone else? No. But from my worst experience came the most beautiful and powerful gift— the knowledge that tomorrow is not a guarantee. The only thing you have control over is how you treat other people. I want to help people learn that lesson without having to go through what I went through.”

Can an accident age you?
The effects of trauma on the body can linger after bruises and bones heal, says Phebe Tucker, M.D., professor of psychiatry at The University of Oklahoma College of Medicine. Seven years after the Oklahoma City bombing, survivors who were reminded of the blast felt a racing heartbeat and blood pressure spikes, a study by Dr. Tucker found. Changes in the brain may play a role in the body’s responses. Scans done three years after the World Trade Center attacks found that witnesses within 1.5 miles of the site‚ people who did not lose loved ones and didn’t develop PTSD had less gray matter than those who lived more than 200 miles away.

“The pattern of gray matter change was very similar to that of aging,” says lead author Barbara Ganzel, Ph.D., a research scientist in the department of human development at Cornell University. She found that 9/11 witnesses also had smaller amygdala (the parts of the brain that control emotional responses and threat detection), which was associated with more anxiety. If you’re struggling after a trauma, visit the American Psychological Association at APA.org.

Jennifer Wolff Perrine