Thirty years ago no one believed that the psychological problems suffered by Vietnam soldiers were caused by their service in the war.
Producer Alix Spiegel documents the evolution of post-traumatic stress disorder from a nameless experience into an officially recognized medical condition.
Post-Traumatic Stress Disorder was produced in 2003.
Alix Spiegel is a reporter with NPR's National Desk, covering social policy. Affiliated with NPR since 2003, Spiegel previously worked as a reporter on NPR's Science Desk. Originally from Baltimore, Maryland, Spiegel graduated from Oberlin College in 1994. She began her career in radio in 1995 as one of the founding producers of the public radio show This American Life. Spiegel left the show in 1999 to become a full-time reporter. She has also written for The New Yorker magazine and The New York Times.
Over the course of her career in public radio, she has won awards including the George Foster Peabody Award, Livingston Award, and Alfred I. duPont-Columbia University Award. Spiegel's 2007 documentary revealing mental health issues and crime plaguing a Southern Mississippi FEMA trailer park housing Katrina victims was recognized with Scripps Howard National Journalism Award and the Robert F. Kennedy Journalism Award.
BEHIND THE SCENES with Alix Spiegel
In your recent work at NPR, you've focused on mental health and psychiatry. What attracted you to this subject?
I first became interested in mental health when I started looking into an old family legend about my grandfather. According to Spiegel-lore, grandpa was the president of the American Psychiatric Association (APA) in 1973 when the APA decided to remove homosexuality from its Diagnostic and Statistical Manual -- that's the book that lists all the official mental diseases. My source (Dad) claimed that my subject (Grandpa), who was gay, was part of this homosexual cabal -- a small group of closeted gay men who hijacked the APA from within and pushed this quite radical change through what was then a fundamentally conservative organization.
Now, like the vast majority of my father's stories, this version of events, while entertaining, is only about 10 percent true. It's really a much more complicated story -- one that I ended up telling on This American Life.
Anyway. It was really through doing that story that I got interested. It's kinda complicated to explain but essentially, the decision to remove homosexuality from the DSM was a moral decision masquerading as a scientific one . . . and that got me thinking: You know, the mental health industry is really just a secular church. Here's what I mean by that: The Church (or synagogue or whatever) used to be the primary cultural institution that told us the meaning of our emotional pain and explained what we could/should expect from our lives -- but for much of America, the church has been replaced by the psychotherapy industry.
Think about it: After the twin towers came down, mental health sessions were mandated for fire and emergency workers. Sixty years ago, the city probably would have provided priests for workers who were troubled by what they saw, but now they motor in therapists. I see this as a sign of the times. Now, there are differences. The Church (or really any religious institution) talks about good and bad, while the psychotherapy industry talks about normal and abnormal, but their function in our society is really quite similar. Also, like the church, much of what passes for science in the mental health profession is really just belief, but because mental health stands under the banner of Science (capital S), I think that people are less critical than they maybe should be as consumers. So my idea was to try to help them see behind the curtain so that they could maybe be empowered as consumers. And also the stories are just damn interesting. Know what I mean?
This story focuses on the creation of Post Traumatic Stress Disorder (PTSD) as a medical condition, and other stories have told similar stories of the evolution of Male Andropause, the Diagnostic and Statistical Manual, and the medical definition of homosexuality. What is it about psychiatric beginnings that fascinate you?
I like psychiatric beginnings because I think it's really interesting to watch the evolution of an idea. There are all these ideas around us that we just take for granted, but like the automobile, atomic energy, or the flush toilet, ideas often have very specific creation narratives, very specific people who invent and advocate on their behalf. Most of the time we don't tell these stories, but I think we should. It would help us to put them in perspective.
How has the medical community reacted to this story and other stories that are similarly critical of the institution?
I don't know. I mean, most of the feedback I get is pretty good. I do try hard to be fair about things, and I always fact-check beforehand so no one in my stories is too surprised by the content. I know Robert Spitzer -- the man who's created more mental diseases than any other living person on the face of the planet -- didn't like the fact that in the intro to his story his office was described as shabby, which is true, shabby wasn't the right word, but other than that I haven't gotten too much grief.
This story is presented in a much more narrative format than we usually hear in standard news stories on public radio. Can you talk about the differences in the two approaches?
Yeah, I'm trying to take the narrative techniques that I learned from Ira [Glass] as a producer at This American Life and use them in a hard-news context. That's the idea. Sometimes it works, sometimes it doesn't. TAL stories differ from NPR stories in a variety of ways. The three big ones are:
1. Position of the Narrator
At TAL, we were told to try to write from the inside. Which basically means you don't hold yourself apart as the narrator of a story. You're not trying to be a cold, authoritative presence . . . the first objective is to try to present the subject of your story in a way that allows the listener to understand the inner emotional reality of that person. NPR is a news organization, so what they're going for is very different. They're trying to inform and provide balance. I like both approaches, they're just different.
2. Writing Style
At NPR you're supposed to write in short declarative sentences. TAL is more informal and conversational. Also, you can write in really long, poetical-type sentences. I don't, but I've seen it done.
3. Narrative Structure
TAL has a very particular narrative structure; the arc is similar to the arc that you would find in a feature film. There's a problem or issue, a series of actions, a decisive crisis or test, and then a resolution. At NPR it's a different structure. It's a hard-news structure that definitely doesn't include that particular arc. I don't really know how to describe the arc, and I'm not sure that I'm all that good at it yet.
Do you think you're pioneering a new form of news story?
Not really. I think that most of the people at NPR wouldn't really think that I'm doing news. News people tend to be pretty strict about what's considered news and what's not considered news. I'm basically doing feature reporting on a news network. But hopefully one day . . . one day. I have a really great editor here, Anne Gudenkauf, who completely and totally rocks, and she's bringing me along. So we'll see.
What challenges have you encountered in switching from producing features to producing current affairs programming?
The main thing, I think, is time. The longest story on NPR is 12-and-a-half minutes. At TAL, it would take me three minutes just to say my name. I guess the natural pace of my storytelling just takes longer. In any case, I'm used to having the time to let a story unfurl. Now I'm trying to work on a much smaller canvas. It's hard. When I came here, I wanted to give people the same feeling that my hour-long stories TAL gave them, but I'm not sure I've been able to do that yet.
What are you working on now? Plans for future projects?
Actually, right now I'm working on a really cool story about killing: the psychological impact --on otherwise healthy men -- of killing. There are surprisingly few scientific studies on this subject, given that war is a relatively regular feature of human affairs, but I found this one really interesting guy who's walking me through it. I've also interviewed a bunch of people about what's it's like to kill someone, and the various emotional stages of people involved. I'm doing the story because of the war in Iraq. We've been talking about killing in the abstract for so long, I thought it would be good to get a little deeper. In the future, I want to do a series on the mental health of soldiers returning from the war in the Gulf, and all things mental health/war related. But I need to get money. I'm working on that now.