The Diagnosis


With her legs tightly crossed, my therapist looked at me intently and leaned forward a little. “I generally don’t like to have this kind of conversation early in therapy. But you know more than most people about mental illness, and you have a daughter in the field. So I’m comfortable talking about your experience within that context, although I don’t want it to affect the work we have to do together.”

“Duly noted. So what do you think?”

“Right now, I would say that you have post-traumatic stress disorder. In fact, I’d say you’re almost a classic case of it.”

“I wondered if you were going to say that.”


“That term is everywhere these days. A trendy acronym for people who are depressed or can’t sleep.”

“It’s a serious illness,” said my therapist.

“I suppose it is. But I think you get my drift.”

“PTSD is a medical condition that develops as a result of a traumatic event. There are many things that can happen to people that trigger it. A wildfire is certainly one of them.”

Even though I expected this diagnosis, it still unleashed a wave of ambivalence. On the one hand, saying I had a disease theoretically meant there was a treatment. It also meant I wasn’t alone and my sour mood wasn’t entirely my fault.

But equating what happened to the Fritz family with the trauma of war felt like an overreaction and an insult to those whose conditions warranted the clinical diagnosis. I hadn’t watched my buddies die, and I didn’t kill anyone. Surely what applied to veterans trying to find their place in a newly alien world shouldn’t be applied to me. I wasn’t worth it.

“PTSD is a condition in the brain,” our therapist said. “It’s biological and chemical and a little mysterious as well. We know more about the brain today than ever before, which is why I don’t think there’s anything wrong with talking about it as a physical condition or giving it a technical name.”

“As opposed to saying I’ve chosen to be hard to live with?” I looked at my youngest daughter out of the corner of my eye. As usual, she said nothing and sat perfectly still. Just having her there was a comfort.

Miranda had already proven to me that the brain sometimes goes its own way, for good as well as ill. While most people could multiply and divide three-digit numbers or shoot a free throw, she could focus intently and patiently on little children long past the breaking point for almost anyone else and still let loose a smile that charmed even the grumpiest of grumps. Miranda had something to teach me.

“Given what I think I know about mental illness, I want to believe you,” I said. “But it feels like we’re just slapping a label on something that continues to make no sense to me.”

“While I could sit here and explain some of it in technical terms,” said our therapist, “I don’t think that will serve any therapeutic purpose. Mental illness and its treatment are a mystery in many ways, and I’m not ashamed to admit that I don’t know why therapy works for some people and not for others. I’m not even sure that saying ‘it works’ is the right way to put it.”

As Miranda and I drove back to our Austin rent house, it occurred to me that having PTSD could be a giant “get out of jail free” card for my many transgressions and shortcomings. Perhaps I could get a tattoo on my forehead: “It’s not my fault: I have PTSD.”

But that juvenile humor was more than offset by the implications of our therapist naming my condition. When I got back, I did what any twenty-first-century man would do: I logged on to Google.

In less time than it takes for a major-league fastball to reach home plate, I received more than 25 million results to my “What is PTSD?” search. I started with the first ten, and over several hours I read about the symptoms, possible treatments, and anecdotal tales of PTSD victims or patients or whatever noun is most appropriate for that condition.

Our therapist was right about the mystery part. The more I learned, the less I knew. And the less I knew, the more I understood.

The brain is an organ that can be analyzed with tools and tests, the existence of which shows how far human beings have come since the invention of the wheel. But there’s a limit as to how much we can, or perhaps even should, connect the biology of the brain and eyes to a middle-aged man who has suddenly gone weepy. At what point is it counterproductive to mention neurotransmitters and MRI readouts in explaining why someone with PTSD can’t think straight or suddenly has an angry streak? Who cares about the “fight or flight” reaction in the dead of a wakeful, agonizing night?

Where did my soul—whatever that is—factor into all of this medical information? If I wasn’t in control of the things happening in my head, then who or what was? Were my PTSD symptoms the problem I needed to solve or merely the signs of a larger, even more implacable one?

I wondered whether the PTSD tribe—of which I was a new initiate—was proud or shameful. How would my burned-out friends react if I told them, “I think you have PTSD, just like me.” While I wouldn’t hesitate recommending an orthopedist to a buddy with a torn ACL, could I refer my therapist, or someone like her, to an acquaintance whose mind seemed as off-kilter as mine?

These were questions with no answers, and I was surprised that I didn’t mind that. Perhaps the schematic of my post-fire mind included new circuitry for the acceptance of ambiguity.

My PTSD research ended with three conclusions: I need my therapist even more than I thought. I must see my doctor because I’m sick. The awareness of ignorance is knowledge.

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