Post-Trumanatic Stress Disorder

Post-traumatic stress disorder is a serious and rampant problem. According to U.S.

Department of Veterans Affairs, approximately 5.2 million people suffer from the disease in the
United States alone. As an issue that affects many, post-traumatic stress disorder is quite often
portrayed in the media.
From a psychological standpoint, research and analyze both post-traumatic stress
disorder, and how it is portrayed and represented in writing by author Truman Capote. Draw
evidence from Capotes writing and reliable outside resources.

Benjamin Bronow
Mr. Russell Stoll
English 12 Honors
December 8, 2014

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The mind is an incredibly complex and important aspect of a human being. It

dictates actions, speech, personality, and almost anything that makes a person themself. The
mind is a seemingly abstract idea. Physical things, however, seriously affect this abstraction. The
mind can easily be damaged or fall ill from external forces. Every day, millions suffer from posttraumatic stress disorder, a mental illness triggered by a physical event or experience. It can
affect anybody at any time in any manner of harm. One of the most interesting aspects of the
mind, however, is its extreme fragility. Traumatic events, physical damage, or even simply old
age can change a person entirely. The author Truman Capote is particularly adept at accurately
representing mental illness within works. His short story Miriam tells the tale of an old widow
(for whom the story is named) who begins to hallucinate a little girl. Throughout the story, the
girl gets more demanding and Miriam descends further into madness. In his novel based on true
events, In Cold Blood, Capote recants the story of the vicious murders of the Clutter family
following the perpetrators, the victims, the townspeople, and the law enforcement officers on the
case. In the novel, it becomes clear that Perry Smith, one of the murderers, is suffering from
post-traumatic stress disorder. Capote displays the characters Miriam and Perry as sufferers of
post-traumatic stress disorder and by displaying their struggles and treatment, shows disapproval
in the insufficient treatment of mental illness.
There are countless possible initial triggers of post-traumatic stress disorder. Any event
that can initiate post-traumatic stress disorder is referred to as a traumatic event or a trauma.
While a trauma is typically a life-threatening event such as military combat, natural disasters,
terrorist incidents, serious accidents, or physical or sexual assault in adult or childhood (Mental
Health America), any event can be considered a trauma due to the subjectivity of the different
ways people experience the event. Along with this, it is possible to develop post-traumatic stress

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disorder despite not being the actual victim of a trauma. It is not uncommon for witnesses,
emergency responders, or even people who simply learn of a traumatic event to suffer from posttraumatic stress disorder (Ibid). No matter how one experiences a traumatic event, it is possible
to be mentally afflicted by it.
The harsh trauma of losing her husband has led Capotes character Miriam to
hallucination. According to the Mayo Clinic, post-traumatic stress disorder can be caused by
go[ing] through, see[ing] or learn[ing] about an event involving actual or threatened death
(Post-traumatic Stress Disorder). Miriam did indeed encounter death through that of her husband,
someone close enough to her to cause significant trauma. Reasonably, this significant event in
her life could be what dropped into a downward spiral, eventually leading to her hallucination of
the little girl. Research at the University of Pennsylvania has shown that severe and rare cases
of PTSD [post-traumatic stress disorder] may involve hallucinations (CTSA: PTSD:
Symptoms). It is reasonable to assume then, that as the trauma of losing her husband was so
severe, Miriams hallucinations are a direct result of her husbands death.
Murdering a family of four triggered Perrys post-traumatic stress disorder, but he was
also exposed to a lifetime of trauma prior to the crime. It is obvious that a viewing an act of mass
murder can leave mental scars, even as the perpetrator of the act, but Perrys post-traumatic
stress disorder began long before the murder of the Clutter family. As a child, Perry was a
witness to and a victim of continual abuse. One of Perrys earliest memories is his father, after a
violent struggle... proceed[ing] to beat [his] mother" (Capote, In Cold Blood, 274). Bearing
witness to his mothers beatings left a huge impression on Perry, but the trauma escalated in
severity when he became the victim of such beatings. Whenever Perrys actions displeased his
parents, or simply when they were enraged, [his] father (or mother) beat [him]" (Capote, In

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Cold Blood, 274). After years of abuse at home, Perry escaped his parents only to be treated
similarly by others. Through his childhood and adolescence, Perry moved through various
orphanages and juvenile detention centers. At these locations, he was often chastised and bullied
due to a kidney condition, which often caused him to urinate in his sleep. Perry recalls that at one
of these centers he:
was beaten severely by the cottage mistress, who called me names and made fun of me
in front of the boys. She used to come around at all hours of the night to see if I wet the
bed. She would throw back the covers and beat me with a large black leather belt- throw
me in the tub & turn the cold water on & tell me to wash myself and the sheets... Later on
she thought it would be very funny to put some kind of ointment on my penis. This was
almost unbearable. It burned something terrible. (Capote, In Cold Blood, 275)
This experience goes on to haunt Perry for the rest of his life. Being abused by his parents and
other authoritative figures are the first in a series repeated traumas which each contribute to the
development and exacerbation of Perrys post-traumatic stress disorder. The murder of the
Clutters, while a contributing trauma, was simply the icing on the proverbial cake of Perrys
mental illness. All of these traumas lead to Perry quite obviously displaying symptoms of posttraumatic stress disorder.
Post-traumatic stress disorder manifests itself in a multitude of manners, and a range of
severity. The basic symptoms can be placed into three categories: re-experiencing symptoms,
avoidance symptoms, and hyperarousal symptoms. Re-experiencing symptoms, as the name
would imply, are reoccurring recollections of the event that triggered the affliction. These can be
in the form of flashbacks, nightmares, or even brief frightening thoughts. These symptoms can
start from the persons own thoughts and feelings. Words, objects, or situations that are
reminders of the event can also trigger re-experiencing ("Post-Traumatic Stress Disorder "). As

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reminders of the event can cause re-experiencing symptoms, sufferers begin to avoid any and all
reminders. This avoidance is not limited to staying away from physical places, things, or people,
but can also be feeling emotionally numb (Ibid) to avoid any emotional reminders of the event.
Unlike re-experiencing and avoidance, hyperarousal is a constant symptom. Those suffering
from post-traumatic stress disorder are constantly easily startled, on edge, and restless (Ibid). In
severe cases, symptoms can go beyond the three standard categories. The afflicted can
experience panic attacks, muscle cramps, substance abuse, suicidal thoughts, and even
hallucinations (Mental Health America). As many of these symptoms are self-reported, their
severity is subjective to those who experience them. It can be noted, however, that if posttraumatic stress disorder goes untreated, symptoms can gradually increase in severity. In each
individual case, the way that symptoms manifest is dependent on the trigger that initially caused
the disorder.
Perrys behavior bears striking resemblance to symptoms of post-traumatic stress
disorder, establishing that he indeed suffers from the disease. During the months after he
murdered the Clutters, while evading the law, Perry began exhibiting stereotypical reexperiencing symptoms. Perry noted that:
"spells of helplessness occurred, moments when he 'remembered things' - blue light
exploding in a black room, the glass eyes of a big toy bear- and when voices, a particular
few words started nagging his mind: 'Oh, no! Oh, please! No! No! No! No! Don't! Oh,
please don't, please!' And certain sounds returned - a silver dollar rolling across the floor,
boot steps on hardwood stairs, and the sounds of breathing, the gasps, the hysterical
inhalations of a man with a severed windpipe." (Capote, In Cold Blood, 110)

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Perrys relivings of the murder continue until his death, and establish that he was definitively
suffering from post-traumatic stress disorder as a result of murdering the Clutter family. This
trauma, however, was not the only one that he re-experienced. As a result of the abuse he lived
through as a child, many of Perrys symptoms followed included the re-experiencing of the
laundry list of traumas he lived through. Since he was a child, Perry often experienced
nightmares in which he relived "living in a California orphanage operated by nuns-shrouded
disciplinarians who whipped him for wetting the bed, and the continuous torture from Older
children, his father, a faithless girl, a sergeant he'd known in the army" (Capote, In Cold Blood,
93). These symptoms do not only confirm that Perry suffers from post-traumatic stress disorder,
but that he has suffered from it for the majority of his life. As he has been afflicted with serious
mental trauma since he was a child for which he received no treatment, Perrys symptoms
progressively escalate. He begins to experience crippling panic attacks, which he refers to as
"bubbles in [his] blood" (Capote, In Cold Blood, 193). These panic attacks leave Perry
debilitated and forced to self-medicate with unhealthy amounts of acetylsalicylic acid. These
symptoms, however, pale in comparison to those of Miriam, which, while peculiar, occur as a
result of her own trauma.
The fact that Miriams hallucinations occur long after the death of her husband furthers
the theory that they are caused by post-traumatic stress disorder. While Capote does not reveal
how or when Miriams husband passed away, it can be assumed that it was a relatively long time
before Miriams hallucinations began as the first sentence of the story states that for several
years, Mrs. H. T. Miller [Miriam] lived alone (Capote, Miriam). This makes complete sense,
as not only can it take years for post-traumatic stress disorder to manifest, its symptoms worsen
in severity as time goes on (CTSA: PTSD: Symptoms). By the time the little girl begins to

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appear to Miriam, it has been years since her husbands death. This provides ample time for her
mental condition to degrade to an unstable and concerning state. With this in mind, the time
between the death of Miriams husband and the manifestation of vivid hallucinations confirms
the fact that these hallucinations are being caused by an extreme case of post-traumatic stress
disorder.
Her hallucinations relation to snow evidences Miriams post-traumatic stress disorder.
Throughout the short story, snow falls sporadically and becomes indicative of hallucinations to
come. Right before Miriams first encounter with the child, Capote makes sure to note that the
snow was fine, falling gently, not yet making an impression on the pavement (Capote,
Miriam). At first glance, it appears as though Capote is simply using the weather as a literary
device to paint a full picture of the scene occurring in the readers head, as he is prone to do;
however, this is not an isolated incident. Several days after their first interaction, Miriam
encounters the child again, this time at her front door. Before the child knocks, however, Capote
vividly describes the weather, saying, in the falling quiet there was no sky or earth, only snow
lifting in the wind, frosting the window glass, chilling the rooms, deadening and hushing the
city (Capote, Miriam). At this point, the falling of snow prefaces every sighting of the child.
While the child is in Miriams home, she specifically demands both glazed cherries and almond
cake. The next day, Miriam goes out shopping and Capote notes that the weather had turned
cold again; like blurred lenses, winter clouds cast a shade over the sun, and the skeleton of an
early dusk colored the sky; a damp mist mixed with the wind and the voices of a few children
who romped high on mountains of gutter snow seemed lonely and cheerless (Capote,
Miriam). As snow it appears to be nigh, Miriam seemingly prepares for the girls recurrence,
buying the glazed cherries and almond cakes she had requested the night prior. Sure enough, the

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girl reappeared as soon as the snow did. Keeping in mind that the girl is merely a hallucination, it
is safe to say that the snow somehow chauffeurs Miriam into an altered state of mind. The fact
that something as simple as the weather can exert stress upon Miriams mind to the point of
hallucination further supports the assertion that she is suffering from post-traumatic stress
disorder. The most severe symptoms of post-traumatic stress disorder, such as hallucinations, are
not constantly plaguing afflicted. Rather, they are triggered by sights, sounds, smells or even
feelings that they [the afflicted] experience. These triggers can bring back memories of the
trauma and cause intense emotional and physical reactions (Mental Health America). It is quite
obvious that snow somehow reminds Miriam of the death of her husband and, as a result, triggers
her most severe symptom: hallucinating a young girl. Miriams trigger completes the puzzle, and
establishes that she undoubtedly suffers from post-traumatic stress disorder.
Statistics show that the development of post-traumatic stress disorder is not solely based
on experiencing trauma. Many people experience severe trauma, which could easily plunge them
into the dark waters of post-traumatic stress disorder. In fact, About 6 of every 10 (or 60%) of
men and 5 of every 10 (or 50%) of women experience at least one trauma in their lives ("How
Common Is PTSD?"). Simply looking at this, it would be safe to assume that the majority of
adults have, or will, deal with post-traumatic stress disorder; however, this is not the case. Only
About 7 or 8 out of every 100 people (or 7-8% of the population) will have PTSD at some point
in their lives (Ibid). While the majority of all people experience a severe trauma, a minority
actually develops post-traumatic stress disorder. It is very clear that some are more likely to be
afflicted than others. This discrepancy is apparent simply looking at sexes, as 10 of every 100
(or 10%) of women develop PTSD sometime in their lives compared with about 4 of every 100
(or 4%) of men (Ibid). There are a lot of different factors that create this incongruence. Not the

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least of these factors is the different types of trauma that men and women face. Studies show that
women are more likely to experience sexual assault and child sexual abuse. Men are more likely
to experience accidents, physical assault, combat, disaster, or to witness death or injury (Ibid).
Different traumas can produce different responses, but cannot be credited with the entirety of
why some walk away from those traumas with only physical scars and some with mental scars as
well. Even when isolating the two sexes, there is a large gap between the number of individuals
who experience trauma, and those who experience post-traumatic stress disorder. This
discrepancy is even more evident when looking at the case of Perry.
Perrys case of post-traumatic stress disorder takes this disparity beyond statistics and
proves that some people are more naturally more susceptible to developing the illness. Perry did
not murder the Clutter family alone; his friend Dick Hickok was equally complicit in the crime.
The night of the crime, Dick was exposed to the same traumas as Perry. They both saw the
Clutters helplessly tied up. They both heard their desperate pleas for mercy. They both felt the
recoil of a .12 gauge shotgun. They both bore witness as the contents of the Clutters skulls
painted the walls red. After this gruesome experience, Perry develops post-traumatic stress
disorder; however, Dick remains mentally unscathed. When Perry wants to discuss the mental
anguish he feels after the murders, Dick simply replies, Deal me out, baby. Im normal
(Capote, In Cold Blood, 111). This assertion is later confirmed by a psychiatrist during Dicks
trial, and reaffirms that some are simply predisposed to developing post-traumatic stress disorder.
While both Perry and Dick experienced the exact same trauma, only Perry re-experiences it and
is cast into the murky waters of mental illness. This predisposition could be caused by Perrys
abusive upbringing: repeated traumas can reasonably lead to harsher reactions. Modern research,
however, suggests that Perrys predisposition may be caused by genetics.

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Recent research clearly shows that certain people are more susceptible to developing
post-traumatic stress disorder due their genetics. The development of fearful memories is reliant
on the protein stathmin. According to the National Institute of Mental Health, studies have shown
that mice that did not make stathmin were less likely than normal mice to freeze, a natural,
protective response to danger, after being exposed to a fearful experience. They also showed less
innate fear by exploring open spaces more willingly than normal mice ("Post-Traumatic Stress
Disorder"). Those who naturally make less stathmin are less likely to form and retain fear
memories, and as such, it is possible for some to naturally develop more due their genetics and
therefore form and retain memories of fear more than the average person. When ones genetics
cause them to produce high levels of stathmin, they are more likely to develop post-traumatic
stress disorder. Along with stathmin, the neural chemical gastrin-releasing peptide, commonly
referred to as GRP, appears to have a strong link to the development of post-traumatic stress
disorder. The National Institute of Mental Health reports that in mice, GRP seems to help
control the fear response, and lack of GRP may lead to the creation of greater and more lasting
memories of fear (Ibid). This research further proves that memories of fear are certainly linked
to brain chemistry and genetics. Logically, those who have high levels of stathmin and low levels
of GRP are most susceptible to developing PTSD. While it is difficult to directly measure the
exact levels of these chemicals, it is possible to detect abnormalities by looking at variants of the
genes TPH1 and TPH2, which produce serotonin. As abnormal levels of stathmin and GRP
inhibit serotonin production, analyzing the expression of TPH1 and TPH2 can be used to identify
those most likely to develop post-traumatic stress disorder. Researcher Dr. Armen Goenjian at
the University of California, Los Angeles claims that pinpointing genes connected with PTSD
symptoms will help neuroscientists classify the disorder based on brain biology instead of

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clinical observation and may also help scientists uncover alternative treatments for the
disorder, such as gene therapy or new drugs that regulate the chemicals responsible for PTSD
symptoms (Schmidt). Goenjians research establishes that genetics do play a major role in posttraumatic stress disorder, and can be used to develop treatments. New, alternative treatments that
treat the genes responsible for post-traumatic stress disorder are absolutely necessary. It can be
assumed both Miriam and Perry were genetically predisposed but did not have access to proper
treatment.
Unfortunately, the current methods of diagnosing and treating post-traumatic stress
disorder fall short of what is necessary, as they are largely subjective and focus mainly on the
diseases symptoms. Currently, post-traumatic stress disorder is diagnosed based on the
symptoms that the patient reports. All current medicinal treatments are individualized for each
patient. Doctors currently rely on a trial-and-error approach to identify the best medication for
controlling an individual patient's symptoms (Schmidt). Depending on the symptoms the patient
reports, doctors prescribe different drug regiments. Most commonly prescribed are selective
serotonin reuptake inhibitors [antidepressants] sedatives [and] anti-anxiety medication
(Mental Health America). These drugs merely treat symptoms, and cannot fully cure the disease.
The only method that focuses on the cause of the disorder rather than the symptoms is
psychotherapy. The process is long, difficult, painful, and not always successful, but utilizing
therapy to deal with the trauma is currently the most effective, and only, method to fully treat
post-traumatic stress disorder; however, many do not have access to such treatments. Perry and
Miriams treatments were even more insufficient.
Capote describes the ineffectiveness of Perry and Miriams treatment to provide
commentary on mental health treatment. In both works, Capote purposefully shows the awful

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effects of mishandled mental illness. In Miriam, Capote displays the outcome of ignoring posttraumatic stress disorder. After her husbands death, Miriam avoids dealing with her posttraumatic stress disorder, which leads to the escalation of her symptoms. When she finally does
reach out for help, she is discredited and ignored. When Miriam goes to her neighbor to help get
the little girl she hallucinates out of her apartment, her neighbor only inspects the home and
declares, I looked all over and there just aint nobody there (Capote, Miriam). Rather
than help Miriam get treatment after clearly noticing her mental illness, her neighbor sends her
back to live the rest of her life suffering. Capote skillfully utilizes this plot to display how society
tends to ignore mental illness rather than treat it, and puts the reader into a position of viewing
society from a critical perspective to make this tendency more blatant. Capote goes on to criticize
how mental illness is treated on the rare occasion it is in In Cold Blood. During Perrys trial, a
trained psychiatrist testified that Perrys examination was inconclusive, but was silenced by the
prosecution before he could tell the jury Perry Smith shows definite signs of severe mental
illness (Capote, In Cold Blood, 296). Because of this, Perry received did receive a treatment: 13
steps to the gallows. By showing a mentally ill man being executed, Capote conveys the
disturbing fact that mental illness is commonly treated criminally rather than medically. Through
his writing, Capote clearly states that the common treatment of post-traumatic stress disorder is
not only insufficient, but also harmful.
Post-traumatic stress disorder is a vicious, unrelenting affliction. It changes people. It
ruins lives. It can even be more damaging than the trauma that causes it. It is quite obvious that
Miriam suffers from post-traumatic stress disorder, and that it is the root of her hallucinations.
Capote has skillfully woven this disease into Miriams blood. Capote utilizes mental illness as
the defining characteristic of Miriam, and in turn, as the very basis of the plot of the story.

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Likewise, Capote depicts Perry as a sufferer of post-traumatic stress disorder. He shows how the
harsh symptoms of the illness crush Perrys spirit and leave him a quivering husk of a human. In
both In Cold Blood and Miriam, Capote makes sure to describe the characters treatment or lack
thereof. By depicting Perry and Miriams struggles and mistreatment, Truman Capote expresses
severe disgust with societys approach to mental illness.

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Works Cited
Capote, Truman. Miriam A Classic Story of Loneliness (Creative Short Stories). Upper Saddle
River: Creative Education, 1981. Print.
Capote, Truman. In Cold Blood: A True Account of a Multiple Murder and Its Consequences.
New York: Random House, 1966. Print.
"CTSA: PTSD: Symptoms." University of Pennsylvania, Perelman School of Medicine.
University of Pennsylvania, n.d. Web. 03 Nov. 2014.
<http://www.med.upenn.edu/ctsa/ptsd_symptoms.html>.
"How Common Is PTSD?" PTSD: National Center for PTSD. U.S. Department of Veterans
Affairs, n.d. Web. 19 Nov. 2014. <http://www.ptsd.va.gov/public/PTSDoverview/basics/how-common-is-ptsd.asp>.
Mental Health America. "Post-Traumatic Stress Disorder." Mental Health America. N.p., n.d.
Web. 02 Nov. 2014. <http://www.mentalhealthamerica.net/conditions/post-traumaticstress-disorder>.

"Post-Traumatic Stress Disorder (PTSD)." NIMH. National Institute of Mental Health, n.d. Web.
21 Nov. 2014. <http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorderptsd/index.shtml#part4>.
"Post-traumatic Stress Disorder (PTSD)." Mayo Clinic. Mayo Clinic, n.d. Web. 02 Nov. 2014.
<http://www.mayoclinic.org/diseases-conditions/post-traumatic-stressdisorder/basics/causes/con-20022540>.
Schmidt, Elaine. "UCLA Study Identifies Genes." UCLA Newsroom. University of California,
Los Angeles, 02 Apr. 2012. Web. 21 Nov. 2014.
<http://newsroom.ucla.edu/releases/ucla-study-identifies-first-genes-231248>.