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He's Dead, She's Free. What's Up With
That?
Mary Winkler is a free woman—free of her abusive marriage and free of jail. After 67 days in a mental-health facility in Tennessee, Winkler was released earlier this week and has returned to her hometown of McMinnville. But is she free of the posttraumatic stress disorder and depression that her legal team said drove her to gun down her preacher-husband, Matthew, last year? After a jury found Winkler guilty of voluntary manslaughter, she was given a three-year sentence, later reduced to 210 days, but she also got credit for the five months she spent in jail awaiting trial—which left only about 60 days, which a judge ruled she could serve in the mental-health facility. Winkler's critics wonder if she ever had PTSD in the first place and say the diagnosis was just a means of getting off easy. Newsweek's Mary Carmichael consulted experts on trauma to answer common questions about the case.
How likely is it that Winkler had PTSD?
It's very likely that she had some form of anxiety disorder brought on, at least in part, by abuse. Forensic psychologists testified at the trial that Winkler had developed PTSD as a teen after her younger sister died. That's certainly possible. The most common cause of PTSD, which afflicts 9 percent of Americans at some point in their lives, is hearing about the unexpected death of a loved one, says Joan Anzia, a clinical psychiatrist at Northwestern Memorial Hospital in Chicago. Trauma in early childhood, she adds, can predispose people to developing PTSD later in life.
"It doesn't have to come from being in a war zone or a terrorist attack," says David Baron, chair of the department of behavioral sciences and psychiatry at Temple University. "It's about being confronted with an event where there was a threat of death or serious injury. You can see it with physical and sexual assault." Some sufferers of PTSD experience "dissociation," which Lynne Zager, a forensic psychologist for Winkler's defense, characterized as "[stepping] outside themselves ... sort of like being in a fog." Zager said Winkler had experienced those episodes and was in the midst of one when she shot her husband; Winkler herself told police she did not remember pulling the trigger. Dissociation, which does not appear in all PTSD cases, is "one of the strangest phenomena associated with the disorder," says Frank Ochberg, a clinical professor of psychiatry at Michigan State University. "The idea is that at some point without having full appreciation of what she was doing, she could have moved into an altered state of consciousness, like a trance, like a sleepwalker. It's not well understood and it's hotly debated. Cops hate to believe it. Prosecutors hate to believe it. A lot of people don't like to think that it belongs in a court of law, but it does if it's the best explanation that fits all the facts." Ochberg is willing to consider the possibility that Winkler was in a dissociative state when she killed Matthew. "It sometimes feels like it's a free pass," he says, "but it does seem realistic to me that if it's true that she was terribly abused, and I mean terribly, she could have had diminished rationality in committing murder."
Baron, however, is circumspect about Winkler's diagnosis. "Having PTSD result in violent, aggressive behaviors is not a common phenomenon," he notes. "Typically the behaviors tend to be more avoidant—patients might stop doing things they used to do, or become detached or estranged from others. If a patient is getting something out of having the symptoms, one needs to at least consider whether the symptoms are real."
What kind of treatments might Winkler have undergone for PTSD?
Typical treatments sometimes include antidepressants and anti-anxiety drugs, and almost always include some form of talk therapy—most likely "cognitive behavioral therapy," which is designed to help patients reprocess their experiences in a rational way. Some psychiatrists believe that to truly heal, PTSD patients should "re-integrate" their dissociative experiences with their other memories—in essence, that they should try to relive what they can't remember and put it in the context of the rest of their lives. "You want to retrain their brain to realize that not everything in their lives is a danger signal," says Anzia. "Part of that involves remembering and reprocessing the trauma in a rational way." Ochberg says the key is getting patients to gain control over a form of memory that "wakes us up in the middle of the night, changes the channel on us and scares the bejesus out of us. Therapy should consist in part of dredging up that traumatic memory and learning how to turn it on and turn it off."
But the "re-integration" treatment isn't always helpful, adds Anzia. "The question is, does it really do them any good? Sometimes the patient is just totally overwhelmed with their present-day life," she says. "In those cases, we would not go back there. Sometimes it's the best choice not to help the patient remember."
Winkler's case presents an added wrinkle: she may have been traumatized not only by years of abuse but by the killing she committed and the guilt she may have felt over it. "Most people with PTSD are not violent," says J. David Kinzie, a psychiatrist and director of the Torture Treatment Center at Oregon Health and Science University. "So I assume there is something extra added to this, probably some guilt that would have to be dealt with."
Ochberg offers another take: "It could well be for her it was the treatment as much as the elimination of her husband that changed her life and allowed her to feel normal."
PTSD is a serious illness; can it really be "cured" in 67 days? And even if Winkler is better now, couldn't her PTSD come back?
Winkler's treatment was certainly shorter than the norm. "I'm not saying it's absolutely impossible that her PTSD was resolved, but usually the treatment lasts a bit longer," says Baron. Typically, patients may endure dozens of therapy sessions—one study found that the sickest needed up to 120 separate hourlong meetings with counselors—before they're ready to make peace with their past. Nonetheless, short-term treatment can reduce some symptoms of PTSD, particularly if the disorder involves nightmares, which can be averted with drugs. And Winkler, unlike most sufferers, was treated as an in-patient, so her therapy may have been more intense than the standard approach.
No matter how successful the treatment appears to have been, though, it may not last. "She may look normal now, but if she has an aggressive confrontation with a male in the future, all the symptoms could come back," says Kinzie. "These patients remain extremely vulnerable to re-activation." Anzia agrees. "You can be removed to a safe place and recover, but if you're presented with an event that's similar to the original trauma, that can trigger [the PTSD] again." Many World War II vets who managed their symptoms successfully for decades experienced "full-blown flashbacks of combat" after seeing "Saving Private Ryan," she notes.
If Winkler wants to keep her own disorder under control, she'll
need to be careful. Kinzie says she should avoid watching TV. "It's
so violent that it can bring back memories," he says. "Almost any
abused woman cannot tolerate the kind of shouting matches that go on
in these detective stories." But, he adds, "if she can maintain
herself without aggression and irritability, she might even be able
to get custody of her kids." That, in fact, is Winkler's next
courtroom battle—and her next chance to prove she's well enough
to return to society.
Source: Mary Carmichael, www.msnbc.msn.com/id/20322236/site/newsweek/?GT1=10252
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