Vulnerability Paradox

Beginning in the 2000s, researchers looking into the prevalence of trauma-related disorders—especially post-traumatic stress disorder, or PTSD—found that rates of these disorders are often higher in richer countries than in poorer ones.

This contrasted with their expectations going in, as it was assumed places where citizens are less vulnerable to things associated with trauma (violence, uncertainty, abuse, etc) would be less prone to things like PTSD, and those trauma-associated variables are more common in poorer nations, on average.

What they found, instead, is that trauma seems to be more closely correlated with the contrast between a person’s expectations and pre-trauma experiences, and the traumatic things they encounter.

Said another way, if you grow up in a peaceful Canadian suburb and, while traveling overseas, are mugged at gunpoint, that might register as a truly alarming and disorienting event that lingers in all sorts of psychologically reflexive and disordered ways.

If, in contrast, you grow up in a part of the world where armed muggings are common—some parts of South Africa, for instance, have very high rates for this type of crime—you might not be thrilled to be thus targeted, and it might very well ruin your day to have someone point a gun at you and take your stuff, but such an experience might also fall within your existing worldview: your heuristic for life might include this sort of eventuality because such crimes are so common where you live.

In practice, this means that some of the most peaceful, stable, and rich places in the world have some of the highest rates of PTSD: one study from 2008 found that Canada has a national lifetime PTSD rate of 9.2%, which is a staggering figure (in contrast, that number was 6.8% in the US in 2007, and a mere 2.3% in South Africa in 2013).

There are good reasons to question these numbers, and resultantly, the concept of what’s become know as the “Vulnerability Paradox.”

For one, there’s always a chance that more and better data is available in richer countries, because of the existence of more thorough, better funded, and better maintained systems capable of collecting and archiving this type of data over time.

It’s also been posited that it might be more culturally acceptable to admit to suffering from things like PTSD in richer areas, while the opposite is true in places where more tangible concerns (like crime and affording food) may be more likely to occupy a person’s mind. More people in poorer areas may suffer from PTSD or similar ailments than in richer countries, but they may be less likely to tell anyone about it, and may not even admit to it, if asked.

It’s possible, too, that the metrics being used don’t actually measure what researchers assume, as some cross-national studies have found no evidence of this paradox, with self-reported subjective well-being more closely lining up with vulnerability rankings (more crime and poverty leading to lower levels of well-being, as was initially expected by those other researchers).

What we might be seeing here, then, is an issue with measurement and the labels we use for different types of psychological suffering.

There’s a chance some aspects of this seeming paradox apply in some places with some people, some of the time, but there’s also a chance that a persistent sense of things not being good can lead to trauma, as well, even if that trauma shows up differently in the numbers, or is categorized and handled in a variety of ways by those suffering from it.