After the Terror

As we now are only too aware, "stress' sometimes means a lot more than just feeling uptight or upset about everyday life. Post Traumatic Stress Disorder (or PTSD) is a very unpleasant, sometimes disabling problem which often affects those who experience or witness horrific events as well as victims of violent personal assaults and childhood abuse. September 11 was so terrible and so widely seen on TV that almost everyone is affected to some degree. PTSD basically consists of:

1) Recurring and terrifying flashbacks and nightmares about the event.

2) Emotional numbing - feeling totally flat and unable to respond normally to others. This is one way the body relieves overwhelming distress, but it robs a person of joy, pleasure, and love. Someone affected by major PTSD may appear indifferent or unharmed when they are definitely not.

3) A general increase in fear, excessive vigilance, and a tendency to avoid situations reminiscent of the event. People suffering from PTSD feel a sense of unreality, and tend to be easily startled, irritable and quick to anger. Unpleasant symptoms - pounding heart, tight breathing and shakiness - make daily activities difficult. They often become depressed, unable to work effectively or sustain relationships.

Professionals such as soldiers, police, and firefighters are most at risk, but because of a need to appear strong and competent they tend to cover up painful feelings and may not begin to suffer until much later. This means that 'debriefing' and counselling at the time of the event isn't always effective. Delayed PTSD can be triggered by significant life changes, more traumatic events or even news stories and may later show itself through gambling and alcohol abuse, or medical symptoms such as headaches, digestive problems or chronic pain. Symptoms are treated but often their true cause is not. Deep depression and a lack of meaning, especially if combined with alcohol and drugs can turn PTSD into a fatal disease - 50,000 Vietnam veterans have committed suicide, more than died in the war.

It really pays to be ready for the time when we may be involved in some disaster. We could prepare by knowing our strengths and weaknesses and learning to cope effectively with the stresses of ordinary life. Afterwards, we need to realize that true courage is not pretending to be fine but recognising when we need help and getting it quickly. We should never forget that traumatised children also suffer many of the symptoms of PTSD, and bad behaviour may be a sign of hidden distress.

Although there's no totally effective treatment, medications and therapy are very helpful. The newer antidepressant drugs can ease depression and anxiety and improve sleep. Psychotherapy involves listening closely to the full story and helping to find some meaning in it. A therapist should be experienced, a sympathetic listener, someone who realises just how devastating PTSD can be. Group therapy with others with a similar background is very helpful. Social support counts for a lot, and so does a religious or spiritual belief. Gradually sufferers can begin to accept what happened, learn how to control tension and anxiety, and to release painful emotions in a more healthy way.

There are no easy answers for PTSD, but with enough time, effort, understanding and support most survivors of trauma can move on to live reasonably happy, productive lives. nnn