Mumbai: Horrific, near-death experiences can cause Post-Traumatic Stress Disorder. Aviva Ingram examines the latest research
When survivors staggered from bombed tube carriages in London, rescuers feared they would never be the same again. Not only had their lives been at risk but they had also witnessed things we all hope we'll never see. In truth, the way people react to terrifying events can vary.
After a few weeks of feeling troubled, most find they can deal with the experience and move on. But up to a third develop Post-traumatic Stress Disorder (PTSD) and are tortured by flashbacks. For months or even years after an event, the slightest detail a noise, texture or smell can trigger painful memories.
As PTSD takes hold, victims feel isolated and fear they are losing control. They may avoid people or places related to the incident and become hypervigilant. Or they may start shaking and sweating, forgetting key parts of the trauma and having recurring thoughts about how they may have prevented it. Irritability and an inability to concentrate can also make it difficult to live a normal life. Many people with PTSD suffer from depression and anxiety disorders. Some turn to alcohol and drugs in an attempt to banish excruciating memories.
PTSD is different from pure stress. People clinically diagnosed with PTSD have been through specific horrific events and fear death or serious injury to themselves or others. They feel horror, fear or helplessness. Witnessing a traumatic event or knowing a victim can be a trigger. After the 9/11 tragedy, thousands of people who saw the attacks are thought to have developed PTSD.
What happens?
For Londoners setting off for work on Thursday July 7 or people sunbathing on the beach before the tsunami hit, the terrors that lay ahead were unexpected and the experience alien. Without warning, life flipped from being safe into an emergency they couldn't begin to comprehend.
"When you find yourself in a traumatic situation, your brain's priority is to help you survive," says Christa Mackinnon, a psychologist and hypnotherapist who specialises in trauma. "The brain shuts down emotions associated with what is happening to allow you to tackle priorities. Once you're away from the situation and your brain starts functioning normally, you feel what you bottled at the time."
You may feel shocked, anxious and edgy, have trouble sleeping and experience nightmares. Although it's unpleasant, feeling this way doesn't lead to PTSD. "It's normal to experience distress after a traumatic event," says Dr Jonathan Bisson, senior lecturer in psychiatry at Cardiff University, "For most people, these feelings subside after a few weeks."
"For some, processing the memory of what happened makes them want to shut down again, and a trauma cycle is established. The memory is never dealt with, so the trauma retains the potential to cause distressing emotions,' explains Mackinnon. Several factors increase the chances of someone developing PTSD. Lack of emotional support afterwards, having to deal with other stresses in your life, or having been through a life-threatening experience before, all increase the risk.
A physiological cause?
"No one knows the exact brain mechanism involved in the development of PTSD," says Dr Bisson, "but research has shown that brain chemicals in people with PTSD have changed." They tend to have abnormal levels of key hormones involved in the response to stress that could lead to symptoms of PTSD. It's also thought that changes in the hippocampus (part of the brain important for memories and emotions) may be related to the intrusive memories. If these mechanisms were fully understood, it may be possible to block the development of PTSD. For now, such a preventative therapy does not exist.
Overcoming your trauma
The sooner you get help, the more likely you are to recover. If your symptoms continue for more than a month, or they're making life unmanageable, go to your doctor.
If you're diagnosed with PTSD, you may be offered one of two psychological 'talking' treatments. The first is trauma-focused Cognitive Behavioural Therapy (CBT). "This involves recalling and talking in great detail about what happened, to help process distressing memories and store them normally," says Dr Grey. "The aim is to help people put their memories and associated feelings in the past." Negative beliefs are also tackled and during CBT, you may receive help in exposing yourself to situations you fear. The second treatment is Eye Movement De-sensitisation and Reprocessing (EMDR).
This helps you process memories of the trauma so you can think about it without feeling anxiety. It involves thinking of the worst image of your trauma and the emotions, thoughts and sensations related to it, while following the therapist's fingers as they move from side to side. "This is not hypnosis but produces a similar trance-like state," says Mackinnon. "The eye movements that mimic REM sleep, are thought to re-programme the brain's response to the memories."
Ironically, simply talking about the event may not be that useful. "If you like talking about your feelings, it can help and assist the outcome of your treatment," says Dr Grey. But if you don't usually share your feelings, it probably won't do much good. A one-off debriefing session soon after your trauma is thought to be unhelpful and can do more harm than good. Recovering from PTSD can be likened to a journey.
David Kinchin, a former PTSD sufferer and author of Post-traumatic Stress Disorder: The Invisible Injury, defines it as 'a game of emotional snakes and ladders'. Some people make a speedy recovery, many recover in stages, with both successes and setbacks, while for one in three people, the journey will last a lifetime.
Treatment can help cope with the symptoms. A majority of people do make a full recovery. The most important thing, if you develop PTSD, is to tackle your emotions. There are therapies that can help you come to terms with your memories and allow you to get on with your life. You are certainly not alone. Planet Syndication
How to move on
Do what you used to enjoy doing. "If you loved gardening or listening to music before the trauma occurred, take up these activities again," says Dr Grey.
Get active. Physical exercise like walking or swimming can help boost self-esteem and aid healing.
Be kind to yourself. "Treat yourself with compassion, as if you were helping a friend," says Dr Grey. Everyone will have a unique response to a trauma and will need to proceed at their own pace, says mental health charity, Mind.
Relax your body. People with PTSD are on constant high alert, jumpy and unable to relax. So relaxation techniques can be very beneficial. But for some, the minute they sit quietly, distressing memories come flooding back. The compromise, says Mackinnon, is to relax your body while keeping your mind occupied. Try yoga, pilates or any form of physical exercise. "A relaxation tape, preferably one made for you, can help," she says.
"Once you've worked through your trauma, relaxation becomes beneficial," says Mackinnon. Try meditation or aromatherapy. Everyone is different, so check with your therapist.
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