WHEN DISASTER STRIKES!
For most of us life meanders along pretty smoothly until disaster strikes—a traumatic event so severe, so devastating that within hours, minutes or even seconds our very existence becomes agonizing and perilous. A world which seemed relatively safe and secure suddenly becomes a terrifying place! These stressors are usually outside the range of normal human experience and can include natural disasters (floods, earthquakes), accidental man-made disaster (industrial accidents, train or road accidents, fires), deliberate man-made disasters (terrorism, bombing or torture) and victims of violence (murder, assault, rape). The suddenness and the severity of these events catches the victim off guard, deterring them from developing any preparatory defenses. The impact may be intense and terrifying and at times the effects may be prolonged or even delayed. The loss of one’s loved ones as in group disasters escalates the trauma inducing feelings of guilt over personal failure to save the loved one. The impact may be more severe if there is intentional cruelty involved as in torture, or if the victim feels cornered or trapped.
VULNERABILITY
Who are the people who suffer the worst consequences of such mammoth stressors? While nobody is spared the crippling psychological trauma, besides the physical injury, several factors predispose an individual to develop symptoms of Post Traumatic Stress Disorder
(PTSD).
- The very young and the elderly are the worst hit as their coping mechanisms are weak or inadequate.
- Those already in poor health, or the disabled who are dependent on others.
- Personality traits such as anxious, nervous, compulsive, brooding, dependent, irritable make the person more prone to
PTSD.
- People who have had a previous psychiatric illness like anxiety or depression have lower threshold to develop this syndrome as they are more emotionally fragile.
- Those with history of alcohol or drug abuse are likely to increase intake and thus increase their dependence on them.
- Victims who have no social support networks such as family, friends or relative who help to cushion the impact of the stress suffer more e.g. single, divorced, separated, widowed, socially or economically disadvantaged.
THE SYMPTOMS
The initial ‘disaster’ syndrome typically involves a first stage of ‘shock’ in which the victim is stunned, dazed and apathetic; the second stage where in the person is passive and suggestible, only too willing to follow instructions; and thirdly the recovery stage in which he may be tense and apprehensive but gradually regaining his psychological equilibrium. When the impact is more severe the individual may suffer deeper trauma that develops into a syndrome throwing him or her off balance, emotionally and psychologically.
The victim has recurrent recollections of the traumatic event, virtually reliving every moment of it again and again and just can’t seem to be rid off them. To make matters worse they may have nightmares or recurrent dreams often awaking in a terror. On the slightest provocation they may show a ‘startle’ reaction and act or feel as if the whole event is about to repeat itself. Some may also show a ‘psychic numbing’ or withdrawal from the external world, showing no interest, no emotions and seemingly cocooned in the relative safety of their private world. Victims may also suffer from survivor guilt, apparent memory loss for the event, difficulty in concentration, hyper alertness, extreme nervousness or irritability, restless, depressive features and many bodily complaints. All these features may seriously interfere with interpersonal relationships, work and family life.
MANAGEMENT
It is aimed at reducing distressing emotional reactions and providing for stability and a return to normalcy. In acute shock reactions proper rest, reassurances, removing the person from the stress situation and mild tranquilizers usually lead to rapid alleviation of shock symptoms. Prompt help prevents the development of the more serious PTSD.
For those who have developed the Post Traumatic Syndrome the treatment is fourfold :
- Behavioral therapy such as relaxation therapy for overcoming anxiety and inducing sleep and desensitization to overcome phobic symptoms.
- Medication such as minor tranquilizers and anti-depressants should not be used. It should only be reserved for those who have severe symptoms but only for a suitable, short period under medical supervision to avoid any dependency on them.
- Supportive psychotherapy that restores confidence, provides emotional catharsis and strengthen their coping abilities.
- Physical, social and occupational rehabilitation to ensure that the victim is back into the mainstream of life.
‘Traumas’ in today’s uncertain world are common place and may affect anyone of us but there is always hope for the future for those affected by Post Traumatic Stress Disorder, with a little help from friends, relatives, community and therapists.
—Dr. Avdesh Sharma is a celebrated mental health expert and Heads 'Media and Public Education Committee' of 'Psychiatry in Developing Countries Section' of World Psychiatric Association.
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