Within the span of a few days “we have witnessed unspeakable tragedy” and remarkable resilience. As an emergency medicine physician I have provided care for patients and families who experienced disasters; man-made and natural. We expect the unexpected in the ER. But not on a trip to the grocery store on a Saturday morning. Our norms and routines were violated beyond belief on Saturday. A parking lot was transformed into a theatre for warfare. Do you wonder if you could have demonstrated the heroism of Daniel Hernadez? How did you feel when you saw the first images of the tragedy unfold on TV? Can you be whole again? The answers to these questions– as is witnessing– is very personal.
It is the ‘witnessing’; directly or indirectly that can lead to one of the most profound & debilitating medical disorder, post traumatic stress disorder(PTSD). Although most commonly associated with combat in the lives of our servicewomen and men, PTSD can and does affect civilians; you, your employees, your family members and communities. While sadness, anxiety and depression can result from exposure to a traumatic event, PTSD is the most devastating long-term response to traumatic stressors.
Direct first-hand experience, for example, such as being in the parking lot in Tucson last Saturday witnessing the assault and victimization, or involvement in accidents, having a life-threatening illness or being involved in natural or man-made disasters can cause the type of severe trauma reaction seen in PTSD. Indirect exposure, watching television and seeing the plight of others who are in danger, or who are seriously injured or killed, can also cause PTSD. Another type of exposure occurs for some through hearing about traumatic events that others have experienced. Typically, the types of experiences that lead to Post traumatic Stress Disorder would be considered overwhelming and traumatic for anyone exposed to them.
Situations which commonly can result in PTSD include:
• the possibility of one’s own serious injury or loss of physical integrity
• the possibility of one’s own death
• one’s own actual serious injury or loss of physical integrity
• the possibility of another’s serious injury or loss of physical integrity
• the possibility of another’s death
• another’s actual serious injury or loss of physical integrity
• another’s death
Fear, helplessness and horror are the key emotions experienced by people suffering from PTSD. People who suffer from PTSD often relive the experience through nightmares and flashbacks, have difficulty sleeping, and feel numb, detached or estranged, and have hyper arousal symptoms. These symptoms can be severe enough and last long enough to significantly impair daily life. This condition is chronic if the symptoms persist for three months or longer. Some people have a delayed onset of symptoms which don’t begin until at least six months after the incident.
In the U.S. it is highly likely (60-70%) you and I will encounter exposure to an overwhelming situation which could lead to PTSD. It is more common in women than men. The good news is that exposure does not mean you will develop the condition. For example studies show that only 5-15% of people in the U.S. developed PTSD post 911.
Are you at risk? When it comes to the range of responses to overwhelming tragedy or trauma, as with any response to a potential trigger in the stress response – its all about you. Vulnerability to PTSD presumably stems from an interaction of biological factors, some personality types, early childhood developmental experiences, and trauma severity(combat, kidnapping, violent sexual or physical assault). Researchers are learning more about the biological factors. Many people who experience extreme trauma will have normal stress response. In PTAD, the stress response system becomes deregulated and chronically overactive. It compromises the immune system and is often associated with other physical health problems.
There’s good news. If you do develop or know someone with PTSD, it can be treated effectively. You can enjoy life, love and have hope again. However, most people do not develop PTSD after direct or indirect exposure. Most people do recover from exposure to the most horrific traumatic events and do not develop PTSD. There is a growing body of literature suggesting that coping and resilience are the norm following trauma.
Recovery is promoted by the following factors:
- A sense of a relationship with a higher power-spirituality
- A sense of self-efficacy
- Being able to talk and disclose with friends and/or mental health professionals
- A sense or perception that others in your circle understand your reactions
- Seeing yourself as a survivor or even a hero and not a victim
Finally some thoughts for your consideration as you seek to heal psychologically from this tragedy, and “do’s and don’ts” if you find yourself in at ground zero of a traumatic event in the future.
DONT: Debriefing. From a mass casualty expert panel who recently reviewed the literature on debriefing, we know psychological debriefing is not necessarily associated with reduced likelihood of PTSD. In fact debriefing is discouraged. Other than for operational purposes (i.e. paramedics, police etc) Any intervention that involves prompted retelling of the event in a way designed to recount or process emotional reactions was not recommended for primary victims in the first week or two following a mass violence event.
DONT: Judge Victims. intensity or type of early actions, words or symptoms of survivors do not predict long-term difficulties.. Studies indicate that no particular symptom or even constellation of symptoms is pivotal in predicting long-term adjustment to trauma across all situations. Different studies emphasize different symptoms as being important. But there isn’t currently no convergence of symptoms which should be weighed more heavily than others.
DO: Psychological first aid. This involves some combination of establishing safety; establishing protective environment for survivors, identifying uncontrollable responses such as gross mental status impairment or suicidally, facilitating social connections, access to additional resources, facilitating contact with loved ones, and reducing event reactions via education about what to expect and being a shoulder to lean on and listen. Psychological first aid does not include assessment of risk and recovery factors and monitoring of individuals for follow-up.
DO: Acknowledge your feelings. If you are predisposed to depression or anxiety, and are feeling unusually anxious or sad as a result of the tragedy in Tucson, seek professional help. It may be very hard to take that first step to help yourself or someone you know, but do so. Exercise, spend time with other people and confide in a trusted friend or relatives.
Carol J. Scott, MD is the Stress Relief Coach and author of Optimal Stress: Living in your Best Stress Zone (John Wiley & Sons. 2010). Listen to her show StressRelief Radio Sundays @ 1pm East and 10 am West on Cable Radio Network. Visit her site at www.optimalstress.com. Or follow her onFacebook or Twitter .