What is Post Traumatic Stress Disorder?
By: David Kinchin

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Translations
09.15 School's settled down. Teacher is about to mark the register. A call of `dinner children' from the corridor. Some go to pay their dinner shillings in the hall. Two are spotted by the headmistress, Miss Jennings, and sent to the senior school with a message.

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09.18 An avalanche crashes through the school. It kills one of the two children on their way to the senior school. A black, wet mass slurps through a classroom, and fills Miss Jennings's study. She's 64, due to retire at the end of term. Next door to her Mrs Bates and 33 children, aged 10 and 11, all die.

09.29 All 11 of the school soccer team, who had won 3-2 the afternoon before, are killed.

If this were fiction it would be horrifying enough, but the fact that it actually happened gives it a traumatic quality. We live in an age when such events seem to occur with ever-increasing frequency. Not a single day passes without a calamity affecting some part of the planet, and pictures of these events are immediately flashed to our TV screens and our newspapers. The disadvantage of having such an efficient and prompt news service is that everyone becomes better acquainted with the dangers life may have in store. We are all more traumatically cognisant.

Apart from headline-making disasters, there are other sources of trauma. All around, people become victims of crime and accidents, quite often with devastating consequences. Many of these events go unnoticed except for the few people who have been directly affected by such ordeals, but many of the victims may later suffer from Post Traumatic Stress Disorder (PTSD).

PTSD results when a person has been exposed to an event which is outside the range of normal human experience: an event which would markedly distress almost anyone. It is the normal human response to an abnormal situation. The experience could be a serious threat to life. It could be a serious threat or actual harm to one's children, partner or other close relative or friend. It could be the sudden destruction of one's home or community, or seeing another person who has recently been seriously injured or killed as the result of either an accident or physical violence.

PTSD goes further. The event only has to be perceived as traumatic by the victim. In reality the incident might not pose a serious threat to life, but if the incident is genuinely considered to be life-threatening, then the victim has experienced an event outside the range of normal human experience. More recent evidence has shown that PTSD can result from sexual abuse, and from bullying. I believe that the drastic increase in PTSD is very much the product of modern living. PTSD case numbers rise in ratio to advances in technology. The more advanced today's world becomes, the greater the scope for the existence of severe life stresses and traumatic situations. The more advanced our communications networks become, the more our minds are filled with plausible traumatic imagery. I suspect the incidence of PTSD cases will continue to rise.

Large-scale disasters, either natural or man-made, will inevitably lead to a large number of people within one community being affected by PTSD. On 21 October 1966 a waste tip from a Welsh coal field slid down the side of a valley and demolished several houses and a village school. The incident at Aberfan killed 116 children and 28 adults (Austin 1967). The opening paragraph of this chapter describes part of this disaster. In less than twenty minutes every person in that community had been permanently scarred by a disaster which touched the hearts of millions.

This disaster is vividly recalled by many Britons because it was covered by television crews who arrived on the scene within hours. The full horror and traumatic consequences of the disaster were screened in millions of homes.

Five-and-a-half years later, a similar event happened in the USA. On 26
February 1972 an enormous slag dam gave way and unleashed thousands of tonnes of water on the communities of Buffalo Creek, West Virginia. The mining hamlets of Becco, Lundale and Pardee were almost totally destroyed. The disaster resulted in 126 deaths, and it left 4,000 people homeless. Like the Aberfan tragedy, the actual incident lasted less than twenty minutes, but the consequences were devastating.

In 1966 the people of Aberfan were considered to be suffering from `severe shock'. In 1972 those in Buffalo Creek were labelled as suffering from a complex which became journalistically known as `Buffalo Creek syndrome'. After seeing so many traumatised Vietnam veterans, the medical profession recognised that all victims of extremely traumatic events tended to exhibit similar behaviour and symptoms. Significant numbers of Vietnam veterans were displaying signs that all was not well with their lives. Their traumatic wartime experiences were adversely

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affecting their state of health. Upon returning home they were not welcomed as heroes. Civilians just did not want to know. The combination of suffering severe trauma and experiencing such a negative reaction back home led some veterans to resort to drink, drugs and violence.

In 1980 the symptoms exhibited by these veterans, and those exhibited by civilian victims such as those who suffered at Buffalo Creek, were grouped under the diagnosis of Post Traumatic Stress Disorder. The definition, coded DSM-III, gave a name to the disorder and officially replaced such terms as: shell shock (1940); gross stress reaction (1952); transient situation disturbance (1968); and Buffalo Creek Syndrome (1972).

In 1994 this definition was amended once more (DSM-IV) and is now recognised world-wide.

In the wake of the terrorist act which caused the Lockerbie plane crash, many of the rescue workers struggled to cope with the horrific scenes before their eyes. By the date of the disaster, 21 December 1988, it was readily acknowledged that these people were likely to develop symptoms of Post Traumatic Stress Disorder.

The shooting incident in Dunblane shocked even the most hardened people. How it was possible for one man to walk into a school and shoot dead sixteen children was hard to imagine. But that is exactly what 43-year-old Thomas Hamilton did on 13 March 1996. The world was deeply scandalised by yet another incident that lasted less than twenty minutes. Britain, and the world, was becoming more aware of what traumatic events can do to

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individual people, to families and to communities.

This tragic shooting provided the largest incidence of "trauma bonding" .In particular, there developed a bond between the residents of Dunblane and those living in Aberfan. The two disasters were separated by thirty years and about 315 miles of countryside, but the two communities were united by an invisible "trauma bond" .This bond is an invisible understanding which exists between those who have witnessed or experienced a traumatic event.

Six criteria need to be met before a diagnosis of Post Traumatic Stress Disorder can be made (DSM IV) (Kinchin 1998):

1. TRAUMA The person must be exposed to a traumatic event or events that involve actual or threatened death or serious injury, or threat to the physical integrity of self or others. The person's response must involve fear, helplessness or horror.

2. INTRUSIVE The event must be persistently relived by the person.

3. AVOIDANT The person must persistently avoid stimuli associated with the trauma.

4. PHYSICAL The person must experience persistent symptoms of increased arousal, or 'over-awareness'.

5. SOCIAL The disturbance must cause significant distress or impairment in social, occupational, or other areas of functioning important to the person.

6. TIME Symptoms, linked to 2, 3 and 4 above, must have lasted at least a month.

Set out in table form, the criteria for establishing PTSD appear cold and clinical. Examples used later will add a considerable degree of reality to the disorder and make these symptoms more understandable.

HOW MANY PEOPLE SUFFER FROM PTSD?

The number of people who suffer from PTSD at any one time is equal to about one per cent of the general population. In 1987 researchers carried out a survey of psychological disorders exhibited by the population of St Louis, Missouri. A total of 2,500 randomly selected residents was studied, and 28 people were diagnosed as suffering from PTSD. Of those 28, the men cited only two types of event as a cause of the disorder: combat and witnessing someone hurt or die. The most common event cited by the women was physical attack, including rape. Other events which were identified as triggering PTSD were being poisoned, and having a miscarriage. Major disasters accounted for none of the 28 cases. Within some groups of society, the incidence of PTSD must be expected to be much higher than one per cent. Within the emergency services (fire, police and ambulance) and the armed forces (army, navy and air force) the incidence of PTSD can be as high as 15 per cent (Ravenscroft 1993). It is a disturbing probability that out of every hundred police officers currently engaged in uniformed patrol duties in our towns and cities, fifteen will be suffering from symptoms in accord with PTSD.

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