Why talk is NOT always the best medicine: How being pushed to talk about trauma immediately after an horrific event can do more harm than good, writes DR MAX
- Studies show 7% of front-line soldiers suffer from Post Traumatic Stress Disorder
- ‘Sometimes, it really isn’t good to talk’ after traumatic event – it can be disastrous
- If sleep doesn’t help then ‘tranquillisers or even a stiff drink may’
Survivors of tragedies such as this week’s Genoa bridge collapse are filled with a toxic mixture of utter relief (sometimes disbelief) that they’re alive, and an overwhelming sense of guilt that others perished.
This, combined with the terror they’ve experienced and the horror they’ve witnessed, can put them at a high risk of mental health problems.
Studies show that around 7 per cent of soldiers who served on the front line in Afghanistan or Iraq display signs of post-traumatic stress disorder (PTSD) following their return.
But these are individuals specially selected and trained to cope in high- pressure environments: rates of PTSD are far higher in the civilian population following trauma. So what can be done to help the survivors in the aftermath of such a disaster? Well, it isn’t what you might think.
A woman is comforted as she mourns a victim of a collapsed highway bridge, Genoa, Italy
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My heart sank a little when I read about the hordes of psychologists descending on hospitals in Genoa to support survivors and witnesses. I hope to God they are providing comfort and reassurance — and avoiding therapeutic intervention.
It may sound strange, but that’s the last thing traumatised people need. The belief that it’s helpful for people to share the horrific experiences they’ve just endured is a myth. Indeed, it could be disastrous for them. Sometimes, it really isn’t good to talk.
What we have learned from studies of military personnel in recent years is that the brain is actually rather good at processing terrible events — but quietly and at its own pace.
Problems develop when, in the hours after the event, people are encouraged to recount what happened to them and what they saw. It’s no protection at all against related mental health issues in the future. Indeed, it actually raises the risk of mental illness such as PTSD.
We know, for example, that soldiers who attend de-briefing sessions after witnessing traumatic incidents actually do worse in the longer term than those who missed the session.
Going over the experience so soon after it has occurred links it with the powerful, still-raw emotions felt at the time — fear, revulsion, anger, helplessness, despair etc. The survivor’s memories are consolidated and a pathway is created in the brain that allows the mind to run through them again and again, as though it is stuck in a groove.
Of course, I’m not saying that people might not need therapy down the line. But that is very different to giving therapy prophylactically before symptoms have developed.
On July 7, 2005, I was working at a London hospital that had taken in survivors from the terrorist bombings in the capital. As the psychiatrist on call, my job was to go round the wards to ensure that none of the staff was asking patients about what happened.
People mourn a victim of a collapsed highway bridge, at the Fiera di Genova exhibition center
You can hold someone’s hand and reassure them if they’re distressed, I explained, but don’t ask anything that might force them to relive what they went through.
I also made sure that every patient had ‘night sedation’ written on their charts as an option if they needed it.
Sleep is the best medicine in situations like this — a chance for the brain to get on and do what it does well: process traumatic experiences and render them ‘safe’ so that the mind can cope.
If sleep won’t come naturally, then tranquillisers or even a stiff drink may help.
When my partner’s sister rang from the Manchester Arena last summer — she’d been just a few feet from the foyer where the bomb went off and saw some truly horrific sights — that’s exactly what I advised.
Your brain can do the rest, I told her, if you just give it a chance.
There’s no such thing as a ‘shopping disorder’
Shoppers walk past a Debenhams shop in Oxford Street, central London
Do you love to shop? Do you dread your credit card bill each month, with proof of just how your purchases stack up?
Well, fear not: you’re probably suffering from a new condition, Compulsive Shopping Disorder.
Unbelievably, there are calls to make this an official diagnosis because of the growing number of people who say that because they just can’t stop buying, they must be ill — and so seek help.
What a relief that would be for profligate shoppers! Once something is deemed an illness, the only proper response is sympathy: ‘That £300 pair of shoes isn’t my fault, darling, it’s my CSD playing up.’ You can’t chastise someone who has a disorder.
I despair of what I see as the creeping medicalisation of everyday life: it removes any sense of personal responsibility for our behaviour and its consequences, and any need for self-discipline.
It’s the same with sex addiction, now a formally recognised condition: ‘No, I’m not a sleazy character who can’t keep his hands to himself. I’m ill.’
Similar attitudes are rife in schools. Children are labelled with terms such as ‘school refusal disorder’ (not wanting to go to school) and ‘oppositional defiant syndrome’ (hostile behaviour to figures in authority).
It’s simply an excuse not to think about, and address, the underlying cause — social or environmental factors — or to discipline the child, while determining what needs to change to improve the situation.
When having a pet beats popping a pill
A fascinating study that was published this week revealed that a third of depressed patients who’d failed to respond to conventional treatments found their condition improved after adopting a pet.
I’ve seen this many times. I once worked in a nursing home where one visitor always turned up with their dog — a crazy creature that caused mayhem.
But the residents adored him. No longer slumped in their chairs with their chins on their chests, half asleep while afternoon TV blared out, they’d be sitting up, laughing at the dog’s antics, scolding him or trying to stroke him as he dashed past. People who hardly said a word were suddenly talking to the dog.
It made me realise that depression is far more complex than the pharmaceutical industry would have us believe — far more than just an imbalance of brain chemicals. Instead, contact with, and caring for, another living creature — and receiving affection in return — is crucial to our well-being.
I often wonder how much of what we label ‘depression’ is actually a perfectly normal and understandable desire to be loved, and to have someone to love. It would certainly explain why a pet is better than a pill.
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