Trauma alleviation policy needed

Garth Rattray

THREE WEEKENDS ago I attended a mental health seminar, organised by the Association of General Practitioner's of Jamaica (AGP). Some of our very knowledgeable colleagues made informative presentations on mental disorders affecting patients of all ages. Naturally, with all the recent troubles in West Kingston, concern over Post-Traumatic Stress Disorder (PTSD) was expressed. The condition was formerly referred to as 'battle fatigue' or 'shell shock'.

The World Health Organisation (WHO) states that after the Vietnam war the concept of Post-Traumatic Stress Disorder was introduced into the language. PSTD comes about as a result of someone experiencing or witnessing an extremely stressful event (like the combat in Tivoli). There is usually a threat of death or serious injury accompanied by feelings of intense fear, horror and helplessness. Of course, other traumatic events, accidents and natural disasters may precipitate similar emotions.

The symptoms of PTSD sometimes last for years, and there isn't always a cure. The Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) , has described the condition rather extensively but for the sake of brevity I quote here from a piece by Phillip W. Long MD. We can expect those affected by PSTD to exhibit symptoms that include:

"Episodes of repeated reliving of the trauma in intrusive memories ('flashbacks') or dreams, occurring against the persisting background of a sense of 'numbness' and emotional blunting, Detachment from other people, Unresponsiveness to surroundings, Anhedonia (the absence of pleasure from acts that would normally bring pleasure) and avoidance of activities and situations reminiscent of the trauma. Commonly there is fear and avoidance of cues that remind the sufferer of the original trauma.

Rarely, there may be dramatic, acute bursts of fear, panic or aggression, triggered by stimuli arousing a sudden recollection and/or re-enactment of the trauma or of the original reaction to it. There is usually a state of autonomic hyper-arousal with hyper-vigilance, an enhanced startle reaction, and insomnia. Anxiety and depression are commonly associated with the above symptoms and signs, and suicidal ideation is not infrequent. Excessive use of alcohol or drugs may be a complicating factor."

The symptoms follow the traumatic event with a latency period ranging from a few weeks to months (but rarely exceeding six months). The course of the illness fluctuates and most people will recover, but, as was already stated, it is incurable in others. In a small proportion of patients the condition may become chronic and a lead to permanent personality changes.

In order to reduce the effects of the trauma we should dedicate a great deal of time and effort in seeing to the proper counselling of all those affected by the events witnessed in Tivoli Gardens. The very moment that the danger subsided, that area should have been blanketed with supplies of food, toys for the children and counselling posts for everyone. Some concerned organisations and individuals have tried to assist in this manner but this should be a governmental policy. We need to remember that not all scars are visible, but all scars can disfigure and warp permanently.

Although the facts of this massacre remain unclear at this time, what we do know is that some of our Jamaican brothers, sisters and children were severely traumatised and are now in dire need of physical, psychological and spiritual assistance. This holds true for our security force personnel as well. They were fired upon and pinned down by gunmen with high-powered rifles.

I will venture to say that at least some good can come out of this horrible event. This is an opportunity to heal old and new wounds, to make positive inroads and to show that Jamaica cares (without the blocking of roads and the derailing of the fragile/struggling economy). The media have been quoting the 'cost' of the actual and potential financial losses incurred because of this violent confrontation and the disruptive sequel that followed. I've heard of some 10 police vehicles being destroyed, several public transport buses being damaged, productivity being disrupted and of course the massive losses incurred in the tourist sector.

However, I have heard nothing about the 'cost' of the actual and potential loss of an entire group of priceless children traumatised by such macabre happenings. To have so many violent deaths occur within one country, within one parish, within one community over a short period of time is extremely traumatic.

It is traumatic to the witnesses, to the other people within that area, to the people within that parish and to the people within this entire country.

Most of us deal with the horrible event by talking about it to others and sharing our emotional pain and concerns; in effect we have been 'counselling' one another. Arising out of this event, the catch phrase of the day has become 'damage control'. Millions will be spent overseas in order to preserve our tourist industry. All this is well and good but what about the 'damage control' needed to preserve the mental well being of those thousands besieged and terrified for so many days because of the Tivoli confrontation? Our government needs to initiate a standard policy for all the people traumatised by events such as these. In my opinion charity and damage control should begin at home.

Dr. Garth A. Rattray is a medical doctor with a family practice.

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