In the recent past Sri Lanka has experienced quite a bit more than a country's normal quota of violent events. The victims of such situations like war, attacks, mass killings and bomb blasts suffer not only physical harm but also emotional stress that could have wide ranging effects on their lives long after the immediate disaster situation is over.
In fact emotional stress triggered by violent, traumatic events affects not only those who were directly involved but also those who were engaged in search and rescue operations, doctors and nurses attending the wounded and also people who simply watched the event over television or relatives of those injured or dead. Psychiatrists term emotional disturbances after violent events as Post Traumatic Stress Disorder (PTSD) . Trauma is defined as a severe stress out of the normal human experience that adversely effects the individual. Dr. Ravin Hanwella at the University Psychological Medicine Unit - Colombo said that disasters like earthquakes and wars could be termed as traumatic events, but here, emotional effects of wars or bombs are more keenly felt than natural disasters.
Dr. Hanwella said that PTSD is not a direct result nor is any way proportional to injury during the event. In fact injured victims might survive the mental stress better that would those who were at the scene and escaped unscathed or those in categories mentioned above. Even doctors treating the wounded could suffer PTSD, he said.
PTSD is considered serious and requires professional help, usually when the symptoms of it last over a month after the incident . The, symptoms according to Dr. Hanwella could be categorized into four groups. The first is constant reliving of the experience, where the individual constantly thinks and ponders on the event, has recurring nightmares and flashbacks of the horrors of the day of the incident. Flashbacks are periods when the person actually relives the moments of trauma again in his mind so realistically that he or she believes that it's actually happening again.
Secondly the affected person would try to completely avoid associating with the event. An individual would try to be as removed as possible from the surroundings of the incident and would disassociate from all that reminds him or her of the episode.
Some affected individuals might be hyper aroused, tense, ever vigilant and spend many sleepless nights because of this anxiety. Then again victims could feel an emotional detachment
from their everyday lives and environments- pay little attention to their work or family lives.
According to Dr. Hanwella, in children the symptoms would manifest in a reluctance to talk positively of future plans as kids normally do. If these symptoms continue for over a month the individual most probably requires trained counselling, Dr. Hanwella said.
The symptoms do not necessarily show up right after the episode but could come weeks or months after the traumatic experience. PTSD would also show up in signs of depression and anxiety. Often affected people would resort to alcohol or other dependent habits to curb their depression and anxiety.
Dr. Hanwella said that it is important for people to recognise these symptoms and seek professional help before the situation could worsen, where treatment would also be more complicated. He said that it is important that the individual realizes his own problem and seeks help since no one else can force psychiatric treatment on any person. He also stressed that people should overcome their shyness about coming to seek help from a psychiatrist since psychological health is as important if not more important than physical health. People tend to have the misconception that those visiting psychiatric wards or the Angoda Hospital are necessarily mad or weaklings who cannot stand pressure. This is not true. This social stigma is preventing many from coming to seek help.
Dr. Hanwella said that many interesting methods have been developed to deal with PTSD patients. Each case has to be analyzed separately, he said. The most common treatment is to make the patient talk about the experience in detail, which is believed to relieve the stress of the trauma.
Another more exotic method is called Eye Movement Desensitization, where the patient, especially those who are constantly reliving the scenes, are said to conjure up the images of the episode and then told to follow slow left-right finger movements of the doctor. This is believed to break the concentration of the image in mind and makes it difficult for the patient to relive that experience again.
Government psychiatric treatment is available at all teaching hospitals and main district hospitals throughout the country and at ward 59 of the Colombo General Hospital.
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