Monday, June 02, 2008

Stiff upper lips

The Mail and the Telegraph have both picked up ( with palpable glee) on a a report from Mark Seery, an expert in the psychology of stress at Buffalo University, reporting that a stiff upper lip is the best way to deal with shock.

Actually, both papers have rather misrepresented the findings of the survey, which tracked 3000 people in NYC and Washington, none of whom had actually been personally involved in the 9/11 attacks, as survivors, or who had lost loved ones.

They were in fact, people who were on their database anyway and the study looked at whether they were talking about the attacks or choosing to carry on much as before, checking back on them over the next two years. The study found that people who had not elected to talk at length and dwell upon it seemed to be doing better, two years on, than those who had emoted at length.

Of course, people who talked about it might have talked about it in the first instance because it upset them deeply, and so they were still upset by it years on. And people who didn't want to talk about it in the early stages simply might not have had much to say about it, because they didn't feel especially affected by it when it happened. But it's still interesting, because in recent years, we've become used to hearing the solemn intonations on 24 hour news media, in the aftermath of a school massacre or a bomb blast in a highly developed Western country, that ''specialist counsellors are on their way to the area.'' And the idea that perhaps people might not want to talk about it has been presented as almost quite dangerous.

'You are getting counselling, aren't you?' people kept asking me after 7/7. Actually, I wasn't. What I wanted was rest, because I wasn't sleeping, and time off work, because I couldn't concentrate, and hugs from my partner, friends and family, and to go down the pub with other bombed passengers once a month and cheer each other up and encourage each other back on the trains and buses and to make each other laugh with the terrible grim black humour we had at the time .

Later I read up on this stuff, because psychology and trauma has interested me for several years now, and I found some studies that came out post 9/11 about the 'grief industry', in which it is assumed that thousands or hundreds of thousands of people would be deeply traumatised by witnessing the 9/11 attacks - even just on TV in some cases - and would subsequently go on to develop post traumatic stress syndrome. Accordingly, thousands of grief counsellors and trauma specialists descended to aid what was expected to be a stricken city. (See this article in The New Yorker for a good overview.)

However, it is now thought that early incident debriefing en masse - where groups of people are all put into a room and urged by a counsellor to relive the traumatic event in horrifying detail often a few days afterwards can do more harm than good. People, like animals have their own innate coping mechanisms and urging people to talk when they are still processing what they have seen and dealing with it in their own way - especially as a group rather than one on one - especially in the first few weeks and days - can simply retraumatise them.

A parallel can be drawn with the less news-worthy human experience of bereavement: when someone loses a loved one, most people's first thought for them is not that they must hie themselves to a grief group, or get into a psychologist's specialist clinic and discuss the passing of their loved one in awful detail, but simply to care for them, try to ensure that they are fed and getting some sleep and rest and support with everyday tasks, and to provide a listening ear in the months afterwards if their friend does want to talk - in their own time, in their own way - understanding that grief is personal and takes its own time.

People have their ways of coping. Often talking to friends and family, or keeping a diary, or going for a long walk or a work-out works better than talking to a strangers. Some people are most uncomfortable talking about personal things at the best of times, and extremely stressed at being considered a 'victim' - or 'survivor' - they quite understandably don't want the event that they had no choice in witnessing to 'define' them. And that does happen, especially in a highly mediatised tragedy. For many people, remaining as determinedly 'normal' as possible in the aftermath is a coping mechanism, and insisting that they are pathologised by pain feels insulting, if not downright damaging.

It's not always a case of putting the kettle on, or pouring a double scotch and keeping a stiff upper lip though. There are things to be aware of, and more people, thankfully, are now more attuned of the warning signs of when they or others are in psychological distress and need help to recover from a psychological injury ( which is what PTSD is - not a mental illness or weakness).

Piling into the alcohol or drugs or cigarettes, nights of insomnia, depression and survivor guilt, flashes of furious anger, loss of libido and a sense of emotional numbness or disconnected hopelessness, still felt months after the event are danger signs - as are headaches, flashbacks, increased susceptibility to illnesses, hair-trigger startle reactions, or the development of phobias or avoidance behaviour relating to things that remind the person of the traumatic event.

If after 10-12 weeks this is still going on, and the usual coping mechanisms - such as chatting to friends and family or others who were involved in the event, or burying oneself in work - are not working, and everyday life and functionality are still affected, then getting an appointment with someone who is trained in post-traumatic syndrome is advised. Cognitive Behavioural Therapy and EMDR have good track records for dealing in a very practical way with management of traumatic symptoms - and the good news is, appointments usually go on for a few months, rather than a few years.

But most people do bounce back in time, harnessing their own support networks and their own mind/body wisdom to recover from witnessing a terrible event. In the case of the 3000 stoic New Yorkers of the study, I am rather pleased that the findings disproved the ' let it all hang out and cry for the cameras/the therapist' meme. When I saw on the news that busloads of counsellors were being rushed to Virginia Tech to support the students after the shootings, I felt a bit anxious for them. I remembered what the trauma specialist told me in the weeks after 7/7. That yes, like others, I was shaking, chain-smoking, not sleeping, jumping, waking every hour re-hearing the screams and smelling the choking dust. And that he was not surprised. Because it had only just happened. And so what I was feeling was normal.

I found my own narrative, my way of pulling the threads back together and stitching the fragmented memories into a whole, over the weeks and months. I went back to work - on the tube - a few days after the bombs - and I wrote, anonymously, online, for half an hour a day and told unseen strangers more than I told my family and friends, because it felt safer to speak of it when I did not have to see the sadness on the faces of those I love. I went to the pub with other people from my train and got drunk with them. We emailed each other. When the flashbacks came, I knew what to do, because I'd had PTSD before. I trusted it would all get better in time, and it did. I was lucky. I was helped. I was not seriously and permanently injured, I was not bereaved.

It's not all about bombs these days. And I'm glad about that.

Linkback: Eddie Mair's blog.



Anonymous Christine said...

Caught you on radio 4 last night as I drove home listening to PM.

Very clear, very sensible - you ARE the voice of reason as usual. It would have been good to have more time to discuss CBT and the effective treatment given to trauma sufferers inc. the work of the NHS Traumatic Stress clinic and the 7 July Assistance centre, but overall well done. Can't belive the Mail and Telegraph failed to point out that the sample was made up of people who were not directly involved in the 9/11 attacks at all. In that context, their headline 'stiff upper lip better for shock' was actually quite misleading. Stiff upper lip for someone who has just escaped from a burning scyscraper in which their colleagues were killed is not appropriate advice.

June 03, 2008 11:15 am  

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