A newly-wedded lady was having lunch with her husband when suddenly armed men broke into their house. They shot dead the husband and raped the woman. After the robbers left, the woman packed a few of her belongings and travelled 400km north to another city.
She lived alone in the new city with little or no social life. She would deflect all questions about her past and had frequent outbursts of anger, difficulty sleeping and nightmares.
She maintained no contact with the past for 10 years until one day, when a relative saw her and alerted the police. It was very difficult trying to get her to remember who she used to be, the very thing the police needed so that she could be a witness in court against the robbers who killed her husband and raped her 10 years earlier.
This woman had PTSD. Post-traumatic stress disorder.
While my story is fiction, PTSD is more common than you think and victims usually suffer from anger, difficulty concentrating, difficulty sleeping, amplified safety concern, exaggerated startle response, significant social and occupational dysfunction.
The risk is higher if there is lots of stress going on and if the victim is female. Victims with poor social support, a low economic status, low level of education, and history of prior traumatization are at more risk of developing PTSD.
Many of the patients that I have seen with PTSD may also complain of chronic pain or vague symptoms that are difficult to unbundle.
Some suffer from anxiety or depression and it is common for many to start using drugs/alcohol to kill the pain they have.
The victim may re-experience the traumatic event repeatedly through ‘flashbacks’, nightmares and intrusive recollections. They also try to avoid thoughts, places and people associated with the trauma they experienced.
In some, the brain actually blocks out the memory so they cannot recollect the trauma or an important aspect of the trauma.
If the victim is a danger to himself or others, he would be admitted otherwise, in-hospital admission isn’t necessary.
Psychotherapy is a big part of treatment. The plan is usually to start debriefing within 10 hours of the trauma when possible. Group debriefing is also effective for many people exposed to the same event (soldiers, medical staff, police)
Drugs like antidepressants, anticonvulsants, alpha blockers, beta blockers all play different roles in helping the victim recover.
Patients usually require specialist level care.
Today as we grief over the tens of people murdered in Orlando Florida, let us remember the hundreds and thousands that will remain ‘injured’ with PTSD and some of them might fight the battle with PTSD till the day they die.
Let us also remember the many who live in places where people are summarily killed in the name of religion or politics, many in the presence of family members, and to the many in developing countries who have been victims of armed robbers, assassins, kidnappers and mobs, many without a face who will live with the torture of PTSD all their life without hope for a diagnosis or treatment.
Let us pray for a world of peace.
