The stress dissident

Yvonne McEwen has angered the counselling world by claiming that trauma victims do not need a talking cure. But what are her own qualifications? Olga Wojtas reports

When Yvonne McEwen was appointed project director of the country's first higher education initiative in trauma management last January, the accompanying press release emphasised the controversy surrounding her views. This week, the initiative itself is under review by its funding institution, Fife College of Further and Higher Education, and has been "temporarily withdrawn" from the college's collaborative venture with the University of Abertay Dundee, the Abertay Fife University Project. The project gives the initiative kudos rather than hard cash, and Ms McEwen's work for Fife College continues unaffected. But this week's move, announced in a terse statement, comes in the wake of far more heated controversy than the college might have wished.

McEwen's criticisms of the "lucrative industry" of post-traumatic counselling, after outrages like Dunblane and Lockerbie, have attracted widespread press coverage. They have also been ferociously attacked by academics and medics working with victims of disasters and tragedies across the world, some of whom have raised questions about what McEwen bases her arguments on.

Gordon Turnbull, for instance, who heads the trauma unit at Ticehurst hospital in Sussex, and who organised the debriefing of the Beirut hostages in 1991, says: "Yvonne McEwen paints an absolutely inaccurate picture of people who work in the trauma field. We want to establish from what basis she puts forward her views, which can be very damaging to victims of trauma and to those who work with them."

Particular interest has focused on the fact that McEwen told Fife college's publicity company that she had been awarded five international visiting professorships. In defence of McEwen, who qualified as a nurse, the college has said that the reference to "professorships" arose from academic naivety. Given the courtesy title of professor when lecturing overseas, and not having an academic background, McEwen understood these courtesy titles to be visiting professorships, says college principal Joyce Johnston.

When press reports first called her professor, the college pointed out her mistake and since then she has disclaimed the title. "This focus on the detail of Yvonne's qualifications and experience is unfortunate because it takes the focus away from the real issue of (debating) approaches to trauma management," says Johnston.

Up till now however, this debate has been fairly widely aired in the pages of local and national newspapers, which have publicised McEwen's passionate desire to "give victims their voice" and her claims that the western world overemphasises the importance of, and need for, professional counselling following a catastrophe. A talking cure, she says, is not what victims primarily want or need; often practical assistance is of much more comfort.

"I think we've pathologised and medicalised people's very natural reactions after traumatic events. From my experience of dealing with a variety of life's victims, they have three basic needs: clear, concise lines of communication and information, to have their civil liberties and human rights upheld and to have their loss acknowledged judicially, socially, economically and politically."

McEwen's arguments stem, she says, from extensive practical experience of working with disaster victims. The plan, now being reviewed, had been for McEwen to work alongside academics who would "rigorously research" her views, which would then underpin the initiative's approach to training, if appropriate.

In an article she wrote earlier this year, McEwen claimed that, in the wake of major disasters, she had seen "counsellors rushing in where they were not invited and causing untold damage". She argues against any compulsory prescription of solutions for individuals, saying that people should be able to choose for themselves what help they need, and that may or may not include counselling. And she warns that many professionals start out with the idea that the victim has post-traumatic stress disorder (PTSD), which inhibits them from looking for any other problems or solutions. Nobody, she argues, has ever proved the existence of PTSD. The "condition" came about in the US because there had to be a legal definition for compensation for Vietnam veterans, she maintains.

"It's become a catch-all for everything now. We've invented a whole type of therapy, and educated people around a condition that we actually aren't sure exists," she says. "The epidemiology is purely western, and the argument I have consistently advanced is that good medicine is always based on good epidemiology."

In the western world, McEwen says, even the victims of burglaries are diagnosed as suffering from PTSD. "What about the victims of life situations, people in third-world countries who are victims of drought and famine, year in year out? How do they cope without western-type crisis intervention and debriefing and compensation? Maybe we've got an awful lot to learn from those countries which don't do these things."

Such views have infuriated many. Dora Black, a consultant psychiatrist who is honorary senior lecturer at London University and former director of the city's traumatic stress clinic, says there are well-attested treatments for PTSD. She is in no doubt from her work as a child psychiatrist in the former Yugoslavia that the disorder exists. "This is a semantic quibble, nobody has proved the existence of schizophrenia. Most psychiatric disorders can't yet be based on recognisable organic pathology," she says.

A recent article in the British Medical Journal called for more research into "debriefing", whereby trauma victims talk about the incidents they have suffered. Findings so far have been contradictory. But Dr Black's own work with children suggests that preventive intervention to avoid the onset of PTSD is successful. She is wary, too, of McEwen's views about third-world countries: "Without doing the research - which hasn't been done - we can't make statements that people cope with disaster and that we have to learn from them," she says. "They cope at enormous cost to their mental health, family happiness and children's development. If we can find ways to help them, we should."

Dave Mearns, director of Strathclyde University's counselling unit, is more sympathetic to McEwen's views. Professor Mearns, who worked with American veterans in the 1970s, remembers a young ex-marine sitting on a supermarket floor in tears because of the gulf between the mundaneness of shopping and his experiences of death and mutilation. "No way would you want to call that any sort of abnormality," says Mearns, who agrees that it is critical to be alert to individuals' different needs and that there have been difficulties in the past when it was thought helpful to make people talk out their problems quickly. "That kind of thinking prevailed for a while, and then people realised that this ignored individual differences and could be traumatic in itself. It doesn't make sense to force a counselling resource on people. Often at the early stages, it's practical things they want."

Many people will want counselling up to two years after the event, he says, which, studies have shown, is when the worst effects of the experience may be felt. "It goes on much longer than common sense would say, and people themselves think there must be something wrong with them because it's going on so long." Mearns insists that counselling must be done by trained counsellors, and acknowledges that there have been problems when other professionals, such as social workers, have been given a counselling role.

The debate on how best to meet trauma victims' needs is undoubtedly important, if extremely controversial at present. McEwen, who describes herself as "a roll-up-your-sleeves" person, has won praise for her practical work.

Keith Little, clinical director of the accident and emergency department at Edinburgh Royal Infirmary, describes her as the catalyst for pioneering emergency medicine facilities in Romania. But her integration into the tertiary sector means that the views which spring from that work will come under a research spotlight from further afield than Fife.

Johnston adds: "Yvonne has extensive experience, sound experience, and strong views based on that. But they are just views, and this new initiative in trauma management has all along been about exploring these views and coming up with a body of evidence."

McEwen seems bewildered by the storm over her use of a professorial title, which she ascribes to academic snobbery. "It's been stated to me that people work very hard to achieve their professorial status, but there's a lot of other people out there in life who work very hard to achieve their status," she says. "I'm not an academic. People will love to discredit me by saying I'm a streetwise person. But I have something they haven't, the hands-on experience."

(Additional reporting by Sarah Nelson)