Post-traumatic debate disorder

November 28, 1997

There has been heated debate surrounding routine psychological help for individuals exposed to traumatic events and the existence of post-traumatic stress disorder ("The stress dissident", THES, October 31).

PTSD exists, evidenced by a wealth of literature and confirmed by epidemiological studies that suggest it can be a major health problem. What is in no doubt is that there are victims. A proportion of these will go on to develop other major psychiatric problems. In addition, the appearance of PTSD in two major diagnostic handbooks has given credence to the significant distress of sufferers.

No experienced clinician or academic in the field of traumatology will claim that every individual exposed to a traumatic event will develop the disorder. But evidence suggests that up to 15 to 20 per cent of individuals exposed to traumatic events may go on to develop chronic anxiety and possibly major psychiatric problems. These people should be encouraged and supported to seek appropriate help from experienced mental health professionals, especially since there is a high incidence of severe depression in this particular group. In-depth training in assessment and therapeutic strategies for sufferers is lacking. Often, that which exists is brief, expensive and rarely open to scrutiny.

The issue is clouded further, by simplistic arguments and uninformed opinion. Yes, "counselling" after the event is routinely offered in many cases. But this is invariably in the form of debriefing, an intervention never intended for use as a counselling strategy. Considerable controversy surrounds its application, as empirical support for its effectiveness is lacking. But both practitioners and recipients attest to its benefits. Nevertheless (and rightly so) concerns have been raised by respected practitioners in the field about the plethora of offers of counselling and debriefing that often follow in the wake of traumatic events.

What is needed is a sense of balance. Individuals exposed to traumatic events experience a range of reactions on a continuum that extends from mild distress to chronic psychiatric problems. Those experiencing the latter will need help. It is people in this group who require the resources and attention of skilled practitioners. Research into effective models of treatment is promising. To deny the existence of genuine distress among this group in a very public way serves only to exacerbate their traumatisation, sense of loss and bewilderment. Counsellors and psychotherapists should also look to the research, where there is a growing body of empirical support for specific therapeutic interventions. The debate and discussion needs to move towards developing a clearer understanding of vulnerability factors, sound therapeutic interventions and the establishment of comprehensive training programmes for professionals and clinicians in the field.

Finally, the media has to accept some responsibility for this confusion and controversy. The debunking of counselling for trauma sufferers and the existence of PTSD was reported to have hit a "populist chord". With whom? Certainly not with sufferers. The media has a responsibility to report facts, provide balanced argument and scrutinise the credibility and credentials of those whose views and cause they espouse and then present as authoritative fact.

Stephen Regel

Senior lecturer in health and human services Nottingham Trent University

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