Whether it is soldiers in combat or survivors of car accidents, post-traumatic stress disorder can be devastating. How far has our understanding of the disorder advanced and how can those affected continue to be better supported?
Professor Judith Pratt, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow
Noting that 2018 was 100 years since the end of World War 1 and that today (6th June) was 74 years since D Day, Julia Wheeler introduced the packed audience to speakers: Dr Martina Di Simplicio, psychiatrist and cognitive scientist, Imperial College London; Ed Gorman, journalist and author; and Rachael Savage,Vamos theatre director.
Martina Di Simplicio introduced the audience to the startling figures that some 80,000 soldiers are recorded as having suffering post traumatic stress disorder (PTSD; then known as shell shock) in World War 1 and that estimates of 30% of deployed soldiers from the Vietnam war and 13% from the Iraq and Afghanistan war experience the intrusive memories and flashbacks of post traumatic stress. These uncontrollable symptoms together with low mood and emotional numbing are similarly experienced by victims of many other traumatic experiences, ranging from car accidents to sexual violence. In the panel discussions, there was a focus on those that have been in combat situations. Martina noted that the symptoms she described are a natural response to traumatic experiences and typically subside after a few months but can persist for months/years if PSTD develops. She explained that the fear learning system in the brain underlies the responses to traumatic experiences which includes the neural connections between the amygdala, hippocampus and prefrontal cortex. In those experiencing PTSD, this system becomes imbalanced such that any reminders of the traumatic experience can trigger the symptoms.
Ed Gorman, provided a harrowing insight into his personal experience of developing PTSD after working as a free lance journalist in the Soviet occupation of Afghanistan in the 1980s. His description of events of the death of his translator were met with an empathetic silence in the theatre. Ed noted that it was 9 years after continuing to play back his experiences before it became recognized that he was suffering from PSTD. His journey to recovery has been helped by cognitive therapy.
Following on from Ed’s personal account, Rachael Savage gave accounts of personal stories from soldiers that had inspired her to write and direct ‘A Brave Face’. She noted that in 2012, more British military and ex-military took their own lives than died on the battlefield. Soldiers my return physically whole but emotionally shattered and often hide from their condition. Rachael noted that this production ‘doesn’t attempt to preach or convert, just to give –through mask theatre-words to those who’ve been robbed of them, who’ve lost their mates in conflict, but who have also lost themselves.’
In the intense debate that followed, topics covered included how access to therapy could be improved, individualising therapy, the impact of those suffering from post traumatic stress on family and friends, support networks and navigation of charitable support agencies. In discussing risk factors, it was highlighted that pre-trauma risk factors included parental neglect, lower socioeconomic status, personal or family psychiatric conditions and poor social support. Not surprisingly this led to discussions as to why pre-recruitment assessments did not cover these elements, why physically and emotional training were not considered equally important and why that there is as yet, no cohesive government policy to retrain soldiers on how to become a civilian again.
Despite the painful experiences of those suffering post traumatic stress, the audience left the venue with the general view that there are reasons for hope. Through our recent increase in the understanding of PTSD and therapies such as EMDR (Eye Movement Desensitisation and Reprocessing) and Exposure therapy along with a new NHS model which can guide Veterans through the support they need, access to treatments have improved although there is a considerable way to go. After the event the discussions continued in Waterstones ‘Conversation Corner’ in the Festival Café; Ed Gorman signed copies of his book ‘Death of a Translator’ and Martina Di Simplicio was interviewed on Radio Gloucester.