Mental health articles

OF mental health care and mentally ill

Post-Traumatic Stress Disorder Cases

Here is the case of Ron, which shows how both the situation and the reaction of the people around him can contribute to the development of Post-Traumatic Stress Disorder(PTSD).

At the time this happened, I was working in a small hut on an industrial estate. They had been building some more units and had a crane on a lorry to lift things around the site. This was right next to our offi ce. You couldn’t see it, because there were no windows on that side of the hut, but you knew it was there  .  .  .  I don’t know why, but on the day of the accident they were using the crane without stabilizing it by putting the legs onto the ground.

The upshot of this was that the crane toppled over and fell onto the building I was in. The fi rst we were aware of things was a lot of shouting and mechanical noises we now know were it toppling. Then there was a great crash and the arm of the crane smashed through the building. I was in there with my mate. Amazingly, neither of us were actually hit by the thing. But we were both trapped by debris from the building. I think I was knocked out for a while because I cannot remember in detail what happened, but it could only have been for a minute or two. I wasn’t hurt too badly, but I was trapped. The worst part of it all, was just having to wait to get out. I was frightened that the gas pipes were fractured and the image of dying in a fi re went through my mind. I hate being unable to move and all sorts of things went through my head about what would happen to me while I couldn’t move. I felt really frightened until I could hear people coming to dig us out, and they lifted the heavy stuff off me and I could move  .  .  . Once I was out, I went to the sick bay and was sent home. I told them I was OK, just ‘cos I wanted to get home and get out of it. I was driven home and spent the rest of the day like a zombie. I just phased out. I didn’t want to talk about it. Kept myself to myself. I slept OK. I hate missing work so I went in the next day. My mates took me to look at the hut, and they were saying how lucky we were to get out alive. Everyone I met said the same thing! I know they were being friendly, but that made things worse, and I began to think about things more and more. I felt shaky and sick  .  .  .  In the end, I had to go home. The nightmares began a couple of days later. I dreamt that I was in the building – this time I was watching the crane fall even though I didn’t in real life and felt trapped as it hit. Each dream was terrifying and I woke up sweating and breathing hard. I could dream two or three times a night. I had to get up and watch TV, have a cup of tea and a fag to help me calm down after them  .  .  .  I couldn’t go back to sleep. I took about eight or nine weeks off work because of all this. I was just too knackered to work. I was also pretty uptight during this time. I’m usually very easy going. But I ran into problems with the wife because I was so diffi cult to live with  .  .  . 

The dreams gradually got better and I forced myself to go back to work. I had a few panic attacks when I went back to start with because I was working in a temporary building which had no windows, so I panicked at the thought of things that were happening outside. The new office has large windows, and that’s OK for me now.

Following the destruction of the WorldTradeCenter buildings by Al Qaeda on 9 September 2001 a number of studies examined the psychological impact of this very public traumatic event. Galea et al. conducted psychiatric telephone surveys one, four and six months after the event throughout the population of New York. The prevalence of ‘probable PTSD’ directly related to the attacks declined from 7.5 per cent one month after the event to 0.6 per cent fi ve months later. Symptoms were highest among people who were directly affected by the attacks – but a signifi cant number of people not directly affected also met criteria for a diagnosis. Predictors of PTSD symptoms included worries about future terrorist attacks, reduced selfconfi dence and feelings of personal control, guilt/shame and helplessness/anger, and low levels of social support. More frequent viewing of television images was associated with a higher risk for PTSD and depression.

People who both watched the events on television and knew someone involved in them were at particularly high risk of PTSD and depression. One key image that seemed to infl uence rates of PTSD was that of people ‘falling or jumping’ from the building. The prevalence of PTSD among individuals who repeatedly saw this image was 17.4 per cent: 6.2 per cent of viewers who did not see this image developed PTSD. The attack also increased risk for a number of mental health problems, including agoraphobia, separation anxiety and PTSD among children in New York. Direct exposure to events, exposure of a family member, and a prior history of trauma increased the risk of problems. As with adults, exposure to events through the television contributed to risk for PTSD. Lengua et al. found that 8 per cent of the children in their sample of children in Seattle, who had only seen events on the television, met criteria ‘consistent with PTSD’. As in the Hoven study, girls experienced more emotional problems than boys.

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