"As memory may be a paradise from which we cannot be driven, it may also be a hell from which we cannot escape."
-John Lancaster Spalding, Aphorisms and Reflections

"Our memories are card indexes consulted and then returned in disorder by authorities whom we do not control."
Cyril Connolly (1903-1974), British critic

"A memory is what is left when something happens and does not completely unhappen."
Edward de Bono

The images were inescapable. Every network and every online news site played and replayed the horrific footage. The radio stations, interrupting their usual play lists, announced each new development and repeated the old time and time again. On everyone's mind and on their tongues were the various reports, authenticated or conjectured, and, for that afternoon and the days following, there was only one possible topic of conversation.

Schools were dismissed, public assemblies canceled, and employers granted liberal leaves to allow their workers time to come to grips with the sudden and cataclysmic alteration of the country's state of affairs.

In the week following the terribly successful terrorist attacks on the World Trade Towers, the equally frightening attempt on the Pentagon, and the averted hijacking and subsequent plane crash in western Pennsylvania the video tapes and cell phone recordings aired twenty-four hours a day. Stories were broadcast about the heroism of the rescue workers in New York City and of the astonishing determination of the passengers of the airliner to prevent that group of extremists from reaching their intended destination.

They were heroes. They were neighbors and friends. They were simply people, like us, that when caught up in world-shaking events were sacrificed to the windmill of the gods and to the fanatical whims of madmen. If they were strangers on the eleventh, by the fifteenth - so well their tales were told and retold - they had become family. Decent people of distant lands spoke words of comfort or support and these messages and images were added to the ones still being televised, broadcast and printed in every news and entertainment venue.

Most of the population of this nation mourned and began the process of healing but, in some circumstances, some people obsessed over the losses and were unable to banish the imprinted images from their minds.

These poor tormented souls, now diagnosed as suffering a previously described condition, joined the legion of earlier victims. Some had been similarly afflicted in the aftermath of the bombing in Oklahoma City or the devastating earthquake in San Francisco. More were military veterans who, despite courage under fire and cool-headed pragmatism during the hellish nightmare of combat, were plagued by vivid dreams, dreadful compulsions, and mind-numbing flashbacks.

Post Traumatic Stress Disorder is an anxiety related syndrome affecting the survivors of traumatic events. Though only recently designated as a separate entity, PTSD has been with mankind since the beginning of time. In classic literature, authors and playwrights regularly created characters suffering with typical symptoms, suggesting that though the disorder hadn't been defined as a malady, it had been recognized as abnormal behavior caused by a person's exposure to traumatic events.

To diagnose PTSD doctors, after identifying the stressor event, examine three different areas for symptoms or disturbances.

Intrusions include flashbacks or nightmares, hallucinations and morbid thoughts, physiologic manifestations when exposed to external reminders (ie rapid heartbeat or uncontrollable crying when shown pictures of the towers), or "premonitions" of further attacks.

Avoidance of situations and topics of conversation is another group of symptoms. This behavior, as opposed to normal means, often takes extreme methods. Quitting a job because the towers used to be visible from the windows in the office, slapping a speaker who has crossed the arbitrary line of comfort, or selling the family car because a friend or relative died while driving are examples of an excessive response. This cluster of symptoms also includes repressing memories of the trigger event, sometimes to the extent of denying any involvement or knowledge.

Hyperarousal refers to disturbances in coping, such as inability to fall or stay asleep, inappropriate violence or outbursts of anger, easily startled, inability to concentrate on a task, and vigilance that borders on paranoid.

Mental health professionals also consider how long after the triggering event the symptoms began, and how long ago the event occurred when making the diagnosis of PTSD.

The process of diagnosis in children and adolescence is hampered by their general lack of experience in appropriate feelings of grief and healing or by an inability to communicate specific fears.

Both adults and children may exhibit depression in addition to the other symptoms of PTSD.

The American Psychiatric Association added Post Traumatic Stress Disorder to its Diagnostic and Statistical Manual of Mental Disorders in 1980. Initially controversial, the new diagnosis encouraged legitimate research and the development of a plan of treatment.

Primary treatment techniques begin with brief immediate counseling, if possible. Studies have suggested that delaying or repressing discussion of the event can increase the likelihood of developing PTSD as may excessive details or extended periods of intense debate and information overload.

Group therapy for adults and play therapy for children have a good history of successfully reducing the behaviors and symptoms. Generally, the adult sessions teach the patient methods of overcoming anxiety or depression and techniques to modify behaviors of avoidance and hyperarousal. Counselors lead the victim into examining the beliefs and damaging thoughts and logically assess the likelihood that the traumatic event may happen again. Children are encouraged to explore the fears that were triggered by traumatic events and are taught to differentiate between what happened before with what may happen next.

Some events are more likely to be stressor events than others. Natural disasters are less traumatic than terrorism. Random accidents are less damaging than intentional acts of violence. Those in closest proximity to the event suffer PTSD at higher rates than distant spectators. The longer the period of violence or delay in rescue, the more likely a person is to experience lasting symptoms.

Women and survivors of previous trauma, perhaps because of heightened feelings of sympathy, are at higher risk.

Pharmacological interventions are usually reserved for patients exhibiting violent or self-destructive tendencies. In other debilitating cases, medications to relieve anxiety, aid sleep, prevent nightmares, or overcome depression may be prescribed for short periods until cognitive therapy is successful.

Researchers are still discovering why stress causes PTSD in some people and not others. They have found hormonal changes to brain function in diagnosed individuals but aren't certain if the traumatic event induces the changes or if the imbalance provides the inclination for the disorder to surface. In one large study, 60 thousand inner city children are being followed to explore the possibility that early trauma or exposure to violence will increase the incidence of PTSD as adults.

Though we can't prevent disasters or eliminate the possibility of catastrophic violence, there are measures that can reduce the risk of developing PTSD.

Reduce collateral exposure to the graphic images of the event. Turn off the television. Restrict viewing, especially by children, to a few minutes a day. Since the most traumatic events preempt usual programming, stock up on the regular broadcasts from your children's after-school favorites.

Stick to your typical routine. Engaging in mundane tasks will help remind your rational mind that life goes on. Witnessing a calm parent performing the usual functions will help children realize that their world hasn't changed. If you have lost a family member during the crisis, the same logic applies but only after an ample period for personal mourning has passed.

Get involved. Donate blood. Volunteer at a crisis center. Use your skills and experience to alleviate whatever amount of suffering that is within your reach. If you know someone who was personally affected by the crisis, be available and helpful. Feelings of hopelessness and helplessness, which increase your risk of PTSD, can be overcome by positive action.

Make an emergency plan before it is needed. Decide where and how your family will reach safety, or what your children should do if the parents are delayed, if only because of a massive power failure. Include pets in your plan. A child might not know how to vocalize his fear of losing a parent but will be reassured if Spot or Fluffy has been included in the family's strategy.

Open the topic and encourage limited discussion of current events. Deal with rumors with valid facts and discourage gossip at home and in the workplace. Participate in public forums about local safety issues or attend church meetings, if you find comfort or enlightenment in planning or prayer.

Seek help without shame. If you, your child or spouse, a co-worker or friend, are having trouble coping, sleeping, or become overtly depressed, contact public mental health agencies, a family doctor, or local support groups.

Be pragmatic about those things beyond your control but not resigned to accepting the worst as fate.

We are not driftwood, swept along on the waves. We are kayaks, comfortable to cruise the current if possible but capable of fighting the tide when necessary.

Hold on to your oar.

Even if I knew that tomorrow the world would go to pieces, I would still plant my apple tree. --Martin Luther

References

What Is PTSD? PTSD Alliance

Etiology of Anxiety Disorders The Office of the Surgeon General

National Institute of Mental Health

1. "Helping Children and Adolescents Cope with Violence and Disaster,"
   NIH Publication No. 01-3518
2. "Reliving Trauma - PTSD,"
   NIH Publication No. 01-4597

About Trauma David Baldwin's Trauma Information

Lisa Binkley works within the medical industry and is the popular author of this health series in the Kudzu Monthly. She also serves as the fiction editor of this ezine, edits for the online sci-fi magazine Distant Worlds, and maintains her own site for her fanciful sci-if work called Jolie Howard Fiction.

As Lisa phrases it, "Woman, wife, worker, writer. We all wear many faces and fill our niches as best we can."

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