The Gazette 1990

' APRIL

1990

GAZETTE

Psychological Trauma

It is a truism to say that there is not much empathy or under- standing for the invisible problems of mental distress and emotional turmoil experienced by some individuals following road traffic accidents and other personal injuries. In Irish society stigma, taboo and a conspiracy of silence have always been closely associated wi th "mental conditions". To be labelled as having one is seen by many as an epitaph. Consequently, it is not un common even in the face of genuine concern and offers of help for individuals to deny any problems, even to the point of becoming hostile, when questioned about their feelings and or behaviour.

"Whe re individuals escape physically unscathed from a life threatening accident, intense emotional reactions can be aroused." individual attempts to "bottle it up". And they get caught between the fear of expression and the difficulty of repression. The strain involved in this balancing act is expressed as hyper-arousal, emotional blunting or numbing, poor concentration, irrita- bility, emotional lability, intrusive disturbing thoughts, flashbacks, nightmares, avoidance reactions, social withdrawal and depression. In essence the process of "bottling it up" is a primitive instinctive survival strategy known as "freezing" or "playing dead". The other two options being "fight" or "flight". While the external threat has long gone, it remains vividly on the internal screen of perception and fails to be "worked through", out of "sight" int' jngterm memory. This traumatic ess response is known as "post traumatic stress disorder" and is paradoxically an unexperi- enced experience. Those that experience primarily physical disabilities may after run- ning the hospital gauntlet of traction, plaster casts, naso gastric tubes, intravenous fluids, parallel

mention the threat of mutilation and death, violently dislodges the individual from habitual attitudes and patterns of behaviour. The in- dividual is forced to face a series of personal and social convulsions

I contend that psychiatric sequelae are a silent epidemic and cause immeasurable suffering for the individual and families con- cerned. In spite of this underground activity, observers are uniformly agreed that psychiatric disturbance are a permanent cause of incapacity for work, and together with cognitive impairments, far outstrip physical sequelae as obstacles in rehabilitation and of reintegration into society. The organic orientations of most medical professionals persist and most accident victims are inform- ally divided into two groups, namely those with legitimate in- juries and those with problems which are out of proportion to the tissue damage or else are "all in the mind". Historically it was with the latter group, particularly when compensation was an added variable, that the pejorative and " . . . psychiatric sequelae . . . far outstrip physical sequelae as obstacles in rehabilitation and of reintegration into society." cynical terms emerged such as "traumatic hysteria", "compensa- tionitis", "unconscious malinger- ing", "neurotic neurosis", and "Greek disease". Even the term "compensation neurosis" while used in some quarters of psycho- logical medicine to describe parti- cular dynamics of the unconscious is now best abandoned as it too has degenerated into pejorative and dis- paraging terminology. The impact of a personal injury can call into question every aspect of an individual's life. The loss of bodily and personal integrity, not to

By Dr. M i c h a el C o r r y Consultant Psychiatrist

which may turn them into grotesque caricatures of them- selves. Many victims of personal injuries experience grief for what they have lost. They grieve for the loss of health, mobility, control, confid- ence, self-esteem, automatic behaviour, emotional control, mem- ory, intellectual functioning, family life, social life and their place in the world of work. Rage, bitterness, anxiety, alienation, despair, hope- lessness and depression are com- mon experiences. The more seriously disabled may have to come to terms with permanent paralysis, intellectual impairment, disfigurement, sexual dysfunction and other complications. Where individuals escape physi- cally unscathed from a life threaten- ing accident, intense emotional reactions can be aroused. In these situations the very core of the individual is threatened with ex- tinction and primal instinctive processes such as fear, rage and hostility can surface. Because the feelings can be so intense, they give the perception that the personality will be overwhelmed. In the fear of total disintegration of the "self" the

Dr. Michael Corry.

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