Cancer of the soul: post-traumatic stress disorder
MORE THAN a million Australians at any given time have post-traumatic stress disorder (PTSD) according to the Australian Bureau of Statistics, making it at least as widespread as depression. Yet the disorder rarely rates a public mention, even during National Mental Health Week last month, and a strong stigma persists, HANNAH ROSE STONE reports.
What is PTSD?
PTSD is an anxiety disorder many people develop after being involved in, or witnessing, an event which almost anyone would find terrifying or horrific.
The World Health Organisation (WHO) describes a person with PTSD as suffering relentless re-experiences of the event as flashbacks and night terrors amidst an enduring sense of emotional “numbness”.
The person will avoid anything – people, places, sounds, smells, tastes – that reminds them of the event out of fear that it will trigger a flashback. This puts them in a state of constant high alert, and WHO says this “hyper-vigilance” causes people with PTSD to be easily startled, unable to sleep properly (if at all), and highly susceptible to panic attacks.
Paradoxically, WHO lists other typical PTSD symptoms as “emotional blunting, detachment from other people, [and] unresponsiveness to surroundings”.
These symptoms rarely set in straight after the event, instead appearing weeks or months later.
Kate Tonacia, co-founder of community group Picking up the Peaces (PUTP), which sets out to raise awareness of PTSD, calls it “a mental injury caused by an event” and says that “like any injury, it worsens without treatment”. PTSD frequently leads to substance abuse, family breakdown, withdrawal from society, or suicide; in fact more Australian veterans of the Vietnam War took their own lives after returning home than died in combat, Ms Tonacia says.
People with PTSD have variously described it as: “a living hell”, “an awake nightmare”, and “having cancer in your soul”.
So who can develop PTSD?
Anyone. The most recent National Mental Health and Wellbeing Survey, conducted in 2007 by the Australian Bureau of Statistics, found 6.4% of Australians aged 16-85 have PTSD at any one time. This made PTSD the most prevalent of the twelve mental disorders addressed in the survey, which included depression, general anxiety, and alcohol dependence.
“A lot of people that get it are uniformed,” Ms Tonacia says, “but the leading cause of PTSD is actually motor vehicle accidents.
“It’s associated with war because of its roots in the Vietnam War where the disorder was first looked at, but it affects people from all walks of life.”
What treatments are used for PTSD?
The Traumatic Stress Clinic at Westmead Hospital bases its PTSD treatment programs around cognitive behavioural therapy (CBT) because, as it says on its website, “many international studies have concluded that this form of treatment is the best treatment for PTSD”.
The Australian Centre for Post-traumatic Mental Health recommends CBT as the starting point for treating PTSD, with antidepressants used to supplement the CBT or as a second choice if CBT is initially unsuccessful.
CBT involves the therapist and patient talking through the thoughts and behaviours that stem from the traumatic event. Once these have been identified, the therapist will devise strategies for the patient to use in changing those thoughts and behaviours to more positive outcomes. Using CBT to treat PTSD inherently involves discussing the traumatic event directly, which is often extremely confronting for the patient.
However, somatic psychotherapist Joanne Marsh has had much success with her PTSD clients using somatic psychotherapy, which she says uses “body awareness” to focus on “the sensations that trigger them [the symptoms], rather than the cognitive process”.
Ms Marsh says that PTSD “manifests physically”, and using somatic psychotherapy allows the person to regain a physical “sense of competence” by bringing the focus back to their body, and also means they “don’t need to go back through the story”, unlike trauma-focussed CBT.
If so many people have PTSD, why does the stigma persist, and where does it come from?
The stigma associated with PTSD comes from it often being perceived as a weakness, rather than as a disorder or “mental injury”.
“We talk about it as an injury, not a weakness or illness”, Ms Tonacia says. “But the stigma is there because you can’t see the injury.
“It’s not like a broken leg which you can see, there’s no stigma with that. Because it’s a mental health injury, there’s nothing. There’s no support.
“Especially with uniformed personnel, they say “you’ll be right mate”, there’s so much pressure. People know there’s something going on but they don’t know what it is. They have come along; there’s still a lot of stigma, but upper management is getting more aware.”
Ms Marsh says the stigma attached to PTSD leads to people bottling their symptoms up and not getting treatment, especially when the traumatic event was work-related:
“If they put their hand up they’re put on light duties indefinitely and their colleagues lose trust in them, because they feel they don’t know how the person will react in dangerous or difficult situations anymore.
“I’ve met people who’d suffered for years but never spoken about it because they say, “I love my job and I don’t want to lose it”.”
Why is public awareness of PTSD so important?
Like all health issues, the sooner PTSD is treated, the less complex and entrenched symptoms become. If public awareness of PTSD were greater, people would be better able to recognise the disorder in its early stages and seek support before their symptoms became chronic.
Picking Up the Peaces launched its pilot PTSD Education Program this year, in which volunteers who have experienced PTSD firsthand give “awareness-raising presentations about PTSD to various emergency services and Defence groups”.
The program is funded by the ACT government, but Ms Tonacia says there is still a hole to be filled. “There’s no money for general awareness,” she said. “With things like prostate cancer, breast cancer, depression, [and] workplace accidents, incident rates dropped dramatically once awareness went up.
“People need to be talking about PTSD, and it needs to be OK to do so.”
Ms Marsh says awareness is important because “PTSD only becomes a “D” if you don’t get treatment. “You can have post-traumatic symptoms, but not a “D”, a disorder, if you have a support network and know what’s happening.”
Where can I get support for PTSD?
Your family doctor or a local counselling service is the best starting point, whether you need support for yourself or a loved one. People who are not quite ready to seek help face to face may find Anxiety Online useful. This internet-based mental health service, run by Swinburne University’s National eTherapy Centre, provides PTSD-specific information, online assessment and diagnosis, and treatment programs (“eTherapy”). Their self-help programs are free, and they also offer “low cost” programs assisted by a therapist. Picking Up The Peaces runs a monthly support group for people with PTSD and their carers. They hope their PTSD Education Program will lead to people with occupational PTSD receiving better support from their workplaces in future.
* If you or someone you know is emotionally distressed, call Lifeline’s national number 13 11 14 for 24 hour support. For crisis situations, Mental Health ACT’s Crisis Assessment and Treatment Team can be contacted at any time on 1800 629 354. Call 000 if life is in immediate danger.