Shaken by the aftershock

Post-traumatic stress disorder may not afflict sufferers until years after a terrible ordeal. Chris Arnot reports

A chilly autumnal dusk was settling over the soft Worcestershire hills as Jane Swire gazed out from her garden. Across the valley lay the wood planted by her husband, Jim, and dedicated to their daughter, Flora. "When someone's life has been tragically cut short, you want to seek ways of making a mark for her name, because that person can't do it herself," she says, choosing her words with care.

Flora was 24 years old when she was blown up with 269 fellow passengers aboard Pan Am Flight 103 as it passed over the Scottish town of Lockerbie on 21 December 1988. She had a first-class degree behind her, a PhD, and a distinguished career as a neurologist beckoned.

Flora's Wood has just been included on Ordnance Survey maps, much to her parents' satisfaction. Nearly seven years on, the pain of their grief has dulled but the burden has not diminished. They know it never will. "The terrible rawness eases a bit but that's as much as you can say," says Jane. "We were so very close, Flora and me, and I do miss her all the time. So many times I feel I'd love to talk to her and I can't."

Dr Jim Swire was devastated by Flora's death, but reacted differently. "When I ceased being numbed by shock, I was angry."

He hurled himself into what he admits is an "obsessional" quest for the truth about the carnage on Flight 103, and although he remains outwardly composed, anger still seethes. "In a civilised society you have to sublimate your desire for revenge. The state is supposed to seek justice on your behalf. What fuels my campaign is the realisation that my government has not done that. It has gone along with an American fabrication for political purposes."

Three years ago he was diagnosed as suffering from post-traumatic stress disorder. By then he had lost his job as well as his daughter. Partners at his general practice called on him to resign. They said his campaign was taking up too much of his time. "You jog along thinking that life in Britain is very predictable. Then something like this happens and you realise how brittle it all is."

Dr Swire has since returned to his old practice to work four days a week. He feels that the shared trauma has brought Jane and him closer together. She slowly nods in agreement. "Jim's hyperactivity has been difficult to live with, but everyone needs space to react in their own way."

Kevin Small was conscious throughout the severing of his left hand. He saw the chainsaw come down on his wrist when his friend tripped in the garden where they were sawing up logs from an old apple tree. He saw his hand fly through the air, followed by the rapid spurt of blood. And he saw, too, that he would have to pick it up himself because his friend, white-faced, just couldn't do it.

Kevin's hand has long been reattached, a tribute to the skill of surgeons at Frenchay Hospital in Bristol. The physical scars have faded but, three years on, he is still suffering flashbacks, which he describes as being "like conscious nightmares".

He has learnt relaxation techniques that help him to cope. "All the same, they still shake me up and leave me unable to sleep."

A visit to the hospital psychologist was prescribed five weeks after the accident. But he felt threatened. What did happy-go-lucky Kevin Small need with a "trick cyclist"? It was his hand he had lost, briefly, not his mind. The first consultation lasted less than 20 minutes. It was not a success because the wise-cracking former double-glazing salesman had, he admits, "put up the shutters".

A week later Kevin was back home in his village near Bristol, preparing to go out for a drink with his wife, Bernadette, and some friends. "I'd come out of the shower and sat on the bed. All of a sudden bang! I replayed the accident completely in my mind. I had to look down to check that my hand was still on. I was shaking and crying like a baby."

Bernadette drove him to the hospital and he has been seeing the psychologist ever since. Hypnotherapy has helped to bring to the horrors that were buried deep in his subconscious. Without it, he believes, he would be dependent on alcohol and sleeping tablets. "I'd started to drink quite heavily because I wanted to get out of it," he says.

Now 34, he has been unable to work or drive since the accident. But he has completed two major cycle rides for charity: once around the British coast and twice around Ireland. Some of the money raised has gone towards the Trauma After-Care Trust (Tact), which offers counselling for sufferers from post-traumatic stress disorder.

"They help people to get over this sense of isolation," says Kevin. "I've had it myself, a feeling that nobody else understands. It does help to talk to people who've experienced something similar. In the next decade, I reckon after-trauma care will become as important as treatment for physical injuries."

Belfast, 1976. Josie was going to the pictures with some friends when they sneaked into a crowded pub for a "quick one". She was six months short of her 18th birthday.

The bomb was planted in the gents' toilets. By the Ulster Volunteer Force, she heard later, much later. Shortly before it went off, a friend had come back through the toilet door and into the bar. As he spotted Josie, he came over and patted her on the back. "I remember thinking as I fell forward with the force of the explosion, 'God, he's slapped me hard'."

Through the darkness and the rubble, she could see that one of her feet was only loosely attached to her leg. "There was no fear and no pain," she recalls. Both came later - some 10 years later in the case of the obsessive, psychologically disturbing fear.

Only in the past 10 months has she begun to come to terms with what happened to her. She lives in England now, in a comfortable suburban villa with an understanding partner and their two children, aged six and two.

Josie is 36, has several degrees and has a naturally friendly manner. Although she is an attractive woman, she feels dissatisfied with her body, particularly her legs, which have been scarred by skin grafts. "I haven't worn a skirt for nearly 20 years," she says.

In the immediate aftermath of the bombing, she had the resilience and bravado of youth on her side. She survived operations that nobody had survived before. And she was proud of that. "For years afterwards I used to say, 'Thank God, I haven't been psychologically affected'. I thought I was so cool."

She was 19 when she left hospital. Student life across the Irish Sea offered a way out of the Troubles and she grabbed it. "I went out to a party for eight years. Whether I was trying to forget or make up for lost time, I don't know. But I went mad for life. I was drinking and smoking heavily."

The party came to an end when she was in her late twenties. "First, it was a fear of flying," she says. "Then it was lifts and heights in general. Yet not long before that I'd been leaning off the top of the Empire State Building, half 'cut'. I started to have panic attacks. I kept feeling as though I was

falling forwards, as I had done when the bomb went off."

During a difficult second pregnancy she began to think she was going mad. "I could be sitting watching the television and suddenly the set would take on a strange tilt. All the angles in the room looked very threatening." Not one of the many doctors she consulted made a connection with the long-forgotten bombing - until, that is, she visited a cranial osteopath.

"He began to unlock powerful forces which had been bottled up inside me. I started to have really gory nightmares. I would wake up in terrible sweats. Then one night I saw a programme on post-traumatic stress disorder, and I knew I had to get further help."

She found it through the helpline of the Trauma After-Care Trust. "It was such a relief to talk to someone who understood. I cried and cried. I still have weird attacks but they're teaching me to control them. I know where they're coming from. When you've looked death in the face, it never goes away."

The Trauma After-Care Trust organises counselling for those who have suffered trauma of any kind. At Aston University tomorrow, it is staging the UK's inaugural meeting of the International Association of Trauma Counselling, a body which sets professional standards for counsellors. More details are available from the Tact Helpline on (01242) 890306.