Health: Finding the right words

Post-traumatic stress disorder has been around for centuries, although it was not always recognised as a medical condition. Now a treatment has been devised that offers new hope for sufferers.

Psychologically scarred British soldiers returning from Kosovo could soon be getting support from a 90-day programme devised to help people suffering from post-traumatic stress disorder.

The programme grew out of the psychological debriefings and therapy offered to former Beirut hostages, John McCarthy and Terry Waite. Two of the RAF doctors who came to their rescue in 1991 have now devised a system which encourages people with complex post-traumatic stress disorder (PTSD), to confront their experiences.

Consultant psychiatrists Dr Gordon Turnbull and Dr Walter Busuttil offer the programme at the PTSD Centre at Ticehurst House Hospital in East Sussex. They have worked with Gulf War veterans - 80 per cent of whom returned to active service - and Gordon Turnbull has also helped people affected by the Lockerbie disaster.

Post-traumatic stress, also known as shell-shock or battle fatigue, can affect those who have suffered major psychological trauma, for example following a severe assault, childhood abuse or a car accident. PTSD may develop weeks or months after the event and is usually characterised by mental numbness and an inability to respond emotionally to other experiences and people. Only about 30 per cent of people recover completely, 40 per cent have mild persistent effects and 30 per cent remain unchanged or get worse.

PTSD has been around for centuries. Homer described classic symptoms of the disorder in Achilles, in the IIiad, as early as 800BC, and Samuel Pepys was clearly familiar with it when he described his experiences of the Great Fire of London in 1666. In his diary, he depicts the scene: "I know not by what despondency or fate, but crying out and lamentation, running around like distracted creatures without at all attempting to save even their goods; such a strange consternation there was among them." Later, he writes: "In this calamitous condition I returned with a sad heart to my house".

PTSD was also recognised in Victorian times, after the introduction of passenger trains. It was known as "railway spine" or "irritable heart syndrome" - railway spine because on early post-mortems of train crash victims, they found bleeding at the base of the brain and top of spine. Survivors of accidents who displayed odd symptoms were also assumed to have `railway spine', when it fact they may have had PTSD.

It has taken centuries for PTSD to be recognised as a genuine medical condition. Even as recently as the First World War, soldiers suffering from "shell-shock" were dismissed as cowards.

In recent years, drugs such as anti-depressants and beta-blockers have been prescribed for PTSD and patients given psychiatric help. However, some experts in the medical profession still believe there is no real cure for PTSD and that it is a neurological disorder that people have no control over.

The 90-day programme at Ticehurst House Hospital mostly involves group therapy, where sufferers share their experiences. The belief is that identifying with fellow sufferers provides an antidote to the isolation that many patients feel after experiencing trauma. Patients are also actively encouraged to explore their traumas with clinicians on a one- to-one basis.

Traditionally it was thought that if you suffered from severe emotional stress, being reminded of it and marking anniversaries was a bad thing. It was considered much better to blank out painful memories rather than relive them.

Thinking has now changed, however. Dr Busuttil says the more you avoid a trauma the less chance you have of resolving the problem. "The process of PTSD is like a computer filing error - normally we file everything into our memory and the subject is closed," he said. "Sufferers of PTSD are unable to do this mental filing and are constantly reminded of their trauma every time they visit these unresolved (unfiled) experiences. The key to this programme is to address the unresolved issues - allowing sufferers to complete this mental filing and get on with normal living."

Patients at Ticehurst are encouraged to talk about what happened to them - not only the facts but also their feelings at the time and their current thoughts. They often recount graphic details of their trauma, describing what it felt like to be burned or attacked.

Some critics say this method increases the danger of retraumatising. Dr Busuttil disagrees: "Talking about what happened is the most important way of getting over PTSD, although it has to be with people who you trust and make you feel safe."

Sandy MacGregor, 58, says talking about his experiences helped him recover from PTSD. Mr MacGregor served in the Vietnam War, which would be enough to traumatise most of us for a lifetime. But the story does not end there. In 1987, his three teenage daughters were gunned down and killed by an intruder who was obsessed with one of the girls, at their home in Sydney. Instead of bottling up his feelings about what had happened MacGregor started talking about it - and several books and seminars later, he is still talking about it.

"At the time when I lost my daughters there was no PTSD programme or discussion group for dealing with the trauma," says Mr MacGregor, who now lives in Britain. "People actually avoided me if I was walking up the road. They didn't know what to say, but really the most helpful thing you can do for someone is get them talking about it even if they don't want to."

"If you ignore what happened and don't talk about it, that is when PTSD will really set in. It doesn't matter what the trauma is, you have to talk about it. Group therapy works really well because most people want to talk to someone they can relate to - someone who's been there, done that. If you avoid talking about it, you start to feel like you're going nuts and you don't understand what is going on. Other people are also better at finding the right words to explain how you feel."

For further information on the 90-day PTSD programme contact Ticehurst House Hospital, Ticehurst, Wadhurst, East Sussex TN5 7HU (01580 200391). For a copy of Sandy MacGregor's latest book, `Switch on to Your Inner Strength' (pounds 12.95) or details of his seminars in the UK, telephone 0171- 5655 225

How to Recognise Post-traumatic Stress Disorder

Psychological symptoms

Depression

Feelings of isolation

Recurrent nightmares

Irrational behaviour

Poor coping skills

A sense of guilt at surviving

Physical symptoms

Hypertension and heart disease

Thyroid/hormonal abnormality

Weakened immune system

Pain intolerance

Alcoholism, excessive smoking and drug abuse

How to overcome PTSD

Recognise you are a survivor not a victim

Accept what has happened, don't try and fight it

Confront rather than avoid what has happened

Put the trauma into the context of your whole life

Focus on the solution rather than the problem

Practise forgiveness

Plan the rest of your life