Letter: Results of traumatic stress

Sir: Your correspondents (Letters, 31 March) confuse two distinct issues of clinical and legal practice.

Post-traumatic stress disorder (PTSD), when properly applied, is an important clinical diagnosis. Many people exposed to major stressful events do recover completely but, equally, many do not. PTSD affects normal people; no other "contributing" factors are required.

For those whose lives continue to be dominated by vivid intrusive images of trauma, or whose lives are markedly restricted by avoidance and emotional numbing, there can be a profound and long-term impact on relationships, employment and other measures of personal fulfilment. The development of the PTSD concept has helped to focus thinking on treatment and now, even years after an event, successful and brief interventions are possible.

On the other hand, there is an issue as to how to apply this clinical knowledge to a legal context. The Law Commission's consultation paper has already stimulated helpful debate.

Research carried out in Norway, by Professor Lars Weisaeth, into a factory fire may be instructive. His group contacted all the survivors. About 20 per cent were initially reluctant to come forwards. This subset was later found to include 64 per cent of the severe PTSD cases. Rather than rushing into litigation (or treatment), many of those with the worst traumatic stress reactions choose to isolate themselves from family, friends and the help which is now increasingly available.

The right balance is needed to make available effective professional treatment and speedy redress to those whose lives are seriously affected.

Yours sincerely,

STUART TURNER

Co-director

Traumatic Stress Clinic

Camden and Islington Community Health Services

London, NW1

3 April

The writer is vice-president of the European Society for Traumatic Stress Studies.