Civilian PTSD – just feeding a trauma industry or real condition?

The “Trauma Industry” has become big business on the High Street and a diagnosis originally used for the Armed Forces in relation to Shell Shock or Combat Stress is now being used to justify insurance claims for thousands of civilians.
This was the proposition of the recent Panorama Programme “The Trauma Industry” of 27th July 2009 on BBC presented by Allan Little regarding the use of the diagnosis of PTSD (Post Traumatic Stress Disorder) in the civilian population. http://www.bbc.co.uk/iplayer/episode/b00lwdb6/Panorama_The_Trauma_Industry/

I had not watched the programme when it was first broadcast but recorded it to watch later. This I have now done and it left me wanting to shout at the television and answer each point in turn.

I have no question in my mind that Allan Little experienced severe trauma in the experience he had in a war zone. As both a Mental Health professional and also a qualified historian I am fully aware of the historical background of shell shock and the impact of trench warfare on the troops during the first world war.

There is no question in my mind that if you place a person in a traumatic, fearful, stressful, shocking situation then it stretches their resilience beyond what is capable of normal tolerance and this leaves lasting damage. It is that classic stretching the elasticity of our ability to cope to breaking point and beyond.

The battlefield is the place of human creation which is almost perfectly designed to cause this to happen – the combination of stress, fear, trauma, horror, including the visual imagery of watching others be injured and killed. It is not surprising that many soldiers suffer severe and ongoing emotional and psychological damage. Many find solace in alcohol or drugs, others are driven to suicide, others still find it hard to control their reactions and responses. Over the years I have known many of these people struggling with their return to live in the UK while coping with thoughts, memories, flashbacks, hypersensitivity, and I have worked alongside them to try to put their lives back together.

So why is it that I found the programme so difficult to watch?

The reason was the premise that PTSD is a military/war zone condition being hijacked by the civilian population to justify how they feel and their compensation claims. Soldiers are not exclusively the only people to experience situations that push them to their limits. Each of us is different and our ability to cope with the challenges and traumas of life will obviously vary from person to person. This will depend on the foundations that are built in our lives. The family and environmental background we have, our childhood experiences, adult relationships, religious faith will all contribute to our potential stability and ability to withstand pressure, however, even the most secure, stable person with positive sense of self-worth, self-esteem and significance will be pushed beyond safe limits if a sudden shock or traumatic incident takes place. This may be a road accident, mugging, abuse, tragedy, or any other event where our normal life is turned upside down and the elements of threat, fear, danger, and horror come flooding in. These can be very individual situations or ones shared with many others. A motorcycle accident may only involve one person but the result can be cataclysmic for that individual whereas major tragedies can impact hundreds or more and only a fraction of these affected.

How we cope will depend on who we are, how we perceive the situation, our response to the threat, our feelings of control or lack of it or of responsibility. Some will come out of the situation appearing undamaged, others will be traumatised and a “nervous wreck”. Just because there is a range of responses between people does not take away from the fact that for some the event will be life changing and they are left traumatised and reeling inside.

This is the problem I have with the programme. Combat PTSD is real and undeniable but so is PTSD in civilian life. I was working in Dover when the Herald of Free Enterprise sank at Zeebrugge, I was in Deal working on the day of the IRA’s bombing of Deal Barracks, and I have worked alongside sufferers of PTSD from a whole range of situations. The trigger setting may be different but the consequence and symptoms the same and equally disabling and debilitating.

Why do I feel so strongly about this? I have suffered the consequences of PTSD for the last twenty-four years. I know what it is like to experience flashbacks both in dreams and daylight. I know what it is like to be going about my daily business and then something suddenly triggers a response, I know what it is like to fight off depression looming at the door wanting to consume, I have also known the effect on emotions and reactions to others. I am thankful to God that I have continued to work, I have received help and prayer ministry and that I have been able to help others. However, I am not free of the PTSD, not because of holding on to it for compensation as the programme suggests as this did not apply to my situation but because effect of real PTSD is so impacting on a person’s life they may never be the same again. They have been pushed beyond a point of coping and the damage caused at best leaves a scar but for many a weeping wound needing regular attention.

So does civilian PTSD exist outside the combat war zone? In my mind unquestionably, Yes. This is no excuse for the legal industry to milk insurance companies for claims but a real sufferer of PTSD may never be able to retain to their previous work and if appropriate needs support and financial help to start a new life.

Jonathan Clark, 20/08/2009