The Gazette 1990

GAZETTE

' APRIL

1990

Psychological Trauma

It is a truism to say that there is not much empathy or under-

standing for the invisible problems of mental distress and emotional

turmoil experienced by some individuals following road traffic

accidents and other personal injuries. In Irish society stigma, taboo

and a conspiracy of silence have always been closely associated

wi th "mental conditions". To be labelled as having one is seen by

many as an epitaph. Consequently, it is not un common even in the

face of genuine concern and offers of help for individuals to deny

any problems, even to the point of becoming hostile, when

questioned about their feelings and or behaviour.

I contend that psychiatric

sequelae are a silent epidemic and

cause immeasurable suffering for

the individual and families con-

cerned. In spite of this underground

activity, observers are uniformly

agreed that psychiatric disturbance

are a permanent cause of

incapacity for work, and together

with cognitive impairments, far

outstrip physical sequelae as

obstacles in rehabilitation and of

reintegration into society.

The organic orientations of most

medical professionals persist and

most accident victims are inform-

ally divided into two groups,

namely those with legitimate in-

juries and those with problems

which are out of proportion to the

tissue damage or else are "all in the

mind". Historically it was with the

latter group, particularly when

compensation was an added

variable, that the pejorative and

" . . . psychiatric sequelae . . .

far outstrip physical sequelae

as obstacles in rehabilitation

and of reintegration into

society."

cynical terms emerged such as

"traumatic hysteria", "compensa-

tionitis", "unconscious malinger-

ing", "neurotic neurosis", and

"Greek disease". Even the term

"compensation neurosis" while

used in some quarters of psycho-

logical medicine to describe parti-

cular dynamics of the unconscious

is now best abandoned as it too has

degenerated into pejorative and dis-

paraging terminology.

The impact of a personal injury

can call into question every aspect

of an individual's life. The loss of

bodily and personal integrity, not to

mention the threat of mutilation

and death, violently dislodges the

individual from habitual attitudes

and patterns of behaviour. The in-

dividual is forced to face a series of

personal and social convulsions

Dr. M i c h a el C o r r y

Consultant Psychiatrist

which may turn them into

grotesque caricatures of them-

selves.

Many victims of personal injuries

experience grief for what they have

lost. They grieve for the loss of

health, mobility, control, confid-

ence, self-esteem, automatic

behaviour, emotional control, mem-

ory, intellectual functioning, family

life, social life and their place in the

world of work. Rage, bitterness,

anxiety, alienation, despair, hope-

lessness and depression are com-

mon experiences. The more

seriously disabled may have to

come to terms with permanent

paralysis, intellectual impairment,

disfigurement, sexual dysfunction

and other complications.

Where individuals escape physi-

cally unscathed from a life threaten-

ing accident, intense emotional

reactions can be aroused. In these

situations the very core of the

individual is threatened with ex-

tinction and primal instinctive

processes such as fear, rage and

hostility can surface. Because the

feelings can be so intense, they give

the perception that the personality

will be overwhelmed. In the fear of

total disintegration of the "self" the

"Whe re individuals escape

physically unscathed from a

life threatening accident,

intense emotional reactions

can be aroused."

individual attempts to "bottle it up".

And they get caught between the

fear of expression and the difficulty

of repression. The strain involved in

this balancing act is expressed as

hyper-arousal, emotional blunting or

numbing, poor concentration, irrita-

bility, emotional lability, intrusive

disturbing thoughts, flashbacks,

nightmares, avoidance reactions,

social withdrawal and depression. In

essence the process of "bottling it

up" is a primitive instinctive survival

strategy known as "freezing" or

"playing dead". The other two

options being "fight" or "flight".

While the external threat has long

gone, it remains vividly on the

internal screen of perception and

fails to be "worked through", out of

"sight" int' jngterm memory. This

traumatic

ess response is known

as "post traumatic stress disorder"

and is paradoxically an unexperi-

enced experience.

Those that experience primarily

physical disabilities may after run-

ning the hospital gauntlet of

traction, plaster casts, naso gastric

tubes, intravenous fluids, parallel

Dr. Michael Corry.