Why PTSD?

Research by the mental health charity Mind has shown that people working in the emergency (”blue light’) services are more likely to suffer from Post Traumatic Stress Disorder (PTSD) than the rest of the population.1 Perhaps this is hardly surprising bearing in mind the types of situations and sights that many emergency services workers encounter on an almost daily basis.  However, as I pointed out in another post on PTSD, the surprising thing is not that some people suffer from flashbacks, recurring nightmares, panic attacks, relationship difficulties and other ‘classic’ symptoms of PTSD, but rather the fact that the majority of people don’t.2 This is because, as I noted in that post, most people, at some point in their lives, are likely to encounter some kind of traumatic experience.

So are we to conclude there is something  especially traumatic about the kinds of experiences that emergency services workers encounter?   But even if this is the case it still doesn’t explain why all such workers don’t suffer from PTSD, just as it doesn’t explain why all ex-service personnel who have been on active service don’t suffer from PTSD.  Does this mean that some people are more ‘susceptible’ to PTSD than others?  On the other hand this still doesn’t explain why the figures are higher in certain professions than others.  Unless, of course, people who are more ‘susceptible’ to PTSD are attracted to the kinds of professions and situations that are more likely to induce trauma.  However, as far as I’m aware there is no research which makes this correlation.

Even so, perhaps it’s still worth considering what it is about certain types of experience that produce certain types of symptoms (flashbacks, nightmares, etc) in some people but not others.  As I’ve pointed out in a number of posts on the subject, the thing that makes trauma traumatic is its apparently meaninglessness; in other words, certain experiences simply don’t make sense, and can’t be accommodated into a person’s ‘worldview’ or framework of understanding.  In the language of cognitive psychology, such experiences are unable, for some reason, to be processed by the individual.   To look at it another way, if a particular experience can be processed, made sense of, then it is no longer traumatic, because it now ‘fits’ into the person’s way of looking at the world.

This gives us a clue as to why ‘blue light’ workers are more likely to suffer from PTSD than other groups in our society (apart from the armed forces of course).   Many of the situations that such workers encounter on daily basis simply do not make sense – either to them or to the wider society.  And I think this is an aspect of trauma and PTSD that often gets overlooked: the fact that trauma is something that is not ‘supposed’ to happen in a ‘civilised’ culture.  Children as not ‘supposed’ to be abused; people of all ages are not ‘supposed’ to die or be horrifically injured in fires, car accidents, terrorist attacks or other acts of violence.  Trauma effectively gives lie to the myth of a (relatively) peaceful and strife-free society.

The problem is, this simply makes it worse for those who actually do confront trauma – either as victims/survivors or as the professionals who have to (sometimes literally) pick up the pieces following a traumatic event.  Not only have they just experienced something horrific and nonsensical, but no-one else wants to know, so it becomes impossible to talk to other people about such experiences and, in the process, to start to make sense of it.  This is a well documented phenomena amongst veterans in the armed forces, who feel that they belong to a small and special group of people who have experienced things that the majority of us will never (hopefully) encounter.  At the same time, of course, this makes it much harder for them to seek help, because they think ‘outsiders’ will never understand.

I would argue that the same goes for many in the emergency services: who wants to hear about somebody’s day when it involves scraping body parts off the tarmac on the M25?  Of course, this begs the question as to why anyone would want to have job that involves this kind of work in the first place.   This raises the possibility that some people may feel more ‘drawn’ to traumatic situations than others.  In one of my posts on trauma and PTSD I pointed out that some people find it very difficult, if not impossible, to ‘process’ certain experiences in early childhood.3 And the reason for this is a failure of what, in psychoanalytic language, is called symbolic mediation, which refers to the fact that the ‘processing’ of experience is not purely a neurobiological or cognitive process, but an intersubjective one as well.  In other words, ‘processing’ or ‘sense-making’ of experience involves another person, normally the child’s mother or another significant other.  The mother ‘mediates’ the child’s experiences and helps them build up a picture of the world.  A key point here is that, for a baby or young child, all experience is traumatic; it’s only through a process of symbolisation that such trauma gets ‘translated’ into a coherent personal narrative.  If for any reason there is a failure of such symbolic mediation, the child grows up unable to ‘process’ traumatic experiences, and hence more likely to develop the symptoms of PTSD and other trauma related disorders.

What is unclear is whether such a failure of symbolic mediation somehow ‘encourages’ the individual to seek out traumatic experiences, for example by joining the army or one of the emergency services.   However, what matters more, perhaps, is that the traumatised individual is able to find a way to ‘process’ or make sense of their experiences; in other words, to find a way to symbolise what is outside of symbolisation.  And bearing in mind what I said earlier about the importance of symbolic mediation, such a process of sense making can only effectively take place within a relationship with another person.  This is where psychotherapy or psychoanalysis can be very helpful, because it provides a safe space within which the client can begin to articulate their experiences and make them part of their history.

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  1. http://news.sky.com/story/1439660/mental-health-boost-for-emergency-services []
  2. http://www.therapeia.org.uk/wp/blog/2012/04/09/what-is-post-traumatic-stress-disorder/ []
  3. http://www.therapeia.org.uk/wp/blog/2012/08/25/trauma-ptsd-and-childhood-experience/ []

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