The bombs made enough victims – let’s not make more
A leading psychiatrist argues that the last thing Londoners need now is trauma counselling.
The immediate gut-wrenching shock of the London bombs on Thursday 7 July is starting to settle, and the wall-to-wall news coverage is slowing. Gradually, as predicted, Londoners are getting on with their lives.
We are seeing something similar to what occurs in Israel. After each terrorist attack there, the immediate response of Israelis is to contact their family and friends by mobile phone or landline; once they have established that their loved ones are safe, their acute anxieties are relieved. For the next few days they might avoid buses or cafes, but that too subsides, and they return to their normal lives. They continue to be vigilant and alert to signs of danger, but work needs to be done, exams passed, shopping collected, and parties attended. Life does indeed go on.
But what about those for whom life will not return to normal after these latest terrorist atrocities in London? Those who lives have been shattered by bereavement, or whose bodies have been shattered by the blasts? For these people, life will never be the same again. All are suffering intense mental anguish at the moment – an anguish that is painful for the rest of us even to witness.
So what can we do to help these people cope? In the past, the conventional wisdom was that those caught up in such disasters needed immediate psychological help to assist them to ventilate their feelings, warn them of the emotional symptoms they might experience in the coming weeks, and thus prevent subsequent breakdown. That may have been conventional – but it was not wisdom.
There have now been over a dozen controlled trials in which people involved in accidents and other traumas were randomly allocated to receive or not receive such counselling. And the results showed conclusively that immediate psychological debriefing did not work. Those who received it were no better emotionally than those who did not. Worse, the better studies with the longer follow-ups showed that receiving such counselling increased the rate of later psychological problems. The group that seemed to be harmed most by this were those who were particularly upset at the time – exactly those who you might think ought to be treated. So immediate post-trauma counselling may help us feel that something is being done, but it doesn’t help those who receive it.
Why doesn’t it work? For some it is just too painful, and too soon. Also, warning people about subsequent symptoms might make it more likely that those symptoms will occur. And for some people, not talking is the most appropriate immediate response. But in my opinion, the biggest problem is that talking to a professional, a stranger whom one has never met before and may not meet again, gets in the way of doing what comes naturally – talking to family, friends, colleagues, a priest or a family doctor. These are the people who know us best, and know best what support we need and when we need it.
Asking people to talk about their feelings and emotions when they are still raw with pain is not always a good idea. Many of Friday’s news bulletins carried an interview with the father and grandfather of a 20-year-old Muslim girl who went to work on Thursday and hasn’t been seen since. We saw real grief: her grandfather was unable to articulate a coherent word, and her father was distraught – so much so that it felt uncomfortable to watch such terrible emotion. We don’t need to ask ‘How are you feeling?’ to know the answer. And likewise, immediate counselling is not going to heal their pain.
Instead, what people need in these first few days is the support of their family and friends, as well as practical assistance with information, finance, travel and, sadly for many, the business of organising funerals. The best immediate mental health interventions are practical, not emotional.
Many of those who are now in distress and despair will heal with time. But we know that some will not, and that some will develop serious psychological illnesses such as depression or post-traumatic stress disorder. The only way to prevent those disorders from developing was by not getting on the doomed trains – but such disorders can be treated. The Camden and Islington Mental Health Trust has been designated to organise help for individuals, and to ensure that those who do need proper psychological treatment in the coming months will receive it. But now is not the time, and counselling is not the answer.
What about the rest of us, who were swept up in the events, wondering what had happened to our loved ones before the phone system starting working again, worried about how we were going to get home? Do we need counselling? Do those who watched the continuous TV coverage of the bombing aftermath also now need professional help, as BBC Breakfast News asked on 9 July? The answer is no.
What we witnessed on Thursday was people dealing with adversity in a sensible way. We did not panic – we coped. People are tougher than we sometimes give them credit for. And that should come as no surprise. People in the World Trade Center on 9/11 had to organise their own ways of leaving the building, and did so without any signs of panic. Our own research using newly declassified files on how Londoners coped with the Blitz tells the same story – they coped, even though over 40,000 people were killed during that period of terror.
People don’t panic – the only exceptions being when in confined spaces without any visible means of exit, such as during a fire in a crowded nightclub. So we can understand the brief moments of overwhelming fear that some clearly did experience while they were trapped in the darkness in the immediate aftermath of the Tube bombings on Thursday.
If the public showed courage and common sense, our emergency services and medical professionals did more than cope – they behaved magnificently, as everyone acknowledged. The plans worked. People did their jobs, and they did them well. We are proud of them, and they should feel proud of themselves.
And yet already I have heard various voices in the media say that ‘London is a city in trauma’. It doesn’t look like it to me. We must be careful that we do not shift from the language of courage and resilience to the language of trauma and victimhood. The bombs made more than enough victims – let’s not make more.
Simon Wessely is professor of psychiatry at the Institute of Psychiatry, King’s College London, and director of the King’s Centre for Military Health Research. He is co-author of a new book, From Shell Shock to PTSD, Psychology Press, 2005 (buy this book from Amazon(UK)).
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