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Children versus trauma
- Alaa Q I Al-sheikh (26 May 2005)
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Response to Wesseley -- Traumatology
- Anne M. Dietrich, PhD (27 May 2005)
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Alaa Q I Al-sheikh, Staff grade psychiatrist Ealing ,London W13
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I think children are as vulnerable as adults to traumatic experiences. However I think they do cope better. This is my conclusion from recent meetings with several children of different ages from Iraq after the last war. Although some of them still suffer from some forms of nightmares they are coping much better than their parents who were subjected to the same trauma of the bombardment of all kinds of vicious weapons. The older generation had used all kind of therapy such as some psychological methods which include, to some ordinary simple persons, only reading the holy book, the Quran or simply gathering with others and chatting about how horrible they feel. Other used tranquilizations in the form of diazepam and other medication to help them block the horror of reality. With children the situation was different due to their concerns and interests. They were running around the house playing with each other or just sitting in their mothers’ lap crying to express their anxiety. After a period of time they were alright trying to forget about what had happened and get on with their life. I do believe children cope with trauma much better than adults. Competing interests: None declared |
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Anne M. Dietrich, PhD, Clinical Psychologist Vancouver General Hospital, Outpatient Psychiatry, 715 W. 12th Ave, Grnd Flr, Vancouver BC, V5Z 1M9
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Wesseley makes some valid points in his commentary -- the DSM diagnostic criteria emphasize the symptom picture for most of the disorders, at the expense of theories regarding complex etiological interactions. He also makes a valid point when he notes that in the DSM criteria per se, there is a focus on one cause of PTSD -- a traumatic event (the DSM also includes the subjective experience of fear, helplessness or horror at the time of the event as a required component). Empirical research tells us that the outcome of a traumatic event involves various factors. There are risk factors for the development of PTSD after a traumatic event. These factors increase the probability that one will develop PTSD as a result of that event. Social support can play a significant role as a mitigating factor. Moreover, traumatic events can lead to any number of disorders other than PTSD -- Brief Reactive Psychosis, Adjustment Disorder, Dissociative Disorders, Major Depressive Disorder, and Substance-related Disorders, for example. PTSD is often co-morbid with depression. Wesseley seems to present his ideas in a somewhat simplistic manner, however. For example, he states that the process of making a diagnosis is simply a matter of ticking off the symptom criteria. In practice, the process of making a diagnosis is somewhat more complex. One must be able to make differential diagnoses and assess the degree of functional impairment and subjective distress, for example. This may answer, at least in part, Wesseley's own question, viz., "...how do we avoid applying psychiatric labels to the normal reactions of distress or dismay felt by most people after tragedies?" The ability to distinguish between normal reactions and clinical distress/functional impairment would be the way it is usually done, which is part of the process of making diagnoses. But perhaps I, too, am being somewhat simplistic. Wesseley also states, in relation to the diagnosis of PTSD, "Out go the intricacies of psychiatric formulation --the complex interplay of genes, early environment, education, marriage, life events, physical illness, and so on." Yet if one were to go beyond the box of diagnostic criteria and read the text of the DSM, one would see that there is clearly reference to some of these factors. The text discusses the potential role of different variables -- genetics, early life history, previous traumatic events, and so forth. Perhaps one of the more useful things we can do to learn from reading analyses of traumatology is to listen to them and reflect on them. Are there valid points? When there are, we might want to reflect on the points and the stated grounds for those points, examine our own assumptions and biases, and evolve our constructs and our practices. If we have valid reasons for disagreeing with the analyses, then we can put forth our own perspectives and readers can decide for themselves where they stand on any given issue. Competing interests: None declared |
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