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Letters

Post-traumatic stress disorder in doctors involved in the Omagh bombing

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7244.1276 (Published 06 May 2000) Cite this as: BMJ 2000;320:1276
  1. Derek Summerfield, principal psychiatrist
  1. Medical Foundation for the Care of Victims of Torture, London NW5 3EJ

    EDITOR—Firth-Cozens et al draw naive conclusions from their questionnaire survey of doctors involved in the Omagh bombing, which supposedly showed that 25% of them had post-traumatic stress disorder.1 In my clinical experience post-traumatic stress disorder models so lack precision in distinguishing between subjective distress and objective disorder that the vast majority of “cases” represent a pseudocondition.2 The tendency of trauma models to transform the social into the biomedical is particularly exposed in highly public events like this: if ordinary human responses—empathic distress, a sense of horror and outrage, and so on—fit a biomedical paradigm for a considerable proportion of workers who are merely doing their duty, there is something wrong with the paradigm. The core clinical question is surely whether any of these doctors are impaired in their capacity to function.

    Noting that only half of those involved professionally in the atrocity had sought help, the authors state that those who delay are at risk of developing more severe and entrenched symptoms. There is simply no basis for this assertion. After a literature survey Wessely et al concluded that there was no evidence that psychological debriefing was useful in preventing post-traumatic stress disorder after traumatic incidents, and other authors concur.3 4 It is interesting that debriefing is often popular with those who go through it, perhaps because it is better understood as an exercise in personnel management than as prophylactic mental health work.

    This question of inappropriate medicalisation and imputation of a sick role has a considerable societal resonance at present. The workplace is being represented as a setting that can generate post-traumatic stress disorder: paramedics attending road accidents, police constables attending disasters or atrocities, and even employees caught up in what they would once have described as a simple dispute with management are all seeking compensation for post-traumatic stress disorder, or for not being offered counselling. A soldier is suing the Ministry of Defence for exposing him to the horrors of war when he was a peacekeeper in Bosnia. The recent reformulation of post-traumatic stress disorder in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association widened the criteria for traumatic stressors, making it still more useful to an expansive trauma industry. Although we recognise that the medicalisation of life has been a Western cultural trend gathering pace in the past century, some professional stocktaking is surely overdue.

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