Intended for healthcare professionals

Rapid response to:

Clinical Review

Post-traumatic stress disorder

BMJ 2007; 334 doi: (Published 12 April 2007) Cite this as: BMJ 2007;334:789

Rapid Response:

Preventing the disorder

Bisson has produced a very practical overview of managing post-
traumatic stress disorder (PTSD), even years after the distressing
symptoms [1] have emerged. PTSD was originally characterised in terms of
two extreme types of violence, warfare and rape, but we now recognise that
a variety of nasty experiences can produce prolonged psychological
disorder (from premature delivery of a sick baby, to imprisonment in camps
designed to break the human spirit [2]).

I was bemused to read one section of Bisson's review [3], 'Preventing
the disorder'. This dealt only with clinical interventions after a
horrific experience. From a public health perspective, 'Preventing' PTSD
would involve reducing exposure to violence and abuse, or else promoting
safer practices in high-risk environments like neonatal units or youth
custody. Doctors may not feel competent to prevent wars, but many
professionals have to engage with potentially violent individuals
(including rapists) or have practical experience with areas like road
safety or fire prevention. Given the will and wherewithall, how much
trauma could we prevent? The pathetic failure, of the UK Government's
'zero tolerance' spin, to protect health service staff from violence
suggests that clinicians will themselves have to take the lead, even for
their own safety.

Thought for the Day:
Tough on Trauma, Tough on the Causes of Trauma ?

1 Caan W. Post traumatic shrapnel dreams. Psychiatry Research Trust
Newsletter 2000; 22: 7.

2 Frankl VE. Man's search for meaning: an introduction to
logotherapy. (English edition of 1946 German original). New York: Pocket
Books, 1963.

3 Bisson JI. Post-traumatic stress disorder. BMJ 2007; 334: 789-93.

Competing interests:
In the past, I have investigated traumatic incidents involving health professionals.

Competing interests: No competing interests

16 April 2007
Woody Caan
Professor of public health
Anglia Ruskin University, Cambridge CB1 1PT, UK.