h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

OK as people seem to have not read Bob's first posting about the new scientist report I've done a little searching on the NS website and here is a link to the article:

http://www.newscientist.com/news/news.jsp?id=ns99993867

The first paragraph states "The counselling routinely offered to people in the immediate aftermath of a disaster seldom protects them from developing post-traumatic stress - and it could even delay their recovery."

This is what I've been talking about - counselling offered routinely to people in the immediate aftermath of a disaster.

And this is what I'm worried about - to continue administering a treatment (whether offered by trained professionals or not - clinical medicine messes up too thalidomide being the most obvious example) after evidence has come to light of its possible side effects is irresponsible. And to perpetuate an environment where those people involved in disasters feel that they *should* seek counselling is simply out of order.

Ah!, now thats useful...

Bob,

I finally had the time to look up the New Scientist article you barely cited when you started this thread. You have made some misrepresetation and failed to provide enough information.

First of all, the article is called "Counselling can add to the trauma" from New Scientist vol 178 issue 2401 - 28 June 2003, page 5.

This article is actually a very brief reporting of the publishing of a paper with some sound bite reportage and none of the actual detail of the study which was published in "The Journal Psychotherapy and Psychosomatics" (vol 72, p 176).

The news report begins with this, "THE counselling routinely offered to people in the immediate aftermath of a disaster seldom protects them from developing post-traumatic stress. And it could even delay their recovery."

As reported, the actual paper is an analysis of eleven independent studies of the, evidently, common procedure of debriefing people who have been involved or associated with some traumatic event, one day after the event to get the details as perceived and to advise the subject of possiblities for treatment, should it be desired, requested, or needed.

No treatment was offered to these people, rather the option for treatment was discussed should it be needed.

From what I can glean from this report of a study of several reports purporting to be studies, these interviews were not conducted by psychiatrists or pyschologists but by social workers dispatched, assembled, or made available routinely for debriefing, informational, and some intended humanitarian purposes.

This quote from that New Scientist article makes it plain that the conselling in the lead sentence does not refer to anything related to psychotherapy.

--
"We have an ideology that it's 'good to talk'," says psychologist Simon Wessely of King's College London, who was involved in the research. "But sometimes that's not so." We should question the whole notion of debriefing, he says.
--

It also includes this statement of scope, "In each study, people who had suffered a trauma, such as fires, motor vehicle accidents, violence, assaults and dog bites, were randomly assigned either a counselling session or no counselling."

I can only presume that the 'study' based it's 'results' on whether or not people 'counselled' were later diagnosed with post-traumatic shock disorder and, somehow, concluded that from the no doubt firmly managed statistical universe that because the group that had been debriefed had more cases of PTS, that that the interview process actually caused the problem -- because, "they prime people to expect that they will suffer post-traumatic stress, and that this may be enough to trigger psychological problems after an incident."

Sorry, the only actual figures quoted, specify that of the eleven field studies, 3 suggested that the interviews helped, 6 indicated that they made no difference, and 2 indicated that they might have caused problems.

I spoke with someone familiar with the study who explained that the actual number of people involved in the various sized studies justified the statements made on the surface. However, both of us share some of the reservations expressed here about criteria used for judgement and the methods of determination and equivalency. (Some questions of apples vs. cod fish)

This New Scientist news report ends with a statement by one of the researchers, Suzanna Rose, which says, in part, that "only about 20 per cent of people who experience potentially traumatic events might need help." She goes on to suggest that assessments might be made "after about a month, as the delay makes it easier to distinguish people who are naturally coping well from those who are still experiencing stressful symptoms such as high anxiety, nightmares and panic attacks."

Only 20 percent? Only one fifth of the population? Thank the lord, *they* can't carry an election.

Barton

So you disagree that 'assessments might be made "after about a month, as the delay makes it easier to distinguish people who are naturally coping well from those who are still experiencing stressful symptoms such as high anxiety, nightmares and panic attacks."'

I read that article too when it first came out, obviously only the New Scientist version, thats the great thing about NS it trawls for articles so we don't have to.

I had some great chats with Moonglum after that one, and we agreed with a lot it said, not all and not with generalisations, but with the received wisdom that everyone needs counselling for every event. Often in this country that is for every media-related event - maybe we just need counselling on how to deal with intrusive media - who just love to do a close-up on your face at the moment you have been told that your life-partner has died.

After recent train crashes, everyone is offered counseling, which may help a little at the time. But the people who are still suffering, say a month afterwards, maybe need more than counselling. And maybe some people didn't need counselling and maybe some people were directly harmed by it.

Some people maybe deal, without focussing on the death and destruction which they have seen, but by accepting it happened, doing their version of mourning and moving on.

When someone close to me dies, I like to talk and remember, one of my relatives finds that far too painful and would rather not, even after a year.

We are all different, offer counselling yes, but some people may just want to get home as soon as possible and be with their loved ones.

Oh and also offer some genuine help for people like me, beyond being nosy about my masturbation habits that it.

It looks as though Bob's getting criticized for not providing an essay with his question. Are we not allowed to ask simple questions anymore?

Sorry, it bugs me when people are prepared to jump down the throats of others so easily (i.e. "the New Scientist article you barely cited"). If the question isn't enough to support your answer, either you're going over the top, or you need to set up another question.

Its cool to ask a simple question, but people like me are over-sensitive and many abused people and those suffering from PTS, have been thrown from pillar to post in their quest for understanding. When they perceive just a little misunderstanding then we over-react to defend ourselves. Then are perceived as jumping down peoples throats!

I feel I can see both sides here, and hope I am not branded a traitor by either side for doing so.

I am quick to pick up criticism, and will then detail my experience of abuse, in gory detail, to make you shut up. Total over-reaction but considering the circumstances which made who we are - hopefully understandable?

At least if you throw him a lifeline, he has the choice whether or not to take hold of it.

On your original thought of public accidents, as you say, we often hear in the news that survivors, friends & family are being offered counselling. I would prefer them to offer support - which ideally should encompass a wider variety of options.
Usually I then think of more isolated incidents & wonder if those affected in such cases are also offered anything, or are they left to deal with it on their own? I suspect it depends on what services (professional or voluntary) are available in their locality, whereas in a more national event, services may be brought in from elsewhere.

Well, I am now probably going to get into trouble here for mentioning an article from the Atlantic Monthly that I read about 15 years ago (so cannot give a link) but it's title was Who Heals the Healers?

It was a very frightening article giving statistics about the number of therapists, cousellors, psychiatrists, etc who get into this business in the first place because they have their own quite serious emotional and mental problems and then go on to use their authority to abuse their patients.

At the time I was seeing a psychiatrist in Toronto for abuse councelling and I told him about this article. And he said that he personally knew several therapists who had abused their patients. Including one who had raped a woman who had come to see him about child abuse trauma. My doctor went on to say that, very unfortunately, this sort of thing was not uncommon. Which I found quite shocking and disturbing.

The thing is, often when someone makes the decision to get professional help they are already in an extremely vulnerable state and so are 'easy prey' for those who choose to abuse them further. Also, we often see people in the medical and 'helping' professions as 'infallable', which further complicates matters.

Perhaps this is a bit 'off-topic' but I just wanted to mention it in case anybody here is presently seeing a councellor that they are not happy with. Although it is difficult one must realise that they have the right to 'shop around' until they find someone who can best help them. Often people get 'emotionally stuck' with the first therapist they visit, thinking that if the therapy isn't working then it must somehow be 'their fault' when in fact, as in all very personal relationships, it is quite difficult to find someone that you 'click' with. Just because a person is a qualified professional does not mean they are the right person for you to be with.

azahar

Yeah! All that! ^

I had a quite recently that psychiatrists are probably more messed up than the rest of us. This idea came about because I've always been really interested in psychology, but since I've explored and become more comfortable with myself, my interest in psychology has waned. I figured that people get into psychology/psychiatry because deep down they're hoping to figure out what's going on in their own head.

Some succeed, some don't. As Azahar so wisely said, shopping around is a definite, just because you don't get on with a counsellor isn't your fault, you may just have a personality clash. They're only people after all.

<>

I think that is something we need to remember. And then have enough faith in our own intuition and reactions to therapists who are not able to help us.

Most people will not submit to having major surgery without getting a second or third opinion. It should be the same with therapists - we should not submit to a therapy process that might only not help but may also cause more damage.

az

hi Kaz,

I have read a lot about your stuff, both here and on some other abuse-related threads. You sound quite amazing to me. And you should be feeling very proud of what you have accomplished. The thing is, *we* are our own best therapists. But sometimes we need someone to guide us in order to find our own answers. This, I believe, is the job of 'helpers'.

And no - we never 'get over' this. But if we persevere then we can find a healthy way of living with what happened to us. Especially so we stop taking things out on ourselves. I think the worst consequence of abuse is the loss of self-esteem. We stop believing in ourselves, that we are of worth. And this is what we need to be working on daily. And then look for people who will help support us in our endeavour. Not people who can give a 'magic pill' or even a 'magic therapy' to make us feel better.

A quote: 'One must visit a wise man from time to time to discover what one already knows' (R. Davies)

But one must also be very careful about which 'wise person' one chooses.

az

Hi azahar! Thanks for the comments!!

I understand the stuff about a lack of self-esteem, thing is sometimes you don't know if it is yourself or the abuse talking (I know they are the same person!). Things can make you see everything else out of perspective, and you don't know if you are normal or not. Again I appreciate that 'normal' is subjective word!

If you have spent a childhood being denigrated, then when someone else offers a little criticism, you may act very inappropriately as you believe you are being attacked again. This is I think the abuse reacting not the person - sort of.

If you are aware of this problem then self-esteem can be a problem. I really hope this makes sense, I know what I mean but just can't describe it!! Anyone fancy having another go?!

Kaz, you are making a lot of sense. You are coming out with some very good points.

Thanks Bob, I worry that my over-sensitization may alienate other people from me. Its good to know that I can make reasoned points! My self-esteem is doing well at the mo, maybe this is what counselling should be like?! A way to compare and contrast the way people look at the world, which includes people who are coping, maybe peole like me should be learning from survivors and from people who havn't had a major incident to survive, or have just coped better.

I had group counselling which put a whole load of disfunctional people in a room, and that included the counselor, it would have been interesting to get feedback from non-disfunctional people as well - if we could find any that is!

I've been offered counselling for the most ridiculous things- even the mere fact that I happened across a human corpse apparently warrented being sheparded to some dank little office in a hospital That sort of behaviour really pisses me off.

The more unsavoury episodes in my life however, do apparently not warrent counselling

This conversation is brining on a manic phase, if anyone hadn't guess, so I will be concentrating on doing loads of ironing for a while, and will be back later!

KerrAvon, thats a view I've heard a lot, counselling is a bit like buses - never there when you need one!

Kaz,

Even most happy shiny 'normal' people (if indeed such people exist) do not react well to criticism.

<>

Well, of course it is the same person! You are not separate from your experiences - this is what makes you YOU. It is also what makes you a rather complicated and interesting person. You see, even bad experiences can be used for personal growth. In fact, it sometimes seems that bad experiences are at the bottom of personal growth and understanding and also being able to feel compassion.

Being defensive is not just what abused people do. Everybody does this to some extent.

The difference is, okay, if you maybe at times over-react in an overly defensive manner - well okay. This does tend to happen quite a lot with people who have been abused and who suffered trauma. In fact, it wouldn't be 'normal' if you didn't sometimes over-react, you know what I'm saying? But okay, then what you do is perhaps apologise for the behaviour but not for what caused it. And never apologise for just being yourself.

Part of the problem with being emotionally damaged is that it is not something that necessarily shows up on the surface at first glance. I mean, you would not ask a blind person out to the cinema, you would not ask someone with no legs to go skiiing with you. But the emotionally damaged are constantly being asked to 'behave normally' and do things that it is assumed they should be able to do because they have no 'obvious' problem. Because this particular handicap is not easily visible to others.

I'm sure you have heard this one, Kaz - that you are just being self-indulgent and perhaps lazy. That if you really wanted to you could get out there and make a 'normal life' for yourself. Stuff and nonsense. This would be like me telling a blind friend - 'well, you *could* see the film if you only really wanted to!'

One has to first accept the limitations that occur after abuse and trauma. And then gradually work towards finding a way - and this will be very personal, quite different for each person - to function better in day-to-day life. To find a way that suits YOU Kaz, not something that people are telling you that you *should* be. Heck, I dunno. Maybe you are going to be a 'weirdo' all you life. If so, I will join you. There is nothing wrong with being different. And there is certainly nothing wrong with occasionally 'behaving inappropriately'. What does that mean anyhow? Most people do this from time to time, in my experience. And they don't go around hating themselves for it afterwards. Which *is* a healthy point of view, I think.

Of course you are going to sometimes make mistakes, etc. So does everybody else. And so what? It is hardly a perfect world, is it?

You are lovely - that is what you have to believe and go with. And good luck with it! I still haven't found the way to do this! But I am working on it.

az

>you would not ask someone with no legs to go skiiing with you.

I've skied with two people with no legs.

Sorry, just thought I'd point that out.

Kerr,

Yes I know that many people without legs can ski quite well - it was just an example to show that most of the time an obvious physical handicap keeps other people from telling them to behave 'normally'. I mean really, the ones that go out to ski with no legs are truly exceptional. Most of us are not. Or maybe we are. At any rate we are just trying to get by. And just because some of don't actually want to 'go skiing' doesn't make us any less.

az