The Walking Wounded

I was having a conversation today about the news story of Stephen and Isabelle Allison, a young couple moving to Winnipeg with big dreams and ambitions. They happened to sit towards the rear of a certain Greyhound bus last summer and their move to Winnipeg hasn't been anything like they expected. They witnessed the brutal killing of a man, imprinted with images that have been indelibly printed like photographs in their brain...perhaps still frames of images with the color red appearing starker than the rest of the frame. The feeling in the pit of their stomach, vaguer now, but reminding them of the terror that immobilized Isabelle, watching the horror, and anticipating her own death as she witnessed unspeakable brutality.

Neither Stephen and Isabelle are doing what they set out to do in Winnipeg. They are the walking wounded, not able to concentrate sufficiently to take courses, not able to maintain normal routines that jobs require, and struggling with finding meaning, purpose and safety as they endeavor to move on.

The interview with the couple states they received compensation to cover their material losses, and six sessions of counselling. Six.

SIX!

The woman I had the conversation said, "If one of them would have had even one slash on part of their body, on a leg maybe, then they would have gotten so much more care and attention. A physical cut would have received extensive treatment. But the wounds they have are so very real...but invisible...and so they are not recognized and not treated."

The conversation perked my ears up...I got an email yesterday about a videoconference happening today out of the University of California at San Francisco by the PainCARE center on, "Post Traumatic Stress Disorder and Pain". I couldn't watch the conference as I wasn't near a viewing site, but I found some of its promotional information compelling:

In recent studies:
· 51% of patients with chronic low back pain exhibited symptoms of PTSD
· 50% of patients experiencing chronic pain after motor vehicle accidents showed evidence of PTSD
· Nearly 50% of women with chronic pelvic pain reported a history of sexual or physical abuse with roughly 1 in 3 of those screening positively for PTSD
· Psychiatric casualties from soldiers serving in Iraq were estimated at 300,000 as of November 2007, a significant number of whom also currently have chronic pain
· Patients with chronic pain, IBS, depression, and anxiety disorder in one urban, hospital-based primary care practice accounted for more than 90% of all cases of PTSD
· In this same urban primary care practice, 25% of patients met the criteria for current PTSD, yet only 11% were identified correctly in the medical record.
The numbers are staggering and should concern us all – regardless of our respective areas of practice.

Post Traumatic Stress Disorder is a significant factor that is often overlooked as we look to understand what a person is struggling with. Physical problems like pain in the joints, muscles, headaches, bowel pain are connected to PTSD. Emotional problems of anxiety and depression result from unresolved trauma in a person's life. Relational problems develop as the symptoms of PTSD ripple throughout the relaltionships in a person's life.

I had coffee with a friend this morning who was in a serious car accident..she walked away from the accident, but the car was demolished. She finds herself anticipating disaster, bracing herself at intersections for another collision, and now has less reserve for the normal ups and downs of her life...small things are irritating and potentially overwhelming, she's tired, and finds herself noticing things and dreading some things in ways she is not familiar with. Her doctor diagnosed her with PTSD--this was a relief because she had understanding for what was happening in her body and mind.

I read an article reviewing the research on pain and PSTD in the Psychotherapy Networker the other day (it was an October issue, but better late than never, right?!), recommending sincere and effective collaboration between physicians and therapists to work in their areas of expertise to help people with that which they struggle:

Cummings estimates that at least 60 percent of physicians' patients seek treatment for conditions with major psychological components, such as stress, anxiety, depression, high blood pressure, fibromyalgia, digestive difficulties, eating disorders, nausea, headaches, and certain kinds of arthritis, that are usually more treatable with therapy than medications. Physicians are so eager for the kind of help therapists can provide that therapists who've integrated themselves into medical settings get substantial boosts in their caseloads and incomes.

While physical symptoms need good medical care, they may also need good psychological care. And with trauma of the magnitude of Stephen and Isabelle Allison, psychological treatment will need to be more than lip service. Six sessions--that's lip service.

More on PTSD in a couple of days.