George W. Doherty, M.S., LPC

There have been some dramatic events in the news over the past few years. Tragedies such as earthquakes, floods, hurricanes, tornadoes, bombings, etc., while certainly not new or even uncommon, are beyond our abilities to control or, in some cases, even difficult to fully comprehend.

In Oklahoma City, rescue workers tried to help survivors and non-survivors following the bombing of a Federal building.

More recently, we all saw scenes on the evening news and elsewhere of the aftermaths of the bombings of the U.S. Embassies in Nairobi and Dar Es Salaam.

Following their return from the Viet Nam War, many Veterans experienced symptoms of what we call Post Traumatic Stress Disorder (PTSD). Veterans of the Gulf War seem to be dealing with a similar related problem which has been called Gulf War Syndrome.

What do all of the above have in common? Studies of PTSD and how to treat it and/or how to prevent it and many of its symptoms was the result of a lot of work with Veterans.

Today, we know more about PTSD and how to alert those at risk (e.g. resuce workers, victims of physical and sexual abuse, victims of natural and man-made disasters) so that they can be better prepared to deal with some of the inevitable feelings and thoughts as well as other symptoms.

PTSD, sometimes also referred to as Delayed Stress, is identified by certain common signs, including the following:


Depression is a common response to a traumatic event. It can be present in a number of forms which may include sleep disturbance (e.g. difficulties sleeping, intrusive or disturbing dreams, or even too much sleep). Other signs may include general feelings of worthlessness or helplessness or difficulties concentrating. Some may experience feelings that no one will understand how they feel. They may find little support among friends, acquaintances and/or relatives. Some may try to alleviate their feelings through attempts at "self-medication" involving alcohol and/or drugs.


There are times when those involved isolate themselves from others or will have few friends. They may feel isolated and distant from peers. For example, they may feel that their peers or friends and family would rather not hear what their experiences were like. They may feel rejected.


Rage is also a common response. Feelings of irritation, touchiness, easily striking out at others who happen to be near (usually verbally, but some- times physically). Some may experience frequent rage reactions while others may sublimate or repress their rage by breaking inanimate objects or putting fists through walls. There are many reasons for the rage - a rage at not being able to control or change the events that occurred.

Avoidance of Feelings

Some may talk about episodes in which they did not feel anything when they witnessed or experienced the death of a buddy or friend or the more recent death of a close family member. Often troubled by their responses to tragedy, on the whole, they would rather deal with tragedy in their own detached way. Especially problematic is an inability to experience the joys of life. They may describe themselves as being emotionally dead.

This "Defense Mechanism" dulls one's awareness of the death and/or destruction surrounding him/her. It is a survival mechanism which does help one to pass through a period of trauma without becoming caught up in its tendrils. This numbing only becomes nonproductive when the period of trauma has passed, and the individual is still numb to the affect or emotions around him/her. They may feel that, should they let themselves release the numbness, they may never stop crying or may completely lose control of themselves.

Survival Guilt

When others have died and some have not or are rescuers, they may ask "How is it that I survived when others more worthy than I did not?" or "What could I have done to get here sooner and save this life?"

Survival guilt is an especially guilt-provoking symptom. It is not based on anything hypothetical. Rather, it is based on the harshest of realities - the actual death of a human being and the struggle of the survivor or rescuer to live. In some cases, the survivor or rescuer has had to compromise him/herself or the life of someone else in order to deal with this. The guilt that results may eventually lead to self-destructive behaviors. Feelings of helplessness may develop over the inability to change the outcome of events. Guilt may develop over "maybe if I had been there sooner or had done more, etc...."

In some cases (e.g. War, earthquakes, other disasters) those who suffer the most painful symptoms are primarily those who have served as corpsmen, medica, EMTs, etc. They save many lives. However, some of those they try to save die. Many casualties are beyond medical help, yet many emergency response workers suffer extremely painful memories for long periods thereafter - some for the remainder of their lives. Some tend to blame themselves for these deaths.

Anxiety Reactions

Many workers describe themselves as very vigilant human beings. Their autonomic senses are tuned to anything out of the ordinary.

Sleep Disturbances and Nightmares

Some may find the hours before sleep very comfortable. As a result, they will stay awake as long as possible.

Intrusive Thoughts

Some workers frequently report replaying especially problematic experiences over and over again. They may search for alternatives to what actually happened. They may castigate themselves for what they might have done to change the situation, suffering subsequent guilt feelings today because they were unable to do so in the situation. Most report that these thoughts are very uncomfortable, yet they are unable to put them to rest.

Not all who are exposed to tragedies experience all or some symptoms. However, it is not possible to be exposed to such events and have no feelings, thoughts or responses. Being prepared for them and recognizing what effects they can have can prepare one to deal with them.

Debriefing following involvement in such experiences can help prepare one for what they may feel or think. It can provide them with support from others; methods for dealing with their feelings, thoughts and responses; and resources for future assistance if needed. It is like a vaccination which helps prevent more serious consequences.

Finally, if any of the above-described feelings, thoughts or responses occur or persist, talking with someone who can help (minister, priest, rabbi or a counselor or therapist) might help alleviate and deal with the symptoms.

When we are exposed directly to tragedy, we are affected by it and need to deal with it.



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