By Dr Mike Neville
“I ain’t crazy”
Most of us are not crazy, but before I grant a general absolution, many of us have symptoms of mental illness despite not being “crazy”.
How many people have experienced severe mental trauma?
As a storm rips off a roof and floodwaters rise, the fear of death and catastrophic loss blows through our minds ... thousands of us.
So many of us have experienced the terror of a robbery, the impotence and loss of control ... thousands.
Rape, sexual harassment, almost considered normal in The Bahamas, creates a fear inside so terrible that it can last a lifetime ... thousands.
Violence in so many forms, domestic violence, bullies in the playground, loss of a loved family member by murder, watching murderers walk freely as they look for more victims ... thousands.
Children physically, sexually and emotionally abused ... thousands.
Imagine how our brains cope with a horrendous emotional stress, the cascading neurochemical changes which will create an imprint in our memory banks never to be forgotten. Months or years later, this imprint leads to the emergence of symptoms of Post Traumatic Stress Disorder (PTSD). I am not sure how common this mental health problem is in The Bahamas but the high prevalence of severe mental trauma would suggest that it must be very common.
The symptoms include intrusive memories of what happened, flashbacks, disturbing dreams or nightmares and getting very upset at events that remind us of the event. There is a tendency to avoid anything that reminds us of what happened, including people, places and activities. Mood deteriorates and thinking becomes increasingly negative and hopeless; a sense of detachment and loss of interest creates difficulties in daily living and impacts on family relationships. There are also numerous physical problems including sleep disturbances, irritability, anger, fear and excessive drinking or drug use.
I have seen people who jump for cover when a car backfires or any other loud noise startles them; I have treated numerous women and men whose ability to have a normal sexual relationship has been destroyed by earlier abuse which still haunts them.
There are many people who still become agitated at the sight of dark clouds as they remember their terror when the winds and floods of a past hurricane are relived. Even the sight of a police car can bring back memories of shootings rather than a sense of safety and protection.
Most do not get treatment and there is a strong chance of developing depression and anxiety, substance abuse problems, eating disorders and it can even lead to suicide. The prevalence of PTSD in veterans of many wars is frightening as is the rate of suicide: it shows that there is no war that does not pay a hefty human price. It is, however, due to the study of soldiers from earlier wars that this concept has been understood; it was first called “shell shock” and efforts were made to treat the men to get them back to the front line. There were those who felt it was cowardice and poor moral fibre and some were executed after a court martial, but the numbers continued to grow.
PTSD is now fully accepted as an illness and treatments have improved. A number of psychological treatments are used, such as Cognitive Behaviour Therapy and Exposure Therapy and these are often combined with medication. Treatment is usually as an outpatient, which creates difficulties in the overcrowded public sector as these therapies are time consuming.
There is an increasing body of work demonstrating the benefits of scuba diving in the treatment of PTSD. I suppose it is just guided imagery therapy to imagine our tranquil waters could attract veterans and even those who have PTSD from our own war zone to get better by diving, the sea being used for great good.
Expulsis Piratis Restituta Commercia.
• Dr Mike Neville is a forensic psychiatrist who has practiced for more than 40 years in The Bahamas, working at Sandilands, the prison and in private practice. Comments and responses to firstname.lastname@example.org