13 October 2010

The trauma of the miners

The expected trauma levels of the rescued miners may have been greatly exaggerated, says CyberShrink.


The expected trauma levels of the rescued miners may have been greatly exaggerated, says CyberShrink.

The Chilean mine rescue as a focus of world-wide attention, has attracted a flood of psychobabble with too little properly informed comment. The rescue seems to have been planned with admirable good sense and attention to expert advice. But some of the instant punditry with no apparent real experience of working with actual trauma, is less than helpful.

 Of course it's essential to recognise the potential problems these men have already met and may still encounter, but it's vital to get this into perspective. Over-blown assumptions that they must be severely damaged can itself be a source of greater harm. Reading over-dramatised assertions in news reports that "they will emerge forever changed", and may "struggle to return to normal life", I'm concerned at how damaging such negative expectations can be.

 This was indeed traumatic stress, with the significant risk of death, unpredictability, uncertainty, and the basic powerlessness of the individuals to do anything material to help save themselves. When exposed to severe trauma, a few of us are likely to be severely affected; a significant number (less than some expect) develop well-recognised problems such as post-traumatic stress disorder (PTSD); and, such is the wonder of human resilience, surprisingly many will show few significant lasting symptoms and can make an excellent recovery.

 Some of the chatterati commenting on the situation prove their ignorance of this field by referring to "post-traumatic stress". Post-Traumatic Stress would occur if one of the paramedics dropped the stretcher or tramped on your broken limb. The actual ailment is PTSD – a disorder, which arises post (after) a traumatic stress.

 Not such an unusual situation

There's a very large field of traumatic stress studies which give useful guidance. These captives have been trapped deeper and for longer than has been previously encountered in mine rescues, but hostages have been confined for far longer, and soldiers in war have had longer exposure to truly horrible and lasting trauma.

Much was made of calling on the experience of the American Space Agency, which was less relevantly analogous than might be assumed. Astronauts, like those in submarines or Arctic/Antarctic stations through winter, do indeed face prolonged confinement. But there are significant differences - they are informed volunteers, on a specific and meaningful mission, with a predictable duration, with certainty of backup, and they were very carefully selected, screened and trained.

Clearly none of these advantages apply to these miners - among them is a diabetic and someone with severe hypertension, who should probably not have been allowed to work deep underground.

Reactions to trauma have a large generic component, shared between the varieties of horror. It was a mistake earlier in the development of this field, that led to the unhelpful and misleading description of a range of very specific syndromes. The Battered Woman Syndrome, for instance, misleadingly claimed locally in the Advocate Barbie case, has been discredited and rejected by most worldwide courts. The shared features of exposure to severe stress are more important than some of the surface differences. It's like ignoring the obvious fact that all broken legs, however caused, share many important features and need much the same management, rather than classifying all fractures on the basis of 1001 specific causes.

There were advantages here. This was a coherent group, who knew each other before and they belonged to a relatively small community. They were confined as a group (rather than the more frightening situation of a trapped individual), with experience of conditions underground, and some relevant skills and knowledge. They could form a social structure with assigned tasks and leadership. This was wholesome and helpful.

Greatest trauma is over
The greatest trauma will have been in the days before they were located and contacted - a situation of life threat, uncontrollable and unpredictable - the first makes coping urgently desirable, the other two make it exceedingly difficult.

There's been talk of the "claustrophobic capsule". While it would surely be terrifying to most of us, miners are more used to being in enclosed spaces. This temporary increase in entrapment is explicitly en route to the open air and freedom, which helps a great deal. One can endure much more awful situations if they lead to desired outcomes.

Long monitoring will be needed, more closely in the early months, less frequent but still alert for years to come. Those with previous major stresses will be more vulnerable, but only a relatively small proportion of the miners are likely to develop PTSD. There needs to be balance, with vigilance, to identify and manage it if and when it arises, but without creating such a major expectations. Doing so would create continuing stress, and waste resources on worrying those who are destined to remain pretty well.

There must be prompt recognition of the significant differences between these men and their current and likely reactions. Though viewed so far as "the miners", individual responses and needs must be the basis of proper care. We've already seen in the earliest men rescued, one who was entirely silent; one who was exhibitionist and eagerly played to the crowds, seeming to spend more time embracing the Chilean President than his own wife and children; and one we were told had been claustrophobic, scared of the dark and of the ghosts of dead miners. No single, routine approach will help them all.

Apparently they have used their time in isolation to make joint plans - we're told that they have agreed on a unified approach to the media, to act together and equally share all proceeds, and so on. Admirable in theory, but very hard to hold to in practice, as each faces lucrative individual offers. They'll face conflict between their sense of unity and loyalty to the group and advantages for themselves and their families.

Within the families there may be unrealistic expectations of family bliss, which any family would find hard to maintain in the best of circumstances. We saw the family of one rescued miner looking sad and neglected as he eagerly rambled garbled thoughts to the camera.

Lessons learned and forgotten
One of the lessons repeatedly learned and forgotten in the study of trauma is that brilliant ideas based on partial knowledge can be really damaging. In Vietnam, for instance, it was thought obvious that providing a fixed and predictable length of tours of combat duty would reduce stress. In fact, as men joined units at different dates, this reduced the essential safeguard of comradeship, mixed levels of experience and skill, and created severe stress near the end of a period in combat, as men feared that they might be killed just before they were due to return home.

Worse still was the experience of the children of London during World War II. It was assumed that they would be terribly traumatised by exposure to the bombing of the city, so very large numbers were removed from their families and familiar streets, and evacuated to the country, some even sent to Canada. Later studies showed that those who remained were far more resilient than assumed, and coped surprisingly well even when their homes were destroyed, so long as they had the support of their family and friends; while some of those evacuated "to safety" were damaged by the dislocation.

(Professor Michael Simpson, aka CyberShrink, October 2010)




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