Only 10-15% of the people affected, directly or indirectly, may even need serious professional counselling, Sekar says. Indeed, some may not need it at all. New Delhi-based M. K. Malhotra, who was trapped in the Taj Mahal Palace and Tower hotel for close to 40 hours, was preparing to return to Mumbai the very next week, back on his job. “It depends on the psychology of each person,” Malhotra says. “Even on Day 1, I had mentally conditioned myself that my chances of survival were low, and once I condition my mind to something, I go by it.” Within an hour of being rescued from the Taj, he says, he had forgotten that he was even there.
This may be an exceptional case, but for those afflicted, there is a counselling infrastructure in place. In Mumbai alone, for example, Shetty estimates that there are around 250 psychiatrists in private practice and an equal number of psychologists. There are also psychiatry departments in four major hospitals and some peripheral hospitals, he says.
In previous crisis situations, initiatives to rapidly groom grief counsellors and deploy them have also proved quite effective. In the aftermath of the tsunami in 2004, the Christian Counselling Centre, based in Vellore, conducted eight-week training sessions. “When we had a refresher course for them, we found they were doing great work,” says Meena Prashantham, associate director of the centre.
Undetected or untreated, PTSD has been known to lead to chronic depression and emotional instability. “Such patients lose the ability to feel both pleasure and sadness,” Shetty says. “The loss of meaning in life is a common consequence.” Medication can help, but if the counselling is good and sustained, doctors are insistent that drugs are necessary only in a fraction of cases.
The importance of talking
The true challenge lies in simply convincing people that they need to talk. Clinical psychologist and psychotherapist Seema Hingorrany, who runs a clinic in Bandra, Mumbai, observed several people approach a clinic with symptoms such as insomnia and depression but immediately recoil when they were told they may have a disorder. “The word ‘disorder’ is what scares them away,” says Hingorrany. Potential sufferers, she explains, often assume that having a disorder means they have a “mental problem”. She says increased awareness of PTSD will help dispel all these myths.
Hingorrany now sends emails to those who were scared away by the prospect of a “disorder”. “The emails have links to more information on PTSD and symptoms. We tell them to read up, compare symptoms and then decide for themselves if they need more help,” she explains. As Sekar says, “They just need to be told that it is good for them.”
PTSD therapy normally involves a combination of medication, sleep and dietary discipline and talk therapy. Many patients, Hingorrany explains, also undergo progressive muscle relaxation or PMR. “PMR is useful for patients who are suffering from high levels of anxiety and need calming. Basically we use heavy breathing exercises to relax all the muscles of the body,” explains Hingorrany.