Moving On3 min read . Updated: 08 Dec 2008, 10:31 PM IST
Meher was 14 when she was gang-raped by militants in Kashmir. Her house was set on fire and her widowed mother abducted. Adopted and rehabilitated by the local community, she married a soldier and settled down. But there are times when she gets nightmares, panic attacks and tremors. Going to counselling sessions organized in her village by NGOs such as ActionAid, a global anti-poverty agency that has been running mental health programmes in Kashmir for five years, provided psychosocial support. Talking about her feelings and connecting with other victims improved her sense of self worth, though she remains a pale shadow of her old self.
Says Arjimand, project officer, ActionAid: “Different skill sets are needed to deal with trauma, post-episodic one-off occurrences such as the recent Mumbai attacks, a riot situation or any other disaster such as the tsunami. These are followed by ‘calm and relative stability’ as opposed to situations of ‘chronic’ unrest and disruption with violent incidents that are an ongoing process."
Simply put, while the dust settles in the former situation, leaving you to pick up the pieces of your fragmented life, in the latter you continue to remain unsettled—anticipating renewed attacks, fearing for your safety, especially when stories of atrocities and casualties around you crop up and to that extent not allowing the person to move on.
Mridula Apte, a clinical psychologist at the Apollo Hospital in New Delhi has helped victims who have battled different kinds of trauma —from survivors of the Latur earthquake, to kidnapped hostages and road rage victims—says that most have to go through the following stages as they come to terms with their grief and shock:
Stage 1: In any trauma situation, the first reaction is of shock. This manifests in a typical physiological and stereotypical manner. It is a “flight" (escape, running away) or “fight" (aggression, being too brave, trying hard to put up a normal front) response and the body gears up to both respectively. The body is in an alarm state and does what it can to save itself. A lot of blood rushes to the hand and feet and one feels more energized and equipped to fight the situation. If the event is prolonged, as in the case of the Mumbai attacks that went up to nearly 60 hours, there could be a resultant impact on the stomach and heart where blood has been pumped to the extremities of the body, resulting in gastric problems and palpitations, sweating and nervous anxiety.
Stage 2: Anger, denial, blaming. Blame could be heaped on politicians, the system, doctors, oneself or even the deceased person with responses like, “he has left me alone".
Stage 3: Guilt and depression. “I did X thing, which is why this has happened to me". The “what if" syndrome could take over, creating dozens of hypothesis in the mind, “what if I had done this" or “what if I had not gone there".
Stage 4: Acceptance. This is the final stage of dealing with trauma and could take six-eight months. The process of healing is well under way and one is able to participate and do the things one used to. There would be relapses and sporadic feelings of guilt, reminiscences and lapses into silence, a display of mood swings, but by and large the individual is able to do what it takes to “put life back on the rails".
Who copes better? People who have had a past history of dealing with problematic issues, handling stress and overcoming tremendous odds will cope better. Also those who have not had signs of previous psychological stress and are in better physical and mental shape will emerge from the trauma faster, with fewer scars.
Crisis intervention, according to Apte, is extremely important. Judgement during the period of healing is severely impaired. The victim needs support and “directive counselling". Usually counsellors refrain from taking decisions for their patients, but in this case they may have to do that since the person is completely helpless.