Stress after 26/11

The stress responses expected in those directly or indirectly involved in 26/11 terror attack can be divided into two main categories:

by: Dr C H Asrani

  • Acute stress reaction – a normal reaction to an excessively traumatic event that does not always require medical attention. Few who require medical intervention are said to be suffering from stress disorder. As high as 90% of those involved will experience at least a brief stress shock. Common symptoms of acute stress are confusion, lack of sleep, inability to concentrate, nightmares etc. Common psychological symptoms are fear (of facing the event again); anger (frustration) at perpetrators/ authorities; guilt or shame (feeling of being impotent). Acute stress reaction will slowly pass off (not to say the anger/ fear will disappear but it will not interfere with day-to-day activities.
  • Post Traumatic Stress Disorder (PTSD) – As the name suggests, these are problems faced some time (maybe few months) after the actual event. Most of those who get have not even had acute stress reaction. PTSD is the abnormal fear of re-experiencing (recurrence) of the traumatic event. As we know people respond differently to stress situations depending on their personality, PTSD can occur even if event is not very significant or of a giant magnitude. The person getting PTSD may not even have actually faced the threat (viewing it repeatedly on TV is real enough). PTSD results in reduced responsiveness and attempts at avoiding events connected with original stress (like huge drop in air traffic post 9/11 and expected drop in foreigners coming to India and locals partying at star hotels).

How will someone with acute stress reaction present?

It can affect all age groups but if there are kids in the family, it is important to be watching them carefully. An otherwise normal person (child) becomes “hyper” – startles at the slightest stimulus; is lost in thoughts, has sleep problems, has nightmares, dreams about the event and demonstrates over alertness  (viewing all police vehicles with suspicion OR Mom, look that man with cargo pants) are all manifestations of acute stress reaction.

Who should treat this?

First stop is your family doctor, who should decide the further course of action. If there is positive past history of any psychological problem and symptoms are affecting daily routine, then referral to a counselor/ psychiatrist may be required. Most cases can be handled by the family doctor only – as he is an old contact and patient is more likely to trust his word than any new therapist. The family doctor must spend good time with the patient as talking will be more beneficial than drugs.

We should not forget the fact that those involved in rescue operations are also at risk of acute reaction or PTSD especially if they have experienced worst crisis of their career. Group psychological debriefing is suitable for groups who are going to work together in the future, such as rescue and medical personnel. Debriefing contributes towards enhanced future work capacity. Group debriefing is also recommended for people actually involved (in this case staff of Taj/ Oberoi/ Leopold/ Cama hospital/ staff on duty at VT station). Group debriefing does not mean that individual attention is not to be given.

Tips on handling Acute stress reaction

  • Avoid watching reruns on TV especially alone; if children are affected, do not allow them to watch the event or aftermath alone on TV. Make sure that at least one parent sits with them to help explain what is happening and anticipate and answer all of their questions.
  • Maintaining daily routine is the best way to convince your self that all is fine. If the trouble is away from your locality it is easy but if is too close to home maintaining a routine or at least a semblance of it is important. A regular routine gives a sense of security.
  • Keep patience: If exposed to a tragedy, expect that someone in the family will show signs of distress in form of fussiness, fear or nightmares. These are normal reactions and one should be ready to deal with them with understanding and patience. Asking people to ‘…take control of your self’ or ‘…don’t be childish’ may be counter productive as the afflicted will clam up and get long term problems.
  • Control emotions: Even young children are acutely aware of the emotional state of their parents. One doesn’t have to hide emotions; It’s fine to let others know that you are upset and sad, but try to be as calm and reassuring as possible.
  • If one experiences physical response to the event like palpitations, heaviness in the chest, sweating etc – even though these are usually normal and expectable responses – If one is under treatment for high BP, diabetes or heart disease – visit your doctor immediately.
  • Try finding a friend, relative or colleague and talk out, what you feel. This kind of sharing is crucial for you to remain calm.

How would someone with PTSD present?

The diagnosis of PTSD is justifiable when the duration of symptoms exceeds one month but is within 6 months.

Following symptoms after more than 1-3 months would raise the possibility of PTSD.

• Persistent fear of re-experiencing of the traumatic event.

• Recurrent distressing recollections of the event.

• Nightmares of the event.

• Intense distress when exposed to reminders of the traumatic event.

• Difficulty falling or staying asleep.

• Irritability or outbursts of anger (recent development)

• Difficulty in concentration.

• Over alertness.

• Lack of interest in significant activities (studies, marriage in the family etc),
feeling of detachment, restricted range of mood, sense of foreshortened future
(kucch to bahut kharab hone wala hai)

Who should treat this?

Treatment is mainly psychological – Supportive psychotherapy should be carried out by the general practitioner, often combined with drug therapy.

If resistant to management or severe symptoms, prompt referral to a specialist is mandatory.

Important – those with PTSD are very likely to resort to alcohol/ drugs for relief from disturbing symptoms. Care taker(s) should be aware and watchful. An attitude of ‘let him drink, it relaxes him’ can be catastrophic.

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22 Comments »

  1. Dr Vishpala Parthasarathy Said,

    December 4, 2008 @ 11:41 am

    Due to the reruns on television and on various channels, people become addicted to watch the scene again and again as if reliving it will somehow be a lifeline for them

    Homoeopathy has some very helpful medicines. Immediately after the shock ie within hours or days, give Aconite 200- single dose to be repeated daily for 3 days till you can see a change or if not then a single dose of Aconite 1M. In most cases this will suffice. If not of course the Homoeopath has to be consulted who will chose another suitable medicine from the Hom armamentarium which cover the specific manifestations in the patient. Counselling and group therapy must go alongside.

    Dr Vishpala Parthasarathy
    Consultant Homoeopath

  2. Sushma Jaiswal Said,

    December 4, 2008 @ 2:00 pm

    I think this effort of Team CMHS should be applauded and you all should be really proud of coming forward and providing such a platform to view our thoughts and educating us on something which either half the population is not aware of and the other half which is, does not know of the serious effects stress can have on our day to day life, on individuals.

    Earlier we would coin the words like laughter and sorrows etc together unfortunately now life and terrorism has become synonymous.

    Life is going on as such like a struggle and this terrorism…which keeps on returning in different form each time with a more ugly face than before…much has been said; little has been done…but yes let us refrain from pointing fingers at others and START with safety first at home!

    The spirit of Mumbai is nothing but struggling and fighting terrorism in everyway.

    Though we can see the explosions around we often miss the plethora of the emotions waiting inside each individual to explode…let us all follow the tips given above and be alert, the least we can do is identify that something like this can happen which atleast solves half the problem then we can take it forward and work it out.

    This by far is really our worst crisis, let us not let our own people resort to alcohol/ drugs for relief.

    This is very serious and identification is a main key. We have already suffered economically, many lives have been wasted, let us not suffer psychologically.

    Thanks once again for the insights.
    Sushma Jaiswal

  3. Dr Samir Chaukkar Said,

    December 4, 2008 @ 2:04 pm

    Some ways that are often suggested for PTSD patients to cope with this illness include learning more about the disorder as well as talking to friends, family, professionals, and PTSD survivors for support. Joining a support group may be helpful. Other tips include reducing stress by using relaxation techniques (for example, breathing exercises, positive imagery), actively participating in treatment as recommended by professionals, increasing positive lifestyle practices (for example, exercise, healthy eating, distracting oneself through keeping a healthy work schedule if employed, volunteering whether employed or not) and minimizing negative lifestyle practices like substance abuse, social isolation, working to excess, and self-destructive or suicidal behaviors.

    Homeopathy can play a very important role .Drugs like Ignatia, Opium, Aconite, Stramonium as well Bach flower remedies like Rescue remedy and star of Bethlehem can come to rescue

  4. Dr SumanRao Said,

    December 4, 2008 @ 4:27 pm

    Dear Doctor,

    As you said,for PTSD ,getting back to work & swiching off the TV is the best solution.People with anger& frustration,should channelize their negative energy into action,thus , contributing something within their means.Talking out their feelings & sharing the emotions,with friends, would be a good way to come out of the situation.

  5. Sunanda Sanyal Said,

    December 5, 2008 @ 1:50 pm

    I have reading your blog(s) regularly as they offer useful info in simple language. this one is very good and timely. I am sure this will help many.
    Keep up the good work, Doc!

  6. Radhika Mohan Said,

    December 6, 2008 @ 11:29 am

    this is the need of the hour to make people aware . its is important to realise that one is stressed and that it is normal . but as one realise it affects ones routine ,the warning bell telling i need help.
    media keeps telling mumbai back to normal which sent waves saying do we have a choice but as it is righty pointed out in this article that keeping to your routine and plan for today is what helps .
    keep the good work on

  7. Hemlata Jiwnani Said,

    December 6, 2008 @ 11:30 pm

    Awesome effort!!
    I have another query…what about the staff who has to go back to the hotels. Recently i came to know, that the staff of the hotels were asked to report on duty and help in cleaning up the hotel. A first hand account with a staffer who had seen colleagues dying in front her has to go back and help in cleaning the hotel (apart from the broken furniture, there are blood stains and stench and no electricity). As a result she has stooped eating her meals and has become quite restless. Working in the hotel is a daily routine for them and every time the staff enters, they will be reminded of what had happened. Is it possible to offer some of kind of help to them? After all they are ordinary people and maybe the effects are not apparent now but in the long run will harm them. (For confidentiality purposes, I have not revealed the hotel’s name)

  8. Dr C H Asrani Said,

    December 8, 2008 @ 1:13 pm

    Hemlata
    you have a valid point. All such staff who have to face the scene of terror (employees of hotels; employees of railways including police) all have to be looked after and if the management is NOT doing anything, they should at least start Prayanama &/ or meditation.

  9. Aadil Chimthanawala Said,

    December 10, 2008 @ 6:45 am

    Post-traumatic stress therapy for 26/11 victims is an absolute need of the hour. I still have a follow-up of a now 11year old child – a witness of Bhuj Earthquake who inspite of all known therapies still sleeps only 3/24 hours. Another form of psychotherapy that is really needed is for all those politicians too who are merely spectaters …

  10. Dr Priscilla Paul Said,

    December 11, 2008 @ 7:04 am

    This is most required. we counsellors are disapointed with the fact that most parents and their doctors do NOT identify acute reaction or PTSD as stress induced ; patient just keeps getting medicines and tonics. this needs to be highlighted more.
    Keep up the good work

  11. Geeta Said,

    December 12, 2008 @ 12:04 pm

    As rightly said the reruns on the TV Shows is what bothers me.
    Otherwise I am fine since we have come across such heinous acts time and again, but every time the repeat telecast brings in anxiety. Something needs to be done regarding the channels i.e. how the news can be told to the masses, so that the main purpose of the news channels is solved without creating hysteria. Less people will be stressed if this happens, is what I believe.

  12. Dr.Vivek Billampelly Said,

    December 13, 2008 @ 12:39 am

    PTSD is an emerging problem related to survivors of natural and man made calmities and though one month is not yet over since the 26/11 tragedy took place we may start seeing cases soon.As far as TV coverageof the event is concerned it may be leaning toward making the news more senstionaland improving the TRP ratings. We may disscuss it theoretically but an empathetic approach to counselling would definately be useful.
    There is a lot to learn from countries like Israel where terrorism is a common phenomenon and how it has changed the mind set of that brave nation.
    The use of art , narration , story telling , survivors tales , writting the experience and counseling done by survivors or their loved ones are effective coping mechanisms for victims( not an appropriate term ) of any disaster.

  13. Dr Ramesh Mehta Said,

    December 13, 2008 @ 10:39 am

    First of all:
    Always think positive.

    Never have ill feeling towards anybody.

    Always speak truth, so that you do’nt have to worry in future.

    If anything unforeseen occurs think of the down trodden so you realise that how lucky you are than him.

    These are the main points to remember to fight stress.

    Thanks
    Dr. Mehta

  14. Vrinda Rohera Said,

    December 13, 2008 @ 10:57 am

    Really good effort on your part to setup this site. It’s language is simple so easily understood. The tips given are really helpful because sometimes we ignore them as normal things. But there is more hidden to it. But what about the scare that has crept into our minds about terrorism? I dread thinking about the lives of those children whose parents have been dead in this mayhem. What about the hatred they developed in this process…has it ever cross our mind. The only thing we can do as the last point in the tips says help them those whom you feel need the support. So why blame everyone around why not start helping like the way you have done on your part.

    Thank you
    vrinda

  15. Dhipal Shah Said,

    December 13, 2008 @ 4:29 pm

    It’s worth appreciating, that in the present situations that we humans are living, it is so necessary to have such mental destressing & how easy it would be if it is reachable over few clicks.

    All the Best…..
    Keep the good work…
    Dhipal

  16. shailesh Said,

    December 14, 2008 @ 12:26 am

    I think your team has done a great job by initiating this site.Many people are undergoing some or other problems due to stress.I think this is a good way for them to get some remedy.I would like to thank the CMHS team from the bottom of my heart.

  17. kishore bhagtani Said,

    December 15, 2008 @ 12:37 am

    good work keep it up

  18. Rohan Said,

    December 16, 2008 @ 11:48 pm

    People themselves say that they are undergoing some stress.Various reasons are given like “work pressure”,”Forthcoming exams of students”,”getting bombarded by the boss at office”,”Loss in business”,”increamental visits at doctors clinic”…etc.What i want to ask is does stress has a precise definition or it is a title given to some unknown phenomena resulting due to a displeased atmosphere?

  19. shailesh Said,

    December 19, 2008 @ 6:04 pm

    I just went through the article on “ENOUGH SLEEP” present on home page.Its really worth reading.I was really not aware about this concept which has been focused by your team.So thanks a lot for this wonderful material presented by you.I m sure ample of people will gain the benefit of quality sleep by reading this matter.

  20. shailesh Said,

    December 24, 2008 @ 11:32 pm

    !!!Merry X’mas to CMHS Team, and all the viewers of this site.!!!!!
    Since your team has helped a lot by focussing on the “Stress World”, I shall get cleared my queries through your answers.Can you please explain the difference between stress and strain.

  21. Sagira Chimthanawala Said,

    February 4, 2009 @ 8:23 pm

    I believe the lesson of 26/11 should never be forgotten -neither by Indians nor by the global fraternity.Now is the time for a deep introspection on how are we electing our government. If this is the state then Stress is here to stay with us 365 days.

  22. Kasim Chimthanawala Said,

    February 4, 2009 @ 8:25 pm

    Homoeopaths can be superb councellers. We should unite to form a help group. I am in!

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