Published: 11 March 2016 at 14:24
VIEWPOINT: Anglia Ruskin expert on why some people recover from major trauma better than othersProfessor Jamie Hacker Hughes
Eleven girls and five boys aged five and six, together with their 45 year-old schoolteacher, were killed at Dunblane Primary School in Scotland on March 13, 1996. Many other children were injured, some seriously. The gunman, Thomas Hamilton, then turned his weapon on himself. It was one of the worst recorded firearms incidents in British history.
Twenty years later, some of the survivors and witnesses remain deeply scarred psychologically, whereas others seem to have made a better recovery. Why do some fare better than others? What enables children and adults to withstand the effects of potentially traumatising events?
Influential pre-trauma factors include family history and social circumstances, age and gender. Also important are the degree of social support in the person’s life and the history of physical and psychological health, both individually and in the family. In general being older and male, being in good psychological and physical health, and in a loving and stable family or relationship are all protective factors. All of these children were very young – but, even so, their close family ties may have protected some to a degree.
When it comes to the trauma itself, the duration and severity of your exposure are both important. It is much worse if you are injured or if you witness others being hurt or killed. It is also worse if the trauma is caused, as with Dunblane, by an individual rather than by some unexpected natural or technical phenomenon. Some of the children may have benefitted from not witnessing everything that happened and might have been protected from the worst aspects of the tragic incident.
The majority of children and adults who are involved in traumatic incidents eventually recover well. Of course everybody – almost everybody – is affected initially. It is a natural response. People often feel numbed, dazed and disoriented, with intrusive thoughts and dreams of the event. Children’s behaviour becomes understandably disturbed. In most cases the symptoms will ease off after a period of days or weeks without any need for therapy. Psychologists never recommend therapy for everybody in a “blanket” fashion, but rather support, comfort, consolation, reassurance and perhaps some education.
In the days and weeks after any traumatic event, psychologists tend to carry out what is termed “watchful waiting”. We watch what is happening to people’s symptoms, screen using appropriate psychological measures and then treat using psychological therapies that are proven, suitable for the age group, evidence-based and delivered by people who have been trained to work with that population.
It is what happens after the trauma that often determines the outcome. It will affect recovery if there is a lack of support, abuse of any kind, or physical or psychological adversity – I’m thinking of family or relationship breakdown, family members being injured or dying, unemployment and poverty or homelessness and so forth.
We consider that there are four possible trajectories from trauma survivors. A small number (up to 5%) develop symptoms but then recover. Between about 5% and 10% have temporary symptoms which do not manifest themselves until a period of months or years has passed and between 10% and 30% develop symptoms which endure in one form or another.
In each case, symptoms can include thinking of unpleasant things, trying to avoid these thoughts or triggers, having trouble concentrating and sleeping and becoming jumpy and irritable. But the largest proportion – around half – remain psychologically intact and are relatively unaffected. This is referred to as resilience.
There is also the phenomenon that we call post-traumatic growth. After trauma, many people see a new purpose in living. Having often narrowly cheated death, many live every day as if it was their last, savouring the present and not thinking much about the future. Many trauma victims go on to have deeply fulfilling lives and many traumatised children go on to work in the helping professions themselves.
The majority who recover are the lucky ones, of course. There are sadly still many who remain scarred for life, despite the very best therapy, because of the intensity of their experiences and what else is happening in their lives. So on March 13 we will remember those 16 children of Dunblane and their teacher, but also all the survivors. Many of them are living proof that it is possible to recover from a major trauma and lead a contented life. That at least is something to be thankful for.
Jamie Hacker Hughes, Professor of Military Psychology (Visiting), Anglia Ruskin University