Eliminating the Trauma Burden

A Reply to Dr Greenwald's Paper

Dr Amit Bhattacharyya

I read with interest Dr. Greenwald's paper. It is refreshing to find he has put the emphasis on health rather than illness. To translate that in the British context, one has to question the real advance that has taken place in making that shift. It is fashionable to call every service in terms of health and not illness and yet the major part of our resources go into cure than prevention. Although it may seem like closing the stable door after the horse has bolted, only now through extensive inducements and effort, the immunisation figures, to quote one of Dr. Greenwald's examples, have reached 95%. Even then, there are troughs whenever there is a scare such as with the measles and whooping cough vaccines.

No one can deny that trauma is a disabling experience, specially for a child when he is impressionable and sufficient experience have not given him a more balanced view of life. Paradoxically however, it is perhaps more difficult to detect the effects of trauma in a child than in an adult because the modes of expression are so different and varied. Clinicians are all adults, working with children and are constantly struggling to create methods and skills to enter into the world of children, trying to make some sense of what is reality and what is phantasy. In cases of abuse, these issues are of paramount importance.

It is encouraging to find, however, that there is, amongst parents, teachers, general practitioners and others working with children, a steady increase in awareness of trauma and its effects. It is commonplace now to learn that some opportunity is readily available, in the event of any unusual incident, for victims to talk through their experiences with a trained counsellor. It is debatable whether this embraces also those silent sufferers who go on feeling the psychological pain long after the incident but cannot come forward or express the pain in a way that is understood. The importance of screening must be paramount here. No doubt, Dr. Greenwald's own efforts in this area will be welcome.

Dr. Greenwald's paper is particularly important because he puts succinctly the recent advances made in the field of childhood trauma, its incidence, prevalence, diagnosis and treatment. He advocates Critical Incident Structured Debriefing(CISD) or Eye Movement Desensitization and Reprocessing(EMDR) as treatments of choice. It is obvious that he prefers the latter and anyone who has experience and training in this relatively new method, has first hand knowledge of its dramatic power in the resolution of symptoms.

Yet this method is not widely available and training facilities are just developing under the auspices of the EMDR(UK & Ireland). Some positive reports of its use have been published in this country, but some others, when practised by untrained therapists and where the protocols have not been always followed scrupulously, give an inferior or equivocal result. No doubt further research is needed to give the method its due place in the treatment of post-traumatic stress disorder.

A final point about Dr. Greenwald's paper where he advocates routine screening of PTSD in school children. There are about seven million children in this country between the ages of 5 to 15 years. It will mean a great deal of training for staff and the resources are unlikely to meet the demand. To establish such a programme, however commendable and revolutionary it may seem, is perhaps rather Utopian similar to Melanie Klein's predictions about half a century ago regarding universal child analysis.

All the same, Dr. Greenwald draws attention to a serious issue and suggests a way forward. Anyone dealing with children should bear the possibility of trauma and its effects as a causal phenomenon when confronted with problems. The necessity to train and equip all such workers with that knowledge cannot be understated. From that point of view, Dr. Greenwald's paper is not only informative but thought provoking.

I wish him success in his task of providing us with a screening test.

Dr Amit Bhattacharyya
Consultant Psychotherapist and trained EMDR therapist
Northampton Community Healthcare Trust
Cheyne Walk Clinic,
3, Cheyne Walk,

Priory Lodge Education Ltd., 1994,1995,1996, 1997

Version 1.0 First Published November 1997

Last amended: 28/03/99.