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Mental Health Matters Journal for Psychiatrists & GP's

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Literacy is a luxury that many of us take for granted.  We depend on written communication for information, guidance, and access to heath care information That is why SADAG created SPEAKING BOOKS and revolutionized the way information is delivered to low literacy communities. It's exactly what it sounds like.a book that talks to the reader in his or her local  language, delivering critical information in an interactive, and educational way.

The customizable 16-page book, accompanied by local celebrity audio recordings, ensures that vital health and social messages can be seen, heard, read and understood..

We started with books on Teen Suicide prevention , HIV, AIDS and Depression, Understanding Mental Health and have developed over 30 titles, such as TB, Malaria, Polio, Vaccines for over 30 countries.

suicide speaking book

Angela was only 19 when she was attacked by two men who forced their way into her home. They took turns in beating her and then they each raped her. Finally they tried to stab her to death, and would almost certainly have succeeded had her boyfriend not arrived home.

For months after, she thought and spoke about the rape solely on an intellectual level, as though it had happened to somebody else. Her parents and boyfriend were deeply concerned about her and urged her to seek counselling, but she said that she was fine and that it was in the past. She went back to work, started socializing at her favourite clubs again, and for a while at least she did seem to be okay. It was four months after the attack when the nightmares started, first as a series of terrifying flashbacks that would leave her startled and frightened. And soon she found that through each of these flashbacks she was repeatedly reliving the ordeal. She was unable to keep the memories of the attack out of her mind and could no longer go to sleep without seeing the eyes of the men that had raped her. Although constantly plagued by these memories, she felt little emotion; just a kind of numbness. She withdrew into a world of her own and unable to cope with the challenges at work anymore, she left her job. Her relationship with her boyfriend fell apart and she moved back home with her parents.

Angela was finally treated for Post – Traumatic Stress Disorder (P.T.S.D.). Although this disorder was once believed to only affect war veterans, we now know that P.T.S.D. can affect anyone that has been involved in a significant traumatic event.

What is P.T.S.D.?

Although many individuals do appear highly resilient, for others the initial response is one of extreme shock, and within hours some people will develop ‘acute stress disorder’. This is only a transient response that lasts less than a full month, and most victims slowly return to normal functioning. However, in some cases such as Angela’s, symptoms become chronic and can appear for the first time some weeks or even months after the traumatic event. A diagnosis of Post – Traumatic Stress Disorder is thus made when the symptoms last for longer than one month and cause distress and interference in daily life. Often, people with this disorder are plagued by persistent frightening memories of the traumatic event and feel emotionally numbed by the ordeal.

Why do we develop P.T.S.D.?

Traumatic events shatter the fundamental assumptions of survivors about themselves and their world. Rapes, life-threatening illnesses, physical assaults, debilitating accidents, natural disasters, and the untimely deaths of loved ones force us to confront our own vulnerability.

Our inner worlds consist of theories or working models constructed through years of experience beginning in infancy. These models include beliefs about ourselves, the external world, and the relationship between the two. At the deepest level, most of us assume that the world is benevolent and meaningful and we are worthy, decent, and competent. We expect others to be kind and caring, and we expect good fortune to outweigh misfortune. We assume that bad things happen mainly to those we regard as bad or careless people – not to us.

The essence of trauma, by contrast, is the abrupt disintegration of the victim’s inner world. The basic trust and confidence of survivors is shaken, and their internal guides seem inadequate. They are beset by thoughts and images of malevolence and meaninglessness.

This may be true not only for the victims themselves, but also for those close to them. When a family member, friend, or spouse is the victim of a violent crime for example, it makes those close to the victim feel vulnerable and that it could happen to them at any time. Knowing that someone you love and care for has been through a trauma, can in itself bring on some of the symptoms of Post – Traumatic Stress.

What are the symptoms of P.T.S.D.?

Symptoms of the disorder are broken up into three categories: Intrusive, Avoidant, and Hyperarousal.

As in Angela’s case intrusive symptoms are diagnosed when the victim is unable to keep the traumatic experience out of mind. Vivid memories accompanied by painful emotions take over the victim’s attention as they repeatedly relive the experience. At times, the re-experiencing occurs in nightmares that appear so real the person wakes up screaming in terror. At other times, the re-experiencing comes as a sudden painful onslaught of emotions that seemingly have no cause, but are usually linked to the traumatic event.

Often victims feel as if their emotions are numbed and report an inability to feel or express emotion. As a result, relationships with other people may suffer. These avoidant symptoms deny the individual of feeling any real emotion, and thus reduce the chances of flashbacks occurring. Family and friends of the victim may feel cut off as a result. Not only are emotional ties avoided, but also certain places and people associated with the traumatic event. Over time, the person may become so fearful of particular situations, that his or her daily life may be characterised by attempts to avoid these situations.

P.T.S.D. can also cause sufferers to act as if they are continually threatened by the trauma that caused their illness. Sufferers often become irritable, even when not provoked, and may have trouble concentrating or remembering current information. Sufferers may develop exaggerated ‘startle reactions’ and become “jittery” and anxious. Panic attacks may also develop. During these attacks, their throats tighten, while breathing and heart rate increase dramatically, resulting in feelings of nausea and dizziness.

Who is affected by P.T.S.D.?

Interestingly, Angela was not the only person treated. When she was finally diagnosed, Matthew, her boyfriend underwent treatment as well. Unknowingly, he had been deeply traumatised by what had happened to Angela. He had been having nightmares and flashbacks from that night, and felt extreme guilt for not being home or able to protect her. It is therefore also important to note that P.T.S.D. can be triggered not only by the experiencing of a traumatic event, but also through witnessing of the ordeal and feeling helpless to prevent it.

Not all people who have experienced trauma will develop P.T.S.D. or require treatment; some recover with the help of family, friends or other support. But many do require professional help to successfully recover from the symptoms that can result from experiencing, witnessing or participating in an overwhelmingly traumatic event.

In this day and age as violent crime is on the increase, it is important that we realise that P.T.S.D. is a very real disorder and that it can affect anybody. It is not a weakness or a fault, and the effects can be devastating if left untreated. If you or somebody close to you has suffered a trauma, it is important to seek help and the Depression and Anxiety Support Group has a team of highly qualified counsellors to assist. The support group will also be launching an anti – stigma campaign for mental illness in the media next month starting off with Post – Traumatic Stress Disorder.


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