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The past two and a half weeks have seen the world shocked by the terrorist attacks on the World Trade Center and the Pentagon, with the death toll of civilian lives reaching almost unbelievable heights. While the American Government and police rally to find those responsible and urge world involvement in the hunt, it is too late for most of the innocent victims of the attacks. Thousands have lost their lives, others their limbs, and many are still recovering from serious injuries. For most of these people, with time, their physical wounds will heal, but often what is overlooked is the immense psychological trauma experienced by not only the victims themselves, but also their families and friends, witnesses of the event, and the rescue workers involved.

Over the past three decades mental health workers have recognized the significant impact of trauma, including sexual abuse and violence, physical and political violence and natural disasters on people's lives. Trauma is said to occur in response to an event "involving life threat or threat to physical integrity" (including witnessing or hearing about the impact of such an event on a close associate), and producing the emotions of intense "helplessness, fear and horror." Traumatic stressors are also often characterized by a sudden or unexpected nature.

Even in a country like South Africa, where violent crime is becoming a normative experience, the shock and horror experienced by South Africans on hearing about and watching the event live on CNN is to be expected. For many, their general sense of safety has been shattered and one struggles to understand how someone could intentionally commit such an act, knowing innocent civilians are going to be killed. An initial state of shock is a normal reaction to any traumatic experience and many people describe feelings of numbness. Many people described watching the horror unfolding on CNN, like watching a movie - it was unbelievable. This is a form of initial denial.

Later people begin to process what actually happened, and for some people this proves to be too painful and they try to avoid anything associated with the trauma. For these people the numbness does not disappear and they display a characteristic restriction or numbing of emotional responsiveness, sometimes being unable to remember certain aspects of the event.

Afterward, some victims re-experience the horror of the event through memories or nightmares. Sometimes these memories come on very suddenly and the victims find themselves reliving the whole event. This is known as a flashback and is a common symptom of a disorder known as post-traumatic stress disorder (PTSD). Flashbacks are just one way that the victim may re-experience the trauma with others being intense psychological and physiological distress at exposure to internal or external cues that symbolize or resemble an aspect of the trauma. Other symptoms of PTSD include feelings of detachment or estrangement from others, a diminished interest in significant activities, and a sense of a foreshortened future, where they don't expect to get married, have a career or a normal life span. People suffering from PTSD also experience feelings of increased arousal and may have difficulty falling or staying asleep, feel irritable and have outbursts of anger, and have difficulty concentrating.

For years now, it has been accepted by mental health professionals that for the symptoms of PTSD to be experienced, the person does not necessarily have to have been directly involved in the trauma themselves. Merely witnessing the distress experienced by those involved, even on television, can be enough. This combined with the indirect threat to our own safety in South Africa - if it can happen to America, supposedly one of the safest countries to live in, it can happen to us - many people are bound to experience at least some of the symptoms of PTSD, although in a milder form. We have all been indirectly affected by this event, through the television coverage or maybe through knowing people who knew people involved.

According to Dr Gordon Isaacs from the Trauma Centre for Survivors of Torture, at the moment we are in the heroic phase, with the community rallying to the aid of the Americans and offering support, but only time will tell how people will resolve the consequences of this event. All people experience trauma differently and as time passes, individual trauma will emerge in PTSD symptoms like hypervigilance and hyperarousal - being constantly alert and suspicious, intrusion of thoughts - constantly thinking about the event or dreaming about it, and eventually changes in behavioural patterns - avoidance of the subject and aspects associated with it.

The good news is that PTSD is highly treatable and there are a variety of treatment options available. These range from critical incident debriefing techniques and short-term psychotherapeutic approaches like cognitive-behavioural therapy, to longer-term trauma psychotherapy. Therapy normally involves the teaching of relaxation techniques and desensitization to the event and its associations. Medication is also available in necessary cases.

For many people what is needed is assistance in incorporating the event into their "world view" or a way to understand the event so that it makes sense. Feelings of powerlessness are often addressed in this way. Some may even be suffering from "survivor guilt" which can also be addressed through therapy.

Self-help and community support groups can also play an important role in helping members to process traumatic experiences. The South African Depression and Anxiety Support Group offers telephone counselling for a number of anxiety and mood disorders, including PTSD, as well as referrals to various mental health professionals and support groups around the country. They can be contacted Monday to Friday between 8am and 7pm, and on Saturday from 8am to 5pm on (011) 783-1474/6.

If you feel you may be suffering from PTSD or are experiencing any negative symptoms as a consequence of a traumatic event that are interfering with your social or occupational functioning, it is important to remember to seek treatment immediately. The sooner help is sought the better the chances of recovery.