The mental health catastrophe that never happened

Let's go back in time to London, 1939. We were waiting for the war and every single person who thought about this, from generals and politicians to psychologists and psychiatrists, were terrified about the onset of strategic bombing. They believed that when that happened it would be a disaster – a mental health catastrophe, if you like, though they didn’t talk in those terms. People would panic. They would stream out of the city. They wouldn't work. They wouldn’t fight. We would lose the war.

Everybody agreed that this would happen.

With the benefit of hindsight, we know that it didn't happen. There were moments during the Blitz, as we call it, when there was a breakdown of law and order for a very brief period of time. There was a mutiny on an air base. There was a breakdown of law and order in Belfast for two nights, following very intense bombing. But by and large, none of those things that had been predicted came to pass. People did go to work. People didn't panic. There was no rise in the rates of mental disorders. Indeed, the suicide rates fell. Everyone who had made these predictions was wrong.

Pubs, cinemas and the Blitz

Why were they wrong? For the same reasons that they're often wrong now. They misunderstood the resilience of normal people. (They didn't use the word “resilience”; they used “morale”, but it meant the same thing.) They didn't realise that actually people would cope after a pretty short period of time. People would habituate to what was going on and find different ways of managing the stresses around them.

In particular, they would do what they’d always done: engage with their social networks. In direct contrast to what we’re doing now, the government knew the importance of people gathering together, of networking, in other words. People kept going to cinemas, pubs, restaurants, bars and clubs. All of these venues stayed open during the war, despite the loss of life.

There were many tragic incidents. In Brighton, a bomb hit a cinema in 1940, killing dozens of people, including children. But that didn't change the policy. Over one and a quarter billion visits were made to the cinemas in 1940, followed by one and a half billion in 1941.

A bus is left leaning against the side of a terrace in Harrington Square, Mornington Crescent, in the aftermath of a German bombing raid on London in the first days of the Blitz, 9th September 1940. The bus was empty at the time, but eleven people were killed in the houses. Wikimedia Commons. Public Domain.

Compare that with the last 12 months. Number of visits to cinemas and theatres: none. Number of visits to restaurants and pubs: not many. A very different approach due to the wicked nature of the pandemic.

Clearly, it’s normal to underestimate people's resilience and how they cope. We see that during contemporary disasters – accidents, traumas, acts of terrorism and things like that. There is a transient increase in being upset, unhappy, frightened and terrified. But most people will gradually return to normal over the following few weeks,

Why trauma survivors need mobile chargers

We looked at the reactions of ordinary Londoners to the London bombings of 2005. Unsurprisingly, we found that many people were made very anxious by the event. 97% of them dealt with it by talking to their neighbours, their friends and their families. Just 1% dealt with it by going to see professionals like me. The vast majority used their networks, and when they couldn't – if their phones didn't work or they couldn’t get through to their families or colleagues – they became more anxious.

If you’re thinking that’s obvious, you’d be quite right. What wasn't obvious was that those who’d been unable to connect with their family and friends on the day of the bombings were still more anxious six months later. And that has been replicated in Israel and other countries since. In other words, allowing people to communicate as quickly as possible is one of the best interventions we can do in the aftermath of trauma.

Nowadays, when we have a civil disaster or an act of terrorism in this country, one of the first things local authorities and other first responders bring along are bags of mobile phones and mobile chargers. That happened after the terrible Grenfell fire and when people were brought back from China to go into quarantine. We now know that that is the best way to help mental health in the immediate aftermath of a trauma.

When debriefings don’t work

We used to go to people and ask: How was it for you? How are you feeling? What happened?

This was called single session psychological debriefing. People will remember that after any terrible event you would often hear TV news readers saying that trained counsellors are at the scene.

Psychologist making notes during therapy session with male soldier by Motortion Films

What were they doing? Well, they would talk to people who had seen something awful and ask: ‘What happened? Tell me about it. How did you feel when the bomb went off or you saw someone's limb flash past your eyes?’ And then they would say, ‘Okay, these are the symptoms you might develop. If you do, please phone this number and we will try to help you.’

This became institutionalised. But people like me and many others kept wondering whether it worked. Is this how we reduce stress? It was very difficult to think about because the only way to study it is in a randomised, controlled trial. There is no other way to arrange it so that half the people receive a debriefing while the other half don’t.

It took many years before we were allowed to do such a study, it having been thought to be unethical. Finally, permission was given. All around the world, people did these studies and they found out that this kind of intervention did not work. Worse, not only did it not work, it made you more likely to develop what we would call a breakdown or post-traumatic stress disorder in the months to come.

Feeling shaken is not a psychiatric disorder

Why is it damaging for people to relive their trauma in its immediate aftermath? The principal reason is that we have defence mechanisms for a purpose. It is simply too much. The trauma is so great that the last thing we need to do is go over it in our minds immediately after the event.

Modern neuroscience has backed that up. One of the ways in which we now deal with trauma is to ask people who've seen something awful to play computer games straight away, because that stops them laying down the traumatic memory in a way that is going to be very difficult to overcome in times to come. Distraction at that time is quite a good idea.

Of course, we also treat traumatised people by asking them to remember the trauma. I've treated soldiers coming back from Iraq or Afghanistan who've developed PTSD because they made a terrible error – they shot a civilian; one I remember killed a child by mistake. Sooner or later I'm going to start talking to that person about the trauma, because if I don't do that they will never recover. But I won't do it all in one go. I'll do it over six to 12 weeks. I'll teach them some techniques to reduce the fear, anxiety and horror, not to eliminate these emotions but to give people a way of managing them. And, gradually, they will.

Each time we discuss it in more detail, it will become easier for them to bear. They will never forget their trauma, but they will now be able to overcome their PTSD in a way they couldn't before. That doesn’t happen over one session with a stranger I’ve never met and will never see again. That only serves to retraumatise someone without providing them with the techniques to manage their stress.

A final reason why it’s unhelpful to ask people to immediately relive their trauma is that it may simply be unnecessary. It’s normal to feel distressed, frightened, shaken, unable to sleep and so on when something terrible happens to you. This is not a psychiatric disorder.

Training trauma counsellors

We’ve given the British armed forces and many other organisations incredibly simple training on how to manage and spot disorders. Even better, we also try to give them the simplest of skills.

What skills do you need? Actually, it's not difficult to spot when someone is distressed. Perhaps they’re drinking too much or not talking enough. But the one skill that people need most of all, which is difficult, is how to deal with someone who is crying. People find that awkward and won't do it. Even worse is when someone starts talking about harming themselves. Studies show that giving people these simple skills reduces the impact of trauma in organisations such as the military and police.

A group help a patient during therapy counselling session concept by Fizkes

We also tell organisations that people should pass on these skills to the people around them, because that will do far more good in the short term than bringing in someone like me. Remember, I'm very expensive. You don't want to keep me there. You want people who you know already, who are part of the team, who don't frighten you, who don't tell you that you're ill but actually can provide that help and support you need right away.

Proust on doctors

Over-medicalising and over-professionalising what is normal to the experience of stress is not just an innocuous thing to do; it can also do real harm. A good quote comes from Marcel Proust, probably the most famous invalid of his age. When writing Remembrance of Things Past, he described exactly this and also used a metaphor that is actually very relevant to our time: ‘For each illness that doctors cure with medicine, they provoke 10 in healthy people by inoculating them with a virus that is a thousand times more powerful than any microbe: the idea that one is ill.’

Discover more about

treatments for trauma

Jones, E., & Wessely, S. (2005). Shell Shock to PTSD: Military Psychiatry from 1900 to the Gulf War. Psychology Press.

Wild, J., Greenberg, N., Moulds, M., et al. (2020). Pre-incident Training to Build Resilience in First Responders: Recommendations on What to and What Not to Do. Psychiatry, 83(2), 128–142.

Greenberg, N., & Wessely, S. (2017). Mental health interventions for people involved in disasters: what not to do. World Psychiatry, 16(3), 249-250.

The importance of communication in treating trauma