The importance of communication in treating trauma

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.

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.

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.

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.

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.

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.

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.’