Thank you.
I want to start by introducing myself. I have a Ph.D. in psychology with a specialty in post-traumatic stress from the University of Montreal. This was the first study on post-traumatic stress experienced by women who had been raped. I was then hired by the Hôpital du Sacré-Coeur de Montréal to train psychologists and psychiatrists in post-traumatic stress. I specialize in the study of post-traumatic stress in terms of both research and intervention. Accordingly, I provide a great deal of training in post-traumatic intervention.
It is important to understand that, in Canada, we are just beginning research on post-traumatic stress, whereas the United States had to deal with the Vietnam war, which led to the return of thousands of very traumatized veterans. Consequently, Americans are very aware of this scourge, this syndrome. It has taken Canada longer to recognize post-traumatic stress disorder and for people to specialize in this field.
I work at the Hôpital du Sacré-Coeur de Montréal, where I see only victims. I provide training at the Valcartier military base to psychologists and psychiatrists treating soldiers and veterans returning from missions. I also continue to provide supervision at the Valcartier base.
Consequently, Mr. Perron invited me here today so that we can talk together about post-traumatic stress disorder. I will start by giving you a general overview of PTSD, because people are talking about it more and more, but we don't really know much about it.
First, we need to understand that victims of a traumatic event experience a series of symptoms. Atraumatic event is a life-threatening event or one that causes feelings of fear, helplessness or horror. The event causes not only fear but also feelings of horror and helplessness.
Our soldiers often experience such emotions. They will tell me, for example, that they did not fear for their lives, but that they were unable to bear the sight of dead bodies or of a 14-year-old child killing a pregnant woman. So, our soldiers often experience feelings of helplessness or horror.
Individuals experience a traumatic event, and then they will experience various symptoms if they are suffering from post-traumatic stress disorder. There are three kinds of symptoms. The first kind is avoidance. For most people, this is the worst experience of their lives. They will then seek to avoid everything related to that event. For our military personnel, this often means that they no longer want to bear arms, or wear their uniform, that they are no longer able to stand the sight of a military base, and that they have trouble looking at the flag because it is closely associated with this horrible experience. Thus, they are prone to avoiding situations associated with the traumatic event.
To a large extent, it's also about avoiding various thoughts. They no longer want to think about it, don't want to remember it ever again or talk about it. The biggest hurdle for psychotherapy is that most people don't want to talk about what they've experienced. So avoidance is the first kind of symptom.
The second kind of symptom is flashbacks, meaning people re-experience the event, when they don't necessarily want to, and in fact are trying not to. People may have flashbacks, nightmares or intrusive thoughts. Even if they don't want to, they are overwhelmed on a daily basis by these intrusive thoughts. The memories of the traumatic event come back.
In relation to everyday life, this symptom can take the following form: people tell me that, when they are talking, all of a sudden they recall a woman's crushed face; while they are watching TV, they hear the word “rape” and they recall their experience in Rwanda; they are walking down the street and they see a child, and they remember a child crucified on a barn door in Bosnia. So they are immersed in these images, which reoccur over several months when they are associated with post-traumatic stress disorder. So this is the second kind of symptom, what is called flashbacks.
The third kind of symptom is hypervigilance, meaning that the body is always on guard. The individual almost died, he was in an extraordinary situation, and then the veteran or victim remains in a state of over-stimulation.
In this room, for example, it would be very difficult for a victim not to be in a constant state of arousal, because there are windows, people everywhere, around us, behind us.
Someone who experienced bombings in Bosnia, the events of the World Trade Center, the horrors of Rwanda, will be extremely vigilant as to who is behind them, who can come in through this door, what is happening with regard to the windows. These individuals are constantly alert. This means, then, that they may be unable to concentrate because their mind is focusing mainly on what is happening around them. This means that they will find it very difficult to sleep because sleeping means letting go, giving up control, and that means they are vulnerable. Such people can also be extremely irritable because if they are constantly in this state of arousal, their stress level is at 9 on a scale of 1 to 10, and the slightest thing can set them off.
So, their spouses find it extremely difficult to live with these people on a daily basis, because they are in a constant state of arousal and irritability.
This syndrome manifests itself in the weeks and months following a traumatic event. Typically, it can be diagnosed when symptoms have lasted at least a month.
Clearly, some symptoms resulting from a traumatic event are not as long-term. For example, people experience symptoms such as shock during an emergency. They tell themselves that they can't believe what is happening. People may experience disassociation. Victims tell me that while the event was occurring, they heard their commander tell them to do this, do that, and they obeyed like a robot but that they were disconnected. They managed to do their job but without feeling anything. They were truly disconnected.
In the days following the event people often feel very alone. Victims feel as if they are the only ones to feel that way. They believe this is unacceptable, particularly for soldiers; they say that it is shameful to experience such symptoms. This is still the case today. If someone is afraid, if they have nightmares, flashbacks, they absolutely cannot talk about it, because this would be a sign of weakness, this is not worthy of someone in the Canadian armed forces. These are emotions that appear in the days following the event, and if they continue, we see the appearance of post-traumatic stress disorder.
When we talk about PTSD, we're talking about a disorder that occurs but that we previously believed to be rare. Currently, it is estimated... We are starting to accumulate data that indicate that it is not so rare and that horrible events can cause PTSD.
Different studies have been done. What can lead to PTSD? What factors may make this disorder worse? We note that this is the case when particularly horrible events, intrusive events, occur, therefore events that affect the victim. Not only did the individual see his colleague get shot, just beside him, but the victim's blood splattered on him. They saw grey matter on the ground. These are intrusive, unpredictable and violent events.
People will often talk about events involving children; such events increase one's chances of experiencing post-traumatic stress disorder. People will tell me, for example, about being sent to Rwanda and not being able to bear the fact that children were carrying weapons. They think that war is civilized only when it takes place between two trained male adults. They tell me that after they got there and saw children killing others, this seemed barbaric. And so, many people find this absurdity to be unbearable, even in the context of war. This can also be a risk factor for post-traumatic stress disorder.
Sexual events are also a significant risk factor in post-traumatic stress disorder. They are often associated with more symptoms because they are very intrusive and traumatic.
Obviously, there are also events that cause physical injury. If an individual witnesses or is injured during a traumatic event, he or she may be more likely to develop PTSD than if they had not been injured.
We also note—and I will conclude on this point—some differences based on the victim's gender. For example, we know that men and women do not experience the same kind of traumatic event. Women are nine times more likely to experience a sexual trauma than men. We also know that men and women react very differently to a traumatic event. We know that women are more likely to consult a professional following a traumatic event. They are more likely to seek help, which may improve their prognosis, whereas, particularly within the Canadian Forces, men are much more likely to feel ashamed and stigmatized.
Men are more likely to try to hide it, and to drink. Some studies indicate a very telling comorbidity between PTSD and alcohol abuse. Fifty per cent of traumatized men will be diagnosed as having a drinking problem. This doesn't mean just drinking a beer now and again, it's truly a diagnosis of alcohol abuse and dependency. This is cause for concern because, if you drink four bottles of gin at night, obviously you will no longer feel anxious. In the short term, this strategy works. The problem is that, in the long term, alcohol abuse will reinforce PTSD and really make the symptoms chronic. This is one thing we need to be very aware of. Untreated PTSD can really get worse with time. It remains chronic, and often, a diagnosis of comorbidity will follow, particularly for men, as a result of their alcohol abuse.
Another comorbid factor that may be cause for concern is realizing that untreated PTSD if often associated with a major depression. The following are symptoms of depression: sadness, difficulty sleeping, constant crying, loss of interest and suicidal thoughts. This is not insignificant, it's truly quite important and is very strongly associated with PTSD. According to the studies, 52% of women and 52% of men with PTSD will also be diagnosed with major depression if the PTSD remains untreated. Society tends to think that, generally, time will heal all wounds and that gradually the symptoms will diminish. This is not what the scientific studies are telling us. What we are seeing is that if nothing is done, several diagnoses may be made, as the victims will try to treat this anxiety the only way they know how, by, for example, drinking alcohol, or else they will develop symptoms of a major depression.
I want to take a few minutes to conclude my presentation, and then we can talk about it together.
Obviously, over the years we have developed a better understanding of PTSD, and of its aggravating factors, but also of what can be done to mitigate its effects. More specifically, there are therapeutic strategies and psychological strategies. There are three levels of intervention. The first level of intervention is the least well-known and that is prior to the trauma.
What can we do to help people who are known to be at risk—military personnel, but also police officers, EMTs, international cooperants—knowing that they may experience trauma, to help them increase their resiliency, their capacity to understand themselves, in order to decrease the prevalence of PTSD? This is the first level of intervention. We can talk more about it later. This is the least well-known and the least well developed.
The second level of intervention is immediately following the trauma, in the hours and days that follow. We know that someone has been traumatized; what can we do right away? You have already heard about post-traumatic debriefings; this is the second level of intervention. How can we help them in the short term? The purpose of this immediate intervention is to try to prevent the appearance of PTSD, to take steps to ensure that the PTSD is not as severe.
The third level of intervention occurs in the longer term, meaning after one month, once a diagnosis of PTSD has been made, and the symptoms, that is, avoidance, hypervigilance, flashbacks, have continued for one month, two months or three months. What can we do to help these victims?
To help these people recover, we need to ensure a level of intervention with longer-term therapeutic strategies.
There you have it.
