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Traumatic Experiences And Ptsd: We're Trapped In A Giant Distant Relationship!
YAZI #7360 © Yazan Uzm.Psk.Eylül Berfin ÖN | Yayın Nisan 2022
Traumatic events are events that bring about significant changes in the lives of individuals and disrupt vital integrity. These events can sometimes be a natural disaster, such as war, torture, illness, loss of relatives, traffic accidents, etc. When people related to the event are given reactions such as feeling ashamed, afraid, terrified, feeling helpless, feeling guilty, the events are described as traumatic events or mental traumatic events. (Aker, 2012). Post traumatic disorder is the most important disorder seen after psychological trauma. It is a mental disorder experienced by the symptoms of anxiety and stress that can take long periods of time after the events that cause people to experience intense anxiety and fear that develop after events that endanger human life, such as sudden natural events, unexpected accidents, and violent events in society. (Yıldırımlı & Tosun, 2012).
The stressors that soldiers face in modern wars are very diverse.Stressful war experiences that can lead to the formation of PTSD by soldiers returning from the conflict zone have been described as; to engage in armed conflict, to be under fire, to witness the injury or death of a friend, to be in an explosion, to smell a corpse, to be exposed to dangerous life events that will create fear and tension, to fear exposure to biological chemical and radiological weapons, inadequate food and shelter conditions, inability to maintain personal hygiene, adverse weather runs, family members and family care left behind while on duty.(Ünlü,2014) Also, the complex and surprising environment of modern warfare today poses a danger of death and injury to soldiers at any time and in this case causes many mental disorders to occur on soldiers. 10% (11,400) of United States soldiers returning from the war in the Basra Körfezi in 1991 were diagnosed with PTSD. In another study conducted by the United States army in 2004, more than 3600 soldiers returning from Afghanistan and Iraq were traumatized by human accident, natural disasters caused by human accidents. Those who have been subjected to war trauma due to political reasons or non political reasons, those who have been subjected to domestic violence, sexual assault, harassment and rape have been found 4 major depression, widespread anxiety disorder and PTSD, and these diagnoses have been determined in 9.3% of those in Afghanistan and 17.1% of those from Iraq. According to Goenjian et al, (1994) the prevalence of PTSD after earthquakes is reported between 3-87% in groups with various cultural and sociodemographic characteristics. It is difficult to explain this variability only by various methodical differences. Many factors such as the destruction caused by the earthquake, the loss of life caused by the earthquake and the time of the study can change the prevalence of the disease. The differences, especially in developed and developing countries, are striking in these respects. The prevalence of PTSD after the 1994 California (USA) earthquake was between 6-13%, while those rates are higher for developing countries. In the first 6 months after the Armenia earthquake (1988), the prevalence of PTSD and major depression was found to be 74% and 24%, respectively. In a community-based generation (Cohort) study, the combined disease probability rate (cumulative incidence) of PTSD in the second year after an earthquake was 50%. In studies conducted in various time periods in China (1976), India, PTSD rates are between 10% and 24%. ( Lai et al., 2004) The data point to a significant community health problem. Lack of preparation and lack of social structure after disaster are important factors in increasing rates of psychopathology in these countries. Many reasons that can be explained by the loss of family members, relatives, friends, the inability to eliminate damaged buildings for a long time, unemployment, economic difficulties, the breakdown of social ties, poverty and administrative disruptions facilitate the development and advancement of psychopathology. (Armenian et al.,2002) In a study conducted, the relationship between the levels of post-traumatic stress disorder in high school seniors who experienced the Van earthquake was examined. In this context, students who had experienced the 2011 Van earthquake in Erciş district of Van in the 2017-2018 academic year were participating in this study. Although a significant period of time (8 years) has passed over the earthquake, it is thought that the psychological effects of the earthquake still affect the society. The psychological effects of major disasters such as earthquakes can be seen for many years (Guven, 2010). The adults who experienced the Marmara and Düzce earthquakes stated that even after 14 years, a significant number of people still experienced chronic psychological problems and that the efforts to eliminate the effects of such catastrophic disasters should be continued in a long period of time. In another study, it was observed that children with severe trauma were diagnosed with PTSD even after 3 years (Kinzie et al.1989, Akt., Cloud, 2010). According to Schlenger et al. (2002) in their study following the September 11, 2001, New York attack, the PTSD rate in New York City was determined to be 11.2%. The study, conducted 2 months after the terrorist attack on 4 different points of Madrid on 11 March 2004, reported that the rate of PTSD among those who were attacked was 44.1%. Considering the studies in our country on this issue, following the terrorist attack carried out with explosives in a car in Diyarbakir on January 03, 2008, the people who witnessed this explosion visually and audibly, will be asked to submit a statement to the 1. 12.5% of 216 people and 3 at the end of the month. they found that 9.6% of 146 people developed PTSD at the end of the month. (Ünlü,2004) Another study was carried out two months after the bombings on four separate sites in Istanbul on 15 and 20 November 2003. In this study, it was determined that the rate of PTSD among adolescents in a school in the area where the explosions occurred was 5.9%, while the rate of PTSD among adults who admitted to police stations after the explosions was 29.9%.(Aker,2006)
According to Wikipedia(2020) epidemics in different places and times throughout human history have caused large masses of people to lose their lives. pandemics, or pandemic diseases, are the common name given to epidemics that spread across a wide range of areas, such as a continent or even the whole world. It is not considered a pandemic because of the prevalence of any medical condition and the fact that it leads to the death of a large number of people. It is also necessary that the disease be contagious. For example, cancer is a disease that causes a large number of deaths in humans, but is not called a pandemic because it is not contagious. According to Brooks et al.(2020), quarantine is the restriction of one's isolation and area of movement to detect whether people who have been exposed to an infectious disease are sick. People under quarantine are people who are presumed to have been exposed to the disease, whose disease status is unknown, who are likely carriers and do not already show the symptoms of the disease. The purpose of quarantine is to cut off contact with the person who is likely to be the carrier and reduce the likelihood that the rest of the community will catch the disease. An example is the monitoring of individuals with tuberculosis infection in a separate section of the chest diseases ward. Also, the first quarantine was imposed in Venice in 1127 for leprosy disease. It was implemented in England some 300 years later to stop the spread of the plague and is one of the most common examples of quarantine in history. In this century, large-scale quarantine practices were carried out during the SARS virus outbreak in 2003, which led to widespread acute respiratory failure, and the Ebola virus outbreak in 2014, which affected West Africa and led to the quarantining of villages. The world wide quarantine for the Coronavirus outbreak (coronavirus disease, COVID-19), which is still in the pandemic state, is being implemented. This outbreak can be cited as an example of mass quarantine of cities. We have entered a social distance process where absolute isolation is not mandatory, where contact and exposure are reduced and kept to the lowest possible level.
According to Akbal(2010), uncertainty and insecurity in risk societies have an impact on all aspects of life, such as the environment, politics, communication and health. Furedi (2001) states that the relationships established between uncertainty and the future are reflected in interpersonal behaviors. This is due to increased uncertainty and mistrust in relationships between individuals. In the face of this uncertainty and insecurity, individuals are cautious in their relationships to avoid future risks. This process is fueled by alienation between people. Looking at the interviews I've done, four out of five people have been separated from their loved ones, so their life routine has deteriorated markedly. They were in distress because they felt bored and hampered by isolation due to quarantine.Insufficient information about the prevalence of the disease and the duration of the quarantine was worrying them. The long quarantine period and lack of access to regular medical care made them feel helpless.They had trouble trusting the reported case results, the health system and the community they experienced. One in five people found it difficult to adapt to the home as they were laid off and felt choked up by their child's concerns during the education process. their anxiety was too much because of the uncertainty in their lives. They said they missed their past lives.
According to Seeman (1965) types of alienation is the principle of meaninglessness that arises in society during the pandemic process. Because there is a lot of research being done in case of any risk. The results of this research are mostly communicated to the public through the press. According to the researches and explanations, when the individual's inability to know what to believe and what general truths reveals, the individuals ' inability to understand what is happening in society and its surroundings is in question(Akbal,2010).
The findings of studies on the spiritual effects of quarantine in epidemics, published in the Lancet on 14 March 2020, were reviewed. The most common mental complaints and diseases, risk factors and risk groups were re-evaluated during the current pandemic. Negative emotions such as fear, irritability, sadness and guilt have been reported to occur frequently during the quarantine process in people who have been quarantined for contact with the person infected with SARS virus. The long-term effects of quarantine include behavior changes such as avoiding crowds and hand washing with extreme caution. In fact, it has been seen that some people cannot return to normal life for months.( Brooks, et.al.,2020) Together with, hospital employees who came into contact with SARS were observed to show more signs of burnout and feeling distant to the people around them in the post-quarantine period, compared to those who were not quarantined. They exhibited symptoms such as increased anxiety, restlessness, insomnia, concentration disorder, indecision, deterioration in job performance, reluctance to work, and thinking about resignation when dealing with patients with fever. One study found that 9% of hospital staff still had symptoms of high-intensity depression 3 years after the outbreak, and 60% of those who had symptoms of depression were quarantined medical personnel. Anxiety associated with many situations experienced in quarantine and isolation conditions is a natural response and a non-pathological spiritual response. There is a sudden change in all of the people's plans for their immediate future. They need to spend time in an environment completely unfamiliar to them, away from the social environment they are accustomed to. In particular, if people who remain in quarantine are completely disconnected from their relationships or do not know that the needs of the people they depend on can be met on a regular basis, their anxiety may rise to the level of illness. Factors such as sickness of relatives of persons during isolation and quarantine, witnessing the force of violence and other coercions to those who are quarantined and knowing that their relatives are at risk of disease may occur traumatic stress symptoms and diseases on such as PTSD. Losing their patients can be an additional traumatizing factor for healthcare professionals (Huramovic,2019). In addition, post-traumatic stress responses are not limited only to those directly exposed to the event. There are findings that witnessing an event, listening to details of a traumatic event, or even just hearing the news about the event can create various levels of anxiety. Based on these findings, it is necessary to know the possible signs of stress in those who voluntarily and officially participate in the work to help people who have experienced the event one-on-one after the traumatic events. It is also important for those involved in such tasks to take precautions when necessary and to survive this process unharmed. It is necessary to consider the fact that there may be some problems they may experience.
As a mechanism for dealing with such situations, basic-Ph fields can be used. To be able to express our feelings by activating our emotions through the concept of 'affect' reduces tension. Trust your emotions in times of stress and crisis. You can also use nonverbal methods such as drawing, reading, or writing to express yourself. The concept of 'physiological' is to try to cope by using reaction and body movements together. Relaxation, desensitization, eating and drinking can be used with meditation. Using our internal and external resources can be functional during these periods. Our internal resources are, that is, our capabilities, our skills, time, space and conditions. Our external resources are to focus on anything that makes us feel better. Furthermore, the concept of resilience is of great importance in these periods. Resilience is to be able to come out of what we are going through with the help of our own resources and others. Resilient individuals can cope well with change and recover faster from its effects. We can increase the concept of resilience in 8 steps. Accept change, keep learning constantly, take responsibilities, set yourself a goal, be balanced, make good associations, look at your experiences as an outside eye, reconsider your abilities and skills.(Kalem, 2020) Exercise to adjust to the feared situation aims to reduce anxiety and fear caused by stimuli that remind you of trauma. For this reason, the same stimulus is gradually applied to the situation that the person is afraid of. For instance, people who cannot sleep in the bedroom because of the condition they experienced after the earthquake may be advised to stay in and out of the bedrooms for increasing periods of time each day by giving necessary training and agreeing on it. These applications must be done in safe environments such as sturdy home. According to Folkman and Lazarus(1988), there were two kinds of coping mechanisms. One is problem-focused coping, and the second is emotion-focused. The problem-focused is about changing the situation itself and is usually the first to be done. Emotion-focused is about changing your perception of the situation. If you can't get out of the situation, change the circumstances in the situation. Also, transaction, and communication occurs between the environment and that person. Therefore, if the difference between sources and expectations increases, the stress factor may also increase. Regardless of what the event is, it is the meaning we attach to the event and its equivalent in our perception. We can reduce the level of stress that it creates for us by addressing every aspect of the situation.
As a result, if we have experienced social and individual traumas that affect our lives deeply, and if these events affect our work, social and daily lives, we should not leave it to time. You should visit a mental health specialist or coping methods. With appropriate treatment and coping methods, you can regain your mental health and reduce the impact of events.




References

Akbal, Alev(2010). Sağlık Alanında Risk ve Korku Kültürünün Sosyolojik Analizi, Domuz Gribi Örneği, Ankara Üniversitesi Sosyal Bilimler Enstitüsü Sosyoloji Ana Bilim Dalı
Aker AT (2006) 1999 Marmara depremleri: Epidemiyolojik bulgular ve toplum ruh sağlığı uygulamaları üzerine bir gözden geçirme. Turk Psikiyatri Derg, 17:204-212.
Armenian, H.K., et al., Risk factors for depression in the survivors of the 1988 earthquake in Armenia. J Urban Health, 2002. 79(3): p. 373-82.
Diagnosis and Management of Posttraumatic Stress Disorder in Returning Veterans, Roy R. Reeves, DO, PhD
Goenjian, A.K., et al., Posttraumatic stress disorder in elderly and younger adults after the 1988 earthquake in Armenia. Am J Psychiatry, 1994. 151(6): p. 895-901.
Pandemi(2020,April 24). Retrieved from
https://tr.wikipedia.org/wiki/Pandemi
Kalem, Ayşegül(2020).Trauma Psychology Lecture Notes.
KURT, E, GÜLBAHÇE, A. (2019). Van Depremini Yaşayan Öğrencilerin Travma Sonrası Stres Bozukluğu Düzeylerinin İncelenmesi. Atatürk Üniversitesi Sosyal Bilimler Enstitüsü Dergisi, 23 (3) , 957-972.
Lai, T.J., et al., Full and partial PTSD among earthquake survivors in rural Taiwan. J Psychiatr Res, 2004. 38(3): p. 313-22.
Huramovic, Damir,(2019) Psychiatry of Pandemics, A Mental Health Response to Infection Outbreak, Springer
Schlenger, W.E., et al., Psychological reactions to terrorist attacks: findings from the National Study of Americans' Reactions to September 11. JAMA, 2002. 288(5): p. 581-8.
The psychological impact of quarantine and how to reduce it: rapid review of the evidence, Samantha K Brooks, Rebecca K Webster, Louise E Smith, Lisa Woodland, Simon Wessely, Neil Greenberg, Gideon James Rubin, www.thelancet.com Vol 395 March 14, 2020
Ünlü, A. Gazi (2014). Operayonel Görev Yapan Askeri Personelde Travma Sonrası Stres Bozukluğu (TSSB) Sıklığını Etkileyen Faktörler.
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