Department of Psychiatry, BJ Medical College and Civil Hospital, Ahmedabad,Gujarat, India
London School of Hygiene and Tropical Medicine, London,UK
Correspondence: Dr Vikram Patel, NPHIRU, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT,UK. Fax: +44(0)2207 958 8111; 8111; e-mailL: vikpat_goa{at}sancharnet.in
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ABSTRACT |
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INTRODUCTION |
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METHOD |
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RESULTS |
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Case 1: married woman, aged 32 years
I was sleeping with my mother-in-law when I heard a commotion outside. I arose and came out: there was a strong smell of petrol from all sides. The sides. The next day my brother-in-law came with his rickshaw and told me that everywhere in the city there was a disturbance, and we should move to his home. Before he could finish we saw a crowd rushing towards our house. Without any thought we just got in a rickshaw and fled. We saw that there were two people riding a motorcycle with waving swords, swords, shouting Victory to Shree Rama! Victory to Shree Rama!, and chasing us. With much difficulty we reached my brother-in-laws house and lived there for 10 days. The situation there was no better, hence we came to the camp. My husband later went to our home with the police, but everything was looted, nothing remained, the house was set on fire. Still today I see two people, faces masked and carrying swords, repeatedly before my eyes and all of a sudden I get a strong smell of petrol. They do not leave me alone, even in dreams. I wake up screaming, bathed in perspiration. If someone talks about the disturbance I feel dizzy, there are tremors all over my body. I feel that someone will come and kill us. I do not enjoy anything. I always remain alert. If a child cries or if there is some soft sound, I am afraid as if a bomb has exploded. What will happen? I brood over this only. I feel scared when I go out. I dare not go to my street and see the burnt house.
Case 2: married woman, aged 30 years
They came and before my eyes they cut my neighbour to pieces. I saw all this with my eyes. I fled away with my family; crossing the railway tracks, my foot got stuck in the track, and Ifell to the ground injuring my foot and face. Somehow we reached Viramgam, and when the disturbance cooled, and we came back, there was no house, only ashes. I remember everything vividly. Scenes of my neighbours killing with swords come again and again before my eyes, his helpless cries for help stillhaunt my ears. My head feels dizzy, my breath gets choked, I perspire and my body shivers with terror. I wish to forget all memories of the disturbance but they come continuouslyin my mind;I get frightening dreams, terrified, I awake from my sleep. My heart is not at rest, the tears do not stop. I do not even wish to talk about it.
Case 3: widow, aged 65 years
When our street was attacked we fled without shoes on our feet. At last we reached the camp. In my dreams, too, I see the people with swords and tridents who came to our street on the day of the attack. There were shouts of "Kill! Cut to pieces!" They were abusing us, some had disrobed and shouted,"Send your daughters to us!" They were making obscene gestures. Some pulled the hair of beards of old men. All this comes to mind repeatedly. I do not wish to wish to talk about all this now. I cannot concentrate on anything. Constantly I am afraid that a crowd is about to come. Even if a pigeon flutters its wings, my heart beats violently. How can I stand my burnt house? I do not get proper sleep. I awake from sleep several times. I do not want anything. I pray to God to call me to him.
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DISCUSSION |
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We describe here the findings of in-depth interviews to study the emotional experiences of women who had been exposed to extreme trauma. The three narratives presented in this paper are typical of the narratives we elicited from most women. These narratives not only vividly illustrate the experiences that are typical of the symptoms of PTSD as described in psychiatric nosology notably re-experiencing, avoidance and hyperarousal but also express their association with the traumatic events. Thus, when women were asked what they thought had caused their current emotional distress, they invariably mentioned two factors: gham (bereavement) and sadma (sudden trauma). The women had sought the help of a mental health provider team, indicating that they associated their experiences with a mental illness. We believe that these observations provide support for the cross-cultural validity at least of the core symptoms associated with the psychiatric category of PTSD.
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ACKNOWLEDGMENTS |
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REFERENCES |
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Eisenbruch, M. (1991) From post-traumatic stress disorder to cultural bereavement: diagnosis of southeast Asian refugees. Social Science and Medicine, 33, 673 -680.[CrossRef][Medline]
Patel,V. (2000) Culture and mental health consequences of trauma. Indian Journal of Social Work, 61, 619 -630.
Sharan, P., Chaudhary, G., Kavathekar, S. A., et al (1996) Preliminary report of psychiatric disorders in survivors of a severe earthquake. American Journal of Psychiatry, 153, 556 -558.[Abstract]
Summerfield, D. (2001) The invention of
post-traumatic stress disorder and the social usefulness of a psychiatric
category. BMJ, 322, 95
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World Health Organization (2002) World Report on Violence and Health: Summary. Geneva: WHO.
Received for publication November 24, 2003. Revision received August 11, 2004. Accepted for publication January 26, 2005.
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