The lingering effects of trauma

Edinburgh-born Professor Gordon Turnbull has spent his career studying the effects of trauma. Now the story of his work, forged by his experiences at Lockerbie, is told in a new book

• The remains of Pan Am 103 at Lockerbie. Picture: AFP

POST Traumatic Stress Disorder (PTSD) is not an illness or indication of "LMF" – low moral fibre – as was once believed. Instead, it's a natural reaction to a highly abnormal event, says Professor Gordon Turnbull. "PTSD seemed to have so many different types of manifestation. After everything I'd seen, I couldn't possibly describe it as an illness. All my research, all my years of clinical experience, had led me to believe it was a survival tool; perhaps our ultimate survival tool."

Turnbull, 63, is Consultant Psychiatrist in Trauma at Capio Nightingale Hospital in London and the Ridgeway Hospital in Wroughton, an adviser in psychiatry to the Civil Aviation Authority and a visiting professor with the University of Chester. He is one of the world's leading authorities on trauma and PTSD, and has spent years fighting for recognition of PTSD, in order to remove the stigma that still surrounds it. The story of his work in this highly contentious field is recounted in his book, Trauma.

And it all started in Leith, where Turnbull and his younger brother, Derek, lived with their parents in a flat at 11 Dalmeny Street. One set of grandparents lived nearby at No 21, the other, at Easter Road, close to where his favourite team, Hibs, played their matches. Turnbull was a clever, curious youngster, endlessly dismantling the family's clocks to see what made them tick. He thrived at George Heriot's School, and in 1967, went to Edinburgh University to do his statutory six years of study training to become a doctor.

With a chuckle he says: "Heriot's was on one side of Lauriston Road, and the Royal Infirmary on the other, so when I joined the Air Force in order to see the world, it wasn't that I particularly wanted to leave Edinburgh, just that I'd spent 25 years there – half of that time on just one street! I am always, always refreshed to go back to Edinburgh. It's not just nostalgia about the people and places: it's just such a nice place to be."

Turnbull remains intensely curious about a wide range of subjects, but especially about what makes humans tick. He began studying PTSD around the time of the Falklands War, in 1982, but his work gained momentum in December 1988, after he received a call from the man in charge of one of the four mountain rescue teams combing Lockerbie for survivors of Pan Am 103. "A significant proportion of those in his team – hard men, conditioned to withstand extremes – were in dire need of help," Turnbull writes.

That surprised him, for he'd worked with mountain rescue teams before, and knew that "as a bunch, they are a pretty tough breed, (but] we were very struck at how severely they had been affected by what they had done and seen." One of the hardest things to accept was that there wasn't any rescuing to do. "There weren't, and never had been, any lives to save."

During mass and individual debriefing sessions, Turnbull heard men describing their feelings of helplessness. It helped him refine his understanding of PTSD. Among other things, he realised that there's a ripple effect: trauma not only damages its victims, but those who come to their aid. That became even more obvious when Scottish police forces experienced problems.

"Three forces were involved, Lothian and Borders, Strathclyde, and Dumfriesshire. The outcome for parameters of distress, like rates of depression or even suicide, depended upon the attitude of their superior officers. Lothian had a particularly bad record, with an awful lot of illness. Strathclyde came out best. The difference was that they acknowledged that people who went into those situations could be adversely affected by it. So when police offers developed things like absenteeism, drinking problems, marriages breaking down, and failure to perform, they knew that it had to be looked into further if those people had been at Lockerbie."

Three main criteria characterise PTSD. "The key criterion is the flashback, an intrusive recollection of what happened. And a nightmare is just a flashback at night. The second criterion is avoidance of having those reminders, and the third is hyper arousal."

The causes of trauma are widespread and, sadly, prevalent. Recent events in Norway are likely to be even more damaging to the psyches of those involved than actual combat, and few can fail to be aware that the tenth anniversary of 9/11 is a few weeks away. But trauma can also be caused by a mugging or rape, by being kidnapped or taken hostage, or even being caught in a car accident.

PTSD, Turnbull explains, "is about getting very close to the edge of your life, looking over into the abyss and realising that you're not immortal and not invulnerable, and somehow coming to terms with that. One of the things that characterises human beings is denial. We don't tend to think about our own mortality – it comes as a bit of a shock".

Surprisingly, Turnbull doesn't think denial is always bad. "It is part of our armour. It is the reason that we invent things. We can be very creative under the cover of denial. It is said that denial is one of the things that separates us from the apes. Being angry is another one. People become very angry when they are being traumatised and often say why me? You have to help them harness that anger and make it positive. Internalised, negative anger leads to depression and physical illnesses. But if you can help people to legitimise their anger, it doesn't have to come out as aggressive or destructive energy; you can be very constructive and create things. For example, the train and the automobile were created out of man's frustration with not being able to get places."

As I understand Turnbull's book – and it feels a cheat trying to distil hundreds of detail-rich pages into a far shorter newspaper article, especially as PTSD has so many causes and forms – one of the main ways to help sufferers is to provide an outlet for their trauma.

"Yes, you take this stuff in and because it's in you, you can't get rid of it. Do you remember television test cards? Think of everyone as having a test card in their heads. It is in tune with the environment signal, and running along nicely, clear with no fuzzy lines, no interference. Then a trauma happens. It's unpredicted, nasty, and shatters assumptions. It's a real challenge to your test card, and it's in your head space already. What do you do? You can absorb the stuff quickly and get it over and done with.

"That is the period of the acute stress reaction. It's quite a troubled time, having to accept things you don't want to accept. If you have a strong test card – ie, personality or character – you might be able to shut it away with considerable energy. But it is going to come back. You will be reminded of it sometime. And when it comes out, it goes through the process of the challenge all over again. It's not people who are weak, but people who are strong, who manage to push it away (at first], only to be challenged again and again and again, who develop PTSD.

"It's a conundrum, because people we know to be strong tend to be those we select to protect us: military, paramedics, police service, doctors, nurses. Therefore we shouldn't regard them as being invulnerable to trauma. They're actually trauma seekers and are more vulnerable, and we have to look after them especially well."

Despite spending his life helping the victims of trauma, Turnbull retains a fairly sunny disposition. "To be a psychiatrist and remain sane you've got to have an optimistic personality disorder and keep looking on the bright side of life. Trauma work is about reconstruction. You're trying to help the traumatised person to assimilate the impact of the trauma, so that the end result is one of personal growth."

• Trauma is out now from Bantam Press, priced 18.99 hardcover.