Hypervigilance is a symptom that could lead to alcohol abuse as the patient is constantly on the lookout for a repeat of the trauma. PHOTO | SHUTTERSTOCK
My uncle was on a bus near the American Embassy 25 years ago when the bomb exploded. He has been unable to pass anywhere near the memorial site. He says he has nightmares and hence the heavy drinking. His wife left him and he later lost his job. Does he have a mental problem?
I was at the Nairobi Hospital on August 7, 1998, when the bomb exploded at about 10.30 am that Friday morning and was one of the many doctors and nurses who received the injured that morning.
In the months and years that followed this tragedy, the mental health landscape in Kenya changed in many ways.
Hundreds of volunteer counsellors were trained and made their contribution to the recovery process. Many became aware for the first time of the term Post Traumatic Stress Disorder (PTSD). Suddenly, mental health was no longer a subject to be discussed in low tones.
The print and electronic media were flooded with talk about the potential psychological consequences of this tragedy.
In the aftermath of an event that is perceived (by the individual) as potentially life-threatening the state of fear and anxiety that follows during the first month is known as Acute Stress Disorder, and in most cases, this condition recedes, and most people go on to lead normal lives.
In some cases such as that of your uncle, one goes on to develop serious consequences that can lead to serious mental health challenges.
Not having examined your uncle, it is impossible to say with certainty that he has PTSD, but he clearly has features that suggest this diagnosis.
For a start, he was near the site of an explosion that led to the death of more than 200 people, with over 5,000 injured. This fact alone satisfies one of the critical requirements for such a diagnosis.
The fact that he has been unable to go anywhere near the site, would indicate that he has the symptom of avoidance of the place where the near-death experience took place.
Many people who have had similar traumatic experiences avoid some roads where an accident took place, or even an area where politically instigated violence led to the loss of life.
That he has been drinking heavily possibly leading to the loss of both his wife and job is a common sequela in people with this diagnosis.
The symptom of numbness, for example, means that your uncle might lose the feelings of affection that he used to have for your aunt. Such people are sometimes said to have become as cold as a deep freezer.
The symptom of anxiety and difficulties in sleeping can also lead to the abuse of alcohol as the patient tries to calm himself down even as he struggles to sleep.
Hypervigilance is a symptom that could also lead to alcohol abuse as the patient is constantly on the lookout for a repeat of the trauma.
Flashbacks of the traumatic event can be most disturbing as the sounds and smells of the trauma keep coming back to the patient, as he tries to “forget” the event and get on with life.
In our studies following the events of 1998, we found, to our surprise, very high levels of baseline PTSD, meaning that Kenya is a significantly traumatised nation, with both adults and children showing features of PTSD unrelated to the bomb blast.
The trauma cited included domestic violence, road accidents, politically instigated violence, the police, and in the case of school children, witnessing acts of violence both at home and in society in general. PTSD is not a subject that is about to go away in this country.
It is not too late to get help for your uncle. Although his wife might have moved on, and his age is now too advanced to be looking for a job, experts might be able to help him with the alleviation of some complications of PSTD, including alcohol abuse.
