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PTSD in Peshawar: The long road back
It was during our morning report on the Inpatient Psychiatric Unit when we heard his screams.
We all ran to his room and found him standing there, his hands tightly clenched into fists, ready to fight. I caught glimpses of anger and fear simultaneously flash across his face as he stared at the empty space in front of him.
He did not respond to us, he did not even turn to look at us when we called his name.
My Attending quickly asked the nursing staff to bring in his medication. Later, he explained to us, the inexperienced interns, that our patient was having a flashback, a severe symptom of Post Traumatic Stress Disorder.
In other words, he was re-living his emotional trauma, unaware of his surroundings and the people around him. He was simply at a time back in his life where he had suffered a distressing ordeal.
This is just one of the diagnostic criteria of PTSD — a disorder where one is exposed to a situation that was life threatening or caused serious injury; symptoms can include flashbacks, nightmares, panic attacks, hyper vigilance and sleep disturbances.
After the APS tragedy, a lot of my colleagues in the US either went to Peshawar or provided Psychiatric services through tele-psychiatry.
Three months since the Peshawar attack, it is with a sense of failure, I realise that despite my more than seven years of experience in psychiatry, I still do not have the emotional strength needed to reach out to the children of APS.
I lack the courage, the self-control required to remain compassionate yet composed, while listening to the events that unfolded in front of their eyes in the very school they grew up in; learning, playing and protected from the harsh realities of the world.
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I fear, even if I tried, they may see an adult, a professional who has heard countless tales of torture and pain, at a complete loss for words, somewhat broken and unable to hold back her tears.
I cannot as once I, too, was a child just like them, growing up in Peshawar, surrounded by friends, trying to bunk classes, playing sports and frantically cramming for my exams at the last minute. I can, however, relate to their life before December 16th. Therefore, I can also relate to their pain.
The image of two young children, walking away with an army personnel, their bags not on their back, small hands holding on to the officer, evoked an extreme sense of loss in me. I wondered if they would wake up at night from tremors; their little hearts racing.
I often wonder how they cope when, during the day at school, they disassociate from their surroundings, they may not remember what they were discussing or who they were talking to. These symptoms can happen out of the blue, at any time.
The sound of footsteps in the playground may take them back to that terrible day when they heard boots coming towards them, taking their friends away from them.
Also read: 'I saw death so close': student recalls Peshawar school carnage
A fundamental requirement of a therapist is to not to be a friend to their patient. In my case, I am a child of Peshawar; I am a friend by default.
I want to be able to sit with them, cry and laugh with them, talk about their hopes and dreams.
I want to talk about our common experience of growing up in Peshawar, or how one friend can change your entire outlook on life in the city. On second thought, I don’t know if they would want to talk about their friends.
I do, however, want to tell them:
I have tried putting myself in your shoes, I have tried to imagine what it means to sit in the same classrooms, turn around to share something funny or pass a note and realise that that friend no longer sits there, that he is gone.
I tried to understand how it feels when you look at old school pictures or go to your favorite hangout place, when you practice for the upcoming match or group study for a test.
Also read: Inside Army Public School, once upon a time...
At this time, I do want to ask you to not hide your pain, to cry openly and whenever you feel the need. Grief has a way of staying put inside us, if we do not accept it and face it, it hurts even more. Therefore, even if you are not ready to talk about it, allow yourself to feel the pain, the anger, the emptiness, the loss. Allow yourself to feel. I promise you, it will help.
I have no doubt that you are the bravest little souls but it will take a lot of courage to face your pain.
I hope you will forgive me for not having the strength to be with you. I do promise you though that your friends will remain alive in our hearts and minds.
We will not forget.
I will pray for your healing. You learned before your time, that life is fragile. I just hope it will not stop you from following your dreams, laughing again and uncontrollably, and finding new friends.
I hope that one day you will have the courage to believe in people again.
Related:
- Undeterred and unafraid, Army Public School reopens
- After two-month fight, APS student succumbs to injuries
- Teachers get gun training after Peshawar massacre
Munaza Khan is a graduate of the Khyber Medical College, Peshawar.
She is currently working in New York as a psychiatrist.
The views expressed by this writer and commenters below do not necessarily reflect the views and policies of the Dawn Media Group.
Comments (17) Closed
Beautifully written Munaza. Best wishes from another Child of Peshawar
Being a mother myself I cannot even imagine how the mothers of martyred children go through a single day. I pray for the children who had died and the ones survived May they find peace and happiness again. I pray for the mother's that Allah give them strength. The children would never be forgotton . Not a single day passes by that i don't think about the incident. May God give them enough strength and may He bring them peace and happiness again.
I just hope that our nation never forgets this sacrifice. Let us all in our individual capacity find ways to remember our young heroes and keep them alive forever, as I have no faith in our Government to do anything about it. Salute to my forever young heroes!
@zainab I value your sentiments and hoping you too would respect the feelings of thousands of Indian women who lost their father, husband, children, brothers, sisters, mothers, friends, neighbours etc in the deadly terrorist attacks in India and Kashmir. I would hope you to courage to ask your government why they have not given punishment to these terrorists?
Islam Zinda hoota hai ...Kurbala Kee baad ...Long live my Heroes, you will always be My Heroes. None Like you. No one gave sacrifies like you...Pakistan is our mother & its not only a mother's duty to sacrify, Son's & dauhter o sacrify for mother also. Always be happy where ever you guys are. We all will Meet soon & will be United for good .
133 innocent angels died for dead nation to change it's destiny..... When I write this I am crying helplessly asking help from ALLAH May good prevail in Pakistan and in Pakistani enough blood is spilt and we saw funerals of flowers.....
I wish we can do something for them. With new technology of video teleconference we as psychiatrist from US can help them. I will be happy to present my services if needed.May Allah help these children and their families to come out of their pain. Ameen
no doubt we can not imagine their sufferings but least we can do is be there for our children and tell them that they are the bravest of all.... and WE WILL NEVER FORGET! beautifully written with pure empathy every true Pakistani feels.
Munaza you have expressed precisely the views of all who spent their childhood in Peace in Peshawar. May Allah help in easing the pain of affected ones with the help of professionals like you. Ameen.
Does this school looks like an average Pakistani school. This picture is the " poster child " of inequality in Pakistan. Does this school represent a face of tax funded or subsidized school of Pakistan.
@Nizamuddin Ahmad Aali Very insensitive comment. Would you have felt more sympathy if they would have been children of average school. Children are children, don't categorise them.the heartless thing is that OUR children have been attacked who are not a party in this war. The fact is that the enemy has hit below the belt .
Thank you Munaza for expressing the pain we all feel from the depths of our souls for so many innocents who's lives were so precious that Allahtallah took them back into the heavens where they are at peace now.
Post Traumatic Stress Disorder is a genuine reaction from tragic violence which many adults have a difficult time processing, let alone children.
Many highly qualified physicians from the Pakistani diaspora serve generously in Doctors Without Borders, and it's essential the psychiatrists and psychologist among this selfless group spend some time in Pakistan to assist in the treatment of many suffering from PTSD.
i am currently dealing with these students in APS as clinical psychologist. And i m satisfied as they r trying to cope well. Only 2 cases of Dissociation reported out of 1100 staff n students.our core team is also working with Shaheed's famlies free of cost... this is done by army to share their grief and to tell them.. they r neither alone nor forgotten. Pray fr us to fulfil this holy cause.
Oh Peshawar !! How long will you continue to bleed?
There is a treatment developed in Canada for PTSD. one can google, Bust PTSD, and find the link on for iTunes, apple phone and iPads and google play for android phone and tablets.
One can down load for I believe $13 and can use as many times as need, usually 2-3 applications resolve PTSD symptoms. There is no restriction for number of users, even using on smart TV, by linking iPhone or Samsung Galaxy type smart phone or tablet, people can benefit in groups. Bust PTSD
We will never forget!
Munaza! You have very rightly expressed your feelings regarding Peshawar tragedy. i also feel the same...unable to express my feelings, extremely saddened by the incident, there comes a point when silence prevails. Right after Dec 16 till to date..... But i keep praying to Almighty Allah, the angel souls, for parents, their families, friends and relatives. silence......!!!! Best Wishes.