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PTSD in Peshawar: The long road back

Updated March 14, 2015

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Soldiers stand guard as APS students leave. —AFP
Soldiers stand guard as APS students leave. —AFP

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