Stiff upper lip or let it all out?

Top trauma psychologist David Alexander reacts to a report suggesting in the wake of 9/11 some peopl

Most cultures have developed rituals and practices to help people express grief, sadness and distress.

Contemporary therapies and counselling have attempted to take this this approach to emotional catharsis further - some have considered the meaning of a trauma and how the individual has reacted to it.

Now a study by the University at Buffalo's Dr Mark Seery has produced data which appear to suggest that not talking about a traumatic event (in this case the World Trade Center and Pentagon terror attacks of 9/11) may be a more successful way of coping than the alternative - sharing the experience.

Strikingly, so far as I can ascertain, none of the participants in the study actually suffered the loss of a close relative. Second, all the individuals gave their views online: so we have no independent clinical opinion. Third, would it not be likely that the “non talkers” would also be those least likely to admit to having post-traumatic symptoms? Fourth, those who did express their experiences may have been the most disturbed and, therefore, the ones most likely to develop symptoms in the longer term. Finally, it is not clear whether the “non talkers” spoke to nobody at all or just refused the offer to speak to the researchers.

Neither I nor anyone I have worked with in 20 years in the trauma field, would challenge the view that, for some, it may be unhelpful (damaging, even) to discuss their experiences openly. Individuals vary widely in terms of personality, previous life experience, concurrent life situation, sources of support, and ways of coping with earlier adversity. Also, some individuals have a basic difficulty in discussing anything emotional never mind their feelings after a catastrophic event. Encouraging them to do so could make matters worse.

With regard to “talking” itself, there are issues. One is the time gap between the event and discussing it; some individuals can remain, for months even, too “raw” to do so. I personally would not find it reassuring in the immediate aftermath of some tragedy, to be told that a “team of trained counsellors is standing by”.

On the contrary, I'd be off home to family, friends and colleagues - people I know and trust - because it is also a question of who you talk to. There are some individuals with whom I would not discuss the weather. Also, I believe there has to be a follow-up to the sharing of feelings, otherwise individuals can be left feeling vulnerable and emotionally naked.

We certainly need more research about to how best to help those who want help in the aftermath of a tragedy. A false polarity, such as “to talk” or “not to talk” will not be helpful to the public or professionals.

What we need is better evidence about when, where, with whom, under what circumstances, and to what end the sharing of intense and sensitive emotions after tragedy can be helpful.

Nothing will be helpful to everybody. We will always have to be guided by the survivors in terms of what they believe would be most helpful. Also, some survivors may wish to change their mind; they may not want to talk today, but that does not mean they may not wish to do so in the future.

David Alexander is director of the Aberdeen Centre for Trauma Research and professor of Mental Health in the Faculty of Health and Social Care