Special Hearings — Mental Health Workshop — 1997-11-20

CHAIRPERSON: Thank you very much Professor Simpson, wonderfully well toned and articulate and smooth as always and witty.
 Would the panel like to ask any questions?  Glenda?

GLENDA WILDSCHUT: Professor Simpson, perhaps I would like to just make one or two comments and then ask a question and ask you to comment on something.  Perhaps for emphasis to underscore what you're saying about the issues of long-term effects of PTSD, it's not well understood by many people and particularly policy makers.  The issue of budgeting and finance for the treatment of people of suffered under the hands of apartheid, people who were tortured and so on and that we have to do long-term projections into what it will cost the State to treat people in the long-term.
 And I think that many of the ...[indistinct] of people who have gone into Government right now, are probably coping because of - sort of, social circumstance you know - that they're financially okay and that they have some family support and that there's some kind of social structure that's supporting them, helps to mask maybe or disguise the fact that they are suffering some kind of sequel of trauma but that once those social systems may perhaps break down or so, that they will have long-term morbidity.
 I think that many - both yourself and Lionel mentioned this morning the issue of comorbidity but both of you have not mentioned the issue of personality and how much personality has impacted on the profile of the perpetrator - you know, what kind of person would want to plead that they're suffering from PTSD so articulately and so conveniently, what kind of personality has this person and what is the link between personality and perpetrator.  
 And perhaps the academics and other people who are involved in that, should articulate that a little bit more for us so that we're able to also then make appropriate recommendations in our final report.
 But what worries me the most perhaps about your submission is number 9 and the whole issue of debriefing and preparing people for traumatic situation and debriefing people after a traumatic situation and your contention in the submission that that has absolutely no impact on PTSD and so on.
 And both yourself and myself and other people have been involved before in working with political detainees, ensuring that they get debriefing immediately after the traumatic situation of being in prison - targeting people who - targeting is not the right word but, identifying people who would be targets of the State and would  potentially be detained. 
 And actually working on those people and preparing them for torture situations, for prison situations, briefing them about what they could expect - with the idea that that would help with PTSD and now you tell us that it doesn't, please can you comment about that - it worries me?

PROF SIMPSON: Thank you.  To take the last point first as it sounded far more urgent and I don't want to have to debrief you afterwards.

GLENDA WILDSCHUT: ...[inaudible] debriefing and actually including that in our recommendations, you've probably seen that.

PROF SIMPSON: Yes.  I think I should clarify a few points.  First of all, one of the things you're talking about which we used to do and which we believe is useful but in those days nobody would allow us to research it and now the opportunity - thank God, isn't around - you're talking in part about pre-briefing and there is some evidence from some studies that pre-briefing - in the sense of preparing someone at risk for what might happen, how it might effect you, what it might be like, what you could do about it, may indeed be useful.  I think our experience suggested it was and where it has been assessed in proper studies, that does appear to be true, so we did no wrong when we tried that.
 What the second category I think we need to distinguish between, is perhaps - I tried to make it clear but obviously not quite clear enough, there is a difference between a form of debriefing which we've all being doing for years and which so commonsensical - mothers have been doing it for centuries, and that is when the kid is ...[indistinct] you say: "What happened, how do you feel about"? - that is so trivially common-sense, of course it's helpful.  
 What we've had though since then, has been a secondary industry - a particular varieties of debriefing which have been codified - almost commercialised, there are groups that will certify you as a debriefer and with a 24 hours course, you now are able to do it and lay on the hands and it works and these other people don't know what they're doing.
 I know of some evidence that what we're talking about at the simple level of listening, being prepared to listen - not necessarily immediately - some people can't talk immediately, when they are ready, to be on a continuing basis able to hear is harmful.
 What is interesting is that where we are getting this marketing of a system  where you've got to go through certain steps in a certain way, you've got to be certified in a particular way, that - because it has made such extreme claims and has never been able to back up any of the data, has in fact been evaluated.  
 And there's some interesting studies - like one I'd address you to, that happened in Aberdeen where by sheer chance someone had done a wide scale evaluation of a bunch of people who then a few weeks later, happened to be on one of the oil rigs in the North Sea when it went up in flames so that by sheer chance they knew a lot of the people - on your issue also of personality, before the event and could look at them after.
 And from some of those studies it does appear that the sort of debriefing that's been commercially provided, not only doesn't show much benefit but doesn't show the benefit that was proposed, that it will prevent PTSD developing and that's still a very open issue.  
 I think the sort of basic level debriefing that we're talking about is worth doing even if it doesn't prevent PTSD because it's a simple human bandage - a psychological bandage, that helps you feel better immediately.  If that was all it did, it would be worth doing, if it does more that's good but we can't assume it until we've checked it.  
 There's some evidence in some studies that that commercialised variety may actually - some of the people who received that were worse off after their trauma than the others were.  So, my ...[indistinct] may actually be good news in the sense that the sort of debriefing I hope we will provide and immediate aftercare, should be the basic level simple thing that can be done on a wider democratic and community based scale - we don't need to pay Americans to teach us how to do that and I think that part of it is good news.

GLENDA WILDSCHUT: ...[inaudible] the comment of debriefing also has wild and unsubstantiated claims made for it and I just think that maybe we need to modify that sentence a little bit because we need to ...[intervention]

PROF SIMPSON: ...[inaudible]

GLENDA WILDSCHUT: Yes, and that would help us to - because I think that you're right.  I mean, Band-Aid has been very, very important in many instances and we do need a psychological Band-Aid that should be done.  Can you comment about the ...[inaudible]