Omagh helps US cope with September 11

New York had 11 September and Omagh had the bomb that killed 29 people and two unborn babies. While the scars from both attacks remained yesterday, a ground-breaking counselling unit in Northern Ireland was showing policemen and firefighters from New York how it worked successfully with survivors of the devastating bomb attack in 1998.

New York had 11 September and Omagh had the bomb that killed 29 people and two unborn babies. While the scars from both attacks remained yesterday, a ground-breaking counselling unit in Northern Ireland was showing policemen and firefighters from New York how it worked successfully with survivors of the devastating bomb attack in 1998.

A dozen experts from New York's police and fire departments toured the Centre for Trauma and Transformation in Omagh and spent time conferring with therapists.

Deputy Chief George Anderson, of the New York police, said yesterday that some of the techniques used in Omagh seemed unique. He said: "We're looking at how they cope in Northern Ireland, which has had an awful lot of conditions where post-traumatic stress disorder (PTSD) could develop. We are here to compare and contrast the methods we use in New York."

Nearly 3,000 people died in New York in the terrorist attacks in 2001 and victims and workers from the emergency services received intensive counselling in the aftermath, funded both by the state and federally.

But if the lessons of the Omagh unit are anything to go by, there is no time limit to incidents of PTSD, and some people could come forward up to 25 years after an event.

The Omagh team, set up hurriedly after the bombing but so successful that it now works on projects across the region, has discovered that unknown thousands might need treatment for PTSD and other forms of psychological distress.

Research showed that the team's pioneering work had improved many people's quality of life and had reduced the misery caused by the Troubles.

But the grim statistics of the Troubles suggest how many might need help: 3,700 killed, nearly 50,000 injured, 16,000 bombings and 37,000 shootings.

The reduction in violence has brought a communal and personal decrease in stress. This in turn means that people who were affected by violent incidents - sometimes decades ago - finally feel able to come forward for treatment.

Michael Duffy, manager of the team at Omagh, said: "We are seeing some cases from incidents that occurred 25 years ago. There are people who have - remarkably - held themselves together until their last child left home and then said, 'Now I must sort this all out'."

One man went to Australia to escape his memories of Omagh. "He managed to function all right for a year," Mr Duffy said, "but of course there was a trigger that set him off. He came back home for treatment and he worked it through very, very well." Other young people went to universities where, without the local support network, they had difficulties. "The stuff was still in their heads," Mr Duffy said.

The trauma team also saw thousands of people in the aftermath of the bombing. "We were overwhelmed," said David Bolton, the head of the centre, who had already dealt with a bombing in Enniskillen.

"In the first two weeks, GPs reported three and a half thousand contacts with people who were highly distressed," he said. "We had to hold the line and support front-line staff in containing these high levels of community distress."

Mr Duffy said that people with severe PTSD could develop a belief that they would never cope again. But some could recover and successfully reclaim their lives.

"What can happen," he said, "is that people can grow out of an incident, become more sensitive. Some people have said they now have a much deeper appreciation of life and intend to live it to the full. They can end up with a new healthier outlook on life." Getting to that point, however, can often mean the intricate dismantling of carefully built-up defence mechanisms.

People could be affected in a variety of ways: with terrifying dreams or nightmares, flashbacks, sweating and faintness. They could become withdrawn, finding it hard to trust people and feeling agitated and fearful. This could result in sleep disturbance, depression, lack of energy, anxiety and panic attacks.

Mr Duffy said: "Trauma memory is disjointed, it is non-integrated and scattered and remains active in short-term memory. It's not processed and moved across, as normal memories are, into the long-term memory. A key element in keeping this trauma memory alive is the negative appraisals a person has of themselves."

This could lead to a whole series of unhelpful strategies. Victims might try to suppress such thoughts and emotions. Sufferers often found it difficult to recognise that they had problems, or think they were unique and could not be helped. They may drink too much, but although many no longer watched the news and systematically avoided television hospital dramas, reminders could never be completely avoided.

Mr Duffy said: "Triggers can bring these trauma memories alive. Most people don't spot the triggers - all they know is that they suddenly have these intrusive memories. And because they don't know what created the flashback, they can assume they're going mad."

Therapists said the event which triggered the trauma was often not the heart of the problem. The sessions could concentrate on the incident which generated the most intrusions and nightmares, but then other events could emerge. A doctor said: "I think of it as clearing away the ghosts."

Some of the most complicated cases involved members of the emergency services. This is because workers such as firemen could in the course of their work be subjected to multiple potential traumas.

Mr Duffy said: "This is a group of staff whose needs have been underestimated. Some of the things they've been through over 30 years have been horrendous, so it's not surprising they include some of our most complex, severe cases."

David Bolton said the centre had developed a programme to help these staff: "These are people that the rest of us rely on at times of our greatest need, and we feel we should make our contribution to helping them."