“I have one patient, 49-year-old Radhika (name changed), who was a survivor of a bus accident. She was on her way to her in-laws’ house in Mangaluru when the accident occurred. It’s been almost 18 years since the accident, but the patient’s fear of buses — their sound and sight — still scares her.”
This is the kind of post-trauma any such accident can cause, explained Dr Ashwini M, a Bengaluru-based clinical psychologist from Sanjeevani Clinic.
“the nightmares she gets after hearing news of any such accidents are all very real. She is still under treatment,” said the doctor.
Like Radhika, hundreds might have relived their traumatic experiences of accidents after watching the visuals or reading about the news of the train accident in Odisha involving three trains, which led to the death of nearly 300 people.
Trauma needs attention
Following the recent train mishap, Dr Mahesh Gowda, a consultant psychiatrist and director of Spandana Hospital in Bengaluru, said that physical injuries suffered by survivors of a train accident or other such mass casualties often take centre-stage in media discussions or care.
However, the profound impact of trauma on these survivors’ mental and emotional well-being cannot be overlooked, he noted.
“Beyond the physical wounds, many accident survivors grapple with long-lasting psychological consequences that can significantly affect their lives,” he said.
Experts argue that the initial concern, most of the time, is for the physical injuries for the people involved and getting help immediately.
After the accident, when that initial shock has subsided, many fail to recognise how these accidents affect their emotional and mental health.
Dr Roopesh BN, a clinical psychologist at NIMHANS in Bengaluru, who has also been part of the study on the psychosocial impact of the Uttarakhand flood disaster on elderly survivors, concurred.
He said that for many survivors, reliving the traumatic event becomes a daily battle. It can become deeply distressing or disturbing and looks different for each individual.
PTSD and its impact on the brain
Dr Sudhir Kumar, a consultant neurologist at Apollo Hospitals in Hyderabad, explained how Post-Traumatic Stress Disorder (PTSD) could impact the brain.
He said, “There are three important sites of the brain that are affected in PTSD cases: The amygdala, the hippocampus, and the prefrontal cortex. These three form a part of what is called the limbic system.”
This system controls the basic emotions — like fear, pleasure, and anger — and drives, which include hunger, sex, dominance, and taking care of the offspring.
Kumar explained: “The amygdala, an integral part of the brain, plays a crucial role in processing fear. It is natural for individuals to experience fear in response to certain events, but this emotional response typically diminishes over time. However, in cases of PTSD, the amygdala can become impaired, either structurally or functionally.”
He continued: “Studies using PET scans have shown structural changes in the amygdala in patients with PTSD, and longstanding cases may even exhibit alterations on MRI scans. As a result, the fear response becomes distorted, persisting even in the absence of a stimulus and reoccurring for weeks or even months.”
Another area of the brain affected by PTSD is the hippocampus, which is responsible for memory functions.
While the ability to remember pleasant moments is generally desirable, individuals with PTSD often experience the intrusion of unpleasant memories, leading to heightened anxiety and fear. This altered response in the hippocampus contributes to the disruptive symptoms of PTSD.
Additionally, the prefrontal cortex, responsible for decision-making and regulating emotional responses, is also affected in individuals with PTSD, causing abnormal reactions to stimuli that would normally be deemed ordinary.
Trauma affects individuals differently
Trauma affects different people in different ways, explained Roopesh.
While not everyone may experience trauma, he said, the difference between a person who has undergone it (injured) and the person who has witnessed it can affect both.
Even the outcome of the trauma and age groups works differently.
Roopesh explained that the level of trauma depended mostly on the resilience of the person.
Following an accident, many people could experience emotional distress. They could experience signs of PTSD, anxiety, depression, anguish, sleeplessness, fearfulness, anguish, bad dreams, recurring nightmares about the accident, fear of train sounds, or even fear of children crying, and screaming. They could also startle quickly.
They may not even want to go on a train journey for many months or years. They might even startle at the sound of the train. The trauma is more in children than in adults in such accidents, he explained.
Trauma therapy practitioner, trainer, and supervisor Dr Shalini Anant said there would be many sounds at the time of the accident survivors would have heard, like a bang, thud, people screaming, babies crying, or shouting.
For many people, these sounds can trigger reactions like fear or anxiety even after many months, as they relive the same experience.
Meanwhile, it can even be the other extreme where the person may just become numb and may not even react if there are any similar incidents or any kind of moment where they may have to express fear, shock, or other emotions.
“For instance, if there is any loud sound or a situation like a fire tragedy, the person facing trauma might go to the other extreme and may not even react. The earlier tragedy could have been too much for the brain to handle, and it became numb. So, trauma can be different in each person,” said Shalini.
Gowda chimed in that being in a situation like an accident or even witnessing an accident could evoke similar traumatic reactions.
He said it could also have a lot of psychological deep down ingrained trauma that can happen and so many times it can go unrecognised.
“The trauma can evoke some responses leading to adjustment disorders, like flashbacks, nightmares, and intrusive thoughts transport them back to the horrific scene, triggering intense feelings of fear, panic, and helplessness,” explained Gowda.
“Even seemingly ordinary situations can serve as potent reminders, evoking overwhelming emotional responses. As a result, survivors may struggle with sleep disturbances, hypervigilance, and difficulties concentrating, impairing their ability to function in daily life,” he added.
However, in some cases, people may be alright for some time and may get into the above-mentioned kind of traumatic situation after a period of three-four weeks of normalcy, explained Gowda. “We call this PTSD.”
He also said some people even learn to deal with it and not be scarred at all.
Some, despite all possible efforts, continue to face trauma and relive the horrifying situation for the rest of their lives.
Some even resort to addictions to help cope with distress. They may take to alcohol, cannabis, or recreational drugs, abusing them to get some sort of relief.
How long can impact of trauma remain?
Trauma impact in collective incidents may fade out faster. However, it is very subjective, said Roopesh.
According to him, if they did not directly impact in terms of physical injury or loss of loved ones then the trauma might last for a few months.
“And in collective traumatic incidents, there is no personal blaming or feeling victimised. For instance, in cases of abuse, it is more of a personal trauma and individualistic in nature. A lot of guilt plays a role, along with confusion and blaming oneself or doubting oneself: Questions like ‘Why me?’” he said.
In collective traumatic incidents, since there are many people in the situation or experiencing the same impact, the collective trauma may fade after a few months, said Roopesh.
However, he reiterated that stresses would be different for each person and were very subjective in nature.
Jitender Bhargava, former executive director of Air India and author of The Descent of Air India, said in an article: “Forty-two years is no short time, but the traumatic effect lingers on. Every train accident with extensive coverage on television only revives the memory, which otherwise one would like to forget.”
He explained that he was in a train accident that had happened on 31 August, 1981 — 42 years ago.
The train involved was the Tamil Nadu Express plying from Chennai — then known as Madras — to Delhi via Nagpur. The accident site was about 20 km from Sirpur/ Kagaznagar, in the then Andhra Pradesh.
Treatment for accident-induced PTSD
Gowda said that while PTSD was subjective and treatment depended on an individual’s status, a combination of counselling, therapy, and medications could be useful in handling it.
He said, “If you look at the problems that generally remain, like clinical depression, and clinical anxiety disorders like panic or phobic avoidance situation, this has to be dealt with by trained therapists and counsellors along with medication.”
Generally, medications that are tried here are antidepressants, which are helpful in taking care of anxiety and traumatic situations.
There is also trauma-focused psychotherapy, which can completely erase trauma-related memories from people who have gone through it.
So it’s a myth that once a person had gone through it, these images would continue to haunt them throughout their life, he said.
“We can undergo very intensive trauma-focused psychotherapy, which is not talking and talking and talking about the incident. This doesn’t help. Talking about it will be more harmful. They are reliving the incident. Neither talking nor suppressing helps,” said Gowda.
“Meanwhile, the likes of play therapy, art-based therapy, or story therapy help children come out of it. But they have to be trauma therapy only, and just talking will not help,” he added.
Doctors say that trauma-focused therapies, such as cognitive-behavioural therapy (CBT) and eye movement desensitisation and reprocessing (EMDR), have shown promising results in helping survivors process their experiences, reduce symptoms, and regain control over their lives.
Group therapy and support networks also play a crucial role in allowing survivors to connect with others who have gone through similar experiences, fostering a sense of community and validation.
Trauma management facilities
It was very important that governments are first of all prepared to handle such accidents, said Dr NK Venkataramana, noted neurosurgeon and chairman of Brains Hospital in Bengaluru.
“It is absolutely necessary that governments are prepared in handling such disasters and accidents. The number of people, paramedics, hospital preparedness, ambulances, medicines, blood arrangement, counsellors etc all of them need to be in place in every district. We don’t know where and when tragedy can strike and such accidents can happen,” he said.
Roopesh said a few weeks after the accident or traumatic event, since this accident involves the death of many, the government teams can take stock of the survivors, send teams to visit them, and learn if they need any psychological help. It can set up helplines to address such issues.