Charles Krupa / AP
See images from the scene of the explosions.
Cops called the twin bombs “IEDs” and a Boston ER doctor said the wounds included “traumatic amputations” normally seen on Iraq battlefields, but now another combat comparison has emerged: Some civilian survivors of the terror attack will suffer PTSD as a result of Monday’s carnage.
A number of the bystanders, runners and public-safety personnel near the blasts — those close enough to see, hear and feel the detonations, those who witnessed or aided the wounded, and the injured themselves — now have a higher risk for developing the same anxiety symptoms known to affect tens of thousands of Iraq and Afghanistan veterans, said a leading expert on Post Traumatic Stress Disorder.
“Absolutely. To be precise, it is called Acute Stress Disorder at the beginning and usually involves some or all of the symptoms of PTSD. If it lasts more than a month, and has enough symptoms, it is then described as PTSD,” said Dr. Harry Croft, a San Antonio-based psychiatrist who has talked with more than 7,000 veterans diagnosed with PTSD.
Common PTSD symptoms include an inability to sleep, nightmares, a craving for isolation and a disquiet when in crowds. Following a decade of wars, experts like Croft have developed a keener understanding of these side effects.
“We know that for some people intensive debriefing after a trauma does not help, and may worsen symptoms in the long run. But getting survivors to safety, helping them understand what has happened, helping them talk — or be quiet but around others — may be of great value,” Croft said. “Mental health professionals are (now) better trained in handling the emotional needs of survivors and passers-by.”
The earlier symptoms to emerge often include a sense of disbelief — in which the event doesn’t seem real — and either no emotion or gushes of emotion, including sadness, fear, anger, Croft said. Typically, people with PTSD have either recurrent memories of the event, or no memory at all. People may discover they are easily startled or abnormally agitated.
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Civilians more susceptible?
How prevalent is PTSD among people who have witnessed or were wounded in a sudden and violent situation? The figure most commonly cited by experts is 20 percent, although that rate is known to vary widely among civilians and can depend on the severity of the event, Croft said, adding: "Long term, the amount of PTSD is greater with man-made traumas as opposed to those caused by hurricanes, floods and fires.”
Civilians are “probably” more susceptible to PTSD than military members, he said.
Veteran Brennan Mullaney, 30, an Army veteran who witnessed some explosions during two tours of Iraq, was between mile marker 24 and 25 when the blasts occurred. He lives in Boston and goes to graduate school at Tufts University. He did not hear the concussions and was not allowed by authorities to get close enough to help the injured.
“My initial concern was with civilians who haven’t witnessed scenes like that,” Mullaney said. “So many of us who have spent time deployed — and I’m not trying to overlook the severity of what transpired yesterday — but we’ve seen it before. It’s infinitively more horrific and disturbing when you see it in your hometown.”
He knows of several Tufts students who were far closer to the finish line when the bombs were detonated and he already has offered to talk with those runners about some side effects they're perhaps feeling two days later.
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“Maybe my experience can help them through that. Veterans have been sloughing [PTSD] off for years. The better way is to talk to someone about it. It’s a process. You can talk to them, be empathetic. You can tell them: 'It’s tough; you’re going to have those visions of what you saw for days to come,'” Mullaney said. “How you synthesize that information, [how you] manage and process that, is going to be a big determination in whether that thought re-entering your mind is entirely a negative thing or if there is some type of silver lining to it.
“My share of what I saw in Iraq was probably less than a lot of guys who played combat roles. Yes, I did see some explosions and some aftermath of what that looks like,” Mullaney said. “A lot of times, we didn’t know the people who were hurt or killed. They were Iraqis — a father, mother, a son. They were people, and that human feeling [about them] is there, whether you’re in war zone or whether you’re home and it’s a fellow American.”