Last March 28, national and global television viewers were witnesses to the hostage-taking of a busload of 32 day-care center schoolchildren and two teachers by Jun Ducat, a day-care center owner who drove them in front of the Bonifacio Shrine near Manila City Hall to demand better housing and education for children. (Apparently, this is the second hostage-taking of Ducat.)
Last April 16, the news of how the Virginia Tech campus massacre unfolded again shocked the world. A frightening reality emerged that day as Cho Seung-Hui, a 23-year-old senior English major, killed 32 people in the university. As authorities closed in, Cho also killed himself.
Investigators described Cho Seung-Hui, a South Korean who migrated to the US with his family when he was eight years old, as an emotionally troubled student and a loner. Other students labeled him as a loser and as a person who never spoke with them, hence the label of "Question Mark." Some said he had been sent for counseling in school and that he had also been on antidepressants. Another report stated that he had an argument with a female acquaintance in the campus prior to the shooting rampage and that his writings had dealt on violence and anger for the well-to-do kids and good-looking females.
Luckily in our local setting, hostage-taking of 32 schoolchildren and two teachers, no deaths were reported. It is, however, so unfortunate that the death toll at the Virginia Tech reached 33.
Now, what do these two shocking incidents have in common: [1] The perpetrators of these separate incidents had apparent histories of emotional disturbances and [2] Both had easy access to guns. If the perpetrators did not have easy access to deadly weapons, would the hostage-taking or the shooting rampage have pushed through?
There was no casualty in our local hostage-taking of schoolchildren and teachers because apparently, Jun Ducat’s cry for help was heard and negotiators were able to talk some sense into him to release his hostages and to give up his weapons.
The mental disturbance of this young South Korean student must have been so severe for him to turn his anger not only towards himself but also towards others. Was Cho totally out of touch with reality at that time? Did he run amok? Did he possess a conscience? What exactly triggered the Virginia Tech campus massacre may remain unanswered because Cho opted to end his life as the SWAT team got close to him.
Amok is an example of a culture-bound syndrome. It is a dissociative episode characterized by a period of brooding followed by an outburst of violent, aggressive or homicidal behavior directed at other persons and objects. It is said to be precipitated by a perceived insult and is prevalent among males. The amok episode is accompanied by persecutory idea, automatism, amnesia, exhaustion and by a return to pre-morbid state. Amok may occur during a brief psychotic episode or may be an exacerbation of a chronic psychotic illness. The original reports of amok came from Malaysia. Similar patterns of amok behavior have been recorded in Laos, Philippines, Polynesia, Papua New Guinea and Puerto Rico and even among the Navajo Indians.
The video of the perpetrator of the university massacre, which he apparently filmed prior the bloodbath and sent to a TV network, showed a very disturbed and highly delusional young man who had a deep-seated anger on the rich and spoiled campus students and women. He rationalized that these people were at fault and had pushed him against the wall to take action against them in the name of Jesus Christ and thus, their blood was on their hands. This video showed that the Virginia Tech massacre was premeditated.
After such unfortunate school campus incidents, perhaps school authorities should start reviewing their policies and make arrangements so that they can handle crisis situations in their campuses. Should we then likewise have stricter laws on securing firearms and other weapons?
Any normal individual subjected to an abnormal situation like that of a hostage-taking or being caught in a shooting rampage may manifest the following symptoms: shows fear and helplessness, persistently relives the traumatic event, and tries to avoid being reminded of it. These symptoms constitute what is called an Acute Stress Disorder and are expected to gradually diminish within four weeks after the trauma incident. If such symptoms last more than four weeks after the traumatic event, this is now the time that a diagnosis of Post-Traumatic Stress Disorder (PTSD) is made. Important areas of life such as family and work are affected in PTSD. Individuals with PTSD usually re-experience the traumatic event in their dreams and in their daily thoughts. As such, they try to evade anything that may remind them of this event. They also experience a numbing of responsiveness together with hyper-arousal. Other symptoms are those of depression, anxiety and cognitive difficulties like poor concentration.
From my clinical experience in doing psychosocial rehabilitation of disaster victims, a single debriefing is usually not enough. Traumatic events may resonate childhood traumas and other personal issues with a single debriefing and leave the individual hanging and more distressed. There should be follow-up sessions (individual cognitive or group therapy) for persons subjected to a critical incident stress debriefing. The mass vigils and other rituals, like the putting of the American flag on half mast now being done at the Virginia Tech and other areas in the state of Virginia, are avenues of helping the university and the state of Virginia population cope with their campus tragedy.
According to the Royal College of Psychiatrists, "Psychological debriefing after trauma does not reduce PTSD, anxiety and depression. People who are highly aroused after a trauma may actually be made worse by single-session emotion-focused psychological debriefing."
Further studies disclosed that individual single-session psychological debriefing does not prevent, and can even aggravate, symptoms of PTSD.
The study showed encouraging highly aroused trauma survivors to express their feelings might activate the sympathetic nervous system to such a degree that the successful encoding of the traumatic memory is disrupted. Researchers stated that "people receiving an emotional debriefing may also feel disempowered, which may keep them in a high state of arousal, causing PTSD symptoms to get worse rather than better."
The British researchers commented that their findings were in line with recent expert statements that do not recommend single-session interventions (National Institute of Mental Health, 2002; National Collaborating Centre for Mental Health, 2005). There are too many reasons, they say, for discontinuing this practice. The British psychiatrists reiterated that: "On the basis of current evidence, more benefits can be expected from early treatment only of those patients with Acute Stress Disorder or acute PTSD with four or five sessions of cognitive behavioral therapy, or 12 sessions of cognitive therapy, in order to prevent a chronic course of PTSD."
We join the world in praying for the repose of the souls of the victims of the Virginia Tech campus shooting tragedy and for their families, classmates, teachers and friends to be able to cope with the loss of their loved ones.
(For questions about love, looks and relationships, e-mail me at ninahalili_allure2001@yahoo.com or mail your letters to Rm. 309 Medical Arts Bldg., St. Luke’s Medical Center, E. Rodriguez Avenue, Quezon City.)