Over the years different people have written about my work - here are some of the articles to give you some context - enjoy!

 
 
The Leipzig International Artist Programme at Die Spinnerei in Leipzig   https://liap.eu/index.php/en/programme/

The Leipzig International Artist Programme at Die Spinnerei in Leipzig

https://liap.eu/index.php/en/programme/

Running at Night

An exhibition by Janice Gobey

 

 

In an old spinning factory in Germany, in the former East German town of Leipzig, it is still possible to see traces of lives ground into the bare factory walls and floors.  Spinnerei, as it is still called, was once home to the largest cotton spinning production in Europe.  It’s fortunes over its 125-year history waxed and waned with economic and political upheavals, two world wars and a cold war, but always, despite fights for wages and conditions, there existed a strong community of workers. When the wall came down in 1989, Spinnerei began its transition from a hard, grafting factory to a space for artists’ studios, workshops and exhibition spaces.  It is a space rich in history with stories to tell, much like one of its visiting artists, Janice Gobey.

              Gobey came to Spinnerei in August 2017 as part of a residential scholarship offered to only a few international artists per year.  With a rough idea in mind of the collection she wanted to create her time there produced the backbone of her current exhibition, Running at Night.  Surrounded and inspired by over 100 artists who are based at Spinnerei full-time, Gobey has produced her most accomplished work to date.  Like her previous collections, Running at Night is more than a loosely themed assemblage of work but instead conveys a powerful message.  This collection offers a window to a world that more and more people are experiencing, one that so many people know intimately and so many others are wilfully ignorant of; dislocation and disharmony.

              The fox is a recurrent theme in Gobey’s work.  Often maligned and misunderstood the fox has come to signify cunning and brutality but in fact it is a small creature that gets by on its wits, furtive, living on the edge of, and the crumbs of, society, much like the plight of many people seeking refuge in a country not their own, the plight of most refugees world-wide.

Gobey is sensitively aware of the plight of those seeking a better life.  An emigrant from South Africa, a survivor of a bad marriage, Gobey is deeply familiar with the sense of dislocation, of coming to a new country and not quite fitting in, of feeling vulnerable and exposed and alone.

Her use of animals in her work are a reflection of the comfort and company she found in them growing up as a child.  The simplicity of nature and the honest order of things offer respite from the chaos and brutality of our human lives. The works seem to clearly say, “These creatures are simply going about their business”.

While her paintings of animals are calm and serene her images of people are more disquieting.  In Ethereal a woman sits with her back to the canvas. There is a gentle femineity to the work, a sensuality in the colour, the use of flowers, the relaxed posture.  Yet to sit with the collection is to understand that the subject is solitary and vulnerable, gaze averted, looking out to a place beyond, a place where she is not.

              Gobey’s work reflects both an inner gentleness and a deeper societal disharmony. In a world besieged by economic uncertainty, environmental degradation, diminishing resources and inequality, the rising anger is palpable.  And in response, perhaps, to the disharmony we as a global people live in, men’s violence towards women feels like it is on the increase, depleting further the world’s transcendental harmony.  The works Rage, Simmer and Cool Down illustrate this face of violence that walk the streets daily.

Back in Germany, although a factory no more, the community is strong and it provides Gobey with a clarity of vision that taps into her own sub conscious and that of the wider community. Running at Night is more than a beautiful collection of paintings, it speaks a deep human truth of our times.

 This is Janice Gobey’s 15th solo exhibition.

 

By Nichola Garvey 2018

 

 


Vulnerability, Janice Gobey, Oil on Linen, 2017, 100 x 100 cm

Vulnerability, Janice Gobey, Oil on Linen, 2017, 100 x 100 cm


Force, Janice Gobey, Oil on Gouche on Linen, 2015, 40 x 30 cm  Painted in London at the London Summer Intensive

Force, Janice Gobey, Oil on Gouche on Linen, 2015, 40 x 30 cm

Painted in London at the London Summer Intensive

 Hunter/Hunted

 

Janice Gobey’s paintings always sit within duality.  Like the fur they depict, they are beautiful but ominous.  The latest collection of works for the exhibition

The Haunting, again reflect this duality but even more so with a new use of vacant backgrounds that leave the viewer feeling uneasy with the lack of clues to place. This lack of detail in the background draws our attention even more so to the fur fragments in the foreground. While the upbeat coloured backdrops makes them feel like a trophy within someone’s recently renovated home. I often feel unsettled upon viewing these works.  I find them beautiful but somewhat gruesome as I try to reconfigure the narrative of what has occurred within the painting.

 

Many people have an uncomfortable relationship with fur.  We are compelled to touch it and stroke it as if it was a loved pet but then we are also repelled by the idea that this is a remnant of a living animal.

 

Memories and thoughts of the past are often ingrained

into objects and clothing. I remember well the rabbit fur coat of my mother’s that was only worn for best.  The sensation of the soft fur on my hand as I ran it across the pelt still seems incredibly fresh and real.  I can visualize an image of her wearing it, looking many years younger than she is today, though I also contemplate the animal that was. 

 

Although my memory of fur is relatively happy, the images displayed in Janice Gobey’s latest exhibition are in contrast.  Fragments of animal, just their skin and fur remaining allude to the remains of a kill, a memory of the animal that was.  We see torn and tatted remains and faces that are mask like with voids for the eyes. In many cases, the subject in the paintings

is the fur remains of a fox.  The fox embodies this duality.  It is a lone hunter, prowling for a kill but has also become the hunted for its luxurious pelt. 

The idea of the predator is further explored with the painting The Haunted, where three wolves watch visitors every move within the gallery space. 

Their eyes follow you around and the uneasiness of being watched

and stalked is constant.The second hand furs who take centre stage in Gobey’s work all reflect some form of postmemory. Gathered from various sources, they have been saved from being discarded to become the focus of Gobey’s work. From looking at them, we can imagine the lives and

interactions these items have had.  “Postmemory is a powerful form of memory precisely because its connection to its object or source is mediated not through recollection but through representation, projection, and creation -

often based on silence rather than speech, on the invisible rather than the visible”.

i

Postmemory can also describe the relationship future generations can have towards cultural or collective trauma.  Many reflect upon experiences of their parents, “experiences that they ‘remember’ only as the narratives and images with which they grew up, but that are so powerful, so monumental, as to constitute memories in their own right”.ii

 

The adopting of trauma or traumatic events has become common within the modern world.  We have almost immediate access to information on worldwide events via social media and the move to online news allows us to be informed within minutes of an incident across the world. Although this allows us to be more informed it also heightens our sense of tension and paranoia. We become witnesses by adoption. Snippets of news stories give us only enough facts to fill in the remaining gaps as we imagine the evil perpetrator and the suffering of victims.  These imaginings only add to the already heightened levels of stress and anxiety that plague our modern lives.

 

We no longer live in a world where we keep our doors unlocked or where we walk alone late at night. “Thus postmemory characterizes the

experience for those who, have grown up dominated by narratives that have preceded their birth, whose own belated stories are displaced by the powerful stories of the previous generation, shaped by monumental traumatic events that resist understanding and integration.  Trauma may also be a way of seeing through another’s eyes, of remembering another’s memories through the experience of their effects”.iii

 

Gobey’s repeated images of discarded fur pieces further enhance the tension. 

Similarly with the media’s continued use of a solo image to encompass a traumatic event (think the Falling Man photo on 9/11 or photos of

blood filled scenes at the Boston Bombings), this repetition can become a traumatic fixation.  Hal Foster described this effect within Andy Warhol’s

repetition works as: “the Warhols not only reproduce traumatic effects, they also produce them.  Somehow, in these repetitions, several contradictory things occur at the same time: a warding away of traumatic significance and an opening out to, a defending against traumatic effect and a producing of it.”iv

 

This is the sensation that Gobey’s exhibition The Haunting has.  Through the emotional response to her works, we find some understanding to our own ideas of trauma. I’ve always felt that good art either makes you feel repulsed or an overwhelming sense of beauty, but never indifferent.   The Haunting

has successfully created this, leaving you to walk away with a constant memory of the sensation you felt while in the space.

 

Mardi Nowak is an artist and curator and is currently the Senior Curator at Town Hall

Gallery, Hawthorn.  Recent curatorial projects have included Fixation (2014), The Act of Seeing (2014) and Likeness (2015).

i

Hirsch, Marianne. “Surviving Images: Holocaust Photographs and the Work of Postmemory”, The Yale Journal of Criticism, vl.14 2001. P.9

ii

Ibid.

iii

Ibid, page 12.

iv

Foster, Hal, “The Return of the Real: The Avant-Garde at the End of the Century”, Cambridge, Mass: The MIT Press, 1996, p.132.

 

Gather Your Phantoms

 

 It happened but I do not know it—that it happened or what it was that happened, the eventless event, unremembered.”

Griselda Pollock

 

The traumatic event is not to be found: to never be found completely. Janice Gobey’s recent paintings draw forth subjects that are alluring, obscured, frightening, and in their collaboration, slippery. From where these belong is not a specified place—more of an elsewhere—where objects, faces and fragments linger in a kind of waiting.

 

i. wounds

 

Defined quite literally as a wound, trauma exists as a form of ‘psychic injury’ that is repressed and difficult to summon. Its existence is stemmed in a particular event, yet for the psychological experience to be traumatic, the memory of the event in question is always, at all traumatic times, unknowable. In keeping, it has been defined as “the event par excellence, the event as unintelligible, as the pure act of sheer happening.”[i] Therefore, when recalling trauma, it comes to us only in pieces. As Lisa Saltzman and Eric Rosenberg describe, trauma is “an experience so overwhelming that its understanding is at best deferred and its very apprehension may only be through symptomatic representations.”[ii] As the event is recalled in fragments, it disallows us to completely unify trauma’s conundrum. Yet when these fragments align, and our event makes itself known, trauma, like a great mystery, dissolves.

 

Symptomatically, the elusive nature of trauma is a problem for the practice of representation in art. Whereas it was believed that Greek Tragedy could successfully incorporate the event into narrative, it wasn’t until Modernism that the problem with representing this unknowable occurrence was addressed.[iii] At this time, trauma became a paradoxical subject in art: although it could be made visible, it would always remain true to its negated, unknowable character. For this reason it is questionable whether trauma can ever truly be represented. As modern history became defined by “an ending succession of catastrophic events” artworks became “overwhelming failures” in capturing these tragic realities in material form. [iv]

 

 

ii. Beelitz, Germany

 

When Gobey first arrived in Berlin to start a three-month artist’s residency in 2012, a friend introduced her to the abandoned and condemned Beelitz sanitarium. Built in 1866, the compound comprises sixty-nine buildings, with a train line intersecting the site from one direction and a road from the other. The hospital was used as respite for the fatally ill, war torn, and insane; famously housing Hitler at one stage as he recovered from an injury inflicted at the Battle of the Somme.

 

Gobey describes entering the forbidden site, its walls boarded up to deter trespassers. Accompanied by a local artist who had regularly visited the working hospital when his friend attempted suicide, the couple walked through old rooms that were now mere ruins, marked with broken stairways, holey floorboards, rusty bed heads and disowned chairs. The walls were covered in the transient scars of graffiti. Memorably, part of the visit explored the basement: a claustrophobic series of rooms encrusted in rust-covered white tiles. Nature did what it does to bones, as the thick forest that surrounded the decrepit building encroached on the architecture, with trees now growing out of roofs from several floors above the ground in a surreal display.

 

On this visit, Gobey took with her a fur found at the bohemian Mauer Park Flea Market. According to the artist, this particular piece was going to “represent Berlin”: a fox fur with full head, arms and legs attached. However, she describes her connection to the animal as sympathetic with its survival instinct. Small, and relatively defenseless, the fox outsmarts its predators, doubling over its own tracks in order to lose unwanted fears. The reason for taking the fox to the hospital was initially an intuitive decision, however at some point the artist recalls this undead object as representing herself. Throughout this excursion, Gobey experiments with the fur in the space, hanging it from the same chairs that once propped patients, letting its presence haunt stairwells and corridors. The traumatized remains of what once roamed as an animal now stalks the traumatized shell of a haunted site: architectures acting like bodies.

 

 

iii. un-present painting

 

To visually represent the traumatic event is, by nature, problematic. Isabelle Wallace outlines two conflicting psychoanalytic viewpoints on this difficult illustration. The first, a Freudian account, argues that the relationship between trauma and representation is mnemonic: “representation, precisely because it is the representation of an absent subject, is seen as a way of remembering an event whose traumatic nature mandates renewed attention.”[v] As in his “Repeating, Remembering and Working Through,” Freud explains that representation returns us to trauma, allowing us to come to terms with the event or happening.

 

In contrast, Jacques Lacan explicates that there is no correlation between trauma and representation, as trauma, simply by nature, is “the very thing about which nothing can be said, written, painted or performed.”[vi] Wallace questions the importance of actual representation when conjuring trauma in painting.  Despite representation’s capacity (or incapacity) to actually illustrate the “eventless event,”[vii] could the painting’s role be more involved with becoming the traumatic event itself instead of re-presenting something that cannot be defined?

 

However, it is painting’s inability to perfectly illustrate that mirrors the inert nature of the traumatic experience: failing to represent the event through the medium is mimetic of how one experiences trauma as both repressed and un-representable. In this way, painting becomes an apt mirroring experience for both artist and viewer. As the artist seeks to illustrate the thing they cannot find, always falling short, the viewer’s digging for concrete meaning is similarly incomplete. As art theorist, Griselda Pollock explains, trauma might be understood as “the pause in which memory forms,” as opposed to the memory itself.[viii] This new spatial concept, that involves but does not illustrate narrative, is a similar experience to that of both making and viewing paintings: “[P]erhaps we should speak of a passage into the temporality of narrative that encases but also mutes trauma’s perpetually haunting force by means of a structuration that is delivered by representation.”[ix]

 

 

iv. invisibility

 

In Gobey’s recent exhibition, The Invisible, the artist has created a darkling pictorial space in her paintings that invites flux and impermanence. The objects and subjects—fur, masks, animals, gloves, flowers, and faces—enter the picture plane, only in-part or only to leave again, amplifying their appearance from somewhere unconscious to the artist, or, parallel to the painting’s frame. This drawing-in from the outside, with no explicable reason for their collaboration, reminds us of the flickering recollection of the traumatic event, where the terrible is buried inside the guise of something more familiar.

 

Affectively, this is an uncanny subjectivity, one meant to unsettle, yet Gobey’s tendency towards the beautiful is what keeps us from looking away. A delicate rendering fills each of the objects with a longing for completion, their indebtedness to beauty connecting the viewer more closely to the horrible: “For beauty is nothing but the beginning of terror which we are barely able to endure.” (Rilke) And it is this lure that attracts and forbids us to leave the psychic space, trapped inside with this phantasmagorical collection of ‘dream things.’

 

For it was Freud who described the “uncanny” as “that class of the terrifying which leads back to something long known to us, once very familiar.”[x] Trauma and the uncanny experience share a similar confusion in both separating, and unifying, that which is known from unknown. As Freud explains, an etymological analysis of the word “uncanny” finds that across cultures, heimlich (or homely) and unheimlich (unhomely) can be used, one instead of the other. He ascertains that the word heimlich belongs to two sets of ideas, which without being contradictory are yet very different: “on the one hand, it means that which is familiar and congenial, and on the other, that which is concealed and kept out of sight.”[xi] In the same way, trauma presents itself in images, yet quickly dissolves away before any concrete representation of the actual past experience is reached. For Freud, it is the arrival of something imaginary in our reality that summons this feeling of the uncanny.[xii]

 

In the case of Gobey’s new work, it is beauty that coaxes her unsettled subjects out of the nighttime space. These are the frights that come to the artist when she dreams; these are those haunting visions that, when collaged together, present an un-representable experience. Artist and psychoanalyst, Bracha Ettinger, describes her attraction towards beauty in contemporary art—as a mode that carries great affective possibilities for exploring the massive effects of transitive trauma—not as a private act or consensus of taste, but as “a kind of encounter, that perhaps we are trying to avoid much more than aspiring to arrive at.”[xiii]In this case, beauty becomes a sublime weapon that leads you to your fears, before begging you to question what it was you found.

 

 

v. the negative shadow

 

From these reflections, I wish to consider the space created for and by trauma in painting. As Gobey recalls visions from her dreams and nightmares, she returns them to painting as a reconciliation of sorts. In repetition, they come from places in her past yet seem to recur in more present moments (as in her excursion to Beelitz). And it is in this process that we see how the traumatic motif might attach itself to an individual without giving any correct or concrete answer for its existence. In this way, it occupies a Lacanian “extimate” site, a place not in opposition to the intimate, but a psychic phenomena that defies the boundaries of the internal and external, the self and the Other: “Extimite is connected with Lacan’s theory of objet a, which is a trace in the psyche of that from which the subject has been cut away, like a negative shadow. It is thus the otherside of the subject, foreign and removed yet encapsulated within the psyche’s most fundamental recesses.”[xiv]

 

And as the zone depicted moves out of fantasy (an imagined reality) and into phantasy (a psychic reality), it makes one last shift to the traumatic. Pollock argues that traumatic events transgress the limits of representation, not because of their sublime quality, but instead because their inherent atrocity is without a definable origin. She notes that although the traumatic exists outside of words and images, their affects exist everywhere. For Pollock, this marks a contemporaneous shift from an imaginary space to a real space, creating “a historically generated crisis in the relations between representation (our form of knowing) and that which having happened has none the less no immediate image or concept to represent it.”[xv] For this reason, the subjects in Janice Gobey’s new work remain both present and absent in compliance with trauma’s own incessant haunting.

 

Laura Skerlj is an artist, writer and current candidate for the Master of Fine Arts at the Victorian College of the Arts, University of Melbourne.

www.lauraskerlj.com

 

 

 


[i] Shoshona Felman, The Juridicial Unconscious: Trials and Traumas in the Twentieth Century (Cambridge, Massachusetts: Harvard University Press, 2002), 179.

[ii] Lisa Saltzman and Eric Rosenberg, “Introduction,” in Trauma and Visuality in Modernity, ed. Lisa Saltzman and Eric Rosenberg (Hanover, N.H.: Dartmouth College Press: University Press of New England, 2006), ix.

[iii] Ibid, x.

[iv] Ibid, x.

[v] Isabelle Wallace, “Trauma as Representation: A Meditation on Manet and Johns,” Trauma and Visuality in Modernity, ed. Lisa Saltzman and Eric Rosenberg (Hanover, N.H.: Dartmouth College Press : University Press of New England, 2006), 3.

[vi] Ibid, 3.

[vii] Griselda Pollock, “Art/Trauma/Representation,” Parallax vol 15, no 1 (2009): 40.

[viii] Ibid, 40.

[ix] Ibid, 40.

[x] Sigmund Freud, “The Uncanny,” (1919): 1-2, accessed May 20, 2013, http://web.mit.edu/allanmc/www/freud1.pdf.

[xi] Ibid, 4.

[xii] Ibid, 15.

[xiii] Bracha Ettinger, “Art as the Transport-Station of Trauma,” Bracha Lichtenberg Ettinger: Artworking 1985-1999, (Gent and Brussels: London, 2000), 91.

[xiv] Dana Arnold and Margaret Iverson, Art and Thought, (Malden; Oxford; Melbourne; Berlin: Blackwell Publishing, 2003), 151.

[xv] Griselda Pollock, “Aesthetic Wit(h)nessing in the Era of Trauma,” EurAmerica vol. 40, no. 4, December (2010): 835.

 

 

 

The Psychological Impact of Trauma: A Clinical Perspective

Mark Creamer, PhD

Department of Psychiatry, University of Melbourne

 

The portrayal of psychological reactions to disaster and trauma through art and literature has a long and respected history – it has done much to raise awareness of the long term suffering experienced by traumatized people throughout the ages and across cultures. Janice Gobey’s work is a valuable contribution to this body of expression. The purpose of this article is to provide a companion perspective from the fields of clinical psychology and psychiatry – what does research tell us about the nature and treatment of these complex conditions?

Historical Development

Human beings have probably always known about the psychological effects of experiencing life threatening events such as military combat, natural disasters, or violent assault. Literature throughout the ages, some of it thousands of years old, provides many vivid portrayals of these psychic struggles to recover from horrific experiences. Homer’s The Iliad and The Odyssey, for example, describe how Achilles and Odysseus struggled to come to terms with their wartime experiences in much the same way as our veterans of today 1,2.  Shakespeare, and other writers around this time such as Samuel Pepys in his famous diary, also described psychological reactions to potentially traumatic events such as war, violence, life-threatening accidents, and fire.

More formal recognition from the medical community began around the American Civil War, when terms such as “soldier’s heart” and “nostalgia” appeared. More well known, perhaps, is the term “shell shock” used to describe the profound mental health impact experienced by some of those fighting in the trenches of the First World War. Similar recognition emerged in the second World War and, later, Vietnam, with terms like “war neurosis” and “battle fatigue”, while in the civilian sector terms like “rape trauma syndrome”, “railway spine”, and “concentration camp syndrome” were coined. Importantly, while the traumatic events may differ widely, it was gradually recognised that the human reactions to these intolerable stressors bore much in common3.

 

It was not until 1980, however, that these reactions were formally recognised by the international psychiatric community. The name chosen was posttraumatic stress disorder, or PTSD, and the diagnostic criteria were agreed. Since that time, we have seen an explosion in research and awareness of the field. We now have a good understanding of the nature of these painful reactions and the best approaches to helping survivors through the process of recovery.

The Nature of Human Response to Trauma

Before discussing the nature of PTSD and related conditions, it is important to emphasise that human beings are generally resilient. Most people exposed to potentially traumatic events recover well with help from family and friends without developing any significant mental health problems. This does not mean that they are not distressed by what happened, nor that they are unaffected by it. Indeed, strong emotional reactions (such as fear, sadness, guilt and anger) and frequent thoughts and images of the trauma are common as the person struggles to make sense of the experience. These can be associated with physical signs (such as muscle tension, gastrointestinal problems, aches and pains), behavioural changes (such as social withdrawal, avoiding difficult situations, and increased alcohol/drug use), and impaired thinking (such as poor concentration, memory problems, and difficulty making decisions). For most people, however, these symptoms settle over the following days or weeks; they are able to take the experiences in their stride without it adversely affecting relationships with loved ones or their ability to function at work or at home.

For others, these problems may be severe enough to warrant a formal diagnosis. In those cases, PTSD is only one possibility, with depression, substance use disorders, anxiety, and physical health disorders also common4. But PTSD is the only condition that is specifically tied to a traumatic experience.

PTSD is a serious psychiatric disorder characterised by three groups of symptoms5. The first is re-experiencing the trauma – people with PTSD describe vivid, painful images and terrifying nightmares of their experience. The second is avoidance – people with PTSD try to avoid reminders of what happened. They become emotionally numb and withdrawn to protect themselves from the pain. The final group of symptoms are those of being constantly tense and jumpy, always on the look-out for signs of danger. PTSD is associated with “significant impairment in social and occupational functioning”. That is, people with PTSD have difficulty relating to loved ones (children, partners, and close friends), with interactions often characterised by anger and irritability or withdrawal and isolation. The emotional symptoms and the thinking impairments make it difficult to carry out their normal role (for example, at work, as a student, as a parent).

The latest Australian National Mental Health Survey reported that over 4% of the population experienced the symptoms of PTSD in the last year6. The incidence of PTSD varies considerably depending on the type of trauma, with those that involve interpersonal violence consistently resulting in the highest rates. Sexual assault, in particular, tends to result in very high rates, with around 50% of rape victims developing PTSD. Accidents and natural disasters – events that do not involve human malevolence – tend to be the lowest at around 10%. About half the people who develop PTSD recover over the first six to twelve months. Unfortunately, in the absence of treatment, the other half are likely to experience chronic problems that may persist for decades.

Risk and Protective Factors

Why do some people develop these problems and not others? The answer is a complex combination of three main areas: (i) what the person was like before the trauma; (ii) their particular experiences of trauma and their reactions at the time; and (iii) what has happened since7.

In terms of pre-trauma factors, genetics plays a part. This does not mean that PTSD and related conditions are genetically caused – simply that some people may inherit a vulnerability that becomes activated if other risk factors are present. Adverse childhood experiences, a history of other traumatic experiences, and general tendencies towards anxiety and depression are all factors that may increase the likelihood of mental health problems following trauma exposure.

In terms of the event itself, it is not surprising to learn that the more severe the traumatic experience – the higher the life threat to the self or others, and the higher the exposure to the suffering of others – the more likely the person will develop PTSD. The person’s reaction at the time also seems to be important. Those people who “dissociate” at the time (e.g., become emotionally detached, numb, on “automatic pilot”), as well as those who show very high arousal that does not settle (e.g., racing heart, rapid breathing, agitation), seem to have more difficulty recovering from the experience.

The final group of risk factors appear after the event. The most important of these is social support: people who have a strong network of friends and family to support them after the experience are more likely to recover and less likely to develop PTSD. The second major post-trauma factor is other life stressors during this period. People who have to deal with stressful issues such as financial, legal, health, or relationship problems may find it more difficult to recover.

So, it is the combination of these pre-trauma, trauma, and post-trauma factors that determine how individuals will adjust to their experiences. A particularly powerful risk factor in any one domain (such as a very severe traumatic event or an especially bad pre-trauma history) may be enough, or it may be the additive effect of several lower severity risk factors.

Effective Treatment

We have come a long way in improving treatments for PTSD and related conditions, and we now have a large body of research evidence to guide our decisions8,9. In several countries, this research evidence has been used to develop guidelines for clinicians and survivors in the hope that people will be able to access the most effective treatment. (See, for example, www.acpmh.unimelb.edu.au for Australian guidelines or www.nice.org.uk for a UK example).

The most effective treatment is “trauma focussed psychological therapy”. There are a few different forms, including cognitive and behavioural therapies (CBT), as well as something called EMDR. The thing they share in common is providing the survivor with an opportunity to confront the painful memories, and to “work through” the experience in a safe and controlled environment. This therapy is not easy for either the patient or the therapist, but it is very effective in most cases. These approaches also help the person to identify unhelpful thoughts and beliefs associated with the trauma that are interfering with recovery (e.g., “it was my fault that I was raped” or “I should have been able to save my friend”). By exploring and challenging these thoughts, the person can be helped to replace them with something more helpful and rational.

Pharmacological treatment can also be useful in PTSD, especially in more complex cases and as an adjunct to trauma focussed psychological therapy. The most effective drugs for PTSD are the new generation anti-depressants – the selective serotonin reuptake inhibitors or SSRIs. Other drugs can also be useful, depending on the clinical presentation.

The bottom line is that effective treatment for people who have been affected by trauma is available if they have the strength and courage to ask for help and if they can find their way to an experienced clinician. Their general practitioner or family doctor is often a good place to start.

Future Challenges

We’ve come a long way in our understanding of mental health response to trauma in the last couple of decades, but many challenges lie ahead. Can we prevent the development of these problems? How should we respond with whole communities following widespread disaster such as bushfires, floods or terrorism? Can we improve the quality and availability of treatment? With continued research, and by learning from the experiences of those who have confronted these events, we will gradually find answers to these questions. In the final analysis, we must strive to make sure the best possible care is available to those whose lives have been devastated by the experience of severe trauma.

 

1.       Shay, J. (1994). Achilles in Vietnam: Combat Trauma and the Undoing of Character. New York: MacMillan.

2.       Shay, J. (2002). Odysseus in America: Combat Trauma and the Trials of Homecoming. New York: Scribner.

3.       Gersons, B. P., & Carlier, I. V. (1992). Post-traumatic stress disorder: The history of a recent concept. British Journal of Psychiatry, 161, 742-748.

4.       Bryant, R. A., O'Donnell, M. L., Creamer, M., McFarlane, A. C., Clark, C. R., & Silove, D. (2010). The psychiatric sequelae of traumatic injury. American Journal of Psychiatry, 167(3), 312-320

5.       American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Washington DC: American Psychiatric Association.

6.       Chapman, C., Mills, K., Slade, T., McFarlane, A.C., Bryant, R., Creamer, M., Silove, D. & Teesson, M. (2012) Remission from post-traumatic stress disorder in the general population. Psychological Medicine, 48, 1695-1704.

7.       Ozer, E. J., Best, S. R., Lipsey, T. L., & Weiss, D. S. (2003). Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis. Psychological Bulletin, 129(1), 52-73.

8.       Forbes, D., Creamer, M., Bisson, J. I., Cohen, J. A., Crow, B. E., Foa, E. B., et al. (2010). A guide to guidelines for the treatment of PTSD and related conditions. Journal of Traumatic Stress, 23(5), 537-552.

9.       Australian Centre for Posttraumatic Mental Health. (2007). Australian Guidelines for the Treatment of Adults with Acute Stress Disorder and Posttraumatic Stress Disorder. Melbourne, Victoria: ACPMH.