The world rejoices now that all 12 members of the Wild Boars football team and their coach have been safely rescued after being trapped in Chiang Rai's Tham Luang cave in Tham Luang-Khun Nam Nang Non Forest Park for over two weeks. All of them are being physically assessed and rehabilitated at Chiangrai Prachanukroh Hospital as of last week.
Despite the accomplishment of the life-saving mission, the big question that lies ahead -- apart from how they will react to several football clubs' invitations -- is how their mental health will be affected by this most nightmarish incident, wherein they were stuck in near-zero darkness with no parents, food or power for 10 days.
Director-general of the Ministry of Public Health's Department of Mental Health Dr Boonruang Triruangworawat said earlier in a press conference that although all 12 boys and their coach were doing well in terms of physical health, long-term emotional support would be paramount after this to prevent feelings of guilt as well as, more importantly, the development of post-traumatic stress disorder, commonly known as PTSD.
Dr Boonruang has sound reason to worry. PTSD -- triggered by terrifying or life-threatening events, either directly experienced or witnessed -- happens in times like this.
Besides looking to prevent the development of PTSD among the Wild Boars football team, the Mental Health Department also sent its Mental Health Crisis Assessment and Treatment Team from Suanraransom Psychiatric Hospital in Surat Thani province to Phuket to aid survivors and victims' relatives who are likely to fall prey to PTSD after last week's ferry tragedy that left 47 dead.
Psychiatrist Dr Anon Thanmanurukkit said it is a wise call to monitor the mental health of the 13 who were saved from the dark, labyrinthine cavern, given that people who have been through such tragic incidents have the likelihood of suffering PTSD -- even though the crisis has already passed.
"When it comes to situations like this, it is always better to be aware of the risk than just letting it go. Monitoring protocol and know-how must be prepared," said Dr Anon.
Stress is common during and after crisis, the psychiatrist added. But in normal circumstances, stress should alleviate within two days. However, stress after traumatic events that last more than two days and interrupt daily life's functions is medically defined as acute stress.
"Acute-stress disorder can be characterised by three symptom clusters: re-experiencing, avoidance and anxiety," explained Dr Anon. "Re-experiencing tragic incidents through recollections, flashbacks and nightmares bars survivors from getting over the crisis. They also avoid places, people, activities or anything that remind them of the trauma. They will also develop anxiety, increased arousal and sleeping difficulty. These conditions, if left untreated, can lead to depression too."
Acute-stress disorder that lasts over a month is diagnosed as PTSD, whose symptoms are mostly similar. Differences are that PTSD is more severe than acute-stress disorder and can last longer -- years, in some cases. The disorder does not necessarily affect survivors right after the crisis. Sometimes, said Dr Anon, it takes six months before the symptoms begin.
PTSD can attack all fragile minds, regardless of gender, race or social status. Pop icon Lady Gaga revealed in 2016 that she had an ongoing battle with PTSD, part of the emotional fallout from her having been raped when she was 19. Earlier this year, American actor and artist Shia LaBeouf admitted for the first time that he had seen his mother raped when he was a child, an experience that left him with PTSD. LaBeouf was arrested in 2017 for public drunkenness and disorderly conduct and sent to 10 weeks of court-ordered rehab. "When I got to rehab, they said I had PTSD," he said.
In Thailand, renowned actress and author Inthira "Sai" Charoenpura also admitted she had suffered PTSD after an almost-fatal car accident that broke her neck and left her bedridden for months. Inthira's PTSD led to a years-long battle with depression, over which she eventually declared victory.
Realising the importance of treating PTSD as one of the global healthcare agendas, the World Health Organization (WHO) in 2013 released its new clinical protocols and guidelines to medical practitioners for treating PTSD, acute stress and bereavement in its Mental Health Global Action Programme.
In Thailand, added Dr Anon, the 2004 tsunami that took the lives of over 4,800 Thais and left almost 4,500 people missing compelled local mental-health experts to properly and thoroughly record and study PTSD.
After the massive wave struck Thailand, Prof Dr Nantika Thavichachart of the Department of Psychiatry, Chulalongkorn University's Faculty of Medicine, visited six tsunami-wrecked provinces to create a mental-health database for survivors. According to her report titled "Post-Traumatic Stress Disorder Of The Tsunami Survivors In Thailand", conducted with other researchers and published five years after the tragedy, it was found that, of the 3,133 tsunami survivors they surveyed, 33.6% suffered from PTSD, while around 14% suffered from depression and 11% from both.
After that visit, 2,573 patients were followed up for six months, after which it was reported that those who still succumbed to PTSD accounted for around 21%. This 21%, according to the report, fell prey to chronic PTSD.
But the incidents that trigger PTSD, Dr Anon continued, do not necessarily have to be life-threatening accidents, deadly natural disasters, or other incidents of such magnitude.
"For some people, getting stuck in a toilet or flying in an airplane that goes through severe turbulence can leave them with PTSD. So the development of the disorder depends heavily on each individual's perception towards a certain incident," said the psychiatrist, adding that women are more likely to suffer PTSD than men, given their sensitivity and vulnerability.
To help people at risk of PTSD -- such as the survivors of Tham Luang mishap and Phuket boat disaster -- Dr Anon said it is crucial to make them feel secure, that someone is always there for them, and that they are not alone. For those already diagnosed as having the disease, the next step is crisis intervention and psychotherapy to be carried out by certified professionals.
"Give them a chance to express their feelings but do not ask them to repeat what has happened. To keep telling the same unfortunate story will imprint it very deeply in their mind. Medication like that used for treating anxiety and depression might be prescribed.
"Also, if left unattended, PTSD can lead to other, more severe psychological conditions like schizophrenia [a severe mental disorder that can result in hallucinations, delusions and extremely disordered thinking and behaviour], depression, drug abuse or even suicidal thoughts. So monitoring people who have just gone through tragic events is a must."
