Diagnosing a person correctly is crucial for right treatment especially in cases involving trauma. This was discussed at the fourth biennial counselling conference in Thimphu yesterday.

Igor Pietkiewicz (PhD) said that modern psychiatry at times diagnose trauma cases with different illness. “A patient had fourteen years history of hospitalisation. He was diagnosed with schizophrenia but was definitely not schizophrenic.” He said that the patient was once diagnosed because of the voices that he heard.

He said that many patients with posttraumatic symptoms are very critical about their symptoms. “Recently, a study in Africa on possession revealed that all people who claimed that they were possessed reported having serious traumatic experiences. But none of them would associate traumatic experiences with traumatic symptoms.”

He said that social learning and cultural norms affect how one interprets reality and inform about people’s behaviour.

Psychiatrist with Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Dr Chencho Dorji, said that people with such problems are referred to hospitals and that doctors are not necessarily geared to think in a physical perspective to treat these issues. “These things keep on happening as we are not addressing the core issue and just looking at the manifestations of the issue.”

He said that the role of counselling was important and that counsellors need to try finding out what was bothering the person to behave in such a way. He said that this was a way for asking help.

In a response to a participant’s query if children in their adult lives would have the same problems their parents had, Igor Pietkiewicz said: “If you had been traumatised as a child this will affect the relationship and create a certain pattern on how you build relationship with other people.”

He said that trauma leads to fragmentation of the personality also called structural dissociation. “A part would be trying to continue living in daily life as if nothing has happened while another part would remain stuck in traumatic experiences and memories.”

He also said that talking about trauma is a taboo. “People don’t realise that the traumatising event happened to them.  As long as the patient is unable to realise what happened to him or her, there won’t be a way for working through the problem.”

Through screening tests and structured clinical interview, a traumatised person could be treated.

A participant, Sonam Yangden Tamang, said that counselling is not at all advising people. “Counselling provides clients a safe haven to vent emotions that are deepest. Often these are wounded parts in the life a person.”

She said that there are therapeutic techniques such as cognitive behaviour therapy and rational emotive behaviour therapy that would help heal a traumatised individual.

Rinchen Zangmo