Neela, a patient, was not her usual self. She was suffering from depression and I had noted that she was better with medication. But today she appeared overwhelmed, restless and anxious. I asked her what happened. Neela replied, “Doctor, life is so uncertain. What will happen? Who will do what, we don't know.” Her anxiety has definitely increased and I needed to find out the reason behind it. It was the recent rape and murder of the Kolkata doctor that was playing in her mind.

Any life-threatening event, either man-made or natural, does have an impact on human psychology. Anyone who witnesses tragedy feels its impact in terms of acute stress disorder and post-traumatic stress disorder. But there are people who also witness such traumatic incidents by hearing the news or seeing it on TV. These people are very sensitive by nature. Another category is people already suffering from mental health ailments. They are very vulnerable during such events, as Neela was. She was anxious thinking whether such an episode could happen with her; what could she do? Such numerous anxieties appear in the minds of vulnerable people and it exacerbates the previous symptoms of mental illness. The nature of trauma may be exposure to actual or threatened death, serious injury or sexual violence. It may be exposure to such events through news channels or reading in newspapers about these happening with other individuals. Or the person with mental illness might be exposed to physical assault or sexual violence, domestic violence or sexual trafficking. This can have a major psychological impact on their vulnerable minds. Emotional neglect and humiliation may also have a similar impact on these people. Trauma and mental illness have the following relationship:

1. Mental illness may increase an individual’s vulnerability to experiencing traumatic events.

2. Traumatic events may exacerbate mental illness.

3. Traumatic events may cause mental illness.

Let us explore how traumatic events cause mental illness. Any of the above-mentioned traumas, either witnessed in person or heard about, may cause acute reaction and chronic reaction, both of which can precipitate mental illness. In acute stage there is shock and denial, numbness and feeling of detachment. After initial shock, the following responses occur:

* repeated memories of the event or flashbacks

* nightmares

* intense fear that the traumatic event will recur

* withdrawal and isolation from day-to-day activities

* continued avoidance of reminders of the event

* irritability, anxiety and nervousness, anger, depression

* denial

* difficulty concentrating

* altered sleeping or insomnia

* physical symptoms of stress, such as headaches and nausea

* worsening of an existing medical condition or psychological illness.

This is post-traumatic stress disorder. It leads to anxiety, depression and psychosis in the future.

In a similar way, these traumatic events exacerbate existing mental illness. It's very important to reduce the impact of trauma. Following are the ways to restore the emotional impact of traumatic events:

* Notice if you feel a pull to avoid things in your life and try to stay engaged in routines like work and social life.

* Spend time with others to avoid becoming withdrawn, even if you do not feel up to it.

* Pursue hobbies or other interests.

* Communicate the experience with family or close friends or in a diary or online journal.

* Give yourself time and recognise that you can’t control everything.

* Ask for support from people who care about you or attend a local or online support group for people who have had a similar experience.

* Try to eat a well-balanced diet, exercise, get adequate rest, and avoid alcohol and drugs.

* Maintain a daily routine with structured activities.

* Avoid major life decisions, such as changing careers or moving, soon after the event.

Person with mental illness are very vulnerable to trauma. These people are very sensitive, already worried and stressed. They tend to have lower self-esteem, cognitive and emotional immaturity, and deficits in communication. Hence they are neglected by society and families. It leads to loneliness and family conflict, unemployment and work stress causing financial difficulties. Ultimately all this leads to lack of confidence and extreme vulnerability to minor traumas.

Hence, it’s better to avoid traumatic incidents in the news and on TV. Family members need to be extra supportive to patients, should not ignore their reaction and sensitivity and should not mock them. Patients should avoid watching such news and events, and should meet their therapist.

Dr Shailesh Umate is a consultant psychiatrist, sexologist and addiction specialist, whose mission is spreading awareness about mental health and well-being