The Psychological Aftermath Of The Sydney Siege

By Jessica Alpert

The images of five hostages escaping from the Lindt Chocolate Cafe in Sydney are striking. A woman runs into the arms of law enforcement, her trauma and fear palpable.

This story is still developing, but one thing is for sure: "It really doesn’t take much to instill fear," says Max Abrahms, a professor of political science at Northeastern University and an expert on terrorism. "This one guy managed to shut down an entire city, divert many planes away from Sydney, and transfix the world in real time following this story."

As of press time, police were reporting that the hostage taker and two people were killed. For those who survived, what lies ahead psychologically?

Dr. David Gitlin, Brigham and Women’s Hospital vice chair of clinical programs and chief of medical psychiatric services, says recent research suggests reliving or "debriefing" survivors is counterproductive and "actually may precipitate the development of PTSD."

Instead, health professionals are encouraged to use a resilience model in the immediate aftermath of an event like this one, "helping people think about the things they need to do to feel safe and secure...to deal with things on their timetable," says Gitlin. Of course, this may come into conflict with the needs of law enforcement, who are looking for further control of an event or preparing evidence for prosecution. As this siege has ended and it's believed that the assailant acted alone, Gitlin hopes that those now released will not be interrogated at this time.

Gitlin, who led the Brigham's psychiatric team after the Boston Marathon Bombings, explains that "people need to be surrounded by their loved ones, put into a safe environment, and only process this when they are ready to do so."

Acute Stress Reaction and PTSD

There are two types of trauma, says Gitlin.

"Loss of control and fear really fits under the rubric of 'acute stress reaction' which also puts people at risk for post-traumatic stress or PTSD," he says. The acute stress reaction comes during and immediately after an event like the Sydney siege. This can include agitation, flashbacks, sensitivity to noise, emotional distance and numbness. Some people will have no acute stress reaction but will develop symptoms of PTSD months later. The more intense the event, the more likely the PTSD, which can be diagnosed as early as one month after a traumatic event.

Our thirst and desire for more information doesn't help the victims.

"I saw this a lot around the Boston Marathon events — the media exposure is so counterproductive," remembers Gitlin. "There are a million people trying to get them [the victims] to tell their story...so the media has to struggle with the fact that the victims might be more victimized by this process."

Gitlin was incredibly busy in the days after the Boston Marathon bombing, helping both staff and victims. He may not remember everything he did during that time but he is certainly convinced of this. "The most important thing I did was walk around the hospital and in the emergency department, the hallways, waiting rooms and patient rooms...I turned off the televisions."