Debriefing: care and sympathy are not enough

To the Editor: I read with interest McFarlane’s article on post-traumatic stress disorder and debriefing,1 which reminded me of a long-term patient.

Over a decade ago, I discovered that this patient was a Vietnam veteran, and expressed concern that he had not told me previously. His reply came thus (although, of course, I no longer remember the exact words): “How would you know what it feels like to be, by sheer chance, the only man left alive in a group of soldiers?” I acknowledged that he was correct, that I had no idea.

With that poignant remark in mind, I planned his care. He is doing OK.

Can we really address an abstraction that we cannot conceptualise, or predict the resulting obstacles in a person’s journey through life? This is equally valid at the beginning of the journey or anywhere along its course. Perhaps the notion of debriefing at an appropriate time is not the problem; perhaps it is the formula we use.