A Parade Square Collapse.
Darrell was 19 years old when he presented for counselling, accompanied by his mother Grace. He seemed jittery and withdrawn, not making any eye contact, and remained silent throughout the initial interview. Grace did most of the talking, clarifying what transpired with Darrell during the last couple of weeks. When he received his call-up paper for his national service stint, Darrell was enthusiastic, and like many of his Junior College cohort who were similarly drafted, was looking forward to the tough officer cadet course. Having represented his school in rugby throughout his high school and Junior College years, his parents did not think that the level of stress at the military academy would be difficult for Darrell. In fact, they were expecting him to just sail through his service with flying colours. The first two weeks went by as normal, as everyone adjusted to the new level of discipline and regimentation that was expected. One morning after a marching drill session at the parade square, the platoon sergeant stood in front of Darrell, looked straight into his eyes, and shouted at the top of his voice, reprimanding the whole platoon for a sloppy drill performance. This immediately shocked Darrell and his anxiety skyrocketed. The following day, again after another disappointing drill, Darrell’s platoon was prepared for another tirade from their drillmaster. After the first sentence of the sergeant major’s bellowing, Darrell collapsed in a heap. He was rushed off to sickbay. When he regained consciousness half an hour later, he wept for the next fifteen minutes. The duty medical officer referred Darrell to a hospital for a full medical. Grace was contacted, and she rushed from her office to the hospital. A psychiatric evaluation was done, and the conclusion was stress! Anxiety medication was prescribed. Darrell was given medical leave for two weeks.
It was during his medical leave that Grace brought Darrell in for counselling. A few psychological tests were completed before a diagnosis for posttraumatic stress disorder (PTSD) was concluded. At this point, Darrell was interviewed on his own, as his mother waited outside the room. The results from the test forms formed the backdrop for the clinical interview. PTSD did not develop suddenly, but Darrell was at first reticent to disclose what had happened that triggered his anxiety-ridden reactions at the camp. After some reassurance regarding our therapeutic alliance, he confessed that his sergeant major’s yelling reminded him of his father. In his younger days, when he was being disciplined, his father would bring him into his bedroom, locked the door, then hollowed and welted him with his belt for about fifteen minutes. Any weeping or attempt to escape his belt only prolonged these sessions. A subsequent one-on-one session with Grace confirmed Darrell’s story. Spousal violence, both physical and emotional, were extant, and Darrell, being the oldest child, witnessed most of them regularly since a young age.
Childhood maltreatment is despicable, but is a fairly common problem in the context of maladjusted parents or family system. Childhood maltreatment is categorised as (1) neglect or failure to provide care in accordance with expected societal standards for food, shelter, protection, and affection; (2) emotional abuse that included verbal abuse, isolation, and witnessing violence; (3) physical abuse that consists of non-accidental bodily injury; and (4) sexual abuse that comprised sexual contact, including attempts or threats. Depending on the nature of the violence, child characteristics, family response, and community context, maltreatment can have multiple consequences. However, when maltreatment is severe and/or repeated, there is emerging consensus that it functions as an uncontrollable, chronic stressor, and its effects may include: (1) depleting and distorting the body’s natural coping and protective system; (2) disrupting normal physical functioning; (3) challenging mood stability and normal reactivity to external events; (4) biasing the processing of information towards supporting survival; (5) making security in attachment bonds more difficult to achieve and maintain; and (6) limiting a healthy, positive sense of self and future. It is not uncommon then that depression, anxiety disorders, especially PTSD, suicidal ideation, self-harm behaviours, dissociative disorders, behavioural problems and disorders, substance abuse disorders, eating disorder, and personality disorders are sometimes linked to childhood maltreatment.