Survivors of Omagh’s ’98 bomb offer lesson on coping with trauma

By Jack Holland

Since Sept. 11, Americans have been searching for answers to questions most of which they have never had to ask themselves before. Questions about terrorism, its origins and nature, have thrust themselves forward. So too have questions about how men and women respond to terror, and cope with the horrors of its aftermath. Not surprisingly, some have turned to Northern Ireland and more specifically to the little market town of Omagh in search of answers. There, on Aug. 15, 1998, a car bomb devastated the town center, killing 29 people. It was the single worst incident in the history of the Northern Ireland conflict.

Within days of Sept. 11, Dr. Christine Padesky, co-founder of the Center for Cognitive Therapy and distinguished founding fellow of the Academy of Cognitive Therapy, both in California, and author of the best-selling book “Mind Over Mood,” was calling colleagues at the trauma center in Omagh with the aim of putting together a task force to help deal with the kinds of psychological problems — identified as Post Traumatic Stress Disorder — that emerge in the wake of tragedies and atrocities.

“I knew that cognitive treatment had such great success in Omagh,” Padesky said. She contacted Dr. Kate Gillespie, David Bolton and Michael Duffy at the Omagh Trauma Center. Also contributing to the task force were four New York-based cognitive therapists. They linked up with the American Psychological Association disaster response team, and the academy’s website (www.academyofct.org) was widely distributed.

At first glance, the vastly different numbers involved — almost 3,000 died in the attacks on Sept. 11, compared with Omagh’s 29 fatalities — would seem to render any comparison distant at best. But numbers can be misleading.

“There are a lot of similarities,” said Gillespie, a consultant psychiatrist and cognitive therapist who had worked with Padesky before. “The Omagh attack came out of a clear blue sky. We thought we had peace, we were all focused on the Good Friday agreement. We thought Omagh was immune.”

During the previous 30 years of violence, the town had escaped it for the most part. It was a mixed community, where Catholics and Protestants lived together in relative harmony, going about their business quietly while all around, in the killing fields of Tyrone, some of the worst horrors in the conflict were being perpetrated. Even when a bomb warning came through at around 3 on that Saturday afternoon, a busy shopping day, few seemed to have taken it seriously.

“Everybody was running about laughing and joking and just carrying on, just the usual bantering of a Saturday afternoon,” said survivor Garry McGillion, whose wife (then fiancTe), Donna Marie, was badly injured in the bombing, and whose 18-month-old niece, Breda, was killed.

As in New York, normality would be turned into a nightmare, and the sense of security that went with it banished forever.

Similar scale

Padesky said that though the numbers are different, the scale is comparable with what occurred in New York. Those who were slaughtered in Omagh came from a town of only 20,000 people.

“Percentage-wise the impact on Omagh was just as great,” she said.

The victims of the 500-pound bomb represented a cross section of the entire society. As one report put it: “The town they attacked is roughly 60-40 Catholic-Protestant, and the dead consisted of Protestants, Catholics, a Mormon, and two Spanish visitors. They killed young, old and middle-aged fathers, mothers, sons, daughters and grannies. They killed Republicans and Unionists, including a prominent local member of the Ulster Unionist Party. They killed people from the backbone of the Gaelic Athletic Association. They killed unborn twins, bright students, cheery shop assistants and many young people. They killed three children from the Irish Republic who were up north on a day trip. Everyone they killed was a civilian. The toll of death was thus both extraordinarily high and extraordinarily comprehensive.”

What was also extraordinary was that though Northern Ireland had endured three decades of violence, there was not much done in the way of investigating the consequences for those who survived it.

“There had been a silence about the effect of the Troubles,” said David Bolton, who as well as working out of the trauma center is director of social work and community care at the Erne Hospital in Enniskillen. He was on the scene within 20 minutes of the attack and has since worked with many of the victims, coordinating the response of health care agencies to the trauma. Bolton believes that over the years of violence, a sort of Ulster stoicism took over, and people suppressed their feelings. Ironically, it was not until April 1998, with the publication of the Sir Kenneth Bloomfield report, “We Will Remember Them,” which looked at the effects violence has had on people’s emotional lives, that any systematic examination of the problem was undertaken — and that was just four months before the Omagh bomb.

To deal with the aftermath of the bombing, which as well as killing 29 people injured more than 400, a trauma team was set up, involving Bolton, Gillespie and Michael Duffy, who is a cognitive therapist and the team’s coordinator. To date, they have treated more than 680 people, including 200 young people. The youngest of those they treated was just 2 years old.

“He was very distressed,” Bolton said, recalling the youngest patient. “The child could not communicate. Any loud noise would start him screaming and crying.”

The team members were trained in the cognitive therapy approach to dealing with PTSD, which focuses on the present, unlike the psycho-dynamic model, which tries to trace an individual’s response to trauma back to childhood experiences. The cognitive therapist will try to help people identify their distressing thoughts and to evaluate how realistic the thoughts are, and then help them to change them.

“What we learned in Omagh was not previously known in Northern Ireland, or in fact anywhere in the world,” said Bolton, referring to the treatment of PTSD.

Typically, PTSD symptoms include a continual re-experiencing of the event. This can take the form of nightmares. Survivors also experience hyper-arousal — they are on edge, on the alert constantly. The third symptom is termed avoidance — they avoid people, television, going out, going to work, anything which has even a remote connection with the event. They can take to drink or drugs, and become fearful of sleeping, expressing anger and irritation, all of which can have a serious impact on their relationships.

However, Padesky emphasized that their therapy targets the feeling that people have that because they are experiencing “trauma disorder there is something wrong with them.” It only becomes a problem when it persists.

“Among the most important factors,” according to Duffy, “are the meanings people attached to the incident, and the appraisals they made about it.” For some survivors, Omagh meant that the world was no longer a safe place. Some asked how could God have let this happen.

“It was a shattering blow to their belief system. The [self]-appraisal: you could have done more on the day, you didn’t, therefore you are a bad person.”

Said Bolton: “Brooding on what happened was very counterproductive. People needed to tell their story, but some got stuck on it. Some forms of therapy actually encourage this. But the victims have to be worked through their story and we do it via cognitive therapy.”

They discovered the importance that rituals play in overcoming trauma — memorials and commemorations which bind the community together and help the survivors share their grief and loss with others.

They found that not everyone gets traumatized on the day of the event.

“Just this week,” said Bolton, “we’ve had two referrals. We encourage early intervention. If you don’t, about one-third remain traumatized for life.”

Natural reactions to an attack on what we value about life, such as anger and rage, do have a role to play in cognitive therapy, according to the team.

“There is a place for outrage,” Bolton said. “But if the anger becomes all-consuming it becomes very destructive. Some feel they have to be angry all the time. But it is a transitional step to getting better.”

The experience of survivors Donna Marie and Gary McGillion bears out Bolton’s thesis. In an interview in December 2000, Donna Marie said: “Gary and I talked about the anger. We decided that anger would get us in the end, it wouldn’t get the people that had done this. It would only ruin our lives and we weren’t prepared to let them ruin our lives forever.”

These are the kinds of decisions those who survived Sept. 11 will have to confront as times passes and they grapple with their loss and pain.