R. Murali Krishna, M.D. President

When something traumatic happens in our lives, it can shake or even shatter our deepest-held assumptions about the safety and goodness of our world. Tornadoes, earthquakes, war, personal assaults, car accidents, sexual abuse in childhood and many other devastating events have the power to overwhelm our mind and emotions.

Those staggering blows to the very core of who we are can cause emotional wounds that are difficult to heal. That's why days, weeks, months or even many years later - at the mention or experience of something that calls to mind the original trauma - the wounds may reopen, causing a great deal of distress.

While this is concern for anyone who has experienced a traumatic event, it has particular significance in Oklahoma right now. As jury selection in the trial of Timothy McVeigh continues - and as the trial gets underway in another few weeks - thousands of Oklahoma Cityans may find their emotional wounds have re-opened. For some, the ways in which their distress shows up will be indicators of a condition known as post-traumatic stress disorder (PTSD).

PTSD refers to a set of emotions and behaviors experienced by some people who have experienced overwhelming trauma. People of any age or any personality type may have PTSD. One study estimated that roughly half of the adults in the United States have undergone a potentially traumatic experience; another study says 8 percent of men and 20 percent of women develop PTSD following such an experience. How does one know if he or she is experiencing PTSD? Having one of more of the three indicators below would be considered evidence of the condition.

First, people experience recurrent and intrusive memories of the event. Sights, sounds, smells, thoughts or perceptions barge forcefully into their lives and consciousness. These intrusive memories might occur during waking hours as a flashback or during sleeping hours as a nightmare. They can be powerful enough to be make one feel as if the event were actually occurring again.

In conjunction with these distressing recollections of the event, people with PTSD feel an intense emotional reaction when exposed to anything that symbolizes, resembles or recalls the original event. A mother who lost a young child may become angry when she sees other women who are pregnant. A man who was nearly killed in a car accident may be terribly frightened when hearing a car horn. And victims' families, survivors and rescuers may find themselves distressed when they hear a prosecuting attorney describe in detail the devastation in and around Oklahoma City's federal building on the morning of April 19.

Second, people with PTSD may also experience a numbing to life experiences and relationships. People with PTSD often find themselves estranged from loved ones and even estranged from feelings of joy. They may also feel that their life is not likely to be a long one, that they won't have the time normally allotted to people for a rewarding career, marriage or family.

Third, people with PTSD find that their nervous system has shifted into a state of high alert. Some people will find it difficult to sleep. They may have concentration problems, a rapid heartbeat, irritability, outbursts of anger, an exaggerated startle response and be hypervigilant.

There are many people in Oklahoma City who were significantly, personally affected by the bombing. There were people who were hurt, terrified, horrified, helpless. No matter what stage they are at in their recovery, some will be surprised or shocked during the trial to find they are affected more deeply than they believed. Their symptoms may re-awaken, or they may appear for the first time. They may hear, see and smell the chaos of that morning. They may be irritable or prone to outbursts of anger. They may have difficulty concentrating. They may feel suddenly detached from other people, or even from the emotions of love and joy.

If you are one of these people, or if you've had other traumatic experiences in your life that have led to similar results, remember that your feelings and reactions are normal and reasonable in reaction to an abnormal situation. When humans experience an assault on their minds and emotions, when they suffer an event that is truly horrifying or frightening, these feelings can be the result. If distress is profound or prolonged, you may need to seek professional support. But just knowing that your feelings are normal can sometimes help anchor you in the middle of the powerful, turbulent storms of PTSD.

R. Murali Krishna, M.D., is president and COO of INTEGRIS Mental Health Inc., one of the state's largest providers of mental health services. He is also president of the James L. Hall Jr. Center for Mind, Body and Spirit. He has maintained a private psychiatry practice for more than 25 years and is a clinical professor of psychiatry at University of Oklahoma Health Sciences Center.