Q: My brother is a veteran who saw friends die in action. He refuses to go for psychotherapy. Should I insist that he go?
A: After a trauma, suffering is common -- if not universal. But psychotherapy is not for everyone. In fact, some experts believe -- in some cases -- talking may backfire after a traumatic experience. It may intensify memories that are better forgotten.
Unfortunately, there is no evidence to support pushing everyone into treatment. Some people actually get worse. Even support groups may be risky for some victims. The simple act of attending a group may cause some individuals to relive traumatic events unnecessarily.
Victims may compare notes in social conversation. This can reinforce traumatic memories. In such instances, having more symptoms may be a true side effect of psychotherapy.
Following an untimely death or loss, family, friends and neighbors often hurry to the side of the sufferer. They offer emotional support and practical assistance. In the first few weeks, the helping response may even be overwhelming.
Strangely, helpers may be so driven by how good it feels to help that they forget to pay attention to what the grieving person actually needs.
So tread lightly. Of course, support is essential. Treatment may be helpful. But be mindful of your brother's wishes.
Your brother may be having significant problems. If so, you probably will want to encourage him to get professional help.
Has his mood changed? Does he appear withdrawn from his usual activities? Is he more irritable than usual? Is he drinking too much or using drugs inappropriately? Any of these could be a signal that treatment is in order.
Otherwise, don't insist on psychotherapy for your brother. That is especially true if he is getting on with his life and doesn't seem to be suffering.
(Michael Craig Miller, M.D., is an Assistant Professor of Psychiatry at Harvard Medical School and an associate physician at Beth Israel Deaconess Medical Center in Boston. He is a Senior Medical Editor at Harvard Health Publications.)
For additional consumer health information, please visit http://www.health.harvard.edu.)