The SUNDAY TIMES 29/11/1998

Ten years on, a psychiatrist reveals how the crash changed attitudes to trauma.

Anjana Ahuja reports

Lockerbie and the legacy of disaster

 The telephone call came two days before Christmas in 1988. Dr Gordon Turnbull, then an RAF psychiatrist, recognised the voice instantly. His friend, head of mountain rescue in Scotland, was not calling to deliver a seasonal greeting. It was two days after a passenger aircraft with 259 people on board had crashed at Lockerbie, Scotland. Mountain rescue had been called in to help to locate the wreckage.

 "Their task over those two days must have been horrendous," says Dr Turnbull. "They had to locate bits of bodies and wreckage, and guard them. The rescue team had been showing signs of strain and my friend was worried about how it would affect them. I think he was concerned about himself, too."

 In that new year, Dr Turnbull spent ten days with 150 men involved in the Lockerbie clean-up operation. He encouraged them to talk about what they had seen with him, with each other, and with their families.

 Hearing the experiences of those who dealt with the aftermath of the Lockerbie tragedy, the horror of which remains undiminished a decade later, was his first encounter with post-traumatic stress disorder. Since then, Dr Turnbull, 49, has established himself as one of the country's leading traumatologists. From his base at Ticehurst House Hospital, a Georgian building set in 46 acres of Sussex countryside,
Dr Turnbull's team has counselled war veterans, car crash victims and former hostages, such as Terry Waite, John McCarthy and Jackie Mann. It is easy to see why he is so popular - his kindly manner and gentle Scottish lilt never waver. For Dr Turnbull, Lockerbie was a "massive validation" that post-traumatic stress disorder was not, as the Army was then inclined to believe, a disease of weak souls but a legitimate response to a stressful situation.
The Army had never called in a dedicated trauma team before, and his friend was a renowned tough guy: "I was gobsmacked. This was a man who had seen it, done it and got the T-shirt, and here he was asking for help from an army doctor."

 Knowing that the idea of trauma counselling did not chime well with the macho image of the Army, Dr Turnbull trod carefully. He worked hard to win access to the Lockerbie mountain rescue team: "I went round in a camper van and I would nip in the back and get changed in different uniforms depending on who I was speaking to. I had a whole wardrobe in there, from the most formal RAF uniform with hat and gloves, right down to casual gear. " And he followed his own advice - Dr Turnbull and his team were themselves debriefed after returning from Lockerbie.

 His connection with Lockerbie did not stop there. A year later solicitors in the small Scottish town needed psychiatrists to assess local citizens to see if they could claim compensation. Over a period of six months, Dr Turnbull was part of a team headed by Morgan O'Connell, a Navy psychiatrist, which saw around 1,000 people. They ranged from local police and fire officers to mortuary workers and farmers who had woken to find their land strewn with body parts.

 Trauma is not a necessary consequence of a harrowing experience. A person must suffer an intense emotional reaction to the ordeal in order to be labelled traumatised. The most important symptoms are a continual reliving of the ordeal, through flashbacks and nightmares that are outside the person's control; avoidance behaviour, such as shunning friends, colleagues and families to avoid having to talk about, and therefore remember, an unpleasant experience; and high levels of anxiety, tension and vigilance, prompted by a determination to avoid dangerous situations. The most important thing to do, says Dr Turnbull, is to encourage people to discuss their experiences, to defuse the avoidance behaviour.

 Dr Turnbull, the son of an Edinburgh cabinet-maker, sees only rewards in his work, never gloom. He is doing something he thinks he was destined to do ever since he spent five months in Antarctica as a medical student. He recalls: "It was  wonderful place to be, but I realised the real unexplored territory was people. Here we were, 16 of us on the ice, a littl crucible of human nature. I acquired the role of confidant - my tent was the one everyone went to if they needed to chat."

 On his return, he abandoned his ambition to become a surgeon. He went to London after graduating from Edinburgh University, and married Alison, a student nurse he met during his college days. He joined the RAF , but left in 1993. The only time his calm veneer looks close to bursting is when talk turns to the controversy over post- traumatic stress disorder, which is still thought of in some circles as a disreputable American invention of the Vietnam era.

 Dr Turnbull says: "In the Eighties, people in Britain tried to explain away the effects of Vietnam in terms of the relative youth of the troops, the fact they lost, and drug use in the combat zone. That's why people believed it wouldn't happen to them. In fact, what is true for Americans is true for Brits, as we realised after the Falklands.

 "The law is also in the Dark Ages on this issue. It still believes that people are responsible for their own trauma, that people who have PTSD are malingerers. It says that you have to be on the scene, or to be closely related to someone who has suffered.

 "I know of a couple from Lockerbie who had been in Spain when the plane came down. Their home was destroyed, they didn't know what had happened to their friends and neighbours. And it was splashed all over Spanish TV. They sued Pan Am in America and won. In Britain we still don't believe people can be traumatised by what they hear on the radio or see on TV, but that's rubbish."

 More than eight out of ten of patients who pass through his trauma unit - many of whom have suffered for decades - make a recovery. And he can take comfort from the fact that he has never needed to see the men from Lockerbie again.