Tham Luang survivors likely to need long-term therapy

IN Thailand 12 boys and their young coach are once again above the ground enjoying fresh air and sunshine after more than two weeks trapped in the darkness of a cave wondering if they would ever see the sky again.
When we read the news that 12 boys and their coach had disappeared into a cave after football practice on June 23 and were thought drowned we all shared in the shock and sorrow.
Then the most amazing story of resilience, courage and achievement unfolded, a tale more potent than any fiction as the boys were found, sustained and rescued by a superhuman effort that cost the life of a brave navy diver.
The uncertainty, the hope, the sacrifice and the noble deeds of heroic rescuers from around the globe has moved all of us and shown us the best of humanity, but now that we have reached the end of this amazing story soon these events will fade from our collective memory, sinking into the same haziness as the Chilean miners and the baby in the well, but has the story really ended, has it reached its conclusion?
The answer for the boys, the coach and their families is clearly no; the events will for many of them become the defining moments of their lives.
Even though the Wild Boars are now free from the shadowy depths of Tham Luang cave, the deeper, darker mental impressions of this story may never fade and could shape their lives forever.
This small group has faced death and any threat to personal survival results in some form of psychological trauma, which in turn leads to memories that will remain vivid long after the threat has passed and some of the survivors may suffer longer-term post traumatic stress disorder, potentially leading to some of them developing mental health issues.
So what lessons can psychology teach us about what may happen and what may help the team?
In the relief of rescue the boys and their families will initially appear to be very happy, but very quickly family and friends will begin to notice some changes and may find it hard to re-establish the relationships that existed before their ordeal.
The teenage years are the time when we begin to individuate, to establish our individual identities as distinct from our family, and in boys this usually means forming strong friendship bonds with other young men.
As the post-traumatic stress begins to appear, some of the boys may appear to regress and return to behaviours that might be considered childish.
They may become scared of the dark, unable to sleep alone and prone to nightmares or disturbed sleep.
The resulting tiredness and psychological strain may combine and result in sudden outbursts of anger and irritation at the smallest things, so the boys may be seen as touchy and difficult.
The psychological insecurities of their ordeal may mean that the boys become quite tearful, easily upset, clingy around parents and other loved ones, seeking hugs, kisses, strokes and other physical signs of affection.
At first it is likely that the boys' loved ones will be patient and accepting of strange behaviour, and parents or close relatives will certainly respond positively to demands for affection and attention, but in a few months these positive feelings may begin to subside.
A tetchy toddler is hard to deal with, but an angry teen is a difficulty multiplied, especially if he is unable to explain why he is angry and does not understand himself why his moods swing so easily.
In most cultures, men are expected to suppress their softer emotions as part of behaving as men so it is possible that some parents may become irritated at perceived childishness.
We should also remember that many of the boys will have brothers and sisters who may begin to feel that they are somehow less special, and as a consequence begin to compete for parental notice and love.
The strain on the families will be great and even if the psychotherapists working with the families now are able to deal with many immediate issues, it is likely that problems will emerge in the weeks and months ahead and these problems will test some families to their limits.
We cannot predict when these problems will occur because they could be triggered by so many things, by anything that reminds the survivors of their ordeal, a chance remark, a damp smell, the sound of rushing water.
So many things could initiate a flashback that might lead to a serious mental health problem that the boys and their families will need to be vigilant for a very long time.
This will be very wearing for all concerned, but we know that a strong and supportive community can help to mitigate many of these risks, so the boys' extended families and social networks have a critical part to play in helping those directly affected to deal with the aftereffects of the rescue.
There will also be blame and there will also be guilt. Although the coach and the boys were innocent victims of the weather, already some of those connected with the families and the Moo Pa club will be focusing on who should take responsibility for what has happened.
When they are upset and fearful many people respond with anger and aggression, so already behind closed doors the accusations will be flying, there will be mutterings leading to whispered demands for retribution and punishment.
The survivors will know this from catching the end of the odd conversation, the sudden awkward silence when they come into a room, or when one day, and it will happen one day, someone says "If you hadn't got yourself lost in Tham Luang then …".
Once these words have been spoken they cannot be unsaid, so some of the boys will blame themselves for what happened and somehow feel that they failed, potentially triggering a collapse in self-esteem and beginning a spiral to deep depression, a sense of guilty worthlessness.
This means that those who know and interact with the boys will need to exercise incredible levels of self-restraint and self-control, and do all that they can to avoid mentioning the events of the last few weeks, and when the topic is raised they must be calm and supportive.
At the other end of the scale, some of the boys will experience feelings of importance and this may possibly shade into narcissism.
The extensive media coverage means that these boys are already celebrities and it is likely that some of them will become stars, perhaps even taking leading roles in the documentaries and film(s) that will inevitably be made of the story.
There will be interviews and photo sessions, book deals and publicity events, but these things will not be distributed evenly within the group, leading to resentment among the 13.
Those who sustained each other through the darkness may find it hard to maintain their friendship under the studio lights, leading the boys who are perhaps less media savvy to feel excluded and cheated of their fame.
Again families may exert a more or less subtle pressure on their sons, making it clear they feel that they have not benefited financially or socially in the ways that other families may have done.
This could cause some boys to experience deep feelings of self-doubt and worthlessness, leading in turn to a profound melancholy that may initiate any number of psychoses.
Professor Hew Gill is Associate Provost and Professor of Psychology Sunway University. Comments: letters@thesundaily.com
Part II appears tomorrow.