will be. the italian navy has rescued more than 100 children from boats near the coast of sicily. of course you can always keep up to date with all of the news on our website, aljazeera.com. bloc >> hi 'em i'm lisa fletcher and you are in "the stream." posttraumatic stress disorder, it's not effecting soldiers returning home. plus the routine medical procedures that may be leaving one in three patients with a mental disorder. about right now. ♪

>> hico host and digital producer wajahat ali is here bricking in all of your feedback throughout the show. it is stunning that nearly one in ten americans will experience lifetime. >> yeah, i also soldiers vets, but sa bean that says we reco r recovering victims of abuse also ex -- experience ptsd. >> there is another trigger that increases your chances of developing the mental disorder, your zip code. researcher were astonished toz find that one in four patients with traumatic injuries like gunshot wounds and stabbings had

signs of ptsd. and it's also where you go. hospitals and clinics are stressful environments. up to 35% of patients in the icu experience ptsd long after being released. we have a great lineup of guests today. dr. james jackson, clinic psychologist and clinical professor of medicine. from chicago, illinois, dr. kimberly joseph, a trauma surgeon, and carol rees violence and prevention coordinator to at her hospital. they are both at cook county hospital. thanks to all of you for being here. dr. jackson, about 5 million people a year are in the icu's across america. and up to 35% of those patients

have ptsd symptoms for up to two years after they leave the hospital. response? >> it could be a number of things. one of them is the suddenness of the events that lead people to the icu. when you go to combat, you are often mentally prepared for the fact that there is danger around every corner, however, when you become acutely ill that happens very quickly. sometimes you are feeling fine on monday and tuesday you wake up and you are on a ventilator. you're not sure what happened. your family is holding a death vigil around your bed. it's sudden, intense and terrifying. kind of intensity and immediacy can foster difficult problems can make it hard to cope and can generate pstd. >> what are the kinds of systems that we're talking about?

>> people after critical illness after intensive care has classic systems of ptsd. they often remember their time in the icu. sometimes they remember things that they think happened that actually didn't happen under the influence of heavy sedatives for instance, they often have dilutions in the icu, dilutions of things that are quite terrifying. those sorts of memories are reexperienced by them. they also have symptoms of avoidance which can be quite problematic. every time they drive by a hospital they have a panic attack. if they get short of breath for some reason, they remember what it was like on a respirator when they couldn't breathe. sometimes they are concerned they could be readmitted and the last thing they want is to go

back to the icu, so we see symptoms of reexperiencing and symptoms of avoidance. >> dr. jackson, icu's and trauma centers have been around a long recognized? >> people had a perception that trauma was combat. trauma was perhaps rape rape -- sexual assault. those things are all traumatic. but there are a lot of things that can constitute a traumatic event. a miscarriage, for example, diagnosis of cancer, and importantly, the experience of critical illness. i think we now are a little more sophisticated and understand that these events, although a bit non-traditional in their description, these are absolutely potential sources of trauma. people are talking about it more. it's being discussed in various

media forums to a degree that it wasn't. there are robust research articles being published. it is getting quite a bit of attention and it should. >> we asked our community what is the next step . . . dr. jackson what is being done now to prevent this alarming number of ptsd in the icu. >> i think it's challenging prevention, because by the nature of a medical critical illness, it's very hard to prevent, it is hard to not get sepsus for instance. for that reason a lot of our

energy has focused on what you might call early intervention. management practices in the icu that hopefully reduce ptsd. one of the biggest ones is decreasing sedation. patients are increasingly less sedated. they are more aware of what is going on around them. the idea there is that even though they are more aware of traumatic things, because they are less sedated they are less likely to have these delusional experiences that are profoundly frightening, and we think that they can deal with reality better, if you will, than with the impact of these dilutions and hallucinations. so decreasing sedation is probably one strategy. icu follow-up clinics, probably another strategy. that is specialized clinics,

targeting the unique needs of isusurvivors. >> dr. joseph you see about 2,000 people a year with violent injuries. recently 43% of patients examined in the center exhibited signs of ptsd, given this is the place you work, you would expect a degree of ptsd, did you expect to see these kinds of numbers? >> so i think that's the important thing, lisa. we knew we were going to see some elements of ptsd-type symptoms in our patients. i think he surprise was it was as prevalent as it was, and not only our parents, but our patients families were experiencing these symptoms. the hyperarousal, the avoidance, the reexperiencing the incident.

and since we rely on our social and emotional systems to get us through, if that system is experiencing stress, then it makes it that much harder for us to recover. >> i think -- >> i'm sorry. >> i didn't mean to interrupt you. i read that posttraumatic stress disorder patients out of traumatic situations like for -- in your case we're talking about your hospital, that they are experiencing this at the same rate as veterans do. is that a stretch or an accurate on? >> i think it's accurate. and i would turn to chaplain rees to talk more about that. >> yeah, actually what the literature would support is the rates of ptsd symptoms that we found among our patients is probably almost twice what you would experience -- expect in veterans who have come from active conflict.

>> did you say it's twice? >> yeah, 40% is what we found among our patients and their family members. >> so trauma patients are experiencing ptsd at twice the rate of war veterans. >> i think we need to be clear, we're talking about a screen for ptsd, although clearly if you screen positive, your chances of having the diagnosis are much higher. so we looked at the screen and saw that we were screening positive at those rates -- >> so showing symptoms -- >> showing symptoms. and that's concerning. >> don ahead. >> specifically it's about symptomology. so we had to figure out how to address.

>> don says . . . >> so dr. joseph, what needs to be done here? we have heard about the grim reality, we know the stats, moving forward what should be a solution. >> let's first be clear this is not just a problem in the inner city. people experiencing motorcycle crashes for example, they were screening positive at similar rates, perhaps not quite as high a our gunshot wound victims but close. so if we think about trauma and injury as something that happens to other people we're not going to have the political will to move forward on this. so we have to recognize that the things happening to my patients -- and i'm seeing more blunt trauma then penetrating trauma, so this is happening to all of our

pare patients. so this could happen to any of us. and i agree with your viewer ship, the people who called in. we do need to develop a robust infrastructure to help people deal with not just the emotional spiritual and fiphysicalissues happening to them but also help their family and community. >> doctor -- >> so -- go ahead. i'm sorry. >> i was just curious do you think there is a broader social cost to neglecting ptsd in the civil population? >> looking at personal experiences, i think that study still has yet to be done. now people will be focusing on the cost benefit analysis, but certainly when i look at my

patients recovering from a traumatic illness, there is the physical aspect. but if their mental health, emotional health, and spiritual health are not also supported, then that makes their physical recovery harder. and that's what we would like to do, build that infrastructure for all of our patients. not just those that are victims of violent injuries. >> thanks so our guests dr. kimberly joefs, carol rees, and dr. james jackson who we'll be seeing later in the program. up next the disturbingly high number of pstd cases. and a former sheriff talks about the emotional toll of first responders. and community wide ptsd in global attack areas. go deeper ae

perspectives on every issue. al jazeera america. welcome back. we're talking about the surprising number of people suffering from ptsd symptoms,

like trauma surgeons, icu patients and inner city residents. but what about entire communities? joining us now is a syrian native who survived a chemical attack in syria last year. you were a translator, a citizen journalist, you are an activist in syria. i mean you have been in places where you have seen the absolute offer. >> yes. >> were you prepared for what was going to happen to you? for what you were going to see and the effects? >> nobody can be prepared to see this amount of violence and terror. we witnessed things that we never learned about -- not in schools, not by our parents, not by history, not anything. we never knew that this amount of

violence does exist. when you see little children torn up to piecing by the shelling or see them starving to death or you see your own government gassing you can chemical weapons. i was gassed and my heart stopped for three minutes, and i was placed among the deceased for 45 minutes. >> is there any one incident that triggered the ptsd for you? >> i remember during the chemical attack, after i was exposed, i was trying to help a small kid at the age of 13. he was laying on the ground suffocating. so i ran to check on him. and the expression i saw on his face was one of the most terrifying that i had seen, because he seemed to innocent

and pure to die this very ugly way without doing anything wrong except living in a town which rose up against a dictator. >> dr. jackson whether it's entire communities in syria, or in nigeria where more than 200 little girls were kidnapped, is there any precedent in the medical community of dealing with large communities who have shown signs of ptsd. >> well, there are challenges on a couple of levels. one is when an entire community is traumatized there are a few who can support their peers and the ones most in need. everyone is hurting, so there are relatively few people you can turn to for support in that context. and that certainly makes it challenging. i think what we know, certainly

what i have learned over the years doing research at vanderbilt and at the va, trauma impacts people and if you ratchet that trauma up enough, and if it happens enough times it doesn't matter how resilient you are, you are going to be affected adversely. not everyone will develop ptsd, many will. but being impacted psychologically is unavoidable. and that's why as communities, we need to think hard about how to help build resilient people, people who are powerful copers if you will, because the hope is that those people will perhaps be relatively less affected by these horrors, even though there's no way to leave these sortsover experiences unscathed.

>> thank you all for joining us. until next time, waj and i will see you online another aljazeera.com/ajamstream. ♪ . welcome to al jazeera america, i'm del walters these are the stories we're following for you. thailand is now under military control. and hurricane season almost upon us. forecasters telling us their predictions for the upcoming here. ♪