The shootings took place in the summer holidays and most of the teenagers involved were starting at new schools in the autumn, which made it harder for them. But the country already had a plan for how to deal with something like this, whether a natural disaster or a crime, and provided a ground-breaking level of support. Every school involved was given advice on what to do, the strict attendance rules were relaxed for survivors and students were given the choice about when and how to talk to their new classmates about what had happened. Some even decided to avoid questions by standing up and telling the whole class about it when they were ready. The bereaved and the survivors were given an opportunity to revisit the island at different times, since it was learned from previous disasters that they come at it from such different perspectives. This kind of support did seem to make a difference and other countries are now looking to the Norwegian experience.

Exposure levels

Another myth about PTSD is that only people who are weak will experience the condition. Why, even after the most horrendous experiences, some people develop PTSD and others don’t, is still a mystery. The psychiatrists’ bible in the US, DSM until recently included a person’s responses to the initial event. Intense fear, helplessness or horror were thought to result in more PTSD, but those indicators have been removed from the newest version of the manual, because it’s been found that they don’t predict who will and won’t suffer.

The nature of the event itself can of course make a difference. Rates of PTSD amongst US troops are almost triple those in the UK, partly because there is a higher proportion of reservists, but also because their average tour of duty is a year, compared with six months for UK service people. A review of the many different studies following up staff at World Trade Center found that those who were injured, worked on the higher floors, witnessed others falling or jumping from the buildings or whose employers were killed, were more likely to develop PTSD. But so were women, younger people, the less well-paid and those who had experienced other setbacks in the preceding years. So it’s a complex picture.