ATD

ACUTE TOUR DISORDER

by Donald Fagen

Definition
Acute Tour Disorder (ATD) is characterized by a cluster of anxiety and dissociative symptoms that develop in response to traumatic events that occur while being employed as a member of a rock concert touring band. Symptoms usually arise some time during the first month of the tour and continue until its conclusion, at which time the onset of PTD (Post Tour Disorder) almost certainly follows. ATD is a related to other disorders brought on as a result of severe vocational stress such as Combat Stress Reaction (a.k.a. Shell Shock).

Causes and Symptoms
Acute Tour Disorder is caused by exposure to traumatic events which occur during a tour. Curiously, the majority of these events are regarded by the participants as being consistent with occupational norms. These include:

- Confinement in vehicles, hotels, dressing rooms, etc,. with the same group of people over long periods of time

- Daily relocation to a new venue such as a sports arena, a “rock palace”, a casino concert hall or a “summer shed”

- Nightly performances in front of large, rowdy, often intoxicated crowds

These are all, in fact, stressors that can produce a broad range of symptoms including:

Anxiety Symptoms
Mania
Panic attacks
Inability to focus
Paranoia
Anger problems (“Stage Rage”)
Bizarre ideations
Replay of traumatic events (flashbacks)
Physical restlessness
Insomnia
Muscle pain and twitching
Headcaches
Diarrhea


Dissociative Symptoms
Depersonalization
Derealization
Emotional numbness
Severe depression
Memory loss

Other Symptoms
Inability to carry out and prioritize tasks
Morbid fixations on minor problems
Physical and mental exhaustion
Sexual dysfunction

In addition, high levels of psychic pain and physical discomfort often lead to secondary problems such as substance abuse, television trance and compulsive, sometimes deviant, sexual behaviour.

Diagnosis
Because the patient suffering from Acute Tour Disorder rarely seeks help until the the condition has resolved itself into Post Tour Disorder (i.e., until after the tour is over), the diagnostic history is brief. Opportunities for diagnosis usually present themselves after a severe functional breakdown or when some overt behavioral abberation is brought to the attention of law enforcement and/or medical professionals. After an examination of the patient’s history has ruled out diseases that can cause similar symptoms, diagnostic criteria can be set as follows:

* The patient presents six of the above symptoms
* Onset of the symptoms was in the first six weeks of the tour      
and show no signs of reduction

Treatment
Treatment for ATD usually includes a combination of antidepressant medications and short-term psychotherapy.

Prognosis
The prognosis for recovery is influenced by the intensity and duration of the tour and the patient's previous level of functioning. Prompt treatment and appropriate social support are major factors in recovery. If the patient's symptoms are severe enough to interfere with normal functioning and last longer than one month, the diagnosis may be changed to PTD. Patients who do not receive treatment for ATD are at increased risk for additional symtoms characteristic of PTD: narcolepsy, major anxiety/depressive disorders and concomitant behavioral abberations.

Prevention
Of course, the best way to avoid ATD is a real-world transformation, such as a change of vocations. With this choice, however, unknown factors come in to play, often linked to the withdrawal of attention from audiences, crew and industry flaks, i.e., a steep and sudden reduction of narcissistic supply. In theory, prompt professional intervention might reduce the likelihood or severity of ATD.

-Donald Fagen

Comments

[Lena Nedergaard]

Hello Donald- won't you write some more?
Best regards,
Lena