"There's nothing wrong with me!"
In life we come across
things that happen so fast we frequently have no time to reflect on what is
occurring around us. An accident, stabbing or witnessing another being
seriously injured or killed. It becomes more horrific when we ourselves
witness anotherís death or injury whilst in a war or battle situation.
That feeling of terror, horror and helplessness, whilst attempting to assist
in the saving of anotherís life. Ignoring danger we place ourselves into.
Put bluntly we think and deal only with others, neglecting our own safety.
It is later when we relax away from this mayhem; those effects begin to take
hold on our rational thinking and behaviour. We start thinking rationally
and calmly again, or do we!
Is it possible we reflect on how lucky we were, escaping out of a hell
situation with our lives intact? Yet not forgetting colleagues, fallen in
the field of battle never to be seen again or able to return home to loved
We are no longer under stressful situations, and hopefully return to our
level of coping abilities. Those events hurt so much inside, are so personal
to us, we try to keep them secret. We find it difficult to use meaningful
words. Any statement to describe in words what has taken place is
impossible. Finding the courage to discuss the matter is now beyond
comprehension, no words are making sense to the Survivor, yet alone the
listener. This adds fear to the Survivor that they are "cracking
We struggle with this burden of extra weight, the loneliness hurting and
festering away inside. This causes grief to be more internalised. At that
stage we pay the price in pain.
Many incidents become more heart wrenching and unreportable than others.
Incidents that inflict deep, personal suffering can be rape, a miscarriage
when caused through anotherís criminal act, a fatal traffic accident,
attempting to rescue another that did not succeed.
In one incident a soldier could have prevented a colleague from being shot.
The soldier levelled his gun at an enemy pressed the trigger and the gun
failed to operate. This resulted in his colleague and best mate being shot
dead in front of him. That memory the lad had to carry around inside his
head, living with it every day locked away a secret inside his mind.
Subsequently, falling into the trauma trap of PTSD.
He could no longer carry on without help. The trauma trap ensnared him,
simply because he took on board the guilt, for what occurred. He was the
only soldier in a position to take out the enemy gunman. This soldier in all
reality could so easily have been one of us. Would we feel the same as he
did? I leave the reply with you.
When tragedy strikes, our reflexive response is "Why this? Why now?
These questions have no easy answers. That doesnít mean the questions
should not be asked. It only means we may not find satisfactory answers to
Anger, frustration and an overwhelming grief are common emotions flowing
from experiences of great trial or pain as described above. There is no
easy fix for these feelings. To assure another of a quick fix would be
tantamount to being totally negligent in the care of a patient.
We all need to be fully in contact with our feelings and emotions.
That is why we respect feelings of survivors, to give them their time and
space. A time will come when survivors realise that they need to move on
and forward. To move on emotionally, that they cannot become stuck in one
incident, as many describe "this out of control feeling".
I do not wish to give all the definitive Criteria here for PTSD, which can
be gleaned from books borrowed from a library. I hasten to add an Individual
who has PTSD will probably be able to quote the Criteria from their head.
The only experts in this field are the survivors sitting in front of us,
relating all the signs and symptoms they are encountering. A pity the
so-called experts did not listen to them more often!
A one-sentence definition for PTSD:
"The sudden cessation of human interaction".
This condition has existed since the times of the ancient Greeks. I would go
further back than that but it would be nit picking! We are accepting PTSD
today, which existed previously as "soldierís heart". In World
War 1 "shell shock", World War II "war neurosis". It
is interesting to note Psychiatrists and Psychologists actually began
getting nearer the truth when they were diagnosing many soldiers with
"combat fatigue" when experiencing symptoms associated with PTSD
during combat. The expression "combat stress reaction" arose
after many soldiers developed symptoms in Vietnam. The symptoms initially
did not subside, and many went on to develop Post -Traumatic Stress
Disorder, which at last was given a diagnostic criteria within the APAs DSM
III. (American Psychiatric Associationís Diagnostic Statistical Manual.
It is not natural, normal or even expected individuals placed under these
conditions such as a combat situation, are going to remain fully alert and
It is however natural and perfectly normal they become tired and fatigued,
physically and emotionally drained. Any person with a grain of common sense
knows this will be expected. It is also foreseeable.
We only need think for a moment how would we react with bombs and gunfire
dropping all around us. Would you feel safe trying to go to sleep, or
resting with the barrage of incoming fire and mortarís whizzing past your
head? Falling nearby with the resultant loud explosion and debris scattered
all over. If all this was not enough the food and rations on the battlefield
are few and far between when actually locked in conflict, this leads to
hunger, and subsequently lack of proper food (rations) over a period of
A factor ignored at time of conflicts, taken for granted, (which catches up
with us later in life) was crawling around and even to lay down in freezing
water and mud. This may have occurred over days, even weeks. When there is a
lack of proper waterproofed clothing the potential for other physical
If an individual becomes soaked to the skin in an open and hostile
environment, unable to seek proper cover, the soaking wet clothing may have
to remain on the person for several days. This again is another trigger
overlooked, which can be a cause of anger and frustration when later
suffering from arthritis and pain. Individuals who feel they gave everything
in a just cause. To return feeling neglected, let down, totally ignored and
snubbed. In other words they have past the sell by date, been cast off and
left to fend for themselves.
When Individuals then start presenting themselves before the Medical Officer
or GPs reporting initially with the following:
Headaches, aches and pains
Feeling tired and
Finding it impossible to
concentrate, inability to complete simple tasks
Poor memory and
A total lack of energy
Irritability, inability to
relax, disturbed sleep
The symptoms above could so easily be mistaken for Anxiety, Depression, even
chronic fatigue syndrome, (referred to as 'ME')
When questioned further by the GP, and the following symptoms are present:
Hypervigilance, disturbing dreams, flashbacks and night sweats - then the
warning bells should now at least be clanging away "PTSD".
If the presentations are delayed for several months or longer following the
trauma it is at this stage the Doctor may enquire if there has been any
history of a stressful event. An event may come forth where they experienced
intense horror, fear or helplessness. It is now the pieces of a large jigsaw
are beginning to fit into place at last. The patient is now informed the
likely cause of these distressful symptoms may be termed PTSD.
The patient feels a little better knowing there is something wrong. They are
not cracking up, they are not mentally ill. What are now taking place are
natural and normal reactions to something, which is certainly NOT NATURAL to
most human beings.
When a diagnosis of PTSD is made, that is fine. It is now the frustration
that lies ahead in an attempt to get treatment. Survivors referred to me
have personally informed me they would have had a wait of 12-18 months had
they not got an appointment; this is totally outrageous and unacceptable.
A support system is the very least required at this stage, otherwise it goes
from a solitary individualís problem, which begins to affect spouses,
children, and family and work colleagues. This is where Tertiary PTSD takes
a stranglehold. The whole cycle starts off again within another, and may be
not picked up for weeks, months even years.
The next question is "So what can be done about it? What treatment is
Obtaining the appropriate treatment for PTSD unfortunately is not as
clear-cut as one might imagine. First, the person diagnosed with PTSD has to
accept something is wrong then appreciating the benefits of seeking help.
Getting help is not easy it can be both frightening and threatening. Simply,
they are walking into unknown territory. Is it not reminiscent once more of
a battlefield situation!
"Will this mean the end of my job? Will my Employer have to be
informed? If my Partner finds out, will he/she walk out with the children
thinking I am unsafe to be left with them? If I loose my temper one more
time I will loose my partner!"
These questions are raised constantly particularly with Armed Services
personnel and those in the Emergency Services. What a sad reflection on a
supposed caring Society!
Without that first step in coming forward to receive help, progress is not
possible in aiding their future recovery.
"It is not easy to find a Specialist who understands PTSD and to whom
you may be able to relate and trust". This is another common remark.
I would advise all, to seek out as many sources of help you may find, until
you feel comfortable and safe enough to relate what occurred in your past.
There are many different aspects of treatment even more different
approaches. Treatment for PTSD may often involve several stages:
Crisis stabilisation and
Education about PTSD and
Strategies to manage the
symptoms (such as anxiety, anger, depression, alcohol abuse, sleep problems,
and relationship problems)
Trauma focused therapy
(confronting the painful memories and feared situations)
(learning to think more realistically and re-evaluating the meaning of the
Relapse prevention and
Lastly it is vital for those seeking help to grasp and understand treatment
can be painful and hard work. There is no easy way to let go of the memories
or make them less distressing.
There is no magic tablet or wand to make it all instantly disappear. We can
reassure that the long term gains can be enormous: that effective
treatment can dramatically assist recovery, helping Survivors become
thrivers to live a normal life once again.
Talking, supporting, reassuring and lending a listening ear is vital in a
If you have confided in a friend who has this condition, and promised you
would support them, be there for them, please donít let them down. It is
your support, friendship and trust that keeps them going forward, until they
can walk that path on their own. When attained you both become friends for
David Bennett (Director)
Traumatic Stress Centre (Wales)
17, Ruggles Terrace, Morriston, Swansea. SA6 7JB
Tel: 01792 521063
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