LIVING WITH PTSD

'Nightmare', copyright: Janine Harrington

A soldier walking along the roadside in Afghanistan witnesses the death of his colleague and friend. Years later, spending Christmas with his family, they switch on the TV at the end of a day, chatting and laughing, relaxed in the easy atmosphere around them. Suddenly, a shot is fired on a film. The young man instinctively ducks, body crouched, eyes alert, furtively looking for signs of the enemy. He's reaching for a gun which is not there. His head whips this way, then that, seeking out the rest of his battalion. Why can't I see them? Are they safe? When was the last time I saw Tim? Trapped in the hell of his past, his actions are ragged, taut, emotions stretched to breaking point. He hears nothing of what is going on around him as slowly, he withdraws to a place deep within himself. Finally, he drops to the floor, folding and hunched like a fetus in the womb, unable to stop his emotions breaking free, sobbing, hysterical, frustrated, anguished, despairing. Nothing makes sense. His sister has never seen her brother like this. She doesn't understand. Concerned for his welfare, immediately she switches off the television and draws to his side, kneeling beside him on the floor, drawing him into her close, hugging and holding, speaking soft in his ear that he is safe, protected, loved. That's all that matters now.

A lady is driving her Citroen down a road she's travelled many times before. She's heading home on a normal weekday, humming along to a tune on the radio. Unexpectedly, from around a corner, a car veers to her side of the road ... slamming into her with such force metal buckles, the windscreen shatters, her body, like a rag doll, is thrown against the steering wheel, held from going further by the seat belt straining tight across her body. Years later, she is still reliving those moments, regurgitating the past, repeatedly feeling the violent thrust of the car careering into her ... seeing the road ahead fragmented through the shattered windscreen ... hearing the crunch of metal ... the smell of burning ... while her chest remains restricted, unable to move, Time held on 'Pause'. Her confidence is so shaken she cannot drive. Even getting into a car or any moving vehicle is tortuous as the crash replays over and over in her mind. She can't switch it off. It's stuck on a loop, while she remains lost in moments from the past.

A girl is taunted in the school playground. She knows the bullies, but doesn't understand why it's happening to her. They take her satchel, tearing her books, ripping up carefully-written homework, removing vital pens, throwing them from one to the other, all the time chanting stupid rhymes about her, calling her names. Once the bell rings and they're inside a classroom, still they target, pulling her hair, tormenting whenever the teacher's back is turned, dragging her chair from under her. At playtime, she hides in the toilets. They know where she is and they bide their time. While she sits, contemplating the dynamics of taking off her tights, looping them around the pipework above, inserting her head in a noose and jumping from the toilet seat in an effort to end her hopeless life filled with despair. Tens of years on, in the workplace, she's still trying to identify the bully. There's always one. She feels weak, vulnerable, helpless in stopping petty acts carried out against her. While at night she hears again the taunts in the playground, seeing faces glaring, spitting, provoking her into a reaction that doesn't come ... other than running away. Her spirit was broken long ago. She supports and helps others, knowing and understanding their need, but inside feels a complete wreck, a nobody, someone who counts for nothing at all.

A small child is sexually abused by a specialist at a hospital she attends three times a week for treatment. Abuse started at the age of four years old. By the time she returns home with her mother a long bus ride away, she remembers nothing of her ordeal. It is blocked somewhere deep within her mind, where bad secrets gather. All she recalls is the donkey ride at Kennards, and the drink and cake in a cafe. Otherwise, there are no words to describe what happened, or a way of making sense of her ordeal on the couch behind the dark green curtains of the cubicle. By the time she reaches home, she remembers nothing about it - a safety mechanism which helps her survive, although something prompts her to wear dungarees and five pairs of knickers each time her hospital appointment comes round. In teenage years, she is sexually abused by a music teacher both at his home and at school. The feelings she experiences are somehow familiar. Meanwhile, she has no idea how to stop her abuser, much less who to tell, adopting the belief it's all she is worth, and who will believe her anyway? She becomes withdrawn, depressed, enveloped in a tsunami of emotion including panic attacks, unaccountable fear, deep depression and dread. She feels so bad inside, she self-harms. It's a way of externalising her pain. Only in later life do puzzle-pieces of memory return, finally making sense of secrets hidden somewhere dark and deep inside which only now begin to surface. Today, she remembers it all. But despite years of therapy, she continues to carry a lead weight in the pit of her stomach, unable to shake free from past pain and fear. Like a rabbit caught in a car's headlights, she can unexpectedly become frozen in Time, her mind filled with swirling images, taking her back to the room where it happened, unable to break free of her abuser and his control over her life, still feeling the pain, the shame, wondering who she might have been had it never happened to her.

Trauma.

Each experience different, yet in the aftermath, filled with the same gamete of emotions.

However long or short the trauma, its effects can last a lifetime.

This is known as Post Traumatic Stress Disorder.

It can happen to anyone at any point in their life - any age, sex, creed, colour, affecting that person forever. Trauma can come from:

• natural disasters - such as a tsunami, a flood, a landslip
• car crashes
• sexual or physical assaults, by someone known or who is a stranger
• torture and enforced confinement
• witness or involvement in an horrific event
• terrorist attacks
• combat during wartime

It represents a cauldron of extreme anxiety and fear, which, when triggered usually by what other people would consider everyday experiences; bubbles over, leaving its victim petrified, confused, disorientated, afraid, helpless, so caught up in their past experience it is as if they are actually there, living it over again. In turn, they dis-associate from present day activities, entering what is referred to as a 'Fugue State'.

Everyone dis-associates to a certain extent. An obvious example is when driving a car on a motorway. Driving mile after mile after mile, it becomes monotonous and, without realising, you go on automatic pilot. Thoughts trickle through your mind ... what to have for tea, how to spend the evening, or puzzle over a thorny problem at work. Suddenly, you're jolted back to reality with no idea how much time has passed, or where you are. A 'Fugue State' is similar. It can be triggered by an everyday event linking back to that past historic trauma, drawing that person back in time, feeling as if it's happening again, until something jogs them back to the present and they're left with residual feelings that linger.

Post Traumatic Stress Disorder (PTSD) was first realised during the Civil War when it was known as 'Soldier's Heart'. During the First World War, the horror of fighting in the trenches, seeing friends blown up, lives shattered, families gone, sitting in the dark waiting for the enemy to strike, understandably took its toll. It became recognised as 'Shell Shock'. Later, during the Second World War, it adopted the label 'Combat Fatigue'. However, for those unfortunates labelled 'LMF' as it became known: 'Lack of Moral Fibre'; it became a living hell as they were bullied for being cowards, 'less-than', showing what everyone else was feeling but keeping hidden for fear of being treated the same. The condition may have been around for thousands of years, yet still it remains difficult to diagnose, controversial, and those experiencing it misunderstood ... which only makes their condition worse.

Living with PTSD means:

• recurrent nightmares
• acting or feeling as though the trauma is happening again, known as 'flashbacks'
• having physical symptoms - a surge in heart rate, sweating, shivering and shaking, lack of concentration, disorientation, memory loss, inability to easily speak or share, an incredible fear and gut-wrenching sadness, panic attacks, hysteria, paranoia, a desperate need to feel safe
• difficulty sleeping
• high levels of anxiety
• irritability or outbursts of anger
• feeling constantly 'on guard', as if danger lurks around every corner
• loss of interest in important, once positive activities
• isolating oneself, avoiding public places and people, yet at the same time needing company, but not knowing who to trust, who might listen and care
• seeing the world around losing its colour, seeming flat and empty
• loss of positive feelings such as happiness and love

Many people try to dull the pain they carry caused by trauma by taking drugs or alcohol. It's the reason they can't be helped because drugs and alcohol are not the real issue. It's the trauma that lies beneath. No-one can help or truly be effective until or unless they reach a point when they need to help themselves. It has to be in their own time.

There are no remedies. No cure. Nothing that can become a quick fix, or take away the memory of what happened, no matter how many years ago.

All it really takes is for someone to be there no matter what, someone to care and support, willing to simply listen and learn. Even if they don't understand, it's vital to offer a hug, to sit and just be. Whatever actions they display, it's important to realise it isn't their fault. They are not to blame. It was the trauma which put them in the dark place they are today. More than anything else, they need understanding and love. Building trust is key to finding a way through the memories which continue to haunt. The phrase 'You should be ... this, or that or the other' doesn't have a place. Nor should people judge. There are many quotations on this theme:

'Never judge someone without knowing the whole story. You may think you understand, but you don't.'

'Walk a mile in my shoes, see what I see, hear what I hear, feel what I feel, THEN maybe you'll understand why I do what I do, 'till then, don't judge me.'

'Not everyone thinks what you think, knows the things you know, believes the things you believe, nor acts the way you would act. Remember this and you will go a long way in getting along with people.'

What is important to anyone living with PTSD is identifying the triggers which cause reactions, taking you back to a place you don't want to be, reviving memories, and with them the reliving of the trauma over and over and over again. Once you know what your triggers are ... and there may be many ... then be prepared. Know what to do when they come if you can't remove or avoid them. Triggers can be diverse, including all of our five senses.

For me, my main triggers are:

• the colour green ... the kind of green which was left over from the Second World War and many places ended up in the early 1950s being painted that particular shade, including the hospital where I was abused.

I never wear the colour green for this reason, and inadvertently, without me even realising I'm doing it, as I enter a room, I'm glancing around, on the look out for that particular colour. If it's there, then I divert to a different room if that's possible, or else turn my back, putting the memory of it behind me.

•  hospitals and dentists

It's a known fact that survivors of abuse particularly are phobic in the extreme about both. It has never been explained as to why dentists, apart from being invasive.

• someone delving unexpectedly into my past, questioning, pushing, judging, without respecting my wishes to stop, or to change the subject

Exploring someone's trauma to know what happened is one thing. Examining it in detail is something else. Wanting to satisfy one's curiosity, or worse, preparing to disbelieve or challenge what happened when someone has had to live with the effects of that trauma most of their life is tantamount to secondary abuse. The person who experienced the trauma has to be the one in control, the one who chooses to share ... and that in itself is an incredible privilege because it means they are giving you the gift of trust.

•  the dark

I always have lights on when I go to bed at night. Always. Memories of what happened in the past comes alive in darkness ... especially so if unexpectedly there's a powercut. It means I freeze like the rabbit caught in a car's headlights. I can't move. Even to reach the torch under the stairs.

•  raised voices, arguments

I never argue. People can call it 'a discussion', but when it gets heated, then that's me ... gone! Again, it evokes scenes from the past, drilling through feelings from another time, other people, different places, and walking away is about protecting myself ... and I have that Right!

•  someone drinking, becoming loud, or being around when people come out of pubs/clubs

I don't drink alcohol. I have never taken drugs, other than prescription-based from the doctor. I have worked with addicts of both and earned their respect through listening to the pain behind what has become their crutch to get through life. I don't know why I never followed this path. I just feel it would have given me a completely new set of problems when I already had more than enough to cope with. Now I avoid any situation which might take me where someone has drunk too much.

•  living alone

There's something called 'The Domino Effect'. Living alone, cocooned with my problems and daily stresses of life, it's easy for one thing to trigger  reactions from the past  ... until they're all lined up like soldiers on parade, and once one falls, it brings down the rest, leaving me in a very dark, deep and lonely place, locked inside with only past memories for company. Feeling isolated, vulnerable, fearful, helpless, are feelings which I live with on a day-by-day basis. It's harder because there is no-one to talk with or share. I can go days without seeing anyone. My instinct is to pull up the drawbridge, withdraw, snuggle into my womb-like existence. But the longer that happens, the harder it is to open the door and step back out into the world. So I set myself targets, small challenges, living on a dot-to-dot basis, ensuring I know where that next essential 'dot' will be, looking no farther than the day ahead. I have a Lunch Club I can attend on a Monday to get my only home-cooked meal of the week, and other points of contact to which I go to be among people. This is vital to a survivor. It is then you can hold your head high, and say with conviction:

'Before you start to judge me ... step into my shoes and live the life I am living and if you get as far as I am ... just maybe you will see how strong I really am.'

There are many many triggers, everyday triggers, the trauma doesn't go away, but lives on in memory, its effects known and lived with daily. I have worked as a Counsellor with countless people who have experienced trauma, and continue to live and manage their trauma and its effects today. Sharing with someone who has experienced the same is the best way forward, realising you're not alone, learning from them in the sharing how they manage their life today, in the aftermath of trauma. It is possible to share without words because you already know ... you've been there, you understand the emotion as your own. Sharing is a powerful force. It breaks the control that trauma has over you. It allows you to realise you can take back your life. It doesn't mean you won't ever be affected again. But be prepared. Understand your triggers. Know what to do when they come. Have a safe place to go, a safe person you trust to talk to. Don't build walls around yourself. In the end, instead of a protective shield, it will become your prison. You need to break free.

Don't be afraid to be yourself. Your true self. Have the confidence to smile, to live, to laugh, as well as to cry oceans of tears. After all, you survived. That in itself is cause for Celebration!

'Never forget that walking away from something unhealthy is brave ... even if you stumble a little on your way out the door.'

'Sometimes walking away has nothing to do with weakness, and everything to do with strength. We walk away, not because we want others to realise our worth and value, but because we finally realise our own.'

Guardian Angel, copyright: Janine Harrington