I would like to try and explain two things: what it is like having post-traumatic stress, and some basic recovery strategies. The first part is for those who are trying to understand what post-traumatic stress is. The second is for those living through the daily and nightly assaults of the trauma. Though I am trained in this field I am going to write from my own experience, because I think that can sometimes be more helpful. I am not suggesting that professionals in my field cannot help with post-traumatic stress. They can and they do, and to great effect, face-to-face, working with and alongside those in this kind of intense pain. It is just that being around people that went through the same violent experience is a very important first stage of recovery. Not having to explain yourself means a great deal when almost every aspect of life has become an internal battle. Post-traumatic stress splits existence between two worlds—’Now’ and ‘Then’. ‘Now’ is just that, wherever you are right now. ‘Then’ is the world where the trauma was triggered. The apparent neuro-sadism of post-traumatic stress is that the world of ‘Then’ makes the world of ‘Now’ unbearable for the sufferer. At times they cannot tell which one they are in, and characters seem to move between the two worlds, cruelly haunting in both. My experience was that the ‘Then’ world had a lurid reality that the ‘Now’ lacked. The world that I was trying to convince myself was the real one had a muffled quality, and it was as though I saw and experienced everything from a distance. Different stories Here is a soldier. He and his patrol unit were ambushed in a hot, busy marketplace. His two closest comrades were killed beside him as he was trying to pull off his dust goggles because he could not see. He had looked down, for one moment, and he still cannot understand why he was not shot as well. He may have come home, he may be back with his family, and in the apparent comfort of daily life, but the ambush returns all the time. If someone comes towards him when he is in the flashback world of the ambush, whoever they are he attacks because they are a threat. In that moment he cannot tell who anyone is, his wife, brother, his children—anyone who approaches is the enemy. There is no peace. One of the most patronising things someone can say to this man is ‘I understand’. You do not, unless you have been through the same thing. This is hard to accept because it could be read as a criticism, but what he has been through is unimaginable to anyone who has not been through the same thing. Here is an eight-year-old girl. She was asleep in her parents’ bed when floods tore through her mountain valley home. A month later she can only remember one clear image from that night—her grandmother clinging to the side of their rescue vessel, an inflatable child’s paddling pool, her clothes torn away by the dark, thundering water. The girl was horrified by the pale weakness of her grandmother. Many other children experienced the same flood, and a month later a lot of them are behaving in the same ways as this girl—nightmares, clinginess, crying, tantrums, not doing well at school, for those where the schools are still functioning. Every night the girl has nightmares. She cannot sleep without holding her mother’s hand, and she wakes screaming, seeing again her grandmother flailing in the water. Even though her grandmother survived the girl seems to find no comfort in this. In fact it is the opposite, and being around her grandmother upsets her. Her teachers, equally traumatised by the flood disaster, lose their tempers with her and the other children, for their inability to concentrate, and their apparent stupidity. Yet these are all natural responses, and will pass in time as the children adapt again after a couple of months or so. But if the nightmares do not fade, if the girl continues to be disturbed around her grandmother, if she goes on finding it hard to understand class material that used to be easy for her, and if she needs to go on holding her mother’s hand in order to sleep, this is when more than patience is needed. This is when, in spite of the extreme differences in the nature of the violence that they have experienced, the girl and the soldier are having the same struggle with processing what happened to them. The soldier says: ‘I don’t recognise myself anymore.’ The girl says: ‘Everything inside me is black.’ This soldier and this girl need to be supported in different ways, partly because of the differences in their ages, their cultures, the circumstances of the trauma they experienced and the aftermaths, but there is also a set of basic principals that both need to follow. Finding the way back Anyone who thinks or knows that they have post-traumatic stress needs to understand that the best place to be is with other people who know what you have been through. This is hard to get because every base instinct is probably telling you that you need to be alone. It is very important that you find a way to accept that your basic instincts are not serving you well at the moment. They are very, very loud and persuasive, but they are giving you the wrong messages. Your most profound survival mechanism has been badly bruised, and it needs time to recover. The structure for that recovery needs to be based on the following things: Routine – the days and nights will get easier if you have a structured system. This means getting up and going to bed around the same time every day, and having a realistic timetable that works around these two times. This is harder for adults. Children are used to being put to bed, and woken. For adults support in sticking to these times is vital. Key to these times is…. Sleep – this can be the place of the greatest comfort but it can also be a place of torture. We are conditioned to think of bed as ‘safe’ but the flashbacks and nightmares can make the nights hell. This is why so many traumatised people actually go to great lengths not to sleep so that they can avoid the nightmares. Finding the way back to a good sleep pattern is very dependent on allowing your system to slow down before trying to sleep. Stay off all the things that stimulate you for a good two hours before sleep – that means caffeine, alcohol, smoking, sugar, hard exercise, being on-line (in any form), and away from TV unless it is something very mellow. It’s a good idea to eat at least two hours before going to bed. Which leads on to… Eating – one of the many difficult impacts of this kind of trauma is that is messes up eating habits. A lot of soldiers, actually let’s face it, almost all young men, are not great about how and what they eat. Children are fed, and parents usually go to great lengths to make sure that their children eat as well as possible. It is an act of love. So why do we cling to junk-eating habits as adults? (Don’t answer that—’it tastes fabulous’ may be true, but would your large intestine give the same answer?) Nourishing food just makes you feel a lot better, and good food is one of the most natural ways to soothe your brain chemistry. Eating can also be a good way of staying in the ‘Now’, as in focusing on the tastes in your mouth, the different textures, and how the tastes change as you chew. The more you chew the better. Half-chewed food is hard to digest, leading to yet another load on an already over-stressed system. It’s useful to remember that there are no teeth in the stomach. Conscious, thoughtful enjoyment of chewing is good, and surprisingly relaxing too, though I know that is beginning to sound like a schoolteacher, and on that note… Exercise – here is a line from John Ratey, a professor of Psychiatry at Harvard Medical School: ‘A bout of exercise is like taking a little bit of Ritalin and Prozac right to where it is supposed to go.’ In short, exercise is the equivalent of taking an anti-depressant. And to flip that around, not exercising is like taking a depressant. Exercise is arguably one of the most powerful supports that you have. I struggle if I cannot exercise, and I can feel the symptoms sneaking back, particularly when the pressure is high. Walk, run, swim, box, wrestle, dance, skip, just do anything that will allow the excess of adrenalin in your system to be burnt off. Exercise has the extraordinary capacity to shift the whole mind-set, and its importance cannot and should not be underestimated. It is particularly important for children as exercise, or any kind of jumping around, allows them to release both physical and psychological tension. Talking – we are all storytellers by nature. Answering the simple question ‘how are you?’ is a form of storytelling about ourselves. When we stop talking there is something wrong. Grief, despair and anger all have the capacity to shut us down. With post-traumatic stress, all three of these are often in play. To be able to tell your story is the beginning of recovery. But the question is, who are the right people to talk to? This is very important, and perhaps the key is talking to people who you feel safe with – those you served with, those who you went through the experience with, and those you know you are not going to have to explain yourself to. Seek out those in my field, a psychotherapist, psychologist, psychiatrist, or counsellor. This is the chance to begin a powerfully supportive therapeutic relationship that has the potential to change how you see yourself and your life. And go and find a group of people, whether it’s a military support group, a 12-step progamme, just any group where you can be with others who will get you and what you have been through. For children school provides a group environment, and this has its own advantages and disadvantages, but there is going to be another blog just on this subject… It is easy to write about joining a group, but often we cling to the idea that we will be okay, that we can do this on our own, and that joining a group would be like an admission of defeat. It is not. Just walking through the door into the group for the first time can feel like one of the hardest things you have ever done, but you will never regret it. Awareness – the past, the world of ‘Then’ makes it very hard to be in the world of ‘Now’. Awareness is the key. It means focusing on something that is happening right now. The easiest one is breath. All you have to do is put you hands on your belly and take one slow breath in, right down to your belly, and then exhale slowly and steadily. Take a few more breaths like this, staying very focused on your breath, and also relaxed in your body. See how slowly you can take these breaths. And notice how you feel afterwards. There is no more to read now. More will follow on this in further postings, but now it’s your turn. Please look up from the screen. Start by taking just one long, slow, easy breath. Close your eyes. Breathe.