By Paul Fjelrad
Why, once you understand PTSD and hyper-vigilance, there's no way back for me.
Amongst the many things we'd all love to see the back of, I think we're all universally fed-up with the phrase "grim milestone". However, we are now in February 2021, and I've got a particularly challenging milestone on the horizon.
I gave up my apartment near Canary Wharf and left London on February 28th, 2020. At the time COVID-19 was a mostly distant phenomenon being reported on as international news, but we had just got reports of the "first" cases here at home as well. However the reason I left London was just because my contract was up, and I wanted to spend some time on my boat.
Ironically, although I didn't know that at the time, I was feeling a need for some solitude.
Little did I know that my plan to spend a few months sailing and getting a much-needed break from the noise and crowds of London, would turn into a year in almost complete isolation.
Of course we haven't spent a year in lockdown, yet I've only spent a few weeks with any company other my own since leaving London. This is because Complex Post-Traumatic Stress Disorder, a global pandemic, and hyper-vigilance are a seriously shitty combo.
Since the beginning of this, it's never been about what I'm "allowed" to do, but what I feel "safe" doing. "Safe" is of course a relative term, and perhaps the best way to describe hyper-vigilance is as a faulty fire-alarm. When you think you're in danger, your primitive brain will trigger a threat response. This causes a cascade of hormones that produce a well understood and well-orchestrated litany of physiological changes.
We've all experienced a situation, such as a near miss in traffic, or a sudden scare when you bump into someone in the dark. Even if you rapidly determine there was no actual threat, once the "alarm" has been rung the natural defences take a moment to lower the DefCon level. Even as we laugh it off, the heart continues to pound, our breathing remains quickened. It can take several minutes for our muscles to un-tense and the beads of sweat to dry.
For those of use with PTSD, that mechanism has been overwhelmed, leading to a faulty alarm system. One of the defining characteristics of Complex PSTD is having lived in fear, with no hope of escape, for years, usually in most critical and defining period of childhood. In the most severe cases, such as my own, you lived with this since birth, and have no "pre-trauma identity".
When I first heard that phrase, "pre-trauma identity", I was confused and horrified in equal measure. I don't know about you, but for me those words are so loaded with the shadow of terrible consequences that I took my weeks to process them. Maybe you won't want to read any further, and I wouldn't blame you if you didn't, but if you'll walk with me a little further, then I'll explain.
In trauma survivors who go on to develop PTSD, the majority will have had a "regular" life before it the traumatic events turned their world upside down. This means they remember a time of having the typical response to a threatening situation. The alarm goes off, the mind and body respond, and when the danger has passed, they return to a normal state of alertness. Following the development of PTSD, they now have to deal with a faulty alarm mechanism, that sometimes goes off when there is no actual danger, but something has triggered a flashback and they re-live those traumatic experiences.
And to be clear, by re-live I don't mean just remembering it. The words "re-live" really don't capture what it's like to experience a flashback. Their trauma is no longer something that happened, but is something that is happening, right now. You could be walking down a street, and catch a glimpse of something, or there will be a sound, smell or word that triggers you and boom, suddenly you're back in the burning building, being attacked, watching a friend die, and your mind and body responds just as it did in the moment. You feel everything. The body reacts with the same cascade of hormones and physiological reactions. Yet somehow, if this is even possible, it's worse. Being hurled without warning from where you were into the middle of your trauma, over and over, knowing it's not real, yet also having every fibre of your being, and your most primitive instincts, telling you it absolutely is real, is traumatising all over again.
This leads to hyper-vigilance. Now your alarm system is on high alert all the time, ever ready for fight, flight or freeze. In the Body Keeps The Score by Bessel van der Kolk, the impact on the body, as well as the mind, is described. You are physically not built to run on a never-ending supply of stress hormones. They are like nitrous oxide (NOS) for race cars. Sure they can super-charge the engine, and make it go a hell of a lot faster for a short sprint, but if you keep using it, the engine will be damaged and eventually explode. Our bodies are no different.
Running on high-alert, is damaging to the body and the mind. Some studies have shown that prolonged severe mental illness can shorten lifespans by 10-15 years or more. Research has shown increased risk of heart-disease, cancer, and other serious illnesses. Survivors describe living in constant pain, with migraines, back and neck ache, insomnia, palpitations, sweating, and night-terrors. I've experienced all of these for as long as I can remember.
However, with the right treatment, and a lot of hard work, many with PTSD can return to their pre-trauma state. It is likely they will have been changed by their experiences, but we would of course expect that. If you think of PTSD as an injury caused by the original traumatic events, then it's not unexpected that survivors will carry their share of scars, even if you can't see all of them.
But we return to Complex PTSD, and the difficult to comprehend phrase, "no pre-trauma identity". My mother was not a very nice person. As far as understatements go, that's right up there with the sea is a little bit damp.
I have images in my head of fists raining down out of the darkness, my mother's face twisted in animalistic rage, the feeling of my back against the wall, my arms over my head, the harsh weave of the carpet underneath me, and the softness of fleecy pyjamas against my skin. All accompanied with overwhelming fear, and yet the instinct is only to curl up in a ball and wait for the storm to pass.
When I first described this flashback, for which I have absolutely no context as these are not events, I remember, my therapist described them as "pre-language". That's another horrible phrase right there.
When I asked my oldest friend, and the only person I can speak to who remembers my mother, if he could ever imagine my mother comforting a crying infant, the look on his face and his silence told me what I already knew.
Trauma raised me, from the infant cringing in fear who rapidly learnt there was no comfort to be had from his mother, to the man I am today. I have no pre-trauma identity. There is no way back, no sense of normality, for me to return to. I had to build a post-trauma identity, and endeavour to teach my faulty alarm system, a new way of looking at the everyday threats that surround us all.
It's been 8 years since my diagnosis, and after 3.5 years of intensive therapy, and a lot of hard work, I was doing pretty well. Then came the pandemic.
We're all feeling aspects of "pandemic burnout". The daily recitation of infections, hospitalisations, and deaths have become so commonplace, that many of us feel numb to them. When masks first appeared on our streets, we were all a little freaked out, but now it's jarring to see someone in a shop who isn't wearing a mask. We struggled at first to remember not to shake someone’s hand or move closer when we wanted to speak to someone, but now we all know it's going to feel very weird when those guidelines are removed.
But imagine, if you can, what it's like if you are constantly on high alert. Instead of becoming numbed to these threat signals, they only become more intense over time. When the restrictions were lifted during the summer, I ventured into town for the first time in months, and after a few minutes, all I wanted was to escape into solitude again. Lockdown felt more comfortable. When I did have to venture to the shops, the streets were nearly empty, and I could pick a time when I'd be the lone shopper. Of course I'd developed techniques to calm my fault alarm system, but now these were being overwhelmed again, because these weren't false alarms because my sensors were on the fritz, the threat from the virus was and is very real.
So even when the restrictions were eased, I've lived more or less as if we were in lockdown. I've had visits from two friends, one of whom had just recovered from the virus, and therefore would have the temporary protection of immune response antibodies, and the other had been isolating herself for a period before visiting. Even then I was on edge. I tried to reacclimatise myself to being in proximity, albeit social distanced, to people, by sitting outside a pub on a sunny day, but it was like I had something in the back of my head, constantly telling me I'd left the gas on, and shouldn't I rush home to check.
So, I retreated to the safety of solitude, and there I have remained. Initially I spent most of the spring, summer and early autumn, living on my boat, anchored in the middle of river, 4 miles west of Plymouth.
Then as winter approached, I rented a remote cottage in Cardinham Woods, Cornwall. I love living on my boat, but being stuck in a marina during winter, unable to go out, would be like living in the middle of a car park. So since I am fortunate enough to be able to work remotely, even when there isn't a global pandemic raging, it made sense to go somewhere then I could get out and feel like I could breathe, whilst also maintaining my solitude. Plus the views from my front door, are pretty spectacular.
So during this time I finished my book, started writing mental health articles, like this one, for both Messy Mind, and The Book Of Man. I've also started running workshops on Mental Health Support in the Workplace for companies, as the more enlightened of them have understood they need to do more to support their employees, not only professionally and in providing physical healthcare services, but also with their mental wellbeing.
I've even managed to get fit, lose those extra pounds I was carrying around, stop drinking and smoking, and eat a much healthier diet. A plus side of not being able to be lazy and order in a takeaway after a day in the office.
Of course, like everyone, I want to lose all the negatives from the last year and keep all the good stuff. Like most people, I'm sure I'll have mixed success with that goal.
However there are a few things that I'm confident about:
Smoking is gone for good, and drinking will only ever be on those rare special occasions.
Advocating for change in attitudes to mental health, and the state of mental healthcare, is a passion that I will continue.
I don't ever want to return to working in an office.
For me, the impact of this pandemic will continue for at least another year. Once you ignore all the "we'll have this beat in 12 weeks", and "return to normal by Christmas", nonsense, then we won't be done with this until hopefully Spring/Summer of 2022. The science and data tell us that we'll not only have to complete the vaccination programme, but the mop up the stragglers who aren't hard-core anti-vaxxers, but just nervous and need convincing, and also continue social distancing guidelines until we have this virus under control.
For me the problem has never been the lockdowns. And just to be clear, blaming the lockdowns for mental health problems, is like having a car accident, and then blaming the surgery for the injuries. To repeat what I said at the beginning, this has never been about what I'm "allowed" to do, but what I feel "safe" doing, and how my faulty alarm system reacts to a post-COVID world.
So what I'm holding out for now, is to once again take my boat out to anchor, which I'll do at the end of March, and then waiting until restrictions are sufficiently eased for me to sail north to the village of Ardfern, on the western coast of Scotland. I'm hopeful that this will fulfil my need for solitude, while also providing me with a remote, and small community of people that I can gently join, as the situation allows.
I'm sure you'll see the pattern that what I look for in places to stay, is a stunning view and room to breathe. I think this will be a good place to see out the remainder of this pandemic, and it'll make a great base for sailing around the Western Isles.
I guess only time will tell on how I do with these goals, but there is something I continue to be 100% sure about. There is no way back for me. Only ever a way forward!
Story & Photos sent and written by 'Paul Fjelrad'.