John is the therapist that Paul met on in his first session at 10am, 3rd of May, 2013. The sense of fear was immediate and palpable. Paul was shaking, hadn’t slept meaningfully for weeks, was barely able to function and in unbearable psychological and physical pain. In The Struggle Continues, together with his daughter Natasha, Paul tells the story of his Complex Post-Traumatic Stress Disorder, the life that led to this life-threatening and life-altering diagnosis, and the long, hard road back from the brink.
But aside from this foreword, and the interviews that Paul held with John, this is a story told from the other end of the therapist's couch. Not a case study, or academic work, but a real-life account from the perspective of the patient, told by a father and daughter.
Foreword by John
“No one can build you the bridge on which you, and only you, must cross the river of life. There may be countless trails and bridges and demigods who would gladly carry you across; but only at the price of pawning and forgoing yourself. There is one path in the world that none can walk but you. Where does it lead? Don’t ask, walk!” ~ Friedrich Nietzsche, Schopenhauer as Educator.
To introduce the introduction, you could try this simple exercise. If, as you are reading this, you are sitting down, stand up next to your seat. If you are not sitting, go to a chair or sofa and stand by it. Now, just sit down, slowly. As you lower yourself, notice the muscles in your legs and back that oppose gravity and allow you to descend gently towards the seat. Notice your first contact with the seat and how you can feel it pressing more and more firmly on the backs of your thighs and then on your buttocks. Finally, notice how you are held, supported, more or less comfortable, but undeniably safe.
This modest demonstration is an exercise in trust. You trust that your chair (or sofa) is there – even if it is behind you and you cannot actually see it. You trust that your weight will be borne, that there will be no collapse or breakage under the load. You trust that you will be comfortable, that, with the minimum of adjustment, you will be at ease in your new position.
Maybe you have had the experience of someone pulling a chair away from you – as a joke? – as you were lowering yourself into it. Maybe you have had a chair collapse as you were sitting down. If so, you might have been bruised – certainly your pride and dignity would have been sore. After an experience like that you might have been a bit more careful when sitting down. For a while, at least.
Trust, threats to trust and the damage it can be subjected to are huge components of our lives. We trust what we know, what we are certain is safe, we check and evaluate anything new. That is the way that we survive.
Sometimes, by design or by accident, something that has been labelled as safe fails to live up to its promise. Something or someone hitherto reliable lets us down. So, now, the trust is broken. When the damage caused by this failure is small, the impact of the event fades. Sometimes the memory is so small or inaccessible, we will expose ourselves to a similar experience. When the damage is large, when the lack of trust is overwhelming, an extra protective mechanism is activated. This is that the mind does not allow the memory of the event to fade, it does not permit the pain to lessen. Even though the smoke and flames have long disappeared, the fire alarm keeps ringing. It is easy to see why this works like this. It does not matter if we repeat some stupidity (forgetting to check if you have your front door key with you when you go out) when the penalty is small. It is another matter if the penalty is life-changing or life-threatening. In that case, the extreme reaction – keeping the memory active – is a good way of preventing a repetition.
This level of extreme response first became widely recognised during the World War of 1914-1918. Combatants, subjected to unendurable horrors, developed responses that were called “shell-shock”. A later wave of severely distressed combatants, this time US military involved in the Vietnam war in the 1960s and 70s resulted in new studies, new terminology (“post-traumatic stress disorder”, PTSD for short) and new treatments. It is probably not a surprise to learn that familiarity with PTSD is a lot older than a hundred years. In Henry IV part 1, Shakespeare wrote these lines for Lady Percy, who was talking about her husband, Harry:
O my good lord, why are you thus alone?
For what offence have I this fortnight been
A banished woman from my Harry's bed?
Tell me, sweet lord, what is't that takes from thee
Thy stomach, pleasure, and thy golden sleep?
Why dost thou bend thine eyes upon the earth,
And start so often when thou sit'st alone?
Why hast thou lost the fresh blood in thy cheeks
And given my treasures and my rights of thee
To thick-eyed musing and cursed melancholy?
In thy faint slumbers I by thee have watched,
And heard thee murmur tales of iron wars,
Speak terms of manage to thy bounding steed,
Cry 'Courage! to the field!' And thou hast talked
Of sallies and retires, of trenches, tents,
Of palisadoes, frontiers, parapets,
Of basilisks, of cannon, culverin,
Of prisoners' ransom, and of soldiers slain,
And all the currents of a heady fight.
Thy spirit within thee hath been so at war,
And thus hath so bestirred thee in thy sleep,
That beads of sweat have stood upon thy brow
Like bubbles in a late-disturbèd stream,
And in thy face strange motions have appeared,
Such as we see when men restrain their breath
On some great sudden hest. O, what portents are these?
Some heavy business hath my lord in hand,
And I must know it, else he loves me not.
Not only are so many of the symptoms of PTSD described accurately, over 400 years ago, there is a sting in the last five words – the effect of PTSD on the people connected to the sufferer.
When I met Paul his lack of trust was palpable. He could not have been less relaxed and comfortable if there had been a swarm of angry hornets in the room with us and the carpet was on fire. Yet this was a therapy room; quiet, calm, comfortable, warm and professional. And I was the therapist that Paul had chosen to see; similarly, quiet, warm and professional. But Paul was not seeing me, he was not absorbing the peace of the situation. He was not reacting to the purpose of engaging with therapy. Paul was afraid - terrified - and this fear, driven by his total lack of trust, was obliterating everything else.
Someone who has lost their trust because of a bad experience can be calmed, reassured, soothed and gradually brought down from that wired, jittery, adrenalin-driven fear. Not when it is PTSD. Every word, every gesture is, potentially yet another assault. The hand extended to stroke is perceived as a hand lifted to smack. Even when the contact proves that the deed is kind, not punitive, the reaction is, “So you did not hurt me this time, but how do I know that you are not fooling me to let my guard down? How do I know that you are just waiting until next time and then you will hurt me?”
Paul had been referred to me by a psychiatrist, which was unusual, and he had asked to have two sessions a week, also unusual. So, this was serious damage, it was something that had been going on for a long time and the trauma was from more than one source, so was complex (and producing C-PTSD). This meant that it would take a while to unravel, and Paul was really desperate to find a way of reducing or ending the fear.
So it was, it is, simple to explain the work – all I needed to do was to get Paul to trust me. Not because of anything to do with me, but because therapy is a bit like a “worked example” in maths. That is, if Paul could trust me, it would show him that he could trust, that somewhere in his troubled mind the mechanism for trusting people was still there. More than that – it would let him access the ability to trust and use it appropriately so that he would be able to develop solid relationships.
And this is what we did. We built trust.
Story & Photos sent and written by 'Paul Fjelrad'.