The Paddington Survivors Group Support Site
Post-Traumatic Stress Disorder (PTSD)
What is it?
A lot has been written about PTSD but, in simple terms, PTSD is a recognised illness based on a defined set of clinical symptoms displayed by a person who has witnessed or experienced an event that involved actual or threatened death. A diagnosis can only be made by a doctor and/or psychiatrist.
The major indicator of PTSD is the persistent re-experience of the event, either consciously (through involuntary recollections and flashbacks) or unconsciously (for instance within recurrent dreams). A diagnosis of PTSD will also depend on the extent of the following behavioural patterns:
PTSD, if untreated, can clearly cause major difficulties for people and lead to increased anxiety, depression and, in extreme cases, suicidal thoughts.
Diagnosis of PTSD doesn't usually take place until about 6 months after the trauma; the body's normal coping mechanisms will have dealt with what they can by then.
PTSD - Intensity
The strength of the PTSD is affected by the degree of control that the individual had during the event, and how aware they were of what was going on.
Awareness, even of only a second, allows the brain a much better chance of processing the mass of information thrown at it.
Being in control similarly lessens the effects. In different transport modes there are varying levels of control and awareness:
This is why people involved in train crashes can display some of the worst PTSD symptoms, they had no control and very little awareness of what was happening.
A layman's Explanation
In our normal lives, we experience a huge host of sights, smells, sounds and so on. As we experience these our brain processes them. They stay in a holding memory for a while, as the brain decides what to do with them. In time some experiences are just discarded, others are laid down in long term memory.
When someone is faced with a life-threatening event, with the senses overloaded, the memories of the event can stay blocked in the holding area - a bit like a blockage in a pipe. The individual doesn't know this has happened, but symptoms will appear that hint at it.
Memory is affected - think of the blockage in the pipe stopping new memories being put away properly. Flashbacks happen - the individual actually feels that they are there at the event again - there is a huge, very real, piece of memory stuck in the pipe, unprocessed. As the brain finds this piece it is like being there all over again. The flashbacks can be set off by triggers like sights, sounds, movements similar to the event itself. This is why many Paddington Survivors have never travelled on trains again, why the smell of diesel is so evocative.
The treatment of PTSD involves the unblocking of the memory pipeline. One effective treatment is EMDR - Eye Movement Desensitisation and Reprocessing. A stimulus is applied alternating between the left and right side, this can be LED lights moving in front of the eyes, sounds in headphones or vibrating paddles touching the ankles.
Patients are encouraged to go through the timeline of the crash as they are stimulated alternately left brain - right brain. It is not understood how this works, but it does! The left-right stimulation helps break down the blockage in the pipeline. This can be very unsettling for the patient, and is an exhausting process. However it is very successful and well worth the effort!