The ‘Real’ Face of PTSD! By David Tredrea

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(With this edition of TPSO magazine taking a long hard look at the Health, Safety and Well-being of front line security professionals, we have to address the huge issue of PTSD suffered by so many of our colleagues. Here we have one of the U.K.’s leading experts, David Tredrea, highlighting the day to day problems experienced by PTSD sufferers…. Please be warned. This article pulls no punches and may cause distress for those lucky enough not to have been touched by this area of mental illness……………. Ed.)

This was initially a 3 part article – for ease of reference all 3 sections have been included below:

Joe was sitting quietly at his desk, all systems calm; he was very warm despite it being obviously cold and wet outside. He glanced the occasional cars passing by wondering which of the drivers were coming or going – and pondered those who may not even know! He’d just eaten his favourite large sandwich, burped then swallowed 1/3 of his thermos of tea.

Tomorrow was his daughter’s 10th birthday and he checked his mobile phone to see pictures of the new bike he’d bought for her, complete with pink handle-bars and tassels.

As his mind drifted, curiously and oddly, he heard a slight clinky sound and sensed, out of the corner of his eye, some unusual movement in the corridor set off behind his back. Then Wham! ….. quickly everything went black.

All he could hear were muffled voices and felt himself being dragged backwards by his feet to an area behind the photocopier. Gaffer tape was roughly put over his mouth, then rolled over (face-down) and similar tape over his wrists and feet. A woolly balaclava was yanked over his head that smelled as if it had just come off a sheep that had given birth. What Joe really needed was a pee … oh yeah, and his amber radio call-sign Delta 2 which he now remembered was in his jacket pocket draped over the back of his chair. He had also dropped his mobile phone when thwacked on the back of his head.

He felt – and knew – he was very vulnerable even though there was silence.

That was scary … and Joe was not easily scared after all his years of front-line exposure. For some reason, he kept hearing the worm-voice in his head repeating: “Daft bugger. You’ve just wasted a ton buying your daughter her bike …”

Joe knew from his military training that one day he might get taken and that he should keep cool and fill his brain with positive thoughts and images – a sort of “Safe-house in the sky”. It wasn’t working though so Joe peed himself because he couldn’t think of anything else to do – and that made him feel better.

About 2 weeks later, Joe came to see me for mental health support. His employer of 3 years was worried he was not fit for work and reported his buddies had noticed him dozy, with hand-tremors and possibly crying. Joe was reluctant to talk and seemed unable to focus on what he needed. His ability to concentrate was gone and his typical sense of fun and pranks had disappeared. He seemed angry with everyone but knew not why.

The back story was Joe’s company HQ had been bandit attacked by professionals – probably 6 experts according to others. Joe had been taken out first, then his 3 colleagues disabled for the 15 minutes or so it took to execute their heist. No-one knew what had been stolen but, of course, everyone knew that only the MD’s office and computer had been targeted.

Digital video was useless and there were (supposedly) no other forensics of merit. There was no media cover and a blanket-ban on all external communications had been imposed on all staff the following morning.

There was no forced entry and no real physical injury although paramedics had attended soon after the Police arrived some 30 minutes after Joe’s black-out.

Joe did not want to go to A&E as he thought he might miss his daughter’s birthday and, anyway, apart from wet pants felt OK. He was taken home in a police car and 2 days later gave a formal statement but the Police told him nothing of use about the incident. He had rung his colleagues to check they were OK and other mates had popped over to check if he needed anything.

His daughter had gone to school and his wife to work as a dental receptionist. HR and OH at work had told him to take the rest of the week off and to go to his GP is he needed anything further.

Although Joe was drowsy and disorientated, he felt OK and, anyway, thought he could do with a few days off to sort out his garden and generally catch-up.

Day 3 was fine but day 4 he started vomiting without good reason and had a bad headache. He went to see his GP and was signed off for another week with stress and tummy flu. He was not given any medication and told to rest and drink lots of fluid – but no alcohol.

For days 5 to 8 he remained in bed then started to feel better. By day 10 he was chopping down an overgrown tree in his garden. He returned to work on day 14 but came to see me on Day 16 looking tired, de-hydrated and sweaty.

I rang the GP as well as the employer’s nurse who both thought there might be PTSD brought on by the attack. They wondered if that could be ‘cured’ rather like anti-biotics might put right a problem chest or septic finger.

Well …. What do you think? Some of the PTSD signs are there but (imho) not enough – nor for long enough. Many experts are of the view PTSD takes up to 6 months after an event to justify the diagnosis.

Meanwhile, there are all sorts of physical and mental reactions to an overwhelming event that might (or might not) be temporary – transitional in medical jargon. It is reasonable to expect there may be a short-lived lack of concentration, sleep disturbance, flashbacks, anger, despair, frustration, appetite change, more booze intake even impotence – but sometimes an increased sexual arousal.

I will tell you in the next instalment about Joe’s recovery what we did, what he did, what I did and why I was curious as to why only Joe suffered when his colleagues who were similarly violated by the same people yet appear calm and peaceful.

To me, it is fascinating why each individual varies in their reaction to trauma – some overwhelmed by relatively small events (the straw which breaks the camel’s back) and others appear hardly affected by the most brutal of attack, rape and kidnap. Part of the answer lies in the rage of ‘red-misting’ – you can look that up on the search engine of your choice – and other parts lie elsewhere.

To help you out … it has nothing to do with age, race, strength, sexuality, intelligence, religion or pay-grade. Any ideas what was uppermost in Joe’s mind’s list of conflicts? If you want to send me your suggestions , I’d like to know! The rest of the artciles in this series will be posted directly to this website…

Part 2 updated March 2020

On Day 17 of his dilemmas, I saw Joe in the special care unit at a London teaching hospital.  He was responding well to fluids and intravenous antibiotics. 

He recognised me and remembered a little about events the previous day.  During our earlier “therapy session” Joe had become more disorientated and faint.  It was obviously he was not well physically.  My clinical colleagues were out but I had some rapid response kit in my car.  It was quick and easy to determine Joe had an increased temperature (38.5), rapid shallow breathing (resps >20), pulse 90, reduced blood pressure (95/60) and blood glucose 7.2 despite no history of diabetes.  He had a new raised itchy patch on his right arm just below his elbow.  My first thoughts were sepsis perhaps due to infection whilst he had been gardening – although why he was showing these clinical signs did not matter too much at this stage.  He needed A&E immediately and a Cat 1 vehicle arrived within 8 mins and then paramedic in an RRV shortly after.  Joe was cannulated and a drip inserted in preparation for the 18 minute blue-light haul to A&E.  He was quickly re-assessed, blood and urine taken for rapid analysis, oxygenated and stabilised with antibiotics as best as possible despite his now quite rapid deterioration.  He was put in special observation ward just as his relatives arrived.

Within hours, Joe’s symptoms had abated and he was stable – able to eat and drink, laughing and enjoying the company of his wife and daughter.   He was due for downgrading to a medical ward for 48hrs when I saw him and he was also listed for a psychiatric review.  However, I did not think the attack on him a couple of weeks earlier had caused the sepsis – this really was due to piercing by a rose-bush thorn in his garden 3 days earlier – but it is possible the trauma had affected and weakened his immune response.  Maybe, maybe not.  We will never know.  Joe didn’t really want to meet the hospital psych team nor to be considered for anti-depressants; however, he was encouraged to meet them and to speak candidly so at least he could get an Opinion. 

Joe was discharged 3 days later and felt fine.  He rested at home for a couple of days then came to see me again, partly to say thanks for the A&E excitement and partly to explain his sleep was very disorientated and he was getting some nasty flash-backs of the attack often when he was lying down resting but also sometimes whilst tinkering in his garage. 

Joe chatted for about 90 mins and reflected on some of his past as well as his expectations for the future – and how he will tear the head off his daughter’s first (and probably later) boyfriend who lays his dirty paws anywhere tender!

It became apparent Joe had a massive reservoir or traumatic experiences from his teenage as well as war years.  He had already had a failed marriage, an aborted child and had lost his brother to narcotic drug overdose 3 years earlier.  His parents had separated whilst he was still in junior school and he was especially angry with his dad whom he hadn’t seen or spoken to for over 20 years.  He appeared to now have a stable home, adoring family, dog, garden, swam frequently, quality mates and only minor debts.  He would dearly love to take his wife (and perhaps family) on a major holiday somewhere exotic, retire at 50 and to have a cottage somewhere warm by the sea.  He would love to play the saxophone but has “butter-fingers” and says that sometimes he cannot even pick his nose elegantly!   

All in all, Joe has a happy scene, safe place and good life – but he carries heavy, considerable sewage in his reservoir; when it uncontrollably overflows, it becomes increasingly toxic.  This affects his overall quality of life, motivation and peacefulness.  He currently rated the general feel of happiness at about 8/10 but when the dark past enters he drops to a 3/10.  Historically, he would wait out the gloom, get pissed, eat pies, chocolate and crisps, swim avidly, become irritable and not sleep.  Usually, the gloom lifted after about 5 days and this had occurred about one every 3 or 4 months until 6 months ago but was now perhaps monthly.  He jokingly said he felt menopausal – but perhaps he was, especially as his sex-drive was more compromised nowadays than it used to be. 

Joe seemed a good candidate for EMDR – eye movement, desensitisation and reprocessing.  Here is a good internet link with more information:  https://www.psychologytoday.com/gb/therapy-types/eye-movement-desensitization-and-reprocessing-therapy I booked Joe in to see me in 2 weeks for 2hrs

Part 3 – updated July 2020

3 fairly rapid sessions of EMDR and much of Joe’s baggage was cleared.   How and why is still uncertain but he (and I) feel better for having gone through the process.  He sleeps well, eats healthily, cycles and enjoys fishing again.  He said in November he had his life back and he was grateful.  He was moving house to a new area in January, changing jobs and looking forward to new opportunities.

This all worked out well and by mid-January, Joe was settled in his new home and his wife had been promoted at her new school.  Joe was working night-shift security watch for a new firm which had recently been set up.  He found some good mates and was enjoying life.   Then … in March he received the dreaded news of furlough and as he was last in he became really fearful of loosing his job and, of course, getting infected.  Worse still, he was worried abut infecting others, especially his family.   He started drinking a bit at home during lunchtime to ease his sorrows and to occupy his time.  His wife was out working and he felt lonely and bored.  Quite quickly, he felt he was losing his mind and became a very angry person with pent-up frustrations.   He lashed out at someone in a nearby park;  the police we called but he succeeded in running away before they arrived.   He still worries about the possible “knock on the door” so does not sleep very well.  He talks less with his wife and he feels ashamed he is no longer the major bread winner.  He has little self-respect and his personal hygiene has deteriorated. 

In May, he got into another brawl, cracked a tooth and damaged his phone.  He has run up considerable credit-card debt and rarely sees his mates, does not go out much and watches television most of the day.  He has put on 5Kg and now his pants don’t fit very well!   4 weeks ago his wife telephoned and asked if I would come and visit to see what might be happening as she was getting alarmed.  The COVID travel restrictions made this harder but we did manage in the first instance to speak on the phone.  He sounded very glum and I was worried about his stamina.   He agreed I could send a note to his GP although as he was new to the area and had not met anyone at the surgery. 

Within 24hrs a very gentle and patient GP telephoned him and arranged a visit.  His mood was low, overweight, stressed, concentration minimal but his blood profile and other tests returned normal.   Joe agreed to a course of anti-depressants and some counselling support to help him work through his identity.  Things got worse.  He was made redundant and was not really entitled to benefits as he was with a new company.  An old school buddy had died from COVID and he was not coping well with the lockdown, financial pressures and general uncertainties.  Mentally, he deteriorated further and his wife started to become afraid of his regular temper-flares.  He developed a cough, thought he had the virus and took to bed for 5 days.  Fortunately, it was only a mild infection of whatever it was and with lots of tea, coffee and water + regular paracetamol he has recovered his physical strength.  He remained unenthusiastic because of the difficulty in finding a new job but completed some of the outstanding DIY jobs in his new home.  The sun comes out for him more often and he enjoys the gardening – although often with gloves due to his previous injury with a rose bush thorn. 

We are not out of the woods yet and Joe is typical of many thousands of able-bodied, capable, genuine, responsible citizens who face an unknown future.  However, just last week a warehouse interview led to a job offer – more pay and better hours than before!  Like a dried-up cactus, Joe re-blossoms quickly at this new opportunity.  He keeps up the medication, agrees to see his GP monthly and telephones me weekly.  We have turned a corner and things look brighter. 

Had we not cleared some headspace from his from his previous traumas using EMDR he might not have had the capacity to cope with the current situation as well as he has.  Let’s see how the next couple of months go, step by step, gently and hopefully his progress will continue to be encouraging.   

David Tredrea – Professional Training Response, 10-12 Harley Street, London W1G 9PF

David Tredrea

David has worked in the specialist international trauma arena for over 40 years – Later, as lead researcher in the rapid treatment of burns to front-line workers, David became very interested in how burn victims process pain; some do well yet others don’t, despite similar age, race, injury and treatment.

Just after ‘Black-Hawk Down’, David was in Mogadishu as UNICEF consultant in child trauma, then air-lifted to Rwanda for the genocide then into New York for 6 months to advise UN very top-brass on the nature of trauma in East Africa, especially for its own teams and aid agencies.

(Blimey! I’ve tried to produce a short mini bio for David…… And I just can’t. Sincere apologies to him and TPSO readers as this is just a minor fragment of his incredible history………Ed!)

Click here to see Davids full bio

Since returning to the UK, David has assisted many Police Forces and other major services still with the occasional overseas rescue mission such as the tsunami, plane crash and hostage. David tends to be a fast, no-bullshit operator, who gets to the roots of the problems quickly in order to find the best, durable, ethical, and most cost-effective solutions. These are often a mix of clinical, emotional, operational or financial imperatives – obviously each tailored for uniqueness. Best of all, David is fun yet tough, effective, rapid, discreet, remarkable at storing secrets, loyal and expert at seeing wider pictures of dread implications and finding best pathways quickly – MENSA style!

David Tredrea

dpt@consultant.com