When I succumbed to post-traumatic stress disorder, I wasn’t a soldier or a war correspondent writes Isabel Hardman.
My life has, on the surface, seemed very pedestrian. This immediately disqualifies me from the popular conception of a PTSD sufferer as someone endlessly recalling bullets and bombs. My trauma hails from my personal life. It was serious and it went on for a long time, ending in a manner that was in itself traumatic in 2016. I know at this point some readers will wish to know more, but I am writing this at a precarious stage of a recovery that has, so far, taken two and a half years and suffered multiple setbacks. To detail what happened when I have yet to come to terms with it myself would retraumatise me, and nothing is more precious to me these days than my sanity.
But I can talk generally about what the illness has done to me. For a while, I had seemed to be coping as well as anyone would who had been through a series of hideous events. It is perfectly natural to be stressed, overly emotional and rather low in mood after something terrible has happened. But after four or five months, I was getting much worse, and behaving very irrationally.
I became obsessed with whether or not I was safe. As my experience had not involved bombs, it wasn’t that I was checking in the cupboards for devices: instead I was examining every aspect of my personal life for evidence that someone close to me was going to turn on me and cause further serious suffering. I became a strange detective in my own life, questioning the oldest and most loyal of my friends, accusing family members and constantly panicking that my new partner was going to leave me.
I would lie awake at night with a washing machine of worries on spin cycle. I had strange, inexplicable flares of anger. I blew up at colleagues who were merely going about their day jobs. I hurt myself. Tasks that most people can do on autopilot, such as going grocery shopping, were utterly terrifying as they would remind me of things in my past. Not just the events, but how I felt when they were happening. Suddenly, in front of tins of anchovies in Tesco I would find myself frozen with fear. It took about a year before any shopping trip ended without me abandoning the trolley and running back to my car to sob, hunched up like an embryo. Even when I was able to keep going and pretend that this flashback wasn’t happening, friends and family observed that my whole posture changed. ‘You look like a question mark,’ exclaimed one friend as he looked at my low head and bent shoulders. My shoulders were often so tight from the stress that I couldn’t turn my head.
It’s sometimes mistaken for depression
Initially, when I visited my GP and told her that I was suicidal, she thought I was depressed, and treated me accordingly. Eventually, though, the discussion turned to PTSD, and I started to learn how to manage and recover from it. While my friends, family and colleagues have been supportive and forgiving, I do notice a scepticism about my diagnosis that just doesn’t accompany apparently more user-friendly depression. It is as though PTSD has been devalued through exposure.
It seems everyone has PTSD these days. Keira Knightley recently revealed she had been diagnosed with the illness at the age of 22 as a result of all the media attention she received when she first became famous. The BBC’s blockbuster Bodyguard featured an ex-soldier suffering from the condition. Other notables with the illness include Lady Gaga, Ariana Grande and Evan Rachel Wood. When I’ve talked about my own struggle with PTSD in the media, trolls have accused me of latching on to the latest celebrity fad. It doesn’t bother me too much: I would rather the diagnosis were just a tag rather than a reflection of the real and debilitating symptoms that have taken me out of work for months on end and damaged relationships with colleagues, friends and family.
Doctors are questioning it, too. Dinesh Bhugra is emeritus professor of mental health and cultural diversity at the Institute of Psychiatry, Psychology & Neuroscience at King’s College London and president of the British Medical Association. He wrote recently: “I have never met a patient who really has PTSD, and I believe the majority of these diagnoses are bogus.” Dr Bhugra argued that “the diagnosis is being hijacked and bandied about far too flimsily, doing a major disservice to the few who do seriously suffer from it.”
Dr Bhugra is not alone. Professor Simon Wessely is a professor of psychological medicine and regularly advises the Government on mental health policy. He also worries about over-diagnosis of the illness in which he specialises. He points to an example from 2002, when a man who suffered from epilepsy was ordered to pay £3,500 in compensation to a student who experienced PTSD as a result of seeing his face contorted by a seizure. “From being a serious psychiatric disorder that arises after serious psychological trauma — which is what it is and should be — there has indeed been inflation,” Wessely tells me. “And as chancellors of the Exchequer always tell us, inflation leads to devaluation.”
A false conception of PTSD comes from its origins in military service. “Shell shock” was first diagnosed by doctors working with soldiers in the First World War who saw men so traumatised by the endless sound of gunfire, death and trench conditions that they were unable to speak. The diagnosis morphed from war to war, gaining prominence when the mental impact of conflict was seen in so many Vietnam veterans in the United States, and then again during the Gulf War, when it became known as “Gulf War Syndrome.” But it is only in recent years that any associations with civilian life have been made at all.
While Wessely is indeed worried about devaluation he is horrified by the attempts to make non-military sufferers feel as though they are faking it. “I think that’s ridiculous,” he says. “The highest rate of PTSD after a traumatic incident is in rape victims, rates being well above those that even soldiers get in combat. PTSD should be diagnosed accurately in both civilians and [the] military.”
The cause is always some sort of trauma
According to the Mental Health Foundation, 4.4 per cent of adults in 2016 screened positively for the illness. And contrary to some of the backbiting about celebrities, only 3.3 per cent of people believe they actually have it. The cause of the illness is always some kind of trauma, but whether that’s a bomb, a rape or a burglary isn’t specified. For military veterans, the current rate is believed to be 6 per cent, while it is estimated that 50 per cent of rape survivors develop the disorder. A 2014 report into adult psychiatric morbidity found 5.1 per cent of women in its London sample screened positive for PTSD, compared with 3.8 per cent of men.
One problem is the diagnosis itself, which is still changing. Currently the Royal College of Psychiatrists says there are three key symptoms: flashbacks to the event itself, avoidance and numbing (often through drugs or alcohol) and being ‘on guard’ constantly. These are distinct and lasting experiences that go far beyond the normal distress that someone might experience for months after a serious incident.
That normal distress, also known as an “acute stress reaction,” is at risk of being overly-medicalised, not just into an erroneous diagnosis of PTSD but also more generally into anxiety and depression. Not only does this come at a cost to those who really do suffer from a mental illness, it also damages those who do not: the treatment for PTSD involves drugs that are often very hard to stop taking, and therapy that involves you reliving every moment and feeling of your trauma. I hated the second, yet I know it has ultimately helped me begin to live a normal life again. But in misdiagnosed cases, it can actually make the patient even worse.
Other cultural changes have made things harder, too. It used to be the case that you would only recognise the phrase “safe space” if you had spent time in a therapy room. But now a safe space can include a university campus where students don’t want to hear controversial or difficult arguments for fear of being upset. And of course a therapy room needs to feel safe. But therapy helps you deal with the experiences that have left you unable to live normally. The modern safe spaces and their accompanying “trigger warnings” on controversial material suggest that anyone who has been traumatised must avoid all reminders of what happened.
This isn’t even possible for veterans who are no longer near a war zone. A common example of a PTSD trigger for someone from the armed forces is a car backfiring or fireworks. Neither can or should be banned. For those of us whose trauma took place in a civilian context, triggers can be so prosaic that no one else would recognise them as such. I do not want to ban supermarkets just because they remind me of terrible events, nor do I want to avoid them.
So much of my therapy has involved me learning to cope with situations in which I might be assaulted by my memories.
The flashbacks come less frequently now and I am learning not to be a detective in my own life, scouring for evidence that a catastrophe is about to occur. I still have bad days. Recently I was paralysed by a flashback that lasted two hours. But generally I have hope that, even if the war zone in my head never fully goes away, I am going to find it easier and easier to skirt around it.