“You were born into this. There are guys out there at 40 who are trying to figure this out for the first time. Some think that they have to “snap” you out of this. Shove a coke in your hand or a coffee.”
Sitting at the counter of our kitchen whilst he preps supper we are talking about how to tackle this subject effectively. I am shocked. Who’d be so ignorant as to try to “snap” a person in a full PTSD episode back to the here and now? Oh.
Quite a lot of people apparently. My bad.
So don’t do that. Like, seriously, DON’T. The most that you can do if you witness another person in a full PTSD episode is to protect them as best you can from hurting themselves, be patient, kind and non-reactive. By your presence, gentle and calm, try to reassure them that they are not “back there”. Where “back there” is does not matter.
Note: when I am in a PTSD episode I can’t be touched. I want to push everybody away. I am a wild beast. Triggered back to my first trauma at age 2. I bite. I scratch. I slump. I hit out at the walls. I hit my own head. Imagine a terrified two year old. In adult body. Thankfully this rarely happens and only when I fight back at the impulse to faint. My automatic PTSD reflex is to faint. If I fight that that is when I risk going to the darkness. Do not attempt to touch a human who reacts like this. Be close but at a safe distance. You are not you to me, you are a man with a machete, you are my mother, you are not safe. I do not see you. i am not a risk to anybody anymore than a tiny child but if you want to help be kind, calm and reassuring.
Your presence will outrank your words. Your words may be essentially useless. Much like the stuff people say at funerals to make you feel better. “Doesn’t he look peaceful, all dead and stuff, in that coffin?” Do not worry about the perfect thing to say as you’re more likely to say something incredibly stupid or appear tongue tied. Instead, try to exude calm. Instead of telling them they aren’t in Afghanistan (a place incredibly hot) maybe you get to a breezy part of the house. Instead of telling them they aren’t by the helicopter landing pad in Rwanda, play some music. Even shitty music. Instead of saying “its all behind you” or “its in the past” , try to do things that remind them of the here and now, like touch. Literally ask them, if its ok to touch their arm or be in their physical space. And if not, hang outside that line and wait. If so, hang out inside that line and touch their arm, and wait. Many minutes may pass, but those minutes of you being there is more of a reminder that they are here today, in this place, with you than any collection of words will do.
Nor is it the time to figure out how they were triggered, except to log it all for their psychologist. A person in a full PTSD episode WILL recover. It will pass. Keep reminding yourself of this. It is an episode, a massive brain fart that will go away. It is the speed with which we can get you there, back to resting that is the focus of this post. Brian’s doctor is a mental health advocate I have known for many years and respect greatly. Jeff Morley is a retired RCMP officer who chose to study psychology to help others with PTSD. He can speak paramilitary and police. He “gets it”. After Brian’s last episode we exchanged a few texts and he reminded me again that whilst it is great to have me in Brian’s life “in the long run he needs to find the tools to help himself, and to self-regulate”. In other words, have the grounding skills on hand within himself to come back to normal brain function instead of counting on external grounding (me, my presence or the voice of an army buddy who can coach him safely back).
The first time I experienced Brian going through a full PTSD episode the most pressing issue for me was to get him into a sitting position. He had face surfed down the stairs in our rental house whilst we were packing up to move into our renovated home: external forces had extended their ugly fingers into our lives and I, fed up, had taken my frustration out on him. It had triggered him unbeknownst to me whilst I stomped around downstairs slamming items into boxes. Sigh. That’s when I heard the crash.
His face was jammed into the wall and his body was cranked under, on top of and around itself. I had no choice but to move him as he couldn’t breath. Adrenalin gives us incredible power and I lifted him into sitting whilst he muttered at me, it was clear that he was in Kabul not White Rock BC. I’d asked a while back who I should call in the event that this happened, so I knew to who to call before dialing 911.
Why did I need to call an army buddy and serving cop first before calling 911? Ignorance and misunderstanding around mental health crisis is always a factor. I needed an army buddy and if possible a cop to be there to manage any fears that the fire fighters or ambulance guys might have coming into a powerfully built veteran in a full PTSD episode. I was right to be wary. When the firefighters arrived on scene they were clearly nervous, Brian was confused by my presence in Kabul but they made sense to him, he grabbed one of the younger firefighters legs, trying to pull him to safety I think as I’m pretty sure Brian was in a burning vehicle having hit an IED rather than with us in that dark hallway, having face surfed down the stairs. The firefighter was visibly shaken and instantly was on full alert, his buddies got tense and I quickly realized I needed to pry Brian’s fingers off the fire fighters trouser leg before this escalated. I managed it and from that point on made sure my body was between Brian and them. I was the one who manhandled him to standing and got him to the chair they put out for him.
His army buddy and off-duty cop friend arrived shortly after getting him into the chair. Instantly the air breezed through the house, the first responders relaxed and as they did, so did Brian. His buddy started coaxing him gently back to the here and now. Quietly, calmly and in a no-nonsense army voice that Brian’s brain recognized. I stood behind Brian using my body to reassure him and make sure he knew nobody was coming from behind to attack him. His body changed.
When Brian is triggered his heart rate is elevated, his breathing is shallow, his body sweats but is cold to touch, his legs don’t work and his vision is compromised. If not caught in time he will pass out. Coming out of the episode is fairly rapid. The sweating is the first physical sign that he is getting better, it stops. Colour returns to his face, when in an episode it is grey. His breathing deepens and slows. His heart rate returns to normal.
What did I learn from this experience?
Firstly, that I am not a voice that can drag him back to present from Kabul but army buddies can. So now I have a list of friends I can call who will come running or I can get on speaker phone to at least start the process of bringing him back to here.
Secondly, my body reassures him. I am allowed into his space when he is triggered and I can manhandle as I need to without any issue. Placing my hand on his chest (around his heart) skin to skin is a code that de-escalates his flight/fight responses.
Thirdly, I am right to be wary of emergency responders and their treatment of a veteran in full PTSD episode. This makes me sad, angry and kind of depressed given how much of my time I have spent over the years educating and pushing the PTSD boulder up the hill. However, they are more than happy to follow my instructions in lieu of the army buddy. I can control their responses if I am calm, in control and focused on keeping Brian informed on what is happening.
What does that mean: keeping Brian informed on what is happening?
Brian can be triggered by needles in his arms. It is a hangover from being around rough medical situations overseas, along with bad needle experiences himself. Army rules say that you keep doing whatever you can no matter what, even if his legs are blown half way up the rocks and he’s bled out to the point of death but his heart is still beating. There is more to this but there is no reason to go into it, war porn isn’t my thing. Needless to say that anybody sticking needles into Brian when he’s in a normal brain state is an issue, never mind when in full PTSD episode. When he’s on a gurney I am by his side, using my body and voice to shield and protect. There are no surprises. I very calmly but in a voice that says “don’t fuck with me” explain to the medical staff exactly how this is going to go down, my job is to manage and ensure that no unnecessary drama is added.
Fourthly, guilt is as about as useful as a chocolate teapot. The “why” he was triggered is futile other than as an aid for his psychologist to tweak out trauma and process it in the safety of his office at the regular psych sessions. Otherwise? Forget it. PTSD episodes are GOING to happen. It just is.
Brian’s psych, Jeff Morley, has a bowl with a marble in it. He uses it to explain PTSD episodes. If you swish the bowl in your hands, the marble will move rapidly up and around the walls of the bowl. Place the bowl down on the table and eventually the marble will sit unmoving, static at the bottom. The aim is to get that marble to a resting position as quickly as possible.
How to do that?
As Jeff said to me, ideally Brian gets there using internal grounding techniques rather than having external forces providing those grounding aids (me and his buddies). What are those internal grounding techniques?
Smells – incredibly powerful they go straight to our lizard brain. Brian loves cedar. So we have bags of wet cedar in his truck and I have one in my handbag. If he is triggered I can shove that under his nose and bring his brain back to resting. He too uses it but isn’t as aware of his state as I am, Sasha (his service dog) and I are keenly aware of his state, his breathing and we know when he’s not okay.
Touch – placing his feet (bare) on cold floor tile. Pacing from foot to foot – releasing the adrenalin. Shaking his hands out (again to release the adrenalin) and touching ice. In times before me he was known to sit on his deck in the winter with his hand in an ice bucket. Doubt that happens again with me around but ice cubes are always on hand. Back of the neck is where I feel is most useful, and inside wrists – but with Brian any touch on the inside of his arms has to be carefully done and likely not a great option in a PTSD episode.
Breath – breathing exercises. This is where his army buddies are invaluable. They are taught breathing exercise prior to an assault. It’s on their hard drive. His army buddies can repeat those drills and he does them. If he could somehow develop this for himself, it would alleviate much of the cascade of crisis within his brain and body.
Bath/Shower/Hot Tub – water is magical. It works not only on the brain but also on the body. Immersing in water or having water on a naked body is a very quick way to come back to neutral.
Music – works for Brian.
People – being around safe people, hearing their voices, feeling their presence. For Brian this is his army friends. And me. I have zero issue asking his buddies to get their asses over to hang out with him, he is more reluctant to lean on them. They know he’d be there for them, so I figure what the hell.
The Fuzzy Humans – we have an African grey parrot called Bella who loves Brian, and a hoard of dogs who pile on him. His service dog, Sasha, though is precious and can quickly get him turned around. This might sound like an external grounding technique but I think that having animals around us is key to our survival.
Brian’s last PTSD episode was brought about again by external forces triggering him and a lack of woman close on hand. I knew something wasn’t right and had asked him not to drive to the shooting range that morning, instead to hang with me. It’s been really hot and sticky which reminds his body of Kabul, never a good thing so I am more cautious on hot days. I left him in the truck whilst our eldest and I went into get her facial done (about 20 minutes), he said he’d sleep. He was in a full PTSD episode by the time I found him looking for me on the street, disoriented and legs not fully working.
His heart rate was elevated, sweating and cold to touch. His face grey. I got him into the truck and as I headed to Emergency with him started working my way through the call list. First look after the kids. His psychologist is a rock star and was able to meet us at his office, so by-passed Emergency and went straight there.
Because Emergency Departments do not know how to handle a PTSD episode. They simply don’t have a clue. In fact they make things a hell of a lot worse in doing the things they do. Getting him to a cool safe environment with a voice that can walk him quietly back to the present was by far the best option. Ativan might work, yes, or it might not. I’ve been prescribed it and tried it once – never again. But will still kick that stone over with his doctor. What works best is to get him into a place that his body and brain recognizes as being safe, with people around him who can walk him calmly back from Kabul or Bosnia to here and now.
Brian here. Hospital staff are there to keep you alive. And they triage you like anyone else. The issue here is they always triage mental health at the bottom of the list. You are the thing that can wait. Unless they think you are a death risk to you or someone else in which case they call security or police. You are ranked below in terms of importance every other thing that comes into the hospital that day. Even the mental health units of this country will spend more time on intake (administration) as opposed to health care. We are working on this. But its a thing.
We have amazing friends.
I tear up a bit when I think about it. I’ve always had friends that had my back no matter what but it’s when they step up and hold you together, that’s worth more than I can possibly say. Having that Emergency List of Who To Call is an imperative. Protocol established, who/what/when. All agreed and a plan in place: A to D plan in fact, a back up times 3. Don’t mess around with this, when the crisis hits it’s important to know exactly what you’re going to do so you can calmly retain control and protect the one you love.