My first client of the day is Ahmed. He witnessed around 30 people, including family members, drowning when the boat in which they were crossing to Europe, sank in a storm. He feels guilty for surviving. He was one of the youngest on the boat, so was wearing one of the few life jackets.
This morning I’ll try to help Ahmed with the flashbacks he has every time it rains, with the nightmares that wake him every night about drowning, people calling his name in the darkness, bombs falling, bodies on the street. He is claiming asylum in the UK. He knows that some people don’t want him here, but he’s frightened of going home. His home town is being bombed, and he doesn’t feel wanted there either.
For all the stories of human suffering, these are also narratives of survival
After Ahmed, I’ll see Erica, who was beaten so badly by her husband that she has a metal plate in her skull; Louise, who regained consciousness in the middle of an operation, able to feel everything but unable to move or raise the alarm; and Alex, who dreams every night about the colleague he could not save when their vehicle was hit by an IED in Afghanistan.
As a trauma therapist, this is a normal day for me. Some people associate post-traumatic stress disorder (PTSD) only with military veterans, but my clients come from a huge range of backgrounds. Almost any life-threatening experience can cause PTSD, as can sexual assaults, witnessing terrible things happen to someone else, or hearing about them repeatedly as part of your job.
There is still a stigma associated with many mental health problems, and PTSD is no exception. Some people feel it is a sign of weakness, and they should just be able to get over what has happened. Others are unaware that help is available, or that treatments are effective.
There is no shortage of referrals, and managing the waiting list is a constant struggle. Trauma therapists spend their days listening to some of the most heartbreaking and horrifying stories imaginable. Confidentiality prevents us talking about what we have heard outside of the therapy room, but we support each other with time, care, biscuits and humour.
NHS trauma services exist in various cities across the UK, but service provision is patchy and postcode-dependent. Cuts over the years have put further pressure on mental health services which are already spread thin, leaving many therapists feeling burnt out by unachievable targets and endless waiting lists. Insidious measures to cut costs, such as limited session numbers, freezes on recruitment and service restructures (another word for cuts) continue to whittle away services, and lead to patients waiting longer for less treatment.
Why would I choose to work in this field? It is fascinating. I’ve heard firsthand accounts of what it is like to be recruited as a child soldier, to survive the Rwandan genocide, to travel Basra’s road of death. Perhaps not experiences everyone would want to hear but, for all the stories of human suffering, these are also narratives of survival. My clients have escaped, endured and overcome events which can, and have, killed many others. I bear witness to their fortitude, and help them mend the mental scars.
Thankfully, many of my clients recover. Trauma memories are not forgotten, but they can fade. Through treatment, clients achieve goals which many of us take for granted, like sleeping through the night without nightmares, or meeting new people without fearing they will be attacked. Things which were previously out of reach because of their symptoms, like working and having relationships, become achievable.
There is no magic pill or quick fix to treat PTSD. The most effective treatments are trauma-focused. Rather than avoiding the horrific memories, therapy involves talking about them, processing what happened, and making sense of what can feel senseless. We spend some sessions out of the office, helping clients to overcome situations and places which they have been avoiding, teaching them to discriminate the past from the present.
As a therapist, seeing someone who has been so mentally, emotionally, and often physically, damaged, begin to heal is incredibly rewarding. On a gloomy day, I read the cards and letters that clients have written to me after treatment. They tell stories of recovery and hope.
Knowing the potential for recovery will help me in my session with Ahmed today. At the moment he feels that he lost everything worth living for in that storm over the Mediterranean. Today, we’ll start picking up the pieces. We’ll talk about what happened, and grieve for the losses. We’ll try to put the bad memories in the past, so that he can look towards a future. When that happens, it will remind me again why I do my job.
Some details have been changed
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Treating former child soldiers and refugees is tough yet fascinating
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