The scars you don't see: what it's like to live with PTSD

I didn’t break down instantly. It was at least a month before I had the first dream where I woke up, safe in my bed, but sheeted in sweat, scared to go back to sleep.

I was standing about 40 ft away from the man when the mortar bomb hit him.

They don’t travel that fast, and I’d swear to this day I could see it coming, a little dart zipping down, hitting right at his feet. At least, that’s what happens in the dreams. The bomb was small – probably a 60mm round with no more than 2lbs of explosive in it.

I know that because I’m not dead. 

That small bomb was still enough to make that man just instantaneously cease to exist as anything recognisably human. The effect was not unlike a jar of strawberry jam being struck with a sledgehammer.

I was knocked to the ground. I scrambled into the slit trench nearby and hid, terrified. As the shelling died down, I felt I had something sticky on my face. I reached up and slowly peeled a rasher of bloody human skin off my cheek. This is hard to write. I’m shaking and breathing quickly from the memory. Thinking about it is like picking at a scab.

I didn’t break down instantly. It was at least a month before I had the first dream where I woke up, safe in my bed, but sheeted in sweat, scared to go back to sleep. After a few months, I was a mess. I was incredibly irritable, and would fly off the handle at the slightest thing. I stopped enjoying reading or watching films, spent whole days doing nothing. Just eating and sleeping. Staying alive.

I loved the oblivion of sleep when I didn’t dream. I didn’t want to talk about it. I knew something was very wrong, but I kept putting off doing something about it. I didn’t want to admit to myself I’d gone mad. I was incredibly embarrassed about the fact I’d often wake up my housemates, screaming. I’m pretty loud.

It was the embarrassment that made me realise I’d become very strange. I reluctantly went to the doctor, and started getting treated. It’s a long process, and I’m much better now, but I’m basically never going to be cured, never going to get a piece of paper saying “Congratulations, you are sane again”. You learn to live with it.

I can’t bear to be touched unexpectedly. This goes from being mildly unpleasant when it’s a pat on the back through clothes, all the way to chills, sweats and burning tension if someone with wet hands touches my bare skin. It makes nightclubs an all but no-go area. Wherever I work, there’s always one touchy-feely person. It’s telly, there’s always a woman who likes to hug you if you don’t get a commission or a man who likes jolly backslaps when things go well. Fairly swiftly I have to have the conversation where I say “Please don’t touch me, I have PTSD.” Cue the odd looks from then on.

When I sleep with someone for the first time, I have to have the conversation where I warn them that if I go to sleep, I might start screaming – literally screaming - about mortars, stumbling out of bed and taking cover behind something in the room. I used to wait until I knew someone quite well before I’d lay that on them, but I had one experience where I didn’t tell the girl, I had one of those dreams, and she was absolutely terrified of me.

The noise of diesel engines turning over upsets me immensely - I took cover from rockets under a tank once. The DUNK-DUNK-DUNK of a diesel just brings bad things back. Buses are a no-go. Oh, and fireworks. I hate fireworks now. If I can see them, it’s OK, but it’s unexpected bangs that really upset me. The week of bonfire night and the week around to New Year I usually spend indoors, with good headphones in.

Those are my most common triggers, but almost anything can set you off. Indeed, after reading this brilliant article about PTSD, I was an emotional mess, and had to take a day off work. Which is pretty ironic as it’s an article that says trigger warnings are bullshit. You live in a world where suddenly you can be pushed into re-experiencing something awful at a moment’s notice.

When I have flashbacks, it’s never a Hollywood hallucination of the sounds of the day, or the sights. I relive what happened emotionally and physically, in moments. The terror, the horror, the emptiness, the dry throat, the tense muscles, all dumped on you in five seconds. A day ruined because some goon lets off a firework.

That said, it’s the dreams that are the most pervasive legacy. A doctor told me to think of them as dreams, not nightmares. I can avoid and mitigate triggers; not the same with dreams. I now probably have them about once every couple of months, but it always ruins the following day. I thrash around in my sleep, live out those moments, over and over. I’ve hurt myself; clawed a couple of nails off on my wall thinking I was buried once.

Of course, I’m much better now than I was. I go to support groups, and often I’m the one leading the discussion. People like that I make jokes in the awkward moments where we break and have tea and biscuits, in between sharing horrors. 

PTSD is much more common than you think – the incident I experienced happened when I was on a journalistic assignment, covering a war. And although veterans - represented by brilliant charities like Combat Stress and Help for Heroes - are the most visible face of it, they represent a small minority of sufferers. There's no shortage of medical care, but support groups are few and far between.

The mix of people in support groups is odd. I’m not sure my experience is representative, but as I say, mine have been split largely between male combat veterans and female rape survivors. While only around 3% of the population are thought to have PTSD, as many as 50% of rape survivors develop it. Rape is by far and away the most common reason for a woman to be there. Everyone bonds over tea; we all share experiences of how we’ve learned to cope, and stories of times when we didn’t.

So that's what it's like. Personally, I always come back to a bitter, sarcastic part of a Sassoon poem, called “Does it matter”, which sums up in 30 words what I've done in a thousand.

Do they matter? — those dreams from the pit?

You can drink and forget and be glad,

And people won't say that you're mad;

And no one will worry a bit.

 

[This piece is part of the New Statesman's Mental Health Week - find more articles on this subject here.]

A soldier on patrol in 2010. Photo: Getty

Willard Foxton is a card-carrying Tory, and in his spare time a freelance television producer, who makes current affairs films for the BBC and Channel 4. Find him on Twitter as @WillardFoxton.

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Air pollution: 5 steps to vanquishing an invisible killer

A new report looks at the economics of air pollution. 

110, 150, 520... These chilling statistics are the number of deaths attributable to particulate air pollution for the cities of Southampton, Nottingham and Birmingham in 2010 respectively. Or how about 40,000 - that is the total number of UK deaths per year that are attributable the combined effects of particulate matter (PM2.5) and Nitrogen Oxides (NOx).

This situation sucks, to say the very least. But while there are no dramatic images to stir up action, these deaths are preventable and we know their cause. Road traffic is the worst culprit. Traffic is responsible for 80 per cent of NOx on high pollution roads, with diesel engines contributing the bulk of the problem.

Now a new report by ResPublica has compiled a list of ways that city councils around the UK can help. The report argues that: “The onus is on cities to create plans that can meet the health and economic challenge within a short time-frame, and identify what they need from national government to do so.”

This is a diplomatic way of saying that current government action on the subject does not go far enough – and that cities must help prod them into gear. That includes poking holes in the government’s proposed plans for new “Clean Air Zones”.

Here are just five of the ways the report suggests letting the light in and the pollution out:

1. Clean up the draft Clean Air Zones framework

Last October, the government set out its draft plans for new Clean Air Zones in the UK’s five most polluted cities, Birmingham, Derby, Leeds, Nottingham and Southampton (excluding London - where other plans are afoot). These zones will charge “polluting” vehicles to enter and can be implemented with varying levels of intensity, with three options that include cars and one that does not.

But the report argues that there is still too much potential for polluters to play dirty with the rules. Car-charging zones must be mandatory for all cities that breach the current EU standards, the report argues (not just the suggested five). Otherwise national operators who own fleets of vehicles could simply relocate outdated buses or taxis to places where they don’t have to pay.  

Different vehicles should fall under the same rules, the report added. Otherwise, taking your car rather than the bus could suddenly seem like the cost-saving option.

2. Vouchers to vouch-safe the project’s success

The government is exploring a scrappage scheme for diesel cars, to help get the worst and oldest polluting vehicles off the road. But as the report points out, blanket scrappage could simply put a whole load of new fossil-fuel cars on the road.

Instead, ResPublica suggests using the revenue from the Clean Air Zone charges, plus hiked vehicle registration fees, to create “Pollution Reduction Vouchers”.

Low-income households with older cars, that would be liable to charging, could then use the vouchers to help secure alternative transport, buy a new and compliant car, or retrofit their existing vehicle with new technology.

3. Extend Vehicle Excise Duty

Vehicle Excise Duty is currently only tiered by how much CO2 pollution a car creates for the first year. After that it becomes a flat rate for all cars under £40,000. The report suggests changing this so that the most polluting vehicles for CO2, NOx and PM2.5 continue to pay higher rates throughout their life span.

For ClientEarth CEO James Thornton, changes to vehicle excise duty are key to moving people onto cleaner modes of transport: “We need a network of clean air zones to keep the most polluting diesel vehicles from the most polluted parts of our towns and cities and incentives such as a targeted scrappage scheme and changes to vehicle excise duty to move people onto cleaner modes of transport.”

4. Repurposed car parks

You would think city bosses would want less cars in the centre of town. But while less cars is good news for oxygen-breathers, it is bad news for city budgets reliant on parking charges. But using car parks to tap into new revenue from property development and joint ventures could help cities reverse this thinking.

5. Prioritise public awareness

Charge zones can be understandably unpopular. In 2008, a referendum in Manchester defeated the idea of congestion charging. So a big effort is needed to raise public awareness of the health crisis our roads have caused. Metro mayors should outline pollution plans in their manifestos, the report suggests. And cities can take advantage of their existing assets. For example in London there are plans to use electronics in the Underground to update travellers on the air pollution levels.

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Change is already in the air. Southampton has used money from the Local Sustainable Travel Fund to run a successful messaging campaign. And in 2011 Nottingham City Council became the first city to implement a Workplace Parking levy – a scheme which has raised £35.3m to help extend its tram system, upgrade the station and purchase electric buses.

But many more “air necessities” are needed before we can forget about pollution’s worry and its strife.  

 

India Bourke is an environment writer and editorial assistant at the New Statesman.