Most would regard post-traumatic stress disorder (PTSD) as a medical system that occurred within the battlefield, PTSD was considered primarily, if not exclusively a condition related to soldiers and the traumas related to their war experiences.
It was therefore surprising that Radhika Sanghani found herself suffering from a post-traumatic stress disorder following a horrific coach crash in Thailand. She thought that PTSD was something soldiers in Afghanistan got – not 22-year-old Londoners who watched the Great British Bake Off.
The first thing to know is that anyone who has PTSD will have undergone a traumatic event.
Since trauma is widely defined but sometimes misunderstood it is helpful that we describe what is meant by a traumatic event.
The American Psychological Association defines a trauma as a response to a horrible event, situation or occurrence such as a natural disaster (hurricane, floods), sexual assault etc.
People who experience these traumas tend to go into shock and denial immediately after the event.
However, long-term reactions become problematic and individuals experience unpredictable flashbacks, strained relationships and physical problems such as headaches.
Some of the events that could cause a trauma are:
- Childhood abuse
- Domestic violence
- Sexual assault
- Survival of a serious accident
- Military combat
- Abduction (kidnapping)
- Abusive relationships
- Witness to an act of violence (such as a crime)
- Survival of a crime-related event (such as a bank robbery)
- The onset of a serious illness or disability (such as M.S., spinal cord injury, etc.)
- Natural disasters such as hurricanes, earthquakes or tornadoes
The following story was printed within the telegraph on how Radhika SanghaniI was on holiday in Thailand when the coach was hit by a tree and veered off the motorway.
She found out later that five people had been killed in the crash: one of the victims was aged 23, a year older than her. She had been sitting across the aisle. When she woke up concussed, she was lying beneath her and not moving.
Radhika SanghaniI tells her story .........
I can still remember William, her boyfriend, repeatedly screaming out her name: Delphine. For weeks after the accident, his voice haunted me in my sleep and I would wake up sweating from the flashbacks. Every time I looked in the mirror, I didn’t see myself; I just saw the girl who didn’t die.
The crash happened in February 2014 and I was the only tourist among 38 passengers to walk away apparently unscathed. I was the “miracle survivor” among my travelling companions. George, 21, lost his left foot; Bradley, 22, punctured his lungs; and Aaron, 21, shattered both hips. They all spent weeks in intensive care.
My only visible wounds were small cuts and scratches. It never occurred to me that in a way I was seriously hurt, too. It was only later that I was diagnosed with post-traumatic stress disorder (PTSD).
At the time, all I knew about PTSD came from reading F Scott Fitzgerald’s Tender Is the Night, set in a time when it was known as “shell shock”, and from news stories about the military in Afghanistan.
I am not alone in this view, according to Sam Challis, from the mental health charity Mind.
“People think it’s something that only affects people in high-risk jobs, like firefighters or soldiers.”
But Sir Simon Wessely, head of psychological medicine at King’s College London, stresses that PTSD can affect anyone who has had a frightening or distressing experience. “Even in the military, PTSD can be caused by assaults and road traffic accidents.
It’s important that we don’t assume PTSD is caused only by the Taliban.”
In fact, PTSD is estimated to affect one in every three people who have a traumatic experience. Those who have previously suffered a trauma, or who lack social support, are particularly vulnerable. Triggers can range from assaults to natural disasters to serious road accidents.
I had been travelling overnight from Bangkok to the islands in the south when one of the coach’s back tyres exploded. After crashing into the tree, it flipped on to its side.
Thai authorities later revealed that the driver – who fled the scene – had taken illegal amphetamines and he was charged with reckless driving.
The last thing I remember was falling asleep to The xx on my iPod. In the crash, my head hit the window and I lost consciousness, before waking up around half an hour later.
There was smoke everywhere and my glasses were gone. I could feel twisted metal all around me and shards of glass embedded in my skin. George was standing next to me with part of his left foot missing: I could see where it had been torn off.
He was trying to comfort his friend Aaron, who was trapped under mangled seats. It was then that William found Delphine’s body.
My immediate reaction was to get out: I was terrified the coach would explode. I managed to crawl out of a window and went in search of help.
I found Bradley lying in the back of a truck, put there by locals. He was having problems breathing; I used hand gestures to ask the local paramedics to bring him oxygen, and shouted at the firefighters who had arrived, to rescue the two boys still trapped inside the coach.
We were eventually taken to the nearest emergency centre, a one‑room wooden cabin in a field in the middle of nowhere.
While my friends were undergoing emergency surgery, I called the British embassy and begged them to come and help us. I eventually met the embassy staff at a second hospital in Chumphon, the nearest town, where we were taken by ambulance.
Conditions were terrible: there were flies surrounding people’s open wounds and visitors sleeping on mattresses in the hallways. I walked around shoe less, with bandages on my feet, for two days. I couldn’t eat or sleep, so I spent all my time trying to cheer up the boys and help the understaffed nurses.
It was only when my friends’ parents arrived and took them to private hospitals in Bangkok that I flew home, five days after the accident (I had asked my parents not to come out, as physically nothing was seriously wrong with me).
Back at my parents’ home in Hertfordshire, I finally broke down. I cried non-stop and had little interest in returning to normal life. But I also knew I needed help and saw my doctor the day after I arrived home.
He wasn’t surprised to hear how I felt completely numb and overcome with guilt, and was haunted by flashbacks of the accident.
He told me these were all key PTSD symptoms and recommended I see a psychiatrist. The NHS service had a long waiting list, so I signed up for private treatment, which meant I could see someone straight away.
The psychiatrist diagnosed PTSD combined with depression, and what is commonly known as survivor’s guilt. It was terrifying to hear my diagnosis in such formal terms. I had gone from being a healthy 22-year-old who never had anything to write on health forms to having a mental illness.
I was advised to take time off work, since my job as a trainee reporter meant I was exposed to events that could trigger my flashbacks. I also agreed to start weekly sessions of cognitive behavioural therapy (CBT) at the Capio Nightingale, a private hospital in London.
At first I avoided discussing my feelings. Whenever my therapist asked me to tell him my version of the accident, I just reeled off a list of facts: when it happened, where, and what injuries my friends had suffered. I didn’t want to “make a fuss” while my friends were still in intensive care.
But the therapist said the only way for me to move on was to talk about my feelings and learn to accept that some were irrational. I realised that I was harbouring huge amounts of guilt about the accident, which was contributing to my anxiety and depression.
CBT works by giving the client the tools to change their filter on an event. With the therapist’s help, I learnt to alter my filter on the accident.
I came to realise that every decision I had made after the crash – to leave the coach, call the embassy and shout at the paramedics – was part of my natural survival instinct and not something for which I should feel guilty. I had to accept those decisions, not wish I had stayed with the trapped boys on the bus to comfort them.
Once I had recognised this, my flashbacks gradually stopped and the anxiety lessened. Ten months after the crash, my therapy is drawing to a close.
No one knows why some people beat post traumatic stress disorder and others don’t, but with each day that passes I know, at least, that I am closer to overcoming it.