THE GREAT TRAIN CRASH: A Story
of Three
Dr. Scott Borrelli, Psychologist
I am having the great privilege of working with three different survivors of the
Paddington Street train crash which occurred on October 5, 1999 in London. This
event represents one of the worst transportation catastrophes that this city has
ever known, and has effected the lives of countless people. It is only just now
that many of the survivors have been allotted money for psychological treatment
of their post trauma symptoms. This type of bureaucratic foot-dragging, an inexcusable
example of man’s inhumanity to man, is just one of a series of injustices
suffered by these folks.
Below, I will concentrate on the bitter-sweet experience as a therapist working
with persons of courage and stamina, who have all been severely traumatised and
were referred for treatment of post-traumatic stress disorder. I will comment
on their remarkable achievements through psychotherapy and especially EMDR intervention,
as well as the various hurdles we have encountered. The healing journeys have
not always been smooth. Their stories are very different, as are the consequences
of the crash on themselves and their families.
It seems right to reflect on the devastating experience and therapy through the
eyes of these three very different individuals having just passed the first anniversary
of the incident. In order to maintain confidentiality, I am presenting a mosaic
of highlights across these three expansive journeys. My admiration and respect
for the powerful survivor skills inherent in human nature reflected in this story
of three is profound. Their powers of resilience are clearly unsurpassable.
Introductions: One Experience in Three
JIM - "The Gentle Processor".
Jim is a 35-yr old successful designer who had been taking the Paddington train
into work for the past ten years. At the time of the crash, his wife was eight
months pregnant with their first child, and their house had been undergoing extensive
renovation in celebration of the newborn's arrival. However, ever since the accident,
they had been planning to relocate into the city in order to avoid the fear now
associated with train commutes. Jim was despondent and anxious, and spent many
sleepless nights wracked with flashbacks of the worst sort. His wife had become
depressed, as well. Since the accident, Jim’s previously joyful family life
and planning activities had become soured and "as if". Home was now
a place where he felt mostly detached and isolated, but safe, at least. He had
become purely mechanical in his actions, and had lost his spontaneously warm style
for which he was beloved by friends and family.
SARA - "Too Eager to Be Well?""
Sarah is a twenty-eight year old assistant manager from the north of England.
She had just begun this new and challenging job a few months ago. It represented
an important promotion in her career, and she was still adjusting to travelling
long distances each day to reap the rewards and exciting challenges of city life
and work. She was a "country girl", but wished to stretch herself. She
was recently married. She and her husband had been sharing exciting discussions
about raising a family soon - before the accident. She had been on medical leave
since the accident, no longer secure in her original plan to reach greater business
management heights. She was depressed, and questioning the meaning of her existence.
Her survivor guilt was "killing me". Planning for a child under these
psychological circumstances was now out of the question
BEN - "Machismo Reluctance"
Ben is a twenty-two year old Australian visiting England on a two-year work/travel
visa. He works in IT, and arrived only a few months before with a wealth of dreams
about making money and seeing the world, and then returning to his homeland with
valuable experience and the financial resources to begin his own business and
marry his sweetheart. His wounds were deep, especially to his valued sense of
adventure and survivability. He had always been a risk taker, but now dread and
caution pervaded his life, making him feel like an "old man" always
seeking security and predictability. He was reluctant to give away his life long
dream plan, although he knew on some level that it (and he) had been permanently
altered. He had lost control of his life, and his characteristic machismo was
in direct contradiction to this new reality. He was face-to-face with his dreaded
"shadow", seeking escape in alcohol, interpersonal conflict and anger,
and is even more despondent than he knows, deep down.
Three-in-One
All three had similar accounts of the devastation they had witnessed on the day
of the crash, including gruesome stories about screams and screeching sounds,
scorched bodies, and burning train debris. Each experienced the aftershock of
the crash in their own ways, yet there are striking similarities in experiences
and personal coping styles. Each was led from the train wreck by well-meaning
helpers, in shock themselves from sites of which nightmares are made. Who can
ever be fully prepared to help on these occasions? Each was very lucky to be alive,
but that did not provide much relief. Fate had placed them in the "safer"
seats, in the opposite direction from the train motion, or "just one car
back". Each of these survival stories posed it’s own problems
in the form of survivor guilt. Remarkably, each of the three walked away from
the train crash with only minimal physical damage. The psychological damage, on
the other hand, was immeasurable.
On the day of the crash, Jim simply continued walking the extra two miles directly
to work: "I didn’t know what hit me, so I just kept on walking."
Sara was picked up by her husband two hours later, still at the site of the accident,
and slept at home for two days: "When I awoke, I had forgotten most of what
had happened". She was too frightened, however, to return to work and requested
indefinite sick leave. Ben walked ten miles straight home, but went to work the
next day "in a weird daze". He knew he was fundamentally changed, but
wore a convincing mask. He seemed to have transformed into a very serious gentleman
that day. For all three, a remarkable series of natural restoration processes
kicked into effect immediately, and each began his/her awkward pilgrimage toward
regaining wholeness, whether they liked it or not.
The Recovery Process
JIM...
Jim’s story of recovery is the most encouraging. It was a series of straight-forward
therapeutic events that most therapists only dream about, made possible primarily
through EMDR work. He came into the office at first with great trepidation, as
they all did. He was reluctant to shake-up the inevitable and rather successful
set of avoidance strategies now firmly in place to manage the terror inside. Unfortunately,
his once rich and steady emotional life also went down in the process. Although
he continued to work and even (very reluctantly) take the train each day, he suffered
flashbacks, heightened startle responses, nightmares and loss of pleasure in previous
activities, as did all the others. His daughter had indeed arrived, healthy and
bright, soon after the accident, yet he felt none of that brightness: "I
couldn’t be her daddy - I couldn’t even feel her presence."
After four standard EMDR sessions, Jim commented that he had "never felt
better in all of my life". He exclaimed that he felt he had experienced his
now ten month old daughter "for the first time, and I finally FEEL like her
daddy!." He also celebrated the restoration of his ability to "hear
and enjoy my music - and how much sweeter it is!". His wife and co-workers
were astounded by the changes in his expressiveness, and the return of his warmth
and contactful nature. His wife’s depression soon lifted in response, her
real and vicarious trauma reactions diminishing as her husband and family were
coming back to life. He even went on to master his fear of flying, also triggered
by the train crash, by participating in an airline course for that purpose, and
was ready to take up his former and enjoyable work-travel agenda which had been
suspended for nearly a year: "I am alive again.!"
SARA...
Sara, on the other hand, presented different complexities on her transit toward
trauma resolution. She had always been an "emotional person", sensitive
and social, and a bit self-conscious. She arrived at the first session hopeful
and enthusiastic, but also quite guarded. She was eager to return back to work.
She had tried to return three times before, but had to retreat, each time overwhelmed
by her fears of imminent disaster and loss of control. She finally told me the
gruesome details of having to peel dead bodies from hers , and how she was terrified
to think of ever leaving the protective and detached "shell" she knew
she had retreated to that day. She still cried every day, but didn’t really
"feel" the tears. She was lonely, yet courageous enough to share a portion
of my optimism for her recovery through the use of EMDR.
Sara responded dramatically and very quickly to the first and second EMDR sessions.
As with all my clients undergoing EMDR treatment, I asked her to ring and check
in with me within forty-eight hours of each session. After each session, she called
with glowing reports of her return to "my self". She exclaimed that
she could no longer even "picture" the accident, and was nearly ready
to return to work. However, during her first session, I also recorded an occasional
"absence" and tendency to dissociate during the eye movements. Although
she recovered quickly from these absences and I suggested that they might be important
opportunities for her to coalesce parts of herself, I remained concerned about
her actual progress and the real meaning of these dissociative events. Sometimes,
Sara seemed almost too "recovered" at this early point. Was this some
sort of "flight to health"? Besides, her history had revealed a series
of tragedies in her recent life that were likely unresolved, including the death
of her father three years ago. These losses were sure to be associated with the
train crash and would be prompted by our current work. On a deeper level, she
was only too aware of the mortality we all face, and the dread that accompanies
this reality.
After three sessions, Sara reported feeling "renewed". The next weekend,
in a misguided attempt to prove her new found confidence, she agreed to participate
in a dangerous rally car ride at very high speed.. Although the driver assured
her that he would stop the car should she become frightened, he ignored her inevitable
screams, and she panicked throughout the ride. The next day, she experienced what
looked like serious dissociative or even seizure activity, based on her own and
her husband’s reports. That humiliating loss of control, together with the
rally car experience, was enough to retraumatize. She is currently under medical
evaluation, and the appropriateness of further EMDR sessions is being assessed
carefully. The dissociative activity will require a longer and more comprehensive
view, including neurological and neuropsychological assessment. Her return to
"normality" will be a much more complex journey.
BEN...
Ben was carefully advised about EMDR treatment during the first session, as is
good practice with all patients. He was provided with a professional brochure
describing the procedure. I had been buoyed by the successes of Jim, and was hoping
for the next relatively uncomplicated success story. However, remaining securely
fastened to the back of his chair with arms folded, Ben did not look to be an
easily convinced customer. I suppose I used my charm and, perhaps, a display of
confidence to engage and convince him to partake of the waters during the next
session. I emphasised that I would be sensitive to his cues, go at his own pace,
and that we could stop the process at any time. In retrospect, I could have listened
more carefully and heard his reluctant acquiescence as a refusal. I suspect I
was a bit too eager to help, buoyed by previous successes. How important it is
to listen well..
Only five minutes into the first EMDR session was all that was needed to realize
that Ben’s foundation, manner of trauma maintenance, and potential resolution
were very different from Jim’s and even Sara's. During the first set of eye
movements, he experienced panic anxiety, which he immediately escaped by stopping
the eye set, and which ultimately turned him away from EMDR as a treatment of
choice. Clearly, he had been a young and sturdy man invested in his sense of power
and control, who had been planning to "take the world by the tail",
as it were. This control and, conversely, fear of loss of control, was accompanied
by a characteristic discomfort with any emotions other than those explicitly allowed
by the machismo culture, i.e., anger, stress, a competitive spirit. Any hint of
an explosion of tears was unacceptable (and terrifying), and he often looked as
if he was "on the verge". Regrettably, he left the first session quite
physically shaken, and experienced "one of the worst weeks" since the
accident ten months ago. I knew we would need do some damage control, and work
harder at establishing a more secure therapeutic base (i.e., "safe place").
I convinced him to return to subsequent sessions, but promised to delay any discussion
of EMDR. We needed to repair and further build the therapeutic alliance, if that
was possible.
Through four "talking" sessions with Ben over the next month, interspersed
with teaching user-friendly simple relaxation/stress-management and confidence
building skills which emphasised self-control, he seemed ready to take on a positive
resource installation session. As he remained strongly against the eye movements,
I introduced him to the bilateral stimulation offered through the use of David
Grand’s remarkable auditory CD’s. He has been responding well to this
gentler reintroduction of EMDR strategies, and I have not yet reintroduced the
desensitization phase for the actual trauma, still uncertain that this will be
appropriate for him. Ben’s recovery is taking a different and slower course,
and one that I am eager and bound to follow with deep respect.
A breakthrough occurred when Ben recently acknowledged a latent desire to "let
all the feelings out", providing grounds for further discussion of the value
of catharsis. Incidentally, the receptionist (who often offers revealing "patient
progress notes") reported that Ben "smiled for the first time"
on the way out that night. As he continues to increase his trust and comfort in
the "safe place" we continuously fortify, he will naturally point to
the ways in which we may go to help relieve the distress. I will need to "check"
my hearing at each point along this journey, keeping my impatience in check. We
are committed to working together for as long as it takes, and freely discussing
adjunctive treatments such as anti-anxiety medication.
AFTERWORD...
I, and my patients, owe much to the philosophy and practice of EMDR, including
emphasis on listening to and following the uniqueness of individual client's responses
to therapy. Although the EMDR protocol is distinct, each individual client requires
a selective approach. Appropriate timing is essential for the various stages of
therapy. The therapeutic task calls into action a broad variety of skills. "Staying
on one’s toes" is vital, as is an openness to learning more each week
about the characteristics of each client's experience. This is no job for the
light-hearted.
I learned from Jim that when a patient is characteristically trusting and comes
from solid family ties with a benign history, the standard EMDR protocol offers
good results. Traumatized families can dare to come together again.
With Sara, I learned of the potential for some patients to push themselves too
hard, too soon. No one before had offered her an inch of hope, and she was eager
to grasp the threads I offered during the preparatory stages of the work. Additionally,
a less stable background and personality style, and confusing messages from a
less supportive spouse unwilling to participate in the therapy, called for a different
and very sensitive approach. Sara’s case also highlights the potential for
EMDR to promote dissociative and even seizure-like activity. Extreme care is necessary
when facing vulnerable patient profiles.
In Ben’s case, the work continues as we plod through the mire of pain, defense
and hope. Baby steps increase the possibility that he can revise and regain significant
parts of his dream, his feelings, and his confidence. His recovery will take more
time.
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