Down Among the Weeds

by Harry Beaves

  However, I had heard much about Combat Stress, the services mental health charity and their treatment of servicemen with Post Traumatic Stress, so I visited their website. I was immediately struck by the similarity of many of my symptoms with cases they quoted. Over and over again there were examples of servicemen who felt that civilian medical authorities and other agencies just did not understand what it took to be a serviceman and the demands that were involved. This was just how I was feeling. When I registered with Combat Stress in December 2010 there was a waiting list of several weeks before assessment, which I could accept as I was hoping the medication from the GP would work and that Combat Stress would just be a fallback option if it was unsuccessful.

  The body has to get used to anti-depressants and they don’t normally become effective for fourteen days or more. I began the treatment in the New Year, but after three days the tablets were actually making me more anxious. After five days the effect was so bad that I returned to the GP who told me to halve the dose until my body became accustomed, then go on to the full dose again. I took the tablets for a fortnight before the anxiety that they induced became completely unbearable. The doctor offered a different type of anti-depressant and I began taking that, but the effect was much the same.

  Barbara was helping and supporting me in my efforts to adjust to the effects of the anti-depressants, but she was very worried about the dramatic effect they were having on me. With varied doses, breaks, advice and encouragement I persisted, but my anxiety levels were at the top of the scale and life was becoming impossible. On one occasion I paid my normal visit to the local gym. There is a key pad lock on the outside of the door to the changing room and, despite the fact that to leave you just push the door to open it, I could not bear to be behind a door with a key pad. Half-changed, I was overcome with anxiety, grabbed my clothes and rushed home to the safety of our house. I was in tears, as much as anything because I knew how stupid and unreasonable it was to worry about something like that. There was no alternative; I had to stop taking the tablets and I am convinced, now, that the two types of anti-depressant that I tried caused immense harm and left me with symptoms from which I took a long time to recover.

  Slowly, I began to feel better, but I felt fragile. I knew my improvement would not last and, sooner or later, some minor event would trigger the anxieties all over again. My hopes were now focussed on Combat Stress with whom I was still waiting for assessment. Meanwhile the GP offered a form of ‘psychiatric first aid’ through ‘Gateway’, a local organisation which, among other things, assesses people with anxiety and depression and decides on a suitable form of treatment. Within days I was assessed by phone and called in for my first counselling session.

  The staff at Gateway were very good and it was reassuring to learn that the symptoms I was experiencing could be categorised, which suggested to me that I had recognisable problems that could be treated. Gateway provides low-level help and mainly concentrated on coping strategies. Their advice made sense and I was able to put most of the techniques they taught into practice with some degree of success, while I continued to wait for assessment by Combat Stress. In March I was eventually visited by a representative from Combat Stress who decided that my tick box score identified problems which needed more accurate analysis by staff at their headquarters. There would be a few months’ wait before I was called forward.

  For days at a time I was relatively normal, but my level of anxiety continued to move in peaks and troughs and sooner or later an unusual event would trigger a huge downswing. I was rung by an old friend and invited to a reunion lunch in London with a group of old military friends. I responded with great enthusiasm and was eagerly anticipating it. Then the doubts and anxieties began and the ‘what ifs’ came flooding into my mind so that I was lying awake every night, worrying, until the only way out was to cancel my attendance. My anxieties were beginning seriously to interrupt the way I led my life, but I struggled on, continuing to pin my hopes on the specialist military experience of Combat Stress to put me right.

  In early July John and Emily were married. It was a wonderful occasion and went without a hitch, but I had been on a downswing and struggled throughout. Among those who attended the wedding were Barbara’s sister, Gwyneth, and her husband Stephen Craske. Stephen had been a consultant psychiatrist and Barbara had spoken to him (I hadn’t!) a number of times about my problems. They were staying with us on the evening following the wedding and Stephen and I were quietly chatting in our sitting room. We talked in very general terms about the problems I was having, about some of my Northern Ireland experiences and I showed him my scrapbooks.

  It was a very easy and relaxed conversation, but one huge piece of the jigsaw fell into place when Stephen described my desire to have a plan or coping strategy for every single contingency as ‘hypervigilance’ and linked it with the prolonged period of tension that I had experienced in Ireland. The penny suddenly dropped and it began to make perfect sense. Hypervigilance had kept me alive throughout those months in Belfast. Now, perhaps my problem was that I simply could not switch it off.

  Stephen expressed surprise at the time it was taking me to get help and recommended a professional colleague who was a former Army doctor who now specialised in PTSD, but I preferred to wait for Combat Stress as they seemed to be the specialists in my particular area and I was, after all, on their waiting list. He also suggested that I should write about my Belfast experience, but I did not take it seriously and thought little more of it. Some days later a package arrived in the post and when I opened it I was amazed to find a copy of his own autobiography in which he described trials and tribulations that he had experienced in his life of which I had no inkling. I read his story with fascination and it was a major spur for me to produce this book.

  In late July I was visited again by Combat Stress only to have my hopes dashed. Because of the huge increase in the national awareness of PTSD in ex-servicemen and of the importance attached to it, Combat Stress had a vastly increased caseload and was expanding its staff and organisation to cope with it. Consequently I would probably not be assessed for several months and was advised to seek further help through the NHS. I had struggled on, pinning my hopes on Combat Stress and wasted seven months when I could have been receiving treatment through the NHS. I felt massively let down.

  The huge disappointment triggered a period of deep depression and I returned to my GP. He referred me back to Gateway, who reassessed me by telephone and offered me a course of Cognitive Behavioural Therapy (CBT).

  Chapter 38

  CBT and Mindfulness

  I was relieved to be starting CBT as I felt that at last I was going to get professional treatment for my specific problems. I have never thought much of tick-boxes tests, but they seemed to precede every form of psychiatric contact. My scores confirmed the need for counselling. The first two sessions looked into my past, identifying possible traumatic experiences. Three events stood out: the death of my mother; events in Northern Ireland; and my heart bypass operation. By now I felt strongly that my problems lay with my time in Northern Ireland and I desperately needed to talk to someone about it. When I discussed Ireland with the CBT therapist I found it extremely disturbing and was only able to talk around events in very general terms while the other two traumatic events posed no significant difficulty.

  On the third session we discussed the plan for my treatment. The therapist announced that she felt that I was suffering from a generalised anxiety disorder triggered by concern over my heart and my health. That would be the focus of her treatment. I stared at her in disbelief and argued that I had no concerns over my heart and that I felt that the source of my problems lay with events in Belfast. We agreed to deal with Belfast later in the treatment, but never actually managed to do so.

  We began with the anxiety spiral, drawn on a white board as we talked, adding arrows going this way and that for associated thoughts and reactions. The resulting jumble looked like the wanderings of a demented spid
er and was impossible to comprehend. As the weeks went on we talked of coping strategies which were barely more than I had learnt from Gateway. So we talked of confronting phobias and Obsessive-Compulsive behaviour and I went away and tried to practise the solutions. Sooner or later each week the phrase ‘Now I think it may be useful to look at the anxiety spiral’ was introduced. We didn’t seem to be getting anywhere and it seemed almost as though considering ‘the anxiety spiral’ was a last resort. Eventually I would be looking at my watch to see how long into the session it would be before the phrase inevitably cropped up.

  I struggled, because I needed objective answers to my questions. For example, I was concerned about the coping strategy that I had been taught whereby when disturbing thoughts came into my head, particularly at night, I diverted my mind away from them by concentrating on pleasant thoughts or events. I could do this successfully and my anxiety would subside, which was fine, but those disturbing thoughts were just shut away for the time being and would eventually return, each time with greater force (the periscope of the submarine breaking the water). If I knew what caused me to have those disturbing thoughts in the first place and what could be done to stop them perhaps I might find it easier to take the appropriate measures. The CBT therapist talked about the danger of ‘cognitive avoidance’ – deliberately not thinking of or doing things that cause anxiety – and stressed the need to confront phobias and the like in order to overcome them. These two principles seemed to run contrary to the coping strategies that she advocated.

  A more practical illustration of my difficulties was the lift in the building, which would take me from reception on the ground floor to the CBT rooms on the first floor. I chose to take the stairs each time because I am claustrophobic and don’t like lifts, but I can use a lift if it is not crowded. So, when I took the stairs, was I giving in to my phobia or just exercising a preference? My real question was, however, ‘Why did lifts bother me, when other people have no problem?’

  My condition was worsening and I was very depressed. It also coincided with the period when I was very distressed by Heather’s deteriorating health. Remembrance Day is always very special for me and I was looking forward to the annual ceremony at our village War Memorial. Unlike the military services that I had attended over the years, the ceremony rarely ran smoothly, but, despite this, I always found it very satisfying. The vicar was new to the village and he had done an excellent job when he married John and Emily, but, sadly, his approach to the Remembrance service was completely wrong and I felt he had treated the occasion casually and not given it sufficient thought and consideration. I was hoping for some sort of spiritual support, but it was totally missing and in my fragile state I felt angry and let down by the vicar. My depression plummeted.

  I was about sixteen sessions into a course of twenty sessions of CBT, but I just could not see what it was trying to achieve. Moreover, I knew that only the symptoms were being treated and that the therapist was not getting to the real cause of my problem. Never once did she suggest any reason for my problems or seem to want to get to the root of them. I remained convinced that Stephen Craske’s suggestion that I was ‘hypervigilant’ as a result of experiences in Northern Ireland was the key and I desperately wanted a solution. I searched the internet for information to help me understand more clearly how CBT was supposed to be helping me and followed a link to post-traumatic stress where I found stories of folk with symptoms and problems like mine.

  Gradually I began to understand a little more about my difficulties. For four months in Northern Ireland, day in, day out, we were under potential threat and had to be constantly alert (hypervigilant) to the dangers around us in order to live. My present anxiety was triggered by the hypervigilance, which for my four months in Belfast had been essential for me to survive, but after almost forty years I was unable to switch off. I was acutely aware that David Storrey and Bob Hope made an error of judgement that I had avoided through my experience and awareness (vigilance). Now I was safe but they had paid for it with their lives. I believed that many of my problems were related to ‘survivor guilt’.

  I discussed my thoughts with the CBT therapist and she accepted the logic. I saw the remaining sessions through with little enthusiasm and on completion asked if I could be referred for analysis. My scores in yet another tick-box test were high enough for further assessment, but there had to be an interim period of a month to see whether CBT had been effective – I believe that was the reason, though I didn’t understand why. The therapist asked if I wanted to try a system based on meditation called ‘Mindfulness’ which she thought might be useful. I felt it could do no harm and might help while I was waiting for counselling so I agreed.

  I had remained on the books of Combat Stress and towards the end of the time that I was undergoing CBT I received a follow-up visit by one of their staff, the timing of which could hardly have been more fortunate. Unlike the other person that I had met from Combat Stress, he was ex-service (a former naval psychiatric nurse) and we seemed to establish a rapport as I felt comfortable with his military manner and the directness with which he approached my problems. I told him that my anxiety had increased considerably and we discussed the concern that I was having over CBT treating the symptoms and not the problem. If I had sprained an ankle, it would have been examined and X-rayed before a physiotherapist would consider treating it so why was the mental health system so reluctant to start with a full diagnosis that identified the cause before beginning treatment? I also asked if the mental health services had to meet waiting-time targets like other branches of the NHS. I was feeling very hard done by!

  We completed the now familiar tick tests and my scores were significantly higher, so he recommended assessment at the centre run by the charity as soon as possible. I was reassured and all my hopes were now pinned on Combat Stress, but I was happy to go ahead with Mindfulness, while I was waiting.

  Around that time Heather died and I had to face the stress of her funeral in Derby. At that time I would have expected the journey to have created massive anxiety for me, with a host of unanswerable ‘what ifs’ creeping into my mind in the small hours of the morning. This happened to a degree, but my desire to be at the funeral was an imperative that seemed to override all of these problems, so I was able to convince myself that nothing untoward could possibly happen.

  We set off in Barbara’s car early on the day of the funeral in order to dispel my fear of losing time because of some unforeseen mishap (what could possibly go wrong?). We had shared the driving and at around midday Barbara was at the wheel on a crowded dual carriageway to the south of Derby. It was raining and we were following a huge lorry carrying builder’s hard core. Sand and gravel were blowing off the top of the load making the windscreen wipers work hard, when suddenly I was aware of a shape arcing through the air, followed by a mighty bang as a rock hit the windscreen. Barbara hung on and braked hard, then eased over to the side of the road in order to gather her wits. The rock the size of a half brick had hit the windscreen with such force that tiny shards of glass had come off the inside and were on the floor at my feet. In front of my face was a star pattern about eight inches in diameter. I got out of the car and when I pressed the windscreen it seemed firm in the frame so we decided we could continue with caution. Fortunately the rock had bounced off the windscreen and done no more damage. To have considered that rock as one of my anxiety ‘what ifs’ would have been completely stupid. It just couldn’t happen – could it? Murphy was reminding me not to forget his ‘law’. Heather’s funeral was a very fitting occasion, held at a cemetery on the edge of the Peak District at four in the afternoon. The cemetery was close to her school and Steve had chosen that particular time so that staff and students could attend. In the pub afterwards it was comforting to hear past and present students of all ages telling happy tales of the contribution that my little sister had made to their lives. Our return journey to Poole was uneventful!

  * * *

  The hand out I received
on Mindfulness describes it as based on Buddhist meditation. I quote:

  Mindfulness is a difficult thing to describe; rather it is understood through actually practising it… we call the kind of moment-to-moment awareness of one’s body and other aspects of our lives ‘Mindfulness’. It is developed by purposefully paying attention in a non-judgemental way to what is wrong in our bodies and mind and in the world around us. Staying in touch from one moment to the next, this shift of awareness may lead to you seeing things somewhat differently, or to a sense of having more options, more strength and more confidence in your possibilities.

  I have always tended to see things as black and white and to think in straight lines. In the spring my daffodils break through the soil and stand like soldiers, which perhaps shows why I was so well suited to the mostly two-dimensional military life. I struggle with abstract theories so, from the unfathomable description above, Mindfulness was always going to be a challenge for me. The handout said that I would ’understand through actually practising it’ and I had nothing to lose, so it was ‘forget the weeds’ and get used to being ‘down among the lentils’.

  The course was run in Bournemouth in an old church with high ceilings and a comfortingly cool, calm feel (or do I mean ‘Karma’?). Surprisingly, I found that the calmness that came with the meditation was pleasant and helpful, but, outside that, my anxiety was not improving and I found many aspects of Mindfulness hard to understand and accept.

  Combat Stress remained my main hope and I was still waiting to be called forward for in-patient assessment, but had heard nothing so I rang to enquire. The response was confusing and symptomatic of the chaos that surrounded the charity at that time as they expanded their activities. I didn’t fully understand the reasons, but it seems my GP had received a report from the CBT counsellor suggesting that my CBT had been successful. As a result, he had not provided the information required by Combat Stress, so they had taken me off their books though somehow they had neglected to tell me! I argued desperately that my problems were actually worsening, but to no avail. I had lost my last hope and it threw me into another huge trough of depression.