"...And can you tell me doctor why I still can't get to sleep, and why the Channel 7 chopper chills me to my feet..."
- Lyrics from the song, I Was Only 19 (Originally titled, A Walk In The Light Green), by Redgum.
Flashbacks are a frightening and difficult to understand symptom of PTSD. They are like a nightmare that is experienced whilst wide awake. They always relate back to the trauma that the sufferer experienced and are triggered by something that subconsciously reminds the sufferer of the event.
A Vietnam Veteran suffering from PTSD will quite likely have triggers such as hearing a helicopter flying overhead, someone barking commands at them in a military manner, or a loud bang from an explosion or firearm; even something as harmless as a firecracker going off or a car backfiring can be a trigger, as it may sound similar to an explosion or firearm. Seeing a bushfire may remind them of the napalm attacks, or just being in a heavy jungle may bring back repressed memories that are too hard to hold back.
When a flashback occurs, it hits suddenly without warning. Then, the sufferer is drawn back into the past in a waking nightmare. It can be rather hallucinatory. The mind recognises the trigger and associates it with the traumatic event, and brings all the memories and feelings of that event to the forefront of the mind, often blocking out the present reality in the process.
The veteran is sitting on his front verandah enjoying a peaceful sunset on a warm afternoon. A car drives past and as it does, it backfires loudly. To the mind of the veteran he is suddenly back in Vietnam and is being attacked by the enemy, they are shooting at him! Fear strikes as his garden takes on a jungle-like appearance. People walking down the street may or may not be the enemy, he can smell the sweat and heat of the jungle, and he is suddenly back in a terrifying combat situation that he faced many years ago - but it is really only played out in his mind as if he was still there. Of course, he isn't there and no one is shooting at anyone, but it is very hard for him to get a grip on reality and believe that, as the flashback is so vividly real.
Some people occassionally physically react to such flashbacks, others seem to zone out and stare off into nowhere. The veteran in this example may dive for cover behind a few bushes in the garden, or he may appear to be daydreaming and switch off to his current surrounds and not react to anything that is actually happening in reality. Or he might be aware enough of reality to just quickly go inside the house to get away from the trigger and thus end the flashback. Sometimes it depends on the person as to how they react, sometimes it depends on the severity of the flashback, and it always depends on how well and how fast they can ground themselves into reality. Most reactions never last more than a few seconds. Fortunately, reality and the past are usually different enough that the flashback is quickly broken by something happening in reality that contradicts the circumstances of the past. For example, the bush that the veteran dove for cover behind is a saltbush - not something that you would find in a Vietnam jungle - and the strong smell and dry greyish leaves break up the illusion as he peers through the bush in search of his enemy. He then realises something isn't right, and comes back to reality.
When a flashback occurs, reacting by staring off into nowhere and being caught doing it can be a little embarassing. Fortunately it is easily overcome as everyone gets caught daydreaming or deep in thought now and then, so you just excuse yourself for being off with the fairies and everyone just shakes their head and thinks not a lot of it. However, reacting physically can be highly embarassing and very hard to explain.
I have a phobia of having my feet touched, especially of having sharp objects stuck in them. At hospital once, a nurse was having trouble getting a canula into the vein in the back of my hands, and told me that if she couldn't get one in my hand she might have to put it in my foot. I started screaming, crying, and begging her to not do it. I once stepped on a pile of large sharp prickles and ended up curled up on the ground in a quivering mess. A neurosurgeon ran a pen up the bottom of my foot to check my reaction without warning me he was going to do it. He got a reaction alright - I screamed and kicked him in the head before I realised what was going on! Oops. That sort of thing is really embarassing and it's worse when you have to suddenly explain what happened. More recently I've learned to pause, think about what might really be happening, and react according to the situation as it really is, but it doesn't always help when the triggers in a situation are extreme.
I recently stepped on a sewing needle in my bedroom. I was able to take a deep breath at feeling the pain, sit down on my bed and calmly look at what was stuck in my foot. I then took another deep breath after seeing what it was and I had to look around my room to get a grip on reality, as seeing the needle in my foot was the greatest trigger of all. I was then able to pull the needle out and put it away. Unfortunately, the pain in my foot lingered long enough that, not long after, another minor trigger that normally doesn't set me off anymore occured, and I ended up laying on my bed in a ball screaming my lungs out for a moment, while a dear friend watched on in horror, wondering what was going on with me. Fortunately he understands my problems and had in fact wondered how I got past the incident with the needle so well, but was a bit shocked to see such a delayed reaction as strong as that. He brought me out of it by holding me and talking to me, asking me what happened and what was going on. The sound of his calm and caring voice and his gentle touch brought me back enough to listen and react to what he was saying, and that made me think about what was going on and what was happening, which brought me out of it and back to reality.
For the sufferer, the only way to get past a flashback is to learn what the triggers are, build up a resistance to them, and to learn to face them when they happen in a calm logical manner. What just happened? I accidently stepped on a prickle, it won't do me any further harm, pull it out and get over it. Learning how to ground yourself into reality by looking for things that are inconsistant with the past helps avoid a flashback and also helps bring you out of one. I'm in a pink room, this didn't happen in a pink room. There was not a vase of flowers on the bedside table. There was no smell of lavendar in the room. It's quiet here, it wasn't quiet then. There is nothing to be afraid of anymore.
If you witness someone experiencing a possible flashback, the best thing to do is usually just calmly ask them - repeatedly if need be - what is going on, what is happening, and react to their answers, if they give any, calmly and with some thought. If they tell you that something is happening that you can't see, you need to be aware that, although you don't believe it, they very much do. Don't question their belief, but do question what they can't see in reality to bring them back. For example, you might want to ask them where something that doesn't likely relate to their past is - such as a recently released cd or dvd, or something they recently purchased that they didn't own before. Or make comments on things that are likely to bring them back, such as the colour of the room or the smell of something. This will make them stop and think about their surroundings, and if the thing you are asking about was not in their past, they may just start realising that something isn't right with this image of what they think is going on and snap out of it. So long as you don't do anything that might give them an impression that you might be going to attack or hurt them, they should be okay with you talking to them. Just stand back, stay calm, and talk gently and logically. This will also be effective for somone suffering a hallucination induced by drugs or a different mental illness. You could also suggest they do something else, such as go outside for some fresh air, or go into another room. The change of atmosphere might help take them away from the situation that is causing the problem and bring them out of it. Of course, if you know the person well and you know what happened to them and why they are reacting the way they are, it will be a lot easier for you to find things they can ground themselves with. You will also know what you can get away with. I wouldn't recommend attempting to touch someone that doesn't know you well, but someone you are close to may be able to use as their grounding if you can give them a gentle hug or hold their hand. If all else fails and after a few minutes they aren't calming down and still appear to be in some sort of trance or hallucination, it may be well advised to call an ambulance.
It may be very difficult for somone who has never experienced such a thing to grasp the concept of what happens in the mind of someone having a flashback. The only thing I can suggest is, imagine the most terrifying nightmare you have ever had, and then imagine being in the middle of that nightmare while you are awake. Freddy Crugar may not really exist, but the horror of those movies with their concept of living in a nightmare even when awake, is a good example of the concept of what it can be like to have a flashback. It is scary, but it can be overcome - and you don't need to destroy an evil demonic undead creature that lives in the realm of dreams to make it go away. Good therapy and an understanding of what they are and why they happen is usually enough.
(August 2007) (
