How do you deal with memories you don’t want?
Airdate: 
Tuesday, September 16, 2014 - 20:30
Channel: 
SBS

Casey is still haunted by the time she hit and killed a pedestrian whilst driving her car. It wasn’t her fault. She remembers vivid details like the woman’s knee high stockings.

Paul still regularly thinks about how his carriage crumbled in the Granville train disaster, although it happened almost 40 years ago.

Esther still struggles to look at a plate of rare meat after years of service as a police officer and forensic investigator.

This week, Insight looks at how our brains process painful memories, and whether talking about them makes them better or worse.

Are some memories so bad they’re better to forget?

Presenter: Jenny Brockie 

Producer: Elise Potaka 

Associate Producer: Alix Piatek

Cadet: Hannah Sinclair

Join the discussion by using the #insightsbs hashtag on Twitter, posting on our Facebook page.

Web Extra: Explainer on trauma-focused CBT and exposure therapy

What is trauma-focussed cognitive behavioural therapy?

Trauma-focussed CBT is a recommended counselling approach for people suffering PTSD. It involves facing and dealing with the memory of a traumatic event, rather than pushing it to the back of the mind. During the treatment, a patient will learn ways to face traumatic memories and confront situations they have avoided since the event, until they are no longer distressed by them.

Source: Australian Centre for Posttraumatic Mental Health – Recovery After Trauma pamphlet

What is exposure therapy?

Exposure therapy is a form of trauma-focussed CBT.  It uses a set of techniques designed to help patients confront feared objects, situations, memories or images. With PTSD, exposure therapy often involves repeated emotional recounting of the traumatic memory and exposure to trauma-related situations that evoke unrealistic anxiety. This is done in a graded and systematic manner.  It’s an evidence-based treatment that has been proven effective across PTSD sufferers with different backgrounds.

Source: National Center for Biotechnology Information

Transcript

JENNY BROCKIE:  Welcome everybody, good to have you with us tonight. Casey, you were involved in a car accident that wasn't your fault, your car hit a woman and she was killed. That happened more than a decade ago? 

 

CASEY HAYES: Yes. 

 

JENNY BROCKIE:  Do you still think about it? 

 

CASEY HAYES: Absolutely. 

 

JENNY BROCKIE:  How often would you think about it? 

 

CASEY HAYES: It varies - I couldn't put, you know it's not daily but I would say at least once a week, if not more. 

 

JENNY BROCKIE:  And what was it like for you in the first few weeks after that happened? How did you try to deal with what had happened initially? 

 

CASEY HAYES: Yeah, to be honest, I didn't actually know what I was meant to do. I didn't know how to deal with something like that. It's so different to anything, you know, that I've ever experienced in my life. My family didn't know how to deal with it. So it really was, I kind of withdrew into myself, didn't talk, didn't talk to my family. However, I went off to work the next day because I didn't know what to do. I thought try to do something normal. 

 

JENNY BROCKIE:  I'm interested because the first night you said that you just wanted to talk about happy memories? 

 

CASEY HAYES: Yeah. 

 

JENNY BROCKIE:  Your very initial reaction? 

 

CASEY HAYES: Yeah. 

 

JENNY BROCKIE:  Was to talk about other things, yeah? 

 

CASEY HAYES: I distinctly remember that night a friend came over, my sister, myself and a friend, and I just wanted to talk about anything. 

 

JENNY BROCKIE:  Good things? 

 

CASEY HAYES: Yeah, Disneyland, didn't want to go to sleep, just wanted to relive happy experiences. 

 

JENNY BROCKIE:  And after that?

 

CASEY HAYES: I talked about the event in intricate detail to anybody that would listen. Um, I went through the step by step of the accident, what happened, what I saw, what it looked like. 

 

JENNY BROCKIE:  Over and over? 

 

CASEY HAYES: Over and over. 

 

JENNY BROCKIE:  Even if people didn't want to listen? 

 

CASEY HAYES: Absolutely. 

 

JENNY BROCKIE:  And how did they react when you did that? 

 

CASEY HAYES: A lot of blank looks, people didn't know what to say. But that didn't faze me, as strange as that might sound - I had to just talk about this event. 

 

JENNY BROCKIE:  And how did the event affect you day-to-day? What impact did that thinking about it a lot have on your day-to-day life? 

 

CASEY HAYES: Um, in the weeks immediately after I would replay the memory over and over in my mind. If I found myself not thinking about it, I would force myself to replay the memory. 

 

JENNY BROCKIE:  Why? 

 

CASEY HAYES: It was almost to punish myself. A lady's just lost her life, I'm sitting here at work, I shouldn't, you know, I need to punish  myself for that, I need to relive the experience. 

 

JENNY BROCKIE:  Has anything shifted for you as time's gone on in terms of memory and how you deal with it? 

 

CASEY HAYES: Yeah. I initially, I was incredibly emotional when thinking about it. Now I talk, I think about it and I talk about it with no emotion whatsoever. I have no emotion around the memory. 

 

JENNY BROCKIE:  So now it's just a bad thing that happened? 

 

CASEY HAYES: It is, but I have a lot of guilt around not having any emotion attached to something so tragic and I find it very difficult to talk to people about it because I do talk about it without emotion and people struggle to understand why aren't I upset about this? Why aren't I crying or in tears? Because they feel for me but I feel nothing and I really struggle with that. 

 

JENNY BROCKIE:  Kristy, you were hit by a car in January this year? 

 

KRISTY FITZGERALD:  Yes. 

 

JENNY BROCKIE:  So very recent really what happened to you?  

 

KRISTY FITZGERALD:  Yeah. 

 

JENNY BROCKIE:  You had physical injuries but you were back at work within a month? 

 

KRISTY FITZGERALD:  Yes. 

 

JENNY BROCKIE:  How were you feeling emotionally in those weeks afterwards, after it happened? 

 

KRISTY FITZGERALD:  It was about, I would say, four to six weeks afterwards that I started feeling that the emotions were getting on top of me, that perhaps I wasn't coping with it as well as I should be, progressing, I was still feeling quite anxious. I don't know where I got the idea of the timeline that I should be working.

 

JENNY BROCKIE:  Yeah, I was going to ask you that.

 

KRISTY FITZGERALD:  No, it was just like no, I should be better now. It was kind of after I'd gotten over the whole scans, finding out exactly what injuries I had. 

 

JENNY BROCKIE:  The physical stuff? 

 

KRISTY FITZGERALD:  After I'd gotten over the physical stuff it was like oh, yeah, I think I need to go see a counsellor. 

 

JENNY BROCKIE:  So what was happening that was making you feel that? What kinds of things were you experiencing? 

 

KRISTY FITZGERALD:  I was feeling mainly anxious, as soon as I stepped near a car that I thought was going too fast or that wasn't going to stop, I couldn't cross a road without there being a pedestrian crossing. I would wait until other people were at the same crossing because I felt safer in a group.  Now I think I'm getting better. I'm not as anxious in the car. It's mainly the long trips when there's lots of traffic around that I start gripping the seat and thinking someone's not going to stop, someone's going to hit us. 

 

JENNY BROCKIE:  Paul, you were a train passenger in the Granville train disaster.

 

NEWSREEL: 83 people died when the Sydney-bound train derailed at Granville and smashed into a bridge, bringing it down on carriages.

 

JENNY BROCKIE: That was 37 years ago, you were in one of the carriages that the bridge collapsed on. How often would you think about that now, 37 years on? 

 

PAUL TOUZELL: Several times a week I would say.  You can't go out on the road and drive a car without going under a bridge, seeing trains go over the top.  Quite often I get stuck under a bridge and it gives me a creepy feeling. I'm a lot better with it now. Shortly after the accident, you know, I decided I'd drive to work after a couple of weeks and it was difficult driving. You'd stop under a railway bridge, a train would go over the stop and freeze, it was…

 

JENNY BROCKIE: And do you still have that reaction now all these years later? 

 

PAUL TOUZELL: Yeah, I would say so. 

 

JENNY BROCKIE:  Yeah?

 

PAUL TOUZELL: It does happen. In fact, we often almost laugh about it because I'll go out, bridges where trains very rarely go over the top, it's like as if they're waiting for me. I'd go to go under the bridge and a train would go over the top. 

 

JENNY BROCKIE: That's always the way? 

 

PAUL TOUZELL:  Where did the train come from?  It knows I'm coming or why? Yes, it shakes me up but, you know, almost instantly straight after that I can keep driving and straight away almost forget about it. 

 

JENNY BROCKIE:  So it's a momentary thing, it doesn't, does it stay with you that feeling, or does it go quickly? 

 

PAUL TOUZELL: No, no, it goes. Yeah, look, I don't think about it all day every day and certainly things that do remind me, remind me briefly of the incident. Sometimes I could - depends on the mood I'm in, probably how tired I am or whatever would depend on how emotional I feel about it at the time. Little things you don't expect to and it was certainly twenty years before I could even talk about it.

 

JENNY BROCKIE:  It was twenty years before you, it was twenty years before you could catch a train again, wasn't it? 

 

PAUL TOUZELL: It was, yes.  Well, the first time I went to get on a train you wouldn't believe it, we were over at Milson's Point and her father, Loretta's father was with me and they said we're going to get you on a train. So we were up at Milson's Point station just going to go over to Town Hall in the city, three stops away, two or three stops away, the announcement came over on the PA: "The train to stop at platform 1 goes to Granville." This is my first time back on the train, I couldn't believe it. 

 

JENNY BROCKIE:  So just the word too?

 

PAUL TOUZELL: The word "Granville" and I must have gone white and they grabbed me and said you're getting on. So I got on, I couldn't believe it, it was a totally different ride to what I could remember. A smoother rain, better tracks and I started to think to myself now, well, you know, Granville didn't get me, I've got more of a chance of having a serious accident in the car, as with Casey here, and I should just try and move on. 

 

JENNY BROCKIE:  Loretta, how much has this over time disrupted your lives?

 

LORETTA TOUZELL: Well, he didn't really talk about it much; he kept it all to himself. I knew him very well when the accident happened and it was still three years before I knew he was on the train. We were having a party with all of our friends and someone said: "Oh, do you know it's the anniversary of the Granville train disaster today", and Paul just stopped and said:  "You know, I was on that", and everyone just clammed up. We didn't even know he was on it and he was one of our best friends and he just didn't like to talk about it. And it wasn't until the 20th anniversary that he really talked about it and brought it all out. 

 

JENNY BROCKIE:  And that helped? 

 

LORETTA TOUZELL: He was better after that but he just kept it in so much that it didn't really disrupt our lives except that he wouldn't get on a train. 

 

PAUL TOUZELL: We were offered counselling. I was offered counselling, we had letters from the government, had all sorts of things like that and I thought well, I was just so lucky  to survive, particularly after numerous events on that day which meant that any other day I would have been killed without a doubt.  I always sat in the middle of the third carriage, running late that day and I guess there was a little bit of that guilt what we've spoken about a little earlier here, that why under any other circumstances on any other day, you know, I would have been killed so why was I spared?

 

JENNY BROCKIE:  Barry, you were the first paramedic on the scene at Granville at the train disaster. Have your memories always been clear about that day? What have you done with your memories? 

 

BARRY GOBBE: Well, it all boils down to thirty years basically of no memory. What we did that day we did, it was our duty to do that, we acted as a team and at the end of the day we all just went home and the next day we all just went to work, so they tell me. I have no recollection from the time I knocked off work that afternoon for whatever happened after that. I have no idea. I think returned back to the scene when I knocked off work but … 

 

JENNY BROCKIE:  So how much is missing of that, what happened, you know, what you did afterwards?

 

BARRY GOBBE: I know I was there, of course, I ran across the tracks, I ran through and I went under the bridge and I spoke to somebody, ran back.  All I've got left of that is snapshots which probably total to fifteen minutes. Now I was under the bridge, in and out of under that bridge for six and a half hours, I have fifteen minutes. I come to write a book and I can't write anything because I've got fifteen minutes, I've got a half a page so I rounded up the survivors, or they rounded up me, relatives contacted me, and we started to put a book together. 

 

JENNY BROCKIE:  So what happened when you started writing the book in 2011 and people came to you with their stories? What happened to your memory? 

 

BARRY GOBBE: My memory started to come back a little bit. There's still a lot that's missing but what happened is I was interviewing one particular gentleman and he actually pulled out his police statement and he started to tell me what I said and it's actually written in the police statement. And he tells me that I yelled out to everybody: "If anybody can hear me call out a number", and people yelled out 1, 2, 3.  He said: "I yelled out 4." He said: "It went on to 12." I said well that's pretty eerie to me because only five people came out of that area and I've got to live with that memory that seven people with their last breath yelled out to me. 

 

JENNY BROCKIE:  So has it been for you, I mean how then on balance do you assess whether this has been a good thing for you to write the book and be exposed to these stories or whether it actually, has it helped you or has it harmed you do you think? 

 

BARRY GOBBE: Well it hasn't only helped me, it's helped everybody that's involved in the book to actually tell their story. 

 

JENNY BROCKIE:  So you're talking about other people. I'm wondering about you, you know, how has it been for you? Where are you now in terms of…

 

BARRY GOBBE: One day at a time. 

 

JENNY BROCKIE:  Yeah? 

 

BARRY GOBBE: That's my life, one day at a time. I was doing really well up until a couple of years ago.  Putting all the book together, there was an incident that occurred and that triggered a lot of things off.  I'm now on post-traumatic stress disorder medication. 

 

PAUL TOUZELL:   Every day's a bonus. 

 

BARRY GOBBE: Every day's a bonus. 

 

JENNY BROCKIE:  Every day's a bonus. Yeah. 

 

BARRY GOBBE: One day at a time. 

 

JENNY BROCKIE: Gary, you attended the accident at Granville with Police Rescue. Do you still think about it? 

 

GARY RAYMOND: You do constantly think about it. But it was quite overwhelming, even for a Police Rescue officer, where we turned up and the late Sergeant Bill Fay, we looked over the culvert and we saw 213 people injured and we looked and you go into disbelief and denial for a little while because of the numbers. Because normally in Police Rescue you go to a road crash and you're getting one, two, or maybe five or - and so here, firstly the ones we could see. 

 

JENNY BROCKIE:  You're seeing so many? 

 

GARY RAYMOND: Seeing so many so you've got to then go into your protocols, your triage.  But it's interesting, he said me, he said: "Don't worry about them, the doctors, the nurses and the ambos will look after them." He said:  "You get down under that bridge into those carriages." Now they were crushed within a metre and a bit of the actual floor so I got down and I then had to crawl through those who had lost their lives. I don't know about everyone here but in the emergency services people say to you:  "Oh, you must see some terrible things." That's true, not all the time, it's on occasions you do, but no one ever says to you: "Oh, listen, you must…" 

 

JENNY BROCKIE:  Save a lot of people? 

 

GARY RAYMOND: "Hear some horrible sounds." 

 

JENNY BROCKIE: Oh sounds, sorry yeah. 

 

GARY RAYMOND: Yeah, or horrible smells, or sometimes it's the silences that are impacting. Like at Granville it was very quiet in the carriages cause everyone lost their lives where there should be sounds in a train. You know, the things you touch with your hands, even covered with surgical gloves that sensory stimuli stays with you. 

 

JENNY BROCKIE:   Does it affect you a lot or are you able to manage those memories? 

 

GARY RAYMOND: I'm able to manage it. What I do is I do talk a lot about it.  I was able to speak about everything and that helps me because firstly, you're getting it out. And secondly, people actually congratulate you and say what a great job you did there, well done.

 

JENNY BROCKIE:  David, you're a psychologist, why do you think some people find themselves thinking about traumatic events they've experienced more than other people do?

 

PROFESSOR DAVID FORBES, AUST CENTRE FOR POSTTRAUMATIC MENTAL HEALTH:   To some degree it's some of the experiences that they might have had before the event but most importantly it does relate to the event itself, the degree to which they felt their or their, their lives or other people's lives were at threat at that moment and they were overwhelmed. So that's the part of the memory that you're really taking in. Whether it's an image or a smell or a sound, these are life or death. It's information so you really get consolidated.

 

JENNY BROCKIE:  Rob, I just wonder are some people more at risk in terms of being affected by these things in an on-going sense than other people? 

 

DR ROB GORDON, CLINICAL PSYCHOLOGIST: Yes, yes, people are. It depends how far outside a person's past experience, I think Kristy, is it Kristy? 

 

KRISTY FITZGERALD:  Yes. 

 

DR ROB GORDON: You mentioned you didn't know what to expect and where - and you didn't know how long to be affected. You know, in normal life when we have a crisis we expect to feel a little bit better in a day or two and then a bit better a few days later. But with a post traumatic injury we  can see all these complex pathways, such as Barry having it come out twenty years later through it being reawakened. So I mean I think that's more to do with the ingenuity and strength a person has to shut it down and put it aside.

 

JENNY BROCKIE:  Casey, you had a question you wanted to ask? 

 

CASEY HAYES: Yeah, I just wanted to ask Rob, you mentioned or you said Rob about having the ingenuity and the strength to put the memory aside and to move on. I don't necessarily want to put the memory aside; I don't want to pretend it never happened. It's happened, something I think about all the time, so I just maybe have misunderstood what you're saying? 

 

DR ROB GORDON: Well, but you're talking about the meaning of it, aren't you? You don't want to lose the meaning because somebody lost their life, you mentioned that. But where the experience brings overwhelming emotions that tend to disorganise us, if we can we will try to get control. But in another sense, I think to be able, that's the whole point of the digestion is to get to the meaning of it and I think this is the thing that we don't realise it's happening with our ordinary memory all the time. We're converting raw experience into something meaningful to become part of our history and it's that process that's disrupted by trauma. 

 

JENNY BROCKIE:   Liz Phelps in New York, you're a neuro scientist, tell us what's happening in the brain when we witness or experience a traumatic event.  Which parts of the brain are activated and how? 

 

PROFESSOR LIZ PHELPS, NEW YORK UNIVERSITY: So one point I want to start with is this notion that we talk about memory as one thing. But really, there's many different kinds of memory, many different brain systems that interact to form a memory. So most of the memories you're talking about are traumatic events. One thing we know about traumatic events is that you don't just record the information that's occurring or the events that are occurring, you also have a fear reaction, a physiological autonomic nervous system we call the flight or fight response that is coinciding with that traumatic event.

Now normally when you would form a memory every day for events that occur that require a part of the brain called the hippocampus so when you recollect what you did yesterday, that requires the hippocampus. When you recollect what happened in a traumatic event, consciously, that requires the hippocampus but in addition to that, we have another brain region called the amygdala which is very close to the hippocampus, as you can see there. The amygdala is very important in detecting threats and helping you remember those threats in the future.

So one of the women who was talking about a car accident, you know, gets close to that intersection and all of a sudden those anxiety feelings come back, you know, I'm assuming heart rate goes up, sweating, et cetera, et cetera, the amygdala is doing that. In addition, the amygdala is helping lay down those memories a little bit more strongly of the events. So it's actually interacting with the hippocampus that gives us those conscious memories of the episodes of our lives and it's helping you store those memories just a little bit stronger.

 

JENNY BROCKIE:  And why do some people have really vivid memories of traumatic events and other people like Barry have gaps, big gaps in their memory of those things that are such big events? 

 

PROFESSOR LIZ PHELPS: When we say, so one of the things that emotion often does is imbue a memory with vividness, right? So you can have vivid memories for things that are not highly emotional, but more often than not if something's highly emotional when you recollect it you have the strong sense of vividness. You know, Barry was talking about going to work, this was part of his job, right? You know, his memory was not so very different from something else that happened and perhaps that was because he was focusing so much at the time on what he had to accomplish there. Having said that, it doesn't mean that he wasn't affected by it in a very significant way but you know, at the time he had a different goal. 

 

JENNY BROCKIE: How much control do you then have over those memories when they resurface? 

 

PROFESSOR LIZ PHELPS: So one of the interesting aspects of the sort of fight or flight response, right, you know, it releases a lot of stress hormones.  When we're very stressed, when we're highly emotional, one of the things that stress hormones do is actually functionally make the pre frontal cortex less able to do its job. These stress hormones then make it harder for you to have some control over your cognitions and sort of what you think about and what you don't. 

 

JENNY BROCKIE: We'll talk a little bit about treatment in a moment but before we do, Scott, you were a soldier in Iraq in 2008? 

 

SCOTT GARDINER: Yes. 

 

JENNY BROCKIE: Do you feel like you've got much control over your memories of what happened there? 

 

SCOTT GARDINER: I don't have a lot of control over it. I've done exposure therapy to try and deal with it but overseas on a deployment, you know, 100 incidents could happen and you can't do exposure therapy on every single one of them. 

 

JENNY BROCKIE:  But just to give some context to people watching you were in an area that came under heavy rocket attack? 

 

SCOTT GARDINER: Yeah.

 

JENNY BROCKIE: I'm just wondering in terms of the triggers, are there things that trigger your memories? 

 

SCOTT GARDINER: Yeah, we were rocketed for forty days and it could be up to 200 rockets a day. You basically had to go about your everyday routine, go and have breakfast, having lunch, in between you know going out and doing the things that we done with recons. So you're doing everyday normal things while these traumatic events are happening. 

 

JENNY BROCKIE: And that's why when you say, you know, separating out…

 

SCOTT GARDINER: Yeah. 

 

JENNY BROCKIE: You have to separate one or two, that's why I raised it because you're dealing with multiple things?

 

SCOTT GARDINER: Yeah, you could be eating your breakfast when a rocket attack comes in. So when you come back home eating breakfast can be a big trigger. Any little thing that you do in your everyday life becomes a trigger and that makes it very, very difficult to deal with. 

 

JENNY BROCKIE: And do you talk about it? 

 

SCOTT GARDINER: Very rarely, yeah, yeah. 

 

JENNY BROCKIE: David, when does something move from being a painful memory to post traumatic stress? 

 

PROFESSOR DAVID FORBES: It's normal for people to have distressing memories in the aftermath of these horrendous experiences. We would hope that things would settle down over the course of the weeks and months ahead. It's when they persist and really start to disrupt your life and cause you continued pain and suffering, we move from a stress reaction through to post traumatic stress disorder. 

 

JENNY BROCKIE: And how common is PTSD amongst people who've experienced severe trauma?

 

PROFESSOR DAVID FORBES:  It's important for us to think about what kinds of trauma because it does make a difference. Probably the biggest distinguishing factor that we have interpersonal trauma, trauma that's deliberately at the hands of another compared to accidental trauma, so for example, after accidental trauma, motor vehicle accidents, we might see about 10 percent. After something like sexual assault we see up to 40, 50 percent. But importantly it does vary greatly on the individual experience, motor vehicle accident a big difference where there's a significant threat to your life or indeed there's been a loss of life.  So those things increase the likelihood. But overall we're talking between about 10 to 40 percent depending on whether it's accidental or disaster trauma compared to interpersonal trauma. 

 

JENNY BROCKIE: Jemma, I want to talk to you because you've survived a natural disaster which was the Boxing Day tsunami in Thailand where you literally had to run for your life, didn't you? And then a few years later you were stabbed in a random attack in Melbourne. Did you react very differently? 

 

JEMMA CLANCY:  It was a vastly different experience, both experiences were incredibly different in terms of the effect that they had on me.  Once I was stabbed I almost felt like half the work had been done in terms of recovering because of a lot of the feelings that I was having, a lot of the emotional responses I was having I had already had. 

 

JENNY BROCKIE: With the tsunami?

 

JEMMA CLANCY: With the tsunami, yeah, so a lot of it was not a surprise and I guess that made it a little easier.  I guess I knew what to expect. Because both were so random a lot of the sort of "why me" questions I had already resolved after the tsunami.

 

JENNY BROCKIE: What about the emotion though? 

 

JEMMA CLANCY: Well I guess I'm the sort of person that once I understand something in a way that makes sense to me, then I can work through the emotions. And I think that almost, and I guess learning that about myself probably helped with the stabbing. But I mean I'm not, certainly not saying it wasn't distressing and I'm certainly not saying they didn't have major impacts on my life. But I mean the tsunami was ten years ago and I was stabbed seven years ago so we're talking about, you know, reasonable periods of time where I've been able to make sense or at least accept what has been happening and put it in sort of the broader context of me. 

 

JENNY BROCKIE: So does any of that affect your day-to-day life now? 

 

JEMMA CLANCY: Um, yeah, I think so. I think that I still have a very distinct feeling of isolation in terms of I do know how odd it is, I suppose, or how very different it is for me to have experienced these two quite major things. 

 

JENNY BROCKIE:  Did you get professional help? 

 

JEMMA CLANCY: Dribs and drabs I suppose you could say.  After the tsunami, no.  After I was stabbed I was allocated some sessions with a counsellor through Vcap and I didn't use them all. It didn't work for me. In hindsight, too soon I think. I was really, really dedicated to being okay. So…

 

JENNY BROCKIE: What do you think helped you the most? 

 

JEMMA CLANCY: Talking to friends and family and knowing that, that they understood. 

 

JENNY BROCKIE: Did you ever get overwhelmed by emotion? 

 

JEMMA CLANCY: Oh, constantly, yeah, absolutely.  Not so much anymore but very much so. I would withdraw a lot and try and get a handle on things again, yeah. 

 

JENNY BROCKIE: Esther, you were a police officer for seventeen years for a long time working in forensics.  You were medically discharged in 2001, tell us why? 

 

ESTHER MCKAY:  Well I was diagnosed with post-traumatic stress in 2001 but it was with a gradual onset so the actual PTSD had started to develop many, many years before. 

 

JENNY BROCKIE: You went through exposure therapy. What did that involve? 

 

ESTHER MCKAY:  It was quite intense and we went through a lot of the memories that I had with the scenes that I'd been at and one of the things that came up was that I was stuck. I was actually still at the scene and I hadn't moved forward and I hadn't realised that the victims and the families of those victims had perhaps, families had perhaps married, had children, grandchildren, and that they'd moved forward with their life. And I had to learn to deal with my emotions and my feelings because when I joined the Police Force they teach you the exact opposite, to have that stiff upper lip, that, you know, that barrier in place.

 

JENNY BROCKIE:  And what sort of things were you exposed to in the exposure therapy? 

 

ESTHER MCKAY:  I've got a very strong sense of smell so I had trouble with certain foods and I wasn't able to eat certain types of foods because that would trigger a memory and I would feel physically sick. So during the therapy we had to slowly expose myself to those types of foods and I had to, you know, say to myself that it wasn't a part of the human body but it was actually a particular food that I was eating to the point where I could actually maybe cut it up into a small piece and then able to eat that type of food. I actually don't have any problems with eating food now but the only thing that I do have is that if it's a rare steak and there's a bit of blood on the plate, I can't, I won't, I won't eat it. It still bothers me but all the other foods that I had trouble with I'm actually okay so it definitely worked for me. 

 

JENNY BROCKIE:  David, what's the theory behind exposure therapy and how common is it as a treatment for this kind of thing? 

 

PROFESSOR DAVID FORBES: So exposure therapy is part of family of therapies calls trauma focused cognitive behaviour therapies and exposure therapy is probably the most dominant of those. But essentially trauma focused cognitive behaviour therapies involve three parts.  One is to  process, deal with the memory of the event and that does involve kind of accessing,  as we've heard here, not only the memory itself but the whole experience of it, the bodily sensations, the fear, the thoughts, the high levels of arousal, to be able to access that and allow the person then to process it.

Part of the problem with PTSD is these memories are stuck in time and they feel, when they're triggered they feel as though they're happening now. So to be able to access that memory is a safe and supportive way, in an environment that's safe. 

 

JENNY BROCKIE: But for some people that's presumably the last thing they want to do? 

 

PROFESSOR DAVID FORBES: Well I think that that's a really important point. It is the one thing often people are trying avoid. So critical is, yep, we know that it can be very, very effective. So very important is that we do so in a time and place that the person's ready. We give them skills to be able to handle some of the anxiety to be able to manage it and we do it slowly and carefully hand in hand all the way through.

 

JENNY BROCKIE:  Scott, you went through exposure therapy, I just wonder what it was like for you? 

 

SCOTT GARDINER: It was very difficult to go through. You sort of wind yourself up a bit when you know you're going to have it. You know you're going to be reliving things that you don't want to relive. It's done over a period of time.  You know, for me it worked on the instances that we dealt with but there's still a lot left that, you know, hasn't been dealt with. But it is a traumatic thing to go through again. 

 

JENNY BROCKIE: Did it help at all or do you…

 

SCOTT GARDINER: It took the sting out of a certain couple of incidents, so, yeah, it did work in that sense. 

 

JENNY BROCKIE: Was it something you wanted to continue with or did you just decide that you'd had enough of it? 

 

SCOTT GARDINER: No, I decided that that was enough.  You know, we got to where we were and I was happy with that so we sort of left it there. 

 

JENNY BROCKIE: I'm interested in this to talk or not too talk.  Rob, I know you talk about people having cupboards that they put stuff in. You know, some people have big cupboards and they've got a lot of things in the cupboard and other people have smaller cupboards.

 

DR ROB GORDON: Yes, well what I observe is that healthy people can simply put a certain amount of bad experience aside and do nothing with it and it doesn't seem to be a problem. But I think it must absorb a certain amount of energy so that when they hit another problem, if they haven't done anything about it, the cupboard flies open and they've got two things and we often get people coming after a trauma but the one they want to talk about is the previous trauma which was worse. And I think people will try and get control of themselves, as I was saying before, and they'll put it aside if they can.

 

JENNY BROCKIE: John, I notice you shaking your head listening to all that, why? 

 

JOHN JARRETT: We appear to be talking about two different illnesses. With the military side of things there are lots of similarity between emergency services and police. The military side of post traumatic stress disorder is, and I don't mean at all to put down any, anyone who has spoken on any event because it's traumatic for them, these young guys and girls are trained for combat, but it's not once, it's not twice, it's for seven or eight months. 

 

JENNY BROCKIE: My question though is about how to deal with that. I mean are you somebody who believes in talking is the way to deal with that? 

 

JOHN JARRETT: Absolutely not. I was, I was in Malaya and Borneo and Vietnam, I come back in 1969.  To this day I haven't talked to anyone about it. I went to a mental health expert who wanted to do the exposure therapy, we spoke once, I went home, I couldn't do anything for nearly a month so that was it as far as I was concerned. And amazingly, I didn't do anything for thirty years. 

 

JENNY BROCKIE: And then what did you do? 

 

JOHN JARRETT: I collapsed. I, I just fell over, I couldn't function. See, we're brought up with a set of rules and as a child you're taught not to bully someone, not to hurt someone, not do this and don't do things wrong. And then suddenly you're put into a situation where maybe you're killing someone and this is totally against, against everything you've been brought up to do, even though you are in the military. 

 

JENNY BROCKIE: So how do you deal then with your memories? 

 

JOHN JARRETT: Switch. 

 

JENNY BROCKIE: How do you deal then with your memories? 

 

JOHN JARRETT: I switch them off. 

 

JENNY BROCKIE: You switch them off? 

 

JOHN JARRETT: Switch them off. There are sometimes, especially since I've started Young Diggers going and I'm talking to all these young guys and I go home and I'm pretty, I'm worse now than what I was thirty or forty years ago, but for me, it's worth it because these young fellows don't have thirty or forty years before they're getting the right sort of help. 

 

JENNY BROCKIE: Now you run support groups that…

 

JOHN JARRETT: Yes. 

 

JENNY BROCKIE: That involve young returned soldiers? 

 

JOHN JARRETT: Yes 

 

JENNY BROCKIE:  When you're in those groups with them do you talk about your own experience at all or not? 

 

JOHN JARRETT: Not much. Mostly we have a lot of laughs because you see when you're on deployment, you do funny things.  It's a survival tool and when they come back we try to get them talking about the fun things that happened and we sit around and we talk and we go on bush camps and we do all sorts of things. But we find if we can get them onto a good diet, if we can get them into fitness and if we can get them involved in little projects, even if they're just doing a little bit to keep their mind on a problem for a little bit it helps them move forward. 

 

JENNY BROCKIE: Rob, what did you want to say? 

 

DR ROB GORDON: I think what John's touching on is something that's profoundly important that is building a social network, a community. 

 

JOHN JARRETT: Absolutely. 

 

DR ROB GORDON: Because that's the precondition for giving meaning to things and anything that disrupts our sense of connectedness and belonging is going to reduce our capacity to confront our own experience.  One of the big myths is that it's all going on inside my head but it's not really, it's going on in my social network of which my head is a part and it may be that we have to build that social network say with veterans who've got this, I agree, it's a very different type of traumatic situation than the one off car accident or whatever. 

 

JENNY BROCKIE:  Gary, I just want to give a bit of context to your story because I think it's really important for people to know this. When I read a list of the events that you've attended as a police officer, I found it extraordinary. I mean it is an incredible number of things, apart from Granville, the Hilton Hotel bombing, you were there.  The Luna Park ghost train fire you were there that killed people. The Newcastle earthquake you were involved in, the Anita Cobby murder you were involved in. 1,500 rescues of which 1,000 were motor vehicle accident rescues. What do you do with all of that? 

 

GARY RAYMOND: Well I think I'm the same too because you detach. It's been said you've got a job to do and that's extricating these people, or you've got a rescue job to do or a recovery job to do. I've got a great wife Michelle who I could go home and just offload to. So when I went home I'd talk about my feelings.  See if I talked about facts, then Michelle would say hang on a minute, I don't need to know that. But when I talk about I'm sad or I'm angry at what this person did or that one happened to them, then I was embraced. So I got the facts and feelings.

Secondly, a Christian faith. Sometimes I just duck in the bedroom, close the door, get on my knees and say God, this is too big for me to carry but you promised you'd carry it for me. And also what I'm doing with Esther and many others is reaching out now to others. I spend half my life now as a Chaplain to the police post trauma telling police officers look, that's a normal response to a very tragic event because they'll turn it around and say Gary, I'm losing it. I say why? I can't stop crying at that dead baby. I say hang on a minute, we're all crying over the dead baby. And so we normalise their response as human. 

 

JENNY BROCKIE: So would you, are you a talker? Do you have a cupboard? Where do you sit in all of this? I mean how much do you put away and how much do you talk? 

 

GARY RAYMOND: There's not much put away at all.

 

JENNY BROCKIE: Casey, what did you want to say? 

 

CASEY HAYES: I guess I just want to ask David perhaps whether to talk or not to talk. I didn't talk, you know, I had one session. I've gone on with life.  It's in, I think about it every week and I have no emotion around it. How do I know, not having spoken to people over the years, how I do know if I've dealt with that effectively and in a healthy way? How do I know that if I haven't spoken to anybody?  

 

PROFESSOR DAVID FORBES: Look, it is hard to know and I think that you've raised a really important issue when we think about how trauma can affect our lives, we think about the fear, the distress, anger.  The other half is also true that we can shut down, that it's so overwhelming that we shut our feelings down and the memories stay abated.  But what we often do see is where it hasn't been spoken about, shut down, and often feelings of guilt that don't get talked about and the potential to actually address the memory can do really important things in terms of shifting people's feelings of guilt about the event. 

 

CASEY HAYES: So fifteen years later, for example, it would be beneficial for me, hypothetically, I know you can't say, someone in my circumstance you're saying could benefit from speaking to someone, even though life's gone on for so long? 

 

PROFESSOR DAVID FORBES: If you feel that it's still affecting the way that you feel and the way you relate to others, fifteen years is not at all too late. 

 

JENNY BROCKIE: Sam, what did you want to say?

 

DR SAM HARVEY, PSYCHIATRIST:  I just think this idea of challenging the idea that it's always good to talk is a really important thing because if we look at all the extraordinary stories we've heard tonight one of the common themes is one of resilience and we know that with things like exposure therapy and that the evidence suggests that the benefits will outweigh the risks, but if we look historically at what we've done around trauma. There was a period in between then and now where this idea that everyone must talk really pervaded the whole system and we were mandating people to have debriefing and we've heard from the stories that that wasn't what people wanted at that time. We know from the evidence that it didn't help and may have been harmful and so I think there is, I think it's really useful to acknowledge that people have their own coping mechanisms and that a lot of what we need to do is not get in the way of that.  

 

JENNY BROCKIE: Laura? 

 

LAURA REAKS:  How are we supposed to know when we're able to go through the therapy like desensitisation of it all and exposure therapy and what happens if we think that we're ready? We go ahead and what are the dangers of it going wrong?

 

JENNY BROCKIE: That is such a good question, I should put some context around this for people Laura too in terms of your story because I know you've seen a number of psychologists, yeah, over time to help you deal with sexual abuse that you suffered as a young child. Now how did you find those sessions, those early sessions with psychologists? Did that help you at all? 

 

LAURA REAKS: It was often, like it was good because I was going through so much depression and I needed someone to talk to, I needed someone to say how horrible I felt all the time and they would just let me go and vent all the current like feelings that I had and they would often ask me to go through my history, usually on the first session, and then they would tell me see you next week. And then I left with all of this like, what am I supposed to do now with that? Like it was helpful to see someone but it wasn't helpful to constantly repeat my history to people and have them tell me what I already knew, like it's not your fault, you shouldn't feel like this, like I already knew that at the time.

 

JENNY BROCKIE: So to get back to your question, your question is how do you know if you're ready to expose yourself to any of these treatments? 

 

LAURA REAKS: Yeah. 

 

JENNY BROCKIE: Rob? 

 

DR ROB GORDON: You know, I think David said that exposure therapy is a component of a much broader therapy, it's a technique, and I think fundamentally I think many counsellors and therapists are very challenged by trauma work and when we're challenged, the risk is we will fall back on some sort of tried and true formula. 

 

JENNY BROCKIE: Theory? 

 

DR ROB GORDON: And not stay connected with the person. So I think what we need as the beginning, before we start any of this, any techniques, is we need a trusting relationship and with an issue like sexual abuse that may take quite some time to develop. And the second thing we need is to give control of the process to the person we're working with and follow their pathway which is often not at all what the text books have taught us so we've got to have the confidence to go with them and take their time. 

 

JENNY BROCKIE: So you have to go against your training in a sense? 

 

DR ROB GORDON:  Yeah, well, we have to make it flexible.

 

JENNY BROCKIE: So are you saying that professionals aren't that good at dealing with the individual as opposed to the theory? 

 

DR ROB GORDON: Many aren't, many aren't.  I have quite a few people come to me who tell me stories about people that I actually cringe a little because I think that sounds like an inexperienced therapist. My goodness, I wonder what I did when I was learning?

 

KRISTY FITZGERALD: It's so hard to find, like you always worry - is this the right person I should be talking to?  I'm actually onto a second psychologist, the first one there was nothing specific wrong with what she was doing with me but I found that I have melded more with the second psychologist that I'm seeing and I'm getting more benefit out of her and after four sessions she has now started talking about exposure therapy in the future to get over the accident. 

 

JENNY BROCKIE: Yes.

 

PROFESSOR DAVID FORBES: And definitely that is very important. While we talk about exposure therapy being the best treatment we have for PTSD, it's always invariably got to be couched in establishing the relationship, getting trust, allowing the person to develop skills and strategies to manage anxiety, so that you together as a unit decide that we're ready to take the next step.  It's very, very important and if you're not feeling ready, that's really, really important information and communicating that.  Having said that, the onus is also on us as a profession to ensure that we, that these treatments are delivered in a way…

 

JENNY BROCKIE: That takes the individual into account? 

 

PROFESSOR DAVID FORBES: Takes the individual into account, absolutely true. 

 

JOHN JARRETT: Where does she start? It shouldn't be the, the onus shouldn't be on Laura to have to find a good psychologist. The onus should be on an organisation to, that you can contact who can say now, this is a person who is in this area near you who is very, very good on this issue. It shouldn't be up to Laura to have to go through the Yellow Pages and say I'll try this one. No, she was no good or he was no good, no I'll try this one or this one or this one.  She should need just to make one phone call to get a decent referral.  

 

 

JENNY BROCKIE: Laura? 

 

LAURA REAKS: As you're a scientist would you say that dealing with traumatic memories is important to do as soon as possible or is it better like let it sit and like cope with it on your own for a bit? 

 

PROFESSOR LIZ PHELPS: So you're bringing up a topic that we're actually investigating which is when are memories most flexible? What we know about memory is when you first, at the very beginning when you encounter something, there's a period of time where the memory is a little bit fragile, where it takes time to let a memory down, we call that consolidation. It's previously been thought that once a memory is stored and consolidated it's kind of fixed and it's a little bit hard to change. And what we've started investigate, and this has been say the last fifteen years scientists have really started to look into the idea that actually now every time you retrieve a memory it's once again flexible and malleable and so this can do two things. One, you know, you retrieve a memory it can strengthen it so that's the reason you might want to deal with things earlier but at the same time when you retrieve a memory in the right context we can also modify it. We can maybe take away a little bit of its emotional power and presumably what we think is happening is we can do that at pretty much at any  age of the memory.

 

JENNY BROCKIE:  So is it about stripping the memory of the emotional part of it?

 

PROFESSOR LIZ PHELPS: So perhaps one of the advantages that these two, these are two separate memory systems that interact but actually also act independently is that the sort of emotional part of the memory, the part that triggers all the anxiety and the heart rate going up and the stress hormones is a little bit easier to trigger because it's more local in your brain.  It's a little bit more easy to disrupt perhaps than these more complex memories of the event.  So it's not that you're forgetting the event. You know it happened but maybe we can find a way to take away some of that emotional impact at least in terms of how your body responds. 

 

JENNY BROCKIE: And where are you up to with that research? 

 

PROFESSOR LIZ PHELPS: You know, right now we're doing, we do these simple laboratory experiments and we don't know yet if these techniques are going to be useful in treating things like PTSD., we're just understanding the neurobiology of how these memories are flexible and when they're flexible and the goal is to take this to treatment of PTSD and other disorders but we're far from that.

 

JENNY BROCKIE: Reaction from some of the clinicians here, David, yes? 

 

PROFESSOR DAVID FORBES: I'll go first and then after you. Look, I think this research is really exciting, the reality is that memory is fluid and being able to use some of these techniques into the future to make some of the therapies we've spoken about today also more manageable and more tolerable, and potentially more effective, it is exciting future research. 

 

JENNY BROCKIE: Let's get back to some of the things that are being done now just to wrap up and Mark, I wanted to just ask you about the peer support group that you run for fire and rescue workers. What do you do?

 

MARK DOBSON, FIRE AND RESCUE NSW:  What we're finding now is if we can educate people and make them a little bit more aware, then they can change, they can be aware of what support's available, they can be aware that there is some benefit in having a talk amongst themselves after an incident. 

 

JENNY BROCKIE: So knowing all that before it happens rather than doing it afterwards.

 

MARK DOBSON:  Doing a program that we designed with the Uni of New South Wales for our recruits called Fit Minds so our guys watch a series of videos of experienced fire fighters talking about how, when they've experienced things, this is how they deal with it and then learning from their mistakes rather than have these young recruits having to learn it from their own mistakes.  

 

JENNY BROCKIE:  Gary, you think it's important to get to police beforehand too? 

 

GARY RAYMOND: Absolutely. The preparedness for trauma is a very untouched area.  We get young people from school or trades, put them in a blue uniform and some of them the first time they see a deceased person is when they get out of the police car. Sometimes they see a body that's been burnt or murdered or suicided, I mean it's awful to talk about but that's the first experience they have of that exposure. Coming back and giving them very steady exposure to the sensory stimuli and a range of other things to get them ready to get out of the police car. 

 

JENNY BROCKIE: Sam, you like this idea of pre exposure as well? 

 

DR SAM HARVEY:  Yes, I think this is where the field is heading I think, it's no longer having to get people sitting in a room during their early training to hear about what it means to be resilient.  We've got on line technology, we've got smart phone technology, so we're developing things that police, fire fighters can take with them.  They can use at their own pace, they can individualise for themselves. And that's exciting but we're still sort of testing to work out what works and what doesn't. 

 

JENNY BROCKIE: We are going to have to wrap up. Laura, I'd like to finish with you, you're seeing a psychologist now? 

 

LAURA REAKS: Yes. 

 

JENNY BROCKIE: How is that going, how are you feeling you're travelling with all of this?  

 

LAURA REAKS: Yeah, really, really good. I think like the main thing, the main reason for that is that she took a different approach from like dozens of mental health workers, not just psychologists, but like mental health, social workers, everything, that she didn't approach me with what happened to you, tell me what happened: She approached me as an individual and said okay, well clearly you're struggling with things, what is it exactly that you need help with? She identified that and she said right, well this is what we're going to do to stop this happening. She took action for what was actually happening right now in my life so I could actually start living my life happily and normally.  Like I know that I'll never really be completely cured I guess of post traumatic stress, but I know that if I have symptoms that I'll be able to cope with them as they come. 

 

JENNY BROCKIE: Thanks so much for joining us and thanks for your questions, they were really good questions. And thank you to everybody who shared your stories tonight, I know this hasn't been an easy one to talk about for a lot of you, I really appreciate you coming along and sharing your stories with us tonight. And that is all we have time for here but we can keep talking on Twitter and Facebook.