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For some asylum seekers who have been tortured, post-traumatic stress disorder means that intrusive memories can be triggered by everyday events. The winner of the BMA News writing competition 2015, Sheffield GP Jo Cannon, describes what the experience of knowing one such refugee has taught her.
When they had taken all he had, the police released Michael and let him board a plane. But he took the prison with him.
Many times an hour he’s back there. A cascade of images, triggered by a colour, smell or movement. The present is lost — a pause, a missed heartbeat — as he keeps the days going. And always he’s vigilant. He never sleeps for long.
Michael was lucky. He arrived 17 years ago, before fear and distrust of asylum seekers reached its current intensity. At Heathrow he was examined by a doctor, then a lawyer.
Carrying little but the evidence of the crimes against him — the scars on his body — he was sent to Sheffield until his case could be heard. In time he received refugee status and permanent residency, and stayed because he had nowhere else to go.
Michael taught me that it doesn’t get better. The men who wrecked his body and mind never think of him now; they have others to process. His scars have faded, although he cannot walk far. When his wife joined him they made a life in this city. But Michael is a ghost within his family: silent, vacant, unavailable. He sits numbly in his living room while his children move unheeded around him.
He no longer trusts the sensations of his body. The slightest physiological change is a threat; he presents symptom after trivial symptom.
If I didn’t know his history, he would be the classic heartsink.
He begins to outline his vague complaints, and then trails off. His expression empties, and I know they are back. Every few minutes, in scarlet explosions, those men reclaim him.
Stripped of pride
Nothing works. Our counsellor tried, but Michael cancelled because he can’t talk about his experiences. He gave up cognitive behavioural therapy after a couple of sessions; the SSRIs he has taken for years have had little effect.
Michael feels helpless. When they have stripped you of all agency and pride, how do you regain control of your life?
So we wait while years go by, and hope that his suffering will diminish. His daughter, a strange unhappy girl, wants to be a doctor. Lacking words for the flaw in her silent family, she yearns to put things right. How many generations will pass before the damage fades?
The world is on fire, and millions of people flee the flames, bearing their trauma with them. Post-traumatic stress changes the brain’s biochemical pathways.
As with other mental states, such as panic attacks, obsession or depression, a protective, mammalian neurological reaction outlives its usefulness.
Since man first picked up a stick, violence has proved the most effective method of getting our own way. Now with all the technology that our genius can invent, we continue to fight chimpanzee battles of territory and sexual control.
Sheffield prides itself as ‘The City of Sanctuary’ and some of my patients are refugees. The fantastical journeys, the stringencies and courage that take people from one end of the planet to another, amaze me. Yet as the world burns, the public response to the daily horror show becomes less compassionate.
Michael came straight to Sheffield; today he would spend months in the dehumanising environment of a detention centre, and probably be sent back to his tormenters.
Nobody suggested then, as they would now, that his wounds were self-inflicted, nor implied that economic opportunism led him to abandon his respected academic career for a paltry life on benefits in a cold northern city.
No one said his torture never happened.
Through Michael I came to understand that other patients have PTSD too, although their sufferings are more subtle.
The lesser traumas of heartbreak, bereavement or frightening illness still burn a vulnerable mind like a cigarette, causing recurrent, distressing flashbacks that leach meaning from the present moment.
Sometimes I experience repetitive intrusive thoughts that crank round and around comparatively minor shocks and sorrows: an argument, rejection or perceived humiliation; tiny events that nonetheless lower my mood and distract me from the joy of life.
Then I glimpse, though fleeting and incomplete as a shadow, the enormity of Michael’s suffering. And understanding the fragility of the brain and its potential for biochemical harm, I consider the huge responsibility that we bear one another to be kind.
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