PTSD with Pseudo-Hallucinations Brentwood, Essex

Diagnosis: Post-Traumatic Stress Disorder. Specific Symptom: Severe, intrusive pseudo-hallucinations

"Adam" (not his real name) came to see me for PostTraumatic Stress Disorder (PTSD), with which he'd been suffering for some twenty years, related to his involvement in a car accident, where he was the driver, and where, through no fault of Adam's, he knocked down and killed an eight year old boy.

He complained to me that he had, since the car accident, continually endured flashbacks to the trauma, to which his preferred response had always been to just try not to think about it.

He always kept himself busy, which seemed to help, and Adam had recently become a father.

But that event had led to the flashbacks becoming worse, and with a rather sinister twist. Adam had begun to suffer hallucinations, seeing the young boy from twenty years ago in various situations and without warning. Adam said that the boy seemed to appear whenever he was relaxed: having a bath, or nodding off to sleep, and whenever he looked at his new born son he would see the face of the dead boy, looking up at him, full of rage – just the same way he remembered the boy looking at him, moments before he died.

Adam believed that the vision of the dead boy was there to "wreak revenge" on him by either getting him to kill himself or, he believed, it meant the boy wanted his own son to come to harm.
As we discussed this further, we managed to uncover beliefs that were grounded in the immense and all-consuming guilt that Adam felt. He believed that, somehow, it was his fault that this boy died, even though the Inquest cleared him of all responsibility.  The boy had simply rushed out in front of his car without warning.

Adam believed that he was a fundamentally "bad person" and, worse, uncaring. He believed that he had, in fact, contributed further to the boy's death, by being of little help to him in his last moments, compared, for example, to the emergency services, and other people on the scene, who had been "brilliant".

In contrast, Adam had been a "complete and utter blubbering, useless wreck". This all meant to Adam that somehow, Adam was "dangerous" and, eventually, this would impact on his only child.

Following the Cognitive Behavioural Treatment (CBT) for processing emotional trauma, Adam began to write the story of the trauma. Through a patient process of Socratic dialogue, we unravelled and began to piece together the whole story of the trauma, culminating in an emotionally charged session where he retrieved 'lost' memories (trauma patients often have gaps in their memory), that linked one part of the event to another.

For example, he had not remembered getting out of the car and holding the dying boy's hand before the emergency services arrived. Because he refused to think about it, he had assumed the emergency services helped the boy before he died.

In fact, Adam was the only one who comforted him as he died. The boy's parents were alcoholics and were drinking in the pub on the same street as their son at the time (something Adam had forgotten until we began uncovering information).

No other onlooker tried to help.

He recalled new information about how the boy (and here Adam was able to say his name for the first time in twenty years), had begged him to stay, had looked at him, not in anger or rage as he believed in his pseudo-hallucination, but with a combination of fear and gratitude; the boys injuries were appalling.

The conflict between what he now remembered as facts and what he had believed for twenty years was evident on his face and he was stunned into silence.

At this point, Adam broke down and cried; the pain of twenty years unravelling. I let him cry, my silence both witnessing and validating his pain.

“I never knew, I never knew” was the only thing he could say over and over again as he cried.
Adam was not crying for the boy, I understood implicitly. He was crying for himself, for the guilt he had carried needlessly all these years, and for how it had shaped and almost destroyed his life.

By recovering these buried memories, Adam was able to take a look at the event in its entirety, through 360 degrees, taking in all the information. He realised that he had felt guilty only because he did not remember that he was the only one to provide the boy with comfort in his last minutes of life.

His view of himself as a "bad person" came about because late-comers to the scene, who had not seen the boy run out, assumed it was Adam's fault and he recalled people shouting abuse and someone kicking him in the back as he held the dying boy's hand.

The "bad person" theory, confirmed in his mind by the “angry” stares of people he passed on the street, and as he stumbled home after being told to leave the scene, came about, he reflected, simply because of the curious and anxious stares of strangers who noted his dishevelled and blood-stained appearance and his vacant look, due to shock.

Over the following weeks, Adam's reprocessing of the events surrounding this trauma fundamentally changed his negative beliefs about himself, and were replaced with more factual and realistic truths.
He became kinder to himself, he stopped seeing the visions of the dead boy and instead remembered clearly the details of the trauma in a “joined up” way.

The strongest image that remained was of the gratitude and fear on the boy's face, and of how he talked to him about his favourite sweets and football, how he told the dying child that it was going to be OK, and that he would never leave him.

Slowly, Adam came to accept that given the awful circumstances, his responsibility for this child's death was minimal and that the greater responsibility lay elsewhere.

Adam is now able to think about the event and feel sadness, but the flashbacks and pseudo hallucinations have ceased.

He is enjoying his new role as a father.