Case 1. Successful elimination of PTSD type 1 ( ‘PTSD’ as per ICD 11) by EMDR fifty five years after the causal event:
The case of the old age pensioner with PTSD type 1 who had been in the 1950-53 Korean War.
A patient first presented at aged 75 — an old age pensioner who lived 200 Km away. He said that he had joined the Army at 18, in 1950, and had been in the Korean War. He left the Army as a Corporal in December 1953, five months after war ended and 54 years before attending the consultation.
He complained that since leaving the Army he had never been free from anxiousness, had never slept well, had constant nightmares about anything at all, constantly on edge, recurrent headaches, difficulties in concentrating and being always grumpy and jumpy. He was otherwise fit physically, despite his age. He had never been out of casual work for long – either on his own tiny bit of land, or helping out part time on the farms around. His wife had said that the General Practitioner was happy to refer him, though somewhat sceptical as to why they wanted to attend.
On being asked if anything had gone wrong for him in the war he replied that he had not been near any action and had not been wounded. His wife confirmed that he was perfectly fine before joining up and going to Korea, but not at all fine since he returned home. They had sought help on many occasions but told that it was just his ‘nerves’ that had given out and were keeping him awake at night. His wife would not give up trying to get help for him because she felt that something had happened to him in Korea, but she didn’t know what.
The Visual Test result indicated he had persistent peripheral oscillopsia, indicating in turn that he had PTSD type 1 (i.e. ‘PTSD’ as per ICD 11). On further closer questioning he spoke of having been involved in a jeep accident, and that he could only clearly remember a certain moment of it, but could remember that moment very clearly. He recalled that the jeep rolled and he found himself trapped beneath the back of it, with his mate trapped beneath the front, both fearing that at any moment the jeep, poised precariously, would topple over on top of them. He said that it was ten minutes or so before the next jeep came along and other mates found them. As the other mates started to lift up the front end to release his mate stuck at the front he had seen the back end of the jeep, slowly at first and then more quickly toppling onto him. He said ‘I felt at that moment terrified that it was about to crush me, and that would be it’. But the jeep had been held and he was soon to be released, uninjured. He was back on duty the next day. The incident was not reported.
He was then eager to talk more ‘…just about every day from then till now I get quick flashes of that dark back end of the jeep coming down on me…it was fairly dark despite the headlights of the other jeep that had just appeared to help…so the back end of the jeep above me was like a big black shadow… but I knew perfectly well what it was and when it started falling towards me I knew exactly what was going to happen to me… now, I keep getting pictures of it coming down on me flashing back every day or so…seeing it I get the that same terrified feeling I got at the moment I saw it coming down…that same miserable flashing back thought going through my mind’s still there…I was twenty one….I’d survived the war by being out of the fighting…I wasn’t a hero or anything like that …there I was about to die in some bloody silly jeep accident one dark night… just before I’m due to go back home. ..when the flashback comes it’s always exactly as though it’s happening all over again….I don’t dream that picture…the nightmares I get are of all sorts of stupid scary situations where I’m about to die and things are out of control…but it’s like that jeep accident happened just yesterday…my poor wife…I don’t know how she has put up with it all these fifty odd years…we have hardly any social life … I like it when we keep to ourselves…’.
It was quite clear that he had PTSD type 1 (‘PTSD’ as per ICD 11) for 54 years of his 75 years of his life. The Army and Veteran Affairs Department told him that there couldn’t be anything wrong with him since he’d not reported any injury at the time, he’d been many miles from the front line, and there was no record of that jeep accident — there were hundreds of jeep accidents. At his discharge medical he was told he was perfectly fit, and was never asked why he had wanted to leave the Army.
At that first consultation there was an immediate trial of EMDR. After half an hour, with his full cooperation, there was just the slightest suggestion that perhaps the ‘picture’ was a tiny bit less frightening. A repeat of The Visual Test showed no change – the oscillopsia came after two seconds or so, just as much, and over the outer half of his visual field as before. He was certain that there was only one recurring flashback ‘picture’ of the event. No, he couldn’t afford to return for another visit and more treatment next week – and probably not next month either.
His wife was promptly taught how to perform EMDR, the lesson taking no more than five minutes. ‘…yes of course I’ll do it… nothing to it…do it once a day for half an hour… no problem…’. He too agreed that his wife could do the EMDR exactly as I had been doing it. We agreed to be in touch by telephone. They drove the 200 Km back. An expensive day in petrol and precious little to show other than recognition of a long standing PTSD type 1 – in 1953 its name was still Traumatic Neurosis,
After the fourth week he answered the phone ‘… Yes there’s some definite progress…about a third better I think…I can’t be sure…but there’s certainly a bit of a difference in the picture when I get it back…it’s a bit less scary than before…a bit less clear…my wife’s had to go blueberry picking as she always does at this time of the year… the neighbours comes in every other day and does the EMDR for half an hour or so…’. There had been a passing-on of the ‘skills’ of EMDR to the next door neighbour, a second case of ‘see one, do one, teach one’ – properly performed EMDR can certainly be ‘not difficult’.
At eight weeks his wife had returned and resumed EMDR. By phone, they both said that all had changed. He couldn’t get any bit of the picture back any more. He felt very much better than ever he could remember. He was sleeping like a baby, better than ever, and having no nightmares. His wife said ‘…it’s nice to have my husband back after fifty or so years… ‘.
On re-attending for the second and last time, twelve weeks after his first visit, there was no peripheral oscillopsia on re-performing the simple Visual Test. On questioning, he reported ‘…yes, of course I can remember the accident but it seems vague and a very long time ago now… there’s no feeling to it …I can remember what the picture was, but I can’t see it anymore…that memory’s all fading…it’s good to have my life back after all these years…you’ve no idea how I enjoy a night’s sleep…’.
Occasionally keeping in touch by telephone for a year, all remained well.
Case 2 Successful elimination of PTSD type 1 with EMDR one hour after the causal event:
The case of lady with PTSD type 1 & 2 who worked in the building next door.
A patient, whose office was in an adjacent office block, attended the office for a post treatment check-up. She had been seen with PTSD type 1 (‘PTSD’ as per ICD 11) three months previously and had been successfully treated with EMDR, success confirmed then via a positive test result for persistent peripheral oscillopsia before EMDR treatment and a negative test result following treatment. The Visual Test on this follow-up visit confirmed the absence of persistent peripheral oscillopsia. She confirmed that since that last EMDR she had had no abnormal flashbacks as she had experienced before EMDR treatment. She had been back at work and felt that she was back to her normal self.
By sheer coincidence she re-attended at 9 am the following morning in a state of intense agitation as an emergency — the day after the successful follow-up visit. She said that half an hour before, at 8.30 am that morning, she had experienced a moment of instant sudden intense fear from a sudden, unexpected and out of control event in a dysfunctional elevator. She had been in the elevator on her way to her office in the adjacent office block.
She had been alone in the elevator when it had suddenly stopped half way between floors, had immediately jerked downwards about a metre, and violently, with a terrifying crashing sound, jolted to a halt. The elevator doors immediately opened between the two floors, revealing the dark bare concrete walls of the elevator-shaft and the elevator cables. The elevator alarm went off at the same instant. She had screamed in panic, not daring to move. She was stuck there alone for what seemed ten minutes, panicking and shouting for help but hearing no response. Suddenly the doors gently closed, the elevator slowly descended to the ground floor, and the doors opened. A security guard was there to help should any help be needed. As she left the elevator, now back at the ground floor, she was still panicking. Within minutes she asked to be taken to my office in the adjoining building. She came straight away, and sat, panicky and shaky, in the waiting room. Her panic settled considerably after the secretary had given her a coffee and reassured her that I would see her very soon.
At nine fifteen I spoke with her and examined her. On re-performing the visual test that had given a negative test result 18 hours previously, she had a return of persistent peripheral oscillopsia, more pronounced than it had been three months before. She also had a return of recurrent abnormal flashbacks of the most frightening moment of being stuck in the dysfunctional elevator an hour or so ago. The abnormal flashback was of the half-open elevator doors and the dirty walls of the elevator shaft and elevator cables. She could also re-hear the crash as the elevator had suddenly come to a halt. The abnormal flashbacks had been recurring every few minutes since the terrifying event, even recurring whilst in the waiting room drinking her coffee. She was repeatedly re-living the terrifying moment of looking at bare concrete walls and cables and fearing that the elevator was about to crash down at any second. There was no other ‘picture’ flashing back, i.e. there was no other recurring abnormal flashback from that experience.
She was treated there and then with EMDR. Her ‘brand-new’ PTSD type 1 (‘PTSD’ as per ICD 11) was eliminated there and then in five minutes. Before she left the office, at around 10.30 am, after another cup of coffee, she had no peripheral oscillopsia on visual re-testing. She could now recall her experience in the elevator in normal fashion without any re-experiencing extra panic and without ‘re-seeing’ the picture of what she had been seeing of the blackened elevator shaft wall through the open doors of the elevator. She could no longer re-hear the crash. She could remember it all quite clearly. It was now certainly a very unpleasant ‘intrusive memory’ but not in any abnormal form. When she left the office she was still ‘shaken up’ with PTSD type 2 – she had an only-very-slowly-subsiding anxiety disorder of PTSD type 2, (a subsiding Acute Stress Reaction in DSM parlance).
She later told me, on a follow-up visit, that she had been unable to summon up the courage – unable to overcome the once-bitten, twice-shy fear – to re-enter that same elevator for several weeks. Her ‘near-instant’ recovery from PTSD type 1 (‘PTSD’ as per ICD 11) with ‘near-immediate’ successful EMDR treatment, did not coincide with her recovery from the PTSD type 2 that had arisen at the same time from the same mental shock. On further follow up her PTSD type 2 anxiety disorder settled slowly over several weeks before she was reusing the same elevator once again.
(This case report does not imply that the sooner the EMDR after the causal event, the easier to perform and quicker the result of EMDR. In eliminating PTSD type 1 (‘PTSD’ as per ICD 11) EMDR is sometimes quick in its action, sometimes very slow in its action, taking many sessions over many weeks, and sometimes totally ineffective regardless of how long EMDR continues.)
Case 3. Total failure of EMDR to eliminate PTSD type 1
The case of the lady, born in Southern Europe, who developed severe PTSD type 1 as an immigrant.
A forty year old lady, born into a close religious family from the Mediterranean littoral, had her initial mental shock triggering PTSD type 1 when her first husband had died, literally in her arms, from an asthma attack. Her next mental shock was when called to give evidence in the Coroner’s Court. Her parents-in-law had stood up in court and publicly blamed her for his death by failing to save him. On returning to work she suffered a third mental shock when she was verbally sexually abused and screamed at by her supervisor.
She presented with extreme levels of anxiety. She spoke of endlessly recurrent experiential flashbacks of each of the three moments of mental shock – the face of her dying husband, the face her parents-in-law accusing her in court, and, her supervisor shouting obscenities.
She had persistent oscillopsia over her whole visual field, with every stationary object seen by her to be oscillating, all day and all night when not asleep. She could not go out in public. She could not take off her dark glasses. She refused to see her general practitioner about her type 2 diabetes. but took her medication for it. She could not read. She could piece together some of what she was looking at on television but without any detail. She could never stop her legs shaking when in any company. In any 24 hour period she had, at the most, two hours of continuous sleep, and lying on the living room couch. She never went to bed at night. The curtains of the house could never be opened day or night.
Despite trying many times she was totally unable to persist with EMDR because of excruciating-for-her anxiety and terrifying-to-her flashbacks. Her religious family values prevented her from killing herself, but she prayed to God every night to let her die. When seen by other psychiatrists at the behest of the Workers Compensation, by which she was covered, she was deemed to be somewhere between hysterical and deliberately uncooperative, with no mention being made of ‘PTSD’.
Case 4. EMDR successfully eliminating PTSD type 1 in a six year old child.
A six year old schoolgirl attended with her parents. On questioning the child in the presence of her parents she reported having had a ‘mental shock’ (not her words) of being very unpleasantly shouted at by her teacher in the classroom in front of all the other children six months previously. She was complaining of persistent nervousness, poor sleep, frightening dreams, and now a fear of going back to school. She also mentioned on specific questioning that she had constantly recurring abnormal experiential flashback (not her words) ‘pictures’ of the school teacher and hearing the teacher’s shouting voice.
With her parents present she there and then co-operated fully with the visual test for peripheral oscillopsia and indicated with her right arm how she ‘saw’ the examiner’s right arm to be swinging over a forty degree range. She immediately thereafter co-operated fully with EMDR. By her report both the recurrent flashback and the peripheral oscillopsia on test were fully eliminated by one single run of saccades lasting 15 seconds. At follow up by telephone four weeks later her parents reported that by the end of two weeks there had been a full return of her pre-PTSD mental state and behaviour, and a return to school with the same teacher – the teacher having been told of their child’s likely exaggerated psychological response to overly-gruff verbal discipline.