She smiled. ‘I didn’t read about you in the papers. I prefer to deal with people.’
‘Then we have that in common.’
‘It may be the only thing. Tell me, Mr. Parker, have you ever been in therapy?’
‘No.’
‘Grief counseling?’
‘No. Are you hustling for business?’
‘As you noted, I’m interested in post-traumatic stress.’
‘And I seem like a candidate.’
‘Well, wouldn’t you agree? I know about what happened to your wife and child. It was appalling, almost beyond countenance. I say “almost” because I served my country in Iraq, and what I saw there, what I endured there, changed me. Every day, I deal with the consequences of violence. You might say that I have a context into which to place what you’ve gone through, and what you may still be going through.’
‘Is this relevant?’
‘It is if you’re here to talk about post-traumatic stress. Whatever you learn today will be dependent on your understanding of the concept. That understanding may be commensurately greater if you can relate to it personally, however peripherally. Are we clear so far?’
Her smile hadn’t gone away. It managed to stay just the right side of patronizing, but it was a close-run thing.
‘Very.’
‘Good. My research here is part of an ongoing effort on the part of the military to deal with the psychological effects of combat, both on those who have served and have been invalided out, and on those who have left for reasons unrelated to injury. That’s one aspect of it. The other relates to pre-empting trauma. At the moment, we are phasing in emotional resiliency programs designed to improve combat performance and minimize mental heath difficulties, including PTSD, anger, depression, and suicide. These symptoms have become increasingly recognizable as soldiers undertake repeated deployments.
‘Not every soldier who experiences trauma will suffer from post-traumatic stress, just as individuals in civilian life react differently to, say, assault, rape, natural disasters, or the violent death of a loved one. There will be a stress response, but PTSD is not an automatic consequence. Psychology, genetics, physical condition, and social factors all play a part. An individual with a good support structure – family, friends, professional intervention – may be less likely to develop PTSD than, say, a loner. On the other hand, the longer the delay in developing PTSD, then arguably the more severely it will be experienced. Immediate post-traumatic stress usually begins to improve after three to four months. Delayed PTSD may be more long-term, up to a decade or more, and is therefore harder to treat.’ She paused. ‘Okay, that’s the lecture part over with for now. Any questions?’
‘None. Yet.’
‘Good. Now you get to participate.’
‘And if I don’t?’
‘Then you can leave. This is a trade-off, Mr. Parker. You want my help. I’m prepared to give it, but only in return for something. In this case, it’s your willingness to acknowledge when, and if, any of the symptoms I’m about to detail are familiar to you. You need answer only in the most general of terms. There are no records of this conversation being kept. If, at some point in the future, you would consider offering some deeper insights into what you’ve been through, then I would be grateful. You might even find it beneficial, or therapeutic. In any event, it goes back to what I said at the start. You’re here to find out about PTSD. This is your chance.’
I had to admire her. I could leave, but I would have learned nothing, except not to underestimate women who look like boxers, and I’d figured that out long before I met Carrie Saunders.
‘Go ahead,’ I said. I tried to keep the resignation out of my voice. I don’t think that I succeeded.
‘There are three main categories of post-traumatic stress disorder. The first involves flashbacks, the re-experiencing of the event that may have sparked the disorder or, less severely, and more commonly, a series of unwanted, intrusive thoughts that may feel like flashbacks, but aren’t. We’re talking about dreams and bad memories on one level, or making associations with the event from unrelated situations: you’d be surprised at how many soldiers dislike fireworks, and I’ve seen traumatized men hit the deck at the sound of a door banging, even a child shooting a toy gun. But on another level there may be an actual reliving of what occurred, to the extent that it feels real enough to disrupt ordinary, day-to-day functioning. One of my colleagues calls it “ghosting”. I don’t like the term myself, but I’ve spoken to sufferers who’ve seized on the concept.’
There was silence in the room. A bird flew by the window, and the sunlight caused its shadow to flit across the room: an unseen thing, separated from us by glass and brick, by the solidity of the actual, making its presence felt to us.
‘There were flashbacks, intrusive thoughts, or whatever you want to call them,’ I said at last.
‘Severe?’
‘Yes.’
‘Frequent?’
‘Yes.’
‘What would bring them on?’
‘Blood. The sight of a child – a girl – on the street, with her mother or alone. Simple things. A chair. A blade. Advertisements for kitchens. Certain shapes, angled shapes. I don’t know why. As time went on, the images that would cause problems for me became fewer.’
‘And now?’
‘They’re rare. I still have bad dreams, but not so often.’
‘Why do you think that is?’
I was conscious of trying not to pause too long before my replies, of not giving the impression to Saunders that she might have hit on an interesting avenue to explore. The possibility that I believed myself to have been haunted by my wife and child, or some dark version of them that had since been replaced by forms less threatening but equally unknowable, would have qualified as an interesting avenue even if I’d been in group therapy with Hitler, Napoleon, and Jim Jones. Under the circumstances, I was pleased that my reply to her last question was virtually instantaneous.
‘I don’t know. Time?’
‘It doesn’t heal all wounds. That’s a myth.’
‘Maybe you just get used to the pain.’
She nodded. ‘You might even miss it when it’s gone.’
‘You think so?’
‘You might if it gave you purpose.’
If she wanted another response, she wasn’t going to get it. She seemed to realize it, because she moved on.
‘Then there are avoidance symptoms: numbness, detachment, social isolation.’
‘Not leaving the house?’
‘It may not be that literal. It could be just staying away from people or places associated with the incident: family, friends, former colleagues. Sufferers find it hard to care about anything. They may feel that there’s no point, that they have no future.’
‘There was some detachment,’ I admitted. ‘I didn’t feel part of ordinary life. There was no such thing. There was just chaos, waiting to break through.’
‘And colleagues?’
‘I avoided them, and they avoided me.’
‘Friends?’
I thought of Angel and Louis, waiting outside in their car. ‘Some of them didn’t want to be avoided.’
‘Were you angry at them for that?’
‘No.’
‘Why not?’
‘Because they were like me. They shared my purpose.’
‘Which was?’
‘To find the man who killed my wife and child. To find him, and to tear him apart.’
The answers were coming more quickly now. I was surprised, even angry at myself for letting this stranger get beneath my skin, but there was a pleasure in it too, a kind of release. Perhaps I was a narcissist, or perhaps I had simply not been so clinically incisive with myself in a very long time, if ever.
‘Did you feel that you had a future?’
‘An immediate one.’
‘That lay in killing this man.’
‘Yes.’
She was leaning forward slightly now, a white light in her eyes. I couldn’t figure out where it was coming from, until I realized that I was seeing my own face reflected in the depths of her pupils.