Counseling for after an incident?

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Matt S.

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A liberal interpretation may be needed for this to qualify as a question about diving medicine... but I was wondering if anyone had experience to share in dealing with the aftermath of a diving accident.

I don't want to get into the details, but in brief I recently witnessed a diving fatality and participated in the subsequent recovery effort. It was obviously an awful thing to be involved in, and it has been on my mind before every dive that I have done since. I am not impaired by anxiety or anything like that, but I'd be lying if I said it hadn't taken some of the appeal from diving. And that sucks!

I am a regular guy and it's tempting to just suck it up and forget about it and soldier on. But why tough out a "recovery" by myself when there are decades of medical science that may be able to assist me? I have no idea where to start, though. I have medical coverage that probably will help cover this but I am not even sure what to ask for!

Any mental health professionals in the crowd tonight?

PMs welcome of course, and thanks in advance.
 
Hi Matt.

In my job we have a psychologist on call for what's called Critical Incident Stress Debriefing. My crew uses them about once a quarter. They come in after a really bad incident (no need to go into details), and we talk about what happened, and how we did our best, and take the blame off of ourselves.

It's not the "tough guy covered in soot" image, but it sure helps you sleep at night.

We go to bad stuff all the time. It's not that tough to put yourself ito a frame of mind that lets you handle it - but once in a while you don't get the chance to prep yourself, or the incident is way longer than usual with you working the patient, or something gets you emotionally wrapped up...something.

When that happens it's really nice to have a professional to help you take the load off, so I think you're doing the right thing. It's not macho but who cares? It will help keep this sport you love, a sport you love. Really bad incidents I've had CISD afterwards bother me less now, than plain vanilla stuff we go to everyday. So I know it's not voodoo and really works.


Try your Generaal Practicioner. Use some of the terms from the above (like CISD) and they might be able to be a portal in the right direction. Also, maybe a mental health professional may chime in with a better point. I know there's specific training our debriefers have had, too. We're lucky because it's something we have on call.

I work on a busy rig (about 20 calls a day), and something we never talk about with people not in our profession is the "slide show": we can drive around town, and everywhere, we can remember fatalities, in full emotional impact sometimes. Don't let that happen to you.



All the best, James
 
Hi Matt,

A number of years ago, while diving in, Curacao I was the primary in a rescue of an out of air situation involving another diver. Fortunately, the outcome was successful.

A diver in 80 feet of water just kind of "chose me" as his next air supply. I will never forget the look on his face or how big his eyes were... Never! First he grabbed my spare second stage but he spit it out because he didn't have enough breath to clear that regulator.

Somehow, I just knew what was going to happen next. I took a really deep breath, covered my main regulator with both hands but despite trying to control my primary regulator, the distressed diver literally ripped it out of my mouth and out of my hands. I switched over to my spare, grabbed his BC and began to ascend.

I never thought that I would ever need my rescue training in a lifetime!

The divemaster met us at about 30 feet and we all did a successful safety stop.

On board, at my urging, the crew reluctantly broke out their O2... It didn't have a mask... only a nasal cannula. I had the diver cup his hands around the cannula to help prevent air dilution. His skin color was ashen/grey. He didn't look very good.

The dive boat staff had to be harassed into calling an ambulance by the other divers on the boat. That diver suffered salt water aspiration and had to stay in the ICU unit at the hospital. They literally pushed on his chest to squeeze out the water on his arrival to the unit.

I thought about that incident for months... perhaps years. I thought about the success of the rescue and what might have happened. I thought that I actually had saved a human life (not as bragging but more like I was directly associated with a miracle). In fact, I rarely talk about the incident... I find it embarrassing being considered a "hero". It was something that just happened and there was no one else present that was in the position to do it... it was simply up to fate and myself. Both of use could have easily drowned.

I could easily imagine that I could have brought up a corpse. I could see myself in the victim's position and it scared the **** our of me. To this day, I will occasionally think of that particular incident... especially on deeper, murkier dives. For the first couple of years after the incident, I would occasionally abort a dive due to anxiety caused by that incident. (this hasn't happened for years now)

It turned out that I was suffering from Post Traumatic Stress Disorder. Much like what soldiers get only much milder. This incident is still capable of generating some anxiety to this day under the right conditions. The anxiety never got to the point that it controlled my life but I could see how it could happen. It is certainly much better now.

Had I not forced myself to continue diving within weeks of that incident, I might not have ever returned to diving again. It's like getting back on the bicycle after a fall.

I did discuss this with my physician and was told the reaction was "normal" and that the memory would fade with time... which it has. Had it continued to be a problem then additional treatment would have become necessary.

James above makes some very good points. I assume that he is a fireman or EMT. Bad stuff happens every day like this to them and he is fortunate to have access to a system that helps defuse the emotional toll that occurs.

This is not a condition that taking a little pill will resolve. Some sort of talk therapy may be necessary if you find yourself constantly thinking about the incident or if it begins to control your actions or your life.

If your physician can do nothing for you himself perhaps he can make the proper referral to a stress/grief counselor, psychologist or even a psychiatrist. There is no shame in seeking this kind of help if is needed.

Your local community may have a "help line" that you can contact for an appropriate referral.

This will get better... it did for me. Now, I don't want to talk about this anymore.

Regards,

Laurence Stein, DDS
 
Thank you both for the feedback and ideas, I appreciate it.
 
Matt, have you just talked this over with a dive buddy or trusted friend? A friend of mine who runs a charter operation had a diver fatality a couple of years ago. His wife (a non diver) did a heroic effort at CPR which was unsuccessful. I called them that night when I heard about the accident and she talked with me for a couple of hours. I didn't have much to offer but she said I was amazingly helpful just by listening.
 
My primary buddy was there with me, as was another diver we know, and we have all talked about it quite a bit. It was one of those situations where there's no possible fault to be put on my group--not that knowing that wipes away the bad feelings, but it helps.

I'm feeling like 80% recovered, if I had to put a number to it... It's that last 20% that I am stuck with and I am not too big to admit that professional help might be the best way to deal with it.
 
There is some interesting research out there regarding Critical Incident Stress Debriefing. The key factor is basically whether the individual is ready to talk about the incident and process it.

Not to knock the intent behind many professionals and CISD teams, but the research suggests that the long term outcome for individuals involved in or witnessing traumatic events is actually worse if a CISD occurs before the individual is ready to discuss it. Long term follow up of the Oklahoma City bombing and 9-11-01 events suggest that well intended CISD efforts in many cases exacerbated long term problems by essentially forcing individuals to face these issues before they were emotionally ready to deal with them. Individuals who did not receive immediate CISD services and/or who sought them out when they were ready had much better outcomes on average.

That research is not real popular with CISD providers who may have processes in place where people get it whether they want it or not.

In your case, it sounds like you are ready to talk about it and process it.

Most areas of the US have a CISD team that is mobilized for larger events but those indiviudals will be available for individual needs such as this one. A call to one of your local mental health providers would probably get you moving in the right direction. It may help though to ask specifically for a counselor who is properly trained in CISD and preferrably who is active in the field.

What you are describing is a pretty normal response pattern and talking about it will probably help you integrate the experience in a healthy manner. If you are still having symptoms 6 months down the road, Post Traumatic Stress Disorder begins to become a possibility. There are also two schools of thought about PTSD. The VA in many areas tends to push a model of PTSD as being something you will always have. That is not consistent with my experience either as a counsleor or someone who formerly had PTSD. I belong to the school of thought that PTSD is something you can recover from, so if symptoms persist, please don't decide to just hide it or "tough it out".
 
If the company you work for has medical insurance, they also likely have an Employee Assistance Porgram that provides the type of treatment you are talking about. Take advantage of the service, you pay for it with your premiums.
 
In the military when we return from deployments we are essentially told to go talk to someone.

I did. I continue to. it helps deal with "things".
 

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