Caleb was in the machine shop on his break, and Wendy had arranged for me to talk with him there since he refused to come and see me in the office. \u201cHe\u2019s anxious about this and a bit agitated,\u201d she warned. We found him hammering a metal sheet on a workbench in a deserted warehouse space filled with machine parts. I said hello, but he didn\u2019t acknowledge me. \u201cCaleb, I know this isn\u2019t easy,\u201d Wendy said, \u201cbut we just discussed this, and you agreed.\u201d<\/p>\n
Her voice was kind but firm. Caleb shoved the metal sheet aside, and turned to face me. \u201cAll right then\u2026 let\u2019s get this over with.\u201d His voice was rough and unwelcoming, and I felt uneasy. I would have to try to establish a rapport. \u201cCan we talk here?\u201d I indicated the workbench. \u201cSuit yourself,\u201d he said.<\/p>\n
He was in his mid-20s, but it would be easy to mistake him for a secondary-school student playing truant. His jeans sagged below his hip bones, and he was so thin and pale I feared he was malnourished. When he spoke, I glimpsed his missing teeth; there were at least three or four dark gaps.<\/p>\n
\u201cWhat am I meant to say to you then?\u201d he asked abruptly.<\/p>\n
I explained my purpose, adding, \u201cI\u2019d just like to ask about how you\u2019ve been since the accident.\u201d<\/p>\n
He made a dismissive gesture. \u201cCan\u2019t you just put down that I\u2019m feeling like s—? Why do I have to explain anything? They should explain how they let us go up in that chopper.\u201d Caleb kicked the metal on the floor, causing a cymbal shimmer to echo around the open space.<\/p>\n
Big, big fear there \u2013 and considerable anger<\/a>, too. I suspected it flared often, probably ignited by almost any interaction; I was just his lightning conductor for the day. I could see how this interview might feel like an intrusive attack at a time when he was feeling vulnerable. \u201cThis process is awful, Caleb, I agree. Just say what you can.\u201d He gestured at my notes. \u201cWrite this down, Doc. I want the helicopter company to pay up. And maybe\u201d \u2013 the sweep of his arm took in the work area around him \u2013 \u201cthis lot, too. Some raffle prize, right? Company should have vetted them properly.\u201d<\/p>\n Caleb then dismissed the notion of the helicopter having a mechanical failure, saying he knew a thing or two about engines. The problem, in his view, was that the pilot was \u201ccrap\u201d and caused the crash because he hadn\u2019t a clue what he was doing. I knew otherwise from the accident report but did not argue.<\/p>\n \u201cDid they tell you I had a breakdown after?\u201d he said suddenly, crossing wiry arms over his chest. I thought for a moment about how to answer. \u201cWendy mentioned you\u2019d been struggling.\u201d He glared. \u201cStruggling?\u201d His voice was sarcastic. \u201cThat what you call it? You can\u2019t imagine. I\u2019m lying there, mouth full of dirt, don\u2019t know if I\u2019m dead or alive, or if this is a bad dream or what, and then I saw it next to me and it\u2026\u201d He stopped again. \u201cHer hand. Nails painted pink and all. Jesus.\u201d His face was reddening, his jaw set.<\/p>\n I decided to move on to what came after the crash, noting that he\u2019d returned to work quite soon after. \u201cI need the job,\u201d he said bitterly. \u201cIf I keep getting signed off sick, they\u2019ll fire me. I can tell the company wants to get rid of me anyhow \u2013 they all think I should\u2019ve died instead of her.\u201d<\/p>\n His rage and paranoia were growing, pulsing, radiating from his body, and I was beginning to feel uncomfortable, a sensation I\u2019d learnt to take seriously in my forensic training. I knew I should end the interview immediately. Nothing I could say would make him feel calmer or less afraid.<\/p>\n Just as I was thinking this, he confirmed it. \u201cShrinks\u2026 f—ing shrinks and lawyers!\u201d His eyes were fierce, and flecks of saliva formed at the edge of his lips. \u201cYou\u2019re all the same, you lot.\u201d Instinctively, I drew back, and that\u2019s when I saw his discarded hammer lying on the floor. I realised his eyes were on it, too. There was a pregnant pause \u2013 then he kicked it, sending it skittering across the floor, shouting, \u201cI\u2019ve had enough!\u201d before stalking off.<\/p>\n Caleb needed urgent help. He presented a risk to himself and others and shouldn\u2019t be in a workplace where many tools could be used as weapons.<\/p>\n The next day, Wendy rang to tell me that he\u2019d been admitted to a psychiatric hospital, detained involuntarily and diagnosed with paranoid psychosis<\/a>.<\/p>\n Follow-up assessments<\/p>\n I didn\u2019t think I needed to meet with Lisa again, but I asked if I could see Martin for a follow-up and as soon as he arrived, I noticed a difference in him; he seemed much more present and alive. He shook my hand and immediately made eye contact, saying he felt better.<\/p>\n Martin\u2019s GP had changed his meds for depression and got him some cognitive behavioural therapy<\/a>, which had made a big difference. He\u2019d given up his job and he and his family were moving to Kent. I could see he was still a saddened man, much altered by his experience, but I felt heartened that he seemed more engaged in the business of life.<\/p>\n Before I followed up with Caleb, I was able to request and review his GP\u2019s notes and found that he\u2019d been known to the child protection services, and some reports referred to him being taken into care briefly as a boy. I also saw a couple of assessments by child psychiatrists who had seen him years earlier \u2013 presumably, the first of his \u201cf—ing shrinks\u201d.<\/p>\n Eventually, I heard from Wendy that Caleb was about to be discharged from the hospital and was ready to meet with me again to complete our assessment. When I arrived at the psychiatric facility, I noticed immediately how his appearance had changed. He\u2019d put on weight \u2013 a side effect of the anti-psychosis drugs \u2013 and it suited him. His attitude was also entirely different: he welcomed me with a smile and a handshake, and swiftly apologised for his sudden exit from the factory that day. I wasn\u2019t surprised to find him so altered; it\u2019s not unusual for acute psychoses to resolve just as quickly as they start, with medication and appropriate care. None of this meant that Caleb had left the trauma behind; he might just be able to speak about it now.<\/p>\n This time, he seemed more sad than angry, and when I asked him about his worst moment, he spoke again about seeing poor Terri\u2019s severed hand, and how he would never forget it.<\/p>\n He started to tell me a little about his early life. His mother had run away from home when she became pregnant at 16, finding work in a pub in London. She often dated men she met there, he said, adding, \u201cI was scared of them, and of her, too. She\u2019d go on the piss and scream at me\u2026 And then her boyfriends beat her up sometimes, in front of me.\u201d They had also beaten him. \u201cSee here?\u201d He pointed to the gaps in his teeth. \u201cI\u2019d only just grown in my big teeth when one of them did that.\u201d He ran away from home and ended up in care, until his mother found safe accommodation away from the pub. He did an apprenticeship that would ultimately lead to his job at the kitchen factory. \u201cI was hired just in time to go along to the Christmas raffle, wasn\u2019t I? Lucky me.\u201d<\/p>\n I asked if he thought he was ready to return to work, but he\u2019d decided to follow his doctor\u2019s suggestion to continue with rehabilitation a little longer. I felt I could now give him the PTSD symptom checklist. In the \u201cpast\u201d column, he ticked \u201cintrusive images\u201d \u2013 that severed hand had been persistent, although it was now largely gone.<\/p>\n \u201cBut I\u2019ve got something else that isn\u2019t on your list. I still don\u2019t feel right. I feel like a snail without a shell,\u201d he said. He told me about memories of how his mother would sometimes lock him in his room all day. He was worried that when he left the facility his rage might boil over, at her. I was seeing him as an independent expert, not a therapist, and I had to be careful not to step outside my role. I told him to consider staying at the facility and having more therapy, looking at his childhood fears as well as the crash. I didn\u2019t add that I had plenty of evidence that he had suffered a significant psychological injury because of the accident, affecting his day-to-day functioning, especially his work. I thought that when the court came to allocate damages, Caleb would get more than Martin or Lisa, and I hoped he would use that money to continue his recovery after being discharged. I would highlight his need for long-term therapy<\/a> in my report.<\/p>\n When I finished my assessments, I sent them to Wendy and my work was submitted into evidence.<\/p>\n Settlements and the aftermath<\/p>\n More than a year later, there was, as predicted, a settlement, which, to my relief, meant that I would not have to go to court to defend my opinions. As I had guessed, Caleb got the most significant amount, Martin a similar sum, and Lisa somewhat less. That seemed a bit unfair to me, with Lisa\u2019s resilience meaning she was compensated less than the others.<\/p>\n These three crash survivors could be considered fortunate, despite their ordeal. As Martin had said, they were the lucky ones. They were alive. But this might be all they had in common; three people could have almost the same traumatic experience but with three very different survival reactions. It was plain that emotional stressors and lack of childhood attachment security<\/a> are significant risk factors that make a difference in how resilient you might be to major trauma. Lisa seemed the \u201cluckiest\u201d in that regard; that\u2019s why I thought she had suffered but recovered. Today, I know better than to think that trauma stories always end so neatly.<\/p>\n About three years later, I received a call from a psychiatrist in Birmingham who ran a perinatal service looking after new mothers with mental health problems. She told me she was treating Lisa for acute post-partum psychosis<\/a>.<\/p>\n My colleague knew about the helicopter crash and had gained permission to discuss Lisa\u2019s case. She was very unwell now, ever since the birth of her daughter six months prior. \u201cSevere depression, believing that she and the baby are about to die, hallucinating that their bodies are decomposing. Her husband thought she was going to bury the baby alive.\u201d I struggled to reconcile this presentation with the Lisa I\u2019d met. Something macabre was bursting out of her memory and manifesting as a paranoid belief that both she and her baby were dying or dead.<\/p>\n Lisa had not mentioned the helicopter crash in her antenatal clinic, and it had taken another life-changing event \u2013 albeit something positive \u2013 to bring this acute response to the fore.<\/p>\n As it happened, I was embarking on some research into maternal violence and its motives, and discovering more about how \u201cmatrescence\u201d \u2013 the transition to motherhood \u2013 can be a potent psychological stressor, even when the pregnancy and the baby are much wanted. My continued research in this area and my work in the family court would reinforce the idea that there is nothing like a pregnancy for activating memories of being vulnerable and making mothers-to-be aware of the potential fragility of life. Rather than \u201cgrounding\u201d women, maternity shifts self-perspectives and memories<\/a>, like tectonic plates moving in the deep unconscious.<\/p>\n I told the psychiatrist that there had been no sign of any persistent mental health problems when I interviewed Lisa. She had successfully avoided engaging with her sense of fear, which meant I saw only her briskness and lucidity, her faith in a positive future. With hindsight, when I recalled how she described her sense of helplessness and that distorted sense of time in the absolute silence after the crash, I realised I had missed something darker. How remarkable the process of encoding and retrieving memories can be; the more I learn about this, the less I think I know.<\/p>\n The perinatal psychiatrist and I kept in touch, and in time she told me that after specialist treatment and care, Lisa made a good recovery and went home with her baby girl. Lisa\u2019s story made me reconsider some important ideas, and it has stayed with me even now because of the mystery of that acute contrast between her response to the crash and her reaction to becoming a mother. Was she just lucky with helicopter crashes and unlucky with the transition to a new identity as a mother? I am left to wonder whether traumatic memories somehow hide in the mind<\/a>. But if so, where? All I can say with certainty is that recovery from trauma sets its own timeline, a trail that may bend, incline or twist without warning.<\/p>\n *All names have been changed<\/p>\n