By Guest Author 11/07/2018

Karen Nimmo

So the psychological recovery begins.

With the physical ordeal behind them, the 12 Thai footballers and their coach who survived underground terror and a high-risk rescue must now re-engage with life.

Physical injuries will heal; hopefully any infections will too. But the invisible wounds will bear tending for the rest of their lives. It is not possible to spend more than two weeks trapped in the dark, fearing death, separated from all you know, without emotional trauma.

The boys now have “hero” status, having gone underground as schoolboy footballers and emerged miracle survivors. The coach will be the target of many questions. There’ll be media and public demands, offers of books and movie deals; everyone will want to know WHAT IT WAS LIKE.

All of which will make it very difficult to put aside their experience and reclaim their stake in ordinary life.

What is Post Traumatic Stress Disorder (PTSD)?

PTSD refers to the emotional and physical reactions in people who have witnessed or experienced an event which has threatened their life, safety or wellbeing. These events include accidents, physical or sexual assaults, abuse, natural disasters, living in war zones, death of a loved one — anything that dramatically alters your life course or view.

These young footballers will demonstrate PTSD symptoms in varying degrees. Some will seem the same, others may be shut down, highly anxious or acting out. The most likely early symptoms are nightmares and flashbacks (thoughts and images) triggered by anything that reminds them of their experience. Emotional distress can show up as unexplained physical aches and pains. There may be distraction and attention difficulties, mood swings, emotional reactivity, behavioural problems, fear of small spaces, darkness and water. Later, anxieties, depression and addictions are possible.

Emotional recovery will depend heavily on three things: (1) The innate resilience of each boy — their ability to adapt to life as it is now (2) the support of the environment/s they return to and (3) the tools they are given to help them cope.

Here are the key considerations as they begin their journey back.

1. Back to basics.

The boys have spent nearly three weeks in the darkness; battling fear, fatigue, boredom, hunger and all that was going on in their heads. Their sleep patterns and circadian (24-hour) rhythms are likely to be seriously disturbed. So the basics of sleep, nutrition and physical movement after sitting still for so long are paramount. Tending to physical needs is a priority because they impact mental health.

2. Go to school, not to Russia.

Even if they were physically strong enough to take up their invite to the World Cup football final in Russia, it wouldn’t be psychologically smart. After two terrifying weeks underground the boys need stability. Even settling down to schoolwork won’t be easy — and may be impossible for a while. While it is important to re-impose routine and structure, the trauma of their experience must also be allowed for.

3. It’s not all happy families.

Not every boy will return to a stable and positive home environment. The public shows of hugs and kisses are not always an accurate reflection of what goes on in families. While the boys will be relieved to return to what they know, they will have to cope with other people’s emotions as well as their own — as well as the ordinary drama of life. For parents and siblings it’s difficult: their son and brother has not just come back from football camp — he’s different, likely to be traumatised, and the change can be hard to understand and cope with.

4. What to do with (bad) memories?

People process experiences and memories in very individual ways. As you see in war veterans, trauma symptoms don’t rise neatly to the surface to be cured with a pill. They can flare immediately (as in nightmares or anxieties) or they can take months to show up. Flashbacks and bad memories need to be processed, not locked down. Talking, counseling, writing things down, drawing can all help but the person must be ready.

5. Mates for life. Or not?

The boys who loved football will want to get back on the pitch, physical health permitting. But the relationships with those they were with in the cave have changed forever. They will be publicly portrayed as a tight unit but that will only be part of the story. Some relationships will be tight like brothers, others fractured, even damaged. For some boys, football and their teammates may be a painful reminder of what they went through. While trauma can bond those involved, this experience would have been for the most part terrifying and that doesn’t bring out the best in everyone.

6. As you think, so are you.

Spiritual beliefs can be helpful in taking you beyond the experience to engage with a bigger picture. These boys reportedly come mostly from Buddhist backgrounds and that mindset may have helped while in the cave. Spirituality can help reground you, reset your thinking, promote gratitude and aid perspective taking. But it does not wipe out the experience altogether, so it should not be used as a mask.

It’s not necessary to aim for full recovery from PTSD, because we all can, and must, learn to live alongside our emotional struggles. The better long-term goal is to find meaning in the experience and make it part of your story. For these boys, the next chapter may be just as challenging as the first.

This post was originally published on On the Couch, Karen is also on Facebook.