Trauma specialist gets first-hand taste of trauma

Australian clinical psychologist and trauma specialist Gary Fulcher has taken first-hand research in his field of expertise to a level few of his colleagues would care to imitate.

Not that it was intentional. Dr Fulcher, who at one point in his career was attached to the burns unit of a New South Wales hospital, found himself back there in 1996 - but as a patient after a near-fatal car fire.

The accident gave him an insight into the recovery and rehabilitation process of the patient. But it also revealed to him the damaging aspects of Australia’s compensation process, which he says forces victims to relive the accident over and over again during the assessments and questioning by doctors and lawyers. The result is to intensify the trauma experience or traumatise the person anew, delaying the process of recovery.

“The short, intense questioning forces victims to re-experience the event without sufficient time or help to process the memories,” he said. “They are rushed out of the office to make way for the next client and are left unaided in an agitated state, exacerbating any post-traumatic stress disorder.”

For all his experience as a therapist dealing with trauma patients, Dr Fulcher found he was having flashbacks for hours after every medical examination or legal interview. He calls the experience litigation-induced trauma sensitisation.

Dr Fulcher discovered he was not alone in this experience. One woman told him she dreaded the repeated examinations and had started not showing up for appointments. “I know I should go,” she said, “but I just can’t face telling another person about what happened to me. Whenever anyone asks me about it my mind just freezes. I feel sick and get terribly anxious but I say nothing.”

A man horribly burned in a place crash told him he would get so angry during the examinations he sometimes abused the examiner before storming out. He would regret his actions later and knew he was damaging his case but could not control his reaction.

Dr Fulcher will present a paper on trauma at Bold Perspectives, an ACC-hosted conference in Auckland on injury prevention and rehabilitation. He believes the no-fault ACC system operating in New Zealand reduces the problems he experienced first-hand and then subsequently in his professional life.

Bold Perspectives runs from March 21-23 and more than 30 speakers from around New Zealand and overseas are addressing questions as the cost of road accidents, the impact of grief in the workplace, employee involvement in improving safety and preventing falls among the elderly.

Dr Fulcher said he found Australia’s health system excellent at fixing bodies but poor at dealing with the emotional and spiritual aftermath of horrific injuries.

“Our hospitals are wonderfully geared for acute care, for saving lives and repairing horribly damaged bodies, but when it comes to looking after patients’ psychological or spiritual needs, they fall short by a long way.”

He realised from personal experience that failure to attend to non-physical healing could result in incapacitation as severe as failing to fix the body. “If I hadn’t known how to treat my post-trauma stress reactions, my depression and suicidal thinking, my anxiety and chronic pain, I could have given up and died, as happens all too frequently in burns units - even months after successful skin grafts.

“I could have given up and accepted disablement and taken a pension as the compensation doctors declared I should. I could have ended my life with a massive insulin overdose, which I knew how to do. And, frighteningly, I believe not one of the hospital, rehabilitation or compensation team was even aware I was at risk.”

He is convinced the main reason victims do not return to full lives is not their physical but psychological condition. Without early and appropriate treatment for psychological distress, victims’ chances of successful rehabilitation fall enormously.

“Anyone who is still struggling to make sense of their catastrophic experience and injuries is unable to resolve the trauma of it all. Without resolving their trauma, they can retain anger, fear, resentment, despondency and dependence. Pain becomes an obstacle and motivation disappears. No matter how well repaired their bodies are, complete rehabilitation is impossible.”

Dr Fulcher has skin grafts to more than 50 per cent of his body, a drop foot, breathing difficulties from inhalation injury and no fingers after amputations. Nevertheless, he is a successful clinical psychologist, teaches at three Sydney universities and is a frequent presenter at conferences around the world.

He is, he says, a walking advertisement for a permanently damaged body enjoying a full life because of a healthy mind, stable emotions and resolved spirit – the essential ingredients of successful rehabilitation.

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