Reliving trauma with little relief
Those diagnosed with PTSD in the wake of political violence are starting to speak out, but others say not enough attention is being paid to the psychological impact
The first flashback occurred several months after Aggarat Bansong was caught in a gun battle during the anti-Yingluck government protests in 2014.
At first it was the image of a protester shot in the head. The large dark-skinned man, wearing a shirt with the red, white and blue of the Thai flag, was being dragged as he bled to death as she stood two metres away. She would hear the same male voice over and over again: "He's not going to make it."
Later, Ms Aggarat would flash back to the 2011 tsunami in Japan, where she was in a van travelling in the stormy night, passing by houses that had been swept away by the massive waves. She would glance at the rolled-up mud-stained blankets and mattresses and mistake them for the arms and legs of the dead.
And then there were the 2010 red shirt protests.
"It's like I was reliving the experiences," said Ms Aggarat, a former producer for the BBC. "I felt guilty that I couldn't help save these people."
The involuntary memories would be the cause of her insomnia, and would later be triggered during a live broadcast or even while having a conversation. At home, she would often lock herself in the toilet because she didn't feel safe outside.
Making the smallest of mistakes would leave her stressed for weeks, and she would often be in a depressed state of mind, crying for no reason.
But she brushed aside the symptoms, regarding them as the result of work-related stress. It wasn't until June 2014 that she realised she may be exhibiting symptoms of post-traumatic stress disorder (PTSD), caused by very stressful, frightening or distressing events. She decided to tell her colleague, who advised her to inform Jo Floto, the BBC's Asia bureau chief.
"It took me the whole day to build the courage to talk to [Mr Floto]," said Ms Aggarat. "It's like admitting that my work efficiency is under par. And I didn't want other people to know that I had some kind of disorder."
By then, she was having suicidal thoughts, constantly thinking of jumping off a building to "end it all". She could not go down Ratchadamri Road or past the Democracy Monument -- both occupied by anti-government protesters in 2010 and 2014.
"Even thinking about it would make my heart race and I would break into a sweat," she said.
Ms Aggarat was allowed to take two weeks sick leave prior to her month-long vacation in the US. On her return in August, she attempted to work but after covering a news event in Cambodia the BBC encouraged her to take more leave to recover. She saw a psychiatrist at Bangkok Hospital and was diagnosed with severe PTSD.
Although Ms Aggarat says she has now fully recovered, two years ago she wouldn't be able to have a conversation about her mental health issues without breaking down in tears or feeling fatigued. "It was the worst thing that ever happened to me," she told Spectrum, her voice trembling.
Thailand's polarised politics has led to waves of mass protests, with the 2010 and 2014 months-long protests leaving hundreds dead and thousands injured in the worst violence in the nation's modern history. But in a country where PTSD is almost unheard of and even psychiatrists struggle to find the Thai term for it, the psychological trauma of the events are rarely touched upon, leaving few to seek professional help following a distressing experience, let alone admit that they themselves are the victims of such trauma.
STATE OF SHOCK
It was May 19, 2010 when the military launched a final crackdown on the red shirt protest, forcing leaders of the United Front for Democracy Against Dictatorship (UDD) to surrender and call off their 68-day rally.
On the front foot: Sumeth Somkanae, president of the National Union of Journalists, says reporters have been the target of violence since partisan media outlets emerged.
Thousands of protesters who had occupied a large area around the Ratchaprasong intersection in a political campaign aimed at reinstalling the proxy government of Thaksin Shinawatra had gone, except for Pussadee Ngamkum. She had promised one of the leaders of her group that she would fight until the end. And she did -- until a group of soldiers found her and told her to go home.
The scenes of dead people being carried into the Police General Hospital left a mark on her, years after the incident occurred.
"I was in a psychological state of shock," said the 51-year-old former nurse. "I was unable to cry at all -- it would take me almost three years before I could bring out the tears."
Feelings of guilt overwhelmed her, and she often wondered why she survived when everyone else died.
Ms Pussadee initially took antidepressants given to her by a friend who worked at a mental hospital, and eventually saw a psychiatrist after the 2014 coup triggered more negative feelings. Although she says she is in a much better condition now, she still feels angry that the red shirt supporters have not yet received justice.
The surrender of the UDD leaders in 2010 disappointed many red shirt supporters at the time, and Permsuk Chai-yen, like several others who decided to stay on, drove his pickup to the nearby Wat Pathum Wanaram about 4pm with his wife, 13-year-old daughter and four-year-old niece.
As he looked up towards the BTS skytrain track, he saw a soldier wearing a military uniform, combat shoes and a helmet pointing a gun towards him. He then heard multiple gunshots which he described as "falling from the sky" as he ran towards the first aid tent. The bullets hit him twice -- one in the leg and another in his buttock.
When he travelled back to his home town in the northeastern province of Nakhon Phanom, he wasn't able to leave the house for six months for fear that he would be killed. He refused to talk to anyone, and often had trouble sleeping as the images of the day of the crackdown appeared.
"I saw many dead people," he said.
Financial troubles forced him to go back to work in the construction industry, but the paranoia did not go away.
"I was still afraid that I would be shot. I was afraid they would kill me to silence me," said the 61-year-old, who was one of the key witnesses in the Wat Pathum Wanaram shooting, which left six people dead. In 2013, the Southern Bangkok Criminal Court ruled that the six were killed by shots fired by the military.
"I didn't think soldiers would do this because I am the son of a soldier. From then on, I developed a hatred of soldiers," said Mr Permsuk.
Thai people became more aware of PTSD after the 2004 earthquake and tsunami that killed an estimated 8,200 people, when the Mental Health Department (DMH) conducted a survey and found that 11.9% of adults had PTSD-related symptoms.
"In the past, people would say they were 'shocked' by an incident, but they wouldn't know that it was a disorder," said DMH spokesperson Apichat Jariyavilas, adding that there are no official statistics of the number of Thais who have experienced some type of traumatic event.
While PTSD can occur after life-threatening events, such as natural disasters, terrorism or rape, many people with PTSD do not directly experience the event.
In the case of the political protests, for instance, living near the protest sites or watching footage of the crackdown on television is enough to cause some people to develop PTSD symptoms, said Dr Apichat, who is also a psychiatrist at Srithanya Hospital.
While stress or fatigue may occur as a result of participating in a protest, PTSD is developed when a person experiences or witnesses life-threatening events. This may be accompanied by feelings of fear, hopelessness, guilt, anger and shame, as well as avoiding activities or places that remind them of the trauma. In addition, the traumatic event is relived repeatedly in the form of recurrent images, frightening thoughts, dreams or "flashbacks" of the event.
Victims of traumatic events may develop an anxiety disorder called acute stress disorder (ASD) if the symptoms persist up to one month after exposure to the traumatic event, while PTSD lasts more than a month after the event. In severe cases, the person risks having depression and suicidal tendencies.
Few journalists, however, are willing to admit they have some form of psychological trauma, and Thai media organisations generally do not provide awareness training for staff who work in hostile environments. Because of this, the increased psychological risk now recognised as associated with journalistic work has not been made clear.
"Previously, journalists were never victims of violence," said Sumeth Somkanae, president of the National Union of Journalists. "But the rise of media outlets with political leanings in 2006 caused the press to become a target in political conflicts." Sumeth, a Thai Rath reporter, added several journalists were attacked during the 2010 crackdown, and some were put under pressure from their employers to "get a good story" despite the ongoing violence.
That year, the Thai Journalists Association hosted its first safety training workshop for journalists, conducted by the International News Safety Institute.
Providing counselling to staff following traumatic events is rare for Thai media organisations, with The Nation newspaper, for instance, offering the service for its journalists for the first time after the tsunami. Foreign media like the BBC, however, assign several senior staff to check whether those who have experienced potentially traumatic events might need counselling.
In Ms Aggarat's case, she was offered to be put in touch with a professional counsellor in London.
"We don't give importance to psychological trauma, which many journalists have but are afraid to admit," said Sumeth, adding the trauma can be reflected in articles showing the writer's emotions. "Thais still have a misunderstanding that people with PTSD are insane."
PATH TO RECOVERY
For Ms Aggarat, the fear of re-experiencing traumatic events was too much to bear, and she eventually decided to leave her dream job in the media after taking almost a year of paid sick leave.
"I was afraid that I wouldn't be able to cope with it," said Ms Aggarat, who now sells cosmetics. "It was so difficult to go through that period. But now it's just a memory."
PTSD also took away the career of freelance journalist and photographer Nick Nostitz, who plans to open a fast-food restaurant back in Germany.
Nostitz developed PTSD following the seven-month Bangkok Shutdown and anti-Yingluck protests led by the People's Democratic Reform Committee, which led to the May 22 coup. When Spectrum asked to meet him near the Thong Lor area, he asked to meet elsewhere.
"There are parts of Bangkok I'm uncomfortable with going," he told Spectrum. "Thong Lor is a bad place for me because there are a lot of yellow shirts."
During the PDRC protests in late 2013, he found himself the target of hate speech on TV and rally stages. The attacks became personal and he was finally assaulted by PDRC guards. In May 2014, several guards of the protest monk leader Phra Buddha Isara attempted to "abduct" him at the Constitutional Court. His detractors believe he was hired by Thaksin, an accusation he denies.
"I'm not a red shirt journalist. Obviously I'm much closer to the political demands of the red shirts because I have a pro-democracy position and I see that the majority of Thailand wants to have a democracy," he said. The assault caused him to fear for his life, and not being able to go close to the PDRC protest areas meant he could not do his paid work.
"I knew if they caught me I would be possibly killed. Some people pointed at me on the streets and you could see hatred on their faces," he said. "For seven months every single day my life was like this. Watching over my shoulder thinking very hard where I can go or can't go."
Nostitz started suffering nightmares and panic attacks several times a week, which caused him to sleep no longer than four hours a night.
In November 2014, he saw a psychiatrist at Srithanya Hospital, where he was diagnosed as having PTSD.
The cases he filed against the people who assaulted and attempted to abduct him did not reach the first stage of investigation. The lack of justice, Nostitz said, has obstructed the healing process, and he is in the process of leaving Thailand after 23 years.
"I can't just go around the streets of Bangkok and be comfortable. And there is a clear signal that they still see me as an enemy -- I'm not going to go through this again," Nostitz said.
Protest leaders from both sides of the political spectrum spoke with certainty that none of their supporters developed PTSD-like symptoms following the two major recent political protests, an indication of the need for greater awareness and reducing the stigma of PTSD.
The 2010 crackdown on the red shirt protesters left 94 dead, and more than 2,000 injured. While key red shirt leader Weng Tojirakarn said the event resulted in "severe hatred towards the Abhisit Vejjajiva government" and the military, no red shirt supporter developed PTSD, let alone sought help from a psychiatrist for stress-related issues.
"They cope with stress by getting drunk," Dr Weng said.
The 2014 Bangkok Shutdown left 24 dead and almost 1,000 injured. Of some 700 people who sought treatment at the hospital, about 200 were severely injured.
"They [PDRC supporters] were told not to see the police as enemies and not to react or be aggressive," said key PDRC leader Buddhipongse Punnakanta.
While a large number of PDRC supporters are Bangkokians, some of those who joined the seven-month occupation of Bangkok travelled from the provinces in a bid to oust the Yingluck government before snap elections in February.
It turned out that having to return home after the coup in May made them feel worse off.
"In the worst case, people became depressed, not due to the stress of participating in the protests -- they actually became addicted to it," said Mr Buddhipongse. "It's fun for them and there was always plenty of food to eat. It was a time for them to enjoy and meet new friends. Not one single person was afraid.
"During the first few days, we were concerned about the grenade attacks, but the presence of soldiers who helped take care of the situation calmed our fears."
Only a month after the coup, the National Council for Peace and Order had summoned more than 500 people, many of them political figures, red shirt activists or businesspeople linked to the Yingluck government.
"For us, the post-coup period did not cause any stress because we weren't arrested or did anything illegal," Mr Buddhipongse said.
Better days: Aggarat Bansong, left, with Nick Nostitz, right, and other journalists before the coup.
Survivor's guilt: Pussadee Ngamkum, right, says she was left in a state of shock after staying to the end of the deadly 2010 red shirt protests.
‘No problem’: Key PDRC leader Buddhipongse Punnakanta says none of the demonstrators suffered psychologically as a result of the 2014 protests.
New life: Permsuk Chai-yen, now a ‘tessakit’ officer, suffered visions of the 2010 crackdown.
Caught in the middle: German photojournalist Nick Nostitz is attacked at Democracy Monument after being singled out as a ‘red shirt’ during the PDRC protests. Nostitz says repeated attacks have left him in fear of his life and prompted him to leave Thailand.