Panic at Depth......

[Mr T.]

OK, so I don't know whether this strictly qualifies as 'Dive Medicine' - more 'Dive Psychology', but here's a true story about what happens when things go wrong - and how, depending on how you react to the circumstances, you can either square it away and crack on, or become an incident......


I have, from memory, only panicked twice in my life: the 1st being on a South African Airlines flight coming back from Cape Town. I had been asleep on the flight (post sherry haze and all that) and had then awoken suddenly to find myself looking at massively unfamiliar surroundings - the inside of the plane's fuselage.

For what ever reason - and I still don't know to this day why it happened or why I responded as I did - I could not make sense of my surroundings (pissed paranoia??) and even when it did dawn on me where we were, I had an unshakeable feeling that we were in imminent danger and about to crash!!

And yay, how my ring did flex!! Completely irrationale behaviour on my part. But, I did remember to breath, and continue to control my breathing for a few minutes until I regained my calm and told myself that everything was OK. Luckily I hadn't gone berserk and started shouting or loosing the plot or anything - it was that time on a long-haul flight, post nosebag, post after dinner drinks, that the whole plane's company was asleep and covered in blankets. Even Fi was asleep, so no drama. I also remembered to grab my book and study not the contents, but the book's form, shape and colour - madness you may think, but it was this very act, combined with controlling my breathing, of occupying myself with a task that brought me back to the here and now (or the then and there).

The second time I panicked was as follows.....

Once, on a shore dive off Shark's Bay, Naama Bay, Sharm, Red Sea, I was diving with two Instructors: one a Zimbabwean BSAC and the other a German PADI from the dive centre with whom I was diving.

The bitter irony for the BSAC instructor was that - because he was not PADI trained - they were making him do a 'check-dive' to see if he was all that and a bag of chips. Bizarre, but true.

Anyway, we kitted up on the beach, tabbed in backwards and descended into a pinnacle-strewn forrest of coral blocks - depth ranged from 2 to 30 metres to the sheer drop-off of the reef wall. The site was gorgeous and I couldn't wait to get in amongst it.

Now I had done many a shore dive in my time, and this one was nothing out of the odinary, but pretty soon in to the dive and at about only 22 metres, I caught site of the blue abyss that presented itself where the wall fell away into the deep......oh shit.......vertigo......oh shit.......

When this strikes, a number of things/feelings/factors kick in.

You feel strangely euphoric momentarily before your feelings change to something akin to blind (and that the big problem...blind) panic, which then rudely takes over and makes a ruddy nuisance of itself.

You're now beginning to breath at a rate at which your reg will quite happily refuse to keep up. Shit, why isn't my air flowing as I need it?? Why am I having difficulty breathing? Why isn't my reg giving me what I need, when I need it? You begin to look around - at what you have no idea - and make irrationale movements in the water. You feel like your buoyancy has just taken the last bus to any where but where you need it, you feel that you're about to drop uncontrollably and there's dick you can do about it.

Of course whilst all this is going on, you're not in the state of mind to remember that a reg will do precisely what it says on the box: it will give you a regualted delivery of air at a 'regulated' rate - never more, never less - regardless of depth. This is, of course, no help to you as you're now chugging air in an effort to get what you perceive to be a more fluid and faster supply to keep up with the demand you're now screaming for.

It's now that you begin to look at the surface (that translucent, shimmering, air-filled prize) and briefly, but repeatedly, ask yourself the question: "how far am I from the surface and as much air as I can get down my neck, and how long will it take me to get there?" - fatal!!! Need to get a grip.

You them remember from some long distant course that, even if you wanted to, there's no way that you can go screaming for the surface and not damage yourself - dichotomy: do I make a break for it and risk what ever damage the ascent will cause me (as sure as shit in your current state it won't be a 'controlled ascent')?? Or do I stay here, knowing that the next thing I'm gonna do is spit my reg with the resultant happiness that will bring?

And that's the other weird thing: the brain works in mysterious ways. That which you have in your mouth and is providing you with that which is keeping you alive is now seen to be the thing that's preventing you from breathing, as it's not playing its part in this little French-farce and giving you air as quick as you're demanding it!!  HELP!!!!!

So now you're well and truly in 'the zone' - you either get your shit together pronto and deploy accordingly, or your face is gonna be wearing a brand new 'Hurt Certificate'.

So what's it gonna be?? A whole new world of pain, or address your needs in a metred way that means you've got a fighting chance of getting out this trauma in one piece??

OK, time to make the call.

I began by looking at my computer - 21 metres: nowhere to go but here. Address it now - get a task to do. OK, check rig: all in working order - straps, valves, dumps, clips; control breathing, slow, s-l-o-w; don't look over the edge - it's beautifully blue and it'll be there tomorrow; you, on the other hand (unless you can get your shit together now) might not be.

OK, beginning to control the breathing - look back at the pinnacles and begin to judge both distance (something you can't do staring into the blue) and perspective. Starting to come easier now, slowly does it, fin back towards the pinnacles, look at the fish, tell yourself that the big ones are just as pretty as the small ones, begin to look at the smaller ones - they demand more concentration and will further help take your mind off the previous 30 seconds (yes, all the above happened in that short space of time).

OK, getting there now. The water appears bright and is warm, you've controlled your breathing and, to all intents and purposes, the dives back on.


I'm happy to report that, later that same tour, we took a detour off a wall and into the blue to get to another wall and some 'chimneys'. I initially (now at 30 metres) thought 'oh no, not again', but as we were in a group of some 30 divers, I simply took my eyes way from the blue and began to examine the dive kit of my fellow divers. Began to ask myself which bits of it I might want, pros/cons of the various pieces of kit on display etc.

The irony is I don't suffer from vertigo - I've done both parachute jumps and bungee jumps (and one or two 'catapults' too), and never had a problem with hurling myself into 'oblivion'. Luckily this was a one off and I took control and got it sorted.

The thing is, the KEY is, control your breathing and you can remain rationale (even when your heart feels like it's about to rip through your chest wall) and things will return to normal. Don't, and they won't! Remember that you HAVE air and that it needs to be breathed at a constant and SLOW rate. Keeping this mantra handy helped me - I hope you guys never have to experience it.

Dive safe all - always.

[Dr Stevil]

Incidentally Bren, pure adrenalin (in powder form) is brown.

(Edited by Steve W at 8:02 pm on Nov. 30, 2002)

[Hobby]

Adrenaline,it's a love hate thing!A trick I was always taught by someone who knows much better than myself was to stop, shut my eyes,and concentrate on my breathing.I found it really worked.
There are many things realted to stress,(the worst case scenario being panic which is probaly the biggest killer of all),things like adrenal dump,adrenal flooding etc,which we should be aware of as these things happen to us all.Like the man said,if you know what's happening..........
For those interested, read Geoff Thompson's books,"Dead or Alive" and "Fear,the Friend of Exceptional People".These books are excellent,interesting(to anyone)and easy to read and understand,they should be standard reading for all divers etc.
http://www.geoffthompson.com
Hope this helps(it did me!)Hobby

[MATTBIN]

Bren
glad you got it all together and lived to tell (us) the tale, takes a brave man to admit to things like that. Maybe the vertigo thing works in reverse I hate heights, with a passion, I cant get on my garage roof without feeling real bad. Yet this year we floated over a drop-off in Lanzarote that was breath taking in its beauty and I felt no fear, admittedly it was only about 35mtrs but for me on land that could have been the Empire State bldg. Anyway you wont have that problem again in the UK cos you aint gonna see no drop-offs like that in 5m of viz. are you?
Stay safe mate.
Matt

[Lawrence Debono]

Very well described, Bren. Indeed !!!This is what struck me most ----
"How far am I from the surface and as much air as I can get down my neck, and how long will it take me to get there?" - fatal!!! Need to get a grip.

Exactly <<need to get a grip>> How does one survive that? It is not easy at that point and I think it is purely mental training and lots of discipline.

This is exactly what I went trough about 3 years ago. Down around 30m in cold murky water about 10 km out on lake Erie. When I tried going up (or so I taught), the up line broke. Dive boat was tied right to a mooring block. The skipper didn't want to damage the wreck with the anchor. When I was trying to pull my self up (my mistake, I should try to ascend up), I got the end of the line in my hand. OOPS, looked at the depth gauge and saw that I was still at the same depth. I felt the beating of my hearth like the some one going at it with a sludge hammer and increasing by the second. I managed to start an ascent, but by the time I was at 20 or 18 meters, I started hyperventilating and the pulse must have been up there. I confess that although I had the urge to go up I managed to calm my self and get under control. That's when your phrase "get a grip" came in handy Bren. I was sucking on that DV so bad that another diver offered his octo. I managed without and refused to take it. I still remember him being puzzled by all the bubbles coming out of my reg. I figured if this isn't enough how is it that his DV is going to be better? I managed to carry on with my own equipment and even managed to calm myself well before the safety stop (6 meters).
To this day I don't know what it was that got the hearth rate going. That was the fuse that triggered the rest. May be fear of not having enough gas; may be concern of not making it back up to the surface or a combination? I doubt that at that depth narcosis is a factor. I know that the urge to go up quickly was "almost" overwhelming. This is great that people share these experiences because others can learn and evaluate the problems to avoid future crises.

Save diving to all

Lawrence

[JohnK]

Wow Bren - you put into words what I have had happen a few times. Starts with increased heart rate - mind thinks `ay up, summits not right.....` and so forth. I can get this on shallow dives (not the panic but the physical manifestations) and can now control it with `ah - here comes the buzz` thoughts - amazing how it disappears - even thought it might be a manifestation of narcosis.

Also, in line with `controlling it` I focus on my camera settings and away it goes......wierd !!

The main thing I have learnt is to recognise that it will not hurt me.....treat it like a buzz and maintain focus on something (even a stone at Cape which I did during training)

I still think its linked to narcosis in some way

Thoughts anyone ?

[Hobby]

Well here's some of mine for what they're worth.One of the problems with being underwater is that your senses become compromised,ie.hearing,touch,sight etc.Altough we may not be aware of it these inhibitions to our natural defence mechanisms serve as stressors to varying degrees.The Australiians for eg.coined the name "Blue Orb Syndrome",this was after findings in various navies etc.where divers in mid water scenarios experienced symptoms including those described.One of the factors they found was in the divers senses being unable to sort of "fix"on something(in Blue Orb this is particularly visual).Best described as being suspended in a blue entity(black for most of us!)with no reference points,particularly visible,it can cause mischeif with your senses and hence have a detrimental effect on your psychological state.At times like this the focusing on a set thing,Kirky's stone,my breathing etc.helps.
The symptoms discussed above,both physical and psychological are indicative of stress(I think you'll agree).Now the extreme physical manifestation of this is panic,none of us wants to go there,but we are at the end of the day human.The stress comes from stressors,the stressors are different for us all but we do have many in common.Much of the problem is recognising when you're becoming affected,as in "I need to get a grip".
Lawrence tells us of his bouyancy problems due to the effects of ice on equipment and a procedure which kept him on the surface.Now thankfully he's experienced enough to recognise where his problems originated here,he was also capable(while under considerable stress)to keep a clear head and do what was required to overcome them.
Ask yourself this honestly,it's very icy,you're compromised to a degree as you're delayed at the surface,vis is nix..then you have an equipment malfunction.Will you really have the clarity of mind to descend(thus rectifying the problem) and overcome your instincts?That however is an example of the psychological make-up needed to keep you alive,the ability to stop panic developing,stop,think and act to resolve the problem,in that time,if you're in panic it may well kill you.
Add to this narcosis and the problems are compounded,thankfully that mindset can help you too as the factors are so interlinked.
So the problem arises,how do we develop this psychological strength,clarity whatever you call it?
Realistic,applied training and application are certainly a major factor.This would include factors such as correct kit selection etc.but more importantly how to use correctly what you have(as opposed to making everyone carry a spare everything in case of a problem-that maybe solved or prevented by correct procedure?).Personally I remain sceptical that this can actually be taught.If one reads medical texts by navy staff on divers they talk of only a percentage of applicants having a suitable pschological framework to be a diver,as a rec.diver we never really see that,it's probable we see the results on a regular basis however.
It's no doubt usefull to understand what stresses us,what maybe more important is being able to deal with it appropriately when it crops up.We can always ponder afterwards what made us jittery,however if we can't deal with it immediately then we may never get the chance.
Take care,all,Hobby.

[Lawrence Debono]

Hobby mentioned (indirectly) – “coping with the issue” and I find that very true. I think it is has to come from two avenues. I would like to get to get to the bottom of this because I don’t want to see my self or any one else in that situation. The two avenues are > physical and >physiological training.

The physical part done by keeping diving and build up the experience. As you are doing this I think that the mental part is being set in slowly.

The mental part can be more complicated to explain. What I found out (correct me if I’m wrong) is to teach the brain and actually convince yourself that: the seabed is your environment. You also have to convince yourself that there are no problems and with your ability will be able to handle different tasks while under the water. This can only be achieved by the frequent diving. Looking at both Bren’s and my experiences, the concerns started when I taught that I’m going to stay there. Bren taught that he’s getting swallowed down the open blue. In both our minds it was the depth or better pictured as the distance between the surface and us. OK, so if we had trained the brain that being down there is “OK” even a few extra minutes in my case, or with Bren’s even if he goes down the drop. I know that we can manage and solve most problems under the water and if we had this persuasion in our minds this probably wouldn’t have happened.

Am I making sense here? I need some more input and experiences to clarify the origin of this issue, so others will know ahead of time how to react. I got to ask your opinion Do you think that this is contagious. What I mean is can some one how comes to the rescue, starts panicking as well?

I think that the more we explain on this then we can understand it better and be able to overcome this problem.

Thanks

Lawrence

[Gavin Yates]

This may sound like a load of tosh but here we go:-

In my previous (pre-journlistic) life I was a sports scientist (Bsc Hons) (MA) and one of the experiments that I did was with elite sportspersons that had had difficultly with stressful situations. A downhill mountain biker that had come off and had been quite badly injured would clam-up whenever she got back to "terminal velocity" again.

Another guy was a gymnast who would panic is certain situations and hence was under-performing.

My team worked with these two athletes and with a mixture of visualisation and positive outcome rehearsal techniques both of the little darlings were back to their best and the gymnast was much better.

Now what the f*ck has this gotta do with diving you might ask?

Easy, try and replicate a difficult situation you might find yourself in. OOA, lost buddy, freeflow, cramp  - whatever.

Then just imagine yourself going through the various steps you'd have to go through to extricate yourself whilst controlling your breathing and obviously reaching a positive conclusion.

For example try this. Close your eyes and visualise yourself diving at your favourite spot. You're at 25m and feeling really good. Your breathing is steady and regular and you're having a good time.

Suddenly your regulator starts to freeflow. You feel your heartrate start to rise but rather than panic you reach for your alternative air source and in a controlled and positive manner you swap regs and immediately get the gas you need. Within a few moments your breathing is back to normal and your attentive buddy has switched off you freeflowing tank, switched it back on again and the freeflow has been solved.

You ascent is slow and controlled and after a safety stop you're back on the surface breathing the same way you were before you originally decended.

This is no replacement for practice but I honestly believe that mental rehearsal can make a huge difference.

Give it a go - after all with the weather as bad as it is at the moment it might be the only sea dive you'll get.

[JohnK]

Its just struck me that during my DM training I was taught to visualise and think through the dive. Interesting is that when I look back I have had no problems. But when I `just go diving` and jump in with a buddy I sometimes (albeit I can control the event) still have those manifestations. So - for experimental purposes, next time you go on a dive, think it through before you get in - depth, time, obstacles, potential problems/resolutions etc etc