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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.
 

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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
 

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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
 

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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
 

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The Artist formerly known as 'Kirky'
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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
?
 

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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.
 

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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
 

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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.
 

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The Artist formerly known as 'Kirky'
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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
 

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Interesting postings on this issue. I'm sure Hobby and others are quite right about people's mindset and psychological vulnerability to stress and panic differing. However, mind and body are inextricably linked and I firmly believe that a healthy body is a prerequisite for a healthy mind. A recreational diver doesn't need to be a highly trained athlete but he does need to be reasonably fit. Regular exercise and a healthy diet  strengthen both body and mind. Fewer pints and bacon sarnies and some form of exercise 2 or 3 times a week should make you better able to cope with any problems you meet while diving. And that is particularly important for us oldies. Here endeth today's sermon. :wink:
 
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Just not enough dive time.
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OH John how can you say that after the mixed grill you had on Sunday!! Enough to feed two people, and dont give me that old waffle that you didnt eat it all either.
Matt
 

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It's a good,and all to often overlooked point John.My fitness is far from what it should be at present,kitting up etc.sweating cobblers in a dry bag as you make your way to the water all have an effect.This may be more so now with people carrying much more kit than before in some instances.Last year at a popular dive site,(I know the guy who runs a dive shop on the seafront)a bloke was kitting up.Huffing and puffing with his kit his mates were having a laugh with him.Alas as he got in the water he suffered what turned out to be a massive heart attack and died at the spot.While tragic this was quite possibly avoidable.How many divers do not dive for a period eg winter in the UK,then come summer, expect to throw their kit on and jump straight in.They probably would'nt do it without making sure their regs were OK but neglect themselves.This is all before we leave the surface,and as you say the last thing you want at the start of a dive is feeling like you've spent a rampant night with Pamela Anderson,altough that may be preferable!Take care,Hobby.

(Edited by Hobby at 11:19 am on Dec. 6, 2002)
 

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Bugger! I hoped you and Lou wouldn't read my posting, Matt. OK, I confess. I DID overeat on Sunday, but I really did leave quite a lot.
 

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Have been diving nearly 5 years, done nearly 40 dives (all bar 5 UK sea dives), nitrox qualified.
A couple of weeks back, did some diving over the weekend - 28M on Saturday, no problems, Sunday did a dive (didn't exceed 22M but could of gone deeper) and 20 minutes into the dive got a really strong urge to bolt for the surface. The viz was 8-10M, my buddy was only a couple of metres away, the dive was a nice easy drift. I was strong willed enough to hold myself back from the urge to bolt, and in a minute or two, felt right as rain again.  It's never happend before and was a bit scarey - anyone got any ideas why/what caused this?  The air was clean, although I did find out that my cylinders were out of O2 test (doh!) - does this sound related?
Sea temperature was 18 degrees, 32% mix, no problems clearing on my descent, hood, drysuit etc.
Regards
Martin
 

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<font color='#0000FF'>Martin

You say you have done 40 dives in 5 years, that's only about 8 a year, when did you last dive before this one?  

Maybe you were just a bit apprehensive about diving if you haven't dived for some time.

Fiona
 

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Hi,

I had this, rather strangley with roughly the same number of dives, it actually happend on dives 43, 44 and 47 (I used to log em then). I remember it very well, it almost stopped me from wanting to dive. I can not for the life of me work out why it happened, two of them were in the Red Sea on the Thistlegorm and Tiran, the third was on the Kyarra in the UK.

All I can tell you is it has not happened since and as you know it it is a horrid feeling.

I guess what I am trying to say is that it will most probably pass, I ended up putting it down to a severe attack of mortality. I now reguarly dive to 60M and beyond with no problem at all.

I doubt it helps but it is the best I can offer.

Andrew
 

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Hi
Fiona:
I dived the morning before to 28M quite happpily, and prior to that it was the end if June, so three months. I only ever get excited about getting wet, so am sure apprehension isn't something I was feeling. I appreciate that my average number of dives is low, but with a wife and family it's not alwys easy to find the time and/or money to dive as often as I'd like. I dived again (although much shallower - above 5M) less than two hours later and had no similar feelings. I dive regularly in the pool and without doubt (with the exception of the few blue water dives I've done) the viz was the best I have had in the UK. Still none the wiser, but thanks anyway.
Andy:
Very strange - I wish I knew what it was, but can only hope it doesn't happen again.  I just have to relax and not let it worry me, so just need to put it out of my head and get on with what I love doing most - diving!
Thanks again
Martin
 

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You had too good a time of it on the Saturday.  Perhaps you weren't 100% sure of your buddy which caused you to be slightly anxious.  It only takes a couple of niggling little problems to escalate into panic.  At least you kept your head and didn't bolt. It does you good now and again to have a livener, it's keeps your feet on the ground and stops you getting complacent.  You should have been more worried about the Saturday dive.
 

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Martin

This is narcosis.  Absolutely no doubt in my mind, classic symptoms. Don't let people tell you that "narcosis starts at 30m" or that they "have a personal narcosis tolerance level of XXm".  That's all rubbish.  It affects different people in different ways and at different depths.  You were particularly susceptible at that particular time.  Think about what you had to eat prior to the dive, your hydration level and whether you had a good nights sleep.  This may give you some clue as to your susceptibility.

Hope this helps.

Bob
 
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