The Railway Man: A Case Study on PTSD and its Treatment

This essay explores the story of Eric Lomax, a protagonist in the film The Railway Man, who suffers from PTSD. It discusses the triggers that have haunted him for years and the treatment plan designed to help him combat PTSD. The therapeutic approach taken is based on the tri-phasic approach by Herman and EDMR.

Running Head: THE RAILWAY MAN
THE RAILWAY MAN
Name of the Student
Name of the University
Author Note

1THE RAILWAY MAN
The Railway Man is a deeply unsettling film given the background of the protagonist,
Eric Lomax. This film is an adaptation of the book of the same name, by the same person.
Throughout the film Lomax shows severe signs of POST TRAUMATIC STRESS
DISORDER. This essay will be exploring the backdrop of his story, which he narrated to me
while I was counseling him, and the trigger points that have haunted him for years, to help
me come to a conclusion about the exact chain of events that made him who he is. This essay
will also be tracing ideas of treatments that I will design as his counselor to help him combat
the POST TRAUMATIC STRESS DISORDER and settle into a better life, where his trauma
does not violently get in the way of normality.
To begin, the personal history of Eric Lomax was traced to get an idea about the
events that triggered such severe POST TRAUMATIC STRESS DISORDER. He narrated
grew up in Scotland and was extremely interested in trains even as a boy, to the extent of
becoming fully aware of timetables and the railway system of Great Britain. It is on a train
that he met his wife, Patti Wallace. Their friendship developed over the fact that the woman
was just as interested in railways like him. All was well until she realized that he has frequent
nightmare and behavioral issues because of the trauma that he suffered as a soldier
(Teplitzky, 2013).
The back-story that he communicated with me was that of him and his comrades
being captured in Singapore, by the Japanese during World War II. They were forced to
construct the Thai-Burma railway line in 1942. The conditions were very inhuman and it was
extremely difficult on them. Eric, being the mechanic that he was, had made a radio receiver
that was quite small in size to remain updated about the World War. That was discovered by
the Japanese who were enraged because it was an act of rebellion on his part as a prisoner of
war. That led to him being isolated from the rest and tortured, incessantly. He tried to reason
with them by telling them that that device can only receive and not send, yet they water

2THE RAILWAY MAN
boarded him and psychologically tormented him so that he admitted his wrongdoing. He was
particularly tortured by the interpreter, Takashi Nagase, who had pushed him to edge of
misery form which there was no return. This man was there in all his nightmares and his
memories continued to torment him well after the war was over.
Lomax informs me that Takashi Nagase was still living, even after thirty five years,
and alive and Lomax could not bear it, and his reaction was only natural. The reason of his
torment was still alive and he felt like the person deserved to die. He had even decided to
confront and kill the man, hoping that it frees from all the trauma which was only getting
worse. He felt threatened an unsafe even in his own home. He slept on the floor and even
talked to his own self. He is extremely strict about where he keeps things and loses his temper
if he does not find his things in their correct place. He sometimes hallucinates that there are
Japanese soldiers who are trying to escort him away and torture him. He suffers from vivid
flashbacks of all the times that he was tortured. He had difficulties in differentiating between
the real and past (Weathers et al., 1993). He often screams and cries out, while yelling, “Not
the water.” He also has recurrent somnambulistic attacks and sometimes feels safe with the
rest of his house, except the kitchen, untidy and often finds himself evading responsibilities
and not paying the bills he is supposed to pay. When the debt collectors had shown up to his
house to collect his debts, he had shown a knife to them as he had assumed that they were the
Japanese who had come to take him away.
These issues that are displayed by Lomax can easily fit the description of POST
TRAUMATIC STRESS DISORDER (Post Traumatic Stress Disorder as described by the
Diagnostic and Statistical Manual of Mental Disorders: DSM-5’s (American Psychological
Association, 2013). It is a psychiatric disorder that occurs in people who have experienced or
been witness to some traumatic event that have left them a lot of stress in the later stages of
their life. In order to assess the trauma that has happened to the Lomax, I will be utilizing the

3THE RAILWAY MAN
PIDB stages as a tool for assessment. This model will also help in planning the treatment out
for Eric Lomax (Hoge et al, 2004). The PIDB stages are Presenting Problem, Issues,
Dynamics, Interventions and Bridge, respectively.
Firstly the client’s ability to present is identified, he is traumatized and unstable. It is
the core foundation of the treatment that will follow.
The problem persists when it comes to safety. Due to trauma and previous instances
of safety being absent in his life, he feels unsafe all the time. As discussed, he feels like the
Japanese are still on the lookout for him and are willing to capture him and torture him.
Then, the dynamics need to be worked upon that is the third stage of the treatment.
This dynamics that is being referred to is the dynamics of the relationship that is shared in
between the counselor and the client. However this is a variable stage. The dynamics keep on
changing, like every other relationship. Trust must be established for the dynamics to be such
that the client feels comfortable sharing his problems with the counselor (Gassner, 1970).
This changes gradually into something better as the client gradually feels like the other
person is trustworthy enough. The counselor has to make sure that this is achieved and the
client is made comfortable enough to give out information that will be integral for locating
the triggers or the stressors.
The fourth stage is that of Interventions. This is based on the three stages that has
already been explored. At first the counselor considers the issues that have been initially
identified. Then the client is to choose the issue that he or she specifically wants to begin with
to begin the gradual process of confronting the issue and dealing with them in a way that can
help the person heal (Seligsman et al., 2005). This is the intervention plan, to help put a stop
or reduce the problems or the trauma. For this particular case, the trauma has to dealt with in
order to help the client return to a life that is free from all the trauma (Herman, 1992).

4THE RAILWAY MAN
The final stage is the stage of bridging, in which the counselor provides a certain
number and kinds of bridging exercises, at the beginning or end of sessions. These exercises
can be of many kinds from connecting sessions to self-regulation exercises (Ryan & Deci,
2006). The exercises have to be carefully thought of and it should be related to the problem
areas of the client. In this case, the exercises of self-regulation should help the client
voluntarily override his feelings of fear whenever he feels that his life is in danger. Bridging
activities may also consist of the client keeping a track of every time he felt like this and
noting which object or phenomenon is the stressor in all these events so that he can focus on
not reacting the same way in case of all these events.
The therapeutic approach that will be brought into consideration for the client will be
the Tri Phasic Model by Herman. This model consists of three phases that are- establishment
of safety, remembrance of the events and mourning followed by reconnection (Herman,
1998).
The client has to firstly consent to the treatment that is being planned for him because
the treatment will be involving a recollection of all the memories of trauma. Establishment of
safety is an important part of the treatment procedure that has to be followed for the client.
Trauma does strange things to people and POST TRAUMATIC STRESS DISORDER makes
people feel vulnerable and exposed to danger all the time. This decrease in a general feeling
of safety is because their awareness about dangers have increased (Blanchard et al., 1996).
They are aware of what the danger are and might be. They feel that they are under threat all
the time because they have been face to face with danger and might have endured pain for
long amounts of time (Bath, 2008). The phase one of treatment will first check if he is in
actual danger. If he is, that danger has to be removed and plans have to be made to ensure
that he actively makes sure his safety is ensured. This has to be followed by counseling him
to understand what real danger is and what is perceived danger. He will be taught about

5THE RAILWAY MAN
methods that will help him check if his feeling of danger is legitimate and if the situation is
actually dangerous (Keane, Zimering & Cadell, 1985). His avoidance will be explored to
understand what situations actually make him feel vulnerable and he will be asked to stand up
courageously in these cases. This will be followed by various strategies that will help him
regulate himself, like relaxing himself in situations he thinks is frightening to allow a normal
course of thought followed by action and relaxation to help himself feel lighter, this can be
followed by grounding activities for understanding the reality of situations better, this is to be
followed by voluntary containment of traumatic feeling and being expressive and open about
how he feels. In the next phase he will be asked to talk about the worst part of the trauma to
accept that it is over and he must try to move forward.
This is to be followed by Remembrance and mourning which will be implementing
the techniques which are utilized in CBT therapies. This will be done by following the eleven
steps of EDMR or Eye movement desensitization procedure (Shapiro, 2002). This will be
beginning with the Situation, which the client wants to work on for a target time. The
negative cognition of the client will be explored along with positive cognition. This will
followed by an assessment of validity of the positive cognition. This will be followed by an
exploration of the emotions around the negative cognition. Then the SUD or the
Subjective Units of Distress are to be rated on the basis of the amount of distress they cause.
Body Scan will be implemented to check for stress units within the body. This is to be
followed by the Desensitization (Bilateral stimulation while processing target)in which
the negative thoughts will be focused while focusing on one still object and then again when
the still object is moved until an effect is reported. This is to be followed by Installation and
accentuation of the positive cognition that has been identified which is followed by another
body scan to any residual tension within the body of the client and recorded for the

6THE RAILWAY MAN
successive sessions and homework journal. The closure will be about facilitation of an
entry into a normal state by the client.
The reconnection phase will be focusing on the reinvention of the self for the client.
His faith needs to be reinstated and should feel like a free and unburdened. The trauma is to
be considered as a part of life and not as the entire part of it. The client is to recognize the
impact of the trauma and tell himself that it is over and that he should do his best to move on
and do better in his life. Follow up must be conducted to address the peripheral issues that
still remain and need work (Marcus, Marquis & Sakai, 2004). They can gain be treated with
EDMR if the client agrees.
In the film, Lomax actually meets the person who was his torturer, Nagase. This had
actually helped in some amount because it can be called the prolonged exposure therapy
(PE). This method is also a method that can help POST TRAUMATIC STRESS DISORDER
(Foa, 2011). Talking to him, confirmed the fact the other person was in no position to cause
him harm and that was there in the past is left behind in the past.
Thus, it can concluded that Eric Lomax was a POST TRAUMATIC STRESS
DISORDER patient and with correct care and treatment he can return to a normal life that
will be devoid of the trauma. His PIDB stages were firstly assessed. Then the therapeutic
approach taken by me was based on the tri-phasic approach by Herman. Therapy was also
based on EDMR that helped him confront his worst fears and realize that what is done is
done and that there is no reason to fear any longer and that he has all the right to move on, a
free man, not just literally but as a person who is free from the pain that has been caused to
him and the trauma it left behind.

7THE RAILWAY MAN
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (DSM-5®). American Psychiatric Pub.
Bath, H. (2008). The three pillars of trauma-informed care. Reclaiming children and
youth, 17(3), 17-21.
Blanchard, E. B., Jones-Alexander, J., Buckley, T. C., & Forneris, C. A. (1996).
Psychometric properties of the POST TRAUMATIC STRESS DISORDER Checklist
(PCL). Behaviour research and therapy, 34(8), 669-673.https://doi.org/10.1016/0005-
7967(96)00033-2
Foa, E. B. (2011). Prolonged exposure therapy: past, present, and future. Depression and
anxiety.
Gassner, S. M. (1970). Relationship between patient-therapist compatibility and treatment
effectiveness. Journal of consulting and clinical psychology, 34(3), 408.
Herman, J. L. (1992). Complex POST TRAUMATIC STRESS DISORDER: A syndrome in
survivors of prolonged and repeated trauma. Journal of traumatic stress, 5(3), 377-
391.https://doi.org/10.1002/jts.2490050305
Herman, J. L. (1998). Recovery from psychological trauma. Psychiatry and Clinical
Neurosciences, 52(S1), S98-S103.
Hoge, C. W., Riviere, L. A., Wilk, J. E., Herrell, R. K., & Weathers, F. W. (2014). The
prevalence of post-traumatic stress disorder (POST TRAUMATIC STRESS
DISORDER) in US combat soldiers: a head-to-head comparison of DSM-5 versus
DSM-IV-TR symptom criteria with the POST TRAUMATIC STRESS DISORDER

8THE RAILWAY MAN
checklist. The Lancet Psychiatry, 1(4), 269-277.https://doi.org/10.1016/S2215-
0366(14)70235-4
Keane, T. M., Zimering, R. T., & Caddell, J. M. (1985). A behavioral formulation of
posttraumatic stress disorder in Vietnam veterans. Behavior Therapist, 8(1), 9-12.
Marcus, S., Marquis, P., & Sakai, C. (2004). Three-and 6-Month Follow-Up of EMDR
Treatment of PTSD in an HMO Setting. International Journal of Stress
Management, 11(3), 195.
Ryan, R. M., & Deci, E. L. (2006). Self regulation and the problem of human autonomy:‐
Does psychology need choice, self determination, and will?.‐ Journal of
personality, 74(6), 1557-1586.
Seligman, M. E., Steen, T. A., Park, N., & Peterson, C. (2005). Positive psychology progress:
empirical validation of interventions. American psychologist, 60(5), 410.
Shapiro, F. E. (2002). EMDR as an integrative psychotherapy approach: Experts of diverse
orientations explore the paradigm prism. American Psychological
Association.http://dx.doi.org/10.1037/10512-000
Teplitzky, J. (2013). The Railway Man.
Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A., & Keane, T. M. (1993, October).
The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. In annual
convention of the international society for traumatic stress studies, San Antonio,
TX (Vol. 462).