Agoraphobia, or other phobias, obsessive behaviour, unexplained outbursts of anger, insomnia or stammering are all key signs of buried shock. An over-sensitive startle reflex or an inability to speak in groups without the help of a sedative or betablocker to calm your racing heart can also be a pointer.

Doctor's surgeries are crowded with people complaining of digestive, nervous, cardiovascular or endocrine disturbances, some of which are the undiagnosed result of shock in the body. More than 2% of the population suffer recognised post-traumatic stress disorder - figures which represent the tip of the iceberg since only those with correctly diagnosed problems are included. Many shocked patients are prescribed tranquillisers, betablockers to calm their racing heart, or anti-depressants, depending on their symptoms. However, these are not the answer because the shock stays buried in the body - and can be restimulated at the slightest stress.

It's not just a near escape from death or serious injury - almost any event has the potential to be traumatic. A situation where you're helpless to affect the outcome of events is most likely to cause symptoms; the problem is also very common among children. Yet, not everyone develops anxiety or health problems after a shock, since some degree of physiological reaction is a normal response to an abnormal event.

The shock we're referring to is not the clinical state of collapse (with faintness or unconsciousness, a weak pulse, cold skin and shallow breathing), caused by a bad accident, burn or loss of blood. The shock we're discussing stems from the phyisical effects of a sudden or overwhelming stress on the body. Under threat our fight or flight responses activate - and adrenaline is released, which wires us up and hones our reflexes. There is a simple, immediate assessment of the level of danger - should we run away (flight), face up to it (fight) or play dead (freeze)? Danger signals put the body on alert; our senses become more acute, our heart beats just a little faster - and it's difficult to switch off in order to sleep. Normally these reactions subside once the body rebalances itself, but if shock is too great or goes on too long, vigilance turns into nervousness, insomnia and anxiety.

Over a long period, of stress our body remains in a state of arousal, unable to relax. The body redirects energy, oxygen and vital nutrients to the central nervous system and other stressed areas of the body, shutting down less immediately essential functions like digesting food and sleeping - so that we're hyped up and ready to deal with possible danger. It's difficult to concentrate on longer term objectives, and we become sensitised to slight upsets. Small upsets in everyday life can then restimulate a state of shock or panic, causing reactions ranging from mild jitteriness to extreme fear. Because the endocrine and sympathetic nervous systems remain over-stimulated a variety of symptoms can develop - often starting some months after the trigger. Typical of delayed shock are panic attacks, depression, 'hysterical' emotions, numbness in parts of the body, amnesia, fainting, dizziness and poor concentration.

Some sufferers are called hypochondriacal, or their symptoms dismissed as 'psychosomatic' by the GP. Because a common reaction is 'dissociation', cutting off from an unpleasant experience by blocking it out (- the 'freeze' option), delayed shock can manifest in physical or psychological symptoms that you don't always connect to the trigger event. An overactive nervous system might be responsible for raised blood pressure, palpitations or circulatory disturbances. By diverting energy away from digestion insufficient digestive enzymes are produced, causing indigestion, constipation or the ubiquitous 'irritable bowel syndrome'.

Buried shock can be difficult to diagnose, but if your health has deteriorated within a year of a trauma, or period of prolonged stress, you may be suffering its delayed effects. Shock can come on after a specific trauma or after a long period of 'life' stress, whether domestic, financial, or even due to a nasty illness. Other common triggers include car accidents, falls, surgery, and emotional crises. What these experiences have in common is the way they shatter our sense of safety, making us aware of how precarious life is. The mere thought that we could die at any moment is especially likely to instil panic and fear, unless we have come to terms with our immortality.

• Constantly reliving aspects of the trauma

• Obsessively ruminating on what happened, or

• Avoiding activities that remind you of the shock - even blanking out thoughts associated with the event.

• Difficulty sleeping - often because thoughts or images keep intruding.

• Feeling of being wired up; tense and unusually irritable or angry.

 

Many traumatised people experience a slow decline in their ability to deal with both old and new stresses - until they find a way of mastering those troublesome past experiences. To psychotherapists stress responses are due to dissociation in the psyche rather than biological changes in the nervous system. They argue that when we go through any trauma, whether it's abuse in childhood, or inability to leave a damaging relationship, we split off part of ourselves in order to bury the bad feelings. This explains why we become 'emotionally constricted'; withdrawn, moody, full of unexplained rage, anxious or subject to panic attacks. Reframing events is important in order to make sense of them. The idea is that by understanding traumas they become less frightening and don't have to be split off into secret corners of our psyche.

 

Aconite: recommended after a fright - where you feel overwhelmed by waves of anxiety and panic with the awareness that you might have died.

Stramonium recommended after situations of pure terror - after a violent attack or rape.

Ignatia: recommended after bereavements - it's for grief or loss rather than a fright.

Staphysagria: recommended after surgery - where you feel violated rather than shocked.

Arnica: recommended after physical injuries. Helps to heal bruising and soft tissue damage as well as the shock.

Rescue remedy, (a bach flower remedy) can be carried around with you. Put 2-3 drops on your tongue whenever you start replaying traumatic incidents in your mind.

After a shock you need to recreate a feeling of safety by having familiar faces around, and a comforting environment. If you feel anxious, talk about your feelings to your friends or family.

NB. Delayed shock is not usually amenable to self-help strategies. After a severe shock, or if you have developed symptoms you suspect are a result of delayed shock, you will need constitutional treatment; find a therapist experienced in shock work.

For those who find themselves on the scene of an accident, or with someone in a state of shock, therapists recommend that you reassure the person as much as possible - it's important to try and make them feel safe.