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John, Himself and His PTSD

Does John have post traumatic stress disorder? Can crime solving cure psychiatric illnesses? Why is John limping after being shot in the shoulder?

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I attempt to explore the enigma that is our favourite army doctor and in the process:

  • Solve the dilemma of how John got shot in the first place (doctors do not fight on the front line)
  • Attempt to diagnose Dr Watson
  • Explain why people get psychosomatic limp
  • Suggest what John might really have suffered from (and its much more mundane than PTSD)




Disclaimer

I actually have very little clinical experience working with soldiers who have returned from Afghanistan so this meta is a theoretical exercise in analysing John’s mental state from a psychiatric perspective.

Not Quite so Glamourous






In my previous metas I have discussed what doctors in the army actually do, how they join up and what kinds of careers/promotions prospects they have (see Semantics In Healthcare series).

In order to take a locum job at Sarah’s surgery in TBB John has to be a qualified GP – for full explanation: Exploring Dr Watson’s Army Career.



This does not necessarily mean he has to be an army GP. If you would like to know how John can realistically have other careers you can read: BAMF!John and Reality and Making John a Realistic Army Surgeon. However the most likely scenario is that John is a army GP and I am going to use this assumption for the rest of the meta

Army doctors do not engage in front line combat, they are confined to the hospital at base and patients are flown back to them in air ambulances. The medical officers who go out on patrol are not doctors, they are the army's equivalent of paramedics but they also belong to the RAMC. 

Only on rare occasions a doctor with specialist trauma training will fly out with the paramedics to stabilise soldiers in the combat zone. An Army GP is not the first person who would be chosen for this kind of mission – in fact they would be one of the last doctors to be chosen. The types of doctors who are experienced at stabilizing massive trauma patients are Accident and Emergency specialists and anaesthetists.

Yes, you read that correctly – anaesthetists. The common saying in hospital is “if the s**t hits the fan, you want an anaesthetist.” Anaesthetists can intubate patients to protect their airway, ventilate, and sedate patients for defibrillation etc.

John, as an Army GP, would have done his Advanced Trauma Life Support course and he would know how to stabilised massive trauma but it is not part of his routine work and he therefore does not have as much experience in this field compared with specialists. Therefore, John would have spent 99% of his time back at base dealing with routine, non-life threatening illnesses.

How he managed to get wounded is something that I have speculated on before (Exploring Dr Watson’s Army Career). The only new theory I can think of is that his base came under sustained attack. The British are based in Helmand province – the major military hospital is in Camp Bastion. The Taliban managed to infiltrate Camp Bastion in September 2012 and initiated a 4 hour fire fight within and around the base. I can imagine John being injured in a situation like this (even though he wasn't in Afghanistan during 2012)

In this scenario the fire fight in which John was wounded would be the first real combat he has ever been personally involved in. This alone can be incredibly traumatic particularly as doctors do not undergo the same combat training as actual combat troops. Doctors who join the military do take part in an abbreviated course at Sandhurst to prepare them for military life. They are trained to use standard issue weapons and in military leadership skills as all doctors are commissioned officers. However they are not extensively psychologically trained for combat.

Much of basic military training is not really about technical skills but psychological conditioning. Marching into a warzone to kill the enemy has profound psychological effects that can be counteracted to some extent by correct training. Additionally desensitization occurs with increased exposure. If you spend all your time in the combat zone, you can become less sensitive to the fear and stress.  Mental preparation also helps humans cope with stressful situations; it is usually unexpected stress that produces the greatest trauma.

Apart from lack of mental preparation – helplessness is another causative factor for psychological trauma. Humans (and rats) secrete less corticosteroids (“stress” hormones) if they believe they have some semblance of control. In similar conditions, people who feel helpless or at the mercy of external factors beyond their control experience a higher degree of physiological stress than people who feel in control. Humans who suffer long periods of helplessness induced stressed are more likely to become clinical depressed than subjects in the same situation who did not feel helpless

Although John is brilliant marksman and has clearly received good combat training, there is a great difference between training and reality. A sudden unanticipated attack on the base hospital without an organised military response may have left John feeling helpless/not in control particularly if he was forced into combat outside the base for whatever reason. It would have left him outside his comfort zone, without the necessary equipment such as body armour, and unable to take command.

We have seen that John generally reacts very well under stress and I do not doubt that he would have held himself together during the fire-fight despite how he was feeling. However even though he is able to remain logical and functional does not protect John from intense psychological problems in the aftermath.



Does John have a psychiatric condition?


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John has clearly been traumatised by the events that culminated in him being shot in the shoulder but does he actually have post-traumatic stress disorder?

PTSD can happen to anyone who undergoes significant trauma. There are situations that everyone will agree are traumatic like being shot in the shoulder. However the severity of the trauma experienced by different people in the same situation can vary greatly. Not everyone who experiences a traumatic situation will go onto develop PTSD. This is a psychiatric disorder rather than a physiological response to trauma.

In the same way not everyone becomes clinical depressed after bereavement and clinical depression is not the “normal” reaction to grief.



How to Diagnose PTSD

The diagnostic criteria used in the UK is from ICD-10 diagnostic manual, which defines PTSD as “severe psychological disturbance following a traumatic event characterised by involuntary re-experiencing of elements or the event with symptoms of hyperarousal, avoidance and emotional numbing.”

Criteria:

2 or more “persistent symptoms of increase psychological sensitivity”

  • Difficulty falling or staying asleep – not enough evidence
  • Irritability or outbursts of anger – John does have an outburst in front of Mrs Hudson “Damn my leg!”
  • Difficulty in concentrating – Not really
  • Hypervigilance – John does not spot Stamford and is aware of him after Stamford says “John” so I would not say that he is hypervigilant at all times.
  • Exaggerated startle response – John does not appear particularly startled or distressed by suddenly seeing Stamford or by the phone call from Mycroft Holmes. This appears to be the only time we actually see him being surprised.

Other criteria:

  • Persistent remembering/reliving in intrusive flashbacks, vivid memories or recurring dreams. Experience stress when exposed to circumstances resembling or associated with the stressor
  • Actual or preferred avoidance of circumstances resembling or associated with the stressor which has not been present before.
  • Inability to recall either partially or completely some important aspects or the period of exposure to the stressor.

The diagnostic manual DSM-IV used in American and other health systems based on America goes into slightly more detail and has a different scoring method. I am not going to go into this because John’s psychiatrists would be British and be mostly using ICD-10.

The difficulty in diagnosing John is that his symptoms only appear in the first half hour of the first episode after which he apparently becomes completely cured.

We do see in the beginning of ASIP that John has a dream sequence in which he is seeing soldiers in combat. I emphatically do not believe that John would have been dressed like any of those soldiers. Doctors in the field hospital usually dress like this:



They do not routinely leave the base, and when they do they do not wonder around in combat zones wearing body armour. In fact they do not have their own specialist combat equipment and armour/rifles are not something you can pick up at random when you feel like it.

Sticking to my earlier theory that the base was attacked/bombed, John may have been forced outside the compound and engaged in a fire-fight without the same equipment as the soldiers in the footage. This dream sequence is John watching the other combatants he happened to end up with fighting for their lives. Perhaps it is the last few moments before he got shot.

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Either way, John does have at least one dream about the “stressor event” but we do not know whether he has persistent recurring dreams. Even if he does, this is not a unique symptom of PTSD – many people who have been traumatised but do not have PTSD also relive the event through a variety of different ways.

The other thing that comes across in John’s demeanour during the first part of ASIP is that he does have outbursts of anger. For example he shouts “damn my leg” at Mrs Hudson. However I cannot convincingly say that any of the other symptoms of psychological sensitivity are positive.

John does not preferentially avoid similarly stressful situations that resemble his original traumatic episode. For example he volunteers to help Sherlock out on his case despite understanding that it will involve a certain degree of danger. He is exhilarated by running from the police, which may resemble attempting to escape from insurgent fire. He is not overtly distressed when he is once again placed in a powerless situation by Mycroft’s kidnapping. In fact, as Mycroft points out, one of his psychosomatic symptoms, the tremor in his hands, disappears when he is under stress.

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We do not have enough information to gage what his memory of the actual traumatic event is like and therefore it is not possible to judge, whether he has difficulty remembering the actual event.

I am not convinced that John does have PTSD, not because Mycroft says so in the warehouse scene, but because John becomes a completely different person in the course of one day. The outbursts of anger and irritability are gone; we are never informed that he has any more trouble with nightmares (so I am going to assume that he doesn’t).

Anxiety disorders like PTSD take longer than a day to recover from. Having purpose, self-esteem, social support etc is very helpful but there is no instant miracle cure. 

However because we haven’t seen the full course of John’s condition – it is impossible tell whether his symptoms have improved and we are simply witnessing the tail-end of what was once PTSD. Perhaps if John hadn’t met Sherlock he might have got better on his own anyway – we just don’t know.



Home for Heroes

In my opinion John is traumatised by being shot in the shoulder but he hasn’t developed PTSD. His main problem is that he has lost purpose.

Many servicemen find it difficult to adjust to civilian life after spending so long in a hermatically seal existence within the armed forces. Although combat personnel are more likely to suffer from this, John clearly also found civilian life difficult to cope with. Unlike some servicemen, he has not actively sort to reintegrate himself into civilian society. He relied on the army to find him accommodation and he did not get back in contact with his civilian friends/family on his return.

Added to this, John has also lost his job. I think many people can relate to the emptiness and loss of purpose this can have. The medical profession in not something you can enter halfway through, most people who go to medical school appropriately expecting to be in the same profession until they retire 40 years down the line. The job becomes an integral part of your life and your self-worth.

John’s psychosomatic symptoms do not have to be a result of trauma. GPs and neurologists often see a wide variety of patients with “functional” problems i.e. motor conditions that have no identifiable underlying cause. Mostly psychosomatic symptoms manifest in patients who have troubled and stressful social lives/lack of social position but onset is not always directly related to specific traumatic events. For example: long term unemployed workers, single mothers trying to survive on benefits, the chronically ill and isolated pensioners some of the most common patients I have seen with functional problems. Around 30% of all patients referred to neurologists on the NHS have functional problems so it is definitely not uncommon. I imagine with all the social and psychological problems that being in a combat can bring, many war veterans are at high risk of developing psychosomatic symptoms

John’s loss of purpose and the belief that he has a psychiatric condition can just as easily have lead to his psychosomatic limp rather than the initial combat stress.

What Sherlock does is fulfil his sense of purpose – John has something useful to do. He is helping to fight crime; at the end of ASIP he has also saved Sherlock’s life and the lives of countless other potential murder victims.

As Mycroft says, John still likes danger. He certainly wasn’t traumatised so much by his combat experience that he could no longer bear to participate in high-octane adrenaline fuelled situations.

If John doesn’t have PTSD why was he diagnosed? And why did he keep going to therapy when it wasn’t working?

I think the problem is that John believes he has PTSD and it took a day with Sherlock and Mycroft to convince him that he doesn’t.

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Mind over Matter

The most likely scenario is that John believes he has PTSD, this is why he sits through those therapy sessions even though he doesn’t feel they are being particularly helpful. He diligently tries the interventions his therapists suggest like keeping a blog, even though he has nothing to write. The therapist would have told him to avoid stressful situations which would have made life even more boring for an adrenaline junkie like John.

Doctors are often guilty of diagnosing themselves (then sticking to their diagnosis whether or not the rest of the medical profession agrees). Doctors are advised by the General Medical Council not to do this because it is impossible to remain impartial or take a logical approach. Emotions get mixed in with the clinical process which will skew any conclusions.

However as a doctor self diagnosis is almost irresistible. We spend so much of our time thinking about the symptoms of illness and disease, it is hard not think of a medical explanation when life is not going to plan. Given that the diagnostic criteria for psychiatric diseases are all very subjective, it is very easy to diagnose yourself with a psychiatric disorder.

What we see in the case of John and therapist is what you could call folie et deux, although to be fair to the therapist John would have been referred to her by a psychiatrist and she would have no reason to question the diagnosis.

Therapists are not doctors; they usually have a background in clinical psychology, although you can qualify as therapist without any prior experience in psychology or psychiatry.  Therapists generally do not diagnose patients (that is the psychiatrist’s job), they work with patients who have already been diagnosed.

I personally think that John gave a very convincing story to the civilian psychiatrist once he left the army and was diagnosed at that point. He would then have been referred to the therapist – cognitive behavioural therapy is one of the main treatments for PTSD. An army psychiatrist who has seen hundreds of cases ofPTSD probably would not have diagnosed John. 

I will discuss John's discharge from the army in more detail in Part 2

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The time he spent with Sherlock and Mycroft convinced John that he doesn’t really have the symptoms of PTSD. Mycroft makes a concerted point to tell John that his psychosomatic symptoms are not due to his combat trauma rather than to his lack of purpose. Sherlock drags John through the backstreets of London on a wild goose chase and then ends up being pursued by the police.

Once John got his head around the fact that he doesn’t have PTSD, and did something that he really enjoyed involving tonnes of adrenaline fuelled action – his problems seem to evapourate. I am sure that John was still traumatised by the war - his trauma has not evapourated, but his despair and loss of purpose have and at the end of ASIP he has a new life to look forwards to





List of Other Metas in the Series

Comments

( 22 comments — Leave a comment )
kizzia
Feb. 13th, 2013 07:00 am (UTC)
This is really interesting, thank you for sharing. I find the topic of PTSD really interesting and this is really informative.
One small thing though, I think you might be giving a slightly skewed impression of the RAMC with the generalisations you give at the top. I agree that in John's case, as a qualified GP who either joined the RAMC as an officer post his medical degree or was sponsored through it by the Army, it is unlikely that he would have been sent to the front line. However RAMC infantry medics do serve on the front line and have specialist medical training (although they are not qualified doctors) as well as being trained to fight - as can be seen here, on the British Army website: http://www.army.mod.uk/army-medical-services/ramc/20897.aspx
I realise that John isn't in the same position as the Lance-Corporal who is describing his life in the link but the generealisations you use in the introduction do seem to imply that it is unusual for any RAMC personnel to be on the frontline and, since that isn't the case, I wondered if you wanted to make it a little clearer?

EDITED to say: That probably doesn't read very well but what I was trying to get at is that not all RAMC personnel are Army Doctors but often it is assumed that they are, hence it would be good make the distinction clear and say that lower RAMC ranks (not John) go out in the field. And I'll shut up now! I have clearly spent far too long immersed in trying to understand what it's like for our troops out in Afghanistan.

EDITED again to say: That I realise you make this clear in your "Exploring Dr Watson's Army Career" and thus I really didn't need to say any of this. And now I'm honestly going away, properly, now!


Edited at 2013-02-13 08:54 am (UTC)
wellingtongoose
Feb. 13th, 2013 10:10 am (UTC)
Hi Kizzia,

Thanks for your comment and the advice. I realise how it might be confusing for some people. So I'm going to change the intro.

spacedmonkey
Feb. 13th, 2013 05:56 pm (UTC)
This is a great article.

Adding to the limp, three years ago I was hospitalised with an injury to my hand and ended up in a semi-military hospital because of the treatment I required. While the injury I had was severe and visible, for some reason I developed a limp when walking around the ward which I did not notice until a squadie in the next bay called Jack asked about my injury. When I pointed to my hand all wrapped in its Bradford sling, he said, "No, I meant your leg?" and I felt quite embarrassed because I wasn't aware I was doing it and I was chatting to a guy just back from Camp Bastion who had lost both legs and an arm. He said a lot of the guys he'd been with limped whether they'd hurt their legs or not because they just seemed to fall into that pattern.
swissmarg
Feb. 13th, 2013 06:02 pm (UTC)
As one of the original prompters for the topic, thank you for this. It certainly makes more sense to me that John never actually had PTSD than that he was instantly cured by spending a day with Sherlock. Although I still think it's valid to write John as having PTSD (and many authors have done it very well), but it does seem that in the series as broadcast, he probably doesn't display enough symptoms for a diagnosis.
wellingtongoose
Feb. 20th, 2013 09:38 am (UTC)
I am really glad you like it! I definitely love fanfic starring PTSD!John and I also think their conclusions are valid because we just don't see enough of John at the beginning to be able to conclusive judge.
hells_half_acre
Feb. 13th, 2013 08:13 pm (UTC)
Another great meta!

Even though my personal headcanon for John is that he DID serve on the frontlines as a soldier, rather than being at the base camp hospital - I still agree that he didn't have PTSD at the start of the series. Like you say, John's problem was that he had lost his purpose in life. It even works if he WAS a soldier on the front-lines, because either way he had still lost the job that he loved. And may have still misdiagnosed himself with PTSD even if he had gotten additional training and had enough desensitizing experiences that he shouldn't have developed it.

There's also the slight stigma around mental illness... and the fact is that John might have gotten more understanding and sympathy (from himself too) with a diagnoses of PTSD than he would with a diagnoses of depression. (Not that clinical depression can be cured in a day either... but I think it's closer to what John was actually suffering from.)
hazeltea
Feb. 14th, 2013 12:22 am (UTC)
This is a great perspective. I wonder about his specialty, though, his resume states that he hopes to go into laproscopic surgery. I don't think a GP would have those skills, perhaps he has some surgical/trauma training as well? Of course, it is possible that the writers didn't research this deeply enough. Also, as far as his dream goes, it doesn't necessarily have the reflect what really happened. He could have been putting himself in the position and uniform of the people he was trying to save.

wellingtongoose
Feb. 14th, 2013 10:27 am (UTC)
I think the producers didn't really research John's CV very well. Laproscopic surgery is not a speciality it is a technique used by orthopaedics, colo-rectal, hepatobiliary surgeons etc so it gives us no clue as to what he actually wants to do.

John would have rotated around general medicine and general surgical specialities for the first 2-4 years of being a doctor anyway so he would have some surgical skills and medical skills.

I like your idea about the dream sequence.
livejournal
Feb. 14th, 2013 03:25 am (UTC)
Wednesday, February 13th, 2012
User dancy_dreamer referenced to your post from Wednesday, February 13th, 2012 saying: [...] by (BBC) + Misc John, Himself and His PTSD [...]
ariadnechan
Feb. 14th, 2013 06:58 am (UTC)
I love this meta!

I think too that John was suffering from lack of porpuse and getting to know the difference and getting a new porpuse that is fighting evil criminals, as before was saving his country ... Both of them are very noble and dangerous. John find his place again as a doctor and as a soldier. So he started to heal.

But i think as we talk before in your meta meta of John and the Army. That John is a doctor and a captain, and not an army doctor. So his ramc mug is a gift like an honorary gift from friends.

Why?

First because the dream. In the dream the person in perspective is fighting and entering the house so he is in a military mission as an scout even.

In Scandal, Mycroft said, that John was captain of the the Fifth Northumberland Fusiliers.
I know that they were disbanded in 1996, but for this series they exists when John was in Afghanistan so he couldn't be a doctor in a camp base. He was a soldier.

Third. John has a incredible precision for a simple doctor with some training. He shot the cabby through two windows steady to the target with a gun!!
That is not something a simple training for an army doctor could give for a person who actually don't fight.

So i was more in acord with your second theory before you take it down in your long meta of John.
John is a military Captain and a GP doctor.

Edited at 2013-02-14 07:01 am (UTC)
wellingtongoose
Feb. 14th, 2013 10:22 am (UTC)
The theory that John is both a doctor and an army captain is still perfectly valid. It is just more probable that he is indeed an army GP.

As for John's marksmenship - he would have received weapons training, and he may also just be naturally talented at sharpshooting. Plenty of sharpshooters are not in the military. Shooting itself is a competitive sport that John may have enjoyed in his university days.

What the dream sequence actually shows is very difficult to interpret - and we don't actually see John in the dream so we have no idea what he was wearing or even doing or if he was even there.
scifishipper
Feb. 14th, 2013 02:16 pm (UTC)
I agree that John does not have PTSD and is instead looking for direction in his life. When Sherlock comes along, he finds again the excitement and purpose that he'd been missing. It's hard to compete with the thrill of combat and the urgency of military medical work, so linking up to solve crimes (and to deal with Sherlock's dizzying narrative) gave him something he might not have even known he was looking for.

Great analysis. :)

scifishipper
Feb. 14th, 2013 05:13 pm (UTC)
As I was walking to work today, I was thinking more about John's therapy and his possible diagnoses. I'm thinking that I'd lean strongly towards a (DSM-IV) dx of Adjustment Disorder with Depressed Mood and a R/O of Major Depressive Disorder. We do get a picture of a "depressed" John, but I don't have a sense of whether or not he'd meet the criteria for that, or if we're really looking at difficulty adjusting to civilian life after war. That seems like a typical crisis for many returning soldiers. And we know that he sought counseling for *some* reason - likely that lethargic, lost sense that we get from him in the series opener.

I think for writers wanting to portray John with PTSD, one could make a case, but his initial symptoms might have to be explained a bit to fit and/or show them recurring as he and Sherlock make their way through crimes. Another alternative is that he is at the waning end of PTSD symptomology and had more severe symptoms before we see him in A Study in Pink.

Thoughts?
wellingtongoose
Feb. 20th, 2013 09:37 am (UTC)
Hi! I think that John doesn't quite meet the criteria for Major depression, though adjustment disorder could be diagnosed if the psychiatrist had a particular leaning towards that (diagnoses are very subjective).

On the other hand - it does not particularly matter which diagnosis he get in terms of treatment: he will get therapy and anti-depressants. Personally I think that giving John a diagnosis is pretty useless - firstly because he evidently didn't need medical intervention, and secondly it would only compound the negative psychological aspects of having a psychiatric illness for John.

I think that John really needed time and social support to build a civilian life, which is exactly what Sherlock and Mrs Hudson offered him. I believe in the armed forces ones position and purpose within society is clearly defined whereas in the civilian world there is no such concrete truths. Some returning soldiers deal with the transition much better than others - I think in John's case the combination of trauma and refusal to find social support compounded the problem. As did his personal belief that he had developed PTSD.

Of course for writers who want to portray PTSD in John there are fertile hints in canon for that because you said we may just be seeing the tail end of his problem.
vibrant_daphne
Mar. 5th, 2013 05:30 am (UTC)
I've read a few of your meta posts and you make some interesting posts, but having been in the Army I keep finding parts of your meta that are not consistent with military SOPs, C&C, regs or training. I am on my Kindle at the moment and pressed for time but just to point out a few, Army docs wear Camo scrubs not Cadet training garb, most of your info about John's joining is just one comissioning source and likely not the one he chose (he probably direct comissioned) and while he might have been a fob bunny with 2nd Regiment he might have also attached which would have put in out on Patrols.
wellingtongoose
Mar. 6th, 2013 09:41 pm (UTC)
Thank you for your comment. I worked at a military hospital in the UK - so I suppose my view point may be skewed by the people I met. All the army physicians wore the uniform displayed in the picture whereas the surgeons had their own scrubs. I assume you mean in the combat zone everyone wears camo scrubs regardless of what type of doctor they are?

Additionally I do say in BAMF!John and reality that doctors do join the army after qualifying although joining through the sponsorship program was more common in the hospital where I worked.

I was told by the army doctors that at only on very rare occasions does their job take them into a combat zone or on patrols. The vast majority of army doctors especially GPs stayed and worked at the base.

However I am sure you know far more than me about this. If you have time would you mind having a PM discussion?
akacat
Apr. 19th, 2013 08:02 pm (UTC)
It's probably right in front of me and I'll feel silly for asking, but you mention a part 2 to this ("I will discuss John's discharge from the army in more detail in Part 2") -- where might I find it?

I've been bouncing all over your tumblr and now here, and I'm really enjoying all the meta. But I can never get enough of John Watson!
wellingtongoose
Apr. 20th, 2013 12:24 am (UTC)
Oh I'm very sorry. Part 2 hasn't been written yet, I'm still in the process of researching it! I will message you when it's done!
akacat
Apr. 20th, 2013 01:19 am (UTC)
Thank you! I look forward to reading it whenever it's done. I friended you here, so I'm sure I'll see it. :)
bootoye
Aug. 31st, 2013 11:26 pm (UTC)
I can't believe that I have only just seen this meta XD

I enjoyed reading very informative.

I know that you are basing John's diagnosis off of ASiP and there JOhn's PTSD is not really shown long enough to give an expert diagnosis of his condition or not. However, in the novels ACD's Watson very clearly said that he was suicidal and traumatised and had lost his will to live. Then he said that if he had never met Holmes he would not have survived much longer. I think that though not much had been shown in ASiP, there is a certain amount of 'take it for granted' that John has PTSD and Sherlock 'cured' him. In the novels it actually took a couple months I think between when Holmes and Watson started rooming together and when Watson became involved in the cases. In ASiP they just did not give it the same scale. But with the characters beign very true to their ACD origins.... we can indeed accept that John has PTSD but the writers did not want him limping for more than a half hour. LOL
wellingtongoose
Sep. 22nd, 2013 09:06 pm (UTC)
Hi!

Thanks for the comment. I think once again we come up against the recurring questions of:

1. Can you diagnose a fictional character? I think I've spent countless hours trying to explain to people that it is entirely possible. Firstly psychiatrists see less of their patients than viewers see of John and Sherlock. They are still able to make a diagnosis in a much shorter time period.

Secondly, most people don't want to think about it like this but patients are no more "real" to me than John and Sherlock are. As a doctor I find out the information I need to make a diagnosis and management plan and nothing more. I hardly find out anything about their lives because that's called prying. My relationship with patients is temporary, transient and very much at arm's length. I will talk to my patients for less than 5 minutes each day unless they are really sick (and then they won't be talking anyway). Watching a TV program actually gives me more information on the characters than I get from a patient in "real life".

2. What to bring from ACD canon into BBC Sherlock. We can make a great deal of assumptions by transferring facts from ACD to BBC Sherlock but the problem is they are in two completely different settings. Sometimes remain constant but so much of the background has changed beyond compare. Dr Watson could have been a general army surgeon - that is just not possible in today's medical career. Dr Watson may have nearly died of cholera or typhoid fever which invalided him out of the army - outbreaks like this hardly ever occur in the military base today and thus cannot be used as a reason for John's discharge. Dr Watson went out into the field - RAMC doctors today do not enter combat and all work in the base hospital at Camp Bastion.

Thus there is only a very very limited amount of flavour text or background we can actually important from ACD canon to fit the modern - or else we would have to bend and break the modern reality to fit Sherlock. Or cop out and say Sherlock exists in some sort of netherworld completely different to our own.
kgreen20
Oct. 13th, 2015 11:52 pm (UTC)
It's not too hard to guess that the nightmare shown at the beginning of "A Study in Pink" wasn't the only nightmare about the fighting in Afghanistan that John had. He probably had them on a pretty regular basis, especially before he moved in with Sherlock. It's not hard to guess that he was probably prone to flashbacks as well.
( 22 comments — Leave a comment )

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