Seasickness: Therapy or medication? Psychologist Thomas Bickhardt on seasickness
Morten Strauch
· 01.03.2023
In this article:
Many sailors suffer from nausea as soon as the sea gets rough and the boat sways a lot. A wide variety of remedies and methods have always been recommended to counteract this. Thomas Bickhardt has now developed a new and surprisingly simple therapeutic approach. It is designed to tackle the root of the problem instead of fighting the symptoms. Successfully trialled in Norway, he is now offering his help in Hamburg. We wanted to find out what's behind it.
YACHT: Mr Bickhardt, can seasickness really be treated just like that?
Thomas Bickhardt: I get asked this question regularly and I understand the scepticism behind it. But I can answer it very clearly with a "yes". Although I'm talking more about training than therapy. The whole thing is not that difficult and most people actually already know that it works, just not how and why. There are many sailors who get seasick on the first day at the start of the season, but then the problem disappears all by itself. The same goes for sailors who spend three months ashore, come on board, get seasick for the first few days and are then "cured". That's how I came up with my research approach: What happens the moment the seasickness disappears and you feel like a human being again?
So, what happens there? And how can this realisation in advance help to avoid getting seasick in the first place?
Something changes in our system, both in our heads and in our bodies. After a while on board a ship, people move differently. I was able to observe this during my six-month time on the cargo ship "Undine" with the regularly changing crews. So the question is how the system adapts and how this process can be actively initiated before you run the risk of becoming seasick.
What was the trigger that led to your research and the therapeutic approach?
In the captain's saloon of the "Undine" there is a huge brass lamp next to a lot of mahogany. When there was a lot of wind, it swayed back and forth. But puff cake! The lamp doesn't swing, it hangs completely plumb, as if nailed down. Instead, the ship swings - around the lamp. Our brain tells us that when something is in motion, the larger part is always fixed and the smaller part is moving. Consequently, we believe that the lamp is moving in space and not the other way round. This triggers the "optical collision" that makes us maladaptive. It is the same with a gimballed cooker. We resolve this perceptual process in therapy - and thus the seasickness problem.
So how should you imagine a therapy session?
First and foremost, it's about understanding the problem from both sides. This initially involves a lot of theory, in which the individual cases are uncovered and people's experiences with seasickness are discussed - this is an in-depth, individualised approach. The participants then also see that other people have the same or similar experiences. This is followed by exercises on the balance board, where I stress them by blocking their perceptions. The learning effect then sets in: that visual impressions are not needed to maintain balance!
Is the recipe for success then "close your eyes and go on"?
There is actually a study that shows that blind people extremely rarely get seasick. This is due to the fact that visual collisions cannot occur. Many sailors will also be able to confirm that it helps to close your eyes when a queasy feeling sets in. However, as you can't move around on a boat with your eyes closed, let alone work, this is obviously not the solution. And as soon as you open your eyes, the uneasiness sets in again. However, as humans can rely on different perceptual systems to maintain balance, we can put visual perception to one side and focus on other systems instead. This is exactly what we train.
Can you explain this in more detail?
In addition to perception via the eyes, the sense of balance is also controlled by the vestibular system, which describes the balance organs in the inner ears, and the proprioceptive system, which deals with muscle and joint sensors. As Westernised people, we are used to using our eyes, i.e. the visual reference, for balance first and foremost because we are surrounded by straight lines in our environment. In urban environments in particular, this system functions quickly and precisely for orientation in space. As a habit has developed since childhood, the visual system beats the other two. Unfortunately, on a moving surface, such as a ship, this no longer works due to incorrect data input. As long as the line of the horizon can be seen, the visual orientation often still works. Below deck, however, the fixed lines start to tilt without you being able to see them if you move parallel to them and hold on tight. That's why people start to hold on at an inclination of just two degrees to avoid falling over. That alone tells you who gets seasick and who doesn't. If, on the other hand, you compensate for the visual misinformation with the other systems, you will be spared the trouble. For people who cannot do this, there is a competition between the systems. While the eyes pretend that everything is straight, the inner ear signals an imbalance, and one leg also signals more strain than the other. Our habit loop is bossy and ensures that it prevails over the visual system. Sooner or later, all of this can no longer be processed.
Even if the next question is almost superfluous: What exactly happens then?
The autonomic nervous system sets the so-called stress loop in motion. This means that the body's activity is reduced due to overload. The digestive system is the first to be affected: you don't need it right now, so it is emptied! Incidentally, this also happens in many other stressful situations, such as in a car accident or when you have a terrible crush. If you go on board and are already stressed from your job, your family, the tax office or even the crew, the stress level is already high. Not much more needs to be added to set the stress loop in motion. All these compensatory, symptom-treating remedies such as ginger or tablets only take care of the stress part, but not the starting point. That's where my training comes in.
When should I start the changeover? And how long does it take?
As casting off is often associated with stress, it helps to actively change your system in advance. This can be done an hour beforehand on the jetty. And it's helpful to do another round as soon as the boat starts moving. For some it takes ten to 15 seconds, for others five minutes. If in doubt, it will strike back again and you will have to repeat it after ten minutes. In most cases, it works within seconds. All you have to do is change the reference for balance.
What was your most difficult case?
I once treated a submarine lieutenant in the Norwegian Navy. A submarine is pretty much the worst means of transport on or in the water that you can imagine in terms of the threat of seasickness. No chance of seeing the horizon, no orientation aid, bad air and the rolling motion of the hull. This doesn't just apply to travelling above water. In heavy weather, these movements caused by waves can still be clearly felt at a depth of 30 to 50 metres. In the end, the training not only helped the lieutenant to serve without suffering. He later even transferred to a research vessel, which was hit by the monster hurricane "Dagmar" in 2011 and suffered severe damage. My former patient was one of the few people on board who didn't get seasick. Such feedback still touches me years after the seminar.
Are there situations in which your approach reaches its limits?
One of the worst scenarios is having to hold out in a life raft for a long time with several people: no horizon, a swaying rubber floor that moves in all directions and a pungent rubber odour. Even seasoned seafarers find their legs pulling away. If the first person starts to vomit, it usually ends in a nasty excess. This is where my approach reaches its limits, as the adaptation measures that I teach are based on a relatively solid surface. I would have to do more research to find out whether you can adjust yourself before entering such a rubber island so that you don't get seasick and can also tolerate the vomiting of others.
What is the success rate of your training programmes?
This is around 98 per cent, regardless of the severity of the cases. From a purely scientific point of view, it is almost problematic that I have only had positive feedback over many years. It's important for research that something sometimes doesn't work so that you can narrow down a problem even more precisely. I've only ever had two cases where people didn't train afterwards or didn't actively change their system. Then, unfortunately, the whole thing didn't work - hence only a 98 per cent success rate.
Are there people who are more prone to getting seasick than others?
It may sound paradoxical, but even people who have great balance - surfers, for example - can quickly become seasick. While they initially have no problems standing on the balance board, I can quickly throw them off balance by confusing them visually. Their well-established link between visuals and balance is interrupted - and there goes their balance. City dwellers are generally more susceptible as they orientate themselves to vertical lines throughout their lives. An illustrative example of this is the high-rise construction of the 1930s in the USA. Native Americans were often used for this, as they were completely free from vertigo. They had not developed the habit of perceiving balance through their eyes, but relied on other systems. Vertigo and fear of heights are directly related. Not to sound chauvinistic, but women are also slightly more prone to seasickness, which has to do with control and protective instincts for children. It often gets better with age, when it is easier to let go. According to statistics, women are worst affected after having their first child.
Have you actually had to treat yourself, or have you never got seasick?
I once had a hard approach that came over me in a flash. On the Undine, we had been in heavy weather for quite some time, and as the toilet was aft, the crew had to walk across the entire side deck to relieve themselves. Some of them didn't really feel like it and therefore spent days peeing in the shower. It was while trying to clean the mess that I got caught. The mix of movement, lack of horizon, stress and a pungent odour got me. Another time I got sick on a small boat because I had been filming. The optical alignment through the viewfinder of the camera irritates the sense of balance to the maximum. In this situation, however, I was able to adjust myself correctly - and the problem was solved.
Are you immune to seasickness after the therapy?
No, you're not immune to it. I like to compare it to skiing. Just as you have to learn to move around on skis, you have to learn to move around on a
ship, as these are different movement patterns. Anyone who skis knows that the first few descents are usually a little wobbly. The system first has to readjust. It works in a similar way on a boat. The adjustment of the balance system has to be actively tackled each time.
How long did you research the topic?
It's difficult to say, as you never really finish your research. New aspects are constantly being added. I started in 1992 after my time on the "Undine", where the first questions arose. I only really understood the last point, which I thought about for a long time, a few years ago.
Who would that be?
Why my training sessions aren't all full to bursting. For a long time, I thought I was doing bad publicity. But a psychotherapist friend of mine told me that many people who have been really seasick are traumatised by it. And who voluntarily deals with trauma in their limited free time? Anyone who is afraid of spiders is also reluctant to have a tarantula put on their head to deal with this problem. It is much easier and also absolutely human to suppress the problem and hope that it won't be so bad next time. The final stage of my research would probably be to get myself into the seasickness stage and then get myself out of it.
Do you actually give a guarantee of success?
Yes, if someone has gone through my programme and later contacts me to say that it didn't work, then I offer a free retraining session. If it doesn't work again afterwards, I'll give them their money back. I give my word on that!
About the person
Thomas Bickhardt studied psychology in Hamburg and has been researching seasickness for 30 years. After his nautical training in the merchant navy, he spent six months on board the cargo ship "Undine", after which the subject of seasickness would never let go of him. For 20 years, Bickhardt lived in the Kråkenes lighthouse on the Norwegian Vestkap, where he successfully treated severe cases of seasickness in professional seamen. He now offers his training sessions for sailors on the Elbe island of Kaltehofe in Hamburg.
