Friday, December 12, 2008
Reprinted from Vol. 4, No. 4 of the Post-Traumatic Gazette. ® 1998, Patience H. C. Mason.
I give permission to copy and distribute this to anyone it might help.
POBox 2757, High Springs, FL 32655-2757, 904-454-1651, www.patiencepress.com
One of the perrennial problems trauma survivors face is the request, usually from family members around holiday times, “Can’t you just be normal for one day?”
The answer is no.
The answer is “I am normal for what I have been through.”
Trauma survivors pay a price for what they have suffered. This price is not rescinded just because it is a holiday. The answer is “I went through hell, and holidays bring up a lot of pain. No. I cannot be normal, as you call it. I am normal for what I have been through.”
Part of the pain induced by the request to be normal is the unspoken assumption that you could be normal for a day if you just tried hard enough. Suzette Hadin Elgin in her book, The Gentle Art of Verbal Self-Defense (Dorsett, 1980), calls this a presupposition. Other presupositions in that statement are that it is wrong not to act like everybody else, that other people’s happiness depends on what you do, that holidays must be celebrated by everyone in the same way, and that trauma shouldn’t affect you, or should only affect you in ways that the other person finds tolerable.
“Can’t you just be normal for one day?” is a verbal attack, although the person doing the attacking probably does not identify it as such. It is couched in terms of sweet reason, but it carries a heavy burden of denial of what the survivor has been through and of the problems the person doing the requesting has in meeting his or her own needs through a variety of other sources, which is why he or she is trying to make the survivor meet them.
Of course, if the trauma survivor spends the rest of the year denying that he or she has problems and refusing to get help, wanting to have special needs over the holidays can be pretty irritating to the rest of the family. If you are doing that, you might want to face your problems and look for some good help.
Families and friends pay a price for living with a trauma survivor. Sometimes it is painful, but any relationship has pain. We feel survivors are worth the pain. We can acknowledge our pain without having to blame the survivor. This is just how it is. As families, we are different. That difference does not have to remain a negative. It takes strenght to survive trauma. It takes strength to survive living with a trauma survivor. We are strong, but our strengths do not lie in conventional holiday celebrations. We need to create our own ways of celebrating survival and recovery which may be quite different from shop-till-you-drop, Christmas crowds at the house, or going over to the houses of relatives who discount and demean trauma survivors.
Each of us can think about what we can do for ourself. Is there some small way you can be there for yourself in ways you haven’t been in the past, even if it is only staying sober or allowing yourself some quiet time? What can you do for the parts of you you may have lost during the trauma or the parts of you you have ignored while living with a trauma survivor? What can you do for other survivors, for other families and friends of survivors? One thing is to pass out last year’s article on PTSD and Holidays. See my previous post. You have permission to make copies of it and this article.
Perhaps this year the trauma survivor and family and/or friends can sit down and discuss how they can create meaningful celebrations. Is there something the trauma survivor would like to do with or for the rest of the family? Starting small is a good idea if you are going to try to change. In my experience, every time I tried to do too much or tried to change quickly, I failed. I strongly recommend very small. low key changes, things that seem like they won’t be a trigger. Have a backup plan for the survivor if he or she is triggered.
Broken promises can create very hard feelings, so I suggest not making promises or asking for them. Making someone promise to do something is also a form of coercion, an attempt to control, and with trauma survivors it can backfire. They need to regain a sense of control in their lives. Extracting promises only gives them something to rebel against.
Sometimes survivors are also controlling, extracting promises from family or friend. It is understandable but it carries the same drawbacks. If we need to stop focusing on the trauma survivor and let him or her heal, we, too, need the freedom to meet our own needs. We should have back-up plans so we can enjoy things even if the survivor has to bow out at the last minute. Yes, we do deserve to go to the Nutcracker, to a movie, to a service, to a tree lighting, a party, or any other treat we have planned, by ourselves or with another friend, if the survivor can’t make it. We do not have to stay home.
—Happy Holidays from Patience
Monday, December 1, 2008
Most people do not realize that people with PTSD have anniversary reactions. Holidays may also be anniversaries of trauma and bring up a lot of pain. This is one of the most distressing forms of reexperiencing for survivors and their families.
If the survivor doesn't recognize that this is one of the symptoms of PTSD, he or she may feel like Scrooge instead of like a normal human being who went through hell at that time of the year.
If the family doesn't understand that this is a PTSD anniversary reaction, they may be very angry at the survivor. "What is wrong with you?" is a heart-rending, humiliating question when the survivor doesn't know why s/he reacts like this.
If your veteran spent a particularly horrible Christmas seeing villagers lose all they had, seeing friends die, seeing the fat cats in the rear partying while the troops were suffering, he may have a hard time with Christmas. If your abusive father tore up the Christmas tree every year, if your uncle molested you at the family get together when you were eight, if you got mugged while out Christmas shopping, or date raped after an office party, or if your violent family pretended nothing was wrong during the holidays, these upcoming holidays may be a hard time for you. This is a normal reaction.
Holidays are also a really stressful time for many trauma survivors because they seem to reinforce the outsiderness of being a survivor of trauma. Everyone else seems so happy while your guts are twisted into knots as you think about past events. For veterans and other survivors, this pain can be compounded by grief for lost friends and their families who now face the holidays without those loved ones who didn't survive. Guilt may also rear its painful head. Why did I survive?
The financial difficulties many trauma survivors experience are highlighted by the commercialization of the holidays. There are a lot of pressures to conform.
One of my first healthy actions in my marriage was to decide that Bob didn't have to celebrate Christmas after he came back from Vietnam. I loved it so I should celebrate it and let him be him. I have no idea where that idea came from but it saved me a lot of fights. Today I look back on it as a miracle, accepting Bob as he was, and detaching in a healthy way. I think this is an important point for all trauma survivors and their families: Let the people who love the holiday celebrate it, and the people for whom it brings pain don't have to. This may cause problems with the extended family or the kids, but treating the survivor with respect is one healing way to frame it: "We have to respect other people's feelings and limits," can be a healthy way to put it.
We can also create our own ways of celebrating the holidays. We don't have to conform to a rigid commercial stereotype of piles of expensive gifts and big gatherings. As a matter of fact one thing that trauma can bring you face to face with is the value of people as opposed to things. We're starting a tradition in our crowd this year (a number of whom are trauma survivors and veterans) of homemade, recycled, or under $5 gifts. Ingenuity and fun!
Many survivors are not comfortable in crowds or at parties, but a quiet meaningful celebration, say singing carols in the living room with just the tree lights on, may be something they can participate in. They may not want to trim the tree, but going out to cut it down or pick it out may be okay. I am mentioning Christmas traditions here because that is what I grew up with, but I'm sure that Hanukkah and Kwanzaa celebrations can be as low-keyed and spiritual as the survivor needs them to be.
Survivors may need to create new rituals to help in their healing. For instance a veteran who lost friends in combat on Christmas may want to feed the homeless (many of whom are combat veterans) instead of participating in a big family dinner with people who may or may not appreciate his service. He may need to go to a special place and tell his lost buddies how much he misses them and wishes they had lived. Someone else may want to help provide Christmas presents for children of poor families or for other survivors of trauma. The range of possibilities is limited only by the imagination.
If all you want to do is stay drunk or stoned through the holidays, it might be good to find help instead. No one wants to be providing traumatic memories for the next generation. What you do while drunk or stoned can be pretty unpleasant for others, and especially painful for family members of both the spouse variety and the small-fry variety. 12 step meetings happen even on holidays like Christmas and New Year's. I'm going to be at my ACOA meeting Christmas Eve. Sobriety is better than big presents. Harder, too.
Crass commercialization and shop till you drop take the fun out of the holiday for me. So does having religion shoved down my throat, but I find that I can celebrate the birth of a child who represents all children to me and use it as an opportunity for me to do good in the world. Perhaps you and your family can do the same.
Holiday Helps: Asking for input and creating family traditions:
As I mentioned before, when Jack was a kid, he and I had our own Christmas without making Bob participate. This is called politeness, although my principal reason was selfishness, wanting my kind of Christmas. Selfishness created a healthy boundary in that case.
Something I didn't think of at the time was asking for input, which is also polite. Rituals For Our Times, by Evan Imber-Black and Janine Roberts (Harper, 1992, $12.00) has a wonderful chapter on holidays and a whole section called "Making Meaningful Rituals." Among other things, they suggest that planning, discussing and getting input from family members can prevent disappointments. Planning small changes in existing family traditions instead of trying to change everything at once is also easier.
Sometimes family traditions are out of balance and only please one side of the family or one spouse or whatever. To fix this, ask what the other person would like to do for the holidays. Say something like: "Maybe we could figure out some new things we could do that we would all like and could do together. Then the kids and I could do the stuff we like without pushing you to be involved."
Your spouse may never have thought about what he or she would like to do. I suggest not expecting an answer right away-maybe not even till next year. Just let him or her know you are interested in discussing it and open to change. People resist doing things they haven't been involved in. Planning or contributing to an event can give them a sense of being valued and having some control.
One final point, without them being aware of it, some traditional activities may clash with issues of safety for survivors. For instance, if Vince Veteran never puts up the Christmas lights despite endless nagging, perhaps it is because in Vietnam the night belonged to Charlie. By lighting up the house at night, he is attracting attention to his nearest and dearest, the kind of attention that could get you killed in Vietnam. Bringing this to consciousness--the need to keep the family safe--may help him get such a natural need met in a more appropriate way--like buying new tires for the car or better locks for the doors. Examining your traditions with that in mind can be rewarding.
Let go of outdated traditions or modify them to suit today. With our without the help of your survivor, you can sit down with whoever else in the family wants to celebrate. Have each person list what is fun for him or her. Do the things everyone likes doing. Let go of what has become a burden or what you think others should do or you should do. You can always go back to doing something if you miss it! Example: I like filling stockings for everyone and I thought they should fill mine. Now I get my own stocking stuffers. It is a lot of fun getting a stocking full of stuff I really like instead of an empty one full of hard feelings. I've also dropped creamed onions, cornbread dressing and mince pie!
Discussing what the family might like to do can be empowering for your children because it gives them a chance to move on to more age appropriate activities as they grow up. This may be hard for the parents, but I suggest that you can hang your own stockings or have your own quiet holiday dinner.
Some new family traditions you might try:
Looking up at the stars can be a beautiful experience of the glory of nature. According to December's Discover magazine, this December  the sky is going to be swarming with planets at twilight. "Every bright 'star' to the left of the sunset is a planet... This is a show that airs before prime time, so observe early. After 9 PM only Saturn remains... This year the natural holiday lights are on display for even the youngest of Earth's appreciative sky watchers."
Get out of the house: Making snow angels is one of my favorite pastimes. There is nothing that helps me recreate the feeling of being a happy kid again like falling over backwards into the snow and waving my arms and legs. Too bad it never snows in Florida! Snow men, snowball fights (no ice balls, please), snow forts, snowy walks, cross country skiing, sledding, ice skating all can be family fun activities. In the south, walks in the woods, canoeing, kayaking, fishing, bicycle rides are still options.
Decorating with natural materials is another thing I like to do. Grapevine wreaths with gold or silver pinecones, magnolia cones, acorns, berries and any weird seed pods I can find give me a sense of satisfaction no store bought wreath ever brought. Look around and be inventive. I also have a wreath made of rusty barbwire which my friend Marci gave me. As a survivor, she feels a little Scroogey at Christmas. I like it!
Recycled and home made decorations (and gifts) bring family members together, minimize the wastage of natural resources, and increase our own resourcefulness and independence in a healthy creative way. For some of us it is important not to contribute to corporate profits. Paper chains and pomanders (oranges covered with cloves) are great home made decorations. Buying cloves in bulk at an oriental grocery store or a health food store makes pomanders affordable. They smell great!
Doing stuff for others. One veteran I know has been feeding the homeless for the last nine years on holidays.
I buy books to contribute to the local newspaper's Christmas book giving program for disadvantaged kids. This is a living amends to a poor little girl to whom Jack wanted to give one of his books when he was 5. I wouldn't let him.
Battered women's shelters always need stuff as do homeless shelters, nursing homes, hospitals and churches.
You can adopt a family if you are well off, or contribute a few cans of food or a toy if you are not. Whatever you give will benefit you as well as those you help. Altruistic people actually are healthier than those who are not!
You can do any of these as a memorial to someone who was lost or abused.
Doing stuff for yourself: Provide yourself with something you didn't get that you needed. Maybe this is a grown woman buying her inner child a Barbie doll, maybe it is a veteran presenting himself with a certificate of thanks for his service. Look inside. People who love you would like to do this for you, too. Let them know if they can help somehow.
Ask people what you could get them within your price range. Tell people what you want. Talking about presents is hard for some of us. I thought I should be able to find the perfect present with no input. Now I ask. I used to expect Bob to know what I liked and wanted. Now I give him guidelines.
Our crowd is having a homemade, recycled or under $5.00 Christmas again. We gave each other some really funny presents last year. If someone has given you something expensive you hated, this year you can recycle it to someone who might like it. I get wonderful containers at garage sales and fill them with cookies or rum balls or spiced pecans so it is homemade and recycled!
Talk to each other: Go for the quiet evening at home together. Many of us never sit down and talk because we are so swept away in the demands of daily living. Make a date and simply talk. What about? About what the holidays and/or the family means to you.
Accept the fact that kids are naturally self-centered and needy but can develop great kindness. A parents job is not to suppress these natural characteristics, but to encourage awareness of others and empathy. People used to think small children were little demons, but they are actually very kind and willing to give of themselves and help others. One great family tradition is to tell them that some little kids need toys and help them weed out ones they want to give away.
Give each child something that will give him or her a feeling of specialness. It needn't be expensive. Magic markers and a pad of paper gave Jack many wonderful hours of fun. I still treasure his creations.¦
Copyright Patience H. C, Mason, 1997. First published in The Post-Traumatic Gazette #16.All rights reserved, except that permission is hereby granted to freely reproduce and distribute this document, provided the text is reproduced unaltered and entire (including this notice)
Wednesday, June 11, 2008
Hi, I found your email linked on a site about PTSD. I have a question, and hopefully you can provide some insight. I am working with a production company to develop a parallel story between the lives of three brothers who served in Vietnam. Their struggle with PTSD and agent orange now, and then their experiences in Vietnam. What do you think is the reason that PTSD is only just starting to get more noticed now? Other vets tell me it's still a pain to get any help from the VA on PTSD. The PTSD information center on the VA's website didn't feel like anything centered towards military troops. What is the deal that causes PTSD to be hidden under the rug?
Any response would be appreciated.
Before Vietnam, PTSD was called soldier's heart or nostalgia during the Civil War, shell shock or soldiers heart in WWI, combat fatigue by doctors in the war zones and combat neurosis by doctors at home during WWII.
In 1952, the American Psychiatric Association published the Diagnostic and Statistical Manual, an attempt to standardize psychiatric diagnoses. It included a category called "Gross stress reaction." If you had been through a big enough stress (gross=big), like a concentration camp or combat (this was in the Freudian denial and delusion period about incest) it could affect you.
In 1968, ironically during the TET offensive, DSM II was published. It dropped, with absolutely no scientific evidence, any reference to any stress reactions except a "transient situational disturbance" which lasted for six months or less. If it lasted for more than six months, you had a pre-existing condition, which meant, for Vietnam veterans, that the VA was not responsible because it wasn't service connected. This was absolute bullshit, propagated by who? No one knows. It is part of the cycle of acknowledgment and denial that PTSD goes through with every generation.
Anyhow a bunch of shrinks who had worked with WWII Combat vets and with battered wives and incest survivors and survivors of concentration and POW camps worked together to get it reinstated in the next edition, which it was in 1980 in DSM III. The APA was against it, because it would cost the government too much money. During the era of DSMII, people were told "Vietnam didn't change you. You were defective before you went." They were diagnosed wit schizophrenia or as sociopaths, narcissists, etc. They were overmedicated with thorazine. Since there was NO HELP, except for the very rare VA shrink, psychologist or social worker who would listen to them, many of them turned to alcohol and drugs to maintain. Psychiatrists who listened to the veterans were often called overly emotional and overly involved by other psychiatrists.
The first study of actual Vietnam vets with PTSD was done by John Wilson, PhD, with funding by the Disabled American Veterans because he couldn't get funding from any foundations or the government. Other studies of the time showed that only a few veterans had problems, but those studies didn't even ask them if they had been in Vietnam, never mind in combat.
My husband, Bob, (Robert Mason, author of Chickenhawk) came home in 1966 with PTSD. He was a helicopter pilot. In 1967 he was diagnosed with "combat fatigue," which at that time meant that he could never be sent to a war zone again. (And these new guys should NEVER be sent back.) But basically he thought he was a loser and I thought I was a bad wife or he would not be having problems. You can read more about that on my website as I use my experiences to help others http://www.patiencepress.com.
For a time after 1980, a lot of work was going on in the PTSD field, and if you could get diagnosed, you could get help, but most guys, having been turned away by the VA when they went for help, wouldn't go back. There was also the problem of the psychiatrist who knew the diagnosis had been made up for Vietnam vets, so they wouldn't diagnose it even when it was obvious.
For a while there did seem to be a lot of help out there if you could find it. But each VA Hospital is a feifdom, under the control of the Chief of Psychiatry, so if he doesn't believe or wants to do research on schizophrenia or whatever, the vets are fucked. Some VA's have great programs. Some have shitty ones. There is no standardization and no oversight that I can see. Plus when staff changes, the program can change. Did you read about the b*tch at Temple Texas who told the staff to stop diagnosing PTSD? That had been a really good VA, and maybe it still is, but probably not.
Up until 9-11, there was also a slow rise in denial and delusion among mental health professionals. This culminated in DSMIV which now describes traumatic stressors with a litany of latinate words punctuated by or's. It is a numbing ritual.
And now there is the bullshit of sending guys back on drugs, which is so EVIL, it can't even be believed. There have been no randomized clinical trials of how people do when the go back on drugs, but we do know from Israeli studies of guys who have been in multiple wars, that if they have PTSD in one war, they get it faster and worse in the next. Supposedly mental health professionals go by "First do no harm."
We also have the right-wing attacks on PTSD: it doesn't exist. Our men are brave and have no problems. It is a liberal attack, blah, blah,blah.
"What is the deal that causes PTSD to be hidden under the rug?"
The fucking government doesn't want to pay for treatment. Like the war, they had no plan.
This is what happens when REMF's (Rear Echelon M*ther F*ckers) run wars. They have no clue.
I could rant on, but this is probably more than you wanted.
Patience Mason, Editor and Publisher
P O Box 2757
High Springs, FL 32655
Wednesday, April 9, 2008
I am writing about this because I got a call from a BBC reporter who wanted to talk to a veteran with PTSD who was being sent back to Iraq or Afghanistan.
When my husband Bob was diagnosed with "combat fatigue" about a year after he got back from Vietnam, (1966) the Army sent him the diagnosis and the information that as a result he could NEVER BE SENT TO A COMBAT ZONE AGAIN.
So what has changed?
They changed the name of the condition, but it is still the same condition.
They have new medication, but there is no medication for combat PTSD, as Jonathan Shay, MD says in his article at www.dr-bob.org/tips/ptsd.html.
There is no draft, but they need more soldiers than they have.
The job of psychiatrists today is to give pills, not find out what is torturing their patients.
The job of military patients, who are in because they want a military career, is to shut up and take the pills so they don't lose their careers.
It is the political situation that has changed.
Politics, as usual, sends people back into hell.
What is the evidence for it being safe? As far as I know there is none. Israeli studies of their multi-war vets showed that those who had PTSD got it faster and worse in the next war.
This is one of those cases where what should be (It ought to work, sending them back on meds) trumps actual experience. We see WWII, Korean, and Vietnam vets with long term effects from war, but this time it's different. We have medications! Well most of those veterans were SELF-MEDICATING all along, and it didn't work. But we have better meds. Oh, yeah? Where are the randomized double-blind trials to prove it. There are none.
It is like the earlier denial and delusion period of American psychiatry-1968 to 1980-when on no scientific evidence, any diagnosis which derived from traumatic events was dropped because people, normal people, "shouldn't" be affected by horrific experiences. Guys with couches decided that. Guys with pill bottles are deciding this.
Recovering from traumatic events takes time, just like recovering from a physical wound. This is a stress injury, not a chemical problem. Even if the chemistry is changed by the experience that should be a hint to everyone that war is not good for people. Our bodies are designed to react to stress and to AVOID it. Most PTSD symptoms start out as brain-and-body based, built-in survival mechanisms, which keep you alive and get you out of there! Modern warfare is designed to provide stress after stress after stress. Pills will numb your edge and, in my humble opinion, get you in worse shape. They may help when you get back as you work on recovery, but they are not recovery.
What works for emotional numbing and avoidance? Feeling the pain of your dead buddies, working through the stages of grief. There is no pill for that. It takes time.
What works for hyper-arousal? Somatic therapies, meditation, learning people-skills like "We can agree to disagree," etc. Learning to avoid triggers. Learning to identify triggers. Learning how to bring yourself back to the present when you are triggered.
What works for re-experiencing? Going through the story of what happened and turning it from fragments of smell, sound, vision, emotion, into a coherent narrative which moves it from your reptile brain up into your narrative memory in your fore-brain.
There are many methods which work to do these things. Probably the fastest is TIR (Traumatic Incident Reduction, www.tir.org). Most of them take TIME and time is what the current situation does not allow for, nor military culture, nor the culture of current psychiatric practice which is heavily influenced by the major drug companies.
It is not ethical. First do no harm. Sending them back with PTSD harms our soldiers.