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Tuesday, May 17, 2011

An ABC of Ideas for Living with PTSD Patience Mason.

copyright 2011, all rights reserved except you can copy it and give it to anyone it might help

A. Acceptance: In the "Big Book," Alcoholics Anonymous, on page 448 (3d Edition) or 417 (4th Edition) is probably the most famous reading on the topic of acceptance. Most people want to be accepted as they are. Balancing acceptance and the desire for change is a delicate task. I learned to accept my painful emotions because of this reading, to sit with them and let them pass. I also learned to accept my husband and to let him find his own path to healing, which I had been blocking with advice. I also learned to accept that changing took time for both of us. In recovery, I also learned to develop a pause button, to take time to think, and then to act instead of always reacting to the behavior of others.
B. Boundaries. Free handout on Boundaries is available at It is a bunch of small actions that helped me develop boundaries with Bob. The Serenity Prayer is a good guideline. Balance. I was a person of extremes, totally busy or wiped out, elsted or deeply depressed. Now I try to be balanced, do stuff for others but practice self care.
C. Compassion: We need compassion for ourselves and for our veterans. The best stuff on self compassion which generalizes to others and prevents a person from allowing abuse was developed by Steven Stosny, Using his HEALS technique is very effective. See issue #20 of the Post-Traumatic Gazette for other ideas.
D. Detachment: Detachment means you don’t get sucked into the chaos that can surround PTSD. You can get a lot of help from Alanon literature which you can pick up at any meeting or online at There are 22 readings on Detachment in One Day At A Time In Al-Anon. I tried to become rapidly detached by reading all 22 everyday when I first started going. Didn’t work, but over time, I learned that skill. There is a .pdf of the Alanon pamphlet at Substitute PTSD for alcoholism.
E. Examination: I found it particularly effective to examine my own cognitive distortions using the book, Feeling Good by David Burns, MD. Adult Children of Alcoholics literature also focuses on patterns learned in childhood, which I did not see as patterns, because I thought they were reality. A daily inventory or self examination, to keep me on track, has also helped me. I write out what made me happy, what challenged me, what I need help with, things I’m grateful for, and things I did well.
F. Focus on yourself. Focusing on the person with problems is easy to do. Cheering him or her up, suggesting solutions, rescuing, cheerleading, all stop healing, but I didn’t know that. I thought I was being “nice.” We may be ashamed to focus on ourselves. It seems selfish. There is a healthy kind of selfishness, however. Focusing on your own growth is very hard. If you do it, you won’t have time to be fixing everyone else, which will give them room to grow. They may grow raggedly or off in some direction that seems useless to you, but mistakes are how people learn (especially if no one is constantly warning and shaming and blaming if it is a mistake). I thought I knew what would help Bob. The things that have actually helped him are different. Very humbling!
G. Get help. In addition to whatever therapy is available for family members, joining Al-anon, Co-Dependents Anonymous or any other 12-Step meeting and working the steps is helpful and free. The third issue of The Post-Traumatic Gazette discusses the 12-step process as a self-initiated, self-regulating process of internalizing compassion and self-care. I have written formats for 12 -step groups for Veterans, Family and Friends and for Trauma Survivors, Family and Friends which can be downloaded from my website ( Sources of help can be as close as the nearest VA/Vet Center or Crisis Center. There are hotlines for soldiers, veterans, and victims of violence. New therapies, from tapping your meridians to Cognitive Behavioral Therapy of PTSD are available.
H. HOW do we recover? We have to be Honest (yes we could use some help), Open to suggestions, and Willing to try things
I. Initiate your own recovery. Even if other members of the family including the veteran are not willing to get help, you can get help. If living with a vet is wearing you out or driving you nuts or you just want to grow and change, it is perfectly okay, not selfish, to seek outside help. If you can’t understand why the survivor can’t just “get over it” or change, I suggest going to Al-anon meetings and working the steps with a sponsor to get some idea of how hard it is to ask for help, to accept help, and to change.
J. Judging is a waste of time. Was this bad enough to cause PTSD? So-and-so went through worse things and he’s fine. This kind of judging is a waste of your time. People are different and are affected differently by different experiences. Dealing with how things are today is more effective.
K. Keep at it. Changing is ridiculously hard. It takes time and effort and more time and more effort. Plus we work though the same stuff over and over, which I call recycling. I have been working on myself for 22 years now, and sometimes I still go back to old behaviors. Not for long, and not as badly, but I practiced being the way I was for 45 years. I may be over my old patterns when I’m 90...
L. Let go. I had plans for how Bob should recover. When I let go of my plans, better things happened than anything I had ever thought of: he found his own way of healing that worked for him. I also had plans that I would recover if I went to 12-Step meetings for a few weeks. It is hard to let go of old behaviors and thought patterns however, so I am still going to meetings 22 years later to reinforce the changes I’ve made.
M. Manage your own life. When I am really working on my own life, really living not just existing, I don’t have time to manage other people. Yes they make mistakes, but if I’m not pointing them out, they seem to learn more from them. And when I am focused on me, I see more of what I do do and what I’d like to change.
N. Network. Other people are going through what you are going through. Find people who are growing and changing themselves, not bitching and moaning about the person with the problems as if they had none. Those people can make suggestions and support you in changing.
O. Organize. PTSD often leads to chaos. Part of recovery for me has been organizing my life and my stuff, one little bit at a time. Progress not perfection is the watchword here. The first time I heard that , I thought, “WHY wouldn’t I want to be perfect?” My answer today: “Because nobody is, and people who try to be are annoying.”
P. Patience. Yep! You definitely need this virtue. It is a quality you can develop as you recover, as I am. Having patience with yourself, which is based on realism about how hard it is to change, helps you have patience for others. Persistence is good, too.
Q. Quiet time. Bob and I both meditate and take quiet time each day to simply be. It takes patience, helps develop patience, and has a profound effect on how you feel. Are you worth your own time? We use the book Wherever You Go, There You Are by John Kabat-Zinn.
R. Repetition and Recycling. “Repetition is the only form of permanence that nature can achieve,” George Santayana wrote. The same problems and old reactions come up again and again. I call this recycling. Repeating a new action that I have learned in recovery. like detaching or saying “You may be right,” helps me get through the problems faster than I did before. It is one of the ways you can tell you are recovering. You get through, around, over, and under things much faster. You see different paths, patterns and possibilities more quickly.
S. Safe means sanctuary. The aim of recovery and of becoming a part of the solution is to make your relationship a sanctuary for both of you, not a battle ground.
T. Trust. Family members sometimes feel betrayed by the person who has PTSD. Promises are broken. Needs are not met. I suggest changing the focus. We don’t expect cancer patients to magically recover for us, nor diabetics to eat cake for us, yet some of us want people with PTSD to get over it for us. I have learned to trust that Bob is doing his best. I belong to support groups so I can get my needs for emotional and social support met without being entirely dependent on him. I never ask him to promise to do something, because I know he needs the freedom to make healthy choices for himself. I also trust him to be human and therefore not perfect. Makes my life a lot easier.
U. Understanding. I’ve gone through layers of understanding PTSD, Bob, and myself, and every new layer has helped me heal. Bob isn’t emotionally unavailable because I’m not pretty enough, not neat enough or no good. It has nothing to do with me. It is because he has PTSD. When I understood that, it helped heal my low self-esteem. Other insights have come and changed the way I viewed myself and him. Understanding leads to compassion, and compassion heals us.
V. Value yourself and the survivor. Once I thought of Bob as the bad boy and treated him as such. Now I think of him as a man who faced death everyday in Vietnam to help others. He is a hero to me, and I value him. And I am a woman who never gives up, so I value myself, too. I used to hate myself because I couldn’t make him or me perfect. Valuing myself is a lot better.
W. Want to vs. willing to: Sometimes we have to be willing to do things we don’t really want to do, like practice compassion and kindness when we are getting hostility and coldness. I tell myself, “This too shall pass.” It does and I didn’t make a bad situation worse by reacting to unkindness with unkindness. Wait. Change is rarely swift. Change is very hard for trauma survivors. It is easier to wait if you are working on yourself and trying to live life while you wait.
X. X-ray your own baggage. Keep that pitiless eye on your own recovery. Judging someone else’s recovery efforts is ineffective and a waste of time.
Y. Yearn. We all yearn to be loved, to be special to someone, to be happy. Let these yearnings motivate you to grow and change.
Z. Zero in on your own part. If I speak to Bob in “Hitler voice,” I apologize for the tone, which is my part. How I say things is my responsibility. So is what I say. I no longer find it acceptable to think, “Well, he spoke in an ugly tone,” or “He said something mean, so I can be mean back.” It would have been nice if I’d been over that in grade school, but I wasn’t. I am now, for the most part. My behavior usually is not a reaction to other people’s behavior, but based on the kind of person I want to be. If I do react angrily or defensively, I make amends as soon as I am able.
These ideas have helped me heal my relationship with Bob and with myself. I hope you find them useful. Take what you like, and leave the rest.
War has consequences. There are some things veterans can’t do because they have been to war. There’s strength in recognizing this.

Sunday, May 15, 2011

New Washington Post article on PTSD and TBI

I just read through this article and cried.
The thing I want to post about however is the absolutely ludicrous argument between the doctors about whether it was TBI or PTSD...
A TBI is a traumatic stressor by its very nature. TBI's on the football field are treated with rest and not letting them back in the game for weeks and that is just being run into by another person, not a bomb blast.
Maybe shell shock in WWI was a combination of both. Maybe a lot of PTSD guys have TBI and maybe all TBI guys have PTSD.
Maybe the Civil War doctors who though rest and feeding up was a cure for Soldier's Heart had a handle on the TBI part of many soldiers' problems. Or maybe everyone with PTSD also needs rest and feeding up.
How is the question of the name of the diagnosis more important than taking care of the wound?
Perhaps people with TBI and people with PTSD can benefit from the rest that TBI needs and the psychological treatment that PTSD needs.
No one benefits from the current practice of drugging people and sending them back into the field, which is the result of the conflict of interest inherent in military psychiatry. Do you send people with PTSD back to war, pleasing your bosses and damaging them? The only study of people who go back into war after having PTSD, done by the Israelis, showed that people with PTSD got it faster and worse in the next war. Or do you keep them home because we don't know how damaging it would be for them to go back? That might end your career. Sending people with combat fatigue back into the war was not done in WWII or in Vietnam
I know of no scientific studies of the effects of sending people back to war on drugs. Is it safe, or just convenient?
I do know that military members who have PTSD are put into Warrior Transition Units where they are at best treated like "second class citizens" as one of them recently told me. Since PTSD is a normal response to war, it should have been expected. Instead, people with PTSD are often accused of malingering and making things up.