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Wednesday, March 20, 2013

What PTSD is by Myke Cole

I found another great blog post, this one by Myke Cole, veteran and writer and asked for permission to repost it, which he kindly gave.
One of my strongest beliefs is that we do not know all the causes and symptoms of PTSD. I believe, as he does, that most military PTSD is the result of a long period of days, not necessarily one super-traumatic event, and that by focusing on that, shrinks can miss a lot.
Here is a link to it followed by the text:
What PTSD is by Myke Cole

I’ve talked before about genre writers who have been very open about per­sonal trials, par­tic­u­larly the kind of depression/anxiety con­di­tions that I feel are a nat­ural part of the uneven ter­rain all authors have to walk. I’ve always appre­ci­ated their will­ing­ness to go public with these issues, as the first (and false) thing that most people suf­fering from these sorts of things think is a.) that they’re alone and b.) the problem is unique to them. When your lit­erary heroes step into the spot­light and say, “hey, this is more normal than you think and you can figure out how to live with it,” well, let’s just say I wouldn’t be sur­prised if there are more than a few folks still pushing air past their teeth because of a blog post they read.
The thought of talking about what goes on in my head in any­thing but the most gen­eral terms in the public square takes me way out of my com­fort zone. But I reread the first para­graph of this post, espe­cially that last line. Some­times, you need to go out­side your com­fort zone, talk about a thing not because you need to get it off your chest, but because it might help others to hear it.
I was diag­nosed with PTSD in August of ’09, just after my third tour in Iraq. Of course my first con­cern (like everyone in my line of work) was losing my secu­rity clear­ance, and that kept me from going for help for a long time. But DoD did right by me, and I kept working for another 2 years before the book deal got me out of the business.
I had a hard time admit­ting it to myself. There was a cul­ture in my line of work, that PTSD was the province of the hard oper­a­tors, the door­kickers who got into 2–3 fire­fights every single day. Like most cul­tures, you bought into it silently, it was simply a thing that was, not worth ques­tioning any more than the law of gravity.
I mean, sure I’d sup­ported cer­tain spe­cial­ized units, sure I’d been to some funerals, sure there’d been some danger close indi­rect rounds. Sure I’d had some mis­giv­ings about what I was fighting for, what my actions were con­tributing to. But, I’d seen the ads on AFN, showing young men with gun­powder still on their hands, often fresh off the bat­tle­field, having trem­bling flash­backs of a fire­fight where their best friend went down right next to them. THAT was PTSD.
Except, it wasn’t.
I kept seeing non­profit TV spots, charity pieces and solemn psy­cho­an­a­lyt­ical essays. They all described a PTSD that I’d never seen in myself, and more impor­tantly, in anyone else I knew who suf­fered from it. I’ll never forget this one spot on AFN, where a sol­dier washes his hands, only to find blood pouring out of the faucet Stephen King’s Shining style. He hears gun­fire, looks into the mirror, the back­ground is a desert bat­tle­field strewn with corpses, glowing red.
I picked that apart with some friends for an hour. I’m not saying that there aren’t people out there for whom PTSD is like that, but it sure as hell wasn’t like that for any of us. As I thought about that spot, as I con­sid­ered the mounting reports of sui­cides, home­less vets, col­lapsing fam­i­lies, I began to get the uneasy feeling that PTSD is a lot like autism: A thing iden­ti­fied, but poorly under­stood. I read about the sup­posed symp­toms, the height­ened alert­ness, the re-experiencing of spe­cific trauma, the going numb. It was all true. Up to a point.
When James Lowder invited me to write an essay for BEYOND THE WALL, we started brain­storming what it would be about. After a few rounds of back and forth, I real­ized that I wanted to write about PTSD, and how I saw it man­i­festing in fan­tasy char­ac­ters. I used the Cooper Color System, talked about how living in the per­petual state of readi­ness known as “Con­di­tion Yellow,” both enfran­chised and hurt people. Con­stant vig­i­lance has its uses, but it is exhausting and, over time, transforming.
After the book was pub­lished I real­ized that I hadn’t gotten close enough to the issue. Arya Stark and Theon Greyjoy aren’t real people, and so addressing their PTSD was tack­ling the issue at a safe remove. It was a toe in the water. It wasn’t good enough.
Because the truth is, I’ve never heard anyone, med­ical pro­fes­sional, spir­i­tual leader or oth­er­wise describe the PTSD I know. What I see are people embracing a def­i­n­i­tion that explains PTSD using the vocab­u­lary of clas­sical pathology. It implies that, like a dis­ease, you can pre­scribe a course of treat­ment and fix it.
But, in my expe­ri­ence, PTSD doesn’t get fixed. That’s because it was never about get­ting shot at, or seeing people die. It was never the snap trauma, the quick moment of action that breaks a person. PTSD is the wages of a life spent in crisis, the slow, the­matic build that grad­u­ally changes the way the suf­ferer sees the world. You get boiled by heating the water one degree each hour. By the time you finally suc­cumb, you realize you had no idea it was get­ting hotter.
Because you kept adjusting.
Because PTSD isn’t a dis­ease, it’s a world view.
War, dis­aster response, police work, these things force a person to live in the spaces where trauma hap­pens, to spend most of their time there, until that world becomes yours, seeps through your skin and runs in your blood. Most of us in indus­tri­al­ized western soci­eties live with feeling that we are safe, that our lives are sin­gular, mean­ingful, that we are loved, that we matter. We know intel­lec­tu­ally that this may not be the case, but we don’t feel it.
PTSD is what hap­pens when all that is stripped away. It is the cur­tain pulled back, the deep and the­matic real­iza­tion that life is fun­gible, that death is capri­cious and sudden. That anyone’s life can be snuffed out or worse, ruined, in the space of a few sec­onds. It is the shaking real­iza­tion that love cannot pro­tect you, and even worse, that you cannot pro­tect those you love. It is the final sur­ren­dering of the myth that, if you are decent enough, eth­ical enough, skilled enough, you’ll be spared. The war­riors that the media ascribes so much power are the first to truly know pow­er­less­ness, as death becomes com­modi­tized, sta­tis­tics that you use to make an argu­ment for pro­mo­tion, or funding, or to score polit­ical points.
War­rior cults (and, heck, most reli­gions) were invented to give death meaning. Even if you look past the promise of immor­tality, they offer a tremor in the world, a ripple of sig­nif­i­cance in your passing. You do the right thing knowing that, some­where down the line, you have a mean­ingful death. PTSD is what hap­pens when you realize that you won’t, that your sur­vival will be deter­mined by some­thing as random as the moment you bent over to tie your shoelace.
Dis­eases are dis­crete things. But how do you treat a change in per­spec­tive? Joe Aber­crombie cap­tured it best in his descrip­tion of Ferro Maljinn’s final rev­e­la­tion of the world of demons just along­side our own. Once seen, the crea­tures cannot be unseen. When you’re quiet enough, you can hear them breathing.
Nobody talks about this. Nobody talks about the boredom, the impos­si­bility of finding meaning in 8 hours work in an air-conditioned office after you just spent months working 18 hours a day on a bat­tle­field where your touch altered his­tory. Nobody talks about the sur­real expe­ri­ence of trying to remember how you got excited about a book, or clothing, or even a car or house. On the bat­tle­field, in the burning building, the ground trem­bled, we felt our impact in every­thing we did, until the world seemed to ripple at our touch. Back home, or off shift, we are sud­denly the sub­ject of sym­pa­thetic glances, of silly, repet­i­tive ques­tions. The anonymity of the uni­form is nothing com­pared the anonymity of com­fort. We drown in it, cut off from what makes it worth­while for others, unable to carve out a piece of it for ourselves.
Time helps you to shift back, but you never shift back all the way. You develop the dreaded “cop’s eyes,” where you see the poten­tial threat around every corner, where you ask the waiter for the chair with its back to the wall. Where the trust essen­tial to build rela­tion­ships is com­pro­mised, because in the world you live in, every­body is trying to harm someone.
And this is why so many of us, even post diag­nosis, go back to work in the fields that exposed us to the trauma in the first place. Because the fear is bone deep, and the only thing that puts it to sleep is the thought that you can maybe patch a few of the holes in the swiss cheese net under the high wire. Because we are fright­ened from the moment we wake until the moment we sleep, and if we can stave that off for someone else, well, then maybe that’s some­thing to live for.
And that’s for those of us who get off easy. In the worst cases, people aren’t able to find meaning in a reg­ular job, or in wealth-building, or rela­tion­ships, or any of the things that modern soci­eties tell us charts the course of a life. These are the people that PTSD takes, as they flail their way into sui­cide, or crime, or insanity, des­per­ately trying to carve meaning out of a world where all the goal posts have sud­denly moved, where the giant ques­tion that no one can answer is, “why bother?”
The root of the treat­ment has to come from meeting those who suffer where they are. It isn’t just hard oper­a­tors. It’s clerks and phle­botomists and chem­ical engi­neers. It’s people who thought they were fine, only to wake up one morning and realize that the last few years have changed them in ways they don’t quite under­stand. It isn’t just sol­diers and cops and ER nurses. Life in poverty can bring on PTSD. An abu­sive parent can have the same effect.
We need to treat the fear, address the world view, acknowl­edging that these aren’t things you cure, maybe aren’t even things you change. We need to tip our hat to the trauma, and look instead at what the life after it looks like. We have to find a way to con­struct sig­nif­i­cance, to help a changed person forge a path in a world that hasn’t changed along with them.
And if you’re a vet, or an EMT, or a cop, or fire­fighter and you’re reading this, I want you to know that you can’t put the cur­tain back, but it’s pos­sible to build ways to move for­ward, to find alter­na­tives to the rush of crisis. There are ways you can matter. There is a way to rejoin the dust of the world, to find your own space on the dance floor.
I know this.
Because I did it, am still doing it, every day.
Don’t give up.

1 comment:

  1. Great post Patience! I always tell counselors and therapists that unless the person you are trying to help sees a sincere desire to help in your eyes, they won't believe you can help them. This begins with real compassion. Thanks for caring so much about our veterans, first responders, and other who have suffered and are looking for compassion.