Day 30 of National PTSD Awareness Month:
So here we are. I have explained my take on PTSD and why I think it is a more helpful way of looking at it. I have talked about most of the symptoms and how they can save your life and make it painful later for you and your family.
If you want more about that there is a free pamphlet at patiencepress.com "The War at Home." It started out as a talk for a retreat the National Conference of Vietnam Veteran Ministers gave for couples. At the end of what I thought was so obvious, everyone cheered. You don't usually get cheers at a spiritual retreat. So I made it into a pamphlet.
I have also talked about types of help and why it is important to look for extra things that help you. I found the 12 steps helpful especially in accepting and sitting with painful emotion. Bob learned that from meditation. It is a skill you learn in many kinds of therapy and it is essential for recovery, because you can't heal what you can't feel.
So no matter where you are in the journey to recovery, I wish you well. It is not easy to change and grow. It is not fair that after all the shit you survived, you have also to do the painful work of recovery. The only thing I can say is that it will be worth it.
When I wake up in the morning, sometimes I  forget and give Bob some advice. Instead of getting mad like he did in the old days when I thought everything I said was RIGHT, he just grins. I go, "Oh, sorry. Doing it again." He gets this ridiculous meek look on his face and says, "Don't worry, honey, I'm used to it." We both laugh like crazy. Then, since it is irresistible, I say, "Well if you need any more shit, let me know, because I have plenty." More laughter.
I love him more every day. And he, oddly enough, loves me!
Every change I made in myself gave him room to change. Since I was only able to make very small changes, I know that is how people change. Every time he makes a little change, I know how hard that is so I appreciate the effort. I used to not notice because I was so wrapped up in how messed up he was.
It is not easy living with PTSD for either of us. I was just kidding him today because occasionally our PBS station messes up. One of those round TV signals that used to come on when the station went off the air comes on. Bob used to sit and watch that and then the snow after that went off. After I said "You used to watch that and the snow," it hit me. I realized and said, "You were in such hell." He looked up at me and I could see it had been hell. But it isn't now most of the time. For that I am glad.
Our suffering has been transformed.
We have been able to help others.
That is a blessing.

Day 29 of National PTSD Awareness Month
When Bob got home from Vietnam in August 1966, he weighed 119lbs. He's 5'11". The first night he was home, a loud smack woke me. Bob was a few feet up in the air. I could see between him and the bed. He made way less noise when he landed. I was impressed, but I had no idea what it meant.
He flicked cigarette butts everywhere, too, in the house. He'd look shocked and say, "Sorry! I've been living in a tent." I thought it was pretty funny.
One day a big palmetto bug was inside and I started shreiking "Kill it! Kill it!" Bob picked it up and put it outside, and said to me, "Patience, I've seen enough things killed." It really made me think.
I still had no idea what he had endured. He mostly told funny stories about Vietnam, Mo'fuck the mongoose biting him when he wouldn't share his coffee and flying on missions with them. Stealing things from the R&U compound so the his unit had stuff to trade, the ambulance full of ladies of the night, his buddy, Jerry, getting stuck overnight in a whore house...
It wasn't till he was writing Chickenhawk that I learned details of what he had lived through. That was why I decided to write my book, Recovering, so other women could give their vets some slack if they knew what they had been through.
My plan was to help women understand and fix their vets, but luckily I found out about 12 step programs by accident. One nurse I interviewed who was running a Vet Center said the Alanon pattern of detaching with love would help.
Then I saw a Hazelden daily meditation book for Adult Children of Alcoholics, Days of Healing, Days of Joy, by Earnie Larsen and Carol Hegarty Larsen. Wow! I thought. I have got to check this out. So many vets are drunks. This will help their kids. So I looked into more ACoA books.
There was a list of ACoA characteristics which started with "Adult Children of Alcoholics do not know what normal is." I almost fell over because adult wives of vets with PTSD do not know what normal is either. I can't tell you how many times I wondered if it was normal to want your husband to say I love you. Was it normal to want hugs? I really couldn't tell anymore. That is what got me going to an independent ACoA meeting.
That was in 1987.
At the time I could not go 100 yards in the car with Bob without telling him how to drive. I believed that he drove the way he did to intentionally piss me off. Everything was about me. I personalized everything and I misunderstood everything. I was always pissed off or depressed. If something good happened it was about f-ing time and it wasn't going to last so why be happy?
I know I was hard to live with, but I thought I was fine (haha) and Bob was f*cked up, so I often told him so, because I thought he's want to know! I found help in the 12 steps. Other women have found other kinds of help, but I think one of the most important parts of recovery for the family and veteran is to focus on yourself. If you're the vet, get help, work on you. That's your job and your duty. If you're the spouse find help and support, so he can be in pain without you trying to fix it, and work on yourself. That's your job and your duty. Sometimes it does not work out, but often if you work at it, your marriage can turn from a battleground into a sanctuary, not a quiet cold sanctuary, either, but one that is also filled with laughter and hope, like ours is.
Tomorrow will be my last post of the month. I will try to post once a week from now on. If you go to patiencemason dot blogspot dot com you will be able to follow my posts by email, since I finally found out how to add that to my blog.

Day 28 of National PTSD Awareness Month.
Traumatic events happen so fast they don't get incorporated into narrative memory which resides in your forebrain, that big lump of brain that gives us high foreheads. It is where the words are.
If the story isn't put together in your mind in words. I think this is one reason for intrusive thoughts and if onlies. It is like when you are trying to figure out the first point in the movie where there was a clue to what was coming. Your mind picks at it and picks at your war experience, trying to have a better past.
If I did this, it wouldn't have happened. If I did that...
This is the main reason that therapy is effective if you have an effective therapist. You get to tell the story. It will probably change during the therapy as you remember more details and feel the emotions you didn't have time for. This is hard for people who are not used to welcoming their emotions. We call them Americans, although I suspect it is common all over the world.
One thing that really hangs people up is guilt. You felt great when you killed that gook/raghead/dink. No one tells you that killing someone is a basic biological high because you lived and every bone in your body rejoices. This even happens when a fellow soldier is killed, because it wasn't you. In Chickenhawk, Bob wrote about the weird smile that possessed his face when he was telling his buddies about someone who was killed. People have thanked him for that because it happened to them and they thought it was only them. A lot of people hate themselves for that and can't even talk about it.
If you are doing therapy and don't get relief, maybe there is something you feel so guilty about you can't even admit it happened.
I wrote this prayer for people in 12 step groups when I realized a lot of them had been traumatized:

Prayer for People with PTSD
Higher Power,
I know that it’s not within the harmony of the universe that I be healed from the trauma of remembering ____________________________ without pain.
Help me through the pain. Surround me with the golden light of healing, fill me with the white light of peace and love. Help me to bear the pain as I go through these memories. Help me to cry. Help me to remember. Help me to love myself no matter what happened to me or what I did to survive. Amen.

A few meetings later someone told me about being raped, having therapy, and still reliving the rape every day. When she read the prayer she remembered something she had never told the therapist or anyone else because she was so ashamed of it. When she remembered it, after reading "no matter what I did to survive," the whole thing went away.
I used to be invited to VA's to give talks on PTSD and Bob would come along if he could talk about writing. One time, he was giving a workshop and one of the vets told about getting an F on his first journal because it wasn't personal enough. Being a Vietnam vet, he said "F her. I'll write one of my nightmares." He did. She handed it back with corrections. He rewrote it several times for her, then several more times for himself, and then he realized he wasn't having the nightmare any more! That night Bob said to me, "I haven't had nightmares since I wrote Chickenhawk, and I didn't notice.' We had a good laugh over that.
Therapy is about debriefing and finding support. The way I described PTSD yesterday, the two clusters of symptoms which start way before reexperiencing (hypervigilance and numbing/avoidance) explain one of the mysterious things about PTSD. Everyone has most of the symptoms right after the trauma (Critical Stress Response) but if it lasts more than a month it is considered PTSD. But some people don't seem to get PTSD which means it is a disorder of healing.
How do you heal? Talk and find support. Some people have someone who listens. Most people don't. Most people can't listen for more than 30 seconds. Trained therapists can listen unless they have been trained to think they know all the answers, but if you go for help, you will know quickly if you can talk to the person. This also means that you can talk to someone who wasn't there as long as they are interested in learning from you what it was like for you there. I think that is why so many guys talked to me about Vietnam for the book. I was interested and they could tell.
Group therapy will help you find support, but sometimes it is difficult to be around people who didn't go through as much as you did or who went through more. That is when my mother's saying is good: comparisons are odious. That means they stink. Each person in the group has been through the worst thing they have been through. If you've been through more, remember how it was when you first got shot at or saw wounded or lost a friend. How rapidly you adapted to sudden death. And if you are feeling guilty because your war was not as hellish, you still have been through your own hell and have a right to be there. Don't compare. Share and support each other. It will be worth it.
More tomorrow.

Today is National PTSD Awareness Day. This is also National PTSD Awareness Month and I have been posting on various aspects of PTSD all month, here at Recovering from the War on Facebook and at patiencemason.blogspot.com
Today, if you take nothing else away from this post, take away the idea that PTSD is NORMAL. It is normal to be affected by what we live through. It is not weak. It is not weird. It probably feels pretty nuts if you have it, so you probably try to hide it or deny that you have it, which takes a lot of time and effort and is usually pretty ineffective.
In the medical model, PTSD means there is something wrong with you. Having PTSD is painful and debilitating and annoying and it brings a lot of disorder into your life.
To me having PTSD proves something is right with you. You are alive. Dead people do not get PTSD, so it is proof of survival. You lived through something, probably many somethings if you are a vet, where others died. You did whatever it took to survive using the God-given or evoloutionary based survival capacities you were born with.
PTSD is not a defect, bus a set of survival mechanisms and therefore wonderful. Unfortunately there is a paradox. These survival skills, which bring you out alive, can, and usually do, become your biggest problems over time.
The medical model thinks PTSD is the problem.
I think WAR is the problem and PTSD is a solution to the problems of surviving war, physically and mentally.
PTSD symptoms are evidence of courage, caring, initiative, endurance, speed, skill, and luck.
If you are currently numb as a stump, you may not see the caring part, but why would you have to be numb if you didn't care? It is a protection God or nature has granted you so you can keep on the the face of a level of pain and fear and exhaustion and guilt and despair and rage most people never have to face.
The post in Post-Traumatic Stress Disorder means it can happen right after the trauma or 50 years later. Further stress or traumatic events can trigger a new round of symptoms even if you have had good therapy. And if you've been dealing with your hidden PTSD with workaholism, that invisible addiciton usually called resilience (how I hate the word), it will seem to the medical model that you just got it. I'd like to talk to your wife and kids before I believe that.
In the medical model, a person with PTSD looks mighty peculiar: flashbacks and nightmares with associated rages and lack of affect (feelings).
I hate this mis-arrangement of symptoms which is based on the fact that psychiatrists didn't notice PTSD till vets were having flashbacks in the beds of the hospitals.
My husband came back from Vietnam in 1966 with PTSD (read about his tour in his memoir, Chickenhawk) and I knew this was not how he was when he left. Eventually we found out about PTSD and I decided to write the book I wished I had had when he got home.
The first part is interviews with vets.
The second part was everything known in 1989 about PTSD, but I kept having the idea that these symptoms had to have a purpose.
Hyperalertness seemed like it should be the first symptom cluster. I bet when the first bullet whizzes past you get plenty alert. I bet you aren't going to be sleeping soundly when you could wake up dead. Makes sense. Your brain is designed to pay attention to threat, way down in the more primitive areas which don't speak English and can't tell time. This set of symptoms is what has to happen if you are to stay alive. In a war, each symptom is pounded into you. I call the "exaggerated" startle response an effective startle response. Outbursts of anger? Most people get pissed if someone tries to kill them. I'd call that a normal reaction. "Difficulty concentrating" seems to be another misnomer. Vets are concentrating on who might have a gun or a bomb and how they will get out of the room, survival information, not whatever some wife (who is not a threat) or clerk, or doctor is saying. They concentrate, just not on you! (So insulting...not really).
Your brain rapidly adapts to stuff, so the first death is horrifying but a few on, it is just everyday and don't mean nothin'. That is another survival skill. You can't sit down in combat and cry... Numbness keeps you able to do your job. Avoidance grows out of numbness, because the losses and pain of combat veterans are so great that it would be illegal to feel that in America, the land of "Aren't you over that yet?"
So in my version reexperiencing comes along last, after you have actually experienced the trauma, lost the friends, been blown up or shot, bobbed and weaved enough not to get shot and feel guilty about that... whatever.
I also included what was known at the time about the effects of having a PTSD vet in the family. Families were depressed, felt different, and developed problems, too. I know I did. I didn't know what the problem was, so I thought Bob was my problem and I set out to fix him. It was pretty awful for us both. When I was writing the book I went to him and said, "I think I might have been (notice the hedging) a bit hard to live with." The look on his face still makes me laugh when I think of it. A vet can't be driving you nuts, without you becoming a little bit nuts. I was.
The last part of my book is about how to begin to recover, and although it is written to the spouse, there is a lot in there aimed at vets. It has a lot of funny stories about my progress because things got better in my family when I stopped trying to change Bob and started working on me. We mostly get along great these days, but if he is having a hard day, I listen and apply compassion and kindness instead of advice.
After the book came out I wrote a book about PTSD for kids of vets, several pamphlets, and The Post-Traumatic Gazette for 7 years, 6 times a year, on ways to recover, reframe, rethink, and work towards your own healing for vets, family members and survivors of other traumas. That is all free at patiencepress.com.
Three more days in the month, so more tomorrow.

Denial is a reality where PTSD is concerned. The four traumatic stressors of DSMIII and IIIR were pretty well laid out: 1. serious threat to your life or physical integrity, 2. serious threat or harm to children, spouse, or other close relatives or friends (and no one is closer than battle buddies), 3. sudden loss or destruction of home or community (like being medevacked), 4. seeing another person who has been seriously injured or killed (including the enemy).
This series of relatively descriptive terms has been replaced in the newer DSM's with a numbing ritual (like "It don't mean nothin'" in Vietnam) which goes something like this: "The person has experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others."
Read that over a few times.
What does it MEAN?
How can some kid in a white coat, no matter how good his or her motives, with his or her brand new MD or PhD know about blood and shit and burning flesh, or the agony of gang rape, or the devastation of losing your best friend from that bit of repetitious sleep inducing drivel, I mean prose?
Being put to sleep helps with denial.
Another reality of PTSD is simply the reality of having it. No one knows it is normal to be affected by what you live through. The statistics conveniently make you feel like it is not common and you won't get it. If you get it you feel like you shouldn't, and like you should be over it. You feel like you are nuts but you are not telling anyone, so you get grumpy and spend a lot of energy and effort trying to appear normal. Your spouse complains and the war at home starts. Sometimes this leads to divorce and isolation. It is not easy. It is not fun. Nobody does it for the money.
There is also the reality for families. A veteran's numbness leads to the discounting of our everyday problems which makes us feel unimportant and worthless. If the vet blows up a lot we are afraid and we feel worthless, because if our nearest and dearest treat us like dirt, we must be dirt, right? If the vet can't concentrate and doesn't seem to listen to anything we say, more proof of our lack of value. It is a losing battle to feel good about yourself when your vet is saying if you just were thinner, or kept the house cleaner, he'd have no problems. (I am sure husbands of PTSD vets get parallel crap.) It can turn into a downward spiral. Bob and I were on it from 1967 to about 1980 when we found out what PTSD was and that we weren't the only nut jobs. It was such a relief.
Another reality is that there is help. It is not easy to get it because the VA is overwhelmed. There are Vet Centers. There are Veterans Service Officers to help with claims. Be sure to use one and keep appealing. There are other services for vets provided by all sorts of organizations. Use Google. Service dogs, yoga, meditation, all sorts of things can help you calm down and have a pause button.
The pause button is what we all need when dealing with PTSD so we can make our relationships a sanctuary instead of a battleground. If someone like me, who used to scream and sulk and rescue and rant, and I didn't even have PTSD, can change, so can you, whether you are a vet or spouse. It is not easy, but it is your job, to change yourself to be the kind of person you want to be. It is a choice: self-righteous or compassionate? Right or happy? Kind or cruel? Like I said, it is not easy. Change is not fast. Small changes are more effective in the long run than a giant leap forward. I wrote 42 plus articles on that which are available at patiencepress.com.
More tomorrow.

Ranting away: Day 25 of National PTSD Awareness Month.

Denial in the professional community.
Wow! Still!
I had to stop writing yesterday because I was so mad, and since then I have had comments from vets and spouses about professionals not believing in PTSD,  saying PTSD can be easily cured, and encouraging women to leave their PTSD vets because they are just a-holes and PTSD doesn't exist.
NICE.
Makes me very angry. I hate trendy shit, and this is simply another trend in the struggle to understand and treat PTSD.
In 1968, the trend was suddenly combat fatigue and gross stress reaction (PTSD) didn't exist. In 1980, PTSD was put into the DSM III but most psychiatrists thought it was made up for Vietnam vets, despite the fact that Holocaust survivors, WWII vets and POW's, flood, fire, tsunami, hurricane and other natural disaster survivors, battered women and children, rape and incest survivors and survivors of industrial accidents and fires all had it. People see what they want to see.
In the 90's it was all "lets fix it with drugs" which did not work. It still doesn't work. Drugs can help but they do not cure.
Then psychologists started getting smart, so if they developed a treatment, they did follow-up studies and some of the new treatments do actually lower PTSD symptoms. Is it a cure? Does it last forever? In 50 years we'll know.
Most of these studies are on sexual abuse (rape) survivors but a few have been done on combat vets. The "evidence based" therapies do work for some. So do a lot of other therapies as long as someone who cares is listening.
Many, many therapists, social workers, psychiatrists, and other mental health people work hard and long to help our vets in the VA system. If you get someone you can talk to, hang on to them.
Then there are the smugly self-righteous. They know the new ways are the best ways. They are going to change the world and human nature.
They have no idea how lethal they can be, especially when they tell you you don't have PTSD, or that you can't be helped, or they can cure you quite quickly.
I call this a profound and pervasive narcissistic sense of entitlement, a phrase I read in a paper about Vietnam vets with PTSD, which really pissed me off. Society makes a deal with soldiers. You go do our dirty work, and it is dirty work in every sense of the word, and we will respect you, and honor you, and take care of you. So vets who felt they were owed something were narcissists. NOT.
But someone with a PhD or MD who thinks they know everything and can fix everyone if they just listen to MEEE. Yep. Narcissistic sense of entitlement.
PTSD has been around since the beginning of writing, if not before. When Saul (who had killed his thousands) was troubled by an evil spirit of the lord (PTSD), they sent for the harpist, David, to soothe him. Saul tried to spear him to the wall twice. I was at a National Conference Of Viet Nam Veteran Ministers (NCVNVM.org) retreat when I first heard this. I laughed. It sounded just like Bob. Most women can identify.
The PTSD psalm, the 137th, starts out with the captors saying forgeddaboutit, just like everyone says to vets.
Be happy. Sing! Yeah, right!
The vets feel they will betray their friends (If I forget thee, oh Jerusalem) if they forget so they don't (and can't).
The last bit isn't usually read in church: happy are they who take the children of the enemy and dash their heads against the rocks. People with PTSD are angry. We all have an innate sense of justice. We know that what happened to us was not right, whether it is people trying to kill us or surviving rape or losing everything in a fire. That is why "irritability and outbursts of anger" are part of the diagnostic criteria.
In the Iliad we read about PTSD (read Jonathan Shay's Achilles in Vietnam) and homecoming in the Odyssey. Shakespeare mentions every symptom of PTSD in Lady Percy's description of her husband in Henry IV, Part I. There are lots of other examples if you look for them. I always do. Always glad to hear about them too.
The final thing I want to say today is the difference between a startle reaction (when a vet wakes up swinging or hits someone who has surprised him) and battering. Batterers go through a cycle: hit, sorry, honeymoon, slowly growing anger, and hit again. A startle reaction is completely different, and any therapist who doesn't know the difference should learn it. Most vets are not batterers and if they are, it is not from the war. It is learned at home and despite the conventional wisdom about battering, there is help for batterers and their wives: Compassionpower.com.
More tomorrow.

The reality of denial: Day 24 of National PTSD Awareness Month

Then there is the reality of denial. It is not just a river in Egypt. Denial is pervasive in veterans where it is protective, in families and in the professional community, where it causes secondary traumatization to people who have PTSD.
The funny thing is that the shrinks who denied PTSD from 1968-1980, (and some still do), were calling numb guys psychopaths because they could talk about horrible things with no emotion. Isn't that what psychiatrists do and call it professionalism?
Well, these guys are professional too, and numbness is required to do their job.
After 1980, when PTSD was forced into the Diagnostic and Statistical Manual despite the American Psychiatric Association's "it will cost too much money," many professionals thought it was a made up diagnosis for Vietnam vets and would not see it, despite the evidence in front of them. People see what they want to see.
There were studies on Vietnam Vets, some of which did not ask if the vet had even been in Vietnam or in combat, which conveniently found that 12 to 17% of vets were adversely affected. Hahaha! And guess what, the current crop of studies, run by the military and the VA, find similar percentages. One military shrink reporting on the unit he was in at an ISTSS meeting said he had to change the diagnostic criteria to get his percentage down to 17 from 28, and he did. NICE.
There has only been one completely observant study, the National Vietnam Veterans Readjustment Study, funded under Jimmy Carter and published under Ronald Reagan, who only allowed the Government Printing Office to print about 100 copies. In this study, which included talking to the veterans as well as standard diagnostic questionnaires, of the people who had been through the most war zone stress, combat, seeing a lot of wounded and dead, being shot at, etc, 66% of them had had diagnosable PTSD at one time, 33% still did. 
Guys, that means it is normal. And no one can say a vet didn't get PTSD till after he's dead. There is always delayed onset...
I also found studies of WWII combat vets and POW's who were receiving treatment at VA's for medical reasons. Over 50 % had had PTSD at one time and about 30 % still did, undiagnosed, lying there in a bed in the VA!
WWII vets were not too modest to talk about it. They didn't talk about it because they couldn't. They had a good GI Bill and a good economy, too, so many of them dealt with their PTSD through workaholism and were considered "resilient," my least favorite word since it is code for workaholism, something doctors aren't likely to notice...
Acceptance of PTSD comes and goes in waves. WWI yes. In between, no. At the start of WWII they thought there wouldn't be any. When there was, they ascribed it to not getting along with your mom (I kid you not) and many other similar blame the survivor phrases until almost the end of the war. Then some people got help. Some of the help was pretty bad. They did lobotomies!
In 1965 Drs. Archibald and Tuddenham published an article on WWII combat vets who were still having nightmares, startle responses, etc. It was totally ignored.
I mentioned "Gross Stress Reaction" the term for PTSD in the first Diagnostic and Statistical Manual of the American Psychiatric Association, which was apparently based on observation and not theory. DSM II came out in 1968, actually in the bookstores during the Tet Offensive (so ironic), and on the basis of NOTHING, dropped GSR and substituted "Transitional Situational Disturbance." This is what I call the APA's denial and delusion period. Eventually, sanity prevailed and PTSD became the name of the diagnosis. There was actually quite a lot of good help there for a while. The Vet Centers were founded where you could get help without hassles.
At the VA's it was more like help with hassles, but it wasn't the PTSD staff that hassled, it was usually the VA Compensation Crooks.
Oh, did I say that? The people who delay and want more info and then give you 10% if you are 50% disabled and 50% if you are completely and totally unable to work but forgot and shaved before you came into be evaluated. I think I mentioned the young woman psychiatrist who told a veteran of Hamburger Hill that it "can't have been as bad as the movie." One of the guys in Recovering from the War was told in a letter from the St Pete Regional Office that since combat was not "Outside the range of human experience for an infantryman" that he did not have a traumatic stressor. This crap is still going on as I write.
Well, now I am too mad to write more, so more tomorrow.

Realities of PTSD: Day 23 of National PTSD Awareness Month

I have covered a lot of different things that help people with PTSD.
I found out today that an inpatient treatment program somewhere in AZ uses my format for a 12 step group for trauma, and the people who are in there for addictions find the trauma group helpful too. I am so glad. Everything on patiencepress.com about PTSD is available for use and to give to people who might be helped.
Traumatic events are a separate reality which other people can't understand at a gut level. They may want to. They may try to, but the shot of adrenaline, the movement without thought, the terror, the rage, the changes in your metabolism... Those are a separate reality. Different people have different elements in their separate reality, like that quote yesterday from a WWI doctor pointed out.
There are a lot of other realities to PTSD.
How about the reality that most people want it to go away and wonder why you are not over it yet... This is really painful to the person who lived through it and will never be over it in the sense that those ignorant people want. This is the reality of societal attitudes. Then there are the scum who like to drop things behind combat vets to see them jump, or call them names to try to get them to fight.
How about the reality that getting diagnosed is really hard. The military, which claimed it would take care of you, is now trying to give you a bad conduct or personality disorder or adjustment disorder discharge, all of which mean no veterans benefits. Or the VA psychiatrist who just doesn't see your PTSD because you shaved when you came in for your C&P exam.
How about the reality that getting treatment tailored to you is hard. Many places have a focus: we do X, Y, or Z. It is even harder now at the VA's where people really care and are simply overwhelmed by the number of people who need help.
I'll talk about more realities of PTSD tomorrow.

Yoga and other stuff: Day 22 of National PTSD Awareness Month.

If you Google PTSD and Yoga you will find a huge number of resources. I first heard of using Yoga with vets at a Ranger Reunion where I was giving a talk on PTSD years ago. MaryAnne Colledge, the wife of one of the Rangers, gave a yoga workshop for all of us. The next morning, one of the Rangers told her he has slept through the night for the first time in decades. It was amazing to him that something so simple could make that kind of difference. That is what I love about the search for the things that help YOU. You never know what will help.
Yoga involves stretching and breathing. You'd think that would have nothing to do with PTSD, but hyperarousal means tense coiled muscles which the vet may not even be aware of. The body develops amnesia about what a relaxed state is and how to breathe in a relaxed way.
Of course Yoga is not the only way that helps people. Other people get relief from running. Brian Castner's memoir, The Long Walk, talks about how running helped him. Some places provide traumatized vets with horses. Google PTSD and horses for more information.
Service dogs are another new aid to veterans with PTSD. I will put a link at the end of this article. BTW, there is a CYA article on the va.gov website saying they don't know if they really help. "Evidence based" therapy is better. Since a lot of the evidence for evidence-based therapy was gotten from civilians or very short term follow ups on vets who didn't drop out, and the drop out rates are huge, I don't think they have any evidence. Veterans need to be heard, not run through a program to fix them. They need to know they can come back if things get worse, and they need a wide variety of approaches because people are different!
Here is a quote from a book published in 1917, Shell Shock and Its Lessons, bu GE Smith and TH Pear, two British doctors.
"The patient must be approached without prejudice and the doctor who wishes to be of real help to him must make up his mind to examine and ponder over the sufferers mental wound with as much, nay, even more care and expenditure of time than would be given to physical injuries...the absolute necessity of obtaining and understanding the patient's past history, before and during the war. A dozen cases sent back from the front as shell-shock may prove to possess not a single feature in common..." In other words, pay attention to the person in front of you and forget your theories.
More tomorrow.

http://www.smithsonianmag.com/science-nature/how-dogs-can-help-veterans-overcome-ptsd-137582968/?no-ist

Modulating arousal: Day 21 of National PTSD Awareness Month

When I first saw Beverly Donovan and Edgardo Padin-Rivera present the Transcend Program at an International Society for Traumatic Stress Studies meeting, they told us their veterans used a guided meditation tape (yes, this was the olden days: cassette tape) created for them by Belleruth Naparstek. This was an amazingly innovative idea and it worked. So one of the other helpful things I want to mention is listening to guided meditations for PTSD which are available at HealthJourneys.com.
Bob found meditation more helpful. He was always mad that he couldn't blank his mind till he read Wherever You Go, There You Are by John Kabat-Zinn which helped him a lot. Now Bob also uses a body scan CD from John Kabat-Zinn's The Mindful Way Through Depression (it has 3 other authors) which also helps him a lot.
At one ISTSS meeting we had someone present on the liberating effect of learning to use your voice. When people are traumatized, they often lose their voice, and singing lessons can be empowering. I will have to look for the paper, which is up in my office in some pile somewhere, but I just found an article: Music Therapy Helps Vets Control Symptoms of PTSD, which you can google. It is about a viola player, but the idea is the same. Different things help different people. Find what helps you to let go of anxiety and retrain yourself for peace.
I often say when I give talks on PTSD that vets need Basic Untraining so they can take care of themselves. They usually laugh a bit and look at me like I am nuts. I say, "Did the military teach you how to take care of yourself?" They nod. I say, "Oh, yeah? Did you ever say to your drill instructor that you couldn't do that right now because you needed to go take a nap?" Laughter.
But that is what self-care is. If you can't talk right now, if you can't go to that party, if you need space or quiet time, you need to be able to say it in a nice way without having to blow up. When you get mad, you need to remove yourself and learn ways you can learn to calm down without drugs or alcohol. The skills of peace are learnable, but often veterans don't even imagine such a thing since the skills they have (including a lot of PTSD symptoms) have kept them alive.
Other things that can modulate arousal are exercise, biofeedback, relaxation training, breathing training, Yoga and movement therapy. I will talk a bit more about Yoga tomorrow.

The right attitude Day 20 of National PTSD Awareness month.

Some people have the right attitude for helping people with PTSD. They are effective.
The right attitude consists of respect, an understanding of human nature, the ability to listen and hear what is being said as well as what is not being said. They teach you skills that will help you have a better life if you use them, as opposed to "I can fix you." Willingness to use a wide variety of techniques is required because people are different and need different things. Acceptance of people where they are while encouraging change is another requirement.
What is not required is a Ph.D. and an attitude of I can fix you if you just do what I say.
People with PTSD have very sensitive control detectors. They also need to find what heals them, not follow directions that may or may not work. History shows that people with PTSD can get better, but also that PTSD symptoms come back with further trauma whether it is a new war, the losses of old age, or huge reminders, like 50th Anniversary celebrations which threw so many stoic WWII vets into the arms of the VA.
So any program that claims to "cure" PTSD is suspect from the beginning. Does it have 50 year follow-ups? I think not.
It is fair to say is we can help you with your symptoms and if they come back, we will help you again. I have seen people who seemed to be cured by one technique or another, but I have not seen fifty year followups.
Human nature means if someone is told they are cured and symptoms come back, that person is going to think they are defective, not that the cure isn't a cure, and they are unlikely to go for more help.
I have also met veterans who have been told that we have done all that can be done for you and you aren't going to get any better. I do not know of any VA Hospital or clinic that even uses all of the forms of therapy I mentioned yesterday. (It was not a complete list, just off the top of my head.) I did not mention all the available forms, and new ones are developed every day, so that is an outright lie.
Here is a quote from the Transcend Program's manual (a joint PTSD and Substance Abuse program which was so effective that the VA cancelled it) "developing a therapeutic alliance that gives responsibility to the client for change and to the therapist for guiding and supporting that change. Basic to this is developing in the client a feeling that taking responsibility for change will be worthwhile. The concept of self efficacy guides much of our general thinking....We work at instilling in clients the benefits of self-exploration, interpretation, and reframing of life experiences. Gentle tenacity is sometimes needed here in the face of resistance. However, we see resistance not solely as a client based problem, but also as an inability of the therapist to frame the issues and benefits of self-exploration in a way that can help the client overcome his fears."
Now that is the right attitude! They go on to say, "there is no real change without behavior change... We see our position as therapists not simply as facilitators of change, but promoters of a certain way to change. Teaching new skills, emphasizing the need to act on newly learned behaviors, assisting clients in generalizing behaviors...to other situations, and helping them maintain new skills by providing reinforcement... and also teaching them self-reinforcement skills..."
Most of what I mentioned yesterday was also developed by people with the right attitudes. I used to go to the International Society For Traumatic Stress Annual Meetings and go to the workshops, looking for people with the right attitudes. Many of the free Post-Traumatic Gazettes on my web page have reports on that. More tomorrow.
http://www.patiencepress.com/patience_press/PTSD_Help-Gazettes.html 

Some things that help: Day 19 of National PTSD Awareness Month

What helps with PTSD: Each person is different, has different reactions, different beliefs, different beliefs about themselves, about whether they are bad or good, whether they can be helped. There is no one size fits all PTSD treatment.
Do people need individual treatment or groups? Groups are good in that other vets won't let you blame yourself for things that you may be blaming yourself for.
There are various form of psychotherapy:
DBT: Dialectical Behavioral Therapy designed for suicidal people with "Borderline Personality Disorder" and very effective for people who can't tolerate their own feelings of pain.
ACT: Acceptance and Commitment Therapy in which you accept that you have problems and commit to work on change.
CBT: Cognitive Behavioral Therapy: several kinds, some of which have huge drop out rates and should be preceded by DBT. There is a version for Trauma Related Guilt developed by Edward Kubaney.
EMDR: Eye Movement Desensitization and Reprocessing which helps some people completely and rapidly and does not help others.
TIR: Traumatic Incident Reduction, a short term very effective therapy which is not commonly used because it cannot be done in 50 minute hours. It takes as long as it takes.
EFT: Susan Johnson's Emotionally Focused Therapy a couples therapy for PTSD couples.
Sand Tray therapy where you set up the event and see things you didn't notice at the time...
Other types of help:
EFT: the tapping kind based on meridians in the body. Works for some people.
Yoga: a way to learn to modulate arousal.
Meditation: ditto.
Twelve Step programs: don't be fooled by the unethical research which says AA works no better than anything else, because the studies are always of court ordered people who do not have the one requirement for membership, the DESIRE to stop drinking. If you have that desire to stop, the 12 step program for your problem will help, whether it is alcohol, drugs, food, sex, gambling, etc. If you understand the symptoms of PTSD and know you are not going crazy when they come back, it helps. I wrote a pamphlet you can read at patiencpress.com, "An Explanation of PTSD for 12 Steppers: When I get sober I feel crazy." I also have a 12 Step Format for vets and one for Trauma Survivors. All free at my site.
Somatic therapies:
Pat Ogden's Sensorimotor Psychotherapy
Babette Rothschild's Somatic Trauma Therapy
Peter Levine's Somatic Experiencing
There are many more. Each of these can be googled.
More tomorrow

Day 18, National PTSD Awareness Month

So I left off with the idea of using humor, compassion and acceptance to deal with PTSD.
What the veteran has been through is the worst he or she has been through. What we have been through is the worst we have been through. Comparisons are odious. Compassion is better. Sharing is better. Even if you can't share details, you may be able to share the feelings, especially if you can identify them. If you can't share feelings, share a meal, or a back rub, or make love to each other.
If you are both really numb just from facing all the stress of living with PTSD, you can ask yourself, "If I were upset about this, what would I be upset about?" Substitute the feeling of your choice, happy, sad, appreciative, mad.
If you decide to talk, plan that while one talks, the other can listen without interrupting, except maybe to paraphrase. Then reverse it. Since the average person spends 30 seconds listening before they start formulating their reply, this takes practice and time.
It takes time to get better. It takes time for relationships to heal and to begin growing again.
Is your loved one worth your time?
Are you worth your own time?
Those are big questions and if you are feeling guilty and like everything is your fault, remember, it takes two to tango. It is nicer when you are working on coordinating your steps instead of dancing at cross purposes.
Compassion helps. Acceptance helps. Laughing at yourself helps. When Bob was writing Chickenhawk:Back In The World, we had to sit down and write out a timeline of what had happened. When we lived through the stuff in that book it was quite painful but in retrospect we were saying "You did what???" "I did what???" and laughing so hard we could barely talk. What had been so painful was now silly. Such drama!
Tomorrow I will talk about the kind of help I wish were available and some of the stuff that is.

St Francis and PTSD, Day 17

"Grant that I may not so much seek to be consoled, as to console; to be understood, as to understand; to be loved, as to love." The prayer of St Francis (who was a combat vet) seemed like a bunch of crap when I first read it, but it has come to mean a lot to me.
A person with PTSD is not good at consoling, understanding, or loving, especially in the acute phases, which they often deny are happening. (So annoying).
We can seek to console them, understand them and love them, but we can't fix them or force them to get help.
That is why we as family members need each other. I belong to a number of online groups and also have tons of stuff I have written on the subject free at patiencepress.com.
We didn't cause it, we can't control it, and we can't cure it. Trying to do this can make us nuts. (If your vet is driving you crazy, you probably are a little nuts, and can't see it. I couldn't).
When we get help, we give them space to change. They may not change as fast as we'd like, but even tiny changes can give us hope, especially if we notice them instead of focusing on the annoying stuff. That was hard for me because I was brought up focusing on the bad stuff and thought that was what intelligent people did. Haha!
Principles of recovery for both:
Let go and let God (or the harmony of the universe, or whatever).
Work on yourself so you can tolerate other people's feelings, mistakes, and live happily yourself. There is a saying, Live and let live, but most people focus on letting the person who is having problems live. They don't focus on having a good life themselves. So everyday, when you get up, you can ask yourself, what can I do to have a good day today?
Respect what your veteran has been through. Respect what you have been through, too. This is hard. To vets I say, remember how you felt when someone was wounded? That is how we feel. We see you bleeding all over the place and we can't fix it and that hurts because we love you. Please respect that.
Progress not perfection.
Have compassion for each other. This is hard. It is hard coming back to civilian life and concerns. It is hard dealing with someone who is showing the effects of war.
Get help. You can start by reading (patiencepress.com) and talking to other people in your situation. There are even several 12 step programs for PTSD (combatvetsanonymous, PTSDanonymous) and stuff on my webpage about how to start one. Spouses can start their own. I also suggest Al-anon for spouses, substituting the word PTSD for alcoholism. If the vet is using addictions to get through the day, working the steps in the program for your addiction can really help. You can seek outside help at the Vet Center or VA, although getting into the system is slow and frustrating and they tend to medicate instead of talk. You can go through the military. Finding someone you can talk to is important.
I want to point out some family triggers that no one thinks about:
Your family is slow: slow people get killed or get other people killed.
Your family is insubordinate: gets people killed
Your family makes mistakes: ditto
Your wife is bossy: bosses can get people killed
Your spouse is controlling: being controlled can get you killed.
Being asked to do something can get you killed too, so when a spouse asks you to do anything, some unconscious process may take over and you don't do it-to save your life- but neither of you knows that and it leads to a lot of arguments. I noticed this with Bob. Eventually I decided he had done as many things he didn't want to do in Vietnam (flying into a hail of bullets) as he was capable of, and I just needed to leave him alone. Now he is pretty helpful, but it took a while.
So if you never take out the trash, is it shooting at you? No? So take it out. Of course you might be thinking, Is the trash shooting? No. Then it is not important... Two perspectives that can be reconciled with compassion and acceptance and laughing together.
Getting better takes time, and mostly it happens if you take the time to recover. More tomorrow.

So if you are really pissed at your vet: Day 16 of National PTSD Awareness Month

So if you are really pissed at your vet, if he has been yelling and unreliable and drunk or watching TV or gaming non stop and all the other crap veterans can pull, can you change your perspective?
Can this be evidence of how hard what he went through was for him? How about if he seemed fine (haha) and recently something came up that triggered his PTSD and Mr. Reliable is falling apart? Most of us wouldn't walk off if he got cancer and wouldn't think cancer is his fault and if he just straightened up... no cancer.
PTSD is a set of survival skills which have become your loved one's biggest problem, and he or she does not want to have problems, and especially doesn't want to have them brought up every day. The current military take on PTSD is it exists but real men/women don't get it. We are so tough...
Human beings are designed to get PTSD because they are designed to do whatever it takes to survive, which is not always pleasant. And the symptoms last and come back on further trauma.
Most of us don't like being told we have problems either. I hate having my mistakes or faults pointed out to me.
So in the face of pain or anger, try calmness and compassion. "It must be so painful to be treated like that/feel so angry/be so depressed." People need to be listened to.
You do too, but when a vet is in the throes of PTSD, it is good to take you concerns to friends, a group or a therapist. Not to the vet.
I didn't know this so I kindly let Bob know whenever he hurt my feelings or disappointed me, but only after enough hurts and disappointments had built up to the point where I felt put upon enough to either explode or be self-righteously martyred and let him know.
It was not effective in getting me what I wanted.
That is the touchstone for me: "IS IT EFFECTIVE?" instead of my old pattern, "Am I right?"
I also learned to have compassion for myself. Living with a PTSD person, vet or otherwise, is very hard. We suffer, but most of us think they are worth the pain.
If you can have a good day when your vet is having a bad one, it lifts the big burden of ruining everyone's day off him or her. I used to think it wouldn't be polite to have a good day when Bob was having a bad one, but now I know it is politer to lift the burden.
I don't believe in long talks and working things out verbally, either. I believe in "Can you help me with this?" "No." "OK." or "Yes." "Thanks a lot." Getting along is a one moment at a time thing.
One thing that really helped me was understanding PTSD and anger. People with chronic PTSD have been found to have depleted cortisol, so they can't calm down once they are angry. This explained a lot to me about Bob. He could not calm down for hours once we started fighting. So I learned to say, "You may be right," and let go. Sometimes I'm thinking, "on Mars," but I don't have to say it. And when your heartbeat is above 175, which often happens when people get upset, your body is ready to run or fight, but no one is home in your brain! They can't take in what you are saying anyhow...
So would you rather be right or happy? And can you find support so you aren't trying to get all your emotional needs met by a numbed out PTSD vet?
That is what I did and still do. Bob and I are quite happy most of the time and when he has bad days, I listen. And guess what, when I have bad days, he does too. He doesn't even give me advice (except as a joke) since I told him "I just want to whine and snivel about this and I don't need suggestions." Luckily he likes my sense of humor.
More tomorrow.

Changing yourself: Day 15 of National PTSD Awareness Month

Learning to listen instead of talk was probably the hardest step I ever took. I only did it after I picked up a book, Parent Effectiveness Training, because I thought it would teach me how to effectively train my son, then 14, to quit arguing with me... Hahaha! It suggested learning to listen and let him find his own solutions, which was good. It also had a section on listening to pre-verbal babies, which I used with Bob because by this time he would not talk to me. I realize, today, that it wasn't safe to talk to me, because I corrected him all the time, "You shouldn't feel/think/act that way."
I had to let Bob have feelings I didn't like and that scared me. I had to work on myself which took up all the time I'd spent obsessing about him and Jack. This gave Bob space to find things that helped him recover. It was a really painful time for me. Change is scary. Bob hated it when I started going to recovery meetings. I developed a broken record in response to the unspoken question, "Will you still love me if you change?" which guys never actually say. It comes out more often as "Why the F. are you going to that meeting/therapist/group, etc?" I translated that and said, "I am going to the meeting because it helps me feel good about myself and I love you and I'll be back at 9." After 6 months of that, said in a loving manner, he stopped asking.
One of the things I hated about the program I went to was that they suggested acceptance as a good strategy for dealing with people you love (or anyone else). I thought this was so wimpy. You're supposed to try to improve people. NOT.
So I learned acceptance. Bob is who he is and I can't change that. I also learned to ask for changes and let go of the result. I don't have to hang around and be yelled at. I also can't expect to ask for a change and have it instantly happen. When I try to change, it isn't instant and I recycle old behaviors a lot! So will he. Now in the times of year that are difficult for Bob, I try to listen and let him be where he's at. Compassion and kindness are more effective than nagging and getting huffy and self-righteous. The bad times pass sooner. I remind myself "Would you rather be right or happy?" At one time I would rather have been right (no kidding!! I never admitted I was wrong in the first 25 years of our now 50 year marriage). Now I would rather be happy.
Many family members have been through hell and are extremely angry at the veteran. They don't see how what they may be doing can be keeping him or her stuck. I have a lot more suggestions at my web page http://www.patiencepress.com/patience_press/PTSD_Help-For_Spouses.html. More tomorrow.

Stuck! Day 14 of National PTSD Awareness Month.

Often after I had been trying to rescue Bob for a while with some new book or herb (Really, someone told me chamomile would stop his wakeups, so I got it and made tea. I was so furious that it didn't work, I can't stand the smell to this day.), I would shift into the persecutor/prosecutor role.
If you just did what I say, you would be fine! (Haha!) I felt each time that I had found the right solution, but I didn't know what the problem was (PTSD) and I didn't know whose problem it was (his), so my solutions, even on the rare occasions when he tried them (he did drink the tea) did not work.
We got into a really painful pattern, the final stage of which was VICTIM. Let me tell you (back of hand on forehead) what Bob did to me this week!
Then back to rescuer.
This is a common pattern in relationships where one person is perceived to have the problem and the other is perceived to be fine. It becomes stable, but usually over time things get worse and worse.
I felt that Bob was driving me nuts, but I had no idea that I was perpetuating the problem with my rescuing, which also consisted of "Don't be mad/sad/" or whatever other feeling I could not tolerate. Like I said before, I thought that was my job. I had no idea I was getting more and more controlling, impatient, self-righteous. I took everything personally.
It never occurred to me that he could be upset by anything but me, and since I was trying so hard to be perfect, if he was, say, depressed, I was furious with him because it meant I was a bad wife and making him depressed. (I think this was depressing, but so were things in Vietnam that he was remembering).
I misunderstood what was going on with him. For instance about 4 times a year he would get cold and distant and I would figure he didn't love me anymore. After I was writing Recovering from the War, I learned about anniversary reactions: The Ia Drang, Happy Valley, Bong Son and the month before he came home! These coincided with his cold periods.
More tomorrow.

Detach with love, Day 13 of PTSD Awareness Month

With all the additional information on PTSD ( although none of it is presented the way I see it) it is hard not to get annoyed when people will not go for help. Why is that? And what can a spouse do about it?
People are human and American, and human Americans do not like to think they need help. They are fine (F*ked up, insecure, neurotic and egotistical, but they don't know it) and you are somewhere between nag and nut case to think they are not.
Detach with love.
Let him be where he is at. Let her be where she is at. Our society tells us we can change people. If this were true, there would not be a new self help book out every week. The only person I can change is me, and that is slow and hard and I have not lived through a war and had the symptoms of PTSD hammered into me by traumatic events, over and over.
So if change is hard for me as a civilian, it is going to be harder for a veteran. He will have to face pain, devastation, horrible memories of blood and guts and fear and despair and anger and vengeance and destruction. It is easy to think he should man up and just do it.
We start out as rescuers: Oh, honey, you should go get help, or read this book, or do that. We do not know what healing from war involves. We have no way to know. I had a lot of advice for Bob, none of which he took, so when I was writing the book, I realized that not taking my advice was evidence too. 
In combat, things are out of the person's control. Wishes will not stop bullets or explosions or someone bleeding out. Those are just words to us. As Bob once said to me when we came out of the movie Platoon, "It's worse when it's real." 
Not following directions is evidence that following directions put them in danger. 
It is evidence that they need to regain a sense of control in their lives and if they do what you say they lose that. 
So even if what you are saying is the right thing, saying it may be the wrong thing.
More tomorrow.

So, I took Bob's feelings personally, Day 12 of PTSD Awareness month

So, I took Bob's feelings personally. I thought if he was mad, it was my fault. I must have done something wrong, so I would try to change. That never worked, because his problems were not my problems, but I saw them that way. I didn't know what the problem was (PTSD) so I thought he was the problem, MY PROBLEM!
I misunderstood what was going on because there was no information on PTSD. My efforts to fix Bob were really ineffectual. So I tried harder. We spent 15 years after he came back thinking we were losers, crazy losers, and I thought it was all my fault because I wasn't trying hard enough to fix him and make him happy. Sometimes he agreed. We had no idea what the problem was or that it was getting a name. In 1980, it became Post-Traumatic Stress Disorder. My mother, Constance Hartwell, MD, was a VA psychiatrist who talked to veterans, and she would tell me Bob's problems had to do with the war. She sent him big bottles of Vitamin B-12 and told him to drink less and smoke more pot.
Our VA in Gainesville was fond of giving valium, and told Vietnam vets to go to the Vet Centers in Jacksonville or Tallahassee. Bob actually went up and got a pamphlet from the Vet Center, the DAV's Readjustment Problems among Vietnam Veterans. (The DAV had actually funded the first study, The Wounded Warrior Project, of  Vietnam vets. No university, foundation or government agency would fund it.) We read the pamphlet and I cried all the way through it. What was happening to us had a name.
Nowadays there is much more information about PTSD, but none of it is formulated like this description of the symptoms as built-into-your-brain normal survival skills which keep you alive. Instead they are described as if they were a random collection of weird behaviors starting with re-experiencing. Then most of the current literature is slanted towards "only a few people will get this," "we can make you resilient," and "we can cure it." Like they can change human nature...
So the spouse thinks a. you won't get it, b. it can be cured, and c. here are the directions.
What I have learned is I did not cause this, I cannot control it, and I can't cure it. That is his job. It will be painful because he has to go back through painful experiences and I have to let him be in pain, be mad, be consumed with grief and guilt or whatever else he feels. So I had to learn to let go. I got help learning this from a couple of 12 step programs for people who want to run other people's lives.
More on this tomorrow

Before I start writing about how PTSD affects families, I want to mention that PTSD can have a delayed onset and it is also the gift that keeps on giving, haha.
PTSD can hit you when they start the next war. If you have had some help and are doing well, it can hit you again when they start the next war. Other traumas bring up the symptoms, your spouse gets sick, someone else is raped, a natural disaster. This is called human nature.
You know what the young soldiers will be going through and it hurts you and brings up pain you may have thought you had dealt with.
My suggestion is if something helped before, go for more of it. This does not mean the therapy didn't work. It means PTSD comes back in normal people when there are further traumas.
PTSD can be held off for years by acceptable "efforts to avoid thoughts or feelings associated with the trauma," like workaholism, hidden sex addiction (affairs, porn), religiosity, food, exercise. The list is endless. Then it is the 50th anniversary of your war and Boom! PTSD.
You can also be hit by PTSD when you reach a point where you can't drink anymore, or your wife gets sick or dies, or you get sick and feel helpless.
I am not going to be able to cover all the effects on families in one post, but I will start out with what happened to me.
I had no idea that war was anything but glorious, having been raised on WWII movies, documentaries, and books. I actually wanted to be either Combat Kelly or Sgt. Rock of Easy Company...
At 14 I realized wishing would not make me a boy, so I gave that up. It didn't occur to me to join as a woman. They couldn't be infantry.
In that era we were brought up to believe you could do anything if you tried hard enough, and you were responsible for the happiness of your family. If they had problems, you could and should fix them.
So when Bob came back from Vietnam, thinner, jumpier and leaping up at night, I started trying to fix it. Booze helped him sleep, so I got it. I made friends for us because Bob started isolating. I read self help books and passed them on to him and got mad when he didn't read them and immediately get better.
I also spent a lot of time telling him "Don't be sad" because I thought if he was sad it meant I was not a good wife, "Don't be mad," because if he was angry it meant I was not a good wife, "You shouldn't feel that way," if something annoyed him.
All of these stop recovery. Vets need to be mad, sad, annoyed and whatever else they feel, but I was always there helpfully trying to cheer him up. This is because I could not tolerate his pain. I did not see it that way. I saw it as being nice and as my job.
More tomorrow.

Duration: Day 10 of National PTSD Awareness Month.

The final note in the diagnosis is that the symptoms have to last more than a month. Hahaha!
This is so ironic for those of us who went through psychiatry's denial and delusion period (1968-1980) when they dropped the diagnosis of "Gross stress reaction," meaning if you had been through a gross (big) stress it could affect you. The examples were a concentration camp or combat.
Based on NOTHING but arrogance, in 1968, in the Diagnostic and Statistical Manual II, the only stress reaction available was a "transient situational disturbance" which could only last 6 months. Any longer than that proved you were screwed up before you went and it had nothing to do with the war.
This caused a lot of deaths and is one reason why some Vietnam vets still won't go to the VA.
People were given personality disorders, a pre-existing condition so the VA was not responsible for your problems, bad conduct discharges, when people were having PTSD reactions. It was an ugly shameful period in the treatment of veterans.
The new veterans are getting the same crap, too.
Studies of people who are traumatized show that most of them have all of the symptoms of PTSD right afterwards (critical stress reaction), but some of them don't go on to get PTSD. That means it is a disorder of healing. As I have pointed out, telling your story is healing but if no one wants to hear it, if they just want to drug you or run you through a 12 week program that will "cure you", or any other one size fits all treatment, it is very hard to recover.
Denial rears it's head here. I'm fine, and you're nuts if you think I need help... Ever said that? Thought it? Sometimes people can see stuff you can't. Plus FINE is an acronym for F*cked up, Insecure, Neurotic and Egotistical.
It is very hard to accept that you might need help. It is totally un-American these days, but remember, people used to have much more time to talk before computers, Facebook, and cell phones.
On the plus side there are lots of online places to get help.
Tomorrow, how this affects families of people with PTSD.

More Reexperiencing symptoms, Day 9 of National PTSD Awareness Month

Another symptom is "intense psychological distress when exposed to external or internal cues that symbolize or resemble an aspect of the trauma."
If you go into a rage when some clerk down at the VA acts like a lifer/REMF/FOBbit, it can cause problems.
If you get nuts when it gets hot and muggy (Vietnam, WWII Pacific Theater vets, Iraq vets) or cold (WWII European Theater, Korea) that is an external cue.
Anniversaries apply here. Veterans find holidays hard because of what they went through on holidays and because of the knowledge that lost buddies' families will be missing them.
On top of that there are private anniversaries (which you might not even know about yourself if it was too overwhelming to remember) which can turn you numb, angry and hypervigilant. The day Joe was killed, or the last hot and heavy lift (lots of helicopters [heavy] going into a firefight [hot] to drop off troops) you were asked to fly the day before you came home from Vietnam, which still affects my nearest and dearest.
The sound of kids crying can be torture to someone who had to clear villages. Grilling meat brings up associations you'd just as soon not have.
This is part of the brain's better safe than sorry system. If you find yourself flaring up, ready for anything and you don't know why, check for progression of triggers, but also check the date. And check the attitude of whoever is with you and the type of thing that is going on. Sometimes being out with people can remind you of the insensitive things people said when you got home.
if you lost your ability trust authority figures in the war, you may find that authority figures make you feel crazy. If you were protested, protestors may upset you. If you were cheered, cheering may upset you. This is a very individual type of thing. Being thanked can hurt as much as being scapegoated if you don't think you did enough.
You may also not want to be around other veterans if someone or some group let you down.
The last symptom in the re-experiencing group is having a physiological reaction to something that reminds you of the war or whatever trauma you suffered. Many Vietnam vets respond to the sound of a Huey with a surge of adrenaline. The new vets get surges of adrenaline at the sight of trash by the road (IED) or cars coming near them among other things.
Even though this is part of the brain's better safe than sorry system, it can be very upsetting, especially if you don't know what the trigger is or think it shouldn't trigger you.
The part of the brain that is doing this can't speak English, so you can't reason with it, and it can't tell time, either, so it does not know you are home.
Tomorrow I will talk about the last diagnostic criteria, duration of symptoms...

Flashbacks: Day 8 of National PTSD Awareness Month

The most well known form of re-experiencing is flashbacks. This is when you feel you are back in the trauma of war or rape or whatever you have lived through.
Everyone knows about this symptom. When an event happened so fast and was so overwhelming, it stays in the reptile brain as bodily memories, emotions, flashes of visual information, smells, sounds, touches. Any one of these can trigger a flashback. Smells and sights are especially triggering because of the direct connection with the brain. This is another form of the brain warning you of danger, but it can also cause danger if you think you are somewhere else for a few minutes and act on that.
One of the biggest problems with PTSD is that survival skills that have kept you alive can become your biggest problems later. This one is mostly a problem.
One of the funniest moments in our life, Bob's and mine, of trying to help people with PTSD happened when he was giving a writing workshop years ago at the Portland, OR VAMC. One of the guys told the group that when he got back from Vietnam he went to a community college and for English he had to write a journal. He got an F on the first one, and said to himself, "F*ck her, I'll make it personal. I'll write one of my night mares." He did. She corrected it and handed it back. He rewrote it. She corrected it and handed it back. He rewrote it. She gave it a good grade. He rewrote it a couple of more times just to make it completely accurate. Then he noticed he was not having the nightmare anymore. That night Bob said to me, "You know I have not had any nightmares since I wrote Chickenhawk. I never noticed..." That is what happens if you can turn those non verbal memories into some form of narrative memory, by writing, talking or any other way that works for you.
If someone is having a flashback, don't jump them. Try to tell them they are safe at home.
One of the quickest ways to get out of a flashback is to carry a safe scent with you, like vanilla or lavender, something you identify with as a good smell and that has nothing to do with the war zone or whatever danger you faced. The direct connection between brain and nose can help you short circuit the flashback.
The next symptom is when you have intense reactions to things that remind you of the trauma or symbolize it in some way. I will talk about that tomorrow.

Day 7, Reexperiencing

Reexperiencing:
So here we are at the set of symptoms which are first in the diagnostic criteria for PTSD. I put them last, because you can't reexperience anything unless you have first experienced it and it has made a big traumatic impression!
Like I said, PTSD makes more sense if you see yourself reacting swiftly and effectively to danger using skills built into the primitive part of your brain. Then you re-experience the events in various ways.
When I started out, I felt reexperiencing was a cry from your inner self for help. I have been through something that is too much for me! So it keeps reminding you of what happened in unpleasant ways. I learned that those parts of the brain store non-verbal memories. (If you want to see a non-verbal memory, hold a ball up in front of a dog.) One of the ways to get those non-verbal memories out of your head is to encode them as narrative memories, which means to talk it out or write it out and get the details right. That is why therapy works, but so does writing a book, like Bob did, or other kinds of writing. I will talk more about that when I get to things that help.
Here is the first symptom: intrusive unpleasant recollections of the event(s). This is like going over and over the plot of a movie, trying to figure it out. Your brain needs to figure it out. That is one of the brain's functions. What happened? Why did it happen (to ME)? this is the better safe than sorry part of your brain which wants you constantly looking out for danger so you won't get hurt again.
People do not want to keep thinking about those experiences. They intrude! Shove in where they are not wanted. This can make you feel quite nuts. Why can't I stop thinking about it, or dreaming about it (the second type of reexperiencing)? What is wrong with me?
PTSD symptoms are proof of survival. You can't re-experience if you don't live. However re-experiencing is disconcerting, painful, devastating, depressing and often horrific. When you can't stop thinking, seeing feeling or dreaming about painful events it makes you cranky or outright angry and it can turn you towards self-medication. You may be unable to sleep because of nightmares or afraid to sleep for fear of having them. To me, your brain is telling you something does bother you. Since military men and women are not supposed to be bothered by anything, it seems like your brain has to whack you over the head with re-experiencing to get you to notice that it did bother you...
Tomorrow I will talk more about the other reexperiencing symptoms.

Loss of interest and Can't remember Day 6 Of National PTSD Awareness Month

Recovering From the War

a few seconds ago

The next to last symptom in the numbing and avoidance set is no longer being interested in things that used to interest you. This is another survival skill because what you are interested in is avoiding triggers at all costs.It helps to understand the progression of triggers. A second generation trigger, like the gun, beer and friends in my example yesterday, can lead to third and fourth generation triggers of things that are around when one of those triggers you. If things trigger you that seem not to make sense, try to figure out when you first felt this way...
Even without second and third generation triggers, people who once had lots of friends may now avoid them. People who loved hunting, now can't hunt. People who were out and around now stay home all the time. Movie lovers don't go to movies anymore.
People who loved sex, don't want to do it anymore. (One of the truths no one ever mentions...war ruins sex for many men for various periods of time after). Naturally wives don't know this so they feel undesirable and get mad. Guys don't know this so they start looking for someone more exciting. Believe me, it is not you spouse and it will pass. I have only talked to men vets about this, but I suspect it is true for women combat vets, and I know being raped ruins sex for anyone.
So when you lose interest in outside things, you may find yourself staying home and advising your wife on how to wash dishes. This is dangerous, guys. Snarling often results. If you did stuff together, she may feel abandoned when you won't participate anymore.
The last symptom in the numbing and avoidance category is when you can't remember all or part of the traumatic event(s). Traumatic amnesia is common. Traumatic events often happen too fast to be laid down as a narrative memory, which is what your fore brain does. Your are reacting with what used to be called the reptile brain in my high school science classes. This is protective. Some events are so overwhelming they would incapacitate you, so evolution or God has given you this capacity. Hugh Thompson, the helicopter pilot who tried to stop the My Lai massacre, forgot it until the Army investigators came to interview him two years later. My husband Bob has a picture of himself in front of a bunch of dead VC at Plei Me, but he does not remember the event. One of my favorite vets tried to kill himself the same day ten years apart, so his therapist decided they should check the unit records. Turned out 28 guys in his unit died on that day. If you find yourself doing odd things the same time every year you may be reacting to an anniversary which leads me into the third set of PTSD symptoms, re-experiencing, which I will start on tomorrow.
If you follow the facebook page Recovering from the War, I think you will get these automatically. I will be posting every day this month. Or you can follow this blog. I cross post.

Efforts to avoid activities and situations Day 5 of National PTSD Awareness Month

Recovering From the War

about a minute ago

Efforts to avoid activities and situations that remind you of the trauma: This is another protective symptom. Avoiding triggers becomes the most important thing.
You may avoid being given orders or a job to do because it can get you killed, so you don't take out the trash, because on some level that you can't even identify, it may get you killed.
You avoid crowds, because one rule in war is "Don't bunch up. Makes a bigger target."
Cookouts bring up memories of burning flesh, parked cars or roadside trash bring up memories of IED's, family parties bring up memories of those who died and don't get to be with families. Sometimes parties are also full of people who want to know why you aren't over it yet, too. Not helpful so you avoid them.
The sound of children crying in the war zone has made you unable to listen to your own kids cry so you avoid that. If you and your family don't understand what is going on, everyone gets mad.
There is also a progression of triggers. Say you are shopping in Wal-Mart and someone drops something big making a loud bang and you hit the floor or some kid is crying and you have to leave. Walmart can now be a trigger you have to avoid. Or you see someone who looks Iraqi or Afghani, while chewing gum and drinking beer in the park with your friends and have a moment of terror. Now gum and beer and friends and parks can become triggers. Needless to say, being triggered by gum is going to make you feel nuts because how does it relate? Not everything will be a trigger, but odd things may become triggers. It helps to see if you can trace them.
Some of the problems veterans have with the VA are based in this symptom. Good old hurry up and wait or SNAFU's, so common in the military, can trigger people in the VA where waiting and SNAFU's are also common.
Tomorrow: Loss of interest in old activities you liked before the war or trauma.
Please share with anyone it might help. You can also follow my Facebook Recovering From the War page to get all the posts this month, National PTSD Awareness Month. I will post every day.

Foreshortened future and efforts to avoid... Day 4 of National PTSD Awareness Month

A sense of a foreshortened future is also realistic. Live in the now! You see other guys or women your age blown up by IED's or whatever was common in your war, why would you expect to have a long life? People die all the time in your experience, suddenly and in ugly ways.
It is also self-protective. Why plan and hope when you could be dead tomorrow? This can lead to a lot of behavior which looks irresponsible, and often is. It ties back to emotional numbing, because often people are so numb the only time they feel alive is when adrenaline is pumping through their bodies. Everything from screwing around to getting into bar fights or driving fast motorcycles, jumping out of airplanes, becoming a cop or firefighter can be a way to get the adrenaline going.
I forgot to mention yesterday that emotional numbing to deal with war also numbs your ability to feel good emotions. Feeling nothing is common with vets, and when you feel nothing about your wife or husband or if your mother dies, that is a symptom, not proof that you are a bad person. You wouldn't have to feel nothing if you didn't care...
Anyhow, back to symptoms: "Efforts to avoid thoughts or feelings associated with the trauma," means that if you think you were at fault, you may spend the rest of your life having to be right. If you lost people you loved (and no one is closer than buddies in combat) you may try never to love anyone again, If you trusted the government or your branch of the military and were hung out to dry or betrayed, you may never trust anyone again.
You may live in denial (It's not just a river in Egypt, haha) and believe that the war didn't affect you. Everyone else is screwed up, but you are fine (f*cked up, insecure, neurotic and egotistical is how I see it...for me.)
Finally the most common way to avoid thoughts or feelings associated with the trauma is to stay drunk or drugged. This used to be considered "willful misconduct" by the VA, but now is considered secondary to this symptom of PTSD. There are other addictions too: food, sex or relationships, gambling, internet gaming or porn, religion, adrenaline, anything you can think of.
The reason for this symptom is self-protection. The pain of what you saw or did can be so great that it is overwhelming. It is illegal to be in pain in America. People want you to be over it now, or at least by tomorrow... And when thinking or remembering or being reminded of what happened, you can be triggered into rages, startle responses, and other disturbing behaviors that cause you a lot of trouble, so avoiding triggers becomes a priority.
Stay numb. Avoid everything. Seems logical, but it is usually pretty ineffective.
Tomorrow: efforts to avoid activities and situations that remind you of the trauma.
One request: If you like my posts, please share them with others.

Numbing and avoidance, day 3 of National PTSD Awareness Month

Before I start on the cluster of numbing and avoidance symptoms I want to make it clear that I think each PTSD symptom starts out as a useful effective survival skill. They keep you alive. They also can become your biggest problems, but they start out as lifesavers.
Under numbing and avoidance there are 7 symptoms. They are based in the brain's built in capacity to rapidly adapt to whatever is going on and on its built in need to be in control.
So, in my opinion, the first one, not having all your emotions, comes from a combination of attention to threat (so feelings fall away because they can actually interfere with survival), the need to be in control (no distractions), and the brain's ability to rapidly adapt to what is going on so you can survive. You may puke at the first kill you see or do, but it will become just another everyday occurrence quickly. It helps you do your job and survive, and it also protects you from a depth of pain most people never have to face. After all, we are all brought up to think we have to get over things and move on, preferably rapidly. This has no relation to the actuality of mourning friends and other losses, but it is a common idea. Being numb helps when there is no space or time for mourning and it helps later when people say, "Aren't you over that yet?" It is practically illegal to be sad in America.
The next symptom in this cluster is "feeling detached and estranged." This is REALITY. You are different and other people can't understand. I realized this when I was writing Recovering from the War and thought I was beginning to understand and then Bob and I went to Platoon. After, I was saying how awful one of the scenes was and Bob looked at me oddly and said, "It's worse when it's real." Holy shit, I thought! I can't understand because I am simply hearing about it, seeing it on the screen, reading. I can't smell it. No one is shooting at me. I'm not there!
This was an epiphany for me, and I share it whenever I speak on PTSD. Do not say you understand, because you can't. Say you want to understand.
Anyhow, feeling detached and estranged form others is appropriate. For one thing your locus coroleus has changed and become hyper-responsive to danger and stress, which inevitably ties back into the hypervigilant symptoms I talked about in the first posts.
This is also an effective survival strategy after the war is over because people say such shitty things to veterans: Arent you over it? How many people did you kill? Or even, like happened to one of my WWII vet friends who hadn't eaten at a table for a year: where are your manners? Being detached and estranged in these circumstances is protective.
I will talk about a sense of a foreshortened future tomorrow.
This will be cross posted at the usual places, My book page on FB, my author page, my personal page and here at blogspot

PTSD Awareness month; days 1 & 2

Just posted this on Patience H C Mason, my author page and Recovering From the War, my book page:
Since I just found out that June is PTSD Awareness Month, I think I will try to publish something each day here and on my Recovering from the War page. Don't ask me why I have two pages on Recovering. It seemed like a good Idea at the time.
I find the professional literature on PTSD lacks insight into human nature.
When I was writing this book, I kept asking myself why would a person have this reaction? What is its purpose?
To my way of thinking, the symptoms of PTSD arise out of survival skills built into all our brains: not into the thinking, speaking parts, but in the more primitive parts which react before thought.
PTSD symptoms are grouped in clusters, but the order of the clusters in the official diagnostic criteria make them look random and weird.
My order is arousal first, then rapid adaptation and avoidance, and then re-experiencing, which can't happen till AFTER, after all...
When someone attacks, your body reacts instantly, shutting down or fighting back or running (freeze, fight or flee). It's instinctive. We don't have conscious access to this ability. Sometimes a highly trained soldier will find himself unable to get up and attack because this part of him knows he won't survive. It is not cowardice.
The most common response is to flee. That is why soldiers have to be trained to fight.
So I start with the brain's built in ability to pay attention to threats. Wave your hand in front of a snake or bat at a kitten to see this in action.
We, too, react that fast. There is no thought involved. People who don't understand danger call this an "exaggerated startle response," instead of an "effective startle response," which kept you alive.
Threat creates an emotional response. Emotions are designed to keep you alive. Threat creates anger. Irritability and outbursts of anger are a pretty natural response to people trying to kill you, or otherwise traumatize you. More tomorrow.
So I got as far as "irritability and outbursts of anger" yesterday, a part of the cluster of symptoms which arise out of the brain's natural ability to pay attention to threats, to act instantly in reaction, and then to become constantly wary, checking for more threats. Normal brains do this, become hypervigilant, especially if the threats are constant, or intermittent and prolonged, both of which are a good description of many war experiences (and violent families). Anger can keep you alive and help you endure the privations of war or other traumatic events. "Inability to fall or stay asleep," is the next symptom in this section of the diagnostic criteria. This will also make you irritable as well as being the most effective form of torture, too. People do not sleep soundly in wars. It can prove fatal. The last symptom in this category is the "inability to concentrate," which is another misstatement. The veteran is not concentrating on normal everyday stuff. He or she is concentrating on who has a weapon, how will I get out of this room, is that an IED on the road ahead, etc. Concentrating on survival leaves very little room for listening to your spouse or a new therapist or some clerk at the VA.
When you look at these symptoms the way I do, you see them as an effective set of responses to war and other traumas. They are not weird or weak or abnormal. As a matter of fact I see PTSD as a solution to the problem of war. You lived! Tomorrow numbing and avoidance.
By the way, if you have friended me on facebook as Patience H. C, Mason, you can also follow me on my book page (Recovering From the War) and my author page Patience H C Mason (no periods after the initials.
I am cross posting all of this.