Patience Mason's PTSD Blog

An ABC of Ideas for Living with PTSD Patience Mason.

2011-05-17T12:36:00.001-05:00

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

A. Acceptance: In the "Big Book," Alcoholics Anonymous, on page 448 (3d Edition) or 417 (4th Edition) is probably the most famous reading on the topic of acceptance. Most people want to be accepted as they are. Balancing acceptance and the desire for change is a delicate task. I learned to accept my painful emotions because of this reading, to sit with them and let them pass. I also learned to accept my husband and to let him find his own path to healing, which I had been blocking with advice. I also learned to accept that changing took time for both of us. In recovery, I also learned to develop a pause button, to take time to think, and then to act instead of always reacting to the behavior of others.
B. Boundaries. Free handout on Boundaries is available at www.patiencepress.com. It is a bunch of small actions that helped me develop boundaries with Bob. The Serenity Prayer is a good guideline. Balance. I was a person of extremes, totally busy or wiped out, elsted or deeply depressed. Now I try to be balanced, do stuff for others but practice self care.
C. Compassion: We need compassion for ourselves and for our veterans. The best stuff on self compassion which generalizes to others and prevents a person from allowing abuse was developed by Steven Stosny, www.compassion-power.com. Using his HEALS technique is very effective. See issue #20 of the Post-Traumatic Gazette for other ideas.
D. Detachment: Detachment means you don’t get sucked into the chaos that can surround PTSD. You can get a lot of help from Alanon literature which you can pick up at any meeting or online at alanon.org. There are 22 readings on Detachment in One Day At A Time In Al-Anon. I tried to become rapidly detached by reading all 22 everyday when I first started going. Didn’t work, but over time, I learned that skill. There is a .pdf of the Alanon pamphlet at www.seattle-al-anon.org/PDF%20Files/S19-detatchment.pdf. Substitute PTSD for alcoholism.
E. Examination: I found it particularly effective to examine my own cognitive distortions using the book, Feeling Good by David Burns, MD. Adult Children of Alcoholics literature also focuses on patterns learned in childhood, which I did not see as patterns, because I thought they were reality. A daily inventory or self examination, to keep me on track, has also helped me. I write out what made me happy, what challenged me, what I need help with, things I’m grateful for, and things I did well.
F. Focus on yourself. Focusing on the person with problems is easy to do. Cheering him or her up, suggesting solutions, rescuing, cheerleading, all stop healing, but I didn’t know that. I thought I was being “nice.” We may be ashamed to focus on ourselves. It seems selfish. There is a healthy kind of selfishness, however. Focusing on your own growth is very hard. If you do it, you won’t have time to be fixing everyone else, which will give them room to grow. They may grow raggedly or off in some direction that seems useless to you, but mistakes are how people learn (especially if no one is constantly warning and shaming and blaming if it is a mistake). I thought I knew what would help Bob. The things that have actually helped him are different. Very humbling!
G. Get help. In addition to whatever therapy is available for family members, joining Al-anon, Co-Dependents Anonymous or any other 12-Step meeting and working the steps is helpful and free. The third issue of The Post-Traumatic Gazette discusses the 12-step process as a self-initiated, self-regulating process of internalizing compassion and self-care. I have written formats for 12 -step groups for Veterans, Family and Friends and for Trauma Survivors, Family and Friends which can be downloaded from my website (www.patiencepress.com). Sources of help can be as close as the nearest VA/Vet Center or Crisis Center. There are hotlines for soldiers, veterans, and victims of violence. New therapies, from tapping your meridians to Cognitive Behavioral Therapy of PTSD are available.
H. HOW do we recover? We have to be Honest (yes we could use some help), Open to suggestions, and Willing to try things
I. Initiate your own recovery. Even if other members of the family including the veteran are not willing to get help, you can get help. If living with a vet is wearing you out or driving you nuts or you just want to grow and change, it is perfectly okay, not selfish, to seek outside help. If you can’t understand why the survivor can’t just “get over it” or change, I suggest going to Al-anon meetings and working the steps with a sponsor to get some idea of how hard it is to ask for help, to accept help, and to change.
J. Judging is a waste of time. Was this bad enough to cause PTSD? So-and-so went through worse things and he’s fine. This kind of judging is a waste of your time. People are different and are affected differently by different experiences. Dealing with how things are today is more effective.
K. Keep at it. Changing is ridiculously hard. It takes time and effort and more time and more effort. Plus we work though the same stuff over and over, which I call recycling. I have been working on myself for 22 years now, and sometimes I still go back to old behaviors. Not for long, and not as badly, but I practiced being the way I was for 45 years. I may be over my old patterns when I’m 90...
L. Let go. I had plans for how Bob should recover. When I let go of my plans, better things happened than anything I had ever thought of: he found his own way of healing that worked for him. I also had plans that I would recover if I went to 12-Step meetings for a few weeks. It is hard to let go of old behaviors and thought patterns however, so I am still going to meetings 22 years later to reinforce the changes I’ve made.
M. Manage your own life. When I am really working on my own life, really living not just existing, I don’t have time to manage other people. Yes they make mistakes, but if I’m not pointing them out, they seem to learn more from them. And when I am focused on me, I see more of what I do do and what I’d like to change.
N. Network. Other people are going through what you are going through. Find people who are growing and changing themselves, not bitching and moaning about the person with the problems as if they had none. Those people can make suggestions and support you in changing.
O. Organize. PTSD often leads to chaos. Part of recovery for me has been organizing my life and my stuff, one little bit at a time. Progress not perfection is the watchword here. The first time I heard that , I thought, “WHY wouldn’t I want to be perfect?” My answer today: “Because nobody is, and people who try to be are annoying.”
P. Patience. Yep! You definitely need this virtue. It is a quality you can develop as you recover, as I am. Having patience with yourself, which is based on realism about how hard it is to change, helps you have patience for others. Persistence is good, too.
Q. Quiet time. Bob and I both meditate and take quiet time each day to simply be. It takes patience, helps develop patience, and has a profound effect on how you feel. Are you worth your own time? We use the book Wherever You Go, There You Are by John Kabat-Zinn.
R. Repetition and Recycling. “Repetition is the only form of permanence that nature can achieve,” George Santayana wrote. The same problems and old reactions come up again and again. I call this recycling. Repeating a new action that I have learned in recovery. like detaching or saying “You may be right,” helps me get through the problems faster than I did before. It is one of the ways you can tell you are recovering. You get through, around, over, and under things much faster. You see different paths, patterns and possibilities more quickly.
S. Safe means sanctuary. The aim of recovery and of becoming a part of the solution is to make your relationship a sanctuary for both of you, not a battle ground.
T. Trust. Family members sometimes feel betrayed by the person who has PTSD. Promises are broken. Needs are not met. I suggest changing the focus. We don’t expect cancer patients to magically recover for us, nor diabetics to eat cake for us, yet some of us want people with PTSD to get over it for us. I have learned to trust that Bob is doing his best. I belong to support groups so I can get my needs for emotional and social support met without being entirely dependent on him. I never ask him to promise to do something, because I know he needs the freedom to make healthy choices for himself. I also trust him to be human and therefore not perfect. Makes my life a lot easier.
U. Understanding. I’ve gone through layers of understanding PTSD, Bob, and myself, and every new layer has helped me heal. Bob isn’t emotionally unavailable because I’m not pretty enough, not neat enough or no good. It has nothing to do with me. It is because he has PTSD. When I understood that, it helped heal my low self-esteem. Other insights have come and changed the way I viewed myself and him. Understanding leads to compassion, and compassion heals us.
V. Value yourself and the survivor. Once I thought of Bob as the bad boy and treated him as such. Now I think of him as a man who faced death everyday in Vietnam to help others. He is a hero to me, and I value him. And I am a woman who never gives up, so I value myself, too. I used to hate myself because I couldn’t make him or me perfect. Valuing myself is a lot better.
W. Want to vs. willing to: Sometimes we have to be willing to do things we don’t really want to do, like practice compassion and kindness when we are getting hostility and coldness. I tell myself, “This too shall pass.” It does and I didn’t make a bad situation worse by reacting to unkindness with unkindness. Wait. Change is rarely swift. Change is very hard for trauma survivors. It is easier to wait if you are working on yourself and trying to live life while you wait.
X. X-ray your own baggage. Keep that pitiless eye on your own recovery. Judging someone else’s recovery efforts is ineffective and a waste of time.
Y. Yearn. We all yearn to be loved, to be special to someone, to be happy. Let these yearnings motivate you to grow and change.
Z. Zero in on your own part. If I speak to Bob in “Hitler voice,” I apologize for the tone, which is my part. How I say things is my responsibility. So is what I say. I no longer find it acceptable to think, “Well, he spoke in an ugly tone,” or “He said something mean, so I can be mean back.” It would have been nice if I’d been over that in grade school, but I wasn’t. I am now, for the most part. My behavior usually is not a reaction to other people’s behavior, but based on the kind of person I want to be. If I do react angrily or defensively, I make amends as soon as I am able.
These ideas have helped me heal my relationship with Bob and with myself. I hope you find them useful. Take what you like, and leave the rest.
War has consequences. There are some things veterans can’t do because they have been to war. There’s strength in recognizing this.

New Washington Post article on PTSD and TBI

2011-05-15T10:14:00.003-05:00

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

A Pill to Prevent PTSD

2010-12-19T20:26:00.004-05:00

I have to laugh when I read this kind of stuff. Are they gonna give a pill after every firefight and every IED? After every time a pedophile molests a kid whom he or she has picked because the parents won't know or won't believe? After every time a battered wife is battered?
This morning, I was thinking about the brain-based survival skills that are activated by danger. We all have them. They are built into us. Attention to threat, the ability to rapidly adapt to whatever is going on (i.e. numbing) and the capacity to pour on the adrenaline to move before thought and do whatever it takes to survive don't reside in the forebrain where we think, use words, use logic, plan. These abilities are built into what they called the reptile brain when I was in high school biology, a part of the brain that doesn't speak English, and can't tell time, so it can't tell something is over. It is also a better safe than sorry system, so it keeps reminding the survivor that the world is not safe.
And they are going to disable this with a pill? Don't they think this system is what has kept the human race alive?
If you jump at a cat, you see the same system in action. Move, adapt, live!
There's a book about meditation, Don't Just Do Something, Sit There. People with PTSD don't need a pill, they need training in techniques that allow them to choose when to be numb (it can have certain advantages when dealing with bureaucracy) and when to feel, when to let hyperalertness take over and when to be calm, when to remember and when to step away from the memories. Meditation is one way to learn how to do this. So is yoga. Somatic therapies developed by Pat Ogden and Babette Rothschild also work. So do the exercises taught in Dialectical Behavioral Therapy developed by Marsha Linehan.
They also need to process what happened to them, moving the non-verbal memories which keep activating symptoms into the forebrain by using words, writing or talking about what happened. It hurts, but then they have already lived through the pain of the actual events.
Avoidance perpetuates PTSD.
Is this pill a form of avoidance? Who knows? I don't, and they don't, but I just can't imagine soldiers taking a pill after every firefight. Would they lose their edge? Who will volunteer to find that out or are we just going to blindly do it like they are now doing with sending soldiers back who have PTSD, on drugs that are un-tested in randomized clinical combat trials?

A good positive change!

2010-12-15T14:15:00.001-05:00

An article on veterans courts in the NYTimes gives me hope.

Does it ever change?

2010-12-14T18:06:00.004-05:00

I found this Time Magazine article while trying to find information on the VA Hospital in Rutland Heights, Massachusetts, where I grew up and my dad was chief surgeon. We moved there after the time of the article, and probably they wanted my Dad because he had been a thoracic surgeon in WWII in Europe so he was a good surgeon and a vet, too.
What I find so surprising is that this article was written after the big one, the good war. Apparently the greatest generation was not the greatest generation when they got home. I think they probably had to fight to get good treatment just as Vietnam vets and OIF/OEF vets are having to do.
Most VA's these days have excellent medical care, but they are overwhelmed because during the previous administration, the VA budget was cut. This was an unfortunate but not unexpected result of a war begun by people who had never been to war. They had never seen the physical damage war does to people, so they failed to plan for the wounded. And like most foolish war planners through out history, they thought the war would be over in a few months.
They also believed the right-wing propaganda that real men are not bothered by war and PTSD is a left wing conspiracy against our troops, so they started attacking the diagnosis.
The actual left-or-right-wing conspiracy against our troops took place during the Vietnam War when DSM II came out (1968) and dropped all mention of post-traumatic reactions from the list of available diagnoses.
At the bottom of the article if you look closely there is a footnote that says:
"Veterans' Hospitals are of three types: general, neuropsychiatric, tuberculosis. More than half the patients are neuropsychiatric cases."

In other words PTSD...
Read more: http://www.time.com/time/magazine/article/0,9171,797525-2,00.html#ixzz18D0v5SBC

Facebook Page and Holiday helps

2010-12-11T15:02:00.003-05:00

I started a Facebook page, Patience H C Mason, Author, which is the business kind of page so it comes with a discussion board (the link to the title of this post) to make it easier for people to ask questions and find help. I have three discussions started including two begun with two different articles I wrote on the holiday season, PTSD and Holidays and one called "Can't you just be normal for one day?"
These are also available at patiencepress.com if you want to print them out. This time of year is hard on veterans and other trauma survivors so I am hoping these will be of help to some of you.
Anyone is welcome to friend me on Facebook, but if you do, please add a note to your friend request saying how I may know you, or what the connection is...
Meanwhile, Happy Holidays!

Women Veterans

2010-12-08T12:03:00.007-05:00

Two things have happened recently that got me started on thinking about women veterans. One, I saw Lioness the film, which totally blew me away. Second, I got an email from a VA therapist working with OIF/OEF veterans asking me to rewrite Why Is Mommy Like She Is? for the new women veterans, which I have done. You can order it at my website.
Today Anonymous posted on one of my posts, Do you have anything for women veterans? My reply to her is let me know what you need and I will try to write it.
Some thoughts:
War changes people.
We, as women, are supposed to take care of other people's emotional and physical needs. Even today, in a household where both people work, the wife still does most of the housework and child care after work, while the guy watches TV. Is this fair? No. Is it right? NO. Is it common? Yes.
I'm not sure how quickly this expectation is laid on our women veterans when they get home: the housework and the parenting. From my own experience when Bob got home from Vietnam, I suspect it is hard to get back into giving a sh*t about laundry and dishwashing... and even the kids... your husband...
No matter how much you may want to be the same, war has changed you, and it will take time, and sometimes therapy, to let go of some of the pain and altered priorities and become who you prefer to be. One of the things war will do for you is to get you thinking about how you were and if you want to be that person...
When Bob went to Vietnam, he smoked. When he got home, he'd been living in a tent and sometimes sleeping in the helicopter for a year, so he'd just flick his butts on the floor. I laughed. He was raised by a much better housekeeper than me, so he would apologize and say he'd been living in this tent, and they all did it. He got so he didn't do it after he'd been back about a month.
At that time, I don't think I was even aware enough to realize he had been living in a separate reality in which all the priorities were different, but I hated housework so I thought it was really funny... I think that was good for our marriage, because if I had taken it personally and felt insulted or any of a million other common thoughtless reactions ("Don't you have any manners," to a WWII combat vet who hadn't eaten at a table for YEARS.), I think our problems would have been greater.
Things happen in war that change a person's priorities.
Another thing that was pretty evident, looking back, was that Bob's physiology and emotional life were changed by the experience. These were the normal results of his brain trying to keep him alive: hyperalertness demonstrated by an utter inablilty to sleep and leaping up over and over in the night, emotional numbing which caused me to feel unloved because I had no idea that in war you have to put away your emotions to rapidly adapt to what is going on around you so you can do your job, despite bullets, rockets, IED's or whatever. He began to drink to get to sleep, another common way of dealing with the changes war creates in the brain.
At the time, most psychiatrists were telling veterans who said war had changed them, that they were wrong, but now we know it does change you, your brain chemistry, your reaction times, etc.
I think this would be harder to accept for a woman because we are supposed to be feeling, emoting, caring people, so If you feel like you don't give a sh*t, be aware that it is a normal protective device of your brain, not some kind of moral defect. It is evidence that you lived through something that killed others, so it is a good thing. It can become a bad thing over time, but right after you come home, give yourself a break and don't expect yourself to be the same.
War changes people. If you understand the changes, it makes them easier to accept. If you don't like them, you can work on unlearning what you have learned under the hammer of war. My "Veterans Day and I'm mad" post has a very detailed explanation of the changes, if you would like to read that.
Meanwhile, whatever happened to you, whatever you did or didn't do, you deserve to recover.
My email is on my profile, so please email me with any questions you have or topics you would like covered.

War veteran barred from CCBC campus for frank words on killing

2010-11-22T15:41:00.005-05:00

I hate this kind of story.
People are allowed to be where they are at!
Imagine! A veteran who loves to kill! Is this a surprise to anyone? People are different. Some people won't hunt or kill anything after they get back from war. Some people love it. Love what we ask them to do in our name.
The human brain is designed to keep you alive, so when you are fighting for your life and win, your body reacts with joy (See On Killing by Dave Grossman). Your brain is also designed to rapidly adapt to whatever is going on, so the first killing is upsetting, but a few killings later it is just everyday, or maybe even fun.
One of my Vietnam vet friends won an argument with the guys he was with and got to be the one to kill the VC they had caught. That was the best thing that could happen in that day , and isn't that a comment on the reality of war. This is not unusual although it is not talked about much, because most people are ashamed of the pleasure they find in that ultimate win, killing.
Another vet told me that when they went on missions to bomb or drop napalm, and the mission failed, they dropped it anywhere in Vietnam on the way back to the airbase. It was SOP.
General James Mattis got in trouble for saying, “ "You go into Afghanistan, you got guys who slap women around for five years because they didn't wear a veil. You know, guys like that ain't got no manhood left anyway. So it's a hell of a lot of fun to shoot them. Actually, it's a lot of fun to fight. You know, it's a hell of a hoot. It's fun to shoot some people. I'll be right upfront with you, I like brawling."
Isn't that what you want in a soldier?
Later on, as they get older, some people are horrified by things they did, which seemed normal, everyday stuff to them at the time. They need help, not condemnation.
I notice that Charles Whittington says in his essay that "We train and train for combat, and then when we actually go to war, it is reality and worse than what we have trained for." There is no training that makes you ready for what will happen to you in combat.
Every person who goes through that is changed by it. Charles Whittington is getting help with his reactions and being honest about the cost of war for him. I admire his honesty.
When I was young and Vietnam was going on, I used to think, very self-righteously, that I would never do any of the bad things we were hearing about. Then I talked to a lot of vets when I got older, writing Recovering from the War, and I realized that at 18 or 19, I was a black and white thinker, and I would have killed any one I was told to, and any one who got in my way, or killed my buddies, or didn't warn us about booby traps... It was quite humbling.
Only something like 10 % of people won't follow orders like the German soldiers in WWII or the American soldiers at My Lai, and I was not one of them. Most of us are not.
I hope I am one of those 10% today.

More rant

2010-11-17T13:33:00.004-05:00

I followed link after link to see if there were a way to find out why I could not contact Military Onesource, and got to a place on the DOD website where I could ask a question. Here is the email I got back:

Thank you for contacting the Department of Defense. We have received
your message. We read every message and will take the appropriate
actions in response to your question or comment.
We are the Office of Public Communication, a part of the Office of the
Assistant Secretary of Defense for Public Affairs
If the answer below does not resolve your query, please update your
question at
http://erms.dma.mil/Scripts/rightnow_DefenseLink.cfg/php.exe/enduser/acct_login.php?p_userid=ptg@patiencepress.com&p_next_page=myq_upd.php&p_iid=120483&p_created=1290016843
Question Reference #101117-000054
---------------------------------------------------------------
Summary: the book Recovering From the War
Category Level 1: Other Issues Not Listed Above
Date Created: 11/17/2010 01:00 PM
Last Updated: 11/17/2010 01:00 PM
Status: Unresolved
Discussion Thread
---------------------------------------------------------------
Customer (Patience Mason) - 11/17/2010 01:00 PM
Why is it not listed on Military Onesource as a resource for families? Why can't I contact Military Onesource myself to find out why?
There is a disclaimer that they can't connect to commercial websites, but the do list a number of books, including one for adolescents. I have also written a couple of childrens books: Why Is Daddy Like He Is? and Why Is Mommy Like She Is? in a new edition for the new women vets.
These are resources used by VA's and Vet Centers and I can't even get to email Military Onesource that they EXIST. I couldn't even find PTSD resources on there without hunting for them. Denial is not just a river in Egypt.
Auto-Response - 11/17/2010 01:00 PM
Title: Locating Service Members or Getting a Mailing Address
Link: http://erms.dma.mil/Scripts/rightnow_DefenseLink.cfg/php.exe/enduser/popup_adp.php?p_faqid=344&p_created=1040069556
Title: Felony Waiver Report for Military Recruits
Link: http://erms.dma.mil/Scripts/rightnow_DefenseLink.cfg/php.exe/enduser/popup_adp.php?p_faqid=656&p_created=1208975537
Title: Overseas Bases - Congressional Commision and the DoD Response
Link: http://erms.dma.mil/Scripts/rightnow_DefenseLink.cfg/php.exe/enduser/popup_adp.php?p_faqid=515&p_created=1115765043

Man, I am so relieved and reassured.

A rant from Belleruth and me

2010-11-17T12:26:00.004-05:00

Belleruth Naparstek has the same problem I have, no one can get her stuff onto Military Onesource. see her rant
She has people who work for her. I am a single person business and years ago, when I first heard of Military Onesource, I tried to get added, but since I am just a wife and not a professional or a big business, I had no luck, so I gave up.
They do list books, five of them. Not mine, Recovering from the War, not the new one by Cynthia Orange from Hazleden, Shock Waves: A Practical Guide to Living with a Loved One's PTSD, not Edward Tick's War and the Soul: Healing Our Nation's Veterans from Post-Traumatic Stress Disorder, not Belleruth's CD's and her book Invisible Heroes.
To say I am pissed is an understatement. There is also no easy way to contact them and ask to be included. Why not add a button for authors, veterans, etc to get in touch and suggest resources? Do they give a sh*t? Apparently not.
Whoever is looking out for our soldiers and veterans is not looking very hard for stuff that actually helps. Better to have a big expensive website, Military Onesource, run by a big corporation making billions of dollars that doesn't even list PTSD as something you might need help with. It also has a what appeared to me to be totally worthless find function which brings up page after page of links to the same posts on the supposed discussion list about having a husband with PTSD, but no information.
So if you are an active duty vet or family member looking for something to read or listen to that might help you deal with PTSD, I invite you to come to my website, Patience Press, where there are free articles, or read the rest of my rants, or try Belleruth's guided meditations (see link above).

Woohoo!

2010-11-15T16:12:00.003-05:00

I just found out I have been listed in this website as one of the top fifty bloggers on PTSD!
It says my website is good for seniors, and I wish it didn't because I am also trying to communicate with the new vets and their wives and get them to my website where they can get a different perspective on PTSD as survival skills that later become your biggest problem.
In case you just found this blog, I have written a book too, Recovering from the War, which was a Viking/Penguin in 1990. After it went out I print, I became a publisher and publish it as Patience Press, along with two children's books (Why is Daddy Like He Is? ditto for Mommy) and three patient education pamphlets, After the War: For the Wives of all Veterans, An Explanation of PTSD for Twelve Steppers: When I Get Sober I Feel Crazy, and The War at Home. There are also 13 free articles at Patience Press which I want all vets and other trauma survivors to have.
However, to say I am pleased at being included is an understatement. Writing is a lonely occupation and I have no idea if I am being read or not, so this is quite happifying! (Hey, I'm an English major. I get to make up words!)

Veterans Day and I'm mad!

2010-11-11T11:05:00.007-05:00

copyright 2010, Patience Mason.
I just listened to some idiot (didn't catch his name) on The Diane Rhem Show (a show I love, by the way) tell the usual lies about how only 10 % of vets get PTSD, and a new and amazing lie, that DSM II came out in the forties, and after that until 1982, I think he said, no one could get help for PTSD because of DSM II.
DSM I came out in 1952. It was an attempt to standardize diagnoses. It contained "Gross Stress Reaction" for survivors of traumas like combat or a concentration camp.
Contrary to what that idiot said, in 1968, DSM II was published during the Vietnam War: it actually went on sale during the TET Offensive. It dropped all stress reactions except for "transient situational disturbance" which could only last up to 6 months... Otherwise you were screwed up before you went to the war and got a diagnosis of personality disorder and no help from the VA since Personality Disorders were pre-existing conditions.... Was this aimed at Vietnam vets? I can't say, but it is quite a coincidence.
People who work for the VA often do not know the history... They don't know the facts... They speak for the VA, not for veterans.
It is the same problem when you get military psychiatrists. They speak for the military, not for the soldiers. They usually don't know the facts, either. Their job is to keep people going back to the war, so they have a conflict of interest with their patients.
They all say they can fix or prevent PTSD.
Maybe they can but there is no proof of that. NO PROOF.
A four year follow up on some 12 week or 12 month treatment is not proof that a lifetime condition has been fixed. (We'll give you insulin for a 12 week course and then you won't be diabetic. No one would say that.) And that's at a VA that uses "evidence based therapy," or some sort of therapy or treatment. Some of them just give drugs, and let me tell you, if the drugs make the vet feel weird, he or she won't take them and won't tell the doctor either.
Each VA is a feifdom. The doctors do what they believe in, and none of them use all the therapies and techniques which are available today and each of which helps some people... It 's like if you want help, fit into our theory. This is wrong. Vets need a variety of therapies because people are different and need different things. Some people need long term help. The government took them long term, perhaps for the rest of their life, and they should be willing to help them long term.
Statistics can always be manipulated so only 10 or 12 or 17 % of people get PTSD. In the National Vietnam Veterans Readjustment Study, of people who had had "high war zone stress" (multiple traumatic incidents) 66% of them had diagnosable PTSD at some time after the war and 33% still did, twenty years after. That means it is a normal reaction to multiple tours and multiple traumatic stressors. The guy today said 10%. The technical term for that is bullsh*t.
It is enough to make me tear out my hair.
I want to help people understand their PTSD.
I want them to know it is normal.
I want them to know there are four basic causes of PTSD, only one of which is the traumatic stress you have endured. The traumatic stressors you may have endured include serious threat to your life or physical integrity, serious threat or harm to spouse, kids, close relatives or friends (i.e. your buddies to whom you are probably closer than anyone), sudden destruction of home or community, and seeing anyone who is or has been recently seriously injured or killed. Traumatic stress is cumulative, it is worse when it is caused by human cruelty, neglect, error or betrayal, worse when you are young, and worse when part of the cause is a person or institution which is supposed to take care of you.
If you have PTSD think about how many of these traumatic stressors did you have? One a day? Ten a day?
The other three causes are that your brain is designed to keep you alive so all the symptoms of PTSD start out as brain based survivor-skills, that you care about other people no matter how numb you feel now, and third, that you lived. Dead people don't get PTSD...
Having lived means you are fast, smart, courageous, ingenious, and lucky. PTSD is proof of survival. It is not weak or weird. Normal people are affected by what they live through. Some psychiatrists know so little about human nature as to deny this. They seem to write the diagnostic criteria as some sort of numbing ritual entirely divorced from the reality of trauma. One of my friends is a lawyer and he says this is good, but I think it makes it easier for them to avoid the reality of war and other traumatic events and think, "I wouldn't be affected."
To psychiatrists, PTSD is a problem. To me the problem is war (or rape, incest, battering, industrial accidents, fires, etc,). PTSD symptoms are a wonderful solution to surviving war (or any other trauma) physically and mentally. They are evidence of courage, initiative, endurance, speed, luck, and caring. You wouldn't have to get numb if you didn't care. The same things that get you through the trauma alive can also become your biggest problem over time.
Post means it can happen any time after the war, right after or sixty years later. Most people have all the symptoms right after a traumatic event (Critical Stress Response, what guys who break down in combat have, not PTSD, although it probably does become PTSD) and some people seem to heal, we don't know why, so it is a disorder of healing.
Some people also appear to heal, but in fact they are using behaviors (work, sex, gambling, tv watching) and/or substances (alcohol, drugs, food, adrenaline) to hide their problems. This is as bad for their families as living with the PTSD would be, but it looks better to the outside world. "My dad never talked about WW II" is actually evidence of PTSD, not that it didn't bother him...
I want every one to know that the symptoms of PTSD begin as evolution-based or god-given survival skills, built into our brains. The symptoms come in three clusters which often overlap and reinforce each other.
The diagnosis of PTSD in DSM, whatever edition, always begins with re-experiencing. This is because psychiatrists had to stop denying PTSD's existence when vets were having flashbacks in the halls of the VA. That is when they noticed PTSD, so they describe it as weird re-experiencing disorder with associated problems.
I look at it differently: what would keep you alive when someone is trying to kill you?
Your brain is designed to keep you alive and a big part of this is paying attention to threats. Moreover, your body is provided with abilities that get you moving long before you actually think I should move out of the way of that bullet. DUCK! Move fast. Action. Action before thought. That is why some of us think somatic therapy should be offered along with talk therapy. Your body retains hyperarousal, and it does not speak English, nor can it tell time in the sense that your fore brain can. It does not know it is over.
The basic built in capacities of your body are usually described as fight or flight, but freeze is also an option the body can take, even against your will, if it thinks that is the only way to survive. Your body will do, is designed to do, whatever it takes to survive. Your brain also has a tremendous need to be in control of things, so it keeps repeating what works.
These reactions, once triggered lead to constant wariness (hypervigilance) one of the PTSD hyperarousal symptoms. Another symptom which the shrinks call "exaggerated startle response," I call effective startle response (You're alive!). Inability to concentrate is actually the inability to concentrate on everyday stuff, because you are concentrating on survival information, who is in the room, how will you get out, where the ambush or IED might be, etc. Irritability or outbursts of anger? Maybe it is normal to get pissed when people are trying to kill you and have killed your buddies. Plus people are so rude (Did you kill anyone? Aren't you over it yet?) and so full of dumb problems (Who cares what color the curtains are?)... Maybe anger makes you feel powerful so you can fight for your life or endure the privations of war and the need to kill people. Inability to fall or stay asleep keeps you alert at all times, keeps you from being killed in your sleep. They all make sense when viewed like this.
Numbing and avoidance probably develop at the same time as the hyperarousal symptoms. Your brain has an incredible capacity to rapidly adapt to situations. Rapid adaptation means that something that is horrifying quickly becomes everyday: emotional numbing. After that it takes a lot of adrenaline to get an emotion out of you. This means you may only feel alive when angry, doing something dangerous, or screwing around, because your emotions have been buried by the need to be in control combined with the need to do whatever it takes to survive and do your job and help others survive. People can do things under these conditions which are hard to look back on later. Feeling detached and estranged from others is reality. War changes you. People can't understand what you have been through, no matter how understanding they want to be. I realized this when my husband Bob and I came out of the movie Platoon, and I was upset by one of the wounded guys, the one with the shredded arm. Bob looked at me like I was nuts and said, "It's worse when it's real." I was starting to think I understood war because of all the interviews I was doing for Recovering from the War, but when he said that it hit me. I will never understand the reality. It is a separate reality. This is also self protective because of the stupid things people say to vets and trauma survivors. Having a sense of a foreshortened future is also realistic and self protective. You see other people dying all around you: why get your hopes up? Live for today because you may be dead tomorrow. (This can be annoying to your spouse...) Inability to recall parts of the trauma is a brain based protective device. The actual events are not recorded in narrative memory (and then, and then...) because it happened too fast and was too overwhelming for you to take it all in. This ties in with the reexperiencing because these unprocessed bits of memory seem to intrude and they are upsetting, so you begin the process of avoidance. You may avoid thoughts, feelings, situations, places, people, and activities that remind you of the trauma. If you were happy with your buddies and got ambushed you may decide never to be happy again. It is not conscious, and often is is done by staying drunk, or drugged, or high on adrenaline. Maybe you feel a mistake on your part got someone killed, so you are never going to be wrong again. Most of these are unconscious decisions, and you may not know you have made them. Avoidance is self protective and helps you avoid triggers, but it also perpetuates PTSD. Being really numb can lead to depression and to outbursts when your emotions erupt and scare every one around you. You may also lose interest in significant activities which helps you avoid triggers. What activities? Sex (losing control), hunting (no more killing), parties (crowds), family gatherings (people who wonder why you're not over it yet), cookouts (burning flesh) among other things.
Finally we get to reexperiencing, where the psychiatrists start the diagnosis. I think your brain keeps you alive by doing better safe than sorry. Primitive parts of the brain can't speak English and can't tell time, so they don't know it is over and you are home. Bits of experience, sights, sounds, smells, emotions, physical feelings like a thump on the head, all bring back the trauma in full living color. These are non-verbal memories, like your dog has when it sees a ball, only they are painful and upsetting. You may have the opposite of avoidance, and be constantly tormented with intrusive recollections of the war or trauma. You may also have nightmares about it, symbolic or actual repetitions of some awful events. You may suddenly act or feel like you are back in the war (flashbacks). You get upset by stuff that resembles or symbolizes the trauma. This includes anniversaries of holidays and of personal events including ones you don't remember! And you can have a physiologial reaction to things that remind you of the trauma. (Heart rate goes sky high when you see a car parked by the road, or hear a helicopter, etc.) You can also have second and third generation triggers. You get triggered by a car backfiring while you are eating a hot dog and watching children play, and after a while you can't stand hot dogs or the sound of kids playing... and you think you are nuts or a bad person, instead of realizing this is from the war.
Reexperiencing symptoms are probably what brings most people in for help, because they feel pretty nuts.
It appears that moving your non-verbal memories from what they called the reptile brain into your fore brain and encoding them as narrative memories is probably the most important healing device. This is called therapy when done with a therapist, writing when done with a typewriter (like Bob in Chickenhawk) or a pen in your journal or your fourth step in a 12 step program. It is the basis of cognitive therapy and narrative therapy and talk therapy, of EMDR, TIR, and other alphabet therapies.
If remembering is too upsetting, you need something like the skills you learn in Dialectical Behavioral Therapy, Acceptance and Commitment Therapy, meditation, or the HEALS technique developed by Steven Stosny, Ph. D., compassionpower.com so you can tolerate painful feelings in order to heal them.
Whatever you have done or not done, witnessed or ignored, you did not deserve to be traumatized, even if everyone says you deserve what you got. You do deserve to recover, and I hope looking at PTSD through my eyes will help you find the courage to get help. It is not fair that it hurts to recover. It is just reality. And since you made it through your war or traumas, you can probably make it through the work it takes to recover.
I also have seen people recycle PTSD symptoms when a new war starts or another traumatic event happens, and I think this is probably normal too. That's why I don't like the term "cured." "In remission," seems more realistic and more accurate to me. If your symptoms do come back, what worked before will work again. Don't give up. Get more help. You deserve to recover.

It is not your fault

2010-09-22T11:51:00.002-05:00

When I was a young wife struggling with a husband who had problems, like emotional numbing, angry outbursts, and inability to sleep, I thought it was all my fault. Everyone knew that if you were a good wife, your husband and family would have no problems. This is a myth, but I believed it.
At that time, there was no diagnosis of PTSD and we had no idea for years that any of it was related to flying into a hail of bullets over and over again as a slick pilot in Vietnam in the 1st Cav, 1965-66.
Bob thought most of his problems were my fault, too. What did he know about the effects of combat?
So I thought if I could just lose a little weight, keep the house cleaner, keep our son Jack a little quieter, and be more responsive to his needs, Bob would be nicer to me and not get mad or cold or whatever.
In fact, coldness (emotional numbing) is often a response to an anniversary, and the veteran may not know that. Bob seemed to turn into an iceman several times a year and when he wrote Chickenhawk, I realized why: Ia Drang, Happy Valley, Bong Son, and the last month flying heavy lifts when they had promised ass and trash (mail and passengers). One vet friend of mine tried to kill himself three times at the same time of year, a few years apart. His counselor suggested looking up the reports on his unit, and they found that a bunch of guys had been killed in a big firefight. He did not even remember. So there can be anniversaries that even the veteran does not know about.
Unfortunately most of us do not know anything about the symptoms of PTSD or we think they are defects instead of survival skills. We misunderstand. We take it personally, when often these behaviors have nothing to do with us.
I used to think that the things I did depressed Bob instead of understanding that the deaths he saw and the things he endured combined with the lack of care when he got home depressed him. He was called a murderer. When he was training new helicopter pilots and saw the standards lowered because they needed bodies. He had combat fatigue and was grounded when all he had ever wanted to do was to fly. And I thought I was the cause and could control and correct all his feelings.
If you are going through a rough time with a veteran, please read the rest of my posts and the free articles at Patience Press.
It is not your fault.
You didn't cause it although you may be thinking that, and he/she may too...
You can't control it by being the best little woman, or the best husband, in the world, although she or he may be telling you that if you only did this, that, or the other, he/she would have no problems.
You can't cure them either.
The hard and painful work of recovering is something they have to do, even though it is not fair.
This will be extremely hard for you, because tolerating someone else's pain is very hard. We want to help. We want to fix, but we can't and if we try to cheer them up and tell them to put it behind them and forget, we will perpetuate it.
If we tell them they are screwed up and to go get help, that can perpetuate it too.
They need to regain a sense of being in charge of what happens to them, so not following our directions is a healthy choice for them. They don't need directions, but suggestions can be helpful if done with a light touch. That's why I tell people to leave my articles in the bathroom instead of giving them to someone with PTSD. People don't like being told they are screwed up.
Get some support for yourself. One place is Living with PTSD. Another can be Alanon, where you can learn to detach with love.
Just remember: It is not your fault!

Medal of Honor Recipients Launch Post-Traumatic Stress Public Service Announcements

2010-05-13T10:49:00.003-05:00

I just went and looked at the website Medal of Honor Speakout and I cried.
Then I began looking more closely at the message, which seems to be a script written by a military PR guy, and they all say the same thing, some with compassion and conviction and some like... Well go see for yourself.
I sent the website the following email:
I have played several of your videos and so far, none of the Medal of Honor recipients says that he had problems after he got home, although Audie Murphy said he did and fought with the VA during Vietnam to get help for combat veterans. Audie Murphy was sleeping in a bedroom he had built in his garage with the lights on all night and a gun under his pillow, and having a recurring nightmare. (50th Anniversary Issue of Esquire, article by Thomas Morgan, I believe). I suspect some of the others may have had similar experiences. Talking about them will have more of an effect than this impersonal stay strong message.
This "stay strong" message does not cut it. Unless some of these guys say that they needed help, it will simply keep our current veterans thinking that these guys did not need help because they were stronger!
Please reconsider the message. Drop the " stay strong," and say "get help. I did." Or "I lost three families before I realized it had affected me," or something like that. The idea that you don't want to let the enemy win is good.
Please forward this message to the Medal of Honor guys and let them decide.
I am the wife of a Vietnam veteran helicopter pilot, Robert Mason, who wrote the memoir, Chickenhawk, and we lived with PTSD when it didn't have a name and was not supposed to exist. Bob thought he was a loser, and I thought I was a bad wife or he would not be having problems. If we had known anyone who said they had problems too, it would have helped.

Patience Mason, Editor and Publisher
Patience Press
P O Box 2757
High Springs, FL 32655
352-215-9251
ptg@patiencepress.com
www.patiencepress.com
Publisher of information on recovering from PTSD
Member:
The International Society for Traumatic Stress Studies
American Academy of Experts in Traumatic Stress
" Every gun that is made, every warship launched, every rocket fired, signifies in the final sense a theft from those who hunger and are not fed, those who are cold and are not clothed." --Dwight D. Eisenhower

Belleruth Naparstek:Note to Colleagues: Please Stop Saying Post-Traumatic Stress Is Incurabel

2010-05-10T13:19:00.002-05:00

If this were anyone but Belleruth, I would be going nuts, saying it's bullshit, but I know Belleruth.
She worked with one of the most effective and innovative PTSD programs in the country, (which of course the VA defunded and closed).
Transcend was a twelve week residential joint PTSD and Substance Abuse treatment program at the Brecksville VA in Ohio. There was a workshop on the Transcend Program at the International Society for Traumatic Stress Studies, probably in 1995, which I went to, and believe me these people, Beverly Donovan PhD and Edgardo Padin-Rivera had the right attitude, and so does Belleruth!
I reviewed the Transcend Treatment Manual and their Workbook for Veterans in the Post-Traumatic Gazette (V1N3, free online at http://www.patiencepress.com/patience_press/Free_Samples.html near the bottom of the page. One of Belleruth's CD's is reviewed in V5, N2 of the Post-Traumatic Gazette).
Edgardo and Bev asked Belleruth to make them a guided imagery tape for the guys in the Transcend program. She did. It worked. It helped them. Now that one tape has blossomed into three pages of CD's that can help you heal from PTSD, (http://www.healthjourneys.com/category.aspx?mcid=20&catid=7).
Guided imagery reaches deep into the primitive areas of the brain, the parts that don't really speak English and can't tell time, so they don't know it is over. Those areas are where your non-verbal memories of the trauma are stored, triggering you over and over and over. If you can access them in talk therapy or write about them as Bob did, it turns them into regular narrative memories in your frontal lobes and they are much less distressing. I agree with her that often this is not enough. It can be going at the problem from the wrong end. Get your body calmed down and things will go better in life, and in therapy if you choose to pursue it.
If you can't talk about it (yet), as a lot of vets can't, do yourself a favor and read Belleruth's article and try some of her suggestions. They are working for veterans right now.
And when some future trauma comes along, if you find your symptoms coming back, don't think it didn't work: think it worked once and it will work again, and get more help.
That is my only problem when people say PTSD has been "cured." I know it can be radically improved by various therapies and treatments, but will it come back? Maybe. We don't know. Trauma is cumulative. So instead of saying it will never come back, tell them if it does, get more of what works! Because otherwise the vets just think they failed and they can't be helped.
BTW, eventually there is always a study saying that some good therapy or technique don't work, and when it comes out you can be sure that the treatment was applied in a rote way by VA staff who didn't believe in it and didn't want to do the work or for the treatment to work and probably thought all vets were whiners. That is why some really excellent treatments work at one VA and not so well at another one.

Feeling Warehoused in Army Trauma Care Units

2010-05-07T14:07:00.002-05:00

I just found out about this. Read the article by clicking on the link.
Fort Carson was originally cited in 2006 as the place where soldiers with PTSD were mistreated, and guess what, they are still doing it! Imagine my surprise.
The fact is that Army psychiatrists, Army doctors, and Army officers and NCO's have a conflict of interest in dealing with PTSD. They want drugs and discipline, so they can send people back to combat. The conflict of interest is that the medical personnel should first do no harm, and sending someone with PTSD back will only make it worse. This was illegal in Vietnam and World War II. Once you had combat fatigue, you could not be sent back to a combat zone. Of course in World War I they sent guys with shell-shock induced paralysis, blindness, etc back to the front after connecting them up to an electrical apparatus and cranking it till, as the report states, the blind see, and the dumb speak and the paralyzed move. I wonder if they have thought of that at Ft Carson? Maybe I shouldn't give them the idea.
There are no randomized clinical trials of whether sending guys back on drugs, who already have PTSD, is even safe. Israeli studies of veterans of several wars show that people with PTSD get it faster and worse in subsequent wars... But you know, they are foreigners...
From the article, it seems that the medical staff are being ignored and exploited by the chain of command. Their recommendations are not being followed. I believe this is because it is not designated a hospital where the medical staff would be in charge, not the brass. This needs to be changed.
To get back to my original idea, that those in charge have a conflict of interest: the Army, as represented by the officers and NCO's, is in loco parentis to the soldiers, in the place of a parent. There are abusive parents we all know, but the Army doesn't advertise "We'll use you and then screw you over." They say we'll give you a future. They say join us and be a hero, not that we'll make your life hell if you have a normal reaction to too much combat trauma.
The people who get PTSD have the most traumatic events (including childhood events), the biggest losses (severe wounds, friends, belief in God and country or that the Army will take care of them, their sense of self), the least social support (so these Trauma Care Units, intended to be social support, but staffed with ignorant abusive NCO's simply make PTSD WORSE), the fewest resources (not just money, also emotional skill in dealing with painful events, relationship skills in dealing with friends and family, etc.). Human cruelty and neglect make PTSD worse. So instead of helping these soldiers, what they are doing makes it worse.
Of course, the NCO's who are doing this, are probably acting out their own PTSD, emotional numbing, irritability and outbursts of anger, feeling like these losers just don't understand being a real man/soldier like me, unable to concentrate on information about PTSD because they are concentrating on their own (survival) priorities: getting these bums in line. Can I keep my job if I can't keep them in line. It's a heads you win/tails I lose situation for everyone.
I am so depressed by this that I can't even rant.

PTSD: Get tougher soldier

2010-05-06T21:16:00.002-05:00

I came upon this letter by a WWII veteran who called Iraq and Afghanistan "so called wars." I could not believe it. I know there were WWII vets who said Vietnam wasn't a real war. Of course they didn't know that the one year tour often meant the Vietnam combat vet was in combat more than they were because they had long periods of retraining after the big battles.
Italy was hell. So this man went through hell. But why is he so incapable of thought and empathy? Well those are symptoms of PTSD. I'm not saying he has it, just that he has a few of the symptoms.
If you don't think, you can't see what might be worse in this war: Not knowing who the enemy is so you can never relax. Multiple tours. IED's. Horrible wounds which are survived. Remember, they don't just heal and then the person is pain free. The pain continues forever in many cases in phantom limbs and body parts.
This man had uniformed enemies and rules of war. They were welcomed as liberators, not attacked as invaders.
It is worth reading all the comments especially the one by pdxbohica about Audie Murphy and others, and of course, you might want to read my rant at the end of the comments.

First Coast veteran’s fall from grace showcases need for PTSD care

2010-05-05T10:50:00.002-05:00

This is one of those "heads I win, tails you lose" dilemmas that face veterans and their families. The criminal justice system is rarely interested in the problems of returning veterans.
They need treatment not prison.
We all remember Kojack, the TV detective, saying "Round up all the recently discharged Vietnam veterans," whenever there was a murder. People who were having flashbacks and doing what they were trained to do wound up in prison like Nathan did. And the prosecutor would say to the judge, "This man is a trained killer and a danger to society." One study I read showed that they got longer sentences for the same crimes.
The police didn't know how to deal with veterans in flashbacks or rages, either. Some of them got shot. Some succeeded in committing suicide by cop.
One group, Nam Vets of Alachua County was formed after the cops shot a Vietnam vet who had PTSD. The cops had tried to get help from our local VA Hospital but were told that no one could come talk to him. It was illegal for them to go. Of course, I asked my mother, Constance G. Hartwell, MD, a psychiatrist at the Boston VA Outpatient Clinic, and she said that in Boston they would and could go. Each VA is a feifdom, however, and ours had a bad attitude at the time and the worst PTSD program in the country.
The guys in Nam Vets went out on calls whenever asked. Some of them, and me, took training at the local Crisis Center and worked on the suicide hot line. We need more of that kind of activism.
You can read more about Veteran's Courts here http://www.slate.com/id/2244158 and here http://www.erie.gov/veterans/veterans_court.asp.
We need to work to make changes that allow for the problems of our returning veterans instead of forgetting about them. Years ago I was at a trauma conference and heard William Mahedy, Vietnam vet, priest, and author of Out of the Night told us that in 1972, they did a survey of the bums on skid row in LA, and 75 percent of them were WWII combat vets. Those are the members of the greatest generation you don't hear about. Today we would call them homeless, not bums. We have a chance to intervene and keep them in homes and out of jail and off skid row.

If there are three phonies and 30,000 with real claims...

2010-05-02T13:10:00.005-05:00

Click on my title to see the stupid AP article.
In one of the stupider articles I have ever read, Alan G Breed makes it clear how little he understands about the VA Claims process. He tracked down three assholes who suckered the system. Did he track down three guys who had had legitimate claims denied, or thirty, or three thousand, or any of the 391,257 claims that are now waiting adjudication? Apparently not, although he does mention one guy whose legitimate VA claim has been repeatedly denied.
I guess denied legitimate claims are just not that interesting.
My experience of the VA claims process is that the compensation system is not on the veterans side. It is slow. It is ponderous. It is full of psychiatrists running veterans through compensation exams in a few minutes, when it should take hours. They get paid the same no matter how long or short the exam is. So the ten minute exam in which the MD asked Bob how he was, and Bob said "about the same" and then the doctor asked him about flying (as a preliminary to put him at ease, Bob thought ) and then said goodbye, got the psychiatrist the same money as a real exam would have. The doctor's write up of this was "the patient reports no problems." Not "I didn't ask him about his problems because I just chit-chatted with him for ten minutes."
I went with Bob to his last compensation exam, with a tape recorder. The woman psychiatrist pointed out to Bob his original diagnosis was for "nervousness." I said "Look at the date!" 1968. "What difference does that make?" she said. She was totally ignorant that in 1968, the American Psychiatric Association came out with the Diagnostic and Statistical Manual II in which PTSD did not appear in any form.
DSMII dropped the category of Gross Stress Reaction (if you had been through a gross [big] enough stress–combat, concentration camp, POW–it could affect you for the rest of your life) and replaced it with "transient situational disturbance" meaning if a trauma like war affected you for more than six months, you were screwed up before you went. This change was not based on any scientific evidence and no one has ever admitted to being responsible for it. A study of WWII combat veterans, Archibald & Tuddenham, Archives of General Psychiatry, 1965, had just reported that twenty years after the war, combat vets were still experiencing startle responses, wake ups, anxiety, difficulties in memory, etc. This was completely ignored. The men who wrote the DSMII, those completely self-centered REMF psychiatrists, turned their narcissistic theories about how war wouldn't have affected them into a reality which would cause problems for a generation of combat vets and other trauma survivors.
May they rot in hell.
Oh, sorry. I guess I got carried away. But having lived through that era, I don't put too much stock in the current brain-imbalance theory of psychiatry in which pills rule.
Then there was the veteran of Hamburger Hill who called me. He was very upset because the VA compensation psychiatrist (this is not the treating psychiatrist but someone hired by the compensation system to do compensation exams) said to him, "Oh, I saw the movie. It couldn't have been as bad as that," thereby ending the exam. (It's worse when it's real," Bob said to me when I was upset about the wounded in Platoon.) This kind of total lack of information and understanding causes people who actually have PTSD to lose their ability to pursue the claim. It triggers them into painful scary reactions as well as makes them feel disrespected, devalued and hopeless, which is what the VA compensation system wants.
One of the guys in my book (Recovering from the War) was told by the St Petersburg VA Regional Office that although he had been shot at a lot and had found his CO in the jungle with his head cut off by the enemy, it wasn't "outside the range of usual human experience" for an infantryman, so he didn't have a traumatic stressor. (Totally false interpretation of the criteria). Of course the St Pete VARO was famous for fucking over veterans.
I'd love to see Mr. Breed do a story on some of our 300.000 plus veterans who are not getting what they fought for (and in many cases nearly died for) instead of one on three crooks.
Perhaps it would be too much effort.

PTSD and Sexuality

2010-04-27T11:28:00.004-05:00

this article is from The Post-Traumatic Gazette #29, copyright Patience H. C. Mason, 2000.
What did you learn about sex and where did you learn it? Did you learn it through words, actions, or unspoken messages? Did you learn sex was dirty? That only “sluts” liked sex and nice women didn’t? (Words define the speaker, in my opinion). Did you learn sex was necessary for proper physical functioning and “shouldn’t” have emotional content? Or that only love justified sex? Did you learn sex is fun? Or duty? Or that you should do it every chance you get with anything that moves of the opposite sex? Did you learn that sex was a power game, that seducing or even forcing others is a sign of strength? Did you learn that men forced sex on women because they have “needs” and women don’t? Perhaps you learned a good wife always has to give her husband sex? Or that sex is only for marriage, so if you are married you must have sex? These are common misconceptions and stereotypes.
Some effects of trauma:
Child sexual abuse, no matter how gentle, has an impact on children which most grownups cannot comprehend. Children are not interested in having sex. Children want to play and explore and grow, not do the same not-very-interesting thing over and over and over. They are young, immature, with short attention spans, and even if they want to please and aren’t being hurt, it is still the same kind of torture as sitting still in church or being lectured by your mom. Children endure it. Child sexual abuse is often physically painful. When the grownup is also violent and physically abusive, the traumatic effects are even more intense.
Children are interested in love, affection, and attention. Wanting closeness, attention and interest from a grownup are not the same as wanting sex. The betrayal of child sexual abuse is a high price to pay for getting natural needs met. Betrayal intensifies the traumatic effect of the experience.
A woman who was sexually abused as a child or raped as an adult may not enjoy sex, or even be able to take part in it. Women who survive other traumas like war also have problems: Sharon Grant, a Vietnam nurse wrote “By the time I bedded a man/who didn’t smell like mud and burned flesh/ He made love and I made jokes.”
Male survivors of childhood sexual abuse or adult rape may be burdened by shame. It says on the National Organization on Male Sexual Victimization site “To be used as a sexual object by a more powerful person, male or female, is always abusive and often damaging.” see http://www.malesurvivor.org/. Only recently has it become possible to talk about it. The rape of men by men in prisons caused Stephen Donaldson to found Stop Prison Rape, Inc. He was gang raped in jail after a Quaker “pray in” at the White House in the 70’s. He wrote, “The catastrophic experience of sexual violence usually extends beyond a single incident, often becoming a daily assault...[some] become rapists, seeking to `regain their manhood’ through the same violent means by which they believe it was lost.” (www.spr.org.) Men who were sexually abused may not be interested in sex or may use it addictively or abusively.
Although there can be other reasons including high blood pressure medications, diabetes, and alcohol abuse—which all may be related to PTSD—PTSD can cause a loss of interest in sex in men who are not survivors of sexual abuse. Perhaps it is an unacknowledged anniversary. Perhaps something triggered a reaction, but men tell themselves “It shouldn’t bother me” (a numbing ritual), and the numbness extends into sexuality. A man who lost control in combat (or in the streets) and hurt people may lose interest in sex because orgasm is like losing control and unconsciously, he’s afraid he’ll hurt someone. Feeling guilt over not saving someone, or over things done in the war zone, may cause him to deny himself the pleasures of sex and love.
People who put their life on the line can feel so alienated from even their nearest and dearest that connecting sexually is almost impossible. After moving a rotted corpse or seeing a decapitated car accident victim, love and sex are from another planet. In CopShock: Surviving Posttraumatic Stress Disorder by Allen R. Kates, one cop mentions “the sexual, sleep and other dysfunctions,” that keep cops from going home, and another talks about occasional bouts of impotence from being on steroids. (Neither appears in the index however.) The book is a terrific resource, however partly because it lists about a million PTSD and law-enforcement/stress sites and all kinds of other resources.
For survivors of other trauma, especially what is called “duty related” trauma, veterans, cops, peacekeepers, EMT’s, firefighters, sexual dysfunction is not discussed except in jokes. At a workshop on Critical Incident Stress Debriefing, one EMT told a joke about condoms. The six pack for Protestants (Monday, Tuesday, etc, but not Sunday), the eight-pack for Catholics, (Monday, Tuesday, etc,. and twice on Sunday) and then the new 12 pack condoms just for EMT’s: (January, February, March...) The audience (EMT’s) howled with laughter.
During the interviews for my book, Recovering From the War, quite a few of the combat veterans I interviewed said that after a year of combat, sex was “inconceivable” or “impossible” for a period after they came back.
The myth that a real man always wants sex can tear up a survivor and partner when he doesn’t. How does that affect the partner? She may feel unloved, undesirable and full of shame. Learning that this is a common reaction to trauma takes the pain of personal rejection out of it. Unfortunately if a survivor doesn’t know this is a common reaction, he may think or tell his partner she’s no longer sexy because he’s no longer reacting the way he once did and doesn’t know why. This can be an extremely painful and scary experience for a man. He may find himself turning to prostitutes, pornography, or a new sex partner who makes him feel like a “real” man again.
If a partner is perceived as demanding sex, people with PTSD may resist the demands because they need to regain a sense of control over their lives.
On the other hand, a person who is dealing with traumatic experiences may use frequent sex as a way of numbing or avoiding pain. The intense adrenaline rush of sex with a new partner, of cheating on someone, or being newly in love can also serve this function. Men and women can become sex and love addicts, looking for the perfect mate who will fix them, or simply drowning their sorrows in sexual activity.
Traumatic experiences may also affect attitudes towards others. Hating the opposite sex, feeling that all men or women are abusive, homophobia based on child sexual abuse (which is pedophilia not homosexuality) can affect sexuality. Who wants to fool around with the enemy?
People who were sexually abused may feel sex is all they have to offer. It can become the focus of a people-pleasing lifestyle that has nothing to do with the person’s real feelings about sex. When the survivor begins to deal with sexual abuse, he or she may need to set limits on sexuality. This is very hard on the spouse. If you are with a person with PTSD it is important to distinguish between sex and love. Sex can be an expression of love, but it isn’t the only one. Taking a vacation together from sex can be a very loving act by the partner of a survivor.
Survivors of any kind of trauma may have to be in control to the extent that they can’t relax enough to enjoy sex or have an orgasm. Many survivors can’t feel loving or sexual feelings. Some, especially survivors of sexual abuse, can’t feel parts of their bodies during sex. They may be triggered by sexual activity, or triggered by specific words or actions during sex. This may lead them to avoid sex, or have scary reactions, flashbacks, crying and screaming, or trying to fight off their partner during sex. They may dissociate during sex, spacing out and not really being there.
Some people are aroused by acts or attitudes which turn out to be reenactments of childhood sexual abuse. Sex may be associated with power and control or pain. Love is pain.
A survivor’s life may be ruled by body image: The only thing I am is sexy, or I will hide my sexuality under layers of fat or huge clothes. Growing a layer of fat may signal to others, “I don’t have boundaries,” as can the big clothes. Skin tight clothes send the same message. Abusers pick up on it.
A survivor may also feel “I am not worthy so I’ll take anyone, no matter how badly they treat me. I deserve it.” If that is the message you are telling yourself, man or woman, I want you to know that you deserve to be treated by your nearest and dearest like a valued friend, with respect and consideration, in every area, but especially in lovemaking.
Solutions: I think it is impossible to find solutions to sexual problems until they are acknowledged and accepted as one of the common normal responses to trauma. The old idea of “shouldn’t be affected” tends to rear it’s ugly head here and combine with societal attitudes about sex as a contact sport so that it is difficult to see when fun becomes addiction. Sexual selectivity can veer into sexual anorexia, the person with no sexual interest at all. That is another signal that PTSD may be involved.
Sexual difficulties brought on by trauma can be a tremendous blow to a person, magnifying the trauma.
Sexual healing is difficult for those who have been sexually abused or violated. An experience which is by nature sensuous, sweet, and spontaneous has been affected by the perpetrator’s criminal behavior. God or evolution gave us sexual pleasure, so we were meant to be able to enjoy it. I consider sexuality a sacred part of being human. Sex can be a spiritual and emotional as well as a physical union. Enjoying all three aspects is the goal of sexual healing.
Many resources exist for survivors of sexual abuse and much of the information in them can be adapted for other trauma survivors. One excellent book is Wendy Maltz’ Healing Your Sexual Self which I just finished reading. Maltz has a web site at www.healthysex.com. The book has inventories you can take and exercises to try which focus on being both safe and sensual. Taking your time and staying safe are emphasized.
Reading about sexual healing can be upsetting. If you become triggered, distraught, or have the urge to hurt yourself or others when you read about sexual healing, finding professional help is really important.
If you are triggered by sexual activity and want to heal, you can start by making a chart of safe, possibly safe, and unsafe sexual activities (see VOICES in Action Conference Report in Issue #25). One survivor whose safe list consisted of being touched on the right knee when she started therapy regained the capacity to feel safe and sexual one inch at a time, and you can, too.
Even if you were not sexually abused, making a chart of what is safe and not safe can help. If you use sex compulsively, and do things that endanger your life (unprotected sex), your freedom (illegal sex or having sex with drunken/drug-using partners, or pressuring people for sex), or a relationship you value (unfaithful sex) then they are not safe behaviors for you. What do these behaviors do for you? What are they doing to you? Are you becoming someone you dislike? If so where can you find help?
Perhaps you are not doing unsafe sex, but aren’t enjoying the sex you have. Another helpful idea is to listen to your body, which means being in your body, not off in your head or someone else’s head, worrying about what they might be thinking. This is called embodiment. In some senses it is like meditation. It takes practice and concentration to be fully present in your own body, focusing on what you physically feel. When you are embodied, you may also find yourself fully aware of what is pleasing to your partner, too. Awareness of these reactions may increase your pleasure.
Listen to your body. If you want to have sex but your sexual parts are not responding, what are they telling you? What are you trying to prove? Who are you trying to please? It is certainly not kindness or self care to force yourself to perform. On the other hand, as we age, sexual responses are slower. It takes more time and stimulation for older people of both sexes to get physically ready for sex, so more foreplay is helpful. The new anti-depressants can have sexual side effects as can blood pressure medications.
I suspect that as other PTSD issues resolve in therapy, some sexual problems may, too. Emotions that were unavailable to you when numbness prevented pain, like joy and closeness, return, improving sex. Talking and listening to your partner are important skills in any part of a relationship and even more important in this area where so much of our self-worth may be affected. As usual, I think using the word “I” is important. “I feel worthless when I don’t want to make love to you, and then I get angry,” is a lot harder to say than yelling “You don’t turn me on!” but it will probably have a more positive effect. “I feel sick when I smell liquor. It is like my step-father is crawling into bed with me all over again,” is better than “You pig!”
Al-Anon’s booklet Sexual Intimacy and the Alcoholic Relationship could be helpful couples dealing with PTSD. The New Male Sexuality by Bernie Zibergeld suggests ways of reconnecting both with your body and your partner. New books on sex come out all the time. Find one that helps you feel okay about yourself and leads you in the direction you want to go.
Acceptance (yes, trauma affected my sexuality, and that is normal for me) and time, combined with finding effective help, (therapy, books, groups) can heal this area of your life, too.
the end of the article.

To this I would add these resources:
http://www.sidran.org is a woman founded foundation which keeps a list of therapists for trauma survivors and publishes books and pamphlets.
In Gainesville Florida they have groups for sexual assault survivors at the local crisis center/victim services which are open to people no matter how long ago it happened.
If you want counseling, I recommend interviewing several counselors (free 15 minute interview, not a paid 55 minutes) and asking what experience they have had with sexual trauma survivors and how they proceed in therapy. When you find someone you fit with, then you proceed. It will hurt, but you survived the traumatic events and you can survive therapy.
Two relatively quick and non-intrusive therapies are EMDR and TIR (traumatic incident reduction) which you can google to find practitioners.
Please also go to http://www.patiencepress.com and read the free handouts and check out the links.

"Can't you just be normal for one day?" More Thoughts on PTSD and Holidays

2008-12-12T10:50:00.002-05:00

“Can’t you just be normal for one day?” More thoughts on PTSD and holidays
Reprinted from Vol. 4, No. 4 of the Post-Traumatic Gazette. ® 1998, Patience H. C. Mason.
I give permission to copy and distribute this to anyone it might help.
POBox 2757, High Springs, FL 32655-2757, 904-454-1651, www.patiencepress.com

One of the perrennial problems trauma survivors face is the request, usually from family members around holiday times, “Can’t you just be normal for one day?”
The answer is no.
The answer is “I am normal for what I have been through.”
Trauma survivors pay a price for what they have suffered. This price is not rescinded just because it is a holiday. The answer is “I went through hell, and holidays bring up a lot of pain. No. I cannot be normal, as you call it. I am normal for what I have been through.”
Part of the pain induced by the request to be normal is the unspoken assumption that you could be normal for a day if you just tried hard enough. Suzette Hadin Elgin in her book, The Gentle Art of Verbal Self-Defense (Dorsett, 1980), calls this a presupposition. Other presupositions in that statement are that it is wrong not to act like everybody else, that other people’s happiness depends on what you do, that holidays must be celebrated by everyone in the same way, and that trauma shouldn’t affect you, or should only affect you in ways that the other person finds tolerable.
“Can’t you just be normal for one day?” is a verbal attack, although the person doing the attacking probably does not identify it as such. It is couched in terms of sweet reason, but it carries a heavy burden of denial of what the survivor has been through and of the problems the person doing the requesting has in meeting his or her own needs through a variety of other sources, which is why he or she is trying to make the survivor meet them.
Of course, if the trauma survivor spends the rest of the year denying that he or she has problems and refusing to get help, wanting to have special needs over the holidays can be pretty irritating to the rest of the family. If you are doing that, you might want to face your problems and look for some good help.
Families and friends pay a price for living with a trauma survivor. Sometimes it is painful, but any relationship has pain. We feel survivors are worth the pain. We can acknowledge our pain without having to blame the survivor. This is just how it is. As families, we are different. That difference does not have to remain a negative. It takes strenght to survive trauma. It takes strength to survive living with a trauma survivor. We are strong, but our strengths do not lie in conventional holiday celebrations. We need to create our own ways of celebrating survival and recovery which may be quite different from shop-till-you-drop, Christmas crowds at the house, or going over to the houses of relatives who discount and demean trauma survivors.
Each of us can think about what we can do for ourself. Is there some small way you can be there for yourself in ways you haven’t been in the past, even if it is only staying sober or allowing yourself some quiet time? What can you do for the parts of you you may have lost during the trauma or the parts of you you have ignored while living with a trauma survivor? What can you do for other survivors, for other families and friends of survivors? One thing is to pass out last year’s article on PTSD and Holidays. See my previous post. You have permission to make copies of it and this article.
Perhaps this year the trauma survivor and family and/or friends can sit down and discuss how they can create meaningful celebrations. Is there something the trauma survivor would like to do with or for the rest of the family? Starting small is a good idea if you are going to try to change. In my experience, every time I tried to do too much or tried to change quickly, I failed. I strongly recommend very small. low key changes, things that seem like they won’t be a trigger. Have a backup plan for the survivor if he or she is triggered.
Broken promises can create very hard feelings, so I suggest not making promises or asking for them. Making someone promise to do something is also a form of coercion, an attempt to control, and with trauma survivors it can backfire. They need to regain a sense of control in their lives. Extracting promises only gives them something to rebel against.
Sometimes survivors are also controlling, extracting promises from family or friend. It is understandable but it carries the same drawbacks. If we need to stop focusing on the trauma survivor and let him or her heal, we, too, need the freedom to meet our own needs. We should have back-up plans so we can enjoy things even if the survivor has to bow out at the last minute. Yes, we do deserve to go to the Nutcracker, to a movie, to a service, to a tree lighting, a party, or any other treat we have planned, by ourselves or with another friend, if the survivor can’t make it. We do not have to stay home.
—Happy Holidays from Patience

PTSD and Holidays

2008-12-01T20:30:00.002-05:00

I wrote this article in 1997, and I hope it helps our new veterans.

Most people do not realize that people with PTSD have anniversary reactions. Holidays may also be anniversaries of trauma and bring up a lot of pain. This is one of the most distressing forms of reexperiencing for survivors and their families.

If the survivor doesn't recognize that this is one of the symptoms of PTSD, he or she may feel like Scrooge instead of like a normal human being who went through hell at that time of the year.

If the family doesn't understand that this is a PTSD anniversary reaction, they may be very angry at the survivor. "What is wrong with you?" is a heart-rending, humiliating question when the survivor doesn't know why s/he reacts like this.

If your veteran spent a particularly horrible Christmas seeing villagers lose all they had, seeing friends die, seeing the fat cats in the rear partying while the troops were suffering, he may have a hard time with Christmas. If your abusive father tore up the Christmas tree every year, if your uncle molested you at the family get together when you were eight, if you got mugged while out Christmas shopping, or date raped after an office party, or if your violent family pretended nothing was wrong during the holidays, these upcoming holidays may be a hard time for you. This is a normal reaction.

Holidays are also a really stressful time for many trauma survivors because they seem to reinforce the outsiderness of being a survivor of trauma. Everyone else seems so happy while your guts are twisted into knots as you think about past events. For veterans and other survivors, this pain can be compounded by grief for lost friends and their families who now face the holidays without those loved ones who didn't survive. Guilt may also rear its painful head. Why did I survive?

The financial difficulties many trauma survivors experience are highlighted by the commercialization of the holidays. There are a lot of pressures to conform.

One of my first healthy actions in my marriage was to decide that Bob didn't have to celebrate Christmas after he came back from Vietnam. I loved it so I should celebrate it and let him be him. I have no idea where that idea came from but it saved me a lot of fights. Today I look back on it as a miracle, accepting Bob as he was, and detaching in a healthy way. I think this is an important point for all trauma survivors and their families: Let the people who love the holiday celebrate it, and the people for whom it brings pain don't have to. This may cause problems with the extended family or the kids, but treating the survivor with respect is one healing way to frame it: "We have to respect other people's feelings and limits," can be a healthy way to put it.

We can also create our own ways of celebrating the holidays. We don't have to conform to a rigid commercial stereotype of piles of expensive gifts and big gatherings. As a matter of fact one thing that trauma can bring you face to face with is the value of people as opposed to things. We're starting a tradition in our crowd this year (a number of whom are trauma survivors and veterans) of homemade, recycled, or under $5 gifts. Ingenuity and fun!

Many survivors are not comfortable in crowds or at parties, but a quiet meaningful celebration, say singing carols in the living room with just the tree lights on, may be something they can participate in. They may not want to trim the tree, but going out to cut it down or pick it out may be okay. I am mentioning Christmas traditions here because that is what I grew up with, but I'm sure that Hanukkah and Kwanzaa celebrations can be as low-keyed and spiritual as the survivor needs them to be.

Survivors may need to create new rituals to help in their healing. For instance a veteran who lost friends in combat on Christmas may want to feed the homeless (many of whom are combat veterans) instead of participating in a big family dinner with people who may or may not appreciate his service. He may need to go to a special place and tell his lost buddies how much he misses them and wishes they had lived. Someone else may want to help provide Christmas presents for children of poor families or for other survivors of trauma. The range of possibilities is limited only by the imagination.

If all you want to do is stay drunk or stoned through the holidays, it might be good to find help instead. No one wants to be providing traumatic memories for the next generation. What you do while drunk or stoned can be pretty unpleasant for others, and especially painful for family members of both the spouse variety and the small-fry variety. 12 step meetings happen even on holidays like Christmas and New Year's. I'm going to be at my ACOA meeting Christmas Eve. Sobriety is better than big presents. Harder, too.

Crass commercialization and shop till you drop take the fun out of the holiday for me. So does having religion shoved down my throat, but I find that I can celebrate the birth of a child who represents all children to me and use it as an opportunity for me to do good in the world. Perhaps you and your family can do the same.

Holiday Helps: Asking for input and creating family traditions:

As I mentioned before, when Jack was a kid, he and I had our own Christmas without making Bob participate. This is called politeness, although my principal reason was selfishness, wanting my kind of Christmas. Selfishness created a healthy boundary in that case.

Something I didn't think of at the time was asking for input, which is also polite. Rituals For Our Times, by Evan Imber-Black and Janine Roberts (Harper, 1992, $12.00) has a wonderful chapter on holidays and a whole section called "Making Meaningful Rituals." Among other things, they suggest that planning, discussing and getting input from family members can prevent disappointments. Planning small changes in existing family traditions instead of trying to change everything at once is also easier.

Sometimes family traditions are out of balance and only please one side of the family or one spouse or whatever. To fix this, ask what the other person would like to do for the holidays. Say something like: "Maybe we could figure out some new things we could do that we would all like and could do together. Then the kids and I could do the stuff we like without pushing you to be involved."

Your spouse may never have thought about what he or she would like to do. I suggest not expecting an answer right away-maybe not even till next year. Just let him or her know you are interested in discussing it and open to change. People resist doing things they haven't been involved in. Planning or contributing to an event can give them a sense of being valued and having some control.

One final point, without them being aware of it, some traditional activities may clash with issues of safety for survivors. For instance, if Vince Veteran never puts up the Christmas lights despite endless nagging, perhaps it is because in Vietnam the night belonged to Charlie. By lighting up the house at night, he is attracting attention to his nearest and dearest, the kind of attention that could get you killed in Vietnam. Bringing this to consciousness--the need to keep the family safe--may help him get such a natural need met in a more appropriate way--like buying new tires for the car or better locks for the doors. Examining your traditions with that in mind can be rewarding.

Let go of outdated traditions or modify them to suit today. With our without the help of your survivor, you can sit down with whoever else in the family wants to celebrate. Have each person list what is fun for him or her. Do the things everyone likes doing. Let go of what has become a burden or what you think others should do or you should do. You can always go back to doing something if you miss it! Example: I like filling stockings for everyone and I thought they should fill mine. Now I get my own stocking stuffers. It is a lot of fun getting a stocking full of stuff I really like instead of an empty one full of hard feelings. I've also dropped creamed onions, cornbread dressing and mince pie!

Discussing what the family might like to do can be empowering for your children because it gives them a chance to move on to more age appropriate activities as they grow up. This may be hard for the parents, but I suggest that you can hang your own stockings or have your own quiet holiday dinner.

Some new family traditions you might try:

Looking up at the stars can be a beautiful experience of the glory of nature. According to December's Discover magazine, this December [1997] the sky is going to be swarming with planets at twilight. "Every bright 'star' to the left of the sunset is a planet... This is a show that airs before prime time, so observe early. After 9 PM only Saturn remains... This year the natural holiday lights are on display for even the youngest of Earth's appreciative sky watchers."

Get out of the house: Making snow angels is one of my favorite pastimes. There is nothing that helps me recreate the feeling of being a happy kid again like falling over backwards into the snow and waving my arms and legs. Too bad it never snows in Florida! Snow men, snowball fights (no ice balls, please), snow forts, snowy walks, cross country skiing, sledding, ice skating all can be family fun activities. In the south, walks in the woods, canoeing, kayaking, fishing, bicycle rides are still options.

Decorating with natural materials is another thing I like to do. Grapevine wreaths with gold or silver pinecones, magnolia cones, acorns, berries and any weird seed pods I can find give me a sense of satisfaction no store bought wreath ever brought. Look around and be inventive. I also have a wreath made of rusty barbwire which my friend Marci gave me. As a survivor, she feels a little Scroogey at Christmas. I like it!

Recycled and home made decorations (and gifts) bring family members together, minimize the wastage of natural resources, and increase our own resourcefulness and independence in a healthy creative way. For some of us it is important not to contribute to corporate profits. Paper chains and pomanders (oranges covered with cloves) are great home made decorations. Buying cloves in bulk at an oriental grocery store or a health food store makes pomanders affordable. They smell great!

Doing stuff for others. One veteran I know has been feeding the homeless for the last nine years on holidays.

I buy books to contribute to the local newspaper's Christmas book giving program for disadvantaged kids. This is a living amends to a poor little girl to whom Jack wanted to give one of his books when he was 5. I wouldn't let him.

Battered women's shelters always need stuff as do homeless shelters, nursing homes, hospitals and churches.

You can adopt a family if you are well off, or contribute a few cans of food or a toy if you are not. Whatever you give will benefit you as well as those you help. Altruistic people actually are healthier than those who are not!

You can do any of these as a memorial to someone who was lost or abused.

Doing stuff for yourself: Provide yourself with something you didn't get that you needed. Maybe this is a grown woman buying her inner child a Barbie doll, maybe it is a veteran presenting himself with a certificate of thanks for his service. Look inside. People who love you would like to do this for you, too. Let them know if they can help somehow.

Ask people what you could get them within your price range. Tell people what you want. Talking about presents is hard for some of us. I thought I should be able to find the perfect present with no input. Now I ask. I used to expect Bob to know what I liked and wanted. Now I give him guidelines.

Our crowd is having a homemade, recycled or under $5.00 Christmas again. We gave each other some really funny presents last year. If someone has given you something expensive you hated, this year you can recycle it to someone who might like it. I get wonderful containers at garage sales and fill them with cookies or rum balls or spiced pecans so it is homemade and recycled!

Talk to each other: Go for the quiet evening at home together. Many of us never sit down and talk because we are so swept away in the demands of daily living. Make a date and simply talk. What about? About what the holidays and/or the family means to you.

Accept the fact that kids are naturally self-centered and needy but can develop great kindness. A parents job is not to suppress these natural characteristics, but to encourage awareness of others and empathy. People used to think small children were little demons, but they are actually very kind and willing to give of themselves and help others. One great family tradition is to tell them that some little kids need toys and help them weed out ones they want to give away.

Give each child something that will give him or her a feeling of specialness. It needn't be expensive. Magic markers and a pad of paper gave Jack many wonderful hours of fun. I still treasure his creations.¦

Happy Holidays

Patience Mason

Short History of PTSD

2008-06-11T11:20:00.001-05:00

On Jun 11, 2008, at 12:32 AM, J N wrote:

Hi, I found your email linked on a site about PTSD. I have a question, and hopefully you can provide some insight. I am working with a production company to develop a parallel story between the lives of three brothers who served in Vietnam. Their struggle with PTSD and agent orange now, and then their experiences in Vietnam. What do you think is the reason that PTSD is only just starting to get more noticed now? Other vets tell me it's still a pain to get any help from the VA on PTSD. The PTSD information center on the VA's website didn't feel like anything centered towards military troops. What is the deal that causes PTSD to be hidden under the rug?
Any response would be appreciated.
Thanks,

My answer:
Before Vietnam, PTSD was called soldier's heart or nostalgia during the Civil War, shell shock or soldiers heart in WWI, combat fatigue by doctors in the war zones and combat neurosis by doctors at home during WWII.
In 1952, the American Psychiatric Association published the Diagnostic and Statistical Manual, an attempt to standardize psychiatric diagnoses. It included a category called "Gross stress reaction." If you had been through a big enough stress (gross=big), like a concentration camp or combat (this was in the Freudian denial and delusion period about incest) it could affect you.
In 1968, ironically during the TET offensive, DSM II was published. It dropped, with absolutely no scientific evidence, any reference to any stress reactions except a "transient situational disturbance" which lasted for six months or less. If it lasted for more than six months, you had a pre-existing condition, which meant, for Vietnam veterans, that the VA was not responsible because it wasn't service connected. This was absolute bullshit, propagated by who? No one knows. It is part of the cycle of acknowledgment and denial that PTSD goes through with every generation.
Anyhow a bunch of shrinks who had worked with WWII Combat vets and with battered wives and incest survivors and survivors of concentration and POW camps worked together to get it reinstated in the next edition, which it was in 1980 in DSM III. The APA was against it, because it would cost the government too much money. During the era of DSMII, people were told "Vietnam didn't change you. You were defective before you went." They were diagnosed wit schizophrenia or as sociopaths, narcissists, etc. They were overmedicated with thorazine. Since there was NO HELP, except for the very rare VA shrink, psychologist or social worker who would listen to them, many of them turned to alcohol and drugs to maintain. Psychiatrists who listened to the veterans were often called overly emotional and overly involved by other psychiatrists.
The first study of actual Vietnam vets with PTSD was done by John Wilson, PhD, with funding by the Disabled American Veterans because he couldn't get funding from any foundations or the government. Other studies of the time showed that only a few veterans had problems, but those studies didn't even ask them if they had been in Vietnam, never mind in combat.
My husband, Bob, (Robert Mason, author of Chickenhawk) came home in 1966 with PTSD. He was a helicopter pilot. In 1967 he was diagnosed with "combat fatigue," which at that time meant that he could never be sent to a war zone again. (And these new guys should NEVER be sent back.) But basically he thought he was a loser and I thought I was a bad wife or he would not be having problems. You can read more about that on my website as I use my experiences to help others http://www.patiencepress.com.
For a time after 1980, a lot of work was going on in the PTSD field, and if you could get diagnosed, you could get help, but most guys, having been turned away by the VA when they went for help, wouldn't go back. There was also the problem of the psychiatrist who knew the diagnosis had been made up for Vietnam vets, so they wouldn't diagnose it even when it was obvious.
For a while there did seem to be a lot of help out there if you could find it. But each VA Hospital is a feifdom, under the control of the Chief of Psychiatry, so if he doesn't believe or wants to do research on schizophrenia or whatever, the vets are fucked. Some VA's have great programs. Some have shitty ones. There is no standardization and no oversight that I can see. Plus when staff changes, the program can change. Did you read about the b*tch at Temple Texas who told the staff to stop diagnosing PTSD? That had been a really good VA, and maybe it still is, but probably not.
Up until 9-11, there was also a slow rise in denial and delusion among mental health professionals. This culminated in DSMIV which now describes traumatic stressors with a litany of latinate words punctuated by or's. It is a numbing ritual.
And now there is the bullshit of sending guys back on drugs, which is so EVIL, it can't even be believed. There have been no randomized clinical trials of how people do when the go back on drugs, but we do know from Israeli studies of guys who have been in multiple wars, that if they have PTSD in one war, they get it faster and worse in the next. Supposedly mental health professionals go by "First do no harm."
We also have the right-wing attacks on PTSD: it doesn't exist. Our men are brave and have no problems. It is a liberal attack, blah, blah,blah.
"What is the deal that causes PTSD to be hidden under the rug?"
The fucking government doesn't want to pay for treatment. Like the war, they had no plan.
This is what happens when REMF's (Rear Echelon M*ther F*ckers) run wars. They have no clue.
I could rant on, but this is probably more than you wanted.
Patience Mason, Editor and Publisher
Patience Press
P O Box 2757
High Springs, FL 32655
386-454-1651
ptg@patiencepress.com
www.patiencepress.com

Is it ethical to send people with PTSD back to war?

2008-04-09T10:49:00.002-05:00

The answer is NO. PERIOD.
I am writing about this because I got a call from a BBC reporter who wanted to talk to a veteran with PTSD who was being sent back to Iraq or Afghanistan.
When my husband Bob was diagnosed with "combat fatigue" about a year after he got back from Vietnam, (1966) the Army sent him the diagnosis and the information that as a result he could NEVER BE SENT TO A COMBAT ZONE AGAIN.
So what has changed?
They changed the name of the condition, but it is still the same condition.
They have new medication, but there is no medication for combat PTSD, as Jonathan Shay, MD says in his article at www.dr-bob.org/tips/ptsd.html.
There is no draft, but they need more soldiers than they have.
The job of psychiatrists today is to give pills, not find out what is torturing their patients.
The job of military patients, who are in because they want a military career, is to shut up and take the pills so they don't lose their careers.
It is the political situation that has changed.
Politics, as usual, sends people back into hell.
What is the evidence for it being safe? As far as I know there is none. Israeli studies of their multi-war vets showed that those who had PTSD got it faster and worse in the next war.
This is one of those cases where what should be (It ought to work, sending them back on meds) trumps actual experience. We see WWII, Korean, and Vietnam vets with long term effects from war, but this time it's different. We have medications! Well most of those veterans were SELF-MEDICATING all along, and it didn't work. But we have better meds. Oh, yeah? Where are the randomized double-blind trials to prove it. There are none.
It is like the earlier denial and delusion period of American psychiatry-1968 to 1980-when on no scientific evidence, any diagnosis which derived from traumatic events was dropped because people, normal people, "shouldn't" be affected by horrific experiences. Guys with couches decided that. Guys with pill bottles are deciding this.
Recovering from traumatic events takes time, just like recovering from a physical wound. This is a stress injury, not a chemical problem. Even if the chemistry is changed by the experience that should be a hint to everyone that war is not good for people. Our bodies are designed to react to stress and to AVOID it. Most PTSD symptoms start out as brain-and-body based, built-in survival mechanisms, which keep you alive and get you out of there! Modern warfare is designed to provide stress after stress after stress. Pills will numb your edge and, in my humble opinion, get you in worse shape. They may help when you get back as you work on recovery, but they are not recovery.
What works for emotional numbing and avoidance? Feeling the pain of your dead buddies, working through the stages of grief. There is no pill for that. It takes time.
What works for hyper-arousal? Somatic therapies, meditation, learning people-skills like "We can agree to disagree," etc. Learning to avoid triggers. Learning to identify triggers. Learning how to bring yourself back to the present when you are triggered.
What works for re-experiencing? Going through the story of what happened and turning it from fragments of smell, sound, vision, emotion, into a coherent narrative which moves it from your reptile brain up into your narrative memory in your fore-brain.
There are many methods which work to do these things. Probably the fastest is TIR (Traumatic Incident Reduction, www.tir.org). Most of them take TIME and time is what the current situation does not allow for, nor military culture, nor the culture of current psychiatric practice which is heavily influenced by the major drug companies.
It is not ethical. First do no harm. Sending them back with PTSD harms our soldiers.

Home from War

2007-08-23T15:18:00.000-05:00

This is my latest article, which I wrote for the new vets. It is also posted on my website, www.patiencepress.com in .pdf form if you want to print it out neatly.

Home From War
by
Patience Mason
Author of Recovering from the War: A Guide for all Veterans, Family Members, Friends, and Therapists
www.patiencepress.com
©2007 Patience H. C. Mason All rights reserved. No portion of this publication may be reprinted without express written permission of the author, which you have if you are a veteran, family member, friend or therapist. Please print, copy, and give to anyone it will help. .

My husband, Bob, spent the second year of our marriage flying a Huey slick in the First Cavalry Division in Vietnam 1965-66. His book, Chickenhawk, tells the story of that year. When he got back, I saw how skinny he was, but I was so glad to have him back, I didn’t notice the thousand yard stare. I had no idea what he had been through. I was just so glad he was alive. Neither of us had any idea that the war was, quite naturally and normally, going to affect both of us for the rest of our lives. We didn’t know any of what you will read in this pamphlet. They told Bob he would be fine in a few weeks. When he wasn’t, he thought he was nuts. I thought I was a bad wife, or he would not be having problems. He often agreed. Our life was not very happy for the next fifteen years, until we found out about Post-Traumatic Stress Disorder. We still deal with it, but today our dealings are informed, which makes things easier.
Stages you may go through when you get home:
Stage 1: I’m fine: Most soldiers come back believing it’s all over. Young, strong, proud, even if you are having some odd moments, you are not about to tell the doctors because you will be kept from going home. The changes that helped you survive war don’t seem that big a deal, and who is going to tell some guy in a white coat that you are seeing dead people? You may not know how much you have changed till you’re home. Life here is flat. People have petty problems. You can’t sleep, have bad dreams, get furious at everything, and keep looking for roadside bombs. When a car backfires, you hit the dirt. Still, you probably think the people around you have problems. Not you. Any comments about how you’ve changed may really piss you off. You’re fine! You survived a war! What kind of help could you possibly need after that? If you don’t know that it is normal to be affected, what else can you do but deny that you are? That’s what everyone else does. Denial can make your family feel nuts. You may be telling them they are nuts. This usually does not improve relationships. Furthermore, in today’s military, you probably will have to go back, so denial may seem necessary..
Stage 2: I’m not fine, but I’m not telling you: You notice some problems. You get angry too fast, you are yelling at people instead of talking to them, you keep seeing your friends die. When civilian things go wrong, you don’t care. (Is anyone shooting?) You may be shocked to feel nothing when a beloved relative gets sick or dies, or you may think you don’t love your spouse anymore because you can’t feel it. You hate civilians or Arabs. You are not fine, but you are not going to tell anyone, especially not anyone who wasn’t there and has been telling you that you have problems. You start to think that you can’t talk to anyone who wasn’t there. You begin isolating so no one will see how nuts you feel. You are pissed off about being affected. You also fear going for help because it may dull your edge, which you will need when you go back. It might also affect your career, and you don’t want people to think you are nuts. You exclude your spouse. He or she gets angry at you a lot.
Stage 3: I can’t talk to people who weren’t there: Since you can talk to other vets, you feel that no one understands unless they were there. This unfortunately is true. Most people make this clear by saying insensitive things like, “So what’s your problem? Get over it!” “Did you kill anyone?” “You’re a hero.” and the inevitable, “But why aren’t you over it?” So you increase your isolation from family and friends. This however tends to make spouses angry, because we are supposed to be understanding. Your sense of humor has become very black, and you laugh at things that would have horrified you once. You may even wonder if your spouse would still love you if they knew what happened over there. You might feel that everyone around you is spoiled and insensitive and it pisses you off. You have to stay so numb that your spouse feels you don’t love him or her anymore.
Stage 4: What’s wrong with me? The term “Post-Traumatic Stress Disorder” is a good description of the effects of war on normal people. The skills of war create a lot of disorder in your life. Shrinks and family members tend to see the symptoms of PTSD as the problem. Not me. I see war as the problem and the symptoms of PTSD as solutions to the problem of war, something right with you, not something wrong with you. Each symptom begins as part of your body’s hard-wired survival responses to danger, which your training has been designed to intensify and strengthen. They worked. You are alive. That is the bottom line. You have been through something that killed others. Having PTSD is proof of survival. I also believe that the people who get PTSD are the ones who care the most. You may feel like you don’t care, but if you didn’t care, you would not have to develop the symptom of emotional numbing to survive. Although PTSD symptoms originate in hard-wired survival skills built into all of us, unhealed, they can become your biggest problems over time.
Stage 5: I’m screwed up and no one can help. Deciding that no one can help is pretty human, but it is not true. I don’t think you are screwed up, either. You are in survival mode. What helped you survive one deployment will probably help you during the next one, unless your symptoms become debilitating. What you will need, when you are finally haome for good, and decide you want to change, is information and tools, someone to talk to, and hope. So will your family. You can get treatment without diagnosis at the Vet Centers and for two years after you get back at the VA. This can be a problem since it might be two years before you realize you have problems.
Admitting you have a problem and asking for help is hard, but you survived the war, and you can survive getting help and healing. If you don’t get help, you can be stuck in any one of these stages for the rest of your life, losing friends and family in the process, like so many veterans of previous wars. War affects people who live through it. There is evidence of PTSD throughout written history. People not affected by war are usually actors in war movies. It’s worse when it’s real. You may have noticed this.
This pamphlet is meant to explain the normal effects of war. Today, you don’t have to feel crazy, weak or defective, or blame each other, like Bob and I did. You can find ways to heal.
What causes PTSD?
Four types of traumatic events, common in war, cause PTSD:
1. When people are trying to kill or injure you.
2. When people are trying to kill or injure those you are close to (and many soldiers are closer to their buddies than to anyone in their lives.)
3. When you suddenly lose your home or community, which happens to soldiers who are wounded and medevacked or when they lose a lot of buddies to an IED or firefight.
4. Seeing anyone who has recently been seriously injured or killed (stranger, enemy, civilian).
Most soldiers have hundreds if not thousands of traumatic events during a deployment.
Traumatic events are cumulative, starting in childhood.
Traumatic events are made worse by human cruelty, neglect, and betrayal. Suicide bombing and the constant killing of civilian men, women, and children by factions in Iraq and Afghanistan make this war very cruel. What an incident means to you may also make it more traumatic. If your friends were “wasted”, it is worse than if they were killed doing something that was noble and important. It’s worse if the deaths were because they had no armor (betrayal). If you shot a car that was full of women and kids, it is a lot worse than if you shot guys with guns. Such incidents can destroy your sense of who you are.
Three other things also cause PTSD: Your brain is designed to keep you alive, so built in systems are activated by war. You care about other people or you would not have to get and stay numb. And finally, you lived. Dead people do not get PTSD.
Who gets PTSD? Given enough trauma, everyone gets PTSD. Most people have all the symptoms right after, but some of them seem to heal better than others. The people who develop PTSD have the most exposure to war, the greatest losses (not only friends, mental health and body parts, but trust, faith in the government or God or the military), the greatest number of previous traumas, the fewest resources [not just family and friends, but also the capacity to know what you feel or sit with a bad feeling and let it peak and fade (emotional intelligence), to let other people think differently, etc.] , the greatest vulnerabilities, and the least social support. PTSD seems to be a disorder of healing. That’s why it is important to be informed about post-traumatic reactions and about different kinds of help. There is no one-size-fits-all treatment for PTSD and no drug that makes it all go away, although research continues. Individuals need different things to heal. However healing seems to be dependant on being able to talk about the war, feel the pain, learn to moderate your reactions, and stay present in the present instead of being stuck back in the war.
What is PTSD? Many people think of PTSD as “the problem.” To me war is the problem, and PTSD is actually a solution to the problem of surviving war. All the symptoms start out as skills that help you survive
What are the symptoms of PTSD? Watch for these three categories. They grow out of the fight-flight-or-freeze survival mechanisms hard-wired into us all.
Set 1: Hyperarousal: Your brain is designed to pay attention to anything new, especially to threats, so you can survive. Hyper-alertness is a capacity that keeps you alive. Under the hammer of war constant watchfulness and expectation of danger (hyper-vigilance) become ingrained. Extremely effective startle responses [the shrrinks call it exaggerated] keep you alive and moving (fight or flight). Irritability and outbursts of anger, keep you alive and fighting instead of giving up. The inability to fall or stay asleep keeps you from being killed in your sleep. Shrinks also mention the inability to concentrate, but that is not exactly what is going on. It is the inability to concentrate on regular everyday stuff like picking up diapers at the store on your way home. Believe me you are concentrating on safety and on survival information. These hyperarousal symptoms are appropriate and effective in a war zone, where you have to do whatever it takes to survive, including things you may regret later. You have developed rapid responses, faster than thought, which can move your body before you know what you are doing. Keeping this edge is very important if you face redeployment. At the same time, at home these can become some of your biggest problems.
Set 2: Numbing and avoidance:
Numbing: The brain has a natural capacity to rapidly adapt to circumstances, especially danger. This is so we can be in control. It enables warriors to numb their feelings automatically so they can do whatever it takes to survive and to help others survive. It’s called professionalism, part of your training. Among the numbing symptoms are feeling like you have no feelings anymore, feeling like there is no future (so why worry when you could be killed tomorrow?), and feeling like no one can understand you unless they were there. Trauma happens so fast that you also may not remember all or part of some incidents. Our brains are also capable of dissociating. When this happens it is like being an observer of what is happening, as if you weren’t there.
Avoidance: We use avoidance to keep from feeling the painful emotions we have numbed. You maintain professionalism through numbness. You must not lose control. Avoiding emotions, thoughts, situations and activities that remind you of the war is easier if you are using substances, like alcohol, or behaviors, like workaholism, TV watching, the internet, or creating chaos (affairs, gambling, fighting). If you think you should be over it and your family and some of your outfit think only weaklings get post-traumatic reactions, avoidance seems like the perfect answer.
Set 3: Re-experiencing: Re-experiencing symptoms make you feel nuts. They include intrusive thoughts of the war, which you can’t stop having, dreams, nightmares, acting/feeling as if you were back in the war, blasts of adrenaline when thing that remind you of the war, and anniversary reactions (see PTSD & Holidays at patiencepress.com). Your brain is a better-safe-than-sorry system designed to keep you alert and alive. Trauma happens so fast and is so overwhelming that the more primitive parts of the brain don’t know it is over. They do not speak English, nor can they tell time. They want you to spend the rest of your life looking for roadside bombs and ambushes, so you won’t die. You know you are home, but your brain doesn’t seem to. Although this part of your brain is trying to keep you alive, the effect of re-experiencing can be the opposite. Acting as if today were the past can get you killed or get other people killed. You have to be reacting to today to stay alive and not harm those around you.
Many people have horrible flashes of non-verbal memory burnt into them by the war. They may be triggered by situations like confrontation, sounds like a backfire, emotions like guilt or shame or fear (many people turn these big three into anger so fast that they don’t know they are feeling them), thoughts like “I should/shouldn’t have…, sights like a car at the side of the road, or smells like cooking meat on a grill. Triggers can remind you of incidents of which you have no coherent memory. Further complicating your life, some sights, smells, emotions, sounds, etc., that are going on around you if you are triggered back home can become second or third generation triggers. This will make you feel even crazier when something with no connection to the war starts to trigger you.
Oddly enough, moving a non-verbal memory up into your frontal lobes, which do speak English and can tell time, either by writing and re-writing or telling and re-telling the story, often stops the re-experiencing. There are several forms of short term exposure therapy that can help with intrusive re-experiencing so you can keep your edge for the next deployment.
Why don’t they just get over it? Avoidance is very understandable, but it is also the main factor in perpetuating PTSD symptoms. By avoiding thinking about the traumatic events, you can’t make sense of it. Part of you is still back in the war zone trying to figure out what happened, going over and over it, hoping for a better ending.
Avoiding triggers leads to isolation, which means you don’t get the help you need to heal.
Avoiding bad feelings means you suppress them all, which can lead to depression and family problems. People can tell you are not feeling what you once felt, and rather than ascribe it correctly to PTSD, they think you don’t love them any more. You may think that, too.
The symptoms of PTSD can reinforce each other, too. Perhaps you are so numb, the only time you feel alive is when you are filled with adrenaline. You may unconsciously create arguments at home or do dangerous things that anger your spouse so you can feel alive. Then you start remembering and feeling, so you have to clamp back down to numbness, and they feel unloved as well as angry.
What you tell yourself can also perpetuate the problem. “I shouldn’t feel like this,” “I should be over it,” “What’s wrong with me?” “I must be crazy!” all can serve to keep you stuck. You are having normal reactions to war, reactions which John Wayne and Rambo never had because they were never in a war.
Although you may need your hypervigilance and emotional numbing in your next deployment, if you have significant re-experiencing it may endanger you and your buddies.
Once you are home for good, PTSD symptoms can become your biggest problems if you simply ignore them and expect them to go away. Although some people seem to heal, a large percentage of veterans exposed to high war-zone stress develop chronic cases. This is partly because of the lack of treatment available before the ‘80’s, but it is also due to the stigma people attach to “being affected”. I hope to reverse some of that, since normal people are affected by what they live through. Since PTSD can also be triggered by subsequent events throughout the rest of your life, it is wise to learn how to heal. Many older veterans have lost their friends and families because of the struggle to hide symptoms and seem fine. The current war has also re-triggered PTSD symptoms in many older veterans because they remember. They know what you’re facing. If this has happened to you, don’t think treatment didn’t work. It worked before and it will work again. Go back for more.
Getting Better: Each symptom of PTSD develops from a bodily-based, God-or-evolution-given built-in survival mechanism, designed to keep you alive. We all have these survival mechanisms, and if we had been through what you have been through, we would also be affected. You learned these survival mechanisms under the hammer of war. When you are ready to get better, you have to learn what they are, when and how they are useful, and new skills for when they are not. Each met a need, usually for survival, and finding other ways to meet your natural needs for safety and security is the job of recovery.
We also have built-in healing mechanisms. Attention (eye contact, being listened to, receiving empathy and respect), telling your story, safe touch, acceptance (bad things happen; they are painful), crying, making a contribution (working for the common good [altruism] and to support your family), justice, and spirituality are some of our built-in healing mechanisms. Our culture finds some of them awkward.
While avoidance strengthens and perpetuates PTSD symptoms, it is much less painful than the work of healing, especially if you have lost buddies, your sense of yourself as good or competent, and/or have shame or guilt or despair associated with the trauma as most people seem to. Somehow feeling like it is your fault, and if only you had done something, it wouldn’t have happened, makes you feel less powerless. The essential ingredient of trauma, however, is that it is overwhelming and you are powerless. No one can stop bombs or bullets with if-onlys. Many people spend their lives after trauma waiting and wishing for a better past, instead of working through the pain and anxiety for a better future.
Exposure is the basic task for healing PTSD. It teaches the parts of your brain that don’t speak English and can’t tell time that it is over. Exposure to what you are avoiding in small safe doses with a trained trauma therapist makes a huge difference. Often this is telling parts of your story again and again so that details come back and you can comprehend the whole experience. If you want to avoid these details because you think whatever happened was your fault, talking can help with that, too.
Most vets feel that if they ever let themselves feel, it would destroy them, but numbing bad feelings means the good ones are gone, too. Healing means you learn how to sit with a feeling and let it peak and fade, so you can process your memories. You went through hell. The feelings will hurt, but they will also pass eventually. Your therapist can teach you how to identify your feelings, that you are not your feelings, and that other people can have different feelings without either of you being wrong.
You can even learn to go in and out of numbing, since it can be handy, as can many of these survival skills. If you have developed an addiction to help you maintain numbness, you probably need to get clean, sober or abstinent from the substance or behavior.
The best way to deal with non-verbal memories is to move them from the non-verbal parts of the brain up to the frontal lobes and turn them into narrative memories, in other words: remember. Writing and rewriting something that happened to you is one way of doing it. Talk therapy is another. You get to tell your story. This is painful but you made it through the event, and you can make it through the memory.
For hyper-arousal, I always suggest basic un-training. Every soldier I’ve ever met thinks the military taught him to take care of himself. “Oh, really?” I often say, “So you used to say to your drill instructor, ‘Sorry Sergeant, I can’t do that. I need a nap.’” This usually gets a big laugh, but that is the kind of self-care you need to learn. After you have been to war, there are some things you simply can’t do. Sometimes it’s parties (don’t bunch up), cookouts (burning flesh), family fights. Sometimes it’s “Don’t ever come up behind me and grab me.” Whatever it is, learning to speak up is important.
You have to learn self-soothing methods, so you’re not always yelling and angry. You have to expose yourself to triggers in small safe doses, too, so they lose the power to trigger you. Learning that what triggers you is not necessarily dangerous here is also important, so your family doesn’t have to avoid your triggers.
Learning to meditate helps with these tasks and keeps you present in the present. The book Wherever You Go, There You Are, by Jon Kabat-Zinn helped Bob a lot. He also reads Thich Nhat Hanh. You may also find ways to heal your body’s constant state of tension through somatic therapies or yoga.
You may have to heal your beliefs. During extremely traumatic events, such as having a buddy die in your arms, or get killed when you weren’t there, people often decide “I will never love anyone again” or “I should never have left” or “It’s my fault.” Other beliefs that can interfere with healing and with everyday life include ideas like “Don’t talk about it,” “Only weaklings and whiners ask for help,” “You can’t trust anyone who wasn’t there,” and it’s converse, “You can (and must) trust anyone who was there.”
PTSD can make you feel totally out of control. By choosing to take new actions which have worked for others, you can regain that sense that you are in charge of your life.
Home life problems: The final topic I want to cover are some of the things I noticed in my family. Bob did things that really made me mad and I told him so a lot. Family members, friends, and even therapists can believe if you just did what they told you, you would be over it. Since the essence of trauma is your powerlessness to prevent it, most veterans need to regain a sense of control in their lives. This makes telling them what to do, even if you are right, counter-productive and ineffective, especially if you are constantly doing it. How do I know? I did it for years. Suggestions, on the other hand, can be quite useful, especially if explained as, “This has helped others. It might be awkward at first, but you might try it?”
For veterans of war, home life also creates triggers which cause major problems in the family without anyone realizing why.
Being asked to do things can get you killed in war, yet not doing common everyday things that your spouse asks you to do can cause a lot of resentment. Ask yourself, “Will taking out the garbage get me killed?” If not, maybe you can help out. Bob also says that common everyday things seem so unimportant when you come home from war, why bother? (Is the garbage shooting? No. Then don’t worry about it.)
Taking orders can also get you killed, so if your spouse gets demanding or bossy, resistance may become even stronger. Spouses resent this, too, because they usually get bossy when they are desperate for help.
Not following orders can also get you killed. Since you have the experience of war, you may find yourself ordering your family around and expecting instant obedience as if you were in the field. This can cause problems and resentments. No one likes to be ordered around.
Lateness can get you killed, so you may react strongly to it.
Mistakes can get you killed, but the way children (and grownups) learn is through mistakes, so they are not all fatal. You can remind yourself of this.
Emotions can get you killed. You have probably become quite numb to survive, but if you react to the normal emotions of your nearest and dearest as if they are trying to get you killed it usually causes problems.
People in your family may also seem like sissies with a lot of whiney problems, and after what you’ve been through you simply want them to shut up and focus on survival. Most people find that demeaning and unkind.
You want to keep them safe by making them strong so you may yell at them and try to toughen them up physically and emotionally. Most people hate that.
You may even envy these spoiled brats who have everything compared to you or to the people you were trying to help in other countries. It rarely helps to point that out.
So in dealing with family issues, you can ask yourself some questions:
1. Is it going to get me killed? Usually taking out the trash or washing the dishes won’t.
2. It is not life or death like stuff in Iraq/Afghanistan, so it may not be important to me, but is it important to my family member or friend? Can I be of help? It is rarely helpful to point out to them that in your scale of things, this is petty bullshit.
3. Do I want my kids to live like the kids I saw in Iraq or Afghanistan? Or do I want them to have an appreciation for what they have and to reach out to help those kids who have less? It is more effective to teach by example than by yelling.
Another problem that develops with PTSD as it becomes chronic is depleted cortisol. When people are flooded with adrenaline during combat (or arguments), a hormone called cortisol calms you down afterwards. Studies on Vietnam veterans with chronic PTSD show that instead of having chronically high levels of cortisol, they have depleted cortisol, not enough cortisol to calm down after they get hyperaroused. For me this explains a lot of the anger problems in veterans. They get angry easily because a killing rage can keep you alive and fighting in combat, but turning off the anger once it is on is really difficult. Not only is cortisol depleted, but in the middle of an argument, if your heartbeat is over 175 beats per minute, no one is home in your frontal lobes where you listen to reason! The forebrain has been hijacked, so you can’t understand your spouse’s arguments. When this happens, it is best to remove yourself from the source of your anger.
The purpose of this article is to give you information that will help you decide to heal whatever post-war reactions you may be having. It is not easy, but if you want to feel less alienated, it is possible. Recovering from war is not for the faint of heart. Bob and I wish you well.

Patience Mason is the wife of Vietnam helicopter pilot, Robert Mason, whose memoir of that war, Chickenhawk, was a bestseller. Her book, Recovering from the War, has been helpful to family members and veterans of all wars. Her website is www.patiencepress.com. Bob’s is www.robertcmason.com. (He has pictures.)

You may download a number of free articles at www.patiencepress.com as well as ordering the book, Recovering from the War. I also sell two books for kids, Why Is Daddy Like He Is? and Why Is Mommy Like She Is?, several pamphlets, After the War: For the Wives of All Veterans, The War at Home, and An Expalnation of PTSD for 12 Steppers: When I get sober, I feel crazy), and the collected Post-Traumatic Gazette.

Irritability and outbursts of anger

2007-05-06T14:58:00.000-05:00

It can save your life to be able to go from fine into a killing rage in nanoseconds. The capacity is built into our brains. Anger is a normal response when people try to kill you and your friends. It is a normal response to the privations of war, the f*ck-ups by higher ups who are not risking thier lives, the job of killing, the fear of dying. Anger helps you feel powerful. It has a lot of survival value while you are at war.
Anger can become your biggest problem after you get home, driving away your friends and family, isolating you so you can't get the help you need to process what you have been through. It can make you dangerous and unreasonable self-righteous and cruel. If you develop chronic PTSD, your cortisol levels will be depleted so you can't calm down once you are angry, and while you are angry, your heartbeat may get above 175 beats per minute which means your brain is not operating either, so no one can reason with you.
If you have been to war and are now constantly angry, that is a symptom of PTSD. You may not like to hear that, but you have been, quite naturally, affected by the war. Many generations of veterans have lost family and friends because of this symptom, and it is not your family nor your friends fault. They could behave perfectly and you would still be pissed off. Nothing they do will prevent that, because this anger is welling up in you due to your experiences, and you need to process those experiences with an experienced therapist, or work a 4th step with a sponsor in AA/NA or some other 12 step program (In the 4th step you start by listing your resentments, the fun part, and then you look at your part...), or start meditating so you can see your anger as an emotion and not THE TRUTH about what is going on.
Handling your anger is your responsibility.
You need to learn to walk away, and your spouse needs to learn to let you. You need to learn how to let go of anger, seeing the emotion beneath it, like feeling disrespected, blamed, guilty, or afraid you won't get what you want. Steven Stosny's HEALS technique is the most effective antidote to anger that I know of. It is an acronym
Healing (see the letters flashing in neon, which takes you out of the angry space)
Explain (to yourself what the underlying feeling is, from disrespected down to worthless and feel that feeling for a few seconds-like an inocualtion, so you can tolerate the painful feeling without flying off the handle, which gets easier with practice)
Apply compassion to yourself: Of course it hurts to feel disrespected or worthless, so I need to have compassion for my pain, and to respect myself or value myself, give myself an antidote to the pain which fits the particular kind of pain I am feeling
Love yourself. If this sounds selfish, loving yourself means you will be able to love others and feel compassion for them too.
Solve the problem. Anything you say or do that does not involve yelling or other outbursts of anger is much more likely to solve the problem. When you are not angry, your thinking is clearer and your solutions are better.
Stosny has written a book for people in emotionally abusive situations, and blowing up at your nearest and dearest is emotional abuse, called You Don't Have To Take It Anymore which contains a boot camp for the person who is doing all the yelling and name calling and criticizing. If you are doing that, the book will help you.
You have to think about what kind of a partner and parent you want to be and commit to that. Was your plan to emotionally abuse your family and friends? Probably not. There is a type of therapy which is used at some VA hospitals called Acceptance and Committment Therapy (ACT). You accept that you have been affected by war (or if you have been diagnosed with PTSD, by that) and you commit to learning how to be the type of spouse and parent you always wanted to be. You learn basic un-training, which means how to take time for yourself so you are not blowing up all the time, how to handle your anger, how to let other people make mistakes (it is how they learn), be human, etc.
You have to commit to your own healing and to being fair to your family, even though what happened to you and your friends in war WAS NOT FAIR. None of them deserved to die. You don't deserve to have PTSD. That is the truth. But you do deserve to recover, no matter what you did or didn't do, saw or didn't see, you deserve to recover and to have a good life.

One cure for reexperiencing (intrusive thoughts, nightmares, flashbacks)

2007-05-05T14:56:00.000-05:00

I just got a copy of "Toward the Flame," by Hervey Allen, a memoir of WWI. I mostly read memoirs because I don't care what the historians say. I want to hear what happened to the people, the soldiers...
Being the good girl that I am, I started with the preface to the original edition (1925) and the preface to this edition (an illustrated 1933 edition which came out after he wrote a bestseller, Anthony Adverse). This is what he wrote:
"After returning home in 1919, I found myself much troubled at night by memories of the war and often unable to sleep. It occurred to me then that I might rid myself of my subjective war by trying to make it objective in writing. Taking in hand the material mentioned above [letters from the front and the hospital], and adding to it what I still so vividly remembered, I whipped the whole into shape without any thought at the time of publishing it. The medicine worked, although perhaps the style of the utterance suffered." Toward the Flame, Hervey Allen, University of Nebraska Press, Lincoln, 2003, xxiv.
This is what happened to Bob also, When he wrote and rewrote Chickenhawk. He didn't realize it had happened until a couple of years ago when he was giving a workshop on writing about war and one of the participants shared this story. When this guy got back from Vietnam, he started going to community college. For his English class, he had to write a personal journal. He got an F on the first one because it wasn't personal enough (Numb??) so he thought, "Fuck her.(Irritability and outbursts of anger??) I'll make it personal. I'll write one of my nightmares (re-experiencing)." So he did. The teacher, bless her, simply corrected it and handed it back to be re-written. This happened several times until she was satisfied and then he rewrote it a couple of more times to make it completely accurate just for his own satisfaction. And then he noticed he was not having the nightmare any more.
When he heard this story, Bob realized that after he finished Chickenhawk, his nightmares also stopped, and he stopped thinking about the war everyday...
There is actually a scientific explanation for this. Much of the information about the traumatic events in your war is stored in the reptile part of your brain (hippocampus, amagdayla, other funny names) in the form of fragments of non verbal memory (sounds, scenes, smells, words, emotions, etc). They often trigger flashbacks, intrusive thoughts, nightmares and hyperaroused bodily states. People are designed to form narrative memories. It is what the whole front part of the brain does, and through the process of verbalizing those fragmented incidents, you can move them out of the part of the brain that causes reexperiencing up into a normal narrative memory, which might be painful, but won't entail involuntary re-experiencing. Therapy, if you get to talk about what happened, can do this too. That is why they want you to talk. But sometimes therapists don't want to hear, or don't want you to feel bad, so they cut short parts of the story. It can also be very hard to remember some parts of it if you feel ashamed of something you did–or didn't–do. So if writing it out doesn't seem to do the job, look deeper.
An example of this: a woman who was raped who was so afraid the guy would kill her and so desperate to get it over with that she moved her body as if it was good for her. In therapy, she didn't even remember this, it was so shameful in her eyes, but when she read my prayer for trauma survivors, which says "Help me to love myself no matter what happened to me or what I did to survive," she remebered, and after that, no more intrusive memories!
Here are the affirmation, prayer and expanded serenity prayer I wrote for veterans:

Affirmation for Veterans with PTSD
I’m _____________ and I’m ____ years old.
I am home from the war. I can feel safe here.
I live in ____________________.
I live with _____________________________, and _________cares about me.
I can feel sadness and despair and fear and anger and guilt.
I can cry and those who love me will still care for me.
I need to have these feelings so I can let them go.
Each time they come up, I can use them as evidence that I need to do whatever it takes to take care of myself.
I can ask for and recieve help.

Prayer for Veterans with PTSD
Higher Power,
I know that it’s not within the harmony of the universe that I be healed from the trauma of my experiences in the war 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.

Serenity Prayer:Grant me the serenity to accept the things I cannot change: the war, what heppened to me and what I did or didn't do, and that what happened was traumatic no matter how effectively I have stuffed it.
Courage to change the things I can: my attitude towards my symptoms—help me to accept them as a normal response to war and evidence that I need to take care of myself by talking about what happened to me with a safe person and getting whatever help I need; my actions—I no longer have to blow up, drug, deny or repress my symptoms. I can accept them as evidence of how much I have been through; my reactions—instead of freaking out, blowing up, or trying to repress what I feel, I can focus on the symptom, whether it is numbness, anger, a painful emotion or memory, dream or flashback, or a physical reaction, feel what I feel, go through and have the pain and learn whatever it is that my Higher Power wants me to learn. Then I can share about the effects of trauma on people. Finally I can change how I see these symptoms—as normal responses to trauma which helped me survive and will help me recover even if they are painful.
And the wisdom to know the difference: help me to be willing to accept that I survived something terrible, and that I can learn from it and heal if I look outside my own head for help, and that I deserve to heal.

Please feel free to change the wording in whatever way works for you. I suggest keeping copies of this with you for those moments when you feel overwhelmed with feelings that you don’t want to have.
REMEMBER: It is okay to feel bad. You can’t heal what you don’t feel.
Patience Press PO Box 1517, High Springs Fl, 32655

Is PTSD normal after War?

2007-05-04T07:30:00.000-05:00

Yes, it is. Right after a single trauma, according to one study, everyone gets all the symptoms of PTSD. Some of them seem to heal, so it is a disorder of healing. Our society seems to be set up especially to prevent healing from trauma. Everyone wants you to be over it in a week. I remember hearing a woman who barely got out of the Trade towers on 9/11 saying a week later that her friends were asking her why she was still upset. After all, she lived.
It is illegal in this country to feel pain. We are all supposed to be fine. FINE is an acronym to some of us: F**cked up, Insecure, Neurotic, and Egotistical, which fits those people who think "It wouldn't have affected me/didn't affect me/shouldn't have affected you."
All the symptoms of PTSD start out as survival skills which are built into the brains of all of us. No one is exempt. Those who seem to have been exempt, like John Wayne or Rambo, actually sat out their wars and were never exposed to combat.
The first survival skill set is called "symptoms of increased arousal not present before the trauma" by the diagnostic criteria. One problem with this is that if they were present before the trauma, it probably means you were traumatized earlier. Beatings, emotional abuse, neglect, sexual abuse, when these happen to a kid, they are more traumatic, not less, and kids react by becoming very wary and very fast. This makes them better soldiers. It is what basic training is designed to reinforce because these behaviors will keep you alive. The first PTSD symptom/survival skill is an effective (not "exaggerated," EFFECTIVE) startle response. Others include irritability and outbursts of anger, inability to fall or stay asleep, hypervigilance, and "inability to concentrate" which is actually the inability to concentrate on anything that is not survival information. These keep you alive. This is the fight/flight/freeze capacity, built into all of us that enables us to react before thought. Our brains are designed to scan for danger and react instantaneously. Since this capacity is based in what they used to call "the reptile brain" in High School science, it doesn't speak English (that's in the frontal lobes, the last part of the brain to develop) and can't tell time, so you can tell yourself you are home and it is over, but the message does not get through to this part of the brain for a long, long time, sometimes never.
The second survival skill set is called numbing and avoidance. Our brains are designed to pay attention to threats, which means extraneous stuff like emotions go into a box. The brain is also designed to rapidly adapt to whatever is going on, which means the first dead person is very upsetting, the second, not so much, and by the third, you may be numb as a stump. This keeps you able to keep fighting and doing your job, saving yourself and others. (In medicine, this is called professionalism). Trauma/combat happens so fast that you can't take it all in, so you may forget all or part of some particualrly horrific incident, which is your brain's way of protecting you. Unfortunately those details remain in the emotional/non verbal parts of the brain and may cause you a bunch of trouble later. Once you have been in combat, you may not be expecting to live long. You know, on the most basic level that life can end in an instant. You've seen it. You will also probably feel like other people can not understand, that you are different, so you get detached and estranged from people. Part of this is because after your buddies are killed, you protect yourself by not attaching to new guys, but it is also a reality you are going to face for the rest of your life. Your brain has been changed by combat. And OTHER PEOPLE CAN NOT UNDERSTAND WHAT YOU HAVE BEEN THROUGH. I learned this when I came out of the movie Platoon and said to my husband, "That was so awful!" He looked at me, almost puzzled, and finally said, "It's worse when it's real." That statement hit me hard and I realized I will never know. I may want to understand, but if I am honest, I know I can't. On top of this people say such shitty things to combat vets, "Did you kill anyone?" "Why aren't you over it yet?" etc. that you know they don't understand. Then you start to avoid things that remind you of the trauma. You avoid thoughts and feelings that remind you of the war, so if you were happy and your squad got hit, you may decide you will never be happy again. If you feel it was your fault, you may decide you will never be wrong or feel guilty again, which will make you self-righteous and argumentative and critical of others. If you love your buddies who died (and soldiers in combat are closer to their buddies than anyone) you may decide never to love anyone again. Next you avoid activities and situations that remind you of the trauma: driving, cookouts (burning flesh), crowds (bigger target), sports involving blood (hunting, football), movies, reunions, etc. Avoidance behaviors are survival skills in that they help you avoid triggers which can cause strange embarrassing behavior. And triggers can have children and grandchildren, so that if a car backfired while you were watching kids play, and you hit the dirt, the sound of kids playing can become a trigger too... The progression of triggers can get you to a point where you can't leave the house. Avoidance is also a survival skill because it keep you from feeling a depth of pain that most people cannot imagine, a depth of pain that is quite illegal in America, the land of the fine. Once you are numb, it is much easier to stay numb. The commonest way to do this is alcohol, although almost any substance (drugs, food, booze, etc) or behavior (sex, gambling, internet, religion, shopping, TV, workaholism) will do.
Unfortunately your brain also wants to figure out what happened, so you will also start re-experiencing the trauma. This is what brought PTSD to the attention of shrinks who were determined not to see it back in the 60's and 70's (the American Psychiatric Association's denial and delusion period) so they think it is a wierd reexperiecing disorder with associated wierd behaviors. I'm lucky in that I knew my husband before he went, and after I found out there was such a thing as PTSD, I began to look at why these symptoms developed and how it would happen under the hammer of war. That is why I see PTSD as normal, meeting the need to survive built into all of us. BTW, others who think like me include John Briere, PhD and Sandra Bloom, MD, and some of the ideas I have mentioned here came from their work.
I have not been able to blog for a couple of months because of my rage at the REMF's who started this war, please note, WITHOUT LISTENING TO THE GENERALS!!!, and are now presiding over the mistreatment of PTSD, sending people back into the war on medications, and the mistreatment of our returning veterans, and giving bonuses to VA managers...
However, I think the most helpful thing I can do for our returning vets and our vets who are being re-triggered by this miserable cluster-f**k is to blog about my take on PTSD as a normal response to war. If you take nothing else away form my blog, remeber it is NORMAL TO BE AFFECTED BY WAR. NORMAL. NORMAL. NORMAL.
More tomorrow.

VA Gilgamesh Cartoon Insults VA Doctors

2007-01-08T13:18:00.000-05:00

I actually need to say that the cartoon version of the Gilgamesh story is aimed at VA doctors, and if I were them I would be insulted. Most of the doctors and nurses I have met at the VA in recent years have been polite, concerned and helpful, nothing like the cartoon of Doctor U. or the way it was for Vietnam Vets in the 60's and 70's.
What angers me is that someone was paid to make this insulting information-free, misinformed (the paralysis before combat...what is that? Are they trying to mention conversion reactions when someone in the field for the duration would become paralyzed??? or blind??? in both World Wars???). And Gilgamesh is dirty and unshaven which proves he has PTSD??? NOT! Most people with PTSD are working a job and killing themselves to look FINE... (although I know at some VA compensation exams if you don't show up dirty and unshaved, you will be denied, that is the compensations system, not the treatment people).
How much did it cost?
Who approved it?
Who made it?
Let them all lose their jobs, and use the money for information which will actually help the doctors do a better job, or inform the patients about PTSD. This cartoon does neither.

A waste of money

2007-01-08T09:03:00.000-05:00

http://www.va.gov/gilgamesh/swf_files/part1_pub.html
This is probably the stupidest waste of VA money I have seen in a long time. If you take the time to watch it, you will be amazed by the self-centered, self-absorbed doctor, the incredibly stupid jokes, the lame attempts to be reassuring, the absolute lack of empathy. I mean it is pathetic.
Actually it may also be accurate. There's a frightening thought.
I followed some of the links at the end.
The scariest was on http://www.pdhealth.mil/clinicians/scp_trackII.asp
"Intensive, three-week, multi-disciplinary treatment program for patients with deployment-related stress, Post Traumatic Stress Disorder (PTSD) and/or difficulties adjusting to re-deployment" [my italics] So they are sending people with PTSD BACK, which is completely unethical. It is well known from Israeli studies that combat vets with PTSD in one war or deployment get it worse in the next one.
Another frightening line towards the bottom of the description of what sounds like it might be a worthwhile program if it weren't used to send people with PTSD back, is "The individual's command must approve program attendance." So the numb ("It didn't affect me") or clueless (no combat experience) CO has to approve a medical decision, instead of the medical staff. Do CO's approve all other medical decisions? Are CO's the new insurance company representatives in the military structure?
Anyone who has studied the Vietnam War, or any other war, as I have, knows there are always officers who will sacrifice their own men so they look good. They should not be in the position to do this to men and women with PTSD.

Heart attacks and PTSD

2007-01-07T10:02:00.000-05:00

Study: War Trauma May Raise Heart Risks

By CARLA K. JOHNSON
Associated Press Writer
http://hosted.ap.org/dynamic/stories/
V/VETERANS_STRESS_HEART?SITE=VAWAY&SECTION=US&TEMPLATE=
DEFAULT&CTIME=2007-01-01-23-22-04
I have no idea how to make that a link.
This is a really good study and about _______ time.
A few years ago, a famous psychiatrist [George Valliant, MD. I remembered!] whose name escapes me at the moment (Halfheimers, when you don't quite have altzheimers, or is it CRS... can't remember) did a study of all the WWII vets who had gone to Harvard. They had thorough medical histories of them when they got into Harvard, so they looked for PTSD in those who had seen combat. He, of course didn't find much (Ha ha. The old school) but he did find that by age 65 most of the WWII Harvard combat vets were either physically very ill or DEAD, which was incredible!
There have been other studies connecting PTSD with stress related diseases.
One of the earliest descriptions of PTSD, in Civil War veterans, was published in 1876. Dr. Da Costa described a set of heart symptoms and called them Soldier's Heart. My husband had this when he came back from Vietnam, but since it was old medicine, no one had ever heard of it, and they told him he could probably die of it anytime. Wonderful for a person diagnosed with "nervousness" since there was no diagnosis of PTSD at that time.
And when he had his last C&P exam a couple of years ago the young woman doctor didn't KNOW that no one was diagnosed with PTSD in 1968 because the Diagnostic and Statistical Manual II of the American Psychiatric Association had no such diagnosis. As a matter of fact, they had just discarded the "Gross Stress Reaction" of the first edition and decided, on no scientific evidence whatsoever, that if a trauma affected you for more than 6 months, you were screwed up before the trauma...
How could a person like that be doing compensation exams for the VA? Of course she was better than Umesh Mahtre, MD, who asked my husband how he was doing. Bob said "about the same." They talked about flying for a few minutes. We thought he was trying to put Bob at ease, but that was the end of the interview and his report was, "The patient reports no problems." He was famous among the local veterans for never seeing PTSD even when it was in his face.(If this has happened to you, the exam is "inadequate for compensation purposes" and you can immediately in writing ask for another exam on that basis.)
The VA compensation system (which is different from and separate from and, as far as I can see, IGNORES the doctors at the VA Hospitals and other treatment facilities) in many areas of the country does it's best to see that those who need help die before they get it, some of the deaths no doubt brought on by stress related heart attacks.
If you want to help, write your representative and senator and ask for more funding for treatment at the VA, and for forced retirement of any old hack in the VA Compensation system who routinely denies PTSD claims or denies them with insane criteria such as this one, which a friend of mine received: "Since you were an infantryman and seeing the death of a friend in combat is not outside the range of usual human experience for an infantryman, you do not have a traumatic stressor." Totally wrong, but he still may have his job...

Hope

2007-01-06T07:31:00.000-05:00

I subscribe to the Psychotherapy Networker e-newsleter and just read a great article by Nancy Errebo, Psy. D. about using EMDR with a returning vet. (This issue has 3 articles on PTSD.) http://www.psychotherapynetworker.com/index.php?category=magazine&sub_cat=articles&type=article&id=Like%20a%20Ghost&page=1
Two quotes struck me:
"while nightmares and flashbacks are very troublesome and painful, avoidance is by far the most dangerous aspect of PTSD-in fact, it maintains the fear and vigilance and the constant preoccupation with the war. "Avoidance also becomes a way of life," I said and described some veterans I know who'd spent many years avoiding almost everything and everybody in their largely unsuccessful attempts to stay calm. There's no healing without exposure to the memory and the emotions that go with it, I added." [my italics-Patience]
and also:
"the brain naturally tries to process trauma by reviewing experience, but the images and emotions are so vivid that nightmares and flashbacks result. So the opposite, also completely natural, tendency kicks in and the brain tries to avoid the pain by numbing the emotions. At this point, the information can't be processed, and the cycle just repeats over and over again-the natural healing process getting caught in a kind of gridlock. EMDR is designed to break the gridlock and keep the information processing system active so that healing can occur."
This article also mentions EFT, Emotionally Focused Therapy for couples, one of the therapies I think is stupendous. Dr. Errebo wrote an article on that: "EMDR and Emotionally Focused Couple Therapy for War Veteran Couples" in the Handbook of EMDR and Family Therapy Processes. I belong to the International Society for Traumatic Stress Studies, and often go to their conferences. I saw Susan Johnson, the developer of EFT, give a workshop on it, and it was simply wonderful.
A lot of VA's do offer EMDR these days, and it works for many people. Processing the trauma may only be the beginning of recovery, however, if you grew up in a home where there was a war between men and women. EFT offers the chance to make your home a sanctuary instead of a battleground. So does applying the principles of Al-anon to life with PTSD and I'm sure there are other effective therapies, but this is the one that I know about.
Another therapy that I attended a workshop on is ACT, Acceptance and Commitment Therapy. I felt that this was another one that I would like to see in every VA. If you Google "Steven C. Hayes" and "Sonja V. Batten" and "Acceptance and Commitment Therapy" you can find out more from the people who developed the concept. I think it pays to be an informed consumer of mental health and to speak up for what you feel would help you.
By the way, none of the devlopers of these therapies think their way is the only way. When a therapist tells you that their therapy should have worked, that's when instead of feeling like a failure, you need to find a new therapist. The failure is not you. It's different if they say "this doesn't seem to have helped you, so lets try and find something that will, perhaps with another therapist." That is honest, because people are best with techniques they know and love, as long as they don't imply that you failed.
Actually, I think I have to qualify that,too. If you try to do therapy while drunk, stoned, in a food coma, etc (all of which may be the PTSD symptom: efforts to avoid thoughts or feelings associated with the trauma) you can prevent your own healing. It is like the healing of any wound. Pain is involved. You went through hell and healing it will hurt. So you heal in small doses with help. But if you don't feel, you won't heal.
I often say it is good to be able to go in and out of the numbing at will, since the numbing is a survivor skill. But healing is something else, something beyond numbing. When you numb pain, you also numb joy...
And if your pain is intolerable, there are programs like Dialectical Behavioral Therapy, which teach you skills in tolerating painful emotions before you try to do trauma work. I don't know of a VA where they do that either, but I hope it will come.

Conflict of Interest

2006-12-07T09:21:00.000-05:00

This morning on NPR they aired a comment by an Army physician, "The Army has a system in place which required questions be asked, but no action be taken." He was told people he'd seen PTSD in were "faking it" to go home or get out of the Army. In my opinion, this is because there is a conflict of interest between the goals of the Army, to train people to fight and keep fighting no matter what, and the health of individuals.
The questions are asked about PTSD symptoms so the Army can say they want to prevent or are preventing PTSD, but the fact that there is no requirement for action means that the service member can't trust that if he or she speaks up, help will follow. "Betrayal of what's right," as Jonathan Shay, MD, called it in Achilles in Vietnam, is one of the significant contributors to PTSD. It makes a mockery of the sacrifices of soldiers.
At the International Society for Traumatic Stress Studies conference a couple of years ago, I saw a presentation by doctors from Walter Reed who were dealing with the PTSD ward. One young, rich, stupid, innocent-of-the-realities-of-war MD told us they were diagnosing personality disorders because some of these guys had been in trouble as adolescents, so it couldn’t have been the war…
This of course is utter bullsomething. The fact that they may have been in trouble before the war may mean they had childhood PTSD, and PTSD gets retriggered by further trauma, but they were functioning well enough to get into the military and go to war, and that means their problems are related to their service. The conflict of interest is that, if they have personality disorders, it is a pre-existing condition and they get bad discharges and no VA benefits. This is wrong. Even a personality disorder can be made worse by war.
There is also a conflict of interest in the VA. Limited resources means that there is pressure not to find PTSD. I know several MD’s who no longer do psychiatric exams for the VA because they were pressured not to find PTSD and could not honestly keep working there when their diagnoses were ignored by the compensation officers.
There is also unforgivable and contemptible professional ignorance. Two recent cases at the Gainesville, FL VA: A young woman psychiatrist says to a vet, “I see you were originally diagnosed with anxiety,” The wife says “Look at the date, 1968,” and the shrink replies, “What difference does that make?” “Well, there was no such diagnosis in 1968…” Even though she is doing compensation exams at the VA, she is completely unaware of the history of PTSD, especially the fact that in 1968, the American Psychiatric Association decided with NO EVIDENCE that the diagnosis of “Gross Stress Reaction” (if you have been through a gross, i.e. big, enough stressful situation like combat or a concentration camp, it can affect you!) was discarded and replaced with “transient situational disturbance,” which meant that if any trauma affected you for more than 6 months you had a pre-existing condition, and the trauma hadn’t caused your problems. No one has ever taken responsibility for this lethal decision. The other case was a woman psychiatrist in the course of a compensation exam, saying to a veteran of Hamburger Hill, “I saw the movie. It can’t have been as bad as the movie.” This ended his ability to speak, as well as indicating an unbelievable inability on the part of the psychiatrist to think or empathize: IT IS WORSE WHEN IT’S REAL.
Then there is the lack of resources for PTSD treatment. These are part of the actual costs of war, but no one but veterans and their families want them paid.
Tomorrow I will talk more about treatment, but right now I am so mad I have to get off the computer and go calm down.

The Realities of PTSD

2006-12-05T12:27:00.000-05:00

I'm starting a blog to talk about the multiple realities of PTSD: The biological basis of PTSD, the brain and body based keys to human survival which we all have, the historical reality of PTSD in literature, the separate reality of trauma (war, abuse, natural disaster), the reality of having PTSD, the reality of living with someone who has it, the reality of denial by survivors and society, the physical reality (depleted cortisol, changes in amygdala and hippocampus, stress related diseases, early death), the reality of how hard it is to get help, especially good help.
I'm inspired partly by a story on NPR yesterday about soldiers saying the Army is not treating PTSD, (see http://www.npr.org/templates/story/story.php?storyId=6576505). This story includes many of the elements which make life hard for people with PTSD. Denial by those in charge (they're faking it) when the likelihood is that those in charge are either REMF's (rear echelon bad word bad word) or so numbed out themselves in order to cope with the trauma of war (usually enabled by alcohol or workaholism or some other addiction) that they think they are fine and it didn't affect them. One sergeant actually said that in the story. I see that as evidence of PTSD, like the mother of a molested child saying, "I don't know why she's making such a fuss. I was molested for years and it didn't affect me." Except to destroy your natural human capacity to care. I think people get this numb because they do care and caring is too painful and utterly unsupported in this society. Been there, done that, being one of the numbing rituals we hear a lot.
Poor treatment. We've all heard the Army, Marines, and VA claim that they are treating and preventing PTSD this time. I always laugh when I hear that. First of all, most guys have to be in extremis to ask for help. Second of all, being in a group with a psychologist is not debriefing, one of the things that does help (see www.icisf.org/ for more information). Critical Incident Stress Debriefing is peer-to-peer, not shrink to clients... The military is not doing that. Third of all, you can't change human nature. We all do our best to survive in war and other traumatic situations. Then we all do our best not to feel the pain. The same things that help us survive: hyperalertness, so we can pay attention to threats and move fast; numbing, rapidly adapting to the situations in order to remain in control and do whatever it takes to survive and keep others alive; and re-experiencing, our brain's better-safe-than-sorry warning system, all can become our biggest problems if the trauma is not addressed. So trying to pretend that 17 soldiers and a shrink is debriefing, and that a suicidal, not-doing-his-job drunken or drug-using combat vet is simply a slacker who should be thrown out of the military will leave us with the same problems we had after the Civil War, First World War, Second World War, Korea, Vietnam, Somalia, The Gulf War, Panama, Beruit, etc.
For interesting reads on the effects of war on family life try Even Dogs Go Home to Die by Linda St John, It's All Over But the Shouting by Rick Bragg, or Change Me Into Zeus's Daughter by Barbara Robinette Ross, none of whom had ever heard of PTSD when they were growing up.
I gotta stop here. As you can see, I have a lot to say.