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Sunday, May 6, 2007

Irritability and outbursts of anger

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.

Saturday, May 5, 2007

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

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

Friday, May 4, 2007

Is PTSD normal after War?

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.