I just spent an hour on the Donnie Moses Show on WBOB AM 600 in Jacksonville, FL, with Bill Carter, talking about PTSD. Within a week the podcast should be available at http://www.wbobradio.com/wbob-archives/podcasts/ scroll down to Donnie Moses show and click on today's date, 4/21/12. It looks like they only keep them online for a couple of months. You can either listen or download. Download if you want to keep it. That's what I plan to do and hope to put it on my website.
One guy called in to help us with PTSD by saying it was caused by chemical exposures and if we just read his book and went to these special doctors (because the VA doesn't treat it) we would all be fine. I tried to be polite, but I told him that PTSD is caused by traumatic events and in soldiers it is caused by hundreds if not thousands of traumatic events. Then Bill, who was a helicopter pilot in the 1st of the 9th Cav, a unit that went looking for bad guys all the time, told him an abrupt goodbye. The rest of the broadcast was about PTSD and I got to say most of what I think is important, that it is normal to be affected by what you live through, that the symptoms of PTSD start out as survival skills built into the "reptile brain" which doesn't speak English or tell time, so that part of you does not know it is over, and that avoidance perpetuates it, which is why writing and talking about it help you heal. I also talked a bit about triggers in the family and how we can misunderstand and personalize things which leads to a lot of fighting and disharmony.
I thought it went well.
Saturday, April 21, 2012
Monday, April 9, 2012
Infants Possess a Sense of Justice: How this affects anger in PTSD
This article reinforces one I read about monkeys also having a sense of justice (give one a banana and one a cucumber, and the cucumber monkey gets pissed). I believe that part of the root of PTSD is a sense of justice. People who are traumatized know it is not fair, even if they are told they deserve it by perpetrators or it is part of the job in the military. It's not fair and it's not right and on some level they know it and it makes them mad. It also makes them mad when people try to kill them or hurt them or their friends... so anger becomes a big problem.
Life isn't fair unfortunately and worse things happen quite often in war and other traumas than people are able to deal with. Finding someone who listens to your anger and doesn't tell you not to have it can be very healing.
Blowing up is the reverse of healing.
Most of what we think of as anger is dysfunctional and ineffective.
Here is my article from the Post Traumatic Gazette
Dealing with Anger in Effective Ways
One of the most terrifying things for trauma survivors is to fly into a rage without any warning. Family members friends and therapists can be terrified, too, although they may not show it. If you have read earlier issues of this newsletter, you know that irritability or outbursts of anger are one of the cluster of hyperalert symptoms that include not being able to sleep, lack of concentration, startle responses, etc. You may still be mystified or afraid that you will do something in a rage that you will regret for the rest of your life. And maybe you already have. I suggest using the pain from incidents you regret to motivate change.
The first task in dealing with anger is to distinguish between anger, which is an emotion, and violence, which is an action. Most people think they are the same thing.
Extreme startle responses can be violent. The violence occurs in nanoseconds when the person is surprised by something, way before the amount of time it takes to process something that pisses you off in your fore brain and get mad. Violent startle responses are very upsetting to the person who has them. Often the person goes from shame and despair (what is wrong with me?) straight into an eruption of anger at the victim of the violent startle response. In one sense it makes no difference to the person you are yelling at or hitting, but it can make a difference in how you handle the incident. Instead of erupting in anger, you can learn to say, “I am so sorry. That was a startle response. I am not angry except at myself for having it.”
Anger is based in thinking. One person is treated rudely by a clerk and thinks “She must be having a hard day.” Another person thinks, ”She cant treat me like I’m nobody,” and gets angry. Same behavior, one way of thinking results in compassion and the other in anger.
Anger is a signal that you have a problem to solve and you probably feel you are about to be harmed. The problem may be real (someone is hurting me) or it may be that what is going on today brings up feelings from the past (what is happening reminds me of my abuser or a traumatic event). Anger is an emotion, not an action like exploding into violence.
Anger can be managed if it is brought to awareness and feeling is separated from action. Boundaries and knowing about emotional reasoning can help here. Say to yourself, “I am over here. That person is over there. He or she has a whole history, feelings, thoughts of his/her own. I may feel pain but that does not mean that person is trying to hurt me (emotional reasoning, a cognitive distortion, says I feel it so it must be true). It may have nothing to do with me.” Just saying this much to yourself will help you pause. When you can pause, you can also learn to act in new ways instead of reacting in old ineffective dysfunctional ways that get you into trouble, ways you may have learned in childhood or in combat. You can learn new skills. It ain’t easy, but it can be done, one little bit at a time!
Several aspects of PTSD contribute to the problems trauma survivors have with anger.
Knowing you are angry: You may be so numb you can’t tell when you are beginning to get angry. It seems to explode out of you but there may be early warning signs that you could learn to detect. Regularly scanning your body for physical signs can help you become aware of this: are you clenching teeth or fists? Is your stomach churning, throat tight, lips turning into a thin blue line? Ask your family or associates how they can tell if you’re getting mad. You may start to twitch in a particular way that you are not aware of, moving your shoulders, drumming your fingers, rubbing one ear. If you know your own signs, you can walk away or calm yourself down.
Knowing why you are angry: Once you start to be aware of what is going on inside you, I’ve found that it helps me to identify other feelings I have numbed which lead me to anger. Most people learn to cover up painful or frightening feelings by getting angry. Anger causes a surge of adrenaline and a feeling of power which is more tolerable for most of us than feeling helpless, afraid, hopeless, needy, fearful, despairing, lost, abandoned, guilty, ashamed, or whatever.
If this is true for you, as it is for me, paying attention to your emotional state will help you deal with the primary feelings under the anger. I find that I do better if I just feel them, no matter how painful, for a while, maybe write down what I feel. The feeling passes and I am okay. “This too shall pass,” is a good slogan for me.
Another PTSD symptom, hypervigilance, constantly scanning for danger out there, makes it hard to concentrate on your inner life and be aware of what you are feeling. This can compound the effect of numbing. Using an affirmation like: “I am safe. I am __years old and no longer in ______. I have more resources today than I did when I wasn’t safe,” can help remind you that hypervigilance may not be necessary today. Fill in the blank with your age and the place you were traumatized whether it was Vietnam, Iraq or Afghanistan, or your own home. Change the wording so that it works for you.
Other symptoms of PTSD can contribute to anger problems: lack of sleep makes you irritable. You may also carry an irritating residue of bad feelings from nightmares into the world of day. Trying to avoid feeling common feelings can be a constant irritation. Plus cultural conditioning says men can be angry; but they can’t cry about things they need to cry about, like losing friends. And women are never supposed to be angry so we tend to stuff and stuff till we blow up.
Changing: If you want to change, the first step is to identify what lies under the anger. Keeping a list of common feelings handy can help you learn to name them. List the beliefs you have which get you mad. A lot of them will have the word should in them. Stopping to identify feelings and beliefs turns out to be a good pause-button for those of us who tend to go off like a rocket.
Knowing your own history is important here, too. If you can identify why that clerk pissed you off so much (like the lifers in Vietnam or the teacher who humiliated you in front of the class), it is easier to go on with the thought “but this isn’t Vietnam. or school, and I’m older now and have more resources, one of which is to write a letter to his/her boss...” Taking a healing action is so much better than letting others push your buttons and jerk you around like a puppet.
When you want to yell, look inside for the feeling beneath the anger. Is it fear that your kid was dead when he stayed out late and didn’t call? It will be a lot more effective to tell him that than to rage. Is it feeling unloved and therefore unlovable because someone forgot something they said they’d do for you? If you can identify that you can be honest about it (I felt hurt when you forgot my sandwich/birthday) and you can also examine whether you are putting yourself in a position to be hurt over and over by relying on unreliable people or expecting someone human to be more than human. Then you can work on that pattern, too.
Much of anger comes from what are called “hot thoughts.” We see someone’s behavior as reflecting on us. I used to see my dog’s unwillingness to let go of the ball after she fetched it as proof that I was no good (Couldn’t even train my dog right!). It would enrage me. One day in the park, I found myself screaming at her, “This is not a game!” as I punched her for not dropping the ball! Me! Nice Patience! It got me to examine my rage and see what I was saying to myself about her natural playfulness vs. having the perfect dog. Today I try not to be perfect or have perfect dogs, plans, parties, newsletters, etc. It is a lot easier!.
Hot thoughts can be as simple as “she should have dinner ready when I get home.” If there is an emotional rush associated with a simple event, the uprush of emotion signals to me that this feeling is probably from a different time zone and I need to examine it. For me, often the intensity of the anger is a cue that my needs were not being met, whether that zone is a traumatic childhood, recent traumatic events, or Vietnam. It helps to remind myself that I have more resources today.
There are a lot of slogans and sayings which help to cool down hot thoughts. “Easy Does it,” is an old AA one. “This is not a life or death situation,” is one many veterans use. “I can handle this,” helps remind me that I have more resources today than I used to have. “Chill out! Cool down! Slow down and take a breath. What is the problem here that I need to solve?” all are helpful phrases.
Disputing your thoughts can help too. Whenever I think “I’m no good,” (which is an old pattern for me), due to the fact that I’ve been working at recovery for nine years, I almost instantly say to myself, “Wait a minute, I’m fine. I’m not perfect but who likes perfect people? I’m okay the way I am.” It really helps. You can learn to do it, too.
Letting go of unrealistic expectations that other people will put your needs first can help. I’ve found that most people can be trusted to be human and think of themselves first. It is okay. So do I most of the time.
In 12 Step programs, we use steps four through nine to free ourselves of anger: not to suppress anger but to become free of it. This involves self examination (the inventory), becoming willing to let go of old patterns which may have served us in the past but are ineffective today, asking for help from our higher power, listing people we have harmed, and making amends to them. (Sometimes it is human nature to be angriest at those we have hurt.)
Feeling vs. Action
I have come to believe that almost none of us sees anger used effectively in this society. And most of what we think of as anger are angry actions which are ineffective and dysfunctional. Yelling, hitting, throwing things, blowing up, hitting pillows, withering sarcasm, getting drunk to pay someone back, shopping till you drop, screwing someone because you were screwed either literally or figuratively are all ineffective actions. There may be a momentary feeling of power, but I don’t think it lasts very long. The effects of such actions usually do last.
The idea you should get anger out to get rid of it also seems to indicate that anger isn’t an acceptable feeling. It is to me. I am allowed to be angry. I prefer not to act in ineffective ways. I can “say what I mean but not say it mean.” I see a distinct difference between the feeling of anger and my old “let me tell you what is wrong with you!” shaming and blaming way of handling it. That was ineffective action. So today I try for the feeling, to sit with it, examine it, say what I need to to keep my side of the street clean (be honest).
Here’s an example from recent experience. Someone yelled at me recently. It really pissed me off. I would have yelled back in the old days but I am really aware through experience of how ineffective that is. So I said to myself, yelling back is my old pattern. I need to use the principles of the 12 step program to find a new solution. She may not even know she is yelling. She also doesn’t know how I feel when she yells because I always act like it doesn’t bother me. In my mind I went from “Shut up, you _____! Don’t yell at me! You’re not perfect!” (my instinctive response) to thinking of saying “I know you don’t realize what an idiot you are being but blah blah blah.” Didn’t say that either because it was you-based and therefore blaming, not telling what I was feeling (not honest but defensive). I needed an I-statement. I ran through other possibilities in my head, shortening it each time. I wanted it to be short because I have a tendency to lecture (as you may have noticed if you read this newsletter). I wanted it to be honest. I did not want to argue the point she was making because, unfortunately, (and this really pissed me off) she was right. (And I had said she was right, but she went right on being mad!) I finally said simply, “I hate being yelled at.” That was honest. It was short. She didn’t like it. That was okay, too. She was allowed to be angry. I no longer want to control what other people feel (most of the time). After a while the yelling stopped. A few hours later she said to me she got carried away and hadn’t meant to yell, and I said “Thanks for saying that.”
Being yelled at is painful, but I can be in pain and survive. Part of the reason it isn’t intolerable anymore is because I know I don’t deserve it. I may have made a mistake, but that is okay. Someone else may be having a hard day, and that is okay too (healthy boundaries and letting go of having to be perfect— or having to have others be perfect).
Like I said, I try to feel my anger today. I don’t stuff and repress it but I also don’t scream and yell. Some studies indicate that geting-it-all-out escalates and reinforces anger. A recent report in the Mind/Body Health Newsletter said that men who blow up and men who repress anger both have significantly higher cholesterol levels than men who were flexible in dealing with anger. Since both those styles are characteristic of PTSD, as is having rigid reaction styles and doing the same thing over and over, it seems important.
Flexibility: So how do you become more flexible in dealing with things that make you angry? One way is working on becoming more flexible in everything. I’ve heard the suggestion of driving home from work a different way every day, a small action that can have far-reaching effects. It may not be the one that works for you, but you can find some small new action to take that fits you better.
I can also use the upsurge of adrenaline I get when I am angry to help me do something healthy (for me) and effective. It is nice to have a number of choices. Keep a list for those desperate moments when you can’t think. I can go for a walk, go outside and let the birds and trees remind me that I am part of the world, clean house, write a letter to my congresswoman, call someone who will understand, motivate myself towards self-examination or simply feel the pain. For instance, when Bob is right about something I haven’t done that I said I would, I can look at myself and see that I’m not perfect, but I can learn to do better one day at a time, starting now. I feel compassion for me, and it makes it a lot easier to be compassionate to others. Then I don’t get mad.
Using the HEALS exercise mentioned in issue #7 (Vol.2, No 1) has helped me develop compassion for myself and for others. Here’s how to do it:
“Healing” comes into my mind in flashing letters.
Explain to myself what hurt I am feeling (disregarded, unimportant, guilty or mistrusted, devalued, rejected, powerless, unlovable) and feel it for a few seconds.
Apply self compassion (because I made a mistake doesn’t mean I’m worthless, because someone forgot me doesn’t mean I’m nothing...)
Love myself (It is okay if I’m not perfect. I’m fine the way I am. It is okay if someone forgot what I wanted. I am still lovable and I can love myself).
Solve the problem. (since I don’t have to blame, accuse or attack, I can use more of my brainpower to find a solution).
Another way to become flexible is developing a sense of humor about your self and your life. There is nothing funnier than the way all of us sometimes behave when we are mad. I think of myself swearing “I’m not angry,” as smoke was probably pouring out of my ears and I have to laugh. I didn’t know I was angry but those around me sure did.
And isn’t it sad that I thought a normal emotion, which I can use to signal that what’s happening is a problem for me, was so terrible I couldn’t admit to having it? So I’d lie to myself and to those around me until stuffing no longer was possible and then I’d blow up, all the time blaming their actions and not my own inability to see and use my anger effectively as a signal and a tool to change me.
Today I know I can’t change you, but today if I feel angry I can walk away, write a letter, speak up in a nice way, take my business my friendship or my love elsewhere. I do have options, but I couldn’t see them without self awareness.
Honesty about how anger affects us
Most people have no idea how scary they can be when they are mad, and I, at least, never used to mention it. Today I even try to be honest about that.
I find that I do best if I use my pause button before I try to be honest, keep it short, and I keep it in the “I.”
Heard at a 12 step meeting:
An expectation is a pre-meditated resentment.
Life isn't fair unfortunately and worse things happen quite often in war and other traumas than people are able to deal with. Finding someone who listens to your anger and doesn't tell you not to have it can be very healing.
Blowing up is the reverse of healing.
Most of what we think of as anger is dysfunctional and ineffective.
Here is my article from the Post Traumatic Gazette
Dealing with Anger in Effective Ways
One of the most terrifying things for trauma survivors is to fly into a rage without any warning. Family members friends and therapists can be terrified, too, although they may not show it. If you have read earlier issues of this newsletter, you know that irritability or outbursts of anger are one of the cluster of hyperalert symptoms that include not being able to sleep, lack of concentration, startle responses, etc. You may still be mystified or afraid that you will do something in a rage that you will regret for the rest of your life. And maybe you already have. I suggest using the pain from incidents you regret to motivate change.
The first task in dealing with anger is to distinguish between anger, which is an emotion, and violence, which is an action. Most people think they are the same thing.
Extreme startle responses can be violent. The violence occurs in nanoseconds when the person is surprised by something, way before the amount of time it takes to process something that pisses you off in your fore brain and get mad. Violent startle responses are very upsetting to the person who has them. Often the person goes from shame and despair (what is wrong with me?) straight into an eruption of anger at the victim of the violent startle response. In one sense it makes no difference to the person you are yelling at or hitting, but it can make a difference in how you handle the incident. Instead of erupting in anger, you can learn to say, “I am so sorry. That was a startle response. I am not angry except at myself for having it.”
Anger is based in thinking. One person is treated rudely by a clerk and thinks “She must be having a hard day.” Another person thinks, ”She cant treat me like I’m nobody,” and gets angry. Same behavior, one way of thinking results in compassion and the other in anger.
Anger is a signal that you have a problem to solve and you probably feel you are about to be harmed. The problem may be real (someone is hurting me) or it may be that what is going on today brings up feelings from the past (what is happening reminds me of my abuser or a traumatic event). Anger is an emotion, not an action like exploding into violence.
Anger can be managed if it is brought to awareness and feeling is separated from action. Boundaries and knowing about emotional reasoning can help here. Say to yourself, “I am over here. That person is over there. He or she has a whole history, feelings, thoughts of his/her own. I may feel pain but that does not mean that person is trying to hurt me (emotional reasoning, a cognitive distortion, says I feel it so it must be true). It may have nothing to do with me.” Just saying this much to yourself will help you pause. When you can pause, you can also learn to act in new ways instead of reacting in old ineffective dysfunctional ways that get you into trouble, ways you may have learned in childhood or in combat. You can learn new skills. It ain’t easy, but it can be done, one little bit at a time!
Several aspects of PTSD contribute to the problems trauma survivors have with anger.
Knowing you are angry: You may be so numb you can’t tell when you are beginning to get angry. It seems to explode out of you but there may be early warning signs that you could learn to detect. Regularly scanning your body for physical signs can help you become aware of this: are you clenching teeth or fists? Is your stomach churning, throat tight, lips turning into a thin blue line? Ask your family or associates how they can tell if you’re getting mad. You may start to twitch in a particular way that you are not aware of, moving your shoulders, drumming your fingers, rubbing one ear. If you know your own signs, you can walk away or calm yourself down.
Knowing why you are angry: Once you start to be aware of what is going on inside you, I’ve found that it helps me to identify other feelings I have numbed which lead me to anger. Most people learn to cover up painful or frightening feelings by getting angry. Anger causes a surge of adrenaline and a feeling of power which is more tolerable for most of us than feeling helpless, afraid, hopeless, needy, fearful, despairing, lost, abandoned, guilty, ashamed, or whatever.
If this is true for you, as it is for me, paying attention to your emotional state will help you deal with the primary feelings under the anger. I find that I do better if I just feel them, no matter how painful, for a while, maybe write down what I feel. The feeling passes and I am okay. “This too shall pass,” is a good slogan for me.
Another PTSD symptom, hypervigilance, constantly scanning for danger out there, makes it hard to concentrate on your inner life and be aware of what you are feeling. This can compound the effect of numbing. Using an affirmation like: “I am safe. I am __years old and no longer in ______. I have more resources today than I did when I wasn’t safe,” can help remind you that hypervigilance may not be necessary today. Fill in the blank with your age and the place you were traumatized whether it was Vietnam, Iraq or Afghanistan, or your own home. Change the wording so that it works for you.
Other symptoms of PTSD can contribute to anger problems: lack of sleep makes you irritable. You may also carry an irritating residue of bad feelings from nightmares into the world of day. Trying to avoid feeling common feelings can be a constant irritation. Plus cultural conditioning says men can be angry; but they can’t cry about things they need to cry about, like losing friends. And women are never supposed to be angry so we tend to stuff and stuff till we blow up.
Changing: If you want to change, the first step is to identify what lies under the anger. Keeping a list of common feelings handy can help you learn to name them. List the beliefs you have which get you mad. A lot of them will have the word should in them. Stopping to identify feelings and beliefs turns out to be a good pause-button for those of us who tend to go off like a rocket.
Knowing your own history is important here, too. If you can identify why that clerk pissed you off so much (like the lifers in Vietnam or the teacher who humiliated you in front of the class), it is easier to go on with the thought “but this isn’t Vietnam. or school, and I’m older now and have more resources, one of which is to write a letter to his/her boss...” Taking a healing action is so much better than letting others push your buttons and jerk you around like a puppet.
When you want to yell, look inside for the feeling beneath the anger. Is it fear that your kid was dead when he stayed out late and didn’t call? It will be a lot more effective to tell him that than to rage. Is it feeling unloved and therefore unlovable because someone forgot something they said they’d do for you? If you can identify that you can be honest about it (I felt hurt when you forgot my sandwich/birthday) and you can also examine whether you are putting yourself in a position to be hurt over and over by relying on unreliable people or expecting someone human to be more than human. Then you can work on that pattern, too.
Much of anger comes from what are called “hot thoughts.” We see someone’s behavior as reflecting on us. I used to see my dog’s unwillingness to let go of the ball after she fetched it as proof that I was no good (Couldn’t even train my dog right!). It would enrage me. One day in the park, I found myself screaming at her, “This is not a game!” as I punched her for not dropping the ball! Me! Nice Patience! It got me to examine my rage and see what I was saying to myself about her natural playfulness vs. having the perfect dog. Today I try not to be perfect or have perfect dogs, plans, parties, newsletters, etc. It is a lot easier!.
Hot thoughts can be as simple as “she should have dinner ready when I get home.” If there is an emotional rush associated with a simple event, the uprush of emotion signals to me that this feeling is probably from a different time zone and I need to examine it. For me, often the intensity of the anger is a cue that my needs were not being met, whether that zone is a traumatic childhood, recent traumatic events, or Vietnam. It helps to remind myself that I have more resources today.
There are a lot of slogans and sayings which help to cool down hot thoughts. “Easy Does it,” is an old AA one. “This is not a life or death situation,” is one many veterans use. “I can handle this,” helps remind me that I have more resources today than I used to have. “Chill out! Cool down! Slow down and take a breath. What is the problem here that I need to solve?” all are helpful phrases.
Disputing your thoughts can help too. Whenever I think “I’m no good,” (which is an old pattern for me), due to the fact that I’ve been working at recovery for nine years, I almost instantly say to myself, “Wait a minute, I’m fine. I’m not perfect but who likes perfect people? I’m okay the way I am.” It really helps. You can learn to do it, too.
Letting go of unrealistic expectations that other people will put your needs first can help. I’ve found that most people can be trusted to be human and think of themselves first. It is okay. So do I most of the time.
In 12 Step programs, we use steps four through nine to free ourselves of anger: not to suppress anger but to become free of it. This involves self examination (the inventory), becoming willing to let go of old patterns which may have served us in the past but are ineffective today, asking for help from our higher power, listing people we have harmed, and making amends to them. (Sometimes it is human nature to be angriest at those we have hurt.)
Feeling vs. Action
I have come to believe that almost none of us sees anger used effectively in this society. And most of what we think of as anger are angry actions which are ineffective and dysfunctional. Yelling, hitting, throwing things, blowing up, hitting pillows, withering sarcasm, getting drunk to pay someone back, shopping till you drop, screwing someone because you were screwed either literally or figuratively are all ineffective actions. There may be a momentary feeling of power, but I don’t think it lasts very long. The effects of such actions usually do last.
The idea you should get anger out to get rid of it also seems to indicate that anger isn’t an acceptable feeling. It is to me. I am allowed to be angry. I prefer not to act in ineffective ways. I can “say what I mean but not say it mean.” I see a distinct difference between the feeling of anger and my old “let me tell you what is wrong with you!” shaming and blaming way of handling it. That was ineffective action. So today I try for the feeling, to sit with it, examine it, say what I need to to keep my side of the street clean (be honest).
Here’s an example from recent experience. Someone yelled at me recently. It really pissed me off. I would have yelled back in the old days but I am really aware through experience of how ineffective that is. So I said to myself, yelling back is my old pattern. I need to use the principles of the 12 step program to find a new solution. She may not even know she is yelling. She also doesn’t know how I feel when she yells because I always act like it doesn’t bother me. In my mind I went from “Shut up, you _____! Don’t yell at me! You’re not perfect!” (my instinctive response) to thinking of saying “I know you don’t realize what an idiot you are being but blah blah blah.” Didn’t say that either because it was you-based and therefore blaming, not telling what I was feeling (not honest but defensive). I needed an I-statement. I ran through other possibilities in my head, shortening it each time. I wanted it to be short because I have a tendency to lecture (as you may have noticed if you read this newsletter). I wanted it to be honest. I did not want to argue the point she was making because, unfortunately, (and this really pissed me off) she was right. (And I had said she was right, but she went right on being mad!) I finally said simply, “I hate being yelled at.” That was honest. It was short. She didn’t like it. That was okay, too. She was allowed to be angry. I no longer want to control what other people feel (most of the time). After a while the yelling stopped. A few hours later she said to me she got carried away and hadn’t meant to yell, and I said “Thanks for saying that.”
Being yelled at is painful, but I can be in pain and survive. Part of the reason it isn’t intolerable anymore is because I know I don’t deserve it. I may have made a mistake, but that is okay. Someone else may be having a hard day, and that is okay too (healthy boundaries and letting go of having to be perfect— or having to have others be perfect).
Like I said, I try to feel my anger today. I don’t stuff and repress it but I also don’t scream and yell. Some studies indicate that geting-it-all-out escalates and reinforces anger. A recent report in the Mind/Body Health Newsletter said that men who blow up and men who repress anger both have significantly higher cholesterol levels than men who were flexible in dealing with anger. Since both those styles are characteristic of PTSD, as is having rigid reaction styles and doing the same thing over and over, it seems important.
Flexibility: So how do you become more flexible in dealing with things that make you angry? One way is working on becoming more flexible in everything. I’ve heard the suggestion of driving home from work a different way every day, a small action that can have far-reaching effects. It may not be the one that works for you, but you can find some small new action to take that fits you better.
I can also use the upsurge of adrenaline I get when I am angry to help me do something healthy (for me) and effective. It is nice to have a number of choices. Keep a list for those desperate moments when you can’t think. I can go for a walk, go outside and let the birds and trees remind me that I am part of the world, clean house, write a letter to my congresswoman, call someone who will understand, motivate myself towards self-examination or simply feel the pain. For instance, when Bob is right about something I haven’t done that I said I would, I can look at myself and see that I’m not perfect, but I can learn to do better one day at a time, starting now. I feel compassion for me, and it makes it a lot easier to be compassionate to others. Then I don’t get mad.
Using the HEALS exercise mentioned in issue #7 (Vol.2, No 1) has helped me develop compassion for myself and for others. Here’s how to do it:
“Healing” comes into my mind in flashing letters.
Explain to myself what hurt I am feeling (disregarded, unimportant, guilty or mistrusted, devalued, rejected, powerless, unlovable) and feel it for a few seconds.
Apply self compassion (because I made a mistake doesn’t mean I’m worthless, because someone forgot me doesn’t mean I’m nothing...)
Love myself (It is okay if I’m not perfect. I’m fine the way I am. It is okay if someone forgot what I wanted. I am still lovable and I can love myself).
Solve the problem. (since I don’t have to blame, accuse or attack, I can use more of my brainpower to find a solution).
Another way to become flexible is developing a sense of humor about your self and your life. There is nothing funnier than the way all of us sometimes behave when we are mad. I think of myself swearing “I’m not angry,” as smoke was probably pouring out of my ears and I have to laugh. I didn’t know I was angry but those around me sure did.
And isn’t it sad that I thought a normal emotion, which I can use to signal that what’s happening is a problem for me, was so terrible I couldn’t admit to having it? So I’d lie to myself and to those around me until stuffing no longer was possible and then I’d blow up, all the time blaming their actions and not my own inability to see and use my anger effectively as a signal and a tool to change me.
Today I know I can’t change you, but today if I feel angry I can walk away, write a letter, speak up in a nice way, take my business my friendship or my love elsewhere. I do have options, but I couldn’t see them without self awareness.
Honesty about how anger affects us
Most people have no idea how scary they can be when they are mad, and I, at least, never used to mention it. Today I even try to be honest about that.
I find that I do best if I use my pause button before I try to be honest, keep it short, and I keep it in the “I.”
Heard at a 12 step meeting:
An expectation is a pre-meditated resentment.
Friday, April 6, 2012
The Hard Road Back
The New York Times is doing a series on wounded soldiers which has simply kicked my butt and made me cry. I am really glad they are doing this. It's video as well as print and it helps show that the war is never over for many people. Check it out.
Thursday, April 5, 2012
Giving a talk to a small group
I just came back from giving a talk to a local group of vets and their counselors. Not going to say exactly where for confidentiality reasons, but I really love giving vets my perspective on PTSD, because it is so different from the medical model with its random collection of weird symptoms and the current 8 week cures. One of the counselors said, and I agree completely, "These new therapists say they are going to cure these guys in 8 weeks. It is insulting. No one would tell the mother of someone killed in Iraq or Afghanistan that they were going to cure their grief in 8 weeks!"
Combat PTSD involves HUGE amounts of grief over friends, ideals, beliefs, and body parts lost. How do you cure that in 8 weeks?
Cognitive Behavioral Therapy of PTSD has a short track record and does not "cure" everyone, but only a percentage. The follow-up studies do not cover a lifetime. PTSD comes back with further trauma because it is a set of survival skills built into your brain, which are activated by war and other traumas. There is nothing a therapist can do to keep you from suffering further traumatic events. Life happens. Shit happens.
The CBT therapies were not developed using combat vets. I think they work on some people. But people need to find out what works for them, not what works for the therapist.
Of course it is easier to apply a manualized therapy and pretend that's it, but for our vets often that isn't it. They simply stop talking and looking for help.
This recently happened to a friend. He finally went to see someone at the VA about his depression, and this woman told him, "I just don't allow myself to become depressed." Well if he could do that, he wouldn't need her help. He felt insulted. Needless to say, he won't be going back.
At one VA I gave a talk at, they told me that the CBT therapist don't let them swear in group. How do you talk about war, real war, ugly, bloody, horrible experiences if you can't swear. It is like these therapists are so full of themselves they have absolutely no comprehension of what vets have been through. I wish they would read Recovering From The War, or some of the recent vet memoirs, and wake the fuck up!
One thing I love to see is a bunch of vets start to nod and sit up and look interested and hopeful as I explain how hyperalertness (attention to threat and the ability to move faster than thought) are built into the reptile brain. So is the ability to rapidly adapt to whatever is going on so you can be in control, which means you become numb so you can do whatever you need to survive and keep others alive.
The talk I gave, The War at Home, goes through each PTSD symptom, giving the vets an idea of what it did for them during the war, what it may be doing to them now, and how that may affect the family. Most of them have never heard anything like what I say before.
I love doing it.
Combat PTSD involves HUGE amounts of grief over friends, ideals, beliefs, and body parts lost. How do you cure that in 8 weeks?
Cognitive Behavioral Therapy of PTSD has a short track record and does not "cure" everyone, but only a percentage. The follow-up studies do not cover a lifetime. PTSD comes back with further trauma because it is a set of survival skills built into your brain, which are activated by war and other traumas. There is nothing a therapist can do to keep you from suffering further traumatic events. Life happens. Shit happens.
The CBT therapies were not developed using combat vets. I think they work on some people. But people need to find out what works for them, not what works for the therapist.
Of course it is easier to apply a manualized therapy and pretend that's it, but for our vets often that isn't it. They simply stop talking and looking for help.
This recently happened to a friend. He finally went to see someone at the VA about his depression, and this woman told him, "I just don't allow myself to become depressed." Well if he could do that, he wouldn't need her help. He felt insulted. Needless to say, he won't be going back.
At one VA I gave a talk at, they told me that the CBT therapist don't let them swear in group. How do you talk about war, real war, ugly, bloody, horrible experiences if you can't swear. It is like these therapists are so full of themselves they have absolutely no comprehension of what vets have been through. I wish they would read Recovering From The War, or some of the recent vet memoirs, and wake the fuck up!
One thing I love to see is a bunch of vets start to nod and sit up and look interested and hopeful as I explain how hyperalertness (attention to threat and the ability to move faster than thought) are built into the reptile brain. So is the ability to rapidly adapt to whatever is going on so you can be in control, which means you become numb so you can do whatever you need to survive and keep others alive.
The talk I gave, The War at Home, goes through each PTSD symptom, giving the vets an idea of what it did for them during the war, what it may be doing to them now, and how that may affect the family. Most of them have never heard anything like what I say before.
I love doing it.
Sunday, April 1, 2012
Book giveaway at Goodreads.com
I am giving away 5 copies of Recovering from the War at GoodReads.com. If you go to the website, you will see how to join.
Part of the reason I am doing this is that I am in the process of bringing out the book as an ebook which will have a new introduction for the new vets and a Mother's Introduction by the mother of one of our new vets. The printed version does not have these, but I think having a book, in my hands at least, is always a comfort. So if you'd like to enter to win, please visit the website and enter
Part of the reason I am doing this is that I am in the process of bringing out the book as an ebook which will have a new introduction for the new vets and a Mother's Introduction by the mother of one of our new vets. The printed version does not have these, but I think having a book, in my hands at least, is always a comfort. So if you'd like to enter to win, please visit the website and enter
Wednesday, March 28, 2012
Vietnam and All Veterans Reunion Talks
I will be giving my usual two talks at the Vietnam and All Veterans Reunion at Wickham Park, 2500 Parkway Drive, Melbourne, FL. When you enter the park, drive around to the right till you see the Moving Vietnam Wall. The Wall Pavilion, where I give the talks will be in front of it.
At 3:00 on Saturday afternoon, I will be talking about Recovering from the War. Since PTSD is a normal reaction to war, I discuss the symptoms as survival skills, give a little history (Saul and Achilles had it), discuss effects on the family and make suggestions for how to begin to recover.
At 10:30 AM on Sunday, I will talk about The War at Home. I talk about what each symptom of PTSD did for the veteran during the war, then what it may be doing to the veteran today, and how that may be affecting the family.
My husband served in Vietnam, but I have been told that the talks I give are helpful to the new vets. I will have free handouts and copies of Recovering from the War for sale.
I try to share my own experience, strength and hope at these talks. Hope to see you there.
At 3:00 on Saturday afternoon, I will be talking about Recovering from the War. Since PTSD is a normal reaction to war, I discuss the symptoms as survival skills, give a little history (Saul and Achilles had it), discuss effects on the family and make suggestions for how to begin to recover.
At 10:30 AM on Sunday, I will talk about The War at Home. I talk about what each symptom of PTSD did for the veteran during the war, then what it may be doing to the veteran today, and how that may be affecting the family.
My husband served in Vietnam, but I have been told that the talks I give are helpful to the new vets. I will have free handouts and copies of Recovering from the War for sale.
I try to share my own experience, strength and hope at these talks. Hope to see you there.
Friday, March 9, 2012
Huge Grant will change human nature! NOT!
So the VA is spending 3.5 million dollars to change human nature. Normal people are bothered by what they live through, especially if it is traumatic. Survival capacities which are part of what we called "the reptile brain" in high school are activated. They don't speak English and they can't tell time.
These survival skills are easily reactivated by further traumatic events, including starting new wars.
“The ultimate goal is to prevent the effects of traumatic stress from occurring in the first place. Having said that, another goal is to determine how we can mitigate the effects of stress once symptoms have occurred,” says principal investigator Seema Bhatnagar, assistant professor of Anesthesiology and Critical Care at Penn/CHOP.
This makes me crazy. Professor of Anesthesiology???? Her research has been into stress on rats.
There is always a chance she will come up with something that will help some veterans, and I am for that.
At least she is not saying "cure" like some of the developers of new therapies. You can't tell if someone is "cured" of PTSD in less than a lifetime, despite the unscientific claims of some therapies. A four year follow up is considered a cure. Tell that to the vet who is back in the throes of PTSD and feels like a total loser because he (or she) was told he was cured. Does he realize that what helped once will help again, or does he give up?
I have seen my PTSD veteran husband have good years and very bad years. It seems to be a lifetime condition to me. The survival skills (PTSD symptoms) are always available at the drop of a hat.
I predict that if something helps some vets, the upper management of the VA and the military will apply it to all vets and then call the ones it doesn't work on defective in some other way like a personality disorder.
People who have been traumatized need to talk or write or process what happened in some way to move the events from the "reptile brain" where they are stored as images, smells, words, feelings, etc, into the forebrain where they become narrative memories. They also often need to re-inhabit their bodies and deal with intractable stress through meditation, yoga, any kind of body therapy or sensorimotor psychotherapy. Learning to live in the now is a continuous process of recovery, more like managing PTSD than having it surgically removed or "cured" with pills. So I would like to see the upper management of the VA provide continuous care for veterans with PTSD and quit screwing around.
These survival skills are easily reactivated by further traumatic events, including starting new wars.
“The ultimate goal is to prevent the effects of traumatic stress from occurring in the first place. Having said that, another goal is to determine how we can mitigate the effects of stress once symptoms have occurred,” says principal investigator Seema Bhatnagar, assistant professor of Anesthesiology and Critical Care at Penn/CHOP.
This makes me crazy. Professor of Anesthesiology???? Her research has been into stress on rats.
There is always a chance she will come up with something that will help some veterans, and I am for that.
At least she is not saying "cure" like some of the developers of new therapies. You can't tell if someone is "cured" of PTSD in less than a lifetime, despite the unscientific claims of some therapies. A four year follow up is considered a cure. Tell that to the vet who is back in the throes of PTSD and feels like a total loser because he (or she) was told he was cured. Does he realize that what helped once will help again, or does he give up?
I have seen my PTSD veteran husband have good years and very bad years. It seems to be a lifetime condition to me. The survival skills (PTSD symptoms) are always available at the drop of a hat.
I predict that if something helps some vets, the upper management of the VA and the military will apply it to all vets and then call the ones it doesn't work on defective in some other way like a personality disorder.
People who have been traumatized need to talk or write or process what happened in some way to move the events from the "reptile brain" where they are stored as images, smells, words, feelings, etc, into the forebrain where they become narrative memories. They also often need to re-inhabit their bodies and deal with intractable stress through meditation, yoga, any kind of body therapy or sensorimotor psychotherapy. Learning to live in the now is a continuous process of recovery, more like managing PTSD than having it surgically removed or "cured" with pills. So I would like to see the upper management of the VA provide continuous care for veterans with PTSD and quit screwing around.
Tuesday, May 17, 2011
An ABC of Ideas for Living with PTSD Patience Mason.
copyright 2011, all rights reserved except you can copy it and give it to anyone it might help
A. Acceptance: In the "Big Book," Alcoholics Anonymous, on page 448 (3d Edition) or 417 (4th Edition) is probably the most famous reading on the topic of acceptance. Most people want to be accepted as they are. Balancing acceptance and the desire for change is a delicate task. I learned to accept my painful emotions because of this reading, to sit with them and let them pass. I also learned to accept my husband and to let him find his own path to healing, which I had been blocking with advice. I also learned to accept that changing took time for both of us. In recovery, I also learned to develop a pause button, to take time to think, and then to act instead of always reacting to the behavior of others.
B. Boundaries. Free handout on Boundaries is available at 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.
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.
Sunday, May 15, 2011
New Washington Post article on PTSD and TBI
I just read through this article and cried.
The thing I want to post about however is the absolutely ludicrous argument between the doctors about whether it was TBI or PTSD...
A TBI is a traumatic stressor by its very nature. TBI's on the football field are treated with rest and not letting them back in the game for weeks and that is just being run into by another person, not a bomb blast.
Maybe shell shock in WWI was a combination of both. Maybe a lot of PTSD guys have TBI and maybe all TBI guys have PTSD.
Maybe the Civil War doctors who though rest and feeding up was a cure for Soldier's Heart had a handle on the TBI part of many soldiers' problems. Or maybe everyone with PTSD also needs rest and feeding up.
How is the question of the name of the diagnosis more important than taking care of the wound?
Perhaps people with TBI and people with PTSD can benefit from the rest that TBI needs and the psychological treatment that PTSD needs.
No one benefits from the current practice of drugging people and sending them back into the field, which is the result of the conflict of interest inherent in military psychiatry. Do you send people with PTSD back to war, pleasing your bosses and damaging them? The only study of people who go back into war after having PTSD, done by the Israelis, showed that people with PTSD got it faster and worse in the next war. Or do you keep them home because we don't know how damaging it would be for them to go back? That might end your career. Sending people with combat fatigue back into the war was not done in WWII or in Vietnam
I know of no scientific studies of the effects of sending people back to war on drugs. Is it safe, or just convenient?
I do know that military members who have PTSD are put into Warrior Transition Units where they are at best treated like "second class citizens" as one of them recently told me. Since PTSD is a normal response to war, it should have been expected. Instead, people with PTSD are often accused of malingering and making things up.
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.
Sunday, December 19, 2010
A Pill to Prevent PTSD
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?
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?
Wednesday, December 15, 2010
Tuesday, December 14, 2010
Does it ever change?
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."
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."
Saturday, December 11, 2010
Facebook Page and Holiday helps
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!
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!
Wednesday, December 8, 2010
Women Veterans
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.
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.
Monday, November 22, 2010
War veteran barred from CCBC campus for frank words on killing
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.
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.
Wednesday, November 17, 2010
More rant
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.
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
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).
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).
Monday, November 15, 2010
Woohoo!
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!)
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!)
Thursday, November 11, 2010
Veterans Day and I'm mad!
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.
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.
Wednesday, September 22, 2010
It is not your fault
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!
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!
Thursday, May 13, 2010
Medal of Honor Recipients Launch Post-Traumatic Stress Public Service Announcements
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
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
Monday, May 10, 2010
Belleruth Naparstek:Note to Colleagues: Please Stop Saying Post-Traumatic Stress Is Incurabel
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.
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.
Friday, May 7, 2010
Feeling Warehoused in Army Trauma Care Units
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.
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.
Thursday, May 6, 2010
PTSD: Get tougher soldier
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.
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.
Wednesday, May 5, 2010
First Coast veteran’s fall from grace showcases need for PTSD care
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.
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.
Sunday, May 2, 2010
If there are three phonies and 30,000 with real claims...
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.
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.
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