What
helps with PTSD: Each person is different, has different reactions,
different beliefs, different beliefs about themselves, about whether
they are bad or good, whether they can be helped. There is no one size
fits all PTSD treatment.
Do people need individual treatment or
groups? Groups are good in that other vets won't let you blame yourself
for things that you may be blaming yourself for.
There are various form of psychotherapy:
DBT: Dialectical Behavioral Therapy designed for suicidal people with
"Borderline Personality Disorder" and very effective for people who
can't tolerate their own feelings of pain.
ACT: Acceptance and Commitment Therapy in which you accept that you have problems and commit to work on change.
CBT: Cognitive Behavioral Therapy: several kinds, some of which have
huge drop out rates and should be preceded by DBT. There is a version
for Trauma Related Guilt developed by Edward Kubaney.
EMDR: Eye Movement Desensitization and Reprocessing which helps some people completely and rapidly and does not help others.
TIR: Traumatic Incident Reduction, a short term very effective therapy
which is not commonly used because it cannot be done in 50 minute hours.
It takes as long as it takes.
EFT: Susan Johnson's Emotionally Focused Therapy a couples therapy for PTSD couples.
Sand Tray therapy where you set up the event and see things you didn't notice at the time...
Other types of help:
EFT: the tapping kind based on meridians in the body. Works for some people.
Yoga: a way to learn to modulate arousal.
Meditation: ditto.
Twelve Step programs: don't be fooled by the unethical research which
says AA works no better than anything else, because the studies are
always of court ordered people who do not have the one requirement for
membership, the DESIRE to stop drinking. If you have that desire to
stop, the 12 step program for your problem will help, whether it is
alcohol, drugs, food, sex, gambling, etc. If you understand the symptoms
of PTSD and know you are not going crazy when they come back, it helps.
I wrote a pamphlet you can read at patiencpress.com, "An Explanation of
PTSD for 12 Steppers: When I get sober I feel crazy." I also have a 12
Step Format for vets and one for Trauma Survivors. All free at my site.
Somatic therapies:
Pat Ogden's Sensorimotor Psychotherapy
Babette Rothschild's Somatic Trauma Therapy
Peter Levine's Somatic Experiencing
There are many more. Each of these can be googled.
More tomorrow
Thursday, June 19, 2014
Wednesday, June 18, 2014
Day 18, National PTSD Awareness Month
So I left off with the idea of using humor, compassion and acceptance to deal with PTSD.
What the veteran has been through is the worst he or she has been through. What we have been through is the worst we have been through. Comparisons are odious. Compassion is better. Sharing is better. Even if you can't share details, you may be able to share the feelings, especially if you can identify them. If you can't share feelings, share a meal, or a back rub, or make love to each other.
If you are both really numb just from facing all the stress of living with PTSD, you can ask yourself, "If I were upset about this, what would I be upset about?" Substitute the feeling of your choice, happy, sad, appreciative, mad.
If you decide to talk, plan that while one talks, the other can listen without interrupting, except maybe to paraphrase. Then reverse it. Since the average person spends 30 seconds listening before they start formulating their reply, this takes practice and time.
It takes time to get better. It takes time for relationships to heal and to begin growing again.
Is your loved one worth your time?
Are you worth your own time?
Those are big questions and if you are feeling guilty and like everything is your fault, remember, it takes two to tango. It is nicer when you are working on coordinating your steps instead of dancing at cross purposes.
Compassion helps. Acceptance helps. Laughing at yourself helps. When Bob was writing Chickenhawk:Back In The World, we had to sit down and write out a timeline of what had happened. When we lived through the stuff in that book it was quite painful but in retrospect we were saying "You did what???" "I did what???" and laughing so hard we could barely talk. What had been so painful was now silly. Such drama!
Tomorrow I will talk about the kind of help I wish were available and some of the stuff that is.
What the veteran has been through is the worst he or she has been through. What we have been through is the worst we have been through. Comparisons are odious. Compassion is better. Sharing is better. Even if you can't share details, you may be able to share the feelings, especially if you can identify them. If you can't share feelings, share a meal, or a back rub, or make love to each other.
If you are both really numb just from facing all the stress of living with PTSD, you can ask yourself, "If I were upset about this, what would I be upset about?" Substitute the feeling of your choice, happy, sad, appreciative, mad.
If you decide to talk, plan that while one talks, the other can listen without interrupting, except maybe to paraphrase. Then reverse it. Since the average person spends 30 seconds listening before they start formulating their reply, this takes practice and time.
It takes time to get better. It takes time for relationships to heal and to begin growing again.
Is your loved one worth your time?
Are you worth your own time?
Those are big questions and if you are feeling guilty and like everything is your fault, remember, it takes two to tango. It is nicer when you are working on coordinating your steps instead of dancing at cross purposes.
Compassion helps. Acceptance helps. Laughing at yourself helps. When Bob was writing Chickenhawk:Back In The World, we had to sit down and write out a timeline of what had happened. When we lived through the stuff in that book it was quite painful but in retrospect we were saying "You did what???" "I did what???" and laughing so hard we could barely talk. What had been so painful was now silly. Such drama!
Tomorrow I will talk about the kind of help I wish were available and some of the stuff that is.
Tuesday, June 17, 2014
St Francis and PTSD, Day 17
"Grant that I may not so much seek to be consoled, as to console; to be understood, as to understand; to be loved, as to love." The prayer of St Francis (who was a combat vet) seemed like a bunch of crap when I first read it, but it has come to mean a lot to me.
A person with PTSD is not good at consoling, understanding, or loving, especially in the acute phases, which they often deny are happening. (So annoying).
We can seek to console them, understand them and love them, but we can't fix them or force them to get help.
That is why we as family members need each other. I belong to a number of online groups and also have tons of stuff I have written on the subject free at patiencepress.com.
We didn't cause it, we can't control it, and we can't cure it. Trying to do this can make us nuts. (If your vet is driving you crazy, you probably are a little nuts, and can't see it. I couldn't).
When we get help, we give them space to change. They may not change as fast as we'd like, but even tiny changes can give us hope, especially if we notice them instead of focusing on the annoying stuff. That was hard for me because I was brought up focusing on the bad stuff and thought that was what intelligent people did. Haha!
Principles of recovery for both:
Let go and let God (or the harmony of the universe, or whatever).
Work on yourself so you can tolerate other people's feelings, mistakes, and live happily yourself. There is a saying, Live and let live, but most people focus on letting the person who is having problems live. They don't focus on having a good life themselves. So everyday, when you get up, you can ask yourself, what can I do to have a good day today?
Respect what your veteran has been through. Respect what you have been through, too. This is hard. To vets I say, remember how you felt when someone was wounded? That is how we feel. We see you bleeding all over the place and we can't fix it and that hurts because we love you. Please respect that.
Progress not perfection.
Have compassion for each other. This is hard. It is hard coming back to civilian life and concerns. It is hard dealing with someone who is showing the effects of war.
Get help. You can start by reading (patiencepress.com) and talking to other people in your situation. There are even several 12 step programs for PTSD (combatvetsanonymous, PTSDanonymous) and stuff on my webpage about how to start one. Spouses can start their own. I also suggest Al-anon for spouses, substituting the word PTSD for alcoholism. If the vet is using addictions to get through the day, working the steps in the program for your addiction can really help. You can seek outside help at the Vet Center or VA, although getting into the system is slow and frustrating and they tend to medicate instead of talk. You can go through the military. Finding someone you can talk to is important.
I want to point out some family triggers that no one thinks about:
Your family is slow: slow people get killed or get other people killed.
Your family is insubordinate: gets people killed
Your family makes mistakes: ditto
Your wife is bossy: bosses can get people killed
Your spouse is controlling: being controlled can get you killed.
Being asked to do something can get you killed too, so when a spouse asks you to do anything, some unconscious process may take over and you don't do it-to save your life- but neither of you knows that and it leads to a lot of arguments. I noticed this with Bob. Eventually I decided he had done as many things he didn't want to do in Vietnam (flying into a hail of bullets) as he was capable of, and I just needed to leave him alone. Now he is pretty helpful, but it took a while.
So if you never take out the trash, is it shooting at you? No? So take it out. Of course you might be thinking, Is the trash shooting? No. Then it is not important... Two perspectives that can be reconciled with compassion and acceptance and laughing together.
Getting better takes time, and mostly it happens if you take the time to recover. More tomorrow.
A person with PTSD is not good at consoling, understanding, or loving, especially in the acute phases, which they often deny are happening. (So annoying).
We can seek to console them, understand them and love them, but we can't fix them or force them to get help.
That is why we as family members need each other. I belong to a number of online groups and also have tons of stuff I have written on the subject free at patiencepress.com.
We didn't cause it, we can't control it, and we can't cure it. Trying to do this can make us nuts. (If your vet is driving you crazy, you probably are a little nuts, and can't see it. I couldn't).
When we get help, we give them space to change. They may not change as fast as we'd like, but even tiny changes can give us hope, especially if we notice them instead of focusing on the annoying stuff. That was hard for me because I was brought up focusing on the bad stuff and thought that was what intelligent people did. Haha!
Principles of recovery for both:
Let go and let God (or the harmony of the universe, or whatever).
Work on yourself so you can tolerate other people's feelings, mistakes, and live happily yourself. There is a saying, Live and let live, but most people focus on letting the person who is having problems live. They don't focus on having a good life themselves. So everyday, when you get up, you can ask yourself, what can I do to have a good day today?
Respect what your veteran has been through. Respect what you have been through, too. This is hard. To vets I say, remember how you felt when someone was wounded? That is how we feel. We see you bleeding all over the place and we can't fix it and that hurts because we love you. Please respect that.
Progress not perfection.
Have compassion for each other. This is hard. It is hard coming back to civilian life and concerns. It is hard dealing with someone who is showing the effects of war.
Get help. You can start by reading (patiencepress.com) and talking to other people in your situation. There are even several 12 step programs for PTSD (combatvetsanonymous, PTSDanonymous) and stuff on my webpage about how to start one. Spouses can start their own. I also suggest Al-anon for spouses, substituting the word PTSD for alcoholism. If the vet is using addictions to get through the day, working the steps in the program for your addiction can really help. You can seek outside help at the Vet Center or VA, although getting into the system is slow and frustrating and they tend to medicate instead of talk. You can go through the military. Finding someone you can talk to is important.
I want to point out some family triggers that no one thinks about:
Your family is slow: slow people get killed or get other people killed.
Your family is insubordinate: gets people killed
Your family makes mistakes: ditto
Your wife is bossy: bosses can get people killed
Your spouse is controlling: being controlled can get you killed.
Being asked to do something can get you killed too, so when a spouse asks you to do anything, some unconscious process may take over and you don't do it-to save your life- but neither of you knows that and it leads to a lot of arguments. I noticed this with Bob. Eventually I decided he had done as many things he didn't want to do in Vietnam (flying into a hail of bullets) as he was capable of, and I just needed to leave him alone. Now he is pretty helpful, but it took a while.
So if you never take out the trash, is it shooting at you? No? So take it out. Of course you might be thinking, Is the trash shooting? No. Then it is not important... Two perspectives that can be reconciled with compassion and acceptance and laughing together.
Getting better takes time, and mostly it happens if you take the time to recover. More tomorrow.
Monday, June 16, 2014
So if you are really pissed at your vet: Day 16 of National PTSD Awareness Month
So if you are really pissed at your vet, if he has been yelling and unreliable and drunk or watching TV or gaming non stop and all the other crap veterans can pull, can you change your perspective?
Can this be evidence of how hard what he went through was for him? How about if he seemed fine (haha) and recently something came up that triggered his PTSD and Mr. Reliable is falling apart? Most of us wouldn't walk off if he got cancer and wouldn't think cancer is his fault and if he just straightened up... no cancer.
PTSD is a set of survival skills which have become your loved one's biggest problem, and he or she does not want to have problems, and especially doesn't want to have them brought up every day. The current military take on PTSD is it exists but real men/women don't get it. We are so tough...
Human beings are designed to get PTSD because they are designed to do whatever it takes to survive, which is not always pleasant. And the symptoms last and come back on further trauma.
Most of us don't like being told we have problems either. I hate having my mistakes or faults pointed out to me.
So in the face of pain or anger, try calmness and compassion. "It must be so painful to be treated like that/feel so angry/be so depressed." People need to be listened to.
You do too, but when a vet is in the throes of PTSD, it is good to take you concerns to friends, a group or a therapist. Not to the vet.
I didn't know this so I kindly let Bob know whenever he hurt my feelings or disappointed me, but only after enough hurts and disappointments had built up to the point where I felt put upon enough to either explode or be self-righteously martyred and let him know.
It was not effective in getting me what I wanted.
That is the touchstone for me: "IS IT EFFECTIVE?" instead of my old pattern, "Am I right?"
I also learned to have compassion for myself. Living with a PTSD person, vet or otherwise, is very hard. We suffer, but most of us think they are worth the pain.
If you can have a good day when your vet is having a bad one, it lifts the big burden of ruining everyone's day off him or her. I used to think it wouldn't be polite to have a good day when Bob was having a bad one, but now I know it is politer to lift the burden.
I don't believe in long talks and working things out verbally, either. I believe in "Can you help me with this?" "No." "OK." or "Yes." "Thanks a lot." Getting along is a one moment at a time thing.
One thing that really helped me was understanding PTSD and anger. People with chronic PTSD have been found to have depleted cortisol, so they can't calm down once they are angry. This explained a lot to me about Bob. He could not calm down for hours once we started fighting. So I learned to say, "You may be right," and let go. Sometimes I'm thinking, "on Mars," but I don't have to say it. And when your heartbeat is above 175, which often happens when people get upset, your body is ready to run or fight, but no one is home in your brain! They can't take in what you are saying anyhow...
So would you rather be right or happy? And can you find support so you aren't trying to get all your emotional needs met by a numbed out PTSD vet?
That is what I did and still do. Bob and I are quite happy most of the time and when he has bad days, I listen. And guess what, when I have bad days, he does too. He doesn't even give me advice (except as a joke) since I told him "I just want to whine and snivel about this and I don't need suggestions." Luckily he likes my sense of humor.
More tomorrow.
Can this be evidence of how hard what he went through was for him? How about if he seemed fine (haha) and recently something came up that triggered his PTSD and Mr. Reliable is falling apart? Most of us wouldn't walk off if he got cancer and wouldn't think cancer is his fault and if he just straightened up... no cancer.
PTSD is a set of survival skills which have become your loved one's biggest problem, and he or she does not want to have problems, and especially doesn't want to have them brought up every day. The current military take on PTSD is it exists but real men/women don't get it. We are so tough...
Human beings are designed to get PTSD because they are designed to do whatever it takes to survive, which is not always pleasant. And the symptoms last and come back on further trauma.
Most of us don't like being told we have problems either. I hate having my mistakes or faults pointed out to me.
So in the face of pain or anger, try calmness and compassion. "It must be so painful to be treated like that/feel so angry/be so depressed." People need to be listened to.
You do too, but when a vet is in the throes of PTSD, it is good to take you concerns to friends, a group or a therapist. Not to the vet.
I didn't know this so I kindly let Bob know whenever he hurt my feelings or disappointed me, but only after enough hurts and disappointments had built up to the point where I felt put upon enough to either explode or be self-righteously martyred and let him know.
It was not effective in getting me what I wanted.
That is the touchstone for me: "IS IT EFFECTIVE?" instead of my old pattern, "Am I right?"
I also learned to have compassion for myself. Living with a PTSD person, vet or otherwise, is very hard. We suffer, but most of us think they are worth the pain.
If you can have a good day when your vet is having a bad one, it lifts the big burden of ruining everyone's day off him or her. I used to think it wouldn't be polite to have a good day when Bob was having a bad one, but now I know it is politer to lift the burden.
I don't believe in long talks and working things out verbally, either. I believe in "Can you help me with this?" "No." "OK." or "Yes." "Thanks a lot." Getting along is a one moment at a time thing.
One thing that really helped me was understanding PTSD and anger. People with chronic PTSD have been found to have depleted cortisol, so they can't calm down once they are angry. This explained a lot to me about Bob. He could not calm down for hours once we started fighting. So I learned to say, "You may be right," and let go. Sometimes I'm thinking, "on Mars," but I don't have to say it. And when your heartbeat is above 175, which often happens when people get upset, your body is ready to run or fight, but no one is home in your brain! They can't take in what you are saying anyhow...
So would you rather be right or happy? And can you find support so you aren't trying to get all your emotional needs met by a numbed out PTSD vet?
That is what I did and still do. Bob and I are quite happy most of the time and when he has bad days, I listen. And guess what, when I have bad days, he does too. He doesn't even give me advice (except as a joke) since I told him "I just want to whine and snivel about this and I don't need suggestions." Luckily he likes my sense of humor.
More tomorrow.
Sunday, June 15, 2014
Changing yourself: Day 15 of National PTSD Awareness Month
Learning to listen instead of talk was
probably the hardest step I ever took. I only did it after I picked up a
book, Parent Effectiveness Training, because I thought it would teach
me how to effectively train my son, then 14, to quit arguing
with me... Hahaha! It suggested learning to listen and let him find his
own solutions, which was good. It also had a section on listening to
pre-verbal babies, which I used with Bob because by this time he would
not talk to me. I realize, today, that it wasn't safe to talk to me,
because I corrected him all the time, "You shouldn't feel/think/act that
way."
I had to let Bob have feelings I didn't like and that scared me. I had to work on myself which took up all the time I'd spent obsessing about him and Jack. This gave Bob space to find things that helped him recover. It was a really painful time for me. Change is scary. Bob hated it when I started going to recovery meetings. I developed a broken record in response to the unspoken question, "Will you still love me if you change?" which guys never actually say. It comes out more often as "Why the F. are you going to that meeting/therapist/group, etc?" I translated that and said, "I am going to the meeting because it helps me feel good about myself and I love you and I'll be back at 9." After 6 months of that, said in a loving manner, he stopped asking.
One of the things I hated about the program I went to was that they suggested acceptance as a good strategy for dealing with people you love (or anyone else). I thought this was so wimpy. You're supposed to try to improve people. NOT.
So I learned acceptance. Bob is who he is and I can't change that. I also learned to ask for changes and let go of the result. I don't have to hang around and be yelled at. I also can't expect to ask for a change and have it instantly happen. When I try to change, it isn't instant and I recycle old behaviors a lot! So will he. Now in the times of year that are difficult for Bob, I try to listen and let him be where he's at. Compassion and kindness are more effective than nagging and getting huffy and self-righteous. The bad times pass sooner. I remind myself "Would you rather be right or happy?" At one time I would rather have been right (no kidding!! I never admitted I was wrong in the first 25 years of our now 50 year marriage). Now I would rather be happy.
Many family members have been through hell and are extremely angry at the veteran. They don't see how what they may be doing can be keeping him or her stuck. I have a lot more suggestions at my web page http://www.patiencepress.com/patience_press/PTSD_Help-For_Spouses.html. More tomorrow.
I had to let Bob have feelings I didn't like and that scared me. I had to work on myself which took up all the time I'd spent obsessing about him and Jack. This gave Bob space to find things that helped him recover. It was a really painful time for me. Change is scary. Bob hated it when I started going to recovery meetings. I developed a broken record in response to the unspoken question, "Will you still love me if you change?" which guys never actually say. It comes out more often as "Why the F. are you going to that meeting/therapist/group, etc?" I translated that and said, "I am going to the meeting because it helps me feel good about myself and I love you and I'll be back at 9." After 6 months of that, said in a loving manner, he stopped asking.
One of the things I hated about the program I went to was that they suggested acceptance as a good strategy for dealing with people you love (or anyone else). I thought this was so wimpy. You're supposed to try to improve people. NOT.
So I learned acceptance. Bob is who he is and I can't change that. I also learned to ask for changes and let go of the result. I don't have to hang around and be yelled at. I also can't expect to ask for a change and have it instantly happen. When I try to change, it isn't instant and I recycle old behaviors a lot! So will he. Now in the times of year that are difficult for Bob, I try to listen and let him be where he's at. Compassion and kindness are more effective than nagging and getting huffy and self-righteous. The bad times pass sooner. I remind myself "Would you rather be right or happy?" At one time I would rather have been right (no kidding!! I never admitted I was wrong in the first 25 years of our now 50 year marriage). Now I would rather be happy.
Many family members have been through hell and are extremely angry at the veteran. They don't see how what they may be doing can be keeping him or her stuck. I have a lot more suggestions at my web page http://www.patiencepress.com/patience_press/PTSD_Help-For_Spouses.html. More tomorrow.
Stuck! Day 14 of National PTSD Awareness Month.
Often
after I had been trying to rescue Bob for a while with some new book or
herb (Really, someone told me chamomile would stop his wakeups, so I
got it and made tea. I was so furious that it didn't work, I can't stand
the smell to this day.), I would shift into the persecutor/prosecutor
role.
If you just did what I say, you would be fine! (Haha!) I felt each time that I had found the right solution, but I didn't know what the problem was (PTSD) and I didn't know whose problem it was (his), so my solutions, even on the rare occasions when he tried them (he did drink the tea) did not work.
We got into a really painful pattern, the final stage of which was VICTIM. Let me tell you (back of hand on forehead) what Bob did to me this week!
Then back to rescuer.
This is a common pattern in relationships where one person is perceived to have the problem and the other is perceived to be fine. It becomes stable, but usually over time things get worse and worse.
I felt that Bob was driving me nuts, but I had no idea that I was perpetuating the problem with my rescuing, which also consisted of "Don't be mad/sad/" or whatever other feeling I could not tolerate. Like I said before, I thought that was my job. I had no idea I was getting more and more controlling, impatient, self-righteous. I took everything personally.
It never occurred to me that he could be upset by anything but me, and since I was trying so hard to be perfect, if he was, say, depressed, I was furious with him because it meant I was a bad wife and making him depressed. (I think this was depressing, but so were things in Vietnam that he was remembering).
I misunderstood what was going on with him. For instance about 4 times a year he would get cold and distant and I would figure he didn't love me anymore. After I was writing Recovering from the War, I learned about anniversary reactions: The Ia Drang, Happy Valley, Bong Son and the month before he came home! These coincided with his cold periods.
More tomorrow.
If you just did what I say, you would be fine! (Haha!) I felt each time that I had found the right solution, but I didn't know what the problem was (PTSD) and I didn't know whose problem it was (his), so my solutions, even on the rare occasions when he tried them (he did drink the tea) did not work.
We got into a really painful pattern, the final stage of which was VICTIM. Let me tell you (back of hand on forehead) what Bob did to me this week!
Then back to rescuer.
This is a common pattern in relationships where one person is perceived to have the problem and the other is perceived to be fine. It becomes stable, but usually over time things get worse and worse.
I felt that Bob was driving me nuts, but I had no idea that I was perpetuating the problem with my rescuing, which also consisted of "Don't be mad/sad/" or whatever other feeling I could not tolerate. Like I said before, I thought that was my job. I had no idea I was getting more and more controlling, impatient, self-righteous. I took everything personally.
It never occurred to me that he could be upset by anything but me, and since I was trying so hard to be perfect, if he was, say, depressed, I was furious with him because it meant I was a bad wife and making him depressed. (I think this was depressing, but so were things in Vietnam that he was remembering).
I misunderstood what was going on with him. For instance about 4 times a year he would get cold and distant and I would figure he didn't love me anymore. After I was writing Recovering from the War, I learned about anniversary reactions: The Ia Drang, Happy Valley, Bong Son and the month before he came home! These coincided with his cold periods.
More tomorrow.
Friday, June 13, 2014
Detach with love, Day 13 of PTSD Awareness Month
With
all the additional information on PTSD ( although none of it is
presented the way I see it) it is hard not to get annoyed when people
will not go for help. Why is that? And what can a spouse do about it?
People are human and American, and human Americans do not like to think they need help. They are fine (F*ked up, insecure, neurotic and egotistical, but they don't know it) and you are somewhere between nag and nut case to think they are not.
Detach with love.
Let him be where he is at. Let her be where she is at. Our society tells us we can change people. If this were true, there would not be a new self help book out every week. The only person I can change is me, and that is slow and hard and I have not lived through a war and had the symptoms of PTSD hammered into me by traumatic events, over and over.
So if change is hard for me as a civilian, it is going to be harder for a veteran. He will have to face pain, devastation, horrible memories of blood and guts and fear and despair and anger and vengeance and destruction. It is easy to think he should man up and just do it.
We start out as rescuers: Oh, honey, you should go get help, or read this book, or do that. We do not know what healing from war involves. We have no way to know. I had a lot of advice for Bob, none of which he took, so when I was writing the book, I realized that not taking my advice was evidence too.
In combat, things are out of the person's control. Wishes will not stop bullets or explosions or someone bleeding out. Those are just words to us. As Bob once said to me when we came out of the movie Platoon, "It's worse when it's real."
Not following directions is evidence that following directions put them in danger.
It is evidence that they need to regain a sense of control in their lives and if they do what you say they lose that.
So even if what you are saying is the right thing, saying it may be the wrong thing.
More tomorrow.
People are human and American, and human Americans do not like to think they need help. They are fine (F*ked up, insecure, neurotic and egotistical, but they don't know it) and you are somewhere between nag and nut case to think they are not.
Detach with love.
Let him be where he is at. Let her be where she is at. Our society tells us we can change people. If this were true, there would not be a new self help book out every week. The only person I can change is me, and that is slow and hard and I have not lived through a war and had the symptoms of PTSD hammered into me by traumatic events, over and over.
So if change is hard for me as a civilian, it is going to be harder for a veteran. He will have to face pain, devastation, horrible memories of blood and guts and fear and despair and anger and vengeance and destruction. It is easy to think he should man up and just do it.
We start out as rescuers: Oh, honey, you should go get help, or read this book, or do that. We do not know what healing from war involves. We have no way to know. I had a lot of advice for Bob, none of which he took, so when I was writing the book, I realized that not taking my advice was evidence too.
In combat, things are out of the person's control. Wishes will not stop bullets or explosions or someone bleeding out. Those are just words to us. As Bob once said to me when we came out of the movie Platoon, "It's worse when it's real."
Not following directions is evidence that following directions put them in danger.
It is evidence that they need to regain a sense of control in their lives and if they do what you say they lose that.
So even if what you are saying is the right thing, saying it may be the wrong thing.
More tomorrow.
Thursday, June 12, 2014
So, I took Bob's feelings personally, Day 12 of PTSD Awareness month
So, I took Bob's feelings personally. I thought if he was mad, it was my fault. I must have done something wrong, so I would try to change. That never worked, because his problems were not my problems, but I saw them that way. I didn't know what the problem was (PTSD) so I thought he was the problem, MY PROBLEM!
I misunderstood what was going on because there was no information on PTSD. My efforts to fix Bob were really ineffectual. So I tried harder. We spent 15 years after he came back thinking we were losers, crazy losers, and I thought it was all my fault because I wasn't trying hard enough to fix him and make him happy. Sometimes he agreed. We had no idea what the problem was or that it was getting a name. In 1980, it became Post-Traumatic Stress Disorder. My mother, Constance Hartwell, MD, was a VA psychiatrist who talked to veterans, and she would tell me Bob's problems had to do with the war. She sent him big bottles of Vitamin B-12 and told him to drink less and smoke more pot.
Our VA in Gainesville was fond of giving valium, and told Vietnam vets to go to the Vet Centers in Jacksonville or Tallahassee. Bob actually went up and got a pamphlet from the Vet Center, the DAV's Readjustment Problems among Vietnam Veterans. (The DAV had actually funded the first study, The Wounded Warrior Project, of Vietnam vets. No university, foundation or government agency would fund it.) We read the pamphlet and I cried all the way through it. What was happening to us had a name.
Nowadays there is much more information about PTSD, but none of it is formulated like this description of the symptoms as built-into-your-brain normal survival skills which keep you alive. Instead they are described as if they were a random collection of weird behaviors starting with re-experiencing. Then most of the current literature is slanted towards "only a few people will get this," "we can make you resilient," and "we can cure it." Like they can change human nature...
So the spouse thinks a. you won't get it, b. it can be cured, and c. here are the directions.
What I have learned is I did not cause this, I cannot control it, and I can't cure it. That is his job. It will be painful because he has to go back through painful experiences and I have to let him be in pain, be mad, be consumed with grief and guilt or whatever else he feels. So I had to learn to let go. I got help learning this from a couple of 12 step programs for people who want to run other people's lives.
More on this tomorrow
I misunderstood what was going on because there was no information on PTSD. My efforts to fix Bob were really ineffectual. So I tried harder. We spent 15 years after he came back thinking we were losers, crazy losers, and I thought it was all my fault because I wasn't trying hard enough to fix him and make him happy. Sometimes he agreed. We had no idea what the problem was or that it was getting a name. In 1980, it became Post-Traumatic Stress Disorder. My mother, Constance Hartwell, MD, was a VA psychiatrist who talked to veterans, and she would tell me Bob's problems had to do with the war. She sent him big bottles of Vitamin B-12 and told him to drink less and smoke more pot.
Our VA in Gainesville was fond of giving valium, and told Vietnam vets to go to the Vet Centers in Jacksonville or Tallahassee. Bob actually went up and got a pamphlet from the Vet Center, the DAV's Readjustment Problems among Vietnam Veterans. (The DAV had actually funded the first study, The Wounded Warrior Project, of Vietnam vets. No university, foundation or government agency would fund it.) We read the pamphlet and I cried all the way through it. What was happening to us had a name.
Nowadays there is much more information about PTSD, but none of it is formulated like this description of the symptoms as built-into-your-brain normal survival skills which keep you alive. Instead they are described as if they were a random collection of weird behaviors starting with re-experiencing. Then most of the current literature is slanted towards "only a few people will get this," "we can make you resilient," and "we can cure it." Like they can change human nature...
So the spouse thinks a. you won't get it, b. it can be cured, and c. here are the directions.
What I have learned is I did not cause this, I cannot control it, and I can't cure it. That is his job. It will be painful because he has to go back through painful experiences and I have to let him be in pain, be mad, be consumed with grief and guilt or whatever else he feels. So I had to learn to let go. I got help learning this from a couple of 12 step programs for people who want to run other people's lives.
More on this tomorrow
Wednesday, June 11, 2014
Before I start writing about how PTSD affects families, I want to mention that PTSD can have a delayed onset and it is also the gift that keeps on giving, haha.
PTSD can hit you when they start the next war. If you have had some help and are doing well, it can hit you again when they start the next war. Other traumas bring up the symptoms, your spouse gets sick, someone else is raped, a natural disaster. This is called human nature.
You know what the young soldiers will be going through and it hurts you and brings up pain you may have thought you had dealt with.
My suggestion is if something helped before, go for more of it. This does not mean the therapy didn't work. It means PTSD comes back in normal people when there are further traumas.
PTSD can be held off for years by acceptable "efforts to avoid thoughts or feelings associated with the trauma," like workaholism, hidden sex addiction (affairs, porn), religiosity, food, exercise. The list is endless. Then it is the 50th anniversary of your war and Boom! PTSD.
You can also be hit by PTSD when you reach a point where you can't drink anymore, or your wife gets sick or dies, or you get sick and feel helpless.
I am not going to be able to cover all the effects on families in one post, but I will start out with what happened to me.
I had no idea that war was anything but glorious, having been raised on WWII movies, documentaries, and books. I actually wanted to be either Combat Kelly or Sgt. Rock of Easy Company...
At 14 I realized wishing would not make me a boy, so I gave that up. It didn't occur to me to join as a woman. They couldn't be infantry.
In that era we were brought up to believe you could do anything if you tried hard enough, and you were responsible for the happiness of your family. If they had problems, you could and should fix them.
So when Bob came back from Vietnam, thinner, jumpier and leaping up at night, I started trying to fix it. Booze helped him sleep, so I got it. I made friends for us because Bob started isolating. I read self help books and passed them on to him and got mad when he didn't read them and immediately get better.
I also spent a lot of time telling him "Don't be sad" because I thought if he was sad it meant I was not a good wife, "Don't be mad," because if he was angry it meant I was not a good wife, "You shouldn't feel that way," if something annoyed him.
All of these stop recovery. Vets need to be mad, sad, annoyed and whatever else they feel, but I was always there helpfully trying to cheer him up. This is because I could not tolerate his pain. I did not see it that way. I saw it as being nice and as my job.
More tomorrow.
PTSD can hit you when they start the next war. If you have had some help and are doing well, it can hit you again when they start the next war. Other traumas bring up the symptoms, your spouse gets sick, someone else is raped, a natural disaster. This is called human nature.
You know what the young soldiers will be going through and it hurts you and brings up pain you may have thought you had dealt with.
My suggestion is if something helped before, go for more of it. This does not mean the therapy didn't work. It means PTSD comes back in normal people when there are further traumas.
PTSD can be held off for years by acceptable "efforts to avoid thoughts or feelings associated with the trauma," like workaholism, hidden sex addiction (affairs, porn), religiosity, food, exercise. The list is endless. Then it is the 50th anniversary of your war and Boom! PTSD.
You can also be hit by PTSD when you reach a point where you can't drink anymore, or your wife gets sick or dies, or you get sick and feel helpless.
I am not going to be able to cover all the effects on families in one post, but I will start out with what happened to me.
I had no idea that war was anything but glorious, having been raised on WWII movies, documentaries, and books. I actually wanted to be either Combat Kelly or Sgt. Rock of Easy Company...
At 14 I realized wishing would not make me a boy, so I gave that up. It didn't occur to me to join as a woman. They couldn't be infantry.
In that era we were brought up to believe you could do anything if you tried hard enough, and you were responsible for the happiness of your family. If they had problems, you could and should fix them.
So when Bob came back from Vietnam, thinner, jumpier and leaping up at night, I started trying to fix it. Booze helped him sleep, so I got it. I made friends for us because Bob started isolating. I read self help books and passed them on to him and got mad when he didn't read them and immediately get better.
I also spent a lot of time telling him "Don't be sad" because I thought if he was sad it meant I was not a good wife, "Don't be mad," because if he was angry it meant I was not a good wife, "You shouldn't feel that way," if something annoyed him.
All of these stop recovery. Vets need to be mad, sad, annoyed and whatever else they feel, but I was always there helpfully trying to cheer him up. This is because I could not tolerate his pain. I did not see it that way. I saw it as being nice and as my job.
More tomorrow.
Tuesday, June 10, 2014
Duration: Day 10 of National PTSD Awareness Month.
The final note in the diagnosis is that the symptoms have to last more than a month. Hahaha!
This is so ironic for those of us who went through psychiatry's denial and delusion period (1968-1980) when they dropped the diagnosis of "Gross stress reaction," meaning if you had been through a gross (big) stress it could affect you. The examples were a concentration camp or combat.
Based on NOTHING but arrogance, in 1968, in the Diagnostic and Statistical Manual II, the only stress reaction available was a "transient situational disturbance" which could only last 6 months. Any longer than that proved you were screwed up before you went and it had nothing to do with the war.
This caused a lot of deaths and is one reason why some Vietnam vets still won't go to the VA.
People were given personality disorders, a pre-existing condition so the VA was not responsible for your problems, bad conduct discharges, when people were having PTSD reactions. It was an ugly shameful period in the treatment of veterans.
The new veterans are getting the same crap, too.
Studies of people who are traumatized show that most of them have all of the symptoms of PTSD right afterwards (critical stress reaction), but some of them don't go on to get PTSD. That means it is a disorder of healing. As I have pointed out, telling your story is healing but if no one wants to hear it, if they just want to drug you or run you through a 12 week program that will "cure you", or any other one size fits all treatment, it is very hard to recover.
Denial rears it's head here. I'm fine, and you're nuts if you think I need help... Ever said that? Thought it? Sometimes people can see stuff you can't. Plus FINE is an acronym for F*cked up, Insecure, Neurotic and Egotistical.
It is very hard to accept that you might need help. It is totally un-American these days, but remember, people used to have much more time to talk before computers, Facebook, and cell phones.
On the plus side there are lots of online places to get help.
Tomorrow, how this affects families of people with PTSD.
This is so ironic for those of us who went through psychiatry's denial and delusion period (1968-1980) when they dropped the diagnosis of "Gross stress reaction," meaning if you had been through a gross (big) stress it could affect you. The examples were a concentration camp or combat.
Based on NOTHING but arrogance, in 1968, in the Diagnostic and Statistical Manual II, the only stress reaction available was a "transient situational disturbance" which could only last 6 months. Any longer than that proved you were screwed up before you went and it had nothing to do with the war.
This caused a lot of deaths and is one reason why some Vietnam vets still won't go to the VA.
People were given personality disorders, a pre-existing condition so the VA was not responsible for your problems, bad conduct discharges, when people were having PTSD reactions. It was an ugly shameful period in the treatment of veterans.
The new veterans are getting the same crap, too.
Studies of people who are traumatized show that most of them have all of the symptoms of PTSD right afterwards (critical stress reaction), but some of them don't go on to get PTSD. That means it is a disorder of healing. As I have pointed out, telling your story is healing but if no one wants to hear it, if they just want to drug you or run you through a 12 week program that will "cure you", or any other one size fits all treatment, it is very hard to recover.
Denial rears it's head here. I'm fine, and you're nuts if you think I need help... Ever said that? Thought it? Sometimes people can see stuff you can't. Plus FINE is an acronym for F*cked up, Insecure, Neurotic and Egotistical.
It is very hard to accept that you might need help. It is totally un-American these days, but remember, people used to have much more time to talk before computers, Facebook, and cell phones.
On the plus side there are lots of online places to get help.
Tomorrow, how this affects families of people with PTSD.
Monday, June 9, 2014
More Reexperiencing symptoms, Day 9 of National PTSD Awareness Month
Another
symptom is "intense psychological distress when exposed to external or
internal cues that symbolize or resemble an aspect of the trauma."
If you go into a rage when some clerk down at the VA acts like a lifer/REMF/FOBbit, it can cause problems.
If you get nuts when it gets hot and muggy (Vietnam, WWII Pacific Theater vets, Iraq vets) or cold (WWII European Theater, Korea) that is an external cue.
Anniversaries apply here. Veterans find holidays hard because of what they went through on holidays and because of the knowledge that lost buddies' families will be missing them.
On top of that there are private anniversaries (which you might not even know about yourself if it was too overwhelming to remember) which can turn you numb, angry and hypervigilant. The day Joe was killed, or the last hot and heavy lift (lots of helicopters [heavy] going into a firefight [hot] to drop off troops) you were asked to fly the day before you came home from Vietnam, which still affects my nearest and dearest.
The sound of kids crying can be torture to someone who had to clear villages. Grilling meat brings up associations you'd just as soon not have.
This is part of the brain's better safe than sorry system. If you find yourself flaring up, ready for anything and you don't know why, check for progression of triggers, but also check the date. And check the attitude of whoever is with you and the type of thing that is going on. Sometimes being out with people can remind you of the insensitive things people said when you got home.
if you lost your ability trust authority figures in the war, you may find that authority figures make you feel crazy. If you were protested, protestors may upset you. If you were cheered, cheering may upset you. This is a very individual type of thing. Being thanked can hurt as much as being scapegoated if you don't think you did enough.
You may also not want to be around other veterans if someone or some group let you down.
The last symptom in the re-experiencing group is having a physiological reaction to something that reminds you of the war or whatever trauma you suffered. Many Vietnam vets respond to the sound of a Huey with a surge of adrenaline. The new vets get surges of adrenaline at the sight of trash by the road (IED) or cars coming near them among other things.
Even though this is part of the brain's better safe than sorry system, it can be very upsetting, especially if you don't know what the trigger is or think it shouldn't trigger you.
The part of the brain that is doing this can't speak English, so you can't reason with it, and it can't tell time, either, so it does not know you are home.
Tomorrow I will talk about the last diagnostic criteria, duration of symptoms...
If you go into a rage when some clerk down at the VA acts like a lifer/REMF/FOBbit, it can cause problems.
If you get nuts when it gets hot and muggy (Vietnam, WWII Pacific Theater vets, Iraq vets) or cold (WWII European Theater, Korea) that is an external cue.
Anniversaries apply here. Veterans find holidays hard because of what they went through on holidays and because of the knowledge that lost buddies' families will be missing them.
On top of that there are private anniversaries (which you might not even know about yourself if it was too overwhelming to remember) which can turn you numb, angry and hypervigilant. The day Joe was killed, or the last hot and heavy lift (lots of helicopters [heavy] going into a firefight [hot] to drop off troops) you were asked to fly the day before you came home from Vietnam, which still affects my nearest and dearest.
The sound of kids crying can be torture to someone who had to clear villages. Grilling meat brings up associations you'd just as soon not have.
This is part of the brain's better safe than sorry system. If you find yourself flaring up, ready for anything and you don't know why, check for progression of triggers, but also check the date. And check the attitude of whoever is with you and the type of thing that is going on. Sometimes being out with people can remind you of the insensitive things people said when you got home.
if you lost your ability trust authority figures in the war, you may find that authority figures make you feel crazy. If you were protested, protestors may upset you. If you were cheered, cheering may upset you. This is a very individual type of thing. Being thanked can hurt as much as being scapegoated if you don't think you did enough.
You may also not want to be around other veterans if someone or some group let you down.
The last symptom in the re-experiencing group is having a physiological reaction to something that reminds you of the war or whatever trauma you suffered. Many Vietnam vets respond to the sound of a Huey with a surge of adrenaline. The new vets get surges of adrenaline at the sight of trash by the road (IED) or cars coming near them among other things.
Even though this is part of the brain's better safe than sorry system, it can be very upsetting, especially if you don't know what the trigger is or think it shouldn't trigger you.
The part of the brain that is doing this can't speak English, so you can't reason with it, and it can't tell time, either, so it does not know you are home.
Tomorrow I will talk about the last diagnostic criteria, duration of symptoms...
Sunday, June 8, 2014
Flashbacks: Day 8 of National PTSD Awareness Month
The
most well known form of re-experiencing is flashbacks. This is when you
feel you are back in the trauma of war or rape or whatever you have
lived through.
Everyone knows about this symptom. When an event happened so fast and was so overwhelming, it stays in the reptile brain as bodily memories, emotions, flashes of visual information, smells, sounds, touches. Any one of these can trigger a flashback. Smells and sights are especially triggering because of the direct connection with the brain. This is another form of the brain warning you of danger, but it can also cause danger if you think you are somewhere else for a few minutes and act on that.
One of the biggest problems with PTSD is that survival skills that have kept you alive can become your biggest problems later. This one is mostly a problem.
One of the funniest moments in our life, Bob's and mine, of trying to help people with PTSD happened when he was giving a writing workshop years ago at the Portland, OR VAMC. One of the guys told the group that when he got back from Vietnam he went to a community college and for English he had to write a journal. He got an F on the first one, and said to himself, "F*ck her, I'll make it personal. I'll write one of my night mares." He did. She corrected it and handed it back. He rewrote it. She corrected it and handed it back. He rewrote it. She gave it a good grade. He rewrote it a couple of more times just to make it completely accurate. Then he noticed he was not having the nightmare anymore. That night Bob said to me, "You know I have not had any nightmares since I wrote Chickenhawk. I never noticed..." That is what happens if you can turn those non verbal memories into some form of narrative memory, by writing, talking or any other way that works for you.
If someone is having a flashback, don't jump them. Try to tell them they are safe at home.
One of the quickest ways to get out of a flashback is to carry a safe scent with you, like vanilla or lavender, something you identify with as a good smell and that has nothing to do with the war zone or whatever danger you faced. The direct connection between brain and nose can help you short circuit the flashback.
The next symptom is when you have intense reactions to things that remind you of the trauma or symbolize it in some way. I will talk about that tomorrow.
Everyone knows about this symptom. When an event happened so fast and was so overwhelming, it stays in the reptile brain as bodily memories, emotions, flashes of visual information, smells, sounds, touches. Any one of these can trigger a flashback. Smells and sights are especially triggering because of the direct connection with the brain. This is another form of the brain warning you of danger, but it can also cause danger if you think you are somewhere else for a few minutes and act on that.
One of the biggest problems with PTSD is that survival skills that have kept you alive can become your biggest problems later. This one is mostly a problem.
One of the funniest moments in our life, Bob's and mine, of trying to help people with PTSD happened when he was giving a writing workshop years ago at the Portland, OR VAMC. One of the guys told the group that when he got back from Vietnam he went to a community college and for English he had to write a journal. He got an F on the first one, and said to himself, "F*ck her, I'll make it personal. I'll write one of my night mares." He did. She corrected it and handed it back. He rewrote it. She corrected it and handed it back. He rewrote it. She gave it a good grade. He rewrote it a couple of more times just to make it completely accurate. Then he noticed he was not having the nightmare anymore. That night Bob said to me, "You know I have not had any nightmares since I wrote Chickenhawk. I never noticed..." That is what happens if you can turn those non verbal memories into some form of narrative memory, by writing, talking or any other way that works for you.
If someone is having a flashback, don't jump them. Try to tell them they are safe at home.
One of the quickest ways to get out of a flashback is to carry a safe scent with you, like vanilla or lavender, something you identify with as a good smell and that has nothing to do with the war zone or whatever danger you faced. The direct connection between brain and nose can help you short circuit the flashback.
The next symptom is when you have intense reactions to things that remind you of the trauma or symbolize it in some way. I will talk about that tomorrow.
Saturday, June 7, 2014
Day 7, Reexperiencing
Reexperiencing:
So here we are at the set of symptoms which are first in the diagnostic criteria for PTSD. I put them last, because you can't reexperience anything unless you have first experienced it and it has made a big traumatic impression!
Like I said, PTSD makes more sense if you see yourself reacting swiftly and effectively to danger using skills built into the primitive part of your brain. Then you re-experience the events in various ways.
When I started out, I felt reexperiencing was a cry from your inner self for help. I have been through something that is too much for me! So it keeps reminding you of what happened in unpleasant ways. I learned that those parts of the brain store non-verbal memories. (If you want to see a non-verbal memory, hold a ball up in front of a dog.) One of the ways to get those non-verbal memories out of your head is to encode them as narrative memories, which means to talk it out or write it out and get the details right. That is why therapy works, but so does writing a book, like Bob did, or other kinds of writing. I will talk more about that when I get to things that help.
Here is the first symptom: intrusive unpleasant recollections of the event(s). This is like going over and over the plot of a movie, trying to figure it out. Your brain needs to figure it out. That is one of the brain's functions. What happened? Why did it happen (to ME)? this is the better safe than sorry part of your brain which wants you constantly looking out for danger so you won't get hurt again.
People do not want to keep thinking about those experiences. They intrude! Shove in where they are not wanted. This can make you feel quite nuts. Why can't I stop thinking about it, or dreaming about it (the second type of reexperiencing)? What is wrong with me?
PTSD symptoms are proof of survival. You can't re-experience if you don't live. However re-experiencing is disconcerting, painful, devastating, depressing and often horrific. When you can't stop thinking, seeing feeling or dreaming about painful events it makes you cranky or outright angry and it can turn you towards self-medication. You may be unable to sleep because of nightmares or afraid to sleep for fear of having them. To me, your brain is telling you something does bother you. Since military men and women are not supposed to be bothered by anything, it seems like your brain has to whack you over the head with re-experiencing to get you to notice that it did bother you...
Tomorrow I will talk more about the other reexperiencing symptoms.
So here we are at the set of symptoms which are first in the diagnostic criteria for PTSD. I put them last, because you can't reexperience anything unless you have first experienced it and it has made a big traumatic impression!
Like I said, PTSD makes more sense if you see yourself reacting swiftly and effectively to danger using skills built into the primitive part of your brain. Then you re-experience the events in various ways.
When I started out, I felt reexperiencing was a cry from your inner self for help. I have been through something that is too much for me! So it keeps reminding you of what happened in unpleasant ways. I learned that those parts of the brain store non-verbal memories. (If you want to see a non-verbal memory, hold a ball up in front of a dog.) One of the ways to get those non-verbal memories out of your head is to encode them as narrative memories, which means to talk it out or write it out and get the details right. That is why therapy works, but so does writing a book, like Bob did, or other kinds of writing. I will talk more about that when I get to things that help.
Here is the first symptom: intrusive unpleasant recollections of the event(s). This is like going over and over the plot of a movie, trying to figure it out. Your brain needs to figure it out. That is one of the brain's functions. What happened? Why did it happen (to ME)? this is the better safe than sorry part of your brain which wants you constantly looking out for danger so you won't get hurt again.
People do not want to keep thinking about those experiences. They intrude! Shove in where they are not wanted. This can make you feel quite nuts. Why can't I stop thinking about it, or dreaming about it (the second type of reexperiencing)? What is wrong with me?
PTSD symptoms are proof of survival. You can't re-experience if you don't live. However re-experiencing is disconcerting, painful, devastating, depressing and often horrific. When you can't stop thinking, seeing feeling or dreaming about painful events it makes you cranky or outright angry and it can turn you towards self-medication. You may be unable to sleep because of nightmares or afraid to sleep for fear of having them. To me, your brain is telling you something does bother you. Since military men and women are not supposed to be bothered by anything, it seems like your brain has to whack you over the head with re-experiencing to get you to notice that it did bother you...
Tomorrow I will talk more about the other reexperiencing symptoms.
Friday, June 6, 2014
Loss of interest and Can't remember Day 6 Of National PTSD Awareness Month
The
next to last symptom in the numbing and avoidance set is no longer
being interested in things that used to interest you. This is another
survival skill because what you are interested in is avoiding triggers
at all costs.It helps to understand the progression of triggers. A
second generation trigger, like the gun, beer and friends in my example
yesterday, can lead to third and fourth generation
triggers of things that are around when one of those triggers you. If
things trigger you that seem not to make sense, try to figure out when
you first felt this way...
Even without second and third generation triggers, people who once had lots of friends may now avoid them. People who loved hunting, now can't hunt. People who were out and around now stay home all the time. Movie lovers don't go to movies anymore.
People who loved sex, don't want to do it anymore. (One of the truths no one ever mentions...war ruins sex for many men for various periods of time after). Naturally wives don't know this so they feel undesirable and get mad. Guys don't know this so they start looking for someone more exciting. Believe me, it is not you spouse and it will pass. I have only talked to men vets about this, but I suspect it is true for women combat vets, and I know being raped ruins sex for anyone.
So when you lose interest in outside things, you may find yourself staying home and advising your wife on how to wash dishes. This is dangerous, guys. Snarling often results. If you did stuff together, she may feel abandoned when you won't participate anymore.
The last symptom in the numbing and avoidance category is when you can't remember all or part of the traumatic event(s). Traumatic amnesia is common. Traumatic events often happen too fast to be laid down as a narrative memory, which is what your fore brain does. Your are reacting with what used to be called the reptile brain in my high school science classes. This is protective. Some events are so overwhelming they would incapacitate you, so evolution or God has given you this capacity. Hugh Thompson, the helicopter pilot who tried to stop the My Lai massacre, forgot it until the Army investigators came to interview him two years later. My husband Bob has a picture of himself in front of a bunch of dead VC at Plei Me, but he does not remember the event. One of my favorite vets tried to kill himself the same day ten years apart, so his therapist decided they should check the unit records. Turned out 28 guys in his unit died on that day. If you find yourself doing odd things the same time every year you may be reacting to an anniversary which leads me into the third set of PTSD symptoms, re-experiencing, which I will start on tomorrow.
If you follow the facebook page Recovering from the War, I think you will get these automatically. I will be posting every day this month. Or you can follow this blog. I cross post.
Even without second and third generation triggers, people who once had lots of friends may now avoid them. People who loved hunting, now can't hunt. People who were out and around now stay home all the time. Movie lovers don't go to movies anymore.
People who loved sex, don't want to do it anymore. (One of the truths no one ever mentions...war ruins sex for many men for various periods of time after). Naturally wives don't know this so they feel undesirable and get mad. Guys don't know this so they start looking for someone more exciting. Believe me, it is not you spouse and it will pass. I have only talked to men vets about this, but I suspect it is true for women combat vets, and I know being raped ruins sex for anyone.
So when you lose interest in outside things, you may find yourself staying home and advising your wife on how to wash dishes. This is dangerous, guys. Snarling often results. If you did stuff together, she may feel abandoned when you won't participate anymore.
The last symptom in the numbing and avoidance category is when you can't remember all or part of the traumatic event(s). Traumatic amnesia is common. Traumatic events often happen too fast to be laid down as a narrative memory, which is what your fore brain does. Your are reacting with what used to be called the reptile brain in my high school science classes. This is protective. Some events are so overwhelming they would incapacitate you, so evolution or God has given you this capacity. Hugh Thompson, the helicopter pilot who tried to stop the My Lai massacre, forgot it until the Army investigators came to interview him two years later. My husband Bob has a picture of himself in front of a bunch of dead VC at Plei Me, but he does not remember the event. One of my favorite vets tried to kill himself the same day ten years apart, so his therapist decided they should check the unit records. Turned out 28 guys in his unit died on that day. If you find yourself doing odd things the same time every year you may be reacting to an anniversary which leads me into the third set of PTSD symptoms, re-experiencing, which I will start on tomorrow.
If you follow the facebook page Recovering from the War, I think you will get these automatically. I will be posting every day this month. Or you can follow this blog. I cross post.
Thursday, June 5, 2014
Efforts to avoid activities and situations Day 5 of National PTSD Awareness Month
Efforts
to avoid activities and situations that remind you of the trauma: This
is another protective symptom. Avoiding triggers becomes the most
important thing.
You may avoid being given orders or a job to do because it can get you killed, so you don't take out the trash, because on some level that you can't even identify, it may get you killed.
You avoid crowds, because one rule in war is "Don't bunch up. Makes a bigger target."
Cookouts bring up memories of burning flesh, parked cars or roadside trash bring up memories of IED's, family parties bring up memories of those who died and don't get to be with families. Sometimes parties are also full of people who want to know why you aren't over it yet, too. Not helpful so you avoid them.
The sound of children crying in the war zone has made you unable to listen to your own kids cry so you avoid that. If you and your family don't understand what is going on, everyone gets mad.
There is also a progression of triggers. Say you are shopping in Wal-Mart and someone drops something big making a loud bang and you hit the floor or some kid is crying and you have to leave. Walmart can now be a trigger you have to avoid. Or you see someone who looks Iraqi or Afghani, while chewing gum and drinking beer in the park with your friends and have a moment of terror. Now gum and beer and friends and parks can become triggers. Needless to say, being triggered by gum is going to make you feel nuts because how does it relate? Not everything will be a trigger, but odd things may become triggers. It helps to see if you can trace them.
Some of the problems veterans have with the VA are based in this symptom. Good old hurry up and wait or SNAFU's, so common in the military, can trigger people in the VA where waiting and SNAFU's are also common.
Tomorrow: Loss of interest in old activities you liked before the war or trauma.
Please share with anyone it might help. You can also follow my Facebook Recovering From the War page to get all the posts this month, National PTSD Awareness Month. I will post every day.
You may avoid being given orders or a job to do because it can get you killed, so you don't take out the trash, because on some level that you can't even identify, it may get you killed.
You avoid crowds, because one rule in war is "Don't bunch up. Makes a bigger target."
Cookouts bring up memories of burning flesh, parked cars or roadside trash bring up memories of IED's, family parties bring up memories of those who died and don't get to be with families. Sometimes parties are also full of people who want to know why you aren't over it yet, too. Not helpful so you avoid them.
The sound of children crying in the war zone has made you unable to listen to your own kids cry so you avoid that. If you and your family don't understand what is going on, everyone gets mad.
There is also a progression of triggers. Say you are shopping in Wal-Mart and someone drops something big making a loud bang and you hit the floor or some kid is crying and you have to leave. Walmart can now be a trigger you have to avoid. Or you see someone who looks Iraqi or Afghani, while chewing gum and drinking beer in the park with your friends and have a moment of terror. Now gum and beer and friends and parks can become triggers. Needless to say, being triggered by gum is going to make you feel nuts because how does it relate? Not everything will be a trigger, but odd things may become triggers. It helps to see if you can trace them.
Some of the problems veterans have with the VA are based in this symptom. Good old hurry up and wait or SNAFU's, so common in the military, can trigger people in the VA where waiting and SNAFU's are also common.
Tomorrow: Loss of interest in old activities you liked before the war or trauma.
Please share with anyone it might help. You can also follow my Facebook Recovering From the War page to get all the posts this month, National PTSD Awareness Month. I will post every day.
Wednesday, June 4, 2014
Foreshortened future and efforts to avoid... Day 4 of National PTSD Awareness Month
A
sense of a foreshortened future is also realistic. Live in the now! You
see other guys or women your age blown up by IED's or whatever was
common in your war, why would you expect to have a long life? People die
all the time in your experience, suddenly and in ugly ways.
It is also self-protective. Why plan and hope when you could be dead tomorrow? This can lead to a lot of behavior which looks irresponsible, and often is. It ties back to emotional numbing, because often people are so numb the only time they feel alive is when adrenaline is pumping through their bodies. Everything from screwing around to getting into bar fights or driving fast motorcycles, jumping out of airplanes, becoming a cop or firefighter can be a way to get the adrenaline going.
I forgot to mention yesterday that emotional numbing to deal with war also numbs your ability to feel good emotions. Feeling nothing is common with vets, and when you feel nothing about your wife or husband or if your mother dies, that is a symptom, not proof that you are a bad person. You wouldn't have to feel nothing if you didn't care...
Anyhow, back to symptoms: "Efforts to avoid thoughts or feelings associated with the trauma," means that if you think you were at fault, you may spend the rest of your life having to be right. If you lost people you loved (and no one is closer than buddies in combat) you may try never to love anyone again, If you trusted the government or your branch of the military and were hung out to dry or betrayed, you may never trust anyone again.
You may live in denial (It's not just a river in Egypt, haha) and believe that the war didn't affect you. Everyone else is screwed up, but you are fine (f*cked up, insecure, neurotic and egotistical is how I see it...for me.)
Finally the most common way to avoid thoughts or feelings associated with the trauma is to stay drunk or drugged. This used to be considered "willful misconduct" by the VA, but now is considered secondary to this symptom of PTSD. There are other addictions too: food, sex or relationships, gambling, internet gaming or porn, religion, adrenaline, anything you can think of.
The reason for this symptom is self-protection. The pain of what you saw or did can be so great that it is overwhelming. It is illegal to be in pain in America. People want you to be over it now, or at least by tomorrow... And when thinking or remembering or being reminded of what happened, you can be triggered into rages, startle responses, and other disturbing behaviors that cause you a lot of trouble, so avoiding triggers becomes a priority.
Stay numb. Avoid everything. Seems logical, but it is usually pretty ineffective.
Tomorrow: efforts to avoid activities and situations that remind you of the trauma.
One request: If you like my posts, please share them with others.
It is also self-protective. Why plan and hope when you could be dead tomorrow? This can lead to a lot of behavior which looks irresponsible, and often is. It ties back to emotional numbing, because often people are so numb the only time they feel alive is when adrenaline is pumping through their bodies. Everything from screwing around to getting into bar fights or driving fast motorcycles, jumping out of airplanes, becoming a cop or firefighter can be a way to get the adrenaline going.
I forgot to mention yesterday that emotional numbing to deal with war also numbs your ability to feel good emotions. Feeling nothing is common with vets, and when you feel nothing about your wife or husband or if your mother dies, that is a symptom, not proof that you are a bad person. You wouldn't have to feel nothing if you didn't care...
Anyhow, back to symptoms: "Efforts to avoid thoughts or feelings associated with the trauma," means that if you think you were at fault, you may spend the rest of your life having to be right. If you lost people you loved (and no one is closer than buddies in combat) you may try never to love anyone again, If you trusted the government or your branch of the military and were hung out to dry or betrayed, you may never trust anyone again.
You may live in denial (It's not just a river in Egypt, haha) and believe that the war didn't affect you. Everyone else is screwed up, but you are fine (f*cked up, insecure, neurotic and egotistical is how I see it...for me.)
Finally the most common way to avoid thoughts or feelings associated with the trauma is to stay drunk or drugged. This used to be considered "willful misconduct" by the VA, but now is considered secondary to this symptom of PTSD. There are other addictions too: food, sex or relationships, gambling, internet gaming or porn, religion, adrenaline, anything you can think of.
The reason for this symptom is self-protection. The pain of what you saw or did can be so great that it is overwhelming. It is illegal to be in pain in America. People want you to be over it now, or at least by tomorrow... And when thinking or remembering or being reminded of what happened, you can be triggered into rages, startle responses, and other disturbing behaviors that cause you a lot of trouble, so avoiding triggers becomes a priority.
Stay numb. Avoid everything. Seems logical, but it is usually pretty ineffective.
Tomorrow: efforts to avoid activities and situations that remind you of the trauma.
One request: If you like my posts, please share them with others.
Tuesday, June 3, 2014
Numbing and avoidance, day 3 of National PTSD Awareness Month
Before I start on the cluster of numbing and avoidance symptoms I want
to make it clear that I think each PTSD symptom starts out as a useful
effective survival skill. They keep you alive. They also can become your
biggest problems, but they start out as lifesavers.
Under numbing and avoidance there are 7 symptoms. They are based in the brain's built in capacity to rapidly adapt to whatever is going on and on its built in need to be in control.
So, in my opinion, the first one, not having all your emotions, comes from a combination of attention to threat (so feelings fall away because they can actually interfere with survival), the need to be in control (no distractions), and the brain's ability to rapidly adapt to what is going on so you can survive. You may puke at the first kill you see or do, but it will become just another everyday occurrence quickly. It helps you do your job and survive, and it also protects you from a depth of pain most people never have to face. After all, we are all brought up to think we have to get over things and move on, preferably rapidly. This has no relation to the actuality of mourning friends and other losses, but it is a common idea. Being numb helps when there is no space or time for mourning and it helps later when people say, "Aren't you over that yet?" It is practically illegal to be sad in America.
The next symptom in this cluster is "feeling detached and estranged." This is REALITY. You are different and other people can't understand. I realized this when I was writing Recovering from the War and thought I was beginning to understand and then Bob and I went to Platoon. After, I was saying how awful one of the scenes was and Bob looked at me oddly and said, "It's worse when it's real." Holy shit, I thought! I can't understand because I am simply hearing about it, seeing it on the screen, reading. I can't smell it. No one is shooting at me. I'm not there!
This was an epiphany for me, and I share it whenever I speak on PTSD. Do not say you understand, because you can't. Say you want to understand.
Anyhow, feeling detached and estranged form others is appropriate. For one thing your locus coroleus has changed and become hyper-responsive to danger and stress, which inevitably ties back into the hypervigilant symptoms I talked about in the first posts.
This is also an effective survival strategy after the war is over because people say such shitty things to veterans: Arent you over it? How many people did you kill? Or even, like happened to one of my WWII vet friends who hadn't eaten at a table for a year: where are your manners? Being detached and estranged in these circumstances is protective.
I will talk about a sense of a foreshortened future tomorrow.
This will be cross posted at the usual places, My book page on FB, my author page, my personal page and here at blogspot
Under numbing and avoidance there are 7 symptoms. They are based in the brain's built in capacity to rapidly adapt to whatever is going on and on its built in need to be in control.
So, in my opinion, the first one, not having all your emotions, comes from a combination of attention to threat (so feelings fall away because they can actually interfere with survival), the need to be in control (no distractions), and the brain's ability to rapidly adapt to what is going on so you can survive. You may puke at the first kill you see or do, but it will become just another everyday occurrence quickly. It helps you do your job and survive, and it also protects you from a depth of pain most people never have to face. After all, we are all brought up to think we have to get over things and move on, preferably rapidly. This has no relation to the actuality of mourning friends and other losses, but it is a common idea. Being numb helps when there is no space or time for mourning and it helps later when people say, "Aren't you over that yet?" It is practically illegal to be sad in America.
The next symptom in this cluster is "feeling detached and estranged." This is REALITY. You are different and other people can't understand. I realized this when I was writing Recovering from the War and thought I was beginning to understand and then Bob and I went to Platoon. After, I was saying how awful one of the scenes was and Bob looked at me oddly and said, "It's worse when it's real." Holy shit, I thought! I can't understand because I am simply hearing about it, seeing it on the screen, reading. I can't smell it. No one is shooting at me. I'm not there!
This was an epiphany for me, and I share it whenever I speak on PTSD. Do not say you understand, because you can't. Say you want to understand.
Anyhow, feeling detached and estranged form others is appropriate. For one thing your locus coroleus has changed and become hyper-responsive to danger and stress, which inevitably ties back into the hypervigilant symptoms I talked about in the first posts.
This is also an effective survival strategy after the war is over because people say such shitty things to veterans: Arent you over it? How many people did you kill? Or even, like happened to one of my WWII vet friends who hadn't eaten at a table for a year: where are your manners? Being detached and estranged in these circumstances is protective.
I will talk about a sense of a foreshortened future tomorrow.
This will be cross posted at the usual places, My book page on FB, my author page, my personal page and here at blogspot
Monday, June 2, 2014
PTSD Awareness month; days 1 & 2
Just posted this on Patience H C Mason, my author page and Recovering From the War, my book page:
Since I just found out that June is PTSD Awareness Month, I think I will try to publish something each day here and on my Recovering from the War page. Don't ask me why I have two pages on Recovering. It seemed like a good Idea at the time.
I find the professional literature on PTSD lacks insight into human nature.
When I was writing this book, I kept asking myself why would a person have this reaction? What is its purpose?
To my way of thinking, the symptoms of PTSD arise out of survival skills built into all our brains: not into the thinking, speaking parts, but in the more primitive parts which react before thought.
PTSD symptoms are grouped in clusters, but the order of the clusters in the official diagnostic criteria make them look random and weird.
My order is arousal first, then rapid adaptation and avoidance, and then re-experiencing, which can't happen till AFTER, after all...
When someone attacks, your body reacts instantly, shutting down or fighting back or running (freeze, fight or flee). It's instinctive. We don't have conscious access to this ability. Sometimes a highly trained soldier will find himself unable to get up and attack because this part of him knows he won't survive. It is not cowardice.
The most common response is to flee. That is why soldiers have to be trained to fight.
So I start with the brain's built in ability to pay attention to threats. Wave your hand in front of a snake or bat at a kitten to see this in action.
We, too, react that fast. There is no thought involved. People who don't understand danger call this an "exaggerated startle response," instead of an "effective startle response," which kept you alive.
Threat creates an emotional response. Emotions are designed to keep you alive. Threat creates anger. Irritability and outbursts of anger are a pretty natural response to people trying to kill you, or otherwise traumatize you. More tomorrow.
So I got as far as "irritability and outbursts of anger" yesterday, a part of the cluster of symptoms which arise out of the brain's natural ability to pay attention to threats, to act instantly in reaction, and then to become constantly wary, checking for more threats. Normal brains do this, become hypervigilant, especially if the threats are constant, or intermittent and prolonged, both of which are a good description of many war experiences (and violent families). Anger can keep you alive and help you endure the privations of war or other traumatic events. "Inability to fall or stay asleep," is the next symptom in this section of the diagnostic criteria. This will also make you irritable as well as being the most effective form of torture, too. People do not sleep soundly in wars. It can prove fatal. The last symptom in this category is the "inability to concentrate," which is another misstatement. The veteran is not concentrating on normal everyday stuff. He or she is concentrating on who has a weapon, how will I get out of this room, is that an IED on the road ahead, etc. Concentrating on survival leaves very little room for listening to your spouse or a new therapist or some clerk at the VA.
When you look at these symptoms the way I do, you see them as an effective set of responses to war and other traumas. They are not weird or weak or abnormal. As a matter of fact I see PTSD as a solution to the problem of war. You lived! Tomorrow numbing and avoidance.
By the way, if you have friended me on facebook as Patience H. C, Mason, you can also follow me on my book page (Recovering From the War) and my author page Patience H C Mason (no periods after the initials.
I am cross posting all of this.
Since I just found out that June is PTSD Awareness Month, I think I will try to publish something each day here and on my Recovering from the War page. Don't ask me why I have two pages on Recovering. It seemed like a good Idea at the time.
I find the professional literature on PTSD lacks insight into human nature.
When I was writing this book, I kept asking myself why would a person have this reaction? What is its purpose?
To my way of thinking, the symptoms of PTSD arise out of survival skills built into all our brains: not into the thinking, speaking parts, but in the more primitive parts which react before thought.
PTSD symptoms are grouped in clusters, but the order of the clusters in the official diagnostic criteria make them look random and weird.
My order is arousal first, then rapid adaptation and avoidance, and then re-experiencing, which can't happen till AFTER, after all...
When someone attacks, your body reacts instantly, shutting down or fighting back or running (freeze, fight or flee). It's instinctive. We don't have conscious access to this ability. Sometimes a highly trained soldier will find himself unable to get up and attack because this part of him knows he won't survive. It is not cowardice.
The most common response is to flee. That is why soldiers have to be trained to fight.
So I start with the brain's built in ability to pay attention to threats. Wave your hand in front of a snake or bat at a kitten to see this in action.
We, too, react that fast. There is no thought involved. People who don't understand danger call this an "exaggerated startle response," instead of an "effective startle response," which kept you alive.
Threat creates an emotional response. Emotions are designed to keep you alive. Threat creates anger. Irritability and outbursts of anger are a pretty natural response to people trying to kill you, or otherwise traumatize you. More tomorrow.
So I got as far as "irritability and outbursts of anger" yesterday, a part of the cluster of symptoms which arise out of the brain's natural ability to pay attention to threats, to act instantly in reaction, and then to become constantly wary, checking for more threats. Normal brains do this, become hypervigilant, especially if the threats are constant, or intermittent and prolonged, both of which are a good description of many war experiences (and violent families). Anger can keep you alive and help you endure the privations of war or other traumatic events. "Inability to fall or stay asleep," is the next symptom in this section of the diagnostic criteria. This will also make you irritable as well as being the most effective form of torture, too. People do not sleep soundly in wars. It can prove fatal. The last symptom in this category is the "inability to concentrate," which is another misstatement. The veteran is not concentrating on normal everyday stuff. He or she is concentrating on who has a weapon, how will I get out of this room, is that an IED on the road ahead, etc. Concentrating on survival leaves very little room for listening to your spouse or a new therapist or some clerk at the VA.
When you look at these symptoms the way I do, you see them as an effective set of responses to war and other traumas. They are not weird or weak or abnormal. As a matter of fact I see PTSD as a solution to the problem of war. You lived! Tomorrow numbing and avoidance.
By the way, if you have friended me on facebook as Patience H. C, Mason, you can also follow me on my book page (Recovering From the War) and my author page Patience H C Mason (no periods after the initials.
I am cross posting all of this.
Sunday, April 27, 2014
Writing to Heal
Here is a post by the wife of one of the new vets which I find helpful and healing. Nice to know people are finding help with the despair that living with someone who has PTSD can sometimes cause.
Writing helps me feel what I feel. I used to tell myself that I shouldn't feel what I felt because it wasn't logical. Well guess what? If feelings were logical they'd be called reasons, but they are not. Feelings just are, and if you sit with them they peak and then they fade. They are not permanent, unless you suppress them...
Please read this Caring for a Veteran/Writing to Heal
Writing helps me feel what I feel. I used to tell myself that I shouldn't feel what I felt because it wasn't logical. Well guess what? If feelings were logical they'd be called reasons, but they are not. Feelings just are, and if you sit with them they peak and then they fade. They are not permanent, unless you suppress them...
Please read this Caring for a Veteran/Writing to Heal
Thursday, February 13, 2014
This is a good infographic on PTSD, which I believe is an epidemic.
It is not a government production so it is not full of bull about how most people will not be affected. You can twist statistics and the military and government specialize in it where PTSD is concerned. http://www.onlinemilitaryeducation.org/ptsd/
It is not a government production so it is not full of bull about how most people will not be affected. You can twist statistics and the military and government specialize in it where PTSD is concerned. http://www.onlinemilitaryeducation.org/ptsd/
Subscribe to:
Posts (Atom)