Telling the kids

Here is a killer quote from Alanon's One Day At a Time daily reader for June 26th:

We who really try to use the Alanon program have various reasons to be grateful as we see the results.  This was one member's experience, which she told her friends at a meeting.
Her greatest difficulty concerned her children. "I never knew what to do about them when my husband came home drunk and disorderly. I felt they should be shielded from violence, yet over-protection wouldn't be good for them. I didn't want to influence them against their father; I knew he loved them, and they him.
"I found all the answers in Alanon. I made sensible explanations about their father's illness and found them naturally compassionate. I avoided scenes by not allowing my frustrations to erupt into anger. I tried hard to be consistent and fair to them. The results have been everything I hoped for, and I am so grateful to Alanon for this."
Today's Reminder: Our children are a first thing to consider first. Our attitude is the key to a successful family relationship - and their normal growing up.
"And above all, I never use the children as pawns in any conflicts. They respond so well to respect."




For me, this is what I would to do when one of the parents, father or mother, is suffering from PTSD in the  acute stage. Or even the chronic stage. When I recognize that my husband, Bob, is not trying to hurt me, is not able to calm down and that what I choose to do (argue or let go) will be the primary decider in the way the day goes. It helps me give up trying to point out what is wrong with him and work on myself, on being the kind of person who can say, "You may be right," and let go. I may be thinking on Mars, but I don't have to say it. After all, I don't have PTSD. He does. I married him for better and for worse. If he had cancer, I would not be expecting him to get over it, put it behind him, or be the same person he was. War changes people, but it also gives them experiences that can propel them to new levels of usefulness to their fellows. Like talking about the costs of war.


For a sensible explanation of PTSD symptoms for children, use my two kids books, Why Is Daddy Like He Is? and the deployment version of Why Is Mommy Like She Is? I was told by VA therapists who use the book that the kids stop at every page and talk over the symptoms and relate it to their lives and it is really helpful to them to understand that they are not causing the symptoms. Kids commonly worry that something they are doing is the problem. These books will be available as free downloads in the next week at Patience Press. Right now there are thirteen free articles available there. Hope you will download them and read them and find them helpful.

I will post when the kids books are up.

I was talking to a Vet Center counselor the other day about these manualized 8 to 12 week therapies for PTSD which some VA's are using now and calling a cure.
I don't like the word cure in relation to PTSD.
I really believe that these therapies do cause remission of very painful and troubling PTSD symptoms for a while. When they have 20 year follow-ups with no return of symptoms on all the participants, I will take it back. Meanwhile, the only person I have met who went through one of these programs and was "cured" and wanted to give a talk at a reunion, decided that they weren't treating him right, so instead of asking the organizers for the equipment he wanted, he never contacted them and just stayed drunk all weekend. Didn't seem like a cure to me.
To change the habits of a lifetime can take the rest of your life, and if the habits were learned to save your life, it will be hard to give them up.
One thing the Vet Center counselor said to me was that if someone told the mother of a young person killed in Iraq or Afghanistan that she could cure her grief in 8 to 12 weeks, everyone would be up in arms. Here are men and women who have lost more than one buddy (closer than family if you have been in combat together) and you are going to cure that grief, plus the pain of killing, the anger at waste of lives, the fear of dying, all that in 12 weeks???
I am not saying not to try out this kind of therapy, Cognitive Processing Therapy, because I have heard it explained and seen the positive changes it produced in a workshop I went to. What I am saying is that if it helps, and then PTSD rears it's ugly head again, go back and do more.
That's what will help if symptoms come back: More of what helped before. Don't believe for one moment that you are a hopeless case. Get more help. People are always developing new treatments for PTSD. Your job is to find what works for you.

the link for the giveaway at goodreads

http://www.goodreads.com/giveaway/show/27316-recovering-from-the-war-a-guide-for-all-veterans-family-members-frien
I am giving away 5 copies to celebrate the fact that Recovering is now available as a kindle, an ibook, for a Sony reader, on Kobo.
It is available for iPad and iPod too. I used bookbaby.com to turn it into an ebook and they were quite good.
If you could pass this on to your friends who might be interested, I would appreciate it. I can always use reviews on any of the sites or on Goodreads itself.

Kindle!!

Woohooo!  Recovering from the War now has both the book and the kindle showing on the book page! It is $4.99 and I am doing another book giveaway (of actual books, not the kindle) on  Goodreads to celebrate. Please let me know if these links do or don't work.
You can look inside the book on the Amazon page and read my fans blurbs and the two new introductions.

I just managed to get Recovering on Amazon as a kindle for $4.99. So far it is not linked in the bookstore but if you look in the kindle store, it is there. I am going to do another book giveaway on Goodreads.com, too.

'Recovering from the War: A Guide for All Veterans, Family Members, Friends, and Therapists' by Patience H. C. Mason

www.amazon.com

Recovering from the War is a systematic investigation of the costs of war for veterans and their families, including information on how to recover from combat trauma. The examples are from Vietnam, but the experience is universal, so the book is helpful to active duty service members. Part One, Vietnam: What it was, consists of a series of chapters containing interviews with Vietnam veterans: Who Went,...

For Memorial Day

I wrote this poem about my husband and about my entirely human inability to understand what he had been through. I think it illustrates the difficulties wives face when someone comes back from war.
If you pair it with Bruce Weigl's Song of Napalm I think it does a good job of explaining some of the post-war problems couples have and why it does not simply go away with time.
It takes understanding (as opposed to misunderstanding), loving detachment (as opposed to personalizing), and compassion (as opposed to judgment) to make a happy life with a veteran, on both sides.
I always say to vets to remember how they felt about their wounded buddies, how much they wanted to help. We see you bleeding, and we want to help, and quite often everything we do has the reverse effect, so that is our pain.
Bless all vets.


I remember how your voice wept

I remember how your voice wept
when you told me

His balls were gone
His leg too
a bloody stump
The skin flapped and sprayed
blood all down the side of your ship
over the gunner and the gun
You flew as fast as was humanly possible
mechanically possible
He still died.
The wedding ring on his left hand glinted
As they flipped him onto a stretcher
And headed for the body piles.

A horrible story. I wept for you inside
but then I had to go make supper,
sing Jack to sleep
wash the dishes
do my homework
run out to buy the quart of whiskey that let you sleep
for a few hours between 1 or 2 AM and your 8 o’clock class
which you could barely sit through even with two stiff whiskeys
under your belt
And after all,
it was just a story to me—
something awful that happened to you
on the other side of the world—
Not real
BLOOD
running down the side of the helicopter
not real
BALLS
blown away
not real
DEAD HAND
with the wedding ring glinting
Him.
ME.
HIM.
ME.
©1989 Patience H. C. Mason

Vietnam and All Veterans Reunion

Due to a mistake, no one knew I was speaking on Saturday afternoon because it wasn't in the program they were handing out. So I did my usual talk, Recovering from the War, to three people. Kind of disappointing, but I can say that what I said helped those three so it was worth it to me.
Bob got really mad when I called and told him and said I should never go again, that they don't respect or appreciate me. I was really down in the dumps, thinking he was right.
The next day, my talk was in the program, but it usually overlaps with the service by John Steer, so once again I gave the talk, The War at Home, to just a few people. Luckily they got a lot out of it and laughed at all my jokes. When I said it was probably my last visit, one couple who come every year got really upset. I was talking to a Korean War and Vietnam vet and to a really lovely Donut Dolly and a Navy nurse and a Special Forces guy and his wife, when the upset couple disappeared.
As I was packing up the free handouts I'd brought and my books, the treasurer of Vietnam Veterans of Brevard, Ralph, showed up with the upset couple to personally apologize and ask what they could do to get me to keep coming.
I suggested they announce my talks on the main stage and do some PR. He offered to put up posters if I could mail them down so they would be up before I get there next year. He suggested that the talk on Sunday should be at noon so it wouldn't be interfered with by the church service. He also said he'd write Bob and apologize. I hope he does.
I did a talk for VVB a few years ago, just so they would know what I was saying over there at the wall pavilion while they are busy running the reunion, and he remembered it and said it was so helpful. So maybe I will be there next year. I do love giving the talks and talking to vets and their families afterwards and Donut Dollies.
One of my pet peeves is that the Red Cross claims the Donut Dollies weren't employees and weren't in danger (yeah, right! like no one ever rocketed or mortared every place they could in Vietnam) so it denies them help with PTSD treatment.
So it was an interesting lesson in how little control I have over events and how perhaps my speaking up will lead to a better result next year.

Link to the readio show

Here is the link for the  radio talk. http://www.wbobradio.com/wp-content/uploads/2012/04/DMS-042112.mp3. I just listened to it and am pretty happy with it except for the guy who wanted to help me by letting me know PTSD is not caused by war but by chemical stuff. I am only on for the first hour, but I have no idea how to only link to the first hour.

Radio Talk

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.

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.

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.

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.

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

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.

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.

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.

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.

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?

A good positive change!

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

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."

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