PTSD SERIES: “THEIR STORIES” (LIVING WITH PTSD)
WEEK 1 OF 6
Phil Smith – “Their Stories”
“When I began writing this series I had very little knowledge of what Post Traumatic Stress Disorder (PTSD) was and the impact it had on our veterans daily lives. Listening to Doctors, Psychotherapists, Counselors and the Veterans diagnosed with PTSD, I still have a lot to learn. But, I do have a much better understanding of what a veteran diagnosed with PTSD goes thru on a daily basis.
These are the true stories told thru hundreds of hours of research and travel and listening to the veterans describe what caused their trauma, medical treatment and how they live with a diagnosis the American Psychiatric Association calls PTSD. Thank you for taking the time to read each segment and hearing “Their Stories.”
The veteran’s real names I interviewed for this series will not be disclosed.
You will recognize them as “Bravo, Dano, Dub, Grunt, Jack, and Stacey.”
Their stories are real. Gut-wrenching and sometimes will be hard to read. That is not my intention. Their real-life stories and how they deal with PTSD, day to day, are.
Van Zandt County Veterans:
BRAVO U.S. Army 1988-1995
Diagnosed PTSD 2005
JACK U.S. Army 2003-2015
Diagnosed PTSD 2016
DUB U.S. Army/Air Force 1995-2015
Diagnosed PTSD 2013
GRUNT U.S. Marines 1981-1984
Diagnosed PTSD 2010
DANO U.S. Air Force 1984-2014
Diagnosed PTSD 2015
STACEY U.S. Air Force 1974-1994
Diagnosed PTSD 2000
SUSAN OXFORD LCSW – Warrior Peer Group Tyler, Tx.
BRENDA McBRIDE LCSW – Warrior Peer Group Tyler Tx.
NORTH TEXAS VETERANS ADMINISTRATION:
DR. JULIA SMITH
VA North Texas Healthcare System
DR. LIA THOMAS
VA North Texas Healthcare System
JEFFREY CLAPPER MA,PMC, CM Public Affairs Officer
VA North Texas Healthcare System
PTSD FOUNDATION OF AMERICA:
CODY BENNETT Chapter Manager PTSD Mentor
Tyler, Tx. / Camp Hope, Houston Tx.
SGB INJECTIONS FOR PTSD:
DR. SEAN MULVANEY Navy Seal & U.S. Army Physician
World Leading Physician in Stellate Ganglion Block ( SGB )
DAKOTA MEYER Former U.S. Marine
Medal of Honor awardee
Phil Smith Book Author and Journalist
PR Director – VZC Veterans Memorial
(Volunteer and author of PTSD Series)
History of PTSD
CODY BENNETT/PTSD Foundation of America: “War has been going on since Biblical times. There is a situation in the Bible where David and his men had been out waging war and whooped up on a city. They came home, their town was ransacked and their family taking hostages. All these hardened warriors fell apart. They started crying and gnashing their teeth. Then they looked to David and started blaming David. David turned to God and God told David what to do. It was a behavior not concurrent with how these men would normally act.
PTSD or post-traumatic stress disorder, got its name from the American Psychiatric Association back in the 1980’s when it added the health issue to its diagnostic manual of mental disorders.
Previous generations have called it “shell shock,” “soldier’s heart,” “combat and battle fatigue,” or “war neurosis.”
PTSD can include war or combat, serious accidents, natural disasters, terrorism, or violent personal assaults, such as rape.
Diagnosis: ( WWW.MAYOCLINIC.ORG) To diagnose post-traumatic stress disorder, your doctor will likely:
• Perform a physical exam to check for medical problems that may be causing your symptoms
• Do a psychological evaluation that includes a discussion of your signs and symptoms and the event or events that led up to them
• Use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association
Diagnosis of PTSD requires exposure to an event that involved the actual or possible threat of death, violence or serious injury. Your exposure can happen in one or more of these ways:
• You directly experienced the traumatic event
• You witnessed, in person, the traumatic event occurring to others
• You learned someone close to you experienced or was threatened by the traumatic event
• You are repeatedly exposed to graphic details of traumatic events (for example, if you are a first responder to the scene of traumatic events)
You may have PTSD if the problems you experience after this exposure continue for more than a month and cause significant problems in your ability to function in social and work settings and negatively impact relationships.
Below are the Standard Screening and Diagnostic test used to Diagnose a patient with PTSD:
Diagnostic and Screening Test for PTSD (PCL-5)
Military Version (PCL-M)
PTSD Diagnostic Criteria (DSM-5)
https://www.verywellmind.com/ptsd-in-the-dsm-5-2797324 (SOURCE: MATTHEW TULL, PHD)
What is the PCL-5?
The PTSD Checklist for DSM-5 is a 20-item self-report measure that assesses the presence and severity of PTSD symptoms. Items on the PCL-5 correspond with DSM-5 criteria for PTSD. The PCL-5 has a variety of purposes, including:
• Quantifying and monitoring symptoms over time
• Screening individuals for PTSD
• Assisting in making a provisional diagnosis of PTSD
The PCL-5 should not be used as a stand-alone diagnostic tool. When considering a diagnosis, the clinician will still need to use clinical interviewing skills, and a recommended structured interview (e.g., Clinician-Administered PTSD Scale for DSM-5, CAPS-5) to determine a diagnosis. There are currently no empirically derived severity ranges for the PCL-5. A total score of 31-33 or higher suggests the patient may benefit from PTSD treatment. The patient can either be referred to a PTSD specialty clinic or be offered an evidence-based treatment for PTSD such as Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), or Eye Movement Desensitization and Reprocessing (EMDR).
There are several screening and diagnostic tests to help diagnose a person with symptoms or a diagnose of PTSD, which one does the VA use?
Julia C. Smith, Psy.D
VA Clinical Director, Mental Health Trauma Services: (VA North Texas Health Care System): “The veteran would initially be screened by a psychiatrist or a licensed clinical social worker or a psychologist that can make a diagnosis of PTSD in terms of qualification.
It depends on the entrance point for a veteran receiving care. There are shorter screening instruments that ask a couple of questions that have been validated to show that if they answered yes, they may need further evaluation. There will be clinical reminder that their first mental health visit will have and will ask them certain questions that may trigger a referral to specialty mental health or to the primary care mental health clinic.
That one doesn’t have a name, we call it the PTSD clinical reminder but it is sensitive enough to capture certain symptoms that are occurring within a time frame. With the PTSD checklist for the DSM-5 (PCL-5), that in itself does not diagnose PTSD. Once a PTSD diagnosis is established usually thru a thorough clinical interview, intake assessment and considering the whole psycho social history, trauma history and military history.
When a veteran is in treatment, whether it is medication management or therapy the PCL-5 is often used as a symptom measure of severity of what is going on with the veteran while he is in treatment.”
Is there a measurement of severity with a number or a range of numbers added up thru the PCL-5 to start an evaluation of a veteran diagnosis of PTSD?
Julia C. Smith, Psy.D
VA Clinical Director, Mental Health Trauma Services: (VA North Texas Health Care System): “It sounds like what you are asking for is a cut score for a diagnosis. I usually look at 33. So, if it is above 33 we are going to continue further assessment. That doesn’t mean that somebody doesn’t have PTSD if it is less than 33, it could be that their symptoms got better. There is a lot to consider when interpreting those kinds of things. There are different versions and it depends on the type of treatment they are in. There is a version of the PCL-5 that is monthly, so it will say in the past month please circle what symptoms you have had then there is one that is weekly. If somebody is doing an evidence-based therapy for PTSD, I will give the monthly one at the outset of treatment when we start and then usually every two weeks.”
Dr. Lia Thomas
VA Medical Director, Mental Health Trauma Services: (VA North Texas Health Care System):
“For medication management it depends on how often we see them. We will get an initial assessment and then it depends on how often they are being seen for medication management. We could see them every six weeks or in three months. We use the monthly screening to see how they have been doing over the last month of care.”
CHILDHOOD, DNA AND TRAUMA
Brenda McBride/Counselor: “Early childhood trauma would be the biggest pre-disposition. There is an ACE questionnaire, Adverse childhood event, which is only ten questions but it gathers information on all the areas of childhood trauma. If you have early childhood trauma and you don’t have health caregivers to take care of you then your amygdala is over active.
People that have adverse childhood events like it’s not safe for me to use my voice, it’s not safe when dad’s drunk, it’s not safe when mom is getting beaten, it’s not safe when I’m not fed, it’s not safe when they are using drugs and it’s not safe when I am bullied at school.
All these post much higher risks for developing Post Traumatic Stress. This means my amygdala has been working since birth. It is like trauma, trauma, trauma and then I get into an environment like a war zone, potential threat is part of my job and now I am scanning for threat and you have been scanning for threat their whole life.”
Susan Oxford / Counselor: “PTSD is not limited to just war experiences. It has broadened in the last several years. We work with women who have been sexually assaulted. Some workers are dealing with complex PTSD issues that go further back like child abuse and neglect.”
STACEY: “I was severely abused as a child. I was hit with belts, water hoses, held under water until just before you drown and he pulls you up out of the water. I went thru a really tough childhood, so I thought the Air Force would be a breeze. I was so self-disciplined as a child. I was not able to think on my own. I was scared of adults.”
Susan Oxford / Counselor: “Trauma can be anything overwhelming to the brain to a point where it no longer can cope. For one person it could be a car accident for another it could be the loss of a loved one. Many times, it will trigger other things that have gone on that just haven’t been dealt with.
It is not uncommon to have family origin type issues. The war was a way for them to cope to not think about or to relive some of the things so they were able to focus their attention and to excel at what they were doing. The military gives them an identity, a place where they belong, it gives them a mission, purpose, passion. That structure can help them feel. A lot of times trauma needs structure that is more calming for them.
A lot of times with veteran PTSD we are working with that old childhood stuff. There was trauma in the military but it opens up older traumas. When we work with trauma we have to work with that early stuff too. It is still there, it may have been festering for years.”
WOMEN AND PTSD : Sexual Assault / Harassment
“Unfortunately, we see it all the time—a leader who abuses his or her power. (Here is an article published just recently about widespread allegations of bullying and hazing by a senior military leader). Of course, this behavior is not confined to the military: Abuses of power are frequently reported among leaders, politicians, and other authority figures within every sector of the population.
In my observation, veterans who are subjected to personally directed abuses of power rarely tell anyone about this. Shame makes these kinds of injuries more invisible, and more insidious, than other “invisible” injuries we associate with military service—for example, combat trauma exposures. These patients suffer immensely, often with no support from behavioral health providers, who fail to build the level of trust that would lead to the disclosure of these experiences. It’s likely the case that this is also true for many civilians who have been exposed to personally directed abuses of power.” (SOURCE: psychologytoday.com)
STACEY: “I had a severe rape, a horrible rape. It put me in the hospital for two weeks. This happened in 1974, I was married at the time. He would show up at my house if I did not show up for work that day. He would be drunk. He would chase me in the supply area where the bins are located and you can climb up to. I would climb as high as I could and he would find me. I got scared to go to my supervisors. I was raised in Texas from the Bible state. You don’t go up and tell your parents stuff like that because it would be your fault anyway. It was my upbringing, you just never told. Three years later my husband and I divorced. The rape was a big part of it. Everything I trusted in the past, was shattered. A lot of guilt and shame. Years later when I saw his picture in the paper that he had died, I just blew apart. I went in and once I saw he was dead, I knew he could no longer get me.”
Dr. Lia Thomas
VA Medical Director, Mental Health Trauma Services: (VA North Texas Health Care System): “As more women are facing combat roles we are seeing more women with both combat and military sexual traumas. We are offering more specialty care to women. The VA has both a women’s health clinic and we also serve a woman’s mental healthcare here in our clinic as well. Military Sexual Trauma is a national offering thru the VA care system. It is part of our screening questions asked to all our veterans, not just women but men as well. Were they assaulted, sexually harassed or felt uncomfortable in their position and depending on how they answer they can be referred if they would like additional treatment they can referred for specialty mental healthcare or referred other services related to military sexual trauma.”
STACEY: “I had a boss throw something at my face, a piece of paper for family leave. It scared me so bad I had to walk out of my job, I knew I couldn’t make it. I cried in the parking lot. I went to the therapist and said I think I need help. My mother had also just died. I was a basket case. It took four years just to get thru all of what had happened. I have to keep my little dog with me. She wakes me when I have nightmares. I see faces in the night. Sometimes I will take off walking like I am running from something.”
Julia C. Smith, Psy.D
VA Clinical Director, Mental Health Trauma Services: (VA North Texas Health Care System): “VA North Texas has different campuses. There is a Ft. Worth, Bonham and Dallas campus. There are military sexual trauma coordinators for mental health clinicians. Part of their job is to get the awareness out there for treatment and normalized reporting.”
Public Affairs Officer/VA North Texas Health Care System: “Our women vet population is the fastest growing within the VA in North Texas. When I started in 2016 there were about 9,000 women, our latest data show between 15-16,000 veterans in our healthcare system.”
Contact: NTXPublicAffairs@va.gov for information on veteran issues
EFFECT ON FAMILY MEMBERS:
Cody Bennett: PTSD Foundation of America: “It is very traumatic on the family members. They have a soldier that is returning to them that is not the same. They are now dealing with all of these issues and then you get secondary post-traumatic stress disorder where the family members are having issues because the issues of their husband and how violent he is.
Usually women will come to a support group to talk about their husbands. How do you get to those women? You have to get that information to them somehow. Do you really think their husbands are going to relay the information to her so she can go to an hour session about him? No.
There is not a lot of programs out there for family members. We are now working on a program in the next couple of years working with the kids that are dealing what is going on with their parents.
There is a very high divorce rate in families struggling with PTSD.”
WIFE OF PTSD VETERAN: “It was 2003. He left to go to Turkey. Everything was I love you, I can’t wait to get back home, don’t work so hard. That type of relationship. We used to talk about everything but when he was deployed for such long times that angered him. He was always thinking about me and the kids. He knew I had issues but he couldn’t do anything about it. He was gone 265 days out of the year. When he finally came home, he had so much anger. I saw a person I never want to see again. I knew something had happened to him. In his journals years later, he wrote that he didn’t tell me about the bombings and shootings or when I hit the floor or had to get into the tunnel because he didn’t want me to worry.
His attitude changed drastically. He became very quiet. You could be having a conversation at the dinner table and everybody is participating but him. When you say something, it is a snap. The eyes tell it all the time. I see it in a lot of PTSD soldiers. Nothing, dead eyes. A blank stare. Like not living. I have seen shit that I don’t want to share. I have seen that I never want you to see stare. There was a lot of anger. There was a lot of throwing things and then not remembering the incident. That was a big part of it. He is having a terrible nightmare. He thinks he is fighting in Afghanistan. He thinks he is protecting me and hurting that person. He will wake up from that and tell me. I am sorry, I am so sorry I was in this situation or that situation. He has no idea.”
BRENDA McBRIDE / COUNSELOR: “It is vicarious trauma for them. They don’t know if dad is going to go Chandelier on them and go off on a rage. If we don’t know when it is going to happen then It wires us for walking on egg shells and it is wiring our nervous systems. In a little kid he thinks if dad is in his room by himself, daddy doesn’t love me. Something is wrong with me, I am bad, it’s my fault. When dad just might be too scared that he is going to hurt him. If the dad gets super mad or super angry, and the kid thinks, I am a bad boy. It is my fault, I made dad angry again. I should this and I shouldn’t that. It is just creating vicarious trauma.”
DANO: “My temper turned into Rage. It took NOTHING to set me off. A lot of violent response and really aggressive. I did not recognize that was happening. To me it was like the normal progression of things that normally tick you off. I am angry, now I am fricking mad…. And then BOOM !!!
I went from the very first tick to that tick that fast. I didn’t recognize it because you don’t realize it. It is like you are going down the road and you are going 40 and then you are going 70. You don’t recognize that. I didn’t understand it. I thought everyone else was over reacting. Why are you giving me so much shit, you drove me to this? It was very difficult for me to see how I had changed. I had changed and I did not see it. That went on all thru the rest of my time in the military which was basically two more years.”
SUSAN OXFORD / COUNSELOR: How can a spouse or loved one spot signs of PTSD? “Disconnection more than anything. It is not common for them to be present in a relationship and engaged. Isolation of them is because they don’t want to put more on their family. They don’t want to be a burden. They don’t want to add to their family doing things different for them. The veterans will have anger for just minute things. Chemical dependency and domestic violence. Big shifts of things going on. These are all signs. Nightmares, and not being able to get any sleep. There is a high divorce rate among spouses dealing with PTSD issues.”
GRUNT: “This is the frickin HORROR of this whole thing. I always stay busy. I am always trying to find something to do outside. I remember this one time I was looking for some tools. My brain was just like fighting. Like raging. Why? Who knows. My wife walked outside where I was at. I told my wife, you need to step back. Go back and yelled at her to get out of here now. It takes a while for that to settle down. I was absolutely afraid of what I was going to do to my wife, because you have no idea.”
DANO: “I had built a mudroom in our garage. A small room where you can put your dirty shoes and pants, a simple mudroom. There are two shelves, one of the left and one on the right. I was retired and my wife was there helping me do this. I looked at one of the shelves and I realized I had put it in backwards so the front edge was not the nice Formica. My wife said, oh you put this on backwards. I lost my shit. Destroyed a tape measure, threw shit around. My wife was like, what the hell is going on with you? I don’t know why, what just happened. This is just a very minor thing. I lost my shit. I went from agitated to mad that fast. My wife kept telling people, this is not my husband, this is not my husband. I kept denying to myself the fact I needed help.”
STACEY: “I was raising 4 kids on my own. My ex-husband had gone to Korea. I sold all my furniture and closed my bank account, repossessed my car, I was pregnant with my 5th child. So, I had five kids to raise on my own as a single mom. This was all as I was going thru PTSD. Everything that I would trust in or start to feel comfortable in, would fall apart. So, from the childhood trauma, the rape trauma and my divorce, it all triggered my PTSD and I was set back several years. I came close to committing suicide. I was at the end of my world.”
In week 2 of our series on PTSD we look at the Stigma of PTSD. Why is it called a Disorder?
The Demons and Causes
The Horrors of War
Symptoms of PTSD
And Trigger Points
THANK YOU FOR SUPPORTING THE VAN ZANDT COUNTY VETERANS MEMORIAL Phil Smith