PTSD – Week 4
PTS SERIES: “THEIR STORIES” (LIVING WITH PTS)
WEEK 4 OF 6
This series will include very rough language and real-life battlefield and military experiences that could be very disturbing to some people reading these articles.
MULTIPLE DEPLOYMENTS:
BRENDA McBRIDE / COUNSELOR: “Trauma on top of trauma. Lock and load, lock and load. When you stockpile hurt and pain, now they are finding it is showing up in the body. The body will say no. People who had trauma will come and seek help after their first stroke, after their first seizure, after their first heart attack, the body will shut down and say no.”
CODY BENNETT / PTSD FOUNDATION OF AMERICA: “If they can hold it together while they are deployed, but multiple deployments just keep adding to the trauma. That is why these young kids are so screwed up like they are now.
They are deploying three or four times in a four-year period. In Vietnam you did your 321 days or whatever it was and then you went stateside you don’t have to go back unless you volunteered to go back. Our boys are being thrown in the mix time and time again in a situation quite similar to Vietnam because you don’t know who the enemy is.
They’re in their element. You can take 90% of these veterans that have PTSD right now. Put them on a bus to Dallas and we’re going to put you back over there. They would be on the bus in a minute and they would go back to functioning.”
DUB: “Next day I packed my bags and got on the Freedom Bird. I was headed back to Fort Campbell. Got debriefed and was told about this new MOS in electronic warfare. He said you were smart and you would be interested in it. So, I stayed and went into electronic warfare training. I graduated from the course. I landed in Alaska and was told I was going back to Afghanistan. I said look, I need a shoulder that needs repair, a neck that needs repair and I had all these injuries. They told me to go get checked out. I had surgery on my neck and surgery on my rotator cuff. I had seizures. I had flashbacks. I was taken off the mission. Nineteen-years, six months, we will call it twenty years brother. I got out August 14th 2015. I retired for good.
I also was also diagnosed with TBI, (Traumatic Brain Injury). I fell and broke my orbital socket. I was seeing a psychologist in Alaska and diagnosed for PTSD around 2013. The Army knew I had PTSD but was ready to ship me over for a third tour in Afghanistan.”
FLASHBACK AND NIGHTMARES:
Flashbacks are considered one of the re-experiencing symptoms of PTSD. In a flashback, you may feel or act as though a traumatic event is happening again. A flashback may be temporary and you may maintain some connection with the present moment or you may lose all awareness of what’s going on around you, being taken completely back to your traumatic event. For example, a rape survivor, when triggered, may begin to smell certain scents or feel pain in her body similar to that which was experienced during her assault. (SOURCE: verywellmind.com)
In the case with STACEY her flashback was from seeing someone or smelling something:
STACEY: “If someone comes up and touches me and I am not expecting it, I freeze. My heart automatically goes super-fast. I will turn around and yell, WHAT. I don’t know who it is and my heart just keeps beating faster and faster. Someone I don’t know could come up and hug me and I will get triggered. I never go to awards ceremony because I don’t want anybody paying attention to me. I never dated again after my marriage. I just raised all five of my kids. I have my own home now. I am still not married, because I can’t.
If I am in a crowd and I see a guy that has red skin like he did, I get away. The smell of alcohol, he was an alcoholic. I won’t be around it. My boss and my husband were alcoholics.
The trigger points come at any time. If I am in the store and someone comes up to me and touches me and says, can I help you? I jump. I go to my car and start crying.”
BRENDA MCBRIDE / COUNSELOR: “We can be going along fine and something comes along to trigger it. It could be a life event, a loss, or a medical illness and we are suddenly not functioning as high as we were.
There is a window of tolerance. We all have it. There is stuff we have to tolerate like taxes. When I am in this window of tolerance I can think and feel. With PTSD trauma my window gets really small. The things I can tolerate get a lot smaller. The things that put me outside that window, like kids screaming, sirens, or fireworks. If we have chronic hyper arousal that will look like the fight or flight, the emotional ability, increased anger, impulsivity, emotional reactivity, or poor emotional regulation. You freeze, I am numb, I am disconnected, I don’t feel.”
SUSAN OXFORD / COUNSELOR: “PTSD is more of the having flashbacks or of reliving or having a reoccurrence of events. They are thinking about it all the time or they are having flashbacks or nightmares or something that is keeping them stuck. They are reliving instead of remembering. That is a big difference. This is in people that have resolved trauma vs unresolved. They have high avoidance. I am isolating to everything I can to avoid whatever is triggering. It might be going outside, it might be driving, it might be not being around loud noises. Everybody is different on what avoidance looks like. At times it might be hyper vigilance so they are constantly scanning for danger doing whatever they can to always have an out or exit strategy. You are also going to see more numbness. Overload, where the system goes out of that fight or flight and goes more into a freeze response. It has had just too much and can’t take anymore. At this point you will have someone more in a hypo aroused state where they are just numb.”
GRUNT: “I went home on leave one time and there was an accident. Me, my brother, dad and mother were there. A friend of ours came to the house and knocked on the door and he told us there had been a bad car wreck and you better come with me. We went out there and saw three young bodies in the ditch, they were just kids. We were about a mile north of Edgewood. It was dark and I said this guy right here is dead dad. I went over to the other guy and he was still moving a little bit. A volunteer fire department finally made it out. There was this girl who was on her back and regurgitating blood. I yelled at the First Responders to lay her on her side. They did. This girl is still confined in a wheelchair today. She still recognizes me. That incident comes back to me sometimes.”
WIFE OF A VETERAN: “We recently went to Ft. Hood in Killeen, Texas. We have family living on the Army base. Every day the Army unloads unused artillery. It was just before midnight. I am in bed and realize my husband is not in bed with me. I get up and start looking for him. I see the backdoor is open a little. I walk out on the patio and I hear the artillery being spent. I hear him say, shhhhh. They are right over there. He is crouched down in the corner. He is back in Afghanistan. So, I quietly say, ok come over this way to get you back out of there. So, he starts coming towards my voice. I get a blanket and put around him and bring him back into the bedroom and lay him on the bed. That is all you can do. If I startle him, he could go crazy on me. You have to be calm and be the voice of reason. You have to bring him back. He does not remember the incident the next day, at all.”
DEALING WITH STUCK POINTS:
Stuck points are thoughts that keep us from recovering. Stuck points are concise statements that reflect a thought – not a feeling, behavior, or event.
Prior to the occurrence of the traumatic event, you held certain beliefs about yourself, others, and the world. To make sense of the event and incorporate it into your memory, you likely either made it fit within your existing beliefs by changing your perception of the event or radically changed your prior beliefs. Certain aspects of your beliefs that may have been affected include safety, trust, power/control, esteem, and/or intimacy. For example, you may blame yourself for the traumatic event occurring or you may now believe that you cannot trust anyone. If you are struggling to recover from the traumatic event, you may be experiencing “stuck points” related to making sense of the trauma or how you think about yourself, others, and the world. (SOURCE: 7cups.com)
How does the VA help the veterans in dealing with getting stuck with their fight or flight struggles?
CODY BENNETT / PTSD FOUNDATION OF AMERICA: “I think a lot of that goes back to possibly moral injury and or survivor’s guilt. You make it home and your buddy didn’t. As a soldier we are trained to kill. We’re not brought up to kill and specially to take lives of women and their children. Unfortunately, in this sick war where women and children become a casualty and I think for a lot of guys they call it a moral injury. So, you get moral injury or you get survivor’s guilt. They relive those moments where they lost a buddy or they wonder why they came home when their buddy didn’t or why they couldn’t save somebody as a medic. They are stuck and they relive those moments over and over again. It is like a broken record. It is very demoralizing, it just tears them up.
Getting unstuck comes with time. That comes with learning to cope with PTSD. The veteran needs to educate themselves but also our Warrior Groups and our mentoring we deal with all those questions about dealing with getting stuck back and remembering what happened to them causing the trauma. Where was God? Why did this happen to me? The list goes on and on. Widening the trauma narrative. The hardest things for these vets to do. To sit down and write in living color what happened. There is something about putting it on paper that helps to take it away.
Once my guys write down their trauma narrative we will have a little get-together and we’ll have a cup of coffee in the backyard or something like that. We light it on fire, we burn it then we get rid of it. Does that mean they are cured? NO.”
RELIVING VS REMEMBERING:
Most everyone has at least one traumatic memory embedded in their brains.
Some have memories from a car accident, a rape, a natural disaster, a violent parent, a drunk husband, a hospital stay, an assault, the horrors of war. Experiences like these are more common than you might think, with an estimated 60% or more of Americans who have experienced at least one of these at some point in life. Not all of these memories cause people to experience trauma later in life, but they can cause problems for many, and for some they can be debilitating.
People with post-traumatic stress can become hypersensitive, with nerves on a permanent state of high alert. Fear and anxiety recur without warning, and nightmares can ruin sleep. (SOURCE: goodtherapy.org)
SUSAN OXFORD / COUNSELOR: “You don’t have to have a diagnosis to need help. Some go to group thinking I don’t have that diagnosis so I don’t need anything. If the nightmares are going on, the hyper vigilance, and the flashbacks then there are things that can be done, you don’t need a diagnosis to need help or get help.
If they are going to look for counseling to look for someone who is trauma informed, meaning the trauma informed therapists will know more about the brain and help meet that person where they are at. They can help deal with that pre-frontal cortex, that thinking part of the brain. They will be able to push that person to tell their story and be able to understand and know their triggers, then they will know what to do get there and they are not living in that part of their brain. So, you have to be able to meet them where they are at. The therapist can focus more on the day to day and help them to regulate their body a little bit.
GUILT AND SHAME:
Shame is an emotion that occurs when you evaluate or judge yourself in a negative light. For example, you might experience shame if you view yourself as worthless, weak, bad, or useless. Guilt occurs when you evaluate a behavior or an action as negative. (SOURCE: verywellmind.com)
BRENDA McBRIDE / COUNSELOR: Can PTSD be prevented or can we help train the military to be more aware of high stress jobs and the potential of trauma and its effects on a soldier?
“Preventive dollars are worth so much more and go so much further. Only when people are dying at the rate of 22 a day do we react to the situation. The VA is not even using evidence-based treatments that we know will help.
The problems I see with veterans is COMING HOME.
They are in these 24 hours a day for years and then they say ok, we are going to take a plane trip home and they think your amygdala is going to shut off, it doesn’t. What happens is our four-year-old kid is doing what four-year old’s do and that is backtalks or spills milk or something and daddy responds.
A veteran today said, “I almost choked my kid out. We were swimming in the swimming pool and they were splashing and they came after my throat and I almost choked my kid out. The shame from that and nowhere to put it.”
Is Post Traumatic Stress something that happens instantly or is it cumulative?
“It can be cumulative. That is another source of shame. Veterans will say, I was fine for twenty years, what the hell is wrong with me? It is cumulative trauma. It can be something really insignificant that triggers a trauma.”
DANO: “As the superintendent I was privy to a lot of videos, top secret shit, of how the Taliban launched this attack and that attack. Countless hundreds of attacks of various bases all around Afghanistan. I deal with a real threat that can happen any moment and nearly all my troops do not have a gun. It is in the expeditor truck. It is in a rack and even if my expeditor needed to get their weapon this would take several minutes to drive around to all the aircraft spots throwing the rifles out the back door at everybody so they could fight back.
My biggest fear was we would get attacked from any one location and my guys can’t do anything. That weighed on me more than anything else.”
WIFE OF VETERAN: “He had a lot guilt and shame for not helping his guys out more. He would say well if my guys can’t carry their guns onto the planes that they are working on then they need some type of security around them. Well we don’t have the people for that. Figure it out, they would say. Lot of times he would work his 14-16-hour shift and if they were working a night shift he would go out and walk the perimeter with a gun. He felt like he took so many chances with someone else’s life.”
SUSAN OSFORD / COUNSELOR: “Stigma and shame sometimes comes when two veterans witness the exact same thing or go thru the exact same event and only one comes out with PTSD symptoms. Some of it can do with the upbringing, the resilience that person already had. Did they already have support? Did they have a voice? Were their emotions ok, or not ok. Sometimes they just learn early to just stuff it. Some families say no we just don’t talk about it. It is more of that authoritative type parenting. Sometimes the vets have that support group. Do they feel like they can open up to somebody and share some of the things they are experiencing? It will become too overwhelming if they don’t feel they can share and become vulnerable they shut down because it is so overwhelming. Having support is a big part of coping and do they feel like they are going to be loved no matter what.
The word “WEAK” is used very often in all types of cases with PTSD. It feels like I am weak if…. That word gets thrown out there a lot. The brain is associating weak with sharing or telling someone how I feel. The more awareness and the more research going into PTSD that it takes courage to speak out. It is not a weakness, it is brave and courageous to come out and share. We are trying to shift that culture a little bit.”
WIFE OF VETERAN: “What he saw carried a lot of guilt with him. He was there so many times as they loaded the flag draped coffins of the soldiers. The dignified loading on the aircraft. Sometimes Dano was required to be there and sometimes he volunteered. Those are your soldiers and you want it done respectfully and the right way.
Sometimes there were so many they would have to schedule two flights. Back in the states you would not hear any of that. At a certain point they stopped telling the American public how many we lost each day. He was ok with making decisions and giving orders. In his position you can’t have a conscious or guilt and you can’t second guess anything. If you second guess anything you will lose people. Those are your people. That is your guilt.”
BRENDA McBRIDE / COUNSELOR: “Shame is different than guilt. Guilt is I did a bad thing. Shame is I did a bad thing; therefore, I am a bad person.
Shame is big for our military veterans. Sometimes, babies and innocent people get killed. Shame is a feeling of disconnection. If people saw me and really knew me and the bad things I have done and I am so bad, then I am disconnected. It is that feeling that you just want to crawl and hide away somewhere.”
WIFE OF VETERAN: “They would watch this guy for days on their drone cameras. They are in this closed room and are watching all of this. They make the decisions, do we blow this guy up, do we not blow this guy up? They decide he is burying something, we have to get rid of him. The upper commanders make the final decision but they want input and Dano has to give his assessment. They would see this over and over as the bombs exploded and killed the person they felt was the enemy. They hoped they made the right decision and sometimes they didn’t. Was he planting an IED or was he digging a ditch for his water to flow to his garden? The question begged, is it my troops or him? You have to live with all of that in your brain. Did I do the right thing, did I say the right thing? That is all on you. The guilt follows you every day.”
SUSAN OXFORD / COUNSELOR: “In our group if one is sharing about a certain thing or issue, another veteran can be there for him. They weren’t looking thru the same lens but he can give him perspective. Could you choose to freeze, NO, that was your brain. That wasn’t a conscious decision, it just happened and hey what did you do afterwards. So, they are able to meet them where they are at. Not to give them shame, because shame is a big piece of all this. They don’t need answers of, this is what you need to do or should do. They are hearing that from other people where they are constantly where they are being told…. Well you should just get over it or you should be fine or hey it’s over and done, you are back home, that doesn’t work. That just makes it worse.”
WIFE OF VETERAN: “Being diagnosed with PTSD is a shame thing. The military carries that over you. Shame on you. You let that get to you. We don’t know if we are going to let you continue to do your job. The stigma was, how can you be able to command troops if you can’t even take care of yourself. Because of that many people did not come forward to say I think I have that and I need help.”
BRENDA McBRIDE / COUNSELOR: “The military from the top-down say, suck it up, or don’t be weak. There is a myth out there, and shame researchers know this, the myth is that vulnerability is weakness.
In a military setting you can understand how if we are vulnerable to our enemy then we would be vulnerable to attack that would be weakness, so don’t show vulnerability.
So, showing vulnerability to your enemy is different than when we say don’t show vulnerability to your wife or your brothers you serve with in saying I need help or empathy and things of that nature.
So, when people can’t use their words to get their needs met because it is not a safe culture. You are shamed. Men’s biggest shame trigger is feeling weak. If you are told that if you are vulnerable if you are weak, or vulnerability is weakness, don’t do that.”
ISOLATION AND AVOIDANCE:
JEFFREY CLAPPER / Public Affairs Officer – VA NTHCS: “Speaking for VA North Texas our Post-911 veterans are among our lowest to population of vets that we serve. Our vets average age is close to 60 years old. There are estimates that 20% of those who served may have been exposed to trauma. A lot of them have not presented yet and they won’t. If you go back to the Vietnam Veterans where there was a 10-15-year gap between their combat trauma and them coming to the VA. It is fair to say we won’t know until later from those veterans because they are in college and are using other VA benefits, using the homeowners and the GI Bill. They are trying to become fully integrated with society and they are not thinking about it yet because they haven’t had a particular incident that has happened to them. Down the road we may see more data, maybe where I did four combat deployments so that means that I have trauma. Nationwide, the stats are only about 14% of Post 9-11 vets are using VA services.
DOD is in the business of triaging and getting people back on the front lines to support their mission. A lot of veterans have the, you press on attitude and you do what you have to do and then come to the VA services for help. Not a lot of veterans for various reasons are making that choice to seek care. Our outreach efforts are to go where those veterans live, work and play and by having mental health summits in the community is where we are bringing the VA healthcare to them. We know they won’t come to us. It may be they have heard a bad narrative from the news media or from something that is not accurate. Something that may have happened in a VA in Atlanta or in West Virginia doesn’t necessarily happen in Dallas. I have had people walk into my office all the time who couldn’t find a parking spot right out front and they come into primary care. Maybe they had to wait 20 minutes after their appointment time. They will go on social media that say the VA SUCKS and that person tells another person and so on. That is not a fair assessment.”
BRAVO: “Once again everybody is different. We talked about the thrill-seeking that’s one of the signs, hyper-vigilance, anger, and depression. There’re so many things. It’s all those things under one umbrella.
Yeah when I got out in 95 we weren’t even looking for this stuff. Now every veteran is screened when they exit the military. They’ve got counselors with these veterans overseas now so they can be treated and put back on the front lines. I guess any dramatic changes that you see in somebody after returning you know of course it’s little Johnny leaves and comes back has been in combat he’s going to be a different man regardless. Extreme measures with PTSD in the anger of the hyper-vigilance depression and isolation. Isolation is a big one. They don’t want to be around other people, they don’t want to get out in crowds, if they do they become very anxious anxiety and will destroy a situation just to get out of it and go home.”
GRUNT: “My nephew is getting married in a couple of weeks and there is going to be about 250 people at this wedding. I will go into crowds but I will stay off by myself. I will stay close to the door. You don’t know when the rage comes. You have to recognize when that rage starts and get away from everybody. I start feeling kind of light, this side of the brain is a battle going on. Get out of here. It could get ugly.”
DANO: “You go into Walmart tonight and someone is in that aisle with you. You are in the middle of the aisle. At the other end is someone with a grocery cart. You start to feel hey, I need that space. If someone comes in on the other side, I have a problem. As they get closer and closer, crisis mode.
It has happened to me more than once where as they get closer I run and I push carts and people out of the way. I am NOT proud of that. Super apologetic of it. It comes to a point where I can’t control myself anymore. You are trapping me and things that I have been thru in my life I can’t accept this so I must find a way out.
It is the most destructive thing to me.
I refuse to go into Walmart during First Monday. I will not. Part of my PTSD counseling says, you have to deal with it. They say put yourself in that position, deal with it because it is constructive. BUT I CAN’T. I put people in danger when I do. I am so afraid of that. I know what is going to trigger me so I avoid it.”
CALMING DOWN THE SYMPATHETIC NERVOUS SYSTEM:
Dr. Sean Mulvaney (Former Navy Seal and Army medic who has performed over 1,000 SGB injections): “I first screen them with the PCL-5 questionnaire. (20 question PTSD Form). This is a good measure of how bad their PTSD symptoms are. This will help indicate if they are improving or getting worse. We follow them out one week later and then one month later. Some just needed a breather so their brains can get back to normal. When they do that they can start to self-repair. They start to sleep better at night. They start repairing their relationships at home. They start going out and doing the simple things like going to a grocery store in even start being in little crowds. They can also start repairing their relationships at work. So, they start an upward spiral. Some people just need some leg room and they are going to do fine.”
BRENDA McBRIDE / COUNSELOR: “Successful life is I have the ability to feel joy and be present and connected in my relationships. When I am working with veterans that is where I want to get. Happiness is much different that joy.
I don’t work with people unless they get better. I don’t take on their stuff. I can give you tools. You can use them or not.
Watch the word SHOULD. It implies one way and the only way. What COULD I do? There are schools of empathy. I can understand what that could be like. I have never been thru what you have but I can sure connect to that feeling. Find a source of connection. Don’t SHOULD on them. Should instead use Could. You could try Yoga. People have a choice. Being outside, being in their home are all helpful things. Have water available because there will be anxiety. Give them choices. Would you like to have this light on or off? Make them feel comfortable. I am giving them a choice. I need to create safety.”
MASKING THE PAIN:
BRENDA McBRIDE / COUNSELOR: “It is uncomfortable to feel feelings. To be vulnerable is to feel. Saying, I love you or saying I love you at all. There is a chance somebody may not say it back. Vulnerability is courage. It takes courage to say, I love you first. It takes courage to set boundaries or to say this is what I need or hey this isn’t working. We are feeling beings and think sometimes. Marketers know that. You may sometimes keep things in and keep things in until it reaches a 20 and that is rage. This creates secondary stress in other people. The kids don’t know what is going on and now we are messing with the whole family amygdala. The trauma can be inter-generational. People do things to off load the hurt. Some people blame, some use numbing and some just hold it in and then you have medical problems and the body will say no. There are different strategies that people off load hurt. You bounce with blaming everyone else for your hurt. Perfectionism, workaholism’s, all the isms.”
SUSAN OXFORD / COUNSELOR: “Avoidance is a way to numb the pain. The brain will associate that with calm or at least I can talk when I am this way. When I am high or drunk at least I can share then. I can cry and engage then. They use it themselves as a tool. I want them to feel like they are empowered and they have tools.”
BRAVO: “Self-medication is a wonderful thing but when you wake up the next morning you still got the same problem. I self-medicated from the time I was in the military in the 90’s until 2005 when I got my DWI and that is when I quit. That is when I quit drinking and doing illicit drugs.”
CODY BENNETT / PTSD Foundation of America: “We see a lot of un-diagnosed and mis-diagnosed veterans who are discharged with dishonorable or other than honorable discharges. They start self-medicating, getting DWI’s, have assaults and then they are removed from the military and the root cause is never addressed.
How does the VA go against the Department of Army or other branches of the military? Congressmen help with that process but it is just a long drawn out process.”
In week 5 of our series on Post Traumatic Stress (PTS) we look at the PTS Toolbox along with:
Treatments Available
Drugs and the VA / “Drug Cocktails”
Antidepressants / Anti-Anxiety Meds / Prazosin
One on one and Group Therapy
Psychotherapy
Cognitive Therapy / Exposure Therapy / EDMR
Yoga, Medicinal Marijuana, Service Dogs, Photography and more.
THANK YOU FOR SUPPORTING THE VAN ZANDT COUNTY VETERANS MEMORIAL Phil Smith