PTSD – Week 3
PTS SERIES: “THEIR STORIES” (LIVING WITH PTS)
WEEK 3 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.
Sympathetic Nervous System:
The Sympathetic Nervous System (SNS) controls the body’s responses to a perceived threat and is responsible for and activates the “fight or flight” response. It originates in the thoracic and lumbar regions of the spinal cord. The body speeds up, tenses up, becomes more alert. Functions not critical to survival shut down. The heart rate increases and the bronchial tubes dilate and muscles contract. The adrenal gland releases adrenaline and the source that converts glycogen to glucose for muscle energy. (Source: diffen.com)
The Amygdala Neurons in the Brain: (Fight or Flight)
The amygdala is responsible for the perception of emotions such as anger, fear, and sadness, as well as the controlling of aggression. The amygdala helps to store memories of events and emotions so that an individual may be able to recognize similar events in the future.
BRENDA McBRIDE / COUNSELOR: “Trauma gets stored in our feelings and in our body. When someone is exposed to dangerous or life-threatening situations over and over the part of the brain that controls the fear response area, the bodies alarm system, that part of the brain gets used a lot and is active.”
The Amygdala plays a prominent role in mediating many aspects of emotional learning and behavior. There exists a vast array of human emotions, ranging from joy to sadness, disgust to excitement, and regret to satisfaction. Most emotions possess a valence (positive or negative) and an intensity (low to high) that reflects emotional arousal. (Source: Bittannica.com)
You can get a very active amygdala and it can get hypersensitive to danger. That has helped you to survive and has been adaptive at certain times like you were in a war or if your family is a war zone. If you hear loud footsteps when you hear your dad come home, that amygdala helps you to survive. Same thing when you are overseas, there are certain sensory cues for danger. The problem is when that becomes over active.
Any sensory stimuli like the door opening or a person dropping their keys triggers a danger response and that response triggers a physical response which causes the release of cortisol which releases the excitatory neural transmitters which regulate mood, appetite, sleep and sex drive. So, anyone with PTSD is struggling with those things. Excitatory does not mean a party, it means a threat. So, there will be adrenalin, and glutamine which is correlated to aggression. The body can’t keep up. It changes your nervous system.
Can you explain the amygdala in the brain and how it treats the “fight or flight” struggle our veterans struggle with?
Dr. Lia Thomas
VA Medical Director, Mental Health Trauma Services: (VA North Texas Health Care System): “The neuroscience and the neurobiology behind trauma and PTSD. Scientists don’t completely have that mapped out yet. They are still working on that issue. You are correctly identifying the area of the frontal cortex and the kind of interplay of things but we don’t actually have the data yet that has that pathway mapped out.”
What are some of the signs of PTS?
SUSAN OXFORD / COUNSELOR: “More of the hyper arousal, they are uncomfortable in their own skin. They are not going to be able to connect relationally or socially because they are going to be hyper aroused. We help them to the more reactive survival part of the brain. Do we need to react, be in survival mode and believe we need to be safe? They may not feel safe with themselves or with others and need to react that they are in danger in that moment. They are not in the present and are kind of stuck. They are scanning and sometimes there will be high substance abuse rates. This is where a lot of avoidance comes in, it helps them numb and helps them not to feel about what is going on, it allows them to go to another place and not be in that state, where their nervous system can come back down. There will be rage and a lot more going on underneath, that anger and that rage. It is like an iceberg where the top is the rage and what you see underneath is much bigger. It might be the shame, or of feeling alone or not feeling safe and getting up to that boiling point. For veterans with PTSD they get to a point where they just lose their words.”
GRUNT: “It is like right now. I am trying to say what I am thinking, but I can’t. Your speech to your brain just does not work right. It is hard for me to explain things.”
DANO: “I have difficulty with my speech. I must walk. If I sit in this chair for three days. I can’t walk. My speech is also tied to this. I lose my ability to recall words and then put them together in sentences.”
The Term “Fight or Flight” what does it mean?
BRENDA McBRIDE / COUNSELOR: “It is the part of the brain that helps us to survive, or what we perceive as a threat. It comes when we physically don’t feel safe or feel safe in a relationship. One of our veterans’ stutters, and that is just one way of his fight or flight comes on. When he feels vulnerable, he gets a charge in the nervous system. It means I can fight the threat or run away from the threat. Another action is I can just freeze and be in my body or not be in my body. If something feels like a threat and those are my options.
When that amygdala gets triggered, it says fight or flight, this is a threat. That part of our brain comes on without our permission. In this case muscles will shorten, muscles will contract. Navy Seals use BOX breathing to help this. Breathing will be very shallow and rapid. It will control heart rate, pulse and will send cortisol to the stomach. Lots of veterans will have IBS or other stomach trouble. Cortisol is always firing.”
GRUNT: “There was a guy sitting in front of me that blew his head off. It was very traumatic. I was a fellow Marine and I knew him. It happened at Camp Pendleton in 1981. My trigger point doesn’t have to take me back to that time, but it triggers something in your head. When you are triggered you will know when it comes. It is called “Fight or Flee.”
JACK: “There are times when I go back to seeing the bodies. Fight or flight is constant. When I go places, it is hard to let your guard down. Constantly checking people out, how they carry themselves. At the VA today, I still feel the need to watch my back. Look over my shoulder. Always have my back to the wall, never have someone in back of me. I have not been out to eat in forever. It has progressed for the worse. When I do go out to eat, I still have my back to the wall, I will scan the whole area. It is constant. I use to go to Walmart. I walk around, I watch everybody. I see what they are doing, see their posture. I am waiting for anything to happen.
I don’t like feeling that way. You can tell your brain to chill, no reason to be like this. Your brain does it. It makes you. I just eliminate things that do that to me.
I was always smiling, always had a grin. Life of the party. Always happy, never had things that stressed me out or worry about things. I try not to worry about things. Back then I was worry free. Now it is different. It is a day to day and sometimes hour to hour.”
SUSAN OXFORD / COUNSELOR: “When you are in survival or fighter or flight the part of your brain, that front part of your brain is deactivated because all the energy needs to go to your body to help you fight, flight or engage.”
DANO: “I am always fight. My wife took the brunt of that. My dreams were always in the military in various locations in places where I had been and not been and lot of them fabricated. It was always a threat I can’t see or who or where. But, I know it is there. There are a LOT of casualties in my dreams. There is a crisis where you have to act immediately to stop it. But, I don’t get to see the remainder of it.”
BRAVO: “Understand when you are in combat you are in constant hyper vigilant state. Your body is running off chemicals in the brain that it doesn’t normally use because of that heightened awareness. A lot of our PTSD veterans when they come back they’re looking for that exhilaration or looking for that adrenalin rush. Like riding a motorcycle down the highway at 110 miles an hour or bungie jumping out of an airplane. They’re hunting for that rush so it does have a physical effect. It is like a drug and they don’t know how to cope without it. That’s where you get into your hyper-vigilance, your heightened awareness. That’s why they’re always constantly scanning and doing these things. The anxiety that comes with that it’s just really weird how it works.”
DUB: “I am a time bomb. The adrenalin runs like gasoline thru me. I will take a few deep breaths and I can do it. Give me a few minutes. Everything is about battle. It is not about the war, it is about the little individual battles we have to fight every day. That is what life is like now. I don’t sleep, I don’t eat. It is part of what happened to me.
Everything was about, how to operate the weapon system and take care of the enemy. The war made me hard.”
TRIGGER POINTS: Heightened State of Arousal
Crying babies, quick yells from somebody, someone drops something, fast moving cars or hummingbirds remind me of bullets going by. I avoid cardboard boxes on the side of the road – they remind me of IED’s. Fireworks, seeing a Muslim in a hijab, the playing of taps, a flag draped coffin, the smell of diesel fuel, ice dropping in an ice bucket.
All of these trigger veterans in some way or another. This list could go on into nauseum. It even changes from day to day.
When you have post-traumatic stress (PTS), your symptoms can come and go. You might feel fine until you hear a car backfire loudly. Suddenly, you become very afraid. Images of your time fighting in a war flood back.
Certain triggers can set off your PTS. They bring back strong memories. You may feel like you’re living through it all over again. Triggers can include sights, sounds, smells, or thoughts that remind you of the traumatic event in some way.
Some PTS triggers are obvious, such as seeing a news report of an assault. Others are less clear. For example, if you were attacked on a sunny day, seeing a bright blue sky might make you upset. Knowing your triggers can help you better cope with your PTS.
How Do You Develop Triggers?
When faced with danger, your body gets ready to fight, flee, or freeze. Your heart beats faster. Your senses go on high alert. Your brain stops some of its normal functions to deal with the threat. This includes your short-term memory. (Source: webmd.com)
BRENDA MCBRIDE / COUNSELOR: “Brain scans show this, so the LIMBIC system, which is our feeling brain and the sensory part of our brain is what lights up in brain scans when someone has PTSD and they get triggered. So that is feelings.
The part of the brain that holds our decision making, that holds rational and verbal memory of our words and that holds our ability to inhibit some things and helps us with long term memory. When we go thru a trauma and it is triggered that part of our brain goes offline.
If I am getting triggered a lot and my rational brain goes offline which means I don’t make good decisions, I am thinking unclearly, I can’t learn. Then you are just stuck, it is these past triggers that is causing the physiology to respond in the present. It is not just feelings, it is heart rate, nervous system, panic attacks, the inability to sleep, and the shaking. “It feels like a million ants biting me at the same time.”
CODY BENNETT / PTSD Foundation of America: “I worked with kids for 11 years. I had this boy who was phenomenal. Never screwed up once in two years. One day we got a new teacher and she showed up in a red shirt and perfume on. This kid just went south. Every time he was molested, by a woman, he remembered the perfume smell and the red shirt. It triggered him. That is the way our veterans are.”
BRAVO: “The smell of JP-8, Diesel jet fuel. The smell of blood. Sand, I HATE sand to this day. My family always wants to go to the beach. NO. Do I go because they want to go? Yes. Does that help me? NO. But, normal people have no problem going to a beach? Yeah, and normal people didn’t live out in a desert for 16 months and every time they take a bite from an MRE that has been sealed and you stick a spoon in it and you go to take a bite and it has grit in it. Everything had sand in it. But do I still go to the beach, yeah. I make myself do things like that. I make myself go to Disney with my grand babies. It was a week of pure HELL for me. I probably took more Lorazepam that week than in my entire life.”
( Lorazepam: a drug of the benzodiazepine group, especially to treat anxiety. )
STACEY: “When I get triggered it’s bad. Mine can last up to a week. When I get triggered, all I want to do is lay down and rest. I don’t want to talk to anybody, I don’t want to go to therapy. I wind up getting sick because I am not taking care of myself. I know I can still be triggered and I have quite a few problems.”
BRENDA McBRIDE / COUNSELOR: “A lot of times veterans have one foot in the past recalling some of these traumatic events and because they were life and death events it stimulates that amygdala to be hyper alert to other potential threats in the future. So, I have one foot in the past and one foot in the future and I can’t enjoy the present. So, I can’t be at my kid’s birthday party and be present because the loud noises or the smoke reminds me of my traumatic event. Those are all triggers for me.”
CODY BENNETT / PTSD Foundation of America: “Watch for your triggers. Approach with caution. You never know how someone is going to respond. Just listen. That does better than anything else. Just listen. If they are stuck, listen. They need to vent.
The most important thing we can do for our veterans, is just LISTEN. A lot of them do not want a pity party. A lot of them don’t want charity. A lot of them live on the streets because they just won’t accept help.
Sometimes it does help if you have walked down that same road. Doesn’t matter if it is PTSD, an Army vet, a police officer, a paramedic, a rape victim or a child molested victim. That is not always the case, but sometimes you build a connection and that works.”
SUSAN OXFORD / COUNSELOR: How does PTS develop in someone? “It is more continuum. There has been something there that hasn’t been dealt with. With veterans they realize it may not have been just one instance but many instances. You were wired to constantly react at any given moment and that gets the body primed for hyper arousal. You are trained to be in survival mode. It is not something you can just turn off. Sometime people can be triggered by something really small and will trigger all these other traumas that have already been there. Every single person is looking thru a different lens.
You may have four military personal that were there and had the same experience one may have run, one may have frozen, one may have fought and done everything right or whatever, they are all looking thru a different lens.”
Phil Smith: I have often wondered with all the trauma I have witnessed in my life that I don’t have PTS. I was a volunteer fireman when I was a teenager and as first responders back in those days we saw a lot of traumatic experiences. There were multi car crashes, train derailments, plane crashes and so forth. As first on the scene we would attend to the victims.
Then when I was a cameraman for television news stations for 10 years I saw and witnessed the usual bad news stories. Bodies mangled in cars, head on collisions with tractor-trailer rigs, school bus crashes, F-5 tornadoes, Cat-5 hurricanes, murders, you name it. I saw lots of decapitated bodies, burned bodies and bodies you could not recognize because of all the crushed metal.
Then in 2005 while shooting a documentary in Baghdad the hotel two blocks from the Palestinian Hotel where we were staying was completely destroyed by a suicide bomber. It left a crater 100 feet wide. The entire face of the hotel was gone. When leaving Baghdad my Iraqi driver did one of those Texas rolling stops. I had five AK-47’s pushed against my temple. I have no flashbacks, no nightmares, no trigger points.
The reason I told this story is, I heard it over and over from the experts interviewed for this series. Phil, everyone is wired differently. Five people can witness the exact trauma and only one have trauma symptoms. Everyone is wired different they told me. So, in essence there are too many variables as to why some people are diagnosed with PTS and others go about their daily lives. There are no easy answers.
CODY BENNETT / PTSD FOUNDATION OF AMERICA:
“When we do things in our lives when we learn how to drive a car or we learn how to go fishing or we learn how to go hunting we have little compartments in our brain. When we go drive a car we open that compartment up and we go drive the car. All the information is stored in that compartment What happens with PTSD is it doesn’t fit in the compartment. It is not compartmentalized. So, therefore it can resurface and resurface and resurface, unwanted. Its caused by a traumatic situation normally. Maybe you’re in the foxhole with a battle buddy and you lose your buddy. Maybe you’re a medic out there or treating soldiers and you lose three or four or you’re a medic out there and there’s been a bombing and you are trying to clean up the aftermath in a terrorist bomb over in Iraq or somewhere. I think it’s just how you’re wired. It seems like those people that live in that little white picket fenced pollyanna world that have been sheltered all their lives, go into combat and their lives get blown to hell in a handbasket. To put it mildly they seem to be more susceptible then those that are pre-exposed to childhood trauma. Whether they were abused, beaten or grew up with drug abused parents whatever they seem to be more predisposed in my opinion. It seems like that middle ground normally. We are all wired differently.”
ANXIETY / FEAR / ANGER:
An individual with PTSD may exhibit irritability and anger in varying degrees and at sometimes unexpected intervals, often to a greater degree than they once did. This can happen for a variety of reasons and can impact interpersonal relationships and job performance.
People with PTSD may find that they feel jumpy or are never completely at ease. This often occurs when a traumatic event that caused the condition is particularly frightening and life-endangering. For example, many soldiers who have spent time in active war zones and other dangerous situations may experience PTSD and, as a result, loud noises and stressful situations reminiscent of the trauma can trigger emotional and physical responses. (SOURCE: www.facty.com)
Grunt: “When I got out of the military, there was a lot of anger. Every time I went into a shopping mall or a store the first thing I did was to look for the exits. You are always watching and being on guard all the time. I have a difficult time concentrating. If I am reading a book I can only read about five lines, about three times and I still don’t remember it later.
I have a hard time having feelings for those close to me. This one has killed me and my wife has never understood it. I don’t even understand it. I have a wonderful family. When they would all come over I would stay there a few minutes and I would ease to the back room not knowing what all this stuff is. My wife would come in and ask me to come back out and I would tell her, I can’t. My wife left and I laid a gun in my lap. I just sat there. She came back in. She said, you are going to cause me problems if you do this. I have kids and grandkids and I just did not want to leave my legacy that way. I eventually got all my family into the room and I said. Look, it is nothing about y’all, it is me. It is in my head. They understood.”
DUB: “For the first couple of years back at home, I had severe flashbacks. Twice, I ended up in the lockdown unit at the VA.
My wife and I got into an argument and I got into a flash. I completely tore a locked door off the hinges, threw it to the side and went after her. She had two dogs that were biting me and I just threw them aside. When I got to her throat I realized who she was. I just stopped and backed off. A huge amount of anger.
The memories and my dreams in Afghanistan they were crazy.”
DANO: “I went to a place one time to get a stack of papers stapled by this machine that will staple a stack of papers. It had some sharp edges on it. I had a hammer and went over to the desk and hit it with the hammer and I immediately jumped to the ground. Oh my God, I thought that was gunfire. I was not prepared for it. I caused it but I could not differentiate it in my brain.
Another time they were testing some exit doors in the building. I did not know it was going to go off. I was talking to two co-workers and that siren went off and I was out of there in a second. It was just a reaction. You hear all this about these active shooters and what would you do. I hear an active shooter and I am gone. If I am not gone then I am the guy attacking that shooter. I don’t need to train my brain, it is already wired to fight back.”
STACEY: “I started realizing that when I am around a group of people or working with people, someone would tap me on the shoulder and everything would go up in the air, including me if I could. You know you are never normal afterwards. You want to think you are going to be ok and someone could walk by and have the “red face” of this guy. There is different type of trauma while you are serving and everybody is nervous and everybody is not being themselves.
I am normal but I know I am not normal. I feel cornered, I want to fight or I want to run and I usually run.”
GRUNT: “There are tools that help to control and lessen the fear and anxiety but when the rage comes you don’t think about what tools to use. The best tool my psychologist gave me was to visualize you are standing in the ocean, you are looking parallel to the beach and the waves are coming in. Here is your problem, it is coming on this wave, just stand there a minute and watch it go back out. Smaller things, yeah, you could probably do that. When that rage comes, it is scary. When it is over, your body is so weak.”
JACK: “When I go out I try to avoid crowds. I avoid them. My wife understands. It could be anything that triggers. A screaming kid. I just avoid anything I know will trigger me. My work tries to understand it but they don’t know how it works. They try to be supportive. I sometimes have problems at work. I go see a therapist for about an hour and a half, I am mentally exhausted for the day. I am not ready to go to work. They don’t understand that part. I have been pealing some layers back. I am exhausted.”
Julia C. Smith, Psy.D
VA Clinical Director, Mental Health Trauma Services: (VA North Texas Health Care System): “It is not a transactional experience where you oh, I am experiencing this so do this and I won’t experience that anymore. It’s a process. If someone is engaged in psychotherapy or if they are doing presence centered coping or some cognitive behavioral therapy, we will teach them coping and to be aware of what’s going on in their body like when it is at this level before it gets up there. We may have them engage in some physiological interventions whether that is breathing or imagery or grounding techniques. These are things that if I am teaching them to a veteran, I teach them in a quiet non-stressful safe space and encourage them to practice them even when they are not feeling stressed that they be more automatic and not when they are in a crowd or when their heart is racing. That helps them like in the moment technique. There is also evidence-based therapy for PTSD. Essentially it is backed by random clinical trials.”
CODY BENNETT / PTSD FOUNDATION OF AMERICA:
“Veterans are at war with the world, they are not so much at war with themselves. They are stuck. The veteran is reliving what happened to him, over and over again. Sometimes the veteran sees no other way out. They just don’t know how to cope, or they are so heavily medicated that they don’t have coherent thought patterns. Next thing you know they have hung themselves or sucked on a bullet.”
In week 4 of our series on Post Traumatic Stress (PTS) we look at the effects of multiple deployments along with:
Flashbacks and Nightmares
Dealing with Stuck Points
Reliving and Remembering
Guilt and Shame
Isolation and Avoidance
Calming down the Sympathetic Nervous System
Masking the Pain
THANK YOU FOR SUPPORTING THE VAN ZANDT COUNTY VETERANS MEMORIAL Phil Smith