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The Gory Details and #PTSD part 1
Two part blogpost starts here. I mentioned in my last post that my wife knows the gory details. You can read that post here. I can never thank her enough.
The gory details are the pieces of our trauma that often leave us Veterans the lasting nightmares. It doesn’t take any gore to develop PTSD. Getting mortared, shot at or losing a friend is more than enough to leave a Veteran with the feelings that trouble us for a lifetime. But, if you are so graced by those gory scenes (Band of Brothers, Saving Private Ryan and The Pacific all do a too close for comfort job) I can assure you they haunt you with the lights on.
I’m going to visit some issues that I have struggled with about gory details, but I will not be gracing this page with specifics. (disappointed? SEO marketing at it’s finest.) I will talk about two aspects. First, if you know a Veteran who has seen “action” there are some of our apprehensions about sharing those scenes, even to our therapists. I will explore why I feel that way. Second, how using Prolong Exposure therapy forced me to use Imaginal Exposure to revisit those days and how it helped. For me, addressing these scenes and facing the onslaught of emotions head on has worked. They are not gone, but I can put them on a shelf in my mind and I know what to expect when I visit them.
When I came home the first time I ignored all of my symptoms and kept right on slugging. I knew I was probably going back to Iraq. I told myself to suck it up. I used the years of lessons about duty and selfless service to justify neglecting my own well being. Strap on the boots and go again. I remember having a long talk with my cousin before I went back my second time. “Why does it have to be you?” she asked. I told her that with the experience I already had that I could prevent more soldiers getting hurt or killed. In my mind, my experience made it my duty to go back. The rest and relaxation was for another time. Our country needed us. Little did I know that I would burn the candle too low and our enemies were getting smarter.
The second tour got really bad. We faced a more organized enemy and that made being alert all the more important. We lost good Soldiers. I stopped sleeping for days on end. I was angry at everyone and everything. By the end of my second tour, with much trepidation, I made my mind up that I was done. I came home in March of 2006.
Three months later I was out of the Army. The things I saw and did were all that greeted me when I closed my eyes. I could see the dead in my dreams. Hell it got to the point where I thought I saw them in crowds. I started sleep meds in theater at the end of OIF3. I heavily medicated just to get the images to go away.
I found a therapist at Fort Carson who was willing to see me because I was now an Army spouse. (Though that opened up a whole new bag of issues. More on that for another day). Even though this therapist was a retiree from the Army, I still had trouble telling him the details. I was ashamed of things that happened. I was scared of revisiting those images for fear of tearing open old wounds. I also wrongly assumed that I would be judged.
Tales of blood and guts were a selective treat I used if I got pissed or wanted to get a rise out of civilians. As I am sure it has happened to all of us at some point, some jerk off asked me if I ever killed anyone. My reply made him pale and I loved it. I then told his boss what an asshole he was and he was fired a week later.
But, I was still just skirting around really dealing with those gory details. Another difficult aspect of the gory details came around family. They were very concerned for my well being and I always got the hand on the shoulder combined with an intense gaze and “How are you doing?” I would sheepishly tell them fine and try to convince them with words what my eyes said otherwise. I would tell a select circle the real deal and even share some gory details, but those sharing sessions were few and far between.
It was not until I completed Cognitive Processing therapy and started Prolonged Exposure therapy that the real work flushing out the gory scenes would begin. Four years of carrying them around made me eager to tone them down, but skeptical of the impact the therapy would have.
I will chronicle the deep dive of Imaginal exercises in my next post.
In summary, I am still on the fence about sharing scenes of war. I am more likely to share with another Veteran so long as it doesn’t turn into a pissing contest of “I have seen more blood than you”. Us grunt types can sometimes wear our hardships like badges. I have found it is easier for me to talk about the feelings and the actual experiences rather than one or the other. For any readers out there, I am open to listening or talking. If anyone wants to chat, please hit me up.
My Old Lady and #PTSD
I am a jerk. My wife lovingly tells me this often, yet I will still write this next blog post. Dealing with me, especially post Army and full swing into PTSD treatment, is a drain and requires a special woman to see and understand.
I am a lucky son of a bitch in that my wife was deployed as much as I was (ok, she has three more months in Iraq but I have a year in Korea, that counts right? No? K.). There were times that her being in theater added stress and there were times that her being on the same operating base reduced stress. (Big Cat knows)
All in all, now that all of the Army stuff is done, her knowledge of the gory details is a trait of our relationship that I would never trade.
I talk with a lot of other Veterans who have PTSD and are still married. They need their wives to keep them straight. But, that is not what I am going to write about here.
I have been diving into this treatment and so focused at times that I lose sight of the impact it has on my family and my wife. Everyday is a struggle and sometimes I take for granted that my wife is being strong and she is doing it for our family. This fact becomes more troublesome because the effects of PTSD on family members is direct.
Here is a link to the VA Website on PTSD and the family.
And here is a link that references the studies done with PTSD, the family and children.
So whats that mean? We, as PTSD survivors, can be real downers. If you are not properly communicating, not emphasizing the important recovery habits, the road goes from bumpy to cratered.
Take the time to thank your support group. Take the time to reflect on what your PTSD is doing to those around you. Depending on where you are on this road back, just continuing to give great effort may be enough. Again, communication is the key.
I have said to my therapist and continue to say that I want to raise my kids on my terms. If something is going to fuck them up, it is going to be all me and none of the PTSD crap. I am closer to this goal today, but not nearly as close if my wife did not support me as much as she does.
Use it, don’t abuse it. With fathers day coming based on where I was a few years ago and how close I came to the edge, it is I who should be thanking her.
The Sleep Game and #PTSD
Oh sleep, how I miss you.
I’m not talking about a medicine induced coma (I can eat Ambien like tic tac). Or exhaustion from being awake for three days (it’s amazing how many TV series you can get through on Netflix). Or won’t get out of bed from depression sleep (see the Anniversary post).
I mean normal, wholesome, lazy Sunday afternoon sleep.
All sleep is not created equal. Getting to normal sleep was the first thing I tackled managing and is a constant battle. My mind and body need it. Given the complexity of PTSD and the issues deeply tied to anxiety and safety, weaving through the dozens of variables that contribute to a good nights sleep can be tricky.
Homecoming Problems: Sleep was just the beginning
I was pretty much terrified to close my eyes when I got home from my second tour. Either I was worried about someone coming into my house, or the nightmares took me right back to a firefight. (Cue story about attacking my wife in my sleep…) What I quickly discovered was that I needed the meds, and because of the meds I needed a routine.
Sleep Journal
I put myself on as strict a routine as I could but, finding the data points was tricky. If you don’t keep a log, I would highly recommend it. I kept med dosages, time to bed, time up, and a few notes and lined up anniversaries and non-Army stressors. The better I kept the journal, the more trends I could find. (we are not talking statistical significance here, it just felt like I was identifying trends)
Probably the biggest significant data point I recognized from the early days was the impact alcohol had on me and my routine. In the beginning I was on trazodone, citalopram, quetiepam and prazosin. Everyday. I hate medicine. My temptation to suck things up gave me serious misgivings about all meds. When avoiding meds was not an option, my soul mission in life was to get the sleep under control so I could get under way with real work. I was also desperate to get away from all the drugs filling up my medicine cabinet and more importantly, my veins.
The labels on those bottles did not lie. Even with small bits of alcohol, I was completely out of whack with my sleep patterns. It was a heavy sleep and a long fog after I woke up. As a result, joblessness or working from home was my only option early on.
One day, I just made up my mind and stopped drinking entirely, and besides saving me a few bucks, I have never looked back (ok, maybe I look back occasionally, and I may have slammed a shot and a beer when they killed OBL… it tastes so good when it touches your lips)
Still, getting sleep to be manageable is in my opinion the best first step on the PTSD treatment road. Sleep makes me happy. Sleep helps me think rationally. Too much sleep and being unproductive gets me down. Finding that balance of sleep and medication helps.
Alternatives to Medicine
I am at a stage now where I need less medicine. Using the lessons from therapy as well as some visualization techniques, I rely on a relaxation exercise to help me when meds are to too much and I am too wound up to get to sleep quickly.
I am including a link to the Army Center for Enhanced Performance site. They have tools there for a variety of stuff, but I will point you to the relaxation MP3. Everyone has an MP3 player now right? Good. Go download it and give it a try. ACEP Resources
In summary: sleep is the gateway to getting to the real work. Understand the labels and the restrictions sleep meds put on you. Be disciplined in your approach to sleep. Try relaxtion techniques to assist with getting to sleep. I hope it helps you.
The VA: Nightmare Buraucracy, Healing Savior, #PTSD and #DDay
On the anniversary of D-Day I cannot help but think about the role the VA has played in the lives of generations of Americans and their service to this country. We do not live with a draft, more people vote for American Idol than the Presidency, and the greatest generation is dying off at a rapid rate. As a result, the Service Men and Women abroad affect the national consciousness with significantly less impact today than they did 67 years ago.
I specifically think about what the greatest generation went through to earn benefits from the VA. Claims written by hand. Eventually typewriters. Computers? Not until 30 plus years after the war ended. PTSD was not even formally accepted as a diagnosis until 1980. We have it easy. Still, frustrations with the VA are at every turn.
Each time I engage the VA there are very distinct mental adjustments I have to make depending on the “branch” I am contacting. The VA essentially has two companies that rarely talk to each other and have diametrically opposing missions housed under the same roof. One scrutinizes, interrogates and ensures validity, the other embraces the individual to provide world class health care. I cannot get to one without going through the other.
The bureaucracy that is a lynchpin of the VA will continue to frustrate Veterans for the foreseeable future. I, like others, waited what seemed like an eternity to hear back on my claims. It adds stress and is at times so convoluted that there almost needs to be (and in some cases are) a mental health group just for people dealing with waiting.
But, once you are accepted and into the system the healing places like the Northport VA Medical Facility and the practitioners cannot be commended enough for the tireless work that is done daily. If you are waiting, hang in there.
Listen, I am not a fan boy. I am trying to tell it like I see it. But, because of the unique job Service Members have, there is not another medical institution that comes close to understanding Veterans the way the VA does. Try and find a PTSD center with the experience the VA has. We are kinda stuck… With the good and the bad. I am not going to make it my mission to point out the injustices of the system (in this blog or elsewhere). Plenty of people and groups do that already. I will however, listen and help whomever I can through this blog and other social media.
As stated earlier, today marks the 67th anniversary of D-Day. I ask that today you think not only about the sacrifices made that day, but the sacrifices of those who lived on and carried or carry their burdens (One in my family in particular comes to mind). I hope the effort of our current Service Members are never forgotten. I will do my part to honor the brave men and women of World War II, DDay, Korea, Vietnam, and all the others. I hope when you read this, you will at least give pause.
“First at Normandy!”
Crowds, a baseball game and #PTSD
I am going to a baseball game tonight. Since coming back from Iraq, I have generally not had good times at baseball games and not because I am a New York Mets fan. I don’t like crowds and in general the traffic (public trains or the LIE) gets me anxious and I don’t have panic attacks so much as angry attacks.
(I have had exceptions, I saw Endy Chavez make the catch from Row V in Shea. Even though the Metsies lost that was a magical night and I was on a hell of a lot of meds..)
In any case, tonight is an opportunity for me to succeed. I recently completed Prolonged Exposure therapy at the Northport VA. PEt has two parts: imaginal exercises and in vivo exposures.
Imaginal Exposure: To summarize in my own words, you sit with your eyes closed and talk in the first person about really crappy traumatic experiences, record it, listen to it all week, then do it over and over. With each iteration the experience uncovers more thoughtful reflection as well as a greater perspective on the traumatic events. It sucks. Like all therapies related to PTSD, it gets harder before it gets easier.
In Vivo Exposure: Then there are homework assignments for in vivo exposure. This is the fun summary: pick out a mess of things you avoid like the plague, rate them from one (in bed about to fall asleep) to one hundred (In the shit bullets flying). Then go do them.
Avoiding public transit? Go ride the subway. Don’t like war movies anymore? Watch Restrepo… Twice. Hate crowds? Go to a Ballgame!
(When my wife heard that one she rolled her eyes, but I can assure you, this is legit.)
As I was immersed in each homework assignment, I was tasked with keeping tack my feelings and mood. It is sort of like embracing the mental suck. But, as advertised, things get easier and easier.
So, tonight is another opportunity to succeed. Let’s Go Mets!
Anniversaries for a Veteran with #PTSD
Most people mark anniversaries with thoughts of joy and celebration. A card, out to dinner, a gift. You can even look at Wikipedia for traditional anniversary gifts by year. For me, and other Veterans, anniversaries carry a special weight. An alive day, the loss of a friend, the time where you treated a civilian casualty, I have them all in my mental calendar. I had deployments that overlapped during the calendar year and anniversaries from both deployments speckle my brain.
IED blows up. Complex Ambush. Mortar attack. My subconscious seemingly sends out messages in the form of depression, extra anxiety,anger, you name it.
I kept a journal both deployments and have specific dates for many of the big events, or a span of time when a collection of events went down. To this day, my mood is affected by those “traumatic” experiences.
Last October my wife and I were chatting and trying to keep each other in check. She turned to me and bluntly asked, “What is your deal these past couple of days? You have been acting like a complete dick.” I took the hint and adjusted my attitude.
Both my deployments to Iraq were shitty for different but similar reasons. When I looked back in my second Iraq journal i figured that since it was closer in dates, those experience would be stronger. But, I could not find a date in my last deployment that matched up. Then I found my first journal and there it was: a week from hell of mortar attacks and close calls.
Now, I am not trying to blame away acting like a dick. I very often do that of my own volition. Also, I am not claiming any scientific support for this, just my own feelings. But, the longer I do this therapy and the more data points I collect, the better I am at avoiding spiraling depression or angry outbursts related to the ghosts of my past. Life often dictates other things to try and focus on, but being conscious of the past stressors is at least helpful to me in heading off destructive behavior. I try now to not let those issues impact my relationships. It’s not easy, and I’m not always successful.
With each passing anniversary, or holiday, I get better at preparing and bracing for what has yet to be anything but a roller coaster of emotions.
This year marks seven years from the end of my first deployment and five from my second. I guess I owe myself a desk and pen set and some silverware…
The one I feed the most
I read a short quip pinned to the wall in the PTSD center at the Northport VA facility. It read this:
A Native American elder once described his own inner struggles in this manner: “inside of me there are two dogs. One of the dogs is evil and mean. The other dog is good. The mean dog fights the good dog all the time.” When asked which dog wins, he reflected for a moment and replied, “The one I feed the most.”
I took a picture of it and I look at the picture/ story often. I feel it relates to one of the first lessons/ worksheets from Cognitive Processing Therapy (CPt): stuck points and absolutes.
A stuck point is really just what it sounds like, a point or thought in your brain that is immovable and ingrained… Stuck. Lots of people in this world have thick heads and are convinced of this or that, but for a Veteran with PTSD these thoughts are burned very deeply into our thought process and linked to primal survival, and it very much feels that way.
CPt starts with identifying and challenging those beliefs. In a war zone it is tough to trust anyone, especially those who are in the least bit different. Traumatic experiences seemingly affirm in extreme ways these habits of survival. Unfortunately, habits start to defy sound logic and over time feel reasonable and essential to survive.
For example, I had a few IEDs hit my vehicles in Iraq. I also saw the devastation created by suicide bombers. When I came home, driving on roads and traveling by car without a weapon to defend myself sent me to super anxious level. When I reflect about my experiences, the reaction sounds like typical and logical responses to the threats we faced in Iraq daily. The real problems came when I could not convince myself otherwise when I was home.
The stuck point I told myself was I am Never Safe when driving. Two things to examine here: one, I tied a mundane common act to my personal safety, two I used the extreme absolute of never. Because I was dealing in absolutes, my emotions and feelings were on hair triggers. Cut me off, I cut you off. Look at me wrong, I try to start a fight with you. Zero to pissed off in the blink of an eye.
These types of statements and emotions feed the evil dog. I cannot trust anyone. I am never safe driving. If I relax I will get killed. If someone dies or is hurt and I am not totally prepared, it is my fault. All of them at one point were in my rule book and I believed in them wholeheartedly. To a certain degree, all of them still are.
What I worked on with CPt was how to take those rules and make them more specific and less absolute. Some would argue I made them softer, but I don’t buy that. I can still get to angry in a heartbeat, it is now more on my terms.
Driving can sometimes be dangerous. It is not always dangerous. Now, with some quick mental preparation before I travel, it can even be a non-issue. Someday, I hope it is fun again, maybe after I starve that damn evil dog…
This is a simple example, there are many more feelings and more complicated cases dealing with relationships or trust to name a few; and, this took me a very long time to get a grip on. I still have to remind myself to live in a world with a spectrum and not absolutes. With the more complex issues, I am still working them out.
Want to read more about CPt? Visit the VA Website
or the Wikipedia Page for Cognitive Processing Therapy
The First Post…
What is this blog going to be about?
For starters, I would like to get a dialog going more than me spewing crap at the screen. I will most likely approach my struggles with PTSD from a chronological perspective to start (I think it will help the longer this blog runs). I will field questions and tell stories or both war, and therapy. I have been going to therapy steady for 6 years now and things that only sort of worked in the beginning, are now sharpened and refined. I want to share what works and what doesn’t, as well as inform people (probably my family and friends to start) what the struggles were and are with PTSD.
Now for some disclosure.
I am going to be as brutally honest as I can be. I am not a Saint, and I do not plan on applying for the holy order anytime soon, so please do not get on me for mistakes that I share. There are many. I am sharing them because the are mistakes and I would like others to know they are not alone and learn from them. But, if someone does ask for advice or guidance, my honest opinion is what they are going to get, not sugar coated, but as straight as I can be with them. I may use examples of people I met, or talk with, but their names will be changed for privacy purposes unless otherwise stated.
My goal for this site is simple: to educate and support the Veterans and their families who are dealing with PTSD.
Why do I feel I am qualified (and how)?
I feel there are a lot of similarities between coping with PTSD and twelve step programs. Through this blog, I am putting myself out there as a sponsor for whomever wants to be sponsored. I am not a health professional, but I have been in our boots. In our Veteran community, experience and trust are major issues at the starting blocks. If I can write and help someone out of the gate, I am more than happy to do it. In fact, I feel at this point, it is my responsibility.
A little more about me…
As I stated earlier I have been dealing with PTSD in therapy for 6 years. I probably had PTSD after my first Iraq tour from 2004. I went back from 05 to 06 and finally reached a point where I was pretty much so burnt out that a change of profession was a must. As this journey of healing progressed I have been on many different drugs, stopped drinking entirely (though I did have a shot of Jack for OBLs death) and have successfully completed both Cognitive Processing and Prolonged Exposure Therapy. Each of these major milestones, along with many other family and professional challenges along the way give me a unique perspective on dealing with PTSD. Also, I am married, have two kid and have had to refine a lot of my tricks to cope with sleepless nights compounded by babies and new anxiety.
For all new readers I will part here with these words as my first “lesson” I had to learn the hard way: There is no magic pill or Super Therapist. Time will help, but it moves so slow it will feel like no change. The only way things will get better is if you work at collecting and sharpening the mental tools necessary to survive and eventually flourish. It requires hard work and discipline.
ptsdsurvivordaily 
The Snipers Never Go Away with #PTSD
Ok, so, I’m editing this post and renaming it. I will start with what I wrote prior and fill in the during and after:
I’m currently preparing to march in a parade. I have been actively mentally preparing for this since Thursday.
I drove with my family down to DC Thursday. No issue. Some fireworks last night and my two kids, my wife and I in asleep in a Queen sized bed left me a bit on edge this morning.
The Metro ride was uncomfortable but manageable. I struck up a conversation with a rider and it seemed to help.
So, here is the the challenge in front of me:
A crowd of people, most of whom I do not know.
Heat. Muggy, hot. Yuck.
Punchy. No sleep, plus the other two equals Angry Mike closer to the surface.
So, here are my steps to keeping it cool:
1. Remind myself that I am in a safe environment. Be on guard but not combative.
2. I have done this before and succeeded.
I will update this more later, but just wanted to capture my before state of being: anxious, nervous and punchy.
Talk to you later!
The parade was packed. It was seven people deep at the most crowded parts and had people lining the streets for the miles we walked. As we started, I was on high alert.
Actual thoughts that crossed through my mind:
Someone is going to blow themselves up.
Someone is going to run into our group and start a fight.
I looked for snipers on buildings and in the windows.
There are more, but for the sake of space, you get the picture. All of these thoughts and the subsequent memories of my experiences with them resulted in me being on edge. For the first ten minutes into the march I was very overwhelmed. But, I was there, committed to my friends and myself, and there was no turning back. I had to keep telling myself I was safe, and to relax.
The thoughts above cover scenarios I was taught to identify in Cognitive Processing Therapy. More specifically the therapy helped to identify the difference between low probability and high probability. I utilized my skills from Prolonged Exposure therapy by immersing myself into an In Vivo Exposure. I tested those feelings of safety and anxiety. Given the nature and length of the parade it was a very good assignment.
Low Probability v High Probability
Is there a chance a Sniper was on a building? Yes. But that probability was very low. In my own brain, just because it had happened in the past I over emphasized and addressed the scenario as though it were highly probable. Snipers and mortars are things that keep many Veterans awake at night. Chaos surrounds their intervention. One minute calm, the next all hell is breaking loose and to make matters worse, most of the time you have no idea where the hell they came from.
I think most Vets will agree that getting punched in the face is far better because at least you can see who is giving you the black eye. The canyons of building surrounding the parade route and gaggle we walked in were enough to remind me of a patrol on the mean streets.
Still, we were in Washington Freaking D.C. I am fairly certain that city has air defense missile systems now, let alone a slew of plain clothes cops… So, acknowledge the probability, but don’t let is consume you.
In Vivo Exposure
Again my summary of In Vivo Exposure: Don’t like doing it? Do it, and do it some more. Ok, maybe that is a bit too simplified. There are some instructions that go a long with the therapy: Take notes on how uncomfortable the situation is. Stay in the situation long enough for the comfort level to increase. Pay attention to the thoughts and specifics. As I stated earlier, I was hard up for comfort as the parade began. It was very loud and there were thousands of people all focused on the parade. After the parade I hung out on the streets for a bit to keep the exposure going. I was selective where we stood and watched the rest of the parade with no incident.
All in all I had a good time. I made it home late that night after another Metro ride and I was mentally and physically exhausted Sunday and into today.
The therapy works but it requires sharpening the edges constantly to remain effective. Shooting is a perishable skill. So is your own mental health.
Moral of the story: Keep at it. Attack the PTSD just as you had attacked other things in other times. Be smart about it and you will see results!
Feedback welcome!