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