Post Traumatic Stress Disorder – Help for our Warriors
Andrew "Doc" Berry
What I've been trying to do recently, is to hook Marines up (and anyone
else) with what is known as Community Mental Health (CMH). The VA has projected in the past couple of years that 25-27 thousand Marines will be rotating home in the next year or so, most of which may be experiencing marked symptoms of PTSD, correlating highly with extended tours of duty (gee, what a surprise!) Also, the VA recently disclosed they have discovered a 1-billion dollar shortfall of funds, which will likely continue for some time. This combined with their usual slowness makes me VERY dubious about whether Marines and other veterans will get the mental health care they desperately need. I certainly don't need to tell you all how PTSD breaks up marriages, destroys families, correlates highly with substance abuse/dependence, and can even lead to suicide. So while Marines are waiting for the care they need while watching their lives fall apart, CMH centers can step in and take up the slack. CMH is AFFORDABLE; for the most part, fees are on a sliding scale. This means you pay ONLY what you can afford; the one I work at charges 7 bucks an hour on the low end, and that's pretty good. I'm figuring Marines may choose this as an option and a better alternative than watching their lives spin out of control. If any Marines want more information about CMH or have general mental health questions, feel free to contact me yesterday. While I cannot provide you therapy, I can point you to where it is, right in your own backyards. Many have never even heard of CMH before, and this is a crying shame, and I can help make this needed introduction to anyone.
While I'm at it, why don't I teach you all how to get to CMH right in your area? Here you go:
2. In the upper left corner you'll see the letters of the alphabet under SITE MAP. Click on the letter S.
3. Scroll down and click on State and provincial associations .4.
Scroll down to the state you live in, and click on the name you see of your state organization, and/or call the phone number provided.
5. Ask whoever you speak with to tell you where the nearest COMMUNITY MENTAL HEALTH center is in relation to where you live. (It may not be labeled as such, making it difficult to find under that title in any phone book). This should get you all CMH places closest to you. Don't be afraid to call these folks; this information is publically available, and it's their job to answer all your questions.
6. If for whatever reason there is no CMH place near you, then ask which ones have a SLIDING SCALE FEE SYSTEM, if they should happen to know. Again, I stress that a sliding scale fee means you pay ONLY what you can afford.
7. Any problems, get ahold of me.(Dr. Andrew S. Berry) at firstname.lastname@example.org. While I cannot provide therapy, I can at least help point you to where it is. In case of absolute, need-help-right-this-minute last resort emergency, dial 911. This is used on occasions for life-threatening psychological crises.
_Here are the clinical particulars of PTSD. Don't diagnose yourself; let the professionals do that:_
A. The person has been exposed to a traumatic even in which both of the following were present.
1. The person experienced, witnessed, or was confronted with an event or invents that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.
2. The person's response involved intense fear, helplessness, or horror.
B. The traumatic event is persistently re-experienced in one (or
more) of the following ways.
1. recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions.
2. recurrent distressing dreams of the event.
3. acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated.
4. intense psychological distress at exposure to internal or external cues that symbolize or resemble as aspect of the traumatic event.
5. physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:
1. efforts to avoid thoughts, feelings, or conversations associated with the trauma.
2. efforts to avoid activities, places, or people that arouse recollections of the trauma
3. inability to recall an important aspect of the trauma
4. markedly diminished interest or participation in significant activities
5. feeling of detachment or estrangement from others
6. restricted range of emotions (such as being unable to have loving
7. sense of a forshortened future (for example when one does not expect to have a career, marriage, children, or a normal life span.
D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:
1. difficulty in falling or staying asleep
2. irritability or outbursts of anger
3. difficulty concentrating
4. hypervigilance (being super alert when it's not needed)
I've been working on this write up for a while now in my mind, and I think I've got something for good discussion.
While I was working in corrections, I had an inmate who was in the Army, and saw combat. I managed to get him to open up quite a bit about his experiences. He did not brag, and his claims appeared genuine. His problems with alcohol were legion, and a major contributory factor to his family leaving him, and his eventual incarceration.
As the conversation turned to those brothers he lost, he became very tearful...and I just let him go on about his experiences, and his losses.
What was to happen next gave me a brilliant insight about the fundamental change that combat vets undergo, and often never recover from. I asked him who he missed the most. I expected him to name a lost comrade.
"I MISS ME!!!" he shouted, sobbing. "I USED TO BE A NICE GUY!!!"
WOW. This encounter has stuck in my mind ever since about the profound and permanent characterological change that occurs in some combat veterans.
So I was hoping we could get some discussion going about this man's remark. I was hoping to hear from any of you Marines, from any and all combat eras.
What do you all think? How much of this sort of thing have you seen in yourselves, and/or in others?
The more I thought about the thread titled "I MISS ME!!!", the more I realized it was about the grieving process...in that case, it was the loss of one's self, never to return from a war.
I then began to think of the grieving process, and how different it is for different people, as it pertains to the loss of comrades-in-arms.
Several have told me in private how they felt as though they died on a particular day, during a particular conflict. I have taken this to mean that they saw the best of themselves put in the ground that day with their comrade(s), never to return, sometimes with the following
sentiments: "it should have been me they buried that day, instead of my buddy."
Other have told me privately that they somehow managed to hold a tearless face, or a thousand yard stare when they put people in the ground....and the tears still have not come, 10, 20, 30, 40 or even more years later.
Still others have told me in private that they grieved during the funeral, never to grieve again until years later, when something unexpectedly triggered memories of those lost. Oftentimes even more memories surface, often those once thought to be also buried. And when it does so, it cruelly hits unexpectedly.
Still others have told me privately how they've wanted, desperately, to go to the families of those they have lost, but often times they haven't been able to muster the strength to do so.
Others have told me that they got stuck doing some clerical job while buddies went to the trenches to be killed....and that now they battle with survivor guilt.
And when Memorial Day, Veteran's Day, the Marine Corps Birthday, or even Flag Day arrives the grieving process becomes all the more difficult, when seemingly ungrateful civilians celebrate a day off from work or whatever, than treat those days as a solemn remembrance of the price of freedom.
I believe the true power of the grieving process is when we realize that veterans know they will experience unspeakable loss--yet they do so willingly....so that others, most of whom they will never know, will experience liberty.
I realize this is an odd title to be found in a support Forum, but the idea came to me from a common theme I have heard from most of you who have served in combat.
Many of you have called me, sometimes in a flood of tears, about the lives of good Marines lost who were near and dear to you, and how their faces never fade from memory. This is a completely understandable reaction, given the circumstances of war. The dead must be mourned, and their deeds memorialized, or they will have died for nothing.
But to those of you who have lost Marines in combat, I ask you all, haven't you saved the lives of Marines as well? And Marines being the Marines that you all are, I am betting most of you have saved far more lives than you have seen lost.
Think hard about this. The children of those you have saved can all look upon you as surrogate fathers. As can their children, and their children's children after that. Because of your actions, in a way you have achieved a kind of immortality few will know. I am in awe of you all for performing these kinds of deeds.
And so it is written in the Talmud: "Whoever saves a life, saves the world entire."
Remember and rejoice in this truth, and your surrogate children, as you mourn the dead.
I thought I would throw a couple of observations about Vietnam, and see what kind of a discussion I could get started on it.
For those of you who don't know me, I was 12 when Vietnam ended, and I have never seen combat, so I obviously know nothing of it. I am here to learn from all of you who have.
I am guessing that just about all of you had fathers who fought in World War II. They came back to ticker-tape parades, national adulation, a brand-new GI Bill, and they all were secure in the knowledge that they had done something of immense significance for their country, and even the world.
In contrast, you fought a war that had the country deeply divided, you had an enemy to fight that was impossible to distinguish from a friend, profound frustration at "limited engagement" orders, and so on.
And then many of you had to endure being spit on by protestors, and likely had to conceal the fact that you fought for this country for fear of being judged negatively by others who either didn't understand or simply didn't want to know about a country no one had heard of. And when the last helicopter left the roof of that Saigon hotel, it seems to me the feelings of futility and emptiness must have been set in stone. You thought of how your fathers were treated, then about how you all were treated, and may well have felt violated.
I sense that while your fathers changed the world and were heroes, many of you felt that what you all had done was viewed by most of your countrymen as not having mattered at all. You all had no ticker tape parades, and had to endure attitudes of either apathy or outright hostility.
If all of the above is true, it seems to me these were the ingredients of the burden you gents have had to bear, and still do, to this very day. This is all aggravated further by posers and phonies claiming to be there, but were not.
I just hope I have not restated the incredibly obvious here.
Many of you have come to me, describing well-documented and profound symptoms of PTSD, and the majority of you have said "Doc, I think I'm going crazy! How do I stop it?"
Let me assure you....you're not "going crazy" at all.
You're acting very sanely to an insane situation, even though it seems as though the insane situation (in other words, combat) has been over for many years. The insane situation is your mind and body are giving you mixed signals, and these largely determine your reactions.
When one is in combat, one's physiological response is to ALWAYS be on the alert, on edge, on point, and on top of one's game, as the results of being anything less would be tragic, right? And being on edge, alert, and on point is how many of you guys are feeling RIGHT NOW, from what I can tell, at least to a certain extent with the exaggerated startle response, hypervigilance, and emotional reactivity. Am I correct so far?
It's as though your body's thermostat seems to be set on "HIGH", and you cannot turn it off....correct? From what we know (psychologists and
psychiatrists) about PTSD, once one's thermostat is set on high, in many ways, it stays there. It's very hard to turn down that thermostat after one has experienced combat.
Part of your mind knows there is no combat right now....but another part of your mind, as well as your body believes otherwise, which is what makes PTSD so hard to control.
This is what I meant by the title of this post; you're "REACTING SANELY TO AN INSANE SITUATION" that your body and part of your mind thinks is still going on around you (the insane situation.) Your survival triggers are on high alert and this is beyond your control. And because you cannot turn them off, your reactions are, in a way, VERY understandable (reacting sanely.)
All we can do is teach you tools of management, to calm both mind and body; once they are relaxed, the seemingly insane situation then goes away, at least for a while.
It's been a while since I thought I had anything worthwhile to write about, but recently, I thought of the words of a little girl who told me the following years ago:
"My daddy went away to war....and something else came back."
"SomeTHING?" The idea is poignant, powerful, understandably human, and profoundly disturbing. This little girl couldn't understand why her loving daddy came home after lengthy tours an angry man who wanted nothing more than to be by himself, who went from arctic emotionlessness to a quick and even violent temper. He had seemingly lost the power to hug his children...
Family members and close friends really do need to be educated about what PTSD is, what to expect when the loved one returns home, but it is of paramount importance that special care be taken to reassure the little ones that daddy's changes are in NO WAY their fault.
Needless to say, entire families need to work with mental health professionals, and not just the newly returned Marine or other veteran.
I have often heard of PTSD referred to as "the gift that keeps on giving." What is not fully realized, is that it not only leaves its "giving" mark on the veteran, but also on all those who matter to that veteran.
And I submit to you all with utter urgency, that the combat veteran must not be forced to fight the PTSD alone. This is the sort of thing that leads to worsening of symptoms, substance problems, families exploding, incarceration, and even suicide.
I have heard from several sources, i.e., different media that the services are "offering" personality disorders to combat veterans suffering from severe PTSD as a means of getting them a quicker discharge out of the service. What happens then, is the exhausted and uninformed combat vet, already worn down from too many tours in the bush is only to happy to sign off on these alleged "diagnoses" in order to get out yesterday.
And I am here to tell you all, that this is where these veterans'
problems begin. When these guys try to get their benefits from the VA that they so dearly earned, they are DENIED their benefits on the grounds that their alleged "personality disorder" is a pre-existing condition, purportedly existing before they ever enlisted. And on these "grounds".....you guessed it! THEY ARE DENIED THEIR BENEFITS.
This appears to me to be an underhanded ploy by our "government" to save money, and that's all. For those who don't know, genuine personality disorders actually are pre-existing conditions, but guess what? Most people with genuine personality disorders either do not enlist, or they otherwise wash out during boot camp or shortly thereafter. After that, if there are any service members with GENUINE personality disorders, they simply do not get anywhere near a combat situation!
I urge you all to investigate this further, to see how widespread the problem is. I implore you all to start writing your representatives, detailing your outrage at these occurrences. This simply has to stop. If these guys don't get their benefits, they will likely develop substance problems, watch their families dissolve, wind up with prison records, or otherwise wind up committing suicide. How do I know all this? Because it's already happening!
And if any of you are on active duty right now, or know those on active duty, SPREAD THE WORD! When you or anyone else is offered the chance at being "diagnosed" with a personality disorder, DO NOT sign on the dotted line!!! That diagnosis will not only cheat you out of your benefits, but it likely will follow you for the rest of your life.
I have spoken with many of combat Marines about all kinds of emotional difficulties, and there has been a theme from many that has been reluctantly brought to my attention. Specifically, in cases of particularly heavy combat such as in Recon or Sniper teams, some show a deeply mixed attitude toward killing, specifically both loathing........and enjoyment.
Prior to the service, we all (presumably) were raised to believe "thou shalt not kill" in one form or another. One then takes the oath, and is trained to kill, with an efficiency of rare abandon, all the while trained to believe one is Superman. If combat arrives, the training hopefully prepares one to do one's job well, complete the mission, be victorious, and survive to tell about it. However, for some, there comes a feeling of missing the opportunity to kill; call it the same as when an animal gets the taste of blood. As Ernest Hemingway once wrote:
"There is no hunting like the hunting of man, and those who have hunted armed men long enough and liked it, never care for anything else thereafter..."
So after the war, and one comes home, one still has that taste for blood, and the adrenalin rush. Some have told me that nothing even comes close in comparison. Some have compared this kind of fighting to sex....and that the sex is never so good again. It's relatively easy to turn a man into a predator; it is very hard to do the reverse.
So the issue then becomes, how does one come to terms with the hating and enjoyment of violence? How does one get past the horrors of the kill, while not acting on the desire to do it again? How does one deal with feeling totally out of place and out of time in Ma 'n' Pa America?
And how does one explain the taste of blood to loved ones and friends when they ask? Can it even be done at all without being thought of as a murderer by those who simply cannot understand? How can one be heard and not judged?