Paranoia – External Causes – Inaction

One of the linkages that has pressed its way into my consciousness is what might be called the “Paranoia – External Causes – Inaction” cycle. My fellow PTSD-spouse buddy and I have started discussing the linkage of these behaviors in our spouses…where does the negativity come from, the inability to finish anything at times? And, of course, the notion that this problem is caused by outside forces?

Individually, I have given these issues a lot of thought. I keep coming back to two characteristics of military culture that would tend to teach or exacerbate these issues:

1. Chain of command

2. Need to know

In the military, orders come down the chain and a given soldier is told only what s/he needs to know to accomplish her/his task.

Granted, any number of bizarre questions rise up…are good leaders those who know when and how to take orders or change them? Do some soldiers improve their odds of survival by nosing around and getting more information? Is this structure changing now, given the random nature of acts of war these days?

But, let’s leave those questions aside for a moment and discuss the basic question:  Why is such a hierarchical information structure necessary in military culture? Why does the military require huge numbers of young people who will – on orders – participate in life-threatening endeavors? The answer is plain enough…how else can you get people to use violence to get what the generals want? War is about breakdown; it’s about fighting. You have to have people who will go forward toward their own destruction given the order to do so.

We decry the “terrorists” who recruit and inculcate in young people the willingness to give up their lives for the cause. Isn’t this what all armies do? Isn’t this the point? The only difference between our wars and those thousands of years ago are that more people survive extreme trauma.

Do we think that if we can save soldiers lives when they are partially blown up – and remove the memory of the pain of the incident through sufficient levels of morphine – that we can prevent PTSD? Maybe for a few years. Maybe we can lower the chances for a while. But we can’t take away what enabled them to get blown up in the first place…that inculcation is the whole point.

We can’t give them something to prevent the hard wiring for the sense of distrust of their environment. The notions of friend or foe…which is which? Never trust. Never. What about the chain of command? That’s it’s own blog…the idea of how to decide what to do at 45 when you are still waiting for orders. How does anything get done? It’s all someone else’s fault.

What concerns me is not what we’re doing to try to prevent the first bout of PTSD. Heavens knows, we have more information than ever before and yet more returning veterans are killing themselves than ever before.

No, my concern is twenty years from now, when the ones who survived those twenty years begin to look at the price they paid. When paranoia and the need for external direction in order to act become the inability to act at all, even to save one’s own life.

Points of Contact

Recently I was talking to another spouse of a veteran with PTSD and I mentioned that I found I could reach my husband by creating “points of contact” that were new. She asked what I meant by the term “points of contact?” I struggled a bit to explain it…I think it is something I have done unconsciously. But, thanks to my friend, I have verbalized it now and realize that as a technique for living a more normal life, it may be helpful to others.

Creating Points of Contact – Example number one: Shortly after we became a couple, we took a vacation together with my parents. During the vacation we swam in the ocean. At the time I was training for triathlons and my husband liked to snorkle. So we went way out in the ocean. My parents watched us from the balcony of the hotel. Later, at dinner, they told us that we went so far out they started to worry. We were safe; the water was not very deep and we are both strong swimmers. But, we probably did go out about a 1/2 mile from shore. The memory of that day’s swim – how we enjoyed it, the strong response from my parents, and the fact that it was unconnected to anything else – has become a touch stone for us.

A Point of Contact is a mutual experience we have that helps us connect with each other and feel good.

I realized from this event that there were ways to make new memories. It’s not always easy because there are times when even the best of times have trouble crowding out the fear-tension-pain syndrome that can take over the whole veteran. But, once there were enough of these Points of Contact, my ability to bring my husband into the present became more powerful.

Here are some more examples of things we have succeeded in making into Points of Contact:

• Doing the fox trot in the kitchen. Yes, we actually took a ballroom dance class…it is a good muscle-bonding experience. This is a phenomenon that happens when soldiers are at war. Muscle-bonding also happens when you are dancing with others or work out together on a sports team. Doing the fox trot turns out to be preferable to arguing.

• Giving money to charities that mean something to us. Because PTSD causes such need in the individual, giving is a gesture that can really break some of its hold. We give to AmVets and other causes that allow us to feel we are giving back. Recently we began doing this instead of giving presents to most of our family and friends at the holidays. It has helped us transition into a new stage of life.

• Mentoring young people. Studies indicate that mentoring is most effective when it happens naturally, so we only do this when it is happenstance. We have helped out some of the interns that come into my office, or provided additional parenting for neighborhood kids. Sometimes we have made substantial contributions to a young person’s well-being; other times, we have just listened a lot.

• We try out new restaurants and when we find some place we both like, we become regulars. How regular depends on the prices!

• Test our memory of people we see in movies or on TV. We try to recall what other films or show they may have been on and when we first noticed them. These people don’t mean anything to us, but it helps establish the passage of time, something we find helpful.

First, Put On Your Own Oxygen Mask..

…before you try to help others. This is what the flight attendants on airplanes remind us before we take off. It’s a good metaphor for dealing with the kind of issues that seep into your life when you are living with someone scarred by battle.

Spouses or families with a PTSD affected person need to have their own lives in working order, if they are to be able to deal with problems that arise and not feel they are always living in survival mode in another person’s life movie. The nature of war – once again – is a survival mode. To live in that state constantly is the equivalent of chronic stress or permanent flight/flight response.

So, how do I take care of me first without appearing selfish? Well, it can be tricky. Here are some priorities I try to keep in mind:

1. In a true emergency, it is necessary to drop my things to help. (Yes, you have to learn the difference between life & death and being blackmailed.)

2. If I have to do something really important for my job or career, I do a lot of preparation to insure my spouse will be okay. I sometimes have to travel as far away as other continents for work. I have not found it helpful to explain why I must do this. However, the key to success is making it clear that I am doing a double house cleaning, washing every article of clothing, bedding, etc., filling the refrigerator, alerting the vet & necessary support personnel, reminding family where our wills and directives are located, and leaving adequate funds that he will want for naught. And, I never take my toothbrush out of the master bathroom.

3. I do not use reason to discuss my work or motivations for doing things I need to do. There is nothing I can explain when the operational situation is a question of control. Long ago, I found that sometimes it is actually easier to do what I need to do and take a little heat than to try to be convincing ahead of time (okay, this may just be me – in any case – but it works).

4. I insure that things he really derives joy from are available to him. There are magazines, people, his lawn tractor, BBQ ribs and various other things and experiences that matter to him. I notice these things and make sure he does not go without anything we can manage.

5. I make sure the things that are really important to me are there for me…within reason. I know what I can and cannot live without. I cannot live without 10 or 15 hours of exercise/dance per week, or without coffee, or without going wherever work takes me, or helping anyone I can. But, I do not jeopardize our well-being for something that I just selfishly want. YOU HAVE TO KNOW THE DIFFERENCE BETWEEN NEED AND WANT.

6. The work is hard enough, so don’t get into the drama. The universe is full of energy; there is plenty of it to get your work done and live well. Don’t waste it where you can’t get anything out of it.

7. I love my husband, so I am not going anywhere. Once I resolved that, things became a lot easier. It’s a trap to be indecisive about this.

8. Don’t look back with regret. It is astonishing what my husband lost in order to defend our country. But, from here on we can only make new memories and habits. There is no “what if.”

9. I accept that the only thing I can fix is myself.

I hope this helps. Let me hear from you.

The “Emotional Shards” of War

Welcome to my mind. Once again, the NY Times has published an article about PTSD. Today an article entitled “When Minds Snap” by Erica Goode appeared on the first Week in Review page. Once again, a perfectly well-educated and literate person revealing that she has identified a phenomenon that pervades the nature of war. War is horrible and you cannot escape the damage when you are exposed to it, even at some distance.

I am perpetually amazed/harassed/annoyed/something or whatever that it is so hard to get out the message that the reason war is so bad is because it kills and maims people, and that not all the death is physical.

I do not intend to be annoyed, but somehow I am. I am annoyed because we are involved in wars today because of people who didn’t really go during Vietnam because they knew it wasn’t in their best interest to go. I am grateful that President Obama is willing to let the computer models play out before he commits the lives of the young to the prospect that they will end in emotional shards.

There was a time when battle mattered. But, most combatants died on the field and resources were gained. Little is gained these days. Battle is a vestige of behavior that mattered in the same way the biblical command to “go forth and multiply” mattered. Long ago, these things became not useful.

How can I help? This is the only important question that I have. If you are a family member of a person dealing with the impact of their war experience, please let me know what you are facing. We are starting to have another horrendous flashpoint in our culture. It is the best interest of warriors to be something that is incompatible with “civilized” society. We must be ready to help these people, whether they are new to our group of damaged minds or are recognizing for the first time that the past exposure really did happen.

Carepacks

If you know anyone who is currently deployed or who will deploy please send their rank, name and address to info@carepacks.org. Carepacks.org is an organization started to send FREE packages to military folks deployed to Iraq and Afghanistan (or to the Middle East in the case of Navy ships!). CarePacks is currently in need of names to send Christmas packages to. Normally, about 500+ packages are sent out at the Christmas packing in November (including packages of Christmas trees, lights and ornaments to units/people we know can have them!), but currently, we only have 25 names! Please cross post this anywhere you think it will reach people with loved ones deployed to Iraq and Afghanistan!

The PTSD Disconnect

Dear Readers: The purpose of this Blog is to provide information for spouses and families of military veterans, especially those who return from a theater of war.

The subject of today’s post is the PTSD Disconnect….

While anger is the most difficult for me to understand (see the previous post), the disconnect between a discussion on feelings and what my husband talks about is the most difficult for me to deal with. I think it is a surprise, too, for those who experience it for the first time and wonder what is going on. Here’s an example.

Topic: How the veteran feels about an event in his/her life, whether a happy occasion or an upsetting exchange.

Veterans response: An unrelated litany of life events that are running in his/her mind overtaking other thoughts. Often it is a mental tape loop that plays and replays, and may be often repeated in response to a question about feelings.

I have come to call this situation the “PTSD Disconnect.” It may run on for 15 or 20 minutes and include work stories, military anecdotes, school or other things the vet has done in the course of his/her life.

What is going on here? A psychiatrist might describe these looped memories as way to suppress fear or anger that the veteran felt in a war setting. And this coping mechanism has come to be used whenever feelings are called upon. Suppressing feelings is helpful when survival is at risk; it is necessary to think clearly and perceive threats in the environment. The adrenal system powers up and in time exerts its addictive capacity (see earlier posts). Feelings themselves are a threat; it is safer to revert to memories or anecdotes that cover up feelings.

What can you do? If you want to truly elicit feelings, be prepared for inappropriate reactions…sometimes the anger I have previously referred to, or – worse – terror or dispair arising from having to actually picture the hardwired image of the situation creating the fear. Sometimes there are child-like responses. There is always the potential for violence or for self-destruction.

My recommendation is to get help through the VA’s mental health services (see previous posts for contact information).

It’s hard to accept that the person who left is not entirely the person who comes back. It is important to become knowledgeable and understanding about what has happened to them. And, give them a chance to live as well as possible within the confines of the mind they bring back with them. Peace.

Dealing With Anger

I think my husband’s anger has been the most difficult thing for me to accept. This powerful emotion – or affect – appears at times when there is no discernible cause. Maybe the topic is what to have for dinner, or whether to go to the movies, or which car to drive some place…common, every day things. But this huge rage appears and blocks out everything else. There is no match between the size of the anger and the importance of the topic.

What is going on? Psychologists, psychiatrists and neuropsychiatrists explain this as perhaps part of the guilt that survivors feel, or anger from losing friends, or an underlying rage or despair from what the veteran has seen. But, I suspect a more malevolent force is in play:  It is the by-product of the military’s need to keep personnel in a chronic stress situation…ever alert, ready to strike, ready to kill; always afraid of the enemy.

Of course, one can see that having a quarter of a million people in this state at any given time is often perceived as a great advantage on the world stage. Unfortunately, when unleashed into the general population, this same group is disabled by the constant adrenaline rush and the notion it is okay to attack. In the worst case situations we see spouse abuse or even murder, drug addiction, suicide and homelessness. But even in the milder version we see withdrawal from family and friends at times, and the mystery of all the anger.

Well, the anger helps disperse the pent up energy to which adrenaline provides access. Some become workaholics, some take up running, some become hoarders. That nervous energy is forever coursing through the body. The eruption is the release.

Whose responsibility is it to deal with this situation? Some veterans take it upon themselves and for years and years and years they sublimate until one day it comes out and they are surprised by it. A very few, I think, truly understand its nature and can actually act in a conscious way to redirect the energy into something productive. But even so, I see sadness sometimes…true raw emotion, tears, a profound sense of loss. Redirection ultimately means losing that manic high that accompanies the adrenaline rush.

The military and the VA try to help. It’s categorized and groups are formed around issues. Research is undertaken. Counseling takes place. Things are explained to those being discharged. Lately, there has been discussion of the need to do preventive counseling when personnel are discharged, rather than wait to see who gets PTSD. It is starting to register that this is the natural outcome of the necessary training.

Families try to help. Some have more success than others. Some have more resources. Some can hold their veterans close enough that the need to flee (fight or flight, all part of the adrenaline rush) is not as strong as the bonds to stay.

So, how do I deal with the anger when it shows up? For a long time, I was simply baffled. I tried dozens of approaches. Rational argument first, but now long gone, was no match for the forces at hand. Yelling…not a great plan, but sometimes effective. But, that is just too tiring. Listening has worked best. There is still the anger and the demands for answers – and of course there is no answer to the endless non-sequitors. What do you say to “I don’t care if we have steak,” followed by “Answer me!”?

But listening helps. On a purely physical level, the angry energy gets used up. It’s not personal. I am fortunate in that my husband is not a violent person and had it instilled in him from a young age by his father not to hurt women. But, not everyone is so lucky.

So, the first rule is safety. Be safe.

Second, listen. It helps.

It may not solve everything, but it dispels the energy and eventually you may hear what’s underneath. Eventually, I heard things underneath. I heard the sadness of the life intended but taken away because of the physical and emotional damage. I heard the pain of what he saw with his own eyes that told him people could do horrible things to other human beings that they didn’t even know. I heard how hard he worked to act normal upon his return, but how his own behavior betrayed him.

There isn’t a solution to this dilemma. As long as we need military forces, we will need to do this to some people. Even when (I like to say when, not if) we figure out we need to use our genius to get off the planet not fight each other over its resources, we will need brave souls willing to stay in chronic stress to protect our people.

So, we owe them this much: Listen, care, and say thank you every time you see a young person in uniform or a grizzled veteran.

Health Care for Veterans

Health care is a key element of successful living with a disabled veteran. As I mentioned in my previous post, we are so grateful to the VA for the care my husband has received. We could get this help because of the excellent use of technology to organize medical records and deliver care, as well as the commitment to the veterans on the part of staff and care providers.

Here is an op-ed that appeared yesterday (September 3, 2009) in the NY Times that explains in terms better than I can why the VA system is the best health care system in the U.S. Yes, it was written to explain how a government sponsored health care system works when it works well. But, it worries me that if those opposed to health care reform get their way, we will lose this quality of care. If you tell disabled veterans they have to buy their own health insurance privately, the rate of homeless veterans, suicides and divorces will go up. I really don’t know what we would have done without the VA.

VA Health Care

To enroll in the eVets program go to this link:

MyHealtheVet

Please check out these links and let me know what you think. Thank you.

The Allure of Battle

The battlefield – like any experience – can be an addiction.

How does this happen? And, what happens when the battlefield comes home?

To answer this, I am going to explain 3 things I have learned in my long, evidence-based search to understand my husband’s mind. These items are:

1) the state of being that causes strong memories to become hard-wired in the brain (otherwise called learned response or addiction)

2) how this learned response produces chronic and debilitating stress when it is repeatedly cued (as in or near the battlefield)

3) what happens when we attempt to dampen this response (as when a soldier comes home or someone goes to rehab)

Item #1: Let’s say I learn that my favorite dog or my grandmother has died in a car crash. My body reacts and stress hormones flow into my bloodstream giving me what is known as a Fight or Flight Response. There is a rush of energy that is intoxicating. Medical students even tell us they like working in the Emergency Department because of this adrenaline rush.

In a dangerous situation, this response improves my survival odds by giving me extra energy and perception. The high energy state in the nervous system causes a strong memory to be hard-wired into the brain. Anytime there is a cue (sight, sound, smell, thought….) that releases that memory, the rush returns to some degree. Living in a violent culture or a battlefield is the kind of experience that produces this energy rush, memory building and learned response or addiction. We have identified this phenomenon as PTSD.

Item #2: When this response is repeatedly cued and the body is constantly full of stress hormones, body tissue is damaged as some of these hormones accumulate or break down over time. Like any system, over use brings damage. The brain/mind is affected as part of this process. But, the rush is intoxicating. To be in the war theater is to live in this constant state of stress addiction.

Item #3: Well, obviously, this is not an ideal preparation for a loving relationship or family. Some individuals will have a greater capacity than others for resilience – or rebounding – from such a background. Over time, the military has learned about this situation and works hard to overcome it. But, this is a very difficult challenge.

For one thing, soldiers entering military culture in their late teens and early 20s are in a developmental phase where their identity is still forming. They are, in essence, forming an identity in which violence is normal.

For another thing, the hard-wiring or addiction to the rush is impossible to remove. Therefore, preparation ahead of time and debriefing after deployment are matters of teaching people how to cope with experiences that are not in their best interest. They can’t be removed. They and we have to learn what to do when they feel the rush.

My conclusions: Before I write down my recommendations to military spouses, I want to extend to the VA system my enormous gratitude for all the help we have received. From our many years experience, I have to say that VA health care is the best health care system in the U.S. today. There are flaws, but the VA is miles ahead of most systems in using technology to implement healthy decisions, especially in light of its daunting mission. And, there is a preventive bent to much of the work we have witnessed or participated in.

That said, there is only so much medicine can do for people returning from the battlefield. Because my husband and I have been able to move from what seemed utter despair to a relatively happy and fulfilled life, here are some things I suggest. If you have others, please click on comments and share them. Thanks.

• learn what triggers cause upset – sometimes avoidance is the only safe strategy

• you cannot replace the bad memories, you can only create new good or bad ones

• keep good records – keep a journal, keep bills, letters, etc

• learn deep breathing and relaxation skills for yourself

• encourage healthy behavior

• maintain the support of others within and outside the military culture

• never lose patience but never submerge your identity completely in your spouse’s

• if there are physical or mental health issues, connect yourselves to the VA

Getting Here From There

I am writing this blog as things come up that I think might help others who are living with disabled veterans or those whose mental state is worrisome.

Today I want to say something reassuring. While neither my husband nor I are living quite the life we expected, we are okay. It is work and has been for 30 years.

When we met, he was functioning well – what I now think of as compensating really well for images in his mind that he can never get rid of. He has seen and participated in war. His injuries are not at first apparent, because they are neurologic/brain damage, and you don’t see them like you would a missing limb.

The hardest part is the memories, which recede but do not go away. When there is a new military action, those memories crowd around the present. Time becomes confusing. Stress is overwhelming. I have been in the hospital, helping care for my husband, and talked to the veterans and their families. We all struggle when there is a new military action.

Sometimes I think it would be easier if the damage were more outward. But that has its own difficulties. I have helped care for my mom in a wheelchair and the damage is with you all the time anyway. It’s physically challenging in a different way. With my husband I am tired from the constant drain on emotions and intellect. With my mom is was the lifting and carrying.

But the memories are what get to you.

How do I deal with it? Sometimes, I don’t. I turn my back on it and say I have to do this or that, or there’s no food or gas. Or even, if I don’t do this or that, there’s no me. I will have to come back to it and it might be harder later, but maybe not. Mostly, I run my own little mental tape: “War is evil and hard; we ask our young ones to go; they go; but they don’t come back – ever – the same as before; love them as much as possible because there is no other way to make it up to them.”

Sometimes at night, when we are all in the bed…husband, memories, self and two dogs…I listen to them all snoring and think: “This is the best it can be; I managed this; we are all here, okay, well fed. They can sleep peacefully and that is what matters.”