Tag Archives: living with ptsd

The Realities of PTSD: Symptoms Are Survival Skills

Patience Mason is a friend of my wife and I. We are also members of the International Council of War Veteran Ministers.

The Realities of PTSD: Symptoms Are Survival Skills

Share this with a friend

Follow the Mental Health Resource

By Patience Mason, Mon, March 11, 2013
soldiers.jpg

Is PTSD normal after war? Yes, it is. Right after a single trauma, according to one study, everyone gets all of the symptoms of PTSD. Some of them seem to heal, so it is a disorder of healing.

Our society seems to be set up especially to prevent healing from trauma. Everyone wants you to be over it in a week. I remember hearing a woman who barely got out of the Trade towers on 9/11 saying a week later that her friends were asking her why she was still upset. After all, she lived.

It is illegal in this country to feel pain. We are all supposed to be fine. FINE is an acronym to some of us: F-ed up, Insecure, Neurotic, and Egotistical, which fits those people who think, “It wouldn’t have affected me / didn’t affect me / shouldn’t have affected you.”

PTSD Symptoms Are Survival Skills

All of the symptoms of PTSD start out as survival skills, which are built into the brains of all of us. No one is exempt. Those who seem to have been exempt, like John Wayne or Rambo, actually sat out their wars and were never exposed to combat.

Increased Arousal Not Present Before Trauma

The first survival skill set is called “symptoms of increased arousal not present before the trauma” by the diagnostic criteria. One problem with this is that, if they were present before the trauma, it probably means you were traumatized earlier. Beatings, emotional abuse, neglect, sexual abuse… when these happen to a kid, they are more traumatic – not less – and kids react by becoming very wary and very fast. This makes them better soldiers. It is what basic training is designed to reinforce because these behaviors will keep you alive.

The first PTSD symptom/survival skill is an effective (not “exaggerated”) startle response. Others include irritability and outbursts of anger, inability to fall or stay asleep, hypervigilance, and “inability to concentrate,” which is actually the inability to concentrate on anything that is not survival information. These keep you alive. This is the fight / flight / freeze capacity built into all of us that enables us to react before thought.

Our brains are designed to scan for danger and react instantaneously. Since this capacity is based in what they used to call “the reptile brain” in high school science, it doesn’t speak English (that’s in the frontal lobes, the last part of the brain to develop) and can’t tell time, so you can tell yourself you are home and it is over, but the message does not get through to this part of the brain for a long, long time – sometimes never.

Numbing and Avoidance

The second survival skill set is called numbing and avoidance. Our brains are designed to pay attention to threats, which means extraneous stuff like emotions go into a box. The brain is also designed to rapidly adapt to whatever is going on, which means the first dead person is very upsetting, the second, not so much, and by the third, you may be numb as a stump. This keeps you able to keep fighting and doing your job, saving yourself and others. (In medicine, this is called professionalism.)

Trauma/combat happens so fast that you can’t take it all in, so you may forget all or part of some particularly horrific incident, which is your brain’s way of protecting you. Unfortunately, those details remain in the emotional/non-verbal parts of the brain and may cause you a bunch of trouble later.

Once you have been in combat, you may not be expecting to live long. You know, on the most basic level, that life can end in an instant. You’ve seen it. You will also probably feel like other people can not understand, that you are different, so you get detached and estranged from people. Part of this is because after your buddies are killed, you protect yourself by not attaching to new guys, but it is also a reality you are going to face for the rest of your life.

Your brain has been changed by combat. And OTHER PEOPLE CANNOT UNDERSTAND WHAT YOU HAVE BEEN THROUGH. I learned this when I came out of the movie Platoon and said to my husband, “That was so awful!” He looked at me, almost puzzled, and finally said, “It’s worse when it’s real.” That statement hit me hard, and I realized I will never know. I may want to understand, but if I am honest, I know I can’t.

On top of this, people say such shitty things to combat vets – “Did you kill anyone?” “Why aren’t you over it yet?” etc. – that you know they don’t understand.

Then you start to avoid things that remind you of the trauma. You avoid thoughts and feelings that remind you of the war, so if you were happy and your squad got hit, you may decide you will never be happy again. If you feel it was your fault, you may decide you will never be wrong or feel guilty again, which will make you self-righteous and argumentative and critical of others. If you love your buddies who died (and soldiers in combat are closer to their buddies than anyone) you may decide never to love anyone again. Next you avoid activities and situations that remind you of the trauma: driving, cookouts (burning flesh), crowds (bigger target), sports involving blood (hunting, football), movies, reunions, etc.

Avoidance behaviors are survival skills in that they help you avoid triggers which can cause strange, embarrassing behavior. And triggers can have children and grandchildren so that if a car backfired while you were watching kids play and you hit the dirt, the sound of kids playing can become a trigger too… The progression of triggers can get you to a point where you can’t leave the house. Avoidance is also a survival skill because it keep you from feeling a depth of pain that most people cannot imagine, a depth of pain that is quite illegal in America, the land of the “fine.” Once you are numb, it is much easier to stay numb. The commonest way to do this is alcohol, although almost any substance (drugs, food, booze, etc) or behavior (sex, gambling, internet, religion, shopping, TV, workaholism) will do.

Unfortunately, your brain also wants to figure out what happened, so you will also start re-experiencing the trauma. This is what brought PTSD to the attention of shrinks who were determined not to see it back in the 60s and 70s (the American Psychiatric Association’s denial and delusion period) so they think it is a weird re-experiencing disorder with associated weird behaviors. I’m lucky in that I knew my husband before he went, and after I found out there was such a thing as PTSD, I began to look at why these symptoms developed and how it would happen under the hammer of war. That is why I see PTSD as normal, meeting the need to survive built into all of us. (By the way, others who think like me include John Briere, PhD, and Sandra Bloom, MD, and some of the ideas I have mentioned here came from their work.)

I think the most helpful thing I can do for our returning vets and our vets who are being re-triggered is to blog about my take on PTSD as a normal response to war. If you take nothing else away from my blog, remember it is NORMAL TO BE AFFECTED BY WAR. NORMAL. NORMAL. NORMAL.

This article is a guest post from Patience Mason’s PTSD Blog. It was republished at Veteran Veritas with permission.

Invisible Wounds Hurt Veterans Job Chances/ LA Times/ Alexandra Zavis

Invisible Wounds Hurt Veterans’ Job Chances

This saga has been underway since the first troops rotated after the Shock and Awe bombing of Iraq in 2003.  For the past 7 years only one mission has been accomplished, the war side one.  Post war battles are harder to fight, because the soldier is not armed with the emotional weapons to overcome a bio-chemical make- over of  their entire being. At least not in the employers minds.

I predicted this patriotic hypocrisy following the first retreat I attended in 2005, for returning combat veterans. There were 19 at the workshop, and 11 of them had trouble getting their jobs back after deployment.  Four of them were engaged in lawsuits with former employers. They were all reservists who by Federal Law must be allowed to return to their jobs after being called up for duty.

What was the Employers response to these young warriors? “Sue me, then.”  So much for the yellow ribbons.

And this is just the first wave of troops rotating home. We think we have an unemployment problem now?  Wait for the next wave to hit the barren beaches of bleakness in the economy.  I remember well 1973 when no one wanted to hire a Vietnam Veteran.

There is, however, an aspect to this job placement dilemma that is really quite positive. Now the VA cares. Now our current Administration cares. Now there are mentoring programs and vocational rehabilitation that never existed in my era of suppression and repression of all war related matters.  We are a bit more enlightened about a soldiers needs. That is a good thing.  The funding and support for these programs needs to be ongoing and stable until every Soldier, Sailor, Marine, Airman, and Coast Guard combatant are safe at home.  Without that assured commitment, we will only see a deja vu of the self destruction and homelessness that visited us in the veteran community for the 25 years following the end of the Vietnam War.  There were no yellow ribbons then, just suicides.  We can do better, and will.   Mike Brewer/USMC

The article follows.

Michael Butcher has applied for at least 25 jobs since injuries he suffered in Iraq forced him to leave the Army three years ago.

“I was even turned down by McDonald’s,” said the 29-year-old San Diego native.

The military is known for developing leadership, adaptability, loyalty and teamwork. But Butcher said when he tells employers he needs time off to see therapists for post-traumatic stress disorder and a brain injury, they don’t call back.

“They think you are mental,” he said.

After nearly a decade of war, many U.S. military veterans have lived through extended periods of combat stress and the trauma of losing colleagues. Nearly a third of the troops returning from Iraq and Afghanistan report symptoms of PTSD, severe depression or traumatic brain injury, according to a 2008 study by the Rand Corp.

Many of these new veterans struggle to find and retain civilian jobs. Not only are they returning to the worst economy in decades, advocates say, but many employers do not know how to accommodate these invisible wounds and worry that they might “go postal.”

“If you are a person with a lost limb, it’s a little more straightforward what you might need,” said John Wilson, assistant legislative director for Disabled American Veterans. “You might need a different kind of keyboard or voice-recognition software to do the typing.”

But employers may not know what to expect from a person with PTSD or a brain injury. The symptoms can include severe headaches, memory lapses, poor concentration, slurred speech, loss of balance, a short temper and anxiety in a crowd.

“These elements can make it a challenge to do everyday activities in the workplace,” said Raymond Jefferson, assistant secretary for the Veterans’ Employment and Training Service in the U.S. Department of Labor. “But there are very reasonable accommodations employers can make to allow wounded warriors with PTSD and [brain injuries] to be high-contributing, high-performing members on the team.”

When the Society for Human Resource Management surveyed its members in June, 46% said they believed post-traumatic stress and other mental health issues posed a hiring challenge. Just 22% said the same about combat-related physical disabilities.

Although media attention has helped make the diagnosis and treatment of PTSD and traumatic brain injury a government priority, veterans say it has also contributed to the stigma associated with these wounds.

“They hear so many stories on the news — this soldier got back from Iraq and killed his wife — which makes people a little reluctant to hire you,” Butcher said.

Butcher deployed to Iraq in 2003 as part of a tank crew that repeatedly came under fire. One hot day he left a hatch open and the force of a grenade blast slammed his head against an iron shield.

Many veterans are using education benefits to improve their qualifications. But when Butcher enrolled in community college, the sight of Muslim students kneeling to pray triggered terrifying flashbacks. He left after one semester.

A friend helped arrange an internship at a computer manufacturing company, but Butcher said he got into frequent arguments with co-workers. After four days, he was asked to leave.

Butcher said he has since learned to walk away when he gets angry and uses weekly counseling sessions to relieve stress. But he said the flexibility he would need from an employer puts him at a disadvantage compared to job seekers who don’t have special needs.

Officials with the U.S. departments of Veterans Affairs, Labor and Defense have worked to assure potential employers that the mental and cognitive disabilities of many veterans can be accommodated with little expense and minimum disruption.

Short rest periods — no longer than a smoking break — can make a big difference, said Ruth Fanning, who heads the VA’s Vocational Rehabilitation and Employment Service. The department also pays for adaptive technology, such as electronic organizers to help keep track of appointments and white-noise machines to reduce distractions.

Denita Hartfield, a veteran now working from home, takes a digital recorder into every meeting, writes lists in color-coded notebooks and covers her workspace with Post-it note reminders. A striking woman, fashionably attired, with a master’s degree in criminal justice and weapons of mass destruction, Hartfield struggled as dean of students at a business school because her disabilities were not immediately apparent.

“I need my appointments to live,” she said.
Hartfield now wants to set up her own business advising veterans and employers how to work together. She says more open communication would have helped in her case, but at first she did not want to acknowledge her disabilities.

“One of the problems is so many folks aren’t even talking about their invisible wounds,” said Tim Embree, legislative associate for Iraq and Afghanistan Veterans of America. “The issues are different with every individual, so what I think matters is that the individual understands what’s going on as well as the employer.”

To help employers better accommodate the mental health issues veterans face, the Department of Labor has set up a web site, America’s Heroes at Work.

Many veterans find civilian work with the U.S. government, which is one of the largest employers of former military personnel; they make up a quarter of the federal workforce. About 40% of the staff at VA medical call centers in Northern California are disabled veterans, many of them with PTSD or brain injuries, according to Project Hired, the nonprofit contracted to run them. Los Angeles Habilitation House is training 18 veterans with invisible wounds to provide contract management services to the government.

They include Ronta Foster, a 49-year-old father of two who has cycled between the Army and low-paying civilian jobs for years.

He was diagnosed with PTSD and traumatic brain injury after deploying to Iraq in 2003 but traces the symptoms back to a beating he received outside a German nightclub in 1982.

“The opportunities have been far and few for me,” Foster said. “This here is going to give me an opportunity to start another career and take care of me and my family. That’s all I have been wanting to do for 30 years.”

Some companies also seek out veterans. Joshua Stout is one of 80 people recruited through Northrop Grumman’s hiring program for severely wounded veterans from Iraq and Afghanistan. A former Marine who served in both wars, he now works as a project manager at a plant in San Diego that is developing an unmanned surveillance plane for the Navy.

The company consulted occupational nurses on how to help the 27-year-old manage PTSD and a brain injury. They showed him how to set reminders on his computer and arranged his cubicle so co-workers could not come up from behind and startle him.

Stout said he struggled to learn how to manage databases, but his supervisor worked with him until he could remember the steps.

“I get a lot of self pride out of working for this company,” he said. “I’m still supporting the troops and I’m still defending freedom.”

Although accommodations have to be made, Karen Stang, who manages the hiring program, said managers appreciate what veterans like Stout bring to the company.

“They bring loyalty, a great work ethic, commitment,” she said. “It’s been a real win-win.”

alexandra.zavis@latimes.com

Copyright © 2010, Los Angeles Times

Online Support for Wives

A support group for women.
A support group for women.
The veteran community has access to numerous programs for veterans struggling with post traumatic stress. Help is available through many channels for veterans, veterans’ caregivers, and veterans’ families. Children are getting a lot of attention these days, and deservedly so. Changes in Mom or Dad when they arrive home can be overwhelming. The person closest to the vet, the one directly in the path of the fire – the spouse – is sadly the one with the fewest resources for support.

No one but another spouse really understands. Friends and family quickly lose patience, both with the veteran, and with the spouse who struggles to hang onto the relationship.

To the women out there who need an understanding friend, who need to feel that they are not alone, I recommend visiting an online support group founded in 2001. Administrators at our local VA hospital and Vet Center refer women to this group. Just this morning, I heard of a woman who was given the web address by her doctor in Texas.

It’s a great site. You really are not alone.

http://livingwithptsd.yuku.com/