Healing Combat Trauma

Accessing Your Built-In Healing Mechanisms after Combat

It's safe to say that Patience Mason is a one-woman, cottage industry of helpful materials about dealing with PTSD.  Married for umpteen years to a Vietnam veteran with PTSD (Robert Mason, author of Chickenhawk), Patience has learned many life lessons of tremendous value to veterans. Along with Kathie Costos, Aphrodite Matsakis, Ph.D., and a few others, Patience Mason is one of the women who've given the most to helping vets and their families to recover from "combat trauma."  Read her helpful suggestions, below, and notice the emphasis on mind-body medicine, and in particular, mindfulness meditation.

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Since PTSD can also be triggered by subsequent events throughout the rest of your life, it is wise to learn how to heal. Many older veterans have lost their friends and families because of the struggle to hide symptoms and seem fine. The current war has also re-triggered PTSD symptoms in many older veterans because they remember. They know what you’re facing. If this has happened to you, don’t think treatment didn’t work. It worked before and it will work again. Go back for more.

Each symptom of PTSD develops from a bodily-based, God-or-evolution-given built-in survival mechanism, designed to keep you alive. We all have these survival mechanisms, and if we had been through what you have been through, we would also be affected. You learned these survival mechanisms under the hammer of war.

When you are ready to get better, you have to learn what they are, when and how they are useful, and new skills for when they are not. Each met a need, usually for survival, and finding other ways to meet your natural needs for safety and security is the job of recovery.

We also have built-in healing mechanisms. Attention (eye contact, being listened to, receiving empathy and respect), telling your story, safe touch, acceptance (bad things happen; they are painful), crying, making a contribution (working for the common good [altruism] and to support your family), justice, and spirituality are some of our built-in healing mechanisms. Our culture finds some of them awkward.

While avoidance strengthens and perpetuates PTSD symptoms, it is much less painful than the work of healing, especially if you have lost buddies, your sense of yourself as good or competent, and/or have shame or guilt or despair associated with the trauma as most people seem to. Somehow feeling like it is your fault, and if only you had done something, it wouldn’t have happened, makes you feel less powerless. The essential ingredient of trauma, however, is that it is overwhelming and you are powerless. No one can stop bombs or bullets with if-onlys. Many people spend their lives after trauma waiting and wishing for a better past, instead of working through the pain and anxiety for a better future.

Exposure is the basic task for healing PTSD. It teaches the parts of your brain that don’t speak English and can’t tell time that it is over. Exposure to what you are avoiding in small safe doses with a trained trauma therapist makes a huge difference. Often this is telling parts of your story again and again so that details come back and you can comprehend the whole experience. If you want to avoid these details because you think whatever happened was your fault, talking can help with that, too.

Most vets feel that if they ever let themselves feel, it would destroy them, but numbing bad feelings means the good ones are gone, too. Healing means you learn how to sit with a feeling and let it peak and fade, so you can process your memories. You went through hell. The feelings will hurt, but they will also pass eventually. Your therapist can teach you how to identify your feelings, that you are not your feelings, and that other people can have different feelings without either of you being wrong.

You can even learn to go in and out of numbing, since it can be handy, as can many of these survival skills. If you have developed an addiction to help you maintain numbness, you probably need to get clean, sober or abstinent from the substance or behavior.

The best way to deal with non-verbal memories is to move them from the non-verbal parts of the brain up to the frontal lobes and turn them into narrative memories, in other words: remember. Writing and rewriting something that happened to you is one way of doing it. Talk therapy is another. You get to tell your story. This is painful but you made it through the event, and you can make it through the memory.

For hyper-arousal, I always suggest basic un-training. Every soldier I’ve ever met thinks the military taught him to take care of himself. “Oh, really?” I often say, “So you used to say to your drill instructor, ‘Sorry Sergeant, I can’t do that. I need a nap.’” This usually gets a big laugh, but that is the kind of self-care you need to learn. After you have been to war, there are some things you simply can’t do. Sometimes it’s parties (don’t bunch up), cookouts (burning flesh), family fights. Sometimes it’s “Don’t ever come up behind me and grab me.” Whatever it is, learning to speak up is important. You have to learn self-soothing methods, so you’re not always yelling and angry.

You have to expose yourself to triggers in small safe doses, too, so they lose the power to trigger you. Learning that what triggers you is not necessarily dangerous here is also important, so your family doesn’t have to avoid your triggers.

Learning to meditate helps with these tasks and keeps you present in the present. The book Wherever You Go, There You Are, by Jon Kabat-Zinn helped Bob a lot. He also reads Thich Nhat Hanh. [Editor's note: Claude Anshin Thomas likes his work very much.] You may also find ways to heal your body’s constant state of tension through somatic therapies or yoga.

You may have to heal your beliefs. During extremely traumatic events, such as having a buddy die in your arms, or get killed when you weren’t there, people often decide “I will never love anyone again” or “I should never have left” or “It’s my fault.”

Other beliefs that can interfere with healing and with everyday life include ideas like “Don’t talk about it,” “Only weaklings and whiners ask for help,” “You can’t trust anyone who wasn’t there,” and its converse, “You can (and must) trust anyone who was there.”

PTSD can make you feel totally out of control. By choosing to take new actions which have worked for others, you can regain that sense that you are in charge of your life.

-- Home from War, by Patience Mason.

Healing and the Mind: Mind-Body Medicine and Mindfulness Meditation

"May the stars carry your sadness away. May the flowers fill your heart with beauty. And may hope forever wipe away your tears." -- Chief Dan George.

Continuing our series on mind-body medicine, here's a little information about Jon Kabat-Zinn, Ph.D. whose multiple works on mindfulness meditation are mentioned frequently in the field.  (See Patience Mason, etc.)

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Back in the early 1990s, journalist Bill Moyers (pictured, left) had a great series on PBS, followed by a book of the same name, called "Healing and the Mind."  It was a fascinating look at the way non-medical aspects of healing could come into play and help restore people to health and vitality. The series was really the first of its kind to talk about these far-ranging subjects to a mainstream American audience, and many people achieved a measure of fame and prominence by being highlighted by Moyers and this series.

Jon Kabat-Zinn, Ph.D., trained as a molecular biologist at MIT, was one such person.  According to Wikipedia, which happens in this case to be right, "Kabat-Zinn is the founder and former Executive Director of the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School. He is also the founder (1979) and former director of its renowned Stress Reduction Clinic and Professor of Medicine emeritus at the University of Massachusetts Medical School."  Mindfulness Meditation is Kabat-Zinn's specialty, and he's had great results teaching it.

Other luminaries in the field of mind-body medicine, of which Kabat-Zinn's work is a part, include James S. Gordon, M.D., Dr. Bernie Siegel, Rachel Naomi Remen, and John Sarno, M.D, among others.

I wish I could remember, at this remove, what the point of Kabat-Zinn's work at the University of Massachusetts Medical Center's Stress Reduction Clinic was - but I think it had something to do with heart disease in men, and whether leading patients through mindfulness meditation exercises would have some beneficial effect on the men's stress levels and heart health. My memory is that it did, and "Healing and the Mind" featured some compelling stories of how much the men's lives had changed who practiced mindfulness meditation with Kabat-Zinn. 

There's a whole semi-wiggy at first but highly interesting concept that's been put forth by several leading lights in the medical arena that "hearts" are where men store "stress," in the form sometimes of sadness and depression -- possibly over all they've experienced in their lives, but have not had the benefit of sharing openly (it's not a guy thing ;-).  If I remember from that program, lo these many years ago, I think it mentioned something about how men who had undergone open heart surgery often suffered severely from post-operation depression, and lives were being lost AFTER operations had been successfully, because the predominantly male patients had not learned better ways of coping with stress, sadness and depression, and would succumb, in a weakened state.  My memory is that when Kabat-Zinn invited some of these very sick patients to class, over a short amount of time they learned to process their needed grief and pain and regret, but still move on with their lives, thanks to the techniques of mindfulness meditation, as taught by Jon Kabat-Zinn, Ph.D.

It's interesting to note how many others have turned to this same "technique" to deal with some of the horrors they've experienced, like PTSD.

Editor's note: Jon Kabat-Zinn, Ph.D.'s most famous books are: Wherever You Go, There You Are: Mindfulness Meditations in Everyday Life, andFull Catastrophe LIving: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness.

Waking up to the Boundlessness of Suffering from War - One Veteran Learns How to Overcome

Continuing our theme of "mind-body medicine," which we revisit from time to time, one of the more interesting books to come out by a Vietnam veteran talking about his experiences in war and afterwards is "At Hell’s Gate: A Soldier’s Journey from War to Peace," by Claude Anshin Thomas. 

 

Thomas grew up like many guys who went to Vietnam: poor in a hardscrabble American town, son of a WW II veteran, with whom he had a rocky relationship; athlete in school who had perhaps a glorified view -- from his relationship with his dad and from athletics -- about what combat would really be like, or what it would do for him.  He was clearly under the impression that it would "make him a man," and when reality hit, and he saw the things war really was made of, and that he saw himself do, well, it was a little too late to turn back. That was Vietnam in 1966. The scars from that experience would be touchstones for the rest of his life, and honestly -- he's shown more healing than many. 

 

First and foremost probably because he's been willing to admit the level of pain and suffering that Vietnam left on his "soul."  Here's some of his reflections from his book that Michael Herr, author of Dispatches, says was "written with relentless courage and utter compassion."  According to Herr, "this account of violence and transformation is one of the most amazing and wonderful stories I've ever read."

 

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Thomas, who went to Vietnam at 18, received numerous awards and decorations, including 27 Air Medals, a Distinguished Flying Cross, and the Purple Heart.  We first wrote about him back in February of 2006, and several times since, because his book -- and the way he's transformed his experience -- appear to be virtually one of a kind.  As he himself says, Vietnam is not unique in that "everyone has their Vietnam...everyone has their own experience of violence, or calamity or trauma."  What stands out about Thomas, though, is his willingness to acknowledge all the raw trauma, and somehow, to transform at least parts of it.  Now, for Thomas in his own words about some of the scarring, as well as some of the transformation from within:

 

"My body is covered with scars from my wars.  Every time I look at my body, touch one of these scars, I touch again the reality of war, and when I touch the reality of war, I touch all the suffering that is intrinsic to war.  In the past, when I felt pain from a scar, I tried to repress it, to hide it from myself.  But the physical wounds are not the most significant wounds of war.  The wounds of the soul, the spiritual wounds, the emotional wounds – they are far deeper, though less obvious.  And they are much more unpleasant to look at."

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"Recently I spoke with a man who said, “If you didn’t feel things so deeply, if you were numb or if you were able to deny your feelings, you probably wouldn’t have any trouble with the war.”  But in fact, the vast majority of the people who have closed themselves off from the reality of their experiences in war are suffering tremendously.  Hiding or avoiding does not eliminate suffering, it just drives it more deeply underground.  Then our suffering controls us more profoundly, in one form or another.  We cannot hide from our pain.  Trying to do so is like attempting to pour a liter of red paint into a half-liter container: It will spill and spread, covering every aspect of our lives.

 

That’s what was happening to me when I hit bottom, a place where the pain was so intense I didn’t know how to hold it.  I thought my only option was to die.  As we wake up to suffering, we may feel at some points as if we might explode.  Because waking up to the boundlessness of suffering is intense, the pain is raw, the feelings immense – spaceless, formless, empty.

The practices of mindfulness and meditation have provided me with invaluable resources and tools in those moments, in those hell places.  They also help me to go to those places with others, to support them in caring for and healing themselves.  I am able to sit with the dying, the wounded, encouraging them to tell their stories and listening deeply. I  also go to the front lines and talk to soldiers about not fighting.  I talk candidly with them about the effects and consequences of war.  I am also able to go to the back wards of hospitals and mental institutions to visit the hidden casualties of war and listen to their stories.  I sit with the disenfranchised, the social and cultural lepers, and listen. In all these places, with all these people, I practice breathing in and breathing out.  I practice being fully present.  And I offer them the tools of Zen Buddhist practice (direct experience), spiritual practice.  I hope to help them discover the practices and tools that have helped saved my life: sitting meditation, walking meditation, mindful speech, and deep listening.  I also hope to provide the experience of sangha (community) – to demonstrate how community can support us on the path to healing and the path to awakening.

 

I invite people to bring an end to their isolation.  Because together we can do more than we can do alone.  These tools, this practice of meditation, are important, even critical, because suffering is a reality of our lives, the lives of all of us.  The “Apocalypse Now” is not just in Vietnam; it is not just for Vietnam veterans.  It exists for all of us because we have eaten the fruits of war, the fruits of violence, the fruits of hatred.  If we don’t wake up to this, it will destroy us.  From the inside out, it will destroy us.  I know this from my own experience.  And I know this because I observe this happening all the time.

-- At Hell’s Gate: A Soldier’s Journey from War to Peace, by Claude Anshin Thomas.

Study Shows Mind-Body Medicine Works on PTSD

(Just what we've been talking about, and who we've just been talking about as well.  Heh.  Love that.  So confirming...)

Read down and see how therapeutic this would be for people in rural communities, with little or no access to the VA, who are in therapy or not, for DIY types and those who prefer to access healthcare through a practitioner of one kind or another.  Just wonderful... and we knew it all along :-)

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The Washington, DC based Center for Mind-Body Medicine (CMBM) announced today the publication of a landmark study on the use of its comprehensive, non-drug model to treat posttraumatic stress disorder (PTSD) in war traumatized children. The study, “Treatment of Posttraumatic Stress Disorder in Post-War Kosovar Adolescents Using Mind-Body Skills Groups: A Randomized Controlled Trial,” which was published today online in the Journal of Clinical Psychiatry is the first randomized controlled trial (RCT) ever of any intervention with war traumatized children. It is also the first RCT of a successful, comprehensive mind-body approach with any traumatized population.

The study demonstrates that the Center’s groundbreaking model can be used to produce highly significant and lasting changes in levels of stress, flashbacks, nightmares, and symptoms of withdrawal and numbing in highly traumatized children – those who lived in an area of Kosovo where in 1999 90% of the homes were burned and bombed and 20% of the children lost one or both parents.

 The CMBM approach includes self-expression and mind-body techniques and was offered to these children over 12 sessions in an educational, supportive small group setting. Eighty-two high school students in Kosovo participated in the study. The program was conducted by teachers and included meditation, guided imagery, breathing techniques, and biofeedback as well as self-expression through words, drawings, and movement. All the students met the criteria for posttraumatic stress disorder (PTSD) which was measured using the Harvard Trauma Questionnaire. Following the program, the number of students having symptoms indicating PTSD was significantly reduced from 100% to 18%. The reduction in symptoms was maintained at a 3 month follow-up. The improvement in PTSD symptoms was significantly greater compared to a similar group of students who did not participate in the mind-body skills program. This is the same model that CMBM’s founder and director, James S. Gordon, M.D., describes in detail in his new book, Unstuck: Your Guide to the Seven Stage Journey Out of Depression.

“This RCT,” Dr. Gordon, the lead author, says, “is important because it provides scientific evidence for the efficacy of a model that has been taught to almost 3,000 health and mental health professionals and educators worldwide. We’ve used this small group model to give tens of thousands of children and adults practical tools that help them to feel better quickly, and we’ve taught them to use their intuition and imagination to solve problems that had seemed overwhelming. We help traumatized people around the world to draw on strengths they may have forgotten they have, and we offer them a ‘safe place’ in which they can share their pain with others who have suffered as they have.”

“This model is educational, non-stigmatizing, and powerfully effective. It can be easily taught and can be used by people of all ages on their own,” Dr. Gordon explains. “It’s highly acceptable to populations which do not want to be given medication, those with no access to a doctor or therapist, and those who are in psychotherapy.”

This model, which Dr. Gordon presents in a step-by-step self-help format in Unstuck, is currently being used by CMBM with war traumatized populations in Israel and Gaza as well as in post-Katrina southern Louisiana. It is widely used with anxious and depressed people and those with chronic illness in the US, and has already been incorporated as a stress reduction program for students in a dozen US medical schools.

The CMBM model is also of increasing interest to the US Department of Defense and the Veterans Administration. “The military,” Dr. Gordon says, “understands the breadth and depth of the psychological crisis (as many as 300,000 returning veterans are expected to have posttraumatic stress disorder or major depressive disorder, and another 320,000 will have been made vulnerable to these conditions by traumatic brain injury). The military’s leadership is committed to finding evidence-based approaches, like the one taught by The Center for Mind-Body Medicine, that can make a difference for the individual veteran and his/her family, an approach that can be taught to the large numbers of professionals and peer counselors who serve them.” More than 100 health and mental health professionals who work with the military are expected at the next CMBM training in mind-body medicine on October 25-29 in Minneapolis, and many more are expressing interest in learning and using the CMBM model.

For more information about the upcoming training, click here,  or to order Unstuck: Your Guide to the Seven-Stage Journey Out of Depression", please email The Center for Mind-Body Medicine (CMBM) at mindbody@cmbm.org or visit www.cmbm.org.

Shaking Off the Blues: Two New Books Help Veterans and Others Get "Unstuck"

A well-regarded psychiatrist who thinks there are other-than-pharmaceutical antidotes to biochemical depression?  Rank heresy!  Oops, actually we meant -- how very refreshing indeed. 

A soulful journalist who's lived and worked in war-torn countries, and knows what it's like to be a survivor -- who then turns her attention to helping veterans and their families come home from war and rebuild the pieces of their often-shattered psyches? Again, a wonderful suggestion.

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NPR the other day published a great interview with none other than James S. Gordon, M.D., author of the new book called "Unstuck: Your Guide to the Seven-Stage Journey Out of Depression." Depression is an important topic, because many people who are risk for suicide have depression as an underlying state.  According to one psychiatry textbook for medical students, "A majority (60% to 80%) of people who commit suicide carry a diagnosis of depression."   

If you remember, we've talked about Dr. Gordon on this blog before.  He has an impressive, very talented background academically (Harvard College, Harvard Medical School), and is the founder of the Center for Mind-Body Medicine in Washington, D.C., as well as a frequent lecturer at the Smithsonian, and the former chairman of the White House Commission on Complementary and Alternative Medicine, also known as "CAM."  (We've blogged about CAM, also known somewhat misinformedly as natural medicine, and its opportunities for treating PTSD here on the blog, at length here; and also about the varieties of mind-body medicinethat might show some promise for treating combat trauma and PTSD, here.)

To listen to the NPR interview, or to read the accompany material on getting unstuck -- in Dr. Gordon's words -- click here.  To read Dr. Gordon's bio -- click here.  To read our previous posts about his work on "Healing the Wounds of War," click here; on "Healing the Troops," click here; and on his and the Center for Mind-Body Medicine's annual conference, planned for October 25-29th in Minneapolis, Minnesota this year, click here.  The topic of this year's conference is the highly-appropriate "Integrating Mind-Body Medicine into Clinical Practice, Medical Education & Trauma Healing."  As Dr. Gordon's website says, "We're teaching thousands to heal the world's millions." Indeed -- and what a noble task that is; and how very, very vital.

If I had ONE RECOMMENDATIONfor the Pentagon, the DOD, the VA, the various branches of the military (Army, Air Force, Navy, Marines, National Guard) that frequently comb this site, looking for answers to the questions they have -- it's that they would get to know Dr. Gordon's work, and send representatives to this conference in late October, 2008.  Check into mind-body medicine, with a credible expert, and somehow who's already worked with, and proven his work with, the war-torn and traumatized (troops and civilians) here and abroad.  Broaden the outlook on how to treat PTSD and combat trauma, by returning people to themselves, and helping them to learn to manage their own stress in creative and supportive ways.

Dr. Gordon says his book, Unstuck, goes into many of the same principles that his trauma work does. I can't wait to start reading my copy, which his office promises to send.

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In the meantime, I hope Dr. Gordon gets to cross paths professionally with Minnesotan Britta Reque-Dragicevic. I have read her book-- devoured it in one sitting is the more accurate description -- and think it has lots of potential to comfort, support and nurture returning veterans and their families in putting the pieces of the puzzle back together.  (One thing I love about both Dr. Gordon and Britta Reque-Dragicevic -- they both "get" it.  They've had a personal experience with what they're talking about; it's not just academic.  And they're both driven to help others heal from their suffering -- the not exactly unspoken single purpose of this blog: there's synchronicity.)

Reque-Dragicevic has written a completely soulful manual on getting unstuck herself, and with her profound understanding of the needs of trauma survivors, as a longtime journalist in post-war Saravejo and Bosnia, I sense a little (**magical?!**) professional matchmaking going on that would only serve to increase the amount of healing and overcoming in the world, especially am