Healing Combat Trauma

Going to the Bunker: A Combat Veteran with PTSD on the Purpose of Protective Isolation

Every combat veteran with PTSD knows what is meant by their "bunker," or what "going to their bunker" means. It's a walled-off, isolated situation that allows them to get some space to themselves, away from other people (including family and friends), when they feel particularly triggered, and they need to stay in there for, well, as long as they're going to. They come out when they're ready, and not a moment before. Obviously this situation can be very frustrating to others in the vet's life, but for the vet it affords him or her some very necessary, protective isolation.

The rest of us who aren't combat vets with PTSD I suppose could think of it as the vet putting himself or herself in a time-out from the world, by taking themselves out of the mix, and away from people and stimulation, both bad and good. And the time-out will be over when it's over, because they decide when it's up.

The recent Fourth of July with its fireworks that remind many vets of combat was a classic bunker situation. Many, many vets were making plans before the Fourth for how to protect and insulate themselves from being triggered by the fireworks (noise, smoke, crowds). One Gulf War vet with PTSD who had already isolated himself, wrote of putting a pillow over his head and just wanting it to be over, so that he didn't have to experience it. The next day, fireworks all exploded, he was better. But during, he had to be in the bunker. Another combat vet with PTSD, from the Iraq war this time, talked about staying in her bunker for days, making brief provision runs, every fourth day or so, to the grocery store and then...back to her bunker. When she needed to be in her bunker...

The bunker concept/construct is so typical to combat vets with PTSD that I thought I'd ask one who I know fairly well how he'd describe it. He has decades of PTSD "experience" under his belt, and I've also seen him retreat to his bunker at various times. A month one time, a week another time, the last time, a day. Sometimes even a few hours. But however long the episode lasts, during that time: totally unreachable. And realistically, you better not even try...because it just makes the situation worse. 

The more chances I've had to experience this with him, the more certain I can be that, short time or long, he'll emerge from his bunker, when he's good and ready, and with a new and improved outlook on why he went in the bunker in the first place. (For those who don't know, the bunker can be anywhere...a shed, a garage, a spot in the woods, a room in a house, even a chair. But it's sacred, inviolate, untouchable space...and the vet goes there in retreat, partly to spare those around him, but also strongly to get control over what he's feeling. (He or she, obviously.) So I figured he'd be able to offer his personal/expert advice on this.

Here's how the conversation went.

Me: "What typically sends vets to their bunkers?"

Him: "Any situation -– losing a job, losing their cool, a fight with their kid -- that makes them lose control sends them back to their bunker, so they can regain control. It may not be much, but while they're there, at least they have control over that little room they're in."

Me: "What's the longest time you've ever spent in your bunker?"

Him: "A year."

Me:  "!!!"

And then he clarified. (Remember, this is just his opinion, but it's worth sharing, because of the number of vets he knows and has observed, as well as what he knows about himself.) "Each time a vet goes into their bunker, they go in for a longer period of time. Until one time they go in and they don’t come out." (He does know an awful lot of other vets who have sadly killed themselves. That happens in bunkers, too. No wonder families and friends are justifiably concerned.)

The progression he just mentioned...vets spending longer and longer times each time in their bunkers...is actually the opposite of what he's been doing, since I've known him (which coincides with his getting better). Each time he goes to his bunker, it's both less frequent, and for shorter and shorter times each time, to the point that the last "bunker" episode I observed him in was actually only about half an hour.

In the middle of a frustrating conversation, not quite an argument, but one where emotions were high and we weren't communicating smoothly, he "withdrew" to his bunker of self-enclosed, protective space -- without moving from the couch he'd been sitting on. I saw him cross his arms, very agitated, close his eyes, and start doing something that looked like huffing and puffing. Even on an animal instinct level I knew, give this person his space. All the body language was daggers. I stepped away, and a short while later, he bounced back, and resumed where things left off, able to manage the conflict without any undue strain. Turns out what he'd been doing during the huffing and puffing phase was actually deep breathing, to calm himself down and regain control. Very smart. On the outside, he looked furious. On the inside, he was doing what he could to get back under control. As a result, he was able to "emerge" from his bunker in record time -- which speaks to the tremendous benefits of learning coping skills and stress-reduction techniques, as he has.

When I first knew this vet, he talked about what he'd learned at an inpatient PTSD program at the VA years ago. It was the cutting-edge program at the time, and he speaks of it with great appreciation, even though many of the guys he went through the program with sadly did not make it. ("Did not make it" is euphemistic code for "sadly, later killed themselves.") One of the biggest things he learned in the program, according to him, was about "red flags" and "triggers," and how to get away before you make things worse. Heading for the bunker, just like in the description of the vet with the pillow over his head,  is one way to keep things from getting worse. For the vet, that is -- for the family or loved ones, it's very difficult to experience, and hard to ignore, though one of the secrets seems to be, going on with your own life, while maintaining a compassionate (but not nagging) concern for how they're doing.

One of the distinctions he likes to make, though, between what he learned from the behavioral modification skills, above, in the VA program, and what he's learned since then, following more of a healing path, is that now he has some ability to not just "avoid" triggers but also "deal with" situations as they come up. The red flags still show that the problem is coming, but instead of being ONLY triggered, there are now new ways to deal with it that don't only involve avoiding or isolating.

The situation above, of being in conflict but being able to "be" with it, and breathe through it, meant that the conflict didn't have to explode into a multi-day saga or a physical exit to an actual bunker, which could last for weeks or months -- or even a year(!) Ahhh, progress is a beautiful thing...

Editor's note: For Part II, "Busting Out of the Bunker at Last," go here.

Quotable Quotes -- the Oft-Neglected Role of the Caregiver in Illness

"As little as we know of illness, we know even less of care. As much as the ill person's experience is denied, the caregiver's experience is denied more completely." -- Arthur Frank, "At the Will of the Body."

Editor's note: We have a section entitled, "Caring for the Caregivers." Click on this link to expand.

Pulling the Pin: Combat Vets, PTSD and Troubled Personal Relationships

Combat veterans with PTSD often have tremendous difficulty with their closest personal relationships: marriages and families.  Divorces, multiple marriages, and short-term relationships that end unhappily are very common: All situations that compound the pain and suffering that already exists with PTSD.

While there are a few books out there that provide some helpful advice about the difficulty of combat vets with PTSD sustaining good relationships, some insight is also in order.  While many obstacles could be mentioned, we'll stick to just a few important ones.

1.    Needing to have a constant enemy. Combat veterans will tell you that their training requires a constant enemy for alertness, vigilance, what amounts to staying alive. Once combat ends -- or between episodes of combat -- that "role" needs to be filled by somebody.  The most obvious candidate to fill that role?  The combat veteran's usually unwitting, and unwilling, partner. If the spouse or partner isn't available, the next best candidate is a child. The combat veteran is often unaware that he or she is using this tactic at all, and the one victimized by it can often tell "something is wrong," but isn't always clear on exactly what that is.

2.    Pestering and teasing doesn't feel like love, but it does feel like irritation. Let's say the coast is clear.  It's a sunny day, everything seems (temporarily) all right in the combat veteran's world. But he or she teases and pesters a spouse, partner or family member (e.g., a child) incessantly, until that person gets fed up and walks away.  "But I was just teasing!" says the combat veteran.  Yes, but the frictional nature of the allegedly good-natured teasing has a predictable effect: it drives close others away, much like bad behavior also does. Now the combat veteran can be left alone: But is that what he or she really wanted?  Perhaps.  Perhaps not.  The main thing, combat vets say informally, that inspires this strategy, even on an unconscious level, is that too much peace and calm is off-putting, and creating (or re-creating) a little "chaos" in interpersonal relationships puts the combat vet with PTSD back where he or she is more likely to be comfortable.

Now factor either (or both) of these two behavioral patterns (among several others that could have been discussed) with the combat veteran's periodic desire for intimacy -- and imagine the realistic toll that such behavior, even if unintentional, takes on the spouse or partner's desire for intimacy.  More likely, either one or both of these behaviors is more likely to shut down or numb the spouse or partner, who then is more tempted to resist attempts at intimacy.  Is turning down intimacy the problem?  Is it the only problem, or even the central problem?  Probably not, if either of these fairly typical behaviors are an issue.

Combat Veterans, PTSD and Domestic Violence - A Sometimes Deadly Combination

Domestic Violence a Growing Problem for Veterans

“The increasing number of veterans with posttraumatic stress disorder [PTSD] raises the risk of domestic violence and its consequences on families and children in communities across the United States,” says Monica Matthieu, Ph.D., an expert on veteran mental health and an assistant professor of social work at Washington University in St. Louis. “Treatments for domestic violence are very different than those for PTSD. The Department of Veterans Affairs [VA] has mental health services and treatments for PTSD, yet these services need to be combined with the specialized domestic violence intervention programs offered by community agencies for those veterans engaging in battering behavior against intimate partners and families.”

Matthieu and Peter Hovmand, Ph.D., a domestic violence expert and an assistant professor of social work at Washington University, are merging their research interests and working to design community prevention strategies to address this emerging public health problem.

“The increasing prevalence of traumatic brain injury and substance use disorders along with PTSD among veterans poses some unique challenges to existing community responses to domestic violence,” says Hovmand. “Community responses to domestic violence must be adapted to respond to the increasing number of veterans with PTSD. This includes veterans with young families and older veterans with chronic mental health issues.”

VA research shows that male veterans with PTSD are two to three times more likely than veterans without PTSD to engage in intimate partner violence and more likely to be involved in the legal system.

— Source: Washington University in St. Louis

Avoiding Intimacy: Passion is Frozen Out, Along with Every Other Good Emotion

In our on-again, off-again series on "healthy sexuality and the combat veteran," here are these words of wisdom from someone involved in a healing profession, who's been married to a combat veteran for more than 25 years now.  Together, they are the parent of one child.

The veterans' aversion to intimacy, she believes, can be traced to one thing, most of all:

"It's the wall," she says -- not meaning the "Vietnam wall," that's for sure; although they may have some inadvertent relationship (poor attempt at humor, I know."  Veterans, she says, "build this emotional wall: the body, mind and spirit join together to "protect" the person [the combat veteran].  Much like the immune system kicks in to fight off illness, the mind sets off a red alert to fight off and keep bad feelings from invading.  Unfortunately this also fights off good feelings. 

Passion is frozen out along with every other good emotion.  Joy, love, hope, excitement, all trapped out.  They can act as if they have all of them but they are unable to really feel any of them. 

 

Men will have one-night stands and visit hookers for the act of having sex, but they also do it because it is safe. There is no chance of emotional involvement.  In their minds, they know there isn't supposed to be one [the chance of getting emotionally involved].  But if they decide to have sex with someone they are supposed to be connected to, it's a letdown because they are not really attached to them. 

 

When you make love to someone you really care about, you feel the passion between you because all of the "human" is participating in it.  With PTSD, the wall stops the unity between the two people.  Physically they are there but the rest of them is not.  When they touch you, it's as if there is no psychic energy in their hands.  When they hold you, their muscles are there, but there is no heat from their embrace.  When they kiss, it's a kiss of a stranger.

 

A lot of this has to do with their age at the time they were wounded by trauma.  Most were under 20 at the time the rest of us were finding ourselves, developing the "unity" of the elements that make us who we are.  Practicing and forming of development of the "unity" comes with experience and if that is subjected to emotional disconnect, it is broken off.  Usually it does not mend.

 

When they are older and trauma hits, they have already developed the connections of the unity and they tend to not have as much of an issue, using the other parts of "them" to compensate for their lack of unity.  Even with age as a factor, there are still the missing elements trapped behind the wall."

In future posts, we will continue to explore this topic further.

When Two Are Better Than One: A Relationship That Can Save You

Although at first glance, we should really save ourselves -- not be saved by others -- there's something wrong with looking externally for something that should come ultimately from within -- still, relationships can exert powerful forces for good in our lives.  It's painful reading about the Vietnam veterans, for example, who are "unable to touch intimacy," or who still clearly keep intimate relationships at a distance, because they're afraid of the weight of failure, among other things. 

There's a nice segment of a poem from T.S. Eliot that speaks to this.  Eliot was a famous Modernist poet, from the school that developed around World War I, and while he wasn't sensational about this in his own life -- his first wife, Vivien, to whom the words "My nerves are bad to-night.  Yes, bad.  Stay with me." are attributed in Eliot's famous poem, The Waste Land, is also a woman he institutionalized; still, he is able to write these comforting words, which perhaps he practiced himself, and perhaps did not.  (They could also be about his marriage to his second wife, which was apparently much happier, though shorter-lived.  He was married to her at the time he wrote these lines.)  In any case, they can still serve to inspire us with their truth:

"If a man has one person, just one in his life,
To whom he is willing to confess everything --
And that includes, mind you, not only things criminal,
Not only turpitude, meanness and cowardice,
But also situations which are simply ridiculous,
When he has played the fool (as who has not?) --
Then he loves that person, and his love will save him."

-- T.S. Eliot, The Elder Statesman (1958).

Editor's note: For our ongoing series on "healthy sexuality and the combat veteran," go here.