Healing Combat Trauma

Shneidman and Camus -- Suicide as "the Fundamental Question" of Philosophy

"Suicide is up in the military once again, and it's also up among veterans -- those who have been deployed previously. While "National Mental Health Awareness Month" may still be a few months off -- in May -- but it's interesting to note what existential philosopher Albert Camus wrote in his book, "The Myth of Sisyphus":

"There is but one truly serious philosophical problem, and that is suicide. Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy."

And also humanity, we might add...because it figures in there, too.

Dr. Edwin Shneidman, the compassionate genius considered the "father" of suicidology, who sadly passed away a few months ago, wrote about how suicide is a narrowing of the distressed person's field of vision, until they can see only two options: staying or going. Without broadening the options to three or more, the way that healthier people think, a distressed person may vacillate between these two options until the pressure in their life mounts, and they can only "see" the one option, and their timing suddenly becomes a desperate "now."

(Clearly, suicide is an event with much collateral damage, particularly to those around the person in pain, who can have an understandably extraordinarily difficult time coming to terms with how or why that decision was made. Read Shneidman; he understands. In one poignant passage, quoted here, he describes the mind of the suicidal person closing down in restricted vision until, not that the victim doesn't care, that he or she can no longer see who else is in the picture, so great is their personal pain.)

While there's much material on this website about suicide, particularly here -- and also help numbers to call if you're in distress, linked here -- I mention the Camus quote to give a certain backhanded respect to the topic as a whole. Many times people claim, rightly or wrongly, that suicide is the quintessentially weak move, "the coward's way out," reserved for those who can't, or won't, face their problems, others say judgmentally or even sometimes accurately. Yet for those who are suffering greatly, and contemplate it periodically -- as many honestly do -- it's "nice" to see someone with real cultural weight give the question some credence or respectability as a topic. To paraphrase Shakespeare, "to stay or not to stay" may turn out to be the real question, after all...

What the Camus quote implies is that even robustly mentally healthy people, if they're philosophically inclined, have dwelt on or wrestled with at least the abstract reality of the question. (Ironically,  Shneidman's obituary in the L.A. Times, linked here, mentions the same quote, and that Shneidman was a fan of Camus.) If we combine their perspectives imaginatively, true mental health might mean wrestling with the topic conceptually, but then enlarging the field of choices so that it doesn't have to become an option that is used. Could open discussions arise from removing the stigma around even broaching or discussing the topic? More on that later...

Editor's note: Cribbed directly from my friend Kathie Costos' blog, Wounded Times, here are the phone numbers and the information for veterans questioning suicide -- some of which support family members as well:

• Vietnam Veterans of America, Crisis Phone Number. Special Notice: If you are a veteran in emotional crisis and need help RIGHT NOW, call this toll-free number 1-800-273-8255, available 24/7, and tell them you are a veteran. All calls are confidential. http://www.vva.org/.
• Also, Veterans’ Crisis Intervention Hotline: 1-888-899-9377. A Crisis Intervention Hotline has been established by the VA Heartland Network to assist veterans who may be dealing with a mental health crisis or difficult issue in their lives. The hotline will also aid family members or friends of veterans who need help in assisting a veteran in crisis.

Triggered by Talking about Trauma

It seems a bit paradoxical that the very act of attempting to talk about trauma might actually trigger trauma, and turn out to be "too much" for the traumatized person to handle, but this can be the case, according to Belleruth Naparstek, in her well-regarded book, "Invisible Heroes: Survivors of Trauma and How They Heal." She writes:

"This is because with PTSD, language can be a trap. If a deeply traumatized person is prompted only to speak and think about the events that created his distress, without enlisting help from the imaginative, emotional, sensory and somatic capabilities of his right brain, his symptoms can actually get worse instead of better.  Encouragement to "talk about it" -- a therapist's and, for that matter, a good friend's stock-in-trade -- can catalyze a tailspin of flashbacks, nightmares and overwhelming anxiety."

Clearly, we're just scratching the surface here of a much larger topic.  But while the case can be made that listening to another deeply is often quite therapeutic, having to talk about (relive) something traumatizing might have adverse effects.

Social Support a "Powerfully Protective Factor" Often Not Available to PTSD Sufferers

A quote about PTSD and its impact on the individual sufferer's ability to receive support from those around him or her:

"Social support is a powerful protective factor (Brewin, Andrews & Valentine, 2000) that includes the capacity of an individual to accept or utilize social support when it is made available (Benight & Bandura, 2004). This may be especially problematic in PTSD where symptoms such as avoidance, alienation and detachment impair affected individuals from benefiting from available marital, family, and social support."

Source: Oxford Handbook of Anxiety and Related Disorders, by Martin M. Antony, Murray B. Stein, linked here.

Understanding Trauma: Exposure to The Darkest and Most Violent Forces of Human Nature

Periodically we run across a quote that seems worth sharing, to create a larger understanding of what those who experience trauma have gone through. Here is such a quote, directed in this case to practitioners.

"The examination of PTSD patients can be very stressful to clinicians. As Blank (1985) notes:

PTSD is caused by contact between the individual and the darkest and most violent forces of human nature. War, murder, rape, floods, etc. take the victim over the edge of life into serious confrontations with death or uncontrolled violence. Some individuals are therefore transformed and become, at some level, bearers of the traumatic experience. The (examiner) with whom they come into contact is thus inevitably exposed to war, rape, flood, etc. (p. 88)."

Source: Post-Traumatic Stress Disorder, by Kirtland C. Peterson, Maurice F. Prout, Robert Alan Schwarz

Abraham Lincoln on Sacrifice, Loss and Grief

"It is with deep, heartfelt regret and sadness that I write this letter. My words seem inadequate at a time like this so I will quote a letter Abraham Lincoln wrote Mrs. Bixby, who had lost five sons in the Civil War:

"I feel how weak and fruitless must be any word of mine which should attempt to beguile you from the grief of a loss so overwhelming. But I cannot refrain from tendering you the consolation that may be found in the thanks of the Republic they died to save.

I pray that our Heavenly Father may assuage the anguish of your bereavement, and leave you only the cherished memory of the loved and lost, and the solemn pride that must be yours to have laid so costly a sacrifice upon the altar of freedom.

Yours, very sincerely and respectfully,

A. Lincoln"

-- From a wonderful tribute written by Matt Farwell, 10th Mountain Division, Afghanistan, over the loss of his brother soldier, Army Sgt. Carlie M. Lee III, this past week. RIP, Sgt. Lee.

Who -- and What -- a Survivor Is

Quotable quotes:

"I define a survivor as one who has touched, witnessed, encountered or been immersed in death in a literal or symbolic way and has himself remained alive." -- Robert Jay Lifton.

LIfton, an American psychiatrist and pioneer in PTSD studies from the 1970s, is also the author of "Home from the War: Learning from Vietnam Veterans."

(Hat tip to Chris Lombardi, for pointing this one out.)

"Ding, Ding" -- Pavlov's Comment on PTSD

Famous Russian scientist (physician and psychiatrist) and Nobel Prize winner Ivan Pavlov -- famous for his experiments with ringing bells, feeding time and dogs that evoked the characteristic "Pavlovian response" -- also had some things to say about PTSD.  Bessel van der Kolk, M.D., a Harvard-trained psychiatrist, writing in his scientific paper, "The Body Keeps the Score: Memory and the Evolving Psychobiology of Post Traumatic Stress," mentions that Pavlov thought that "individual differences in temperament account for the diversity of long-term adaptations to trauma."  Interesting!

Editor's Note: The item van der Kolk appears to be citing is Pavlov IP.  Edited and translated by GV Anrep.  "Conditioned reflexes: An investigation of the physiological activity of the cerebral cortex."  New York: Dover Publications (1926).

Reality Check: Every Warrior Affects 50 Other People Around Him or Her

I was privileged to get to go to the Roxie Theater in San Francisco yesterday and see the world premiere and kickoff of the national tour for "Broken Promise," part of the "In Their Boots" documentary film series that focuses on veterans issues.

The Northern California location was appropriate, because the "Broken Promise" segment focuses on the Pathway Home, at the California Veterans Home in Yountville, and follows the lives of three Iraq War veterans who are residents there, part of an innovative treatment program for PTSD, run by longtime veterans advocate, Fred Gusman, M.S.W.

The documentary is interesting -- I'm still mulling over what I think about it -- and it was neat both having gone to the Pathway Home before to visit with some of the residents, and then seeing some of them there at the screening (including one whose story was featured in the film).  However, the best part of the movie for me was this particular quote of Gusman's, which drives home the importance of both seeing -- and treating -- vets with PTSD in community.

Said Gusman, 

"For every one person that's affected (by PTSD), there's generally 50 others attached to them, when you start looking at family members, employers, educational systems -- all the different folks who are affected by just one warrior."

While Gusman (in the film) goes on to make the argument for including vets' families in the treatment of the vets, the point here is a separate one.  That a single vet who's suffering -- or for that matter, overcoming -- is not a single vet.  He or she is the center of a number of concentric circles of effect that ripple outwards, affecting many others.  All the more reason to not neglect, or ignore, or put aside the struggles of veterans with PTSD.  Each one has 50 people he or she is affecting -- by his or her failures, and, over time, by his or her successes as well.  They're not just individual struggles: they're the center of a social web in which many others play a part, either directly or indirectly (by compassion and concern, for example, or neglect and indifference).

Editor's note: For more on the "In Their Boots" documentary film series, click here.  For more on Fred Gusman, M.S.W., click here.  For more on his work as Executive Director of the Pathway Home, click here.  For more on the Pathway Home residential treatment center for combat veterans with PTSD, click here.

The Ongoing Struggle for Combat Veterans

"I know I have to deal with it (PTSD): Because I'm either going to destroy it...or it's going to destroy me." -- Vietnam combat veteran.

Deep Survival -- Turns Out, It Can Be Due to "What's In Your Heart"

I read the most interesting book lately, having nothing to do with combat trauma and PTSD, yet everything to do with human beings' abilities to fight tenaciously for their own survival, and outmaneuver both death and chance, occasionally.  The book's title says it all: "Deep Survival: Who Lives, Who Dies, and Why" -- and it's by a risk junkie author who is himself the son of a genuine WWII battle hero, who survived some spectacular near-death experiences (including a fall 27,000 feet out of an airplane he was piloting, only to land in a German field and have a farmer nearby then try to shoot him to death, until that guy's gun misfired.  Unbelievable...). 

The book is riveting -- it follows the stories of well-prepared experts who perish needlessly, while under-prepared or un-prepared neophytes sometimes make it out alive -- and the author takes a look at recent brain research as well as in-depth accident reports to draw his conclusions about why sometimes the most unlikely types beat the odds and survive. 

The author's conclusion at the end of the prologue, introducing the rest of the book, is that often it's an unseen factor that accounts for who inexplicably beats the odds.  His book isn't at all about combat trauma or PTSD, of course, but I'm going to offer up what he says anyway, because I think (in a different, yet related context) it might give some people hope, who are struggling mightily with circumstances seemingly far beyond their control.  The message remains that there is still hope for them, too.  In the words of the author:

"It's easy to imagine that ... survival would involve equipment, training and experience. It turns out that, at the moment of truth, those might be good things to have but they aren't decisive. Those of us who go into the wilderness or seek our thrills in contact with the forces of nature soon learn, in fact, that experience, training and modern equipment can betray you. The maddening thing for someone with a Western scientific turn of mind is that it's not what's in your pack that separates the quick from the dead.  It's not even what's in your mind.  Corny as it sounds, it's what's in your heart." -- Deep Survival: Who Lives, Who Dies, and Why, by Laurence Gonzales.

We've talked about hope recently; and the reality is, sometimes you just know you're going to get better, even when it feels like no one else believes in you, or the evidence seems to point completely to the contrary.  Sometimes you just know, and it's only a question of time before that comes true. Here's "hope"-ing that many, many veterans survive and thrive, despite combat trauma and PTSD, even when initially it seems like there might be little realistic "hope" for doing so, whether the struggle has gone on for months...or decades. 

This blog isn't about me, in the slightest, but I do have a story to tell that somewhat relates.  Years ago, when I had chronic fatigue syndrome -- which at the time, as now, no one really understood well or unfortunately recovers from -- I went through a "state of the art" multidisciplinary program for treating chronic fatigue, covered by insurance.  Hmmmn.  No one really got better through that program either -- some people, including me, actually got sicker from reactions to the medications, etc. -- but, there was one odd moment in the program that stuck with me afterwards.  As part of what we had to do, we had sessions in biofeedback and hypnosis, among other things.  The psychologist who led those sessions was someone who at one point had been the team psychologist for a very competitive sports team.  After one hypnosis session, he came up to me, out of the blue, put his hand on my shoulder, and just said, warmly -- to me, and not to anyone else -- "I just know you're going to beat this..." -- and I thought to myself, how on earth does he "know" that?  I'm totally sick as a dog here.  So I put that moment completely out of my mind.  A few years later, when I WAS fully recovered, a complete rarity, it's sad to say -- almost all the people who were sick when I became sick still are, if not quite a bit worse -- years later -- suddenly that memory came back.  And someone he must have been able to tap into what was inside me, which definitely was a fighter, after all. Hmmmn. Even I didn't know that at the time, but he was able to figure that out.  Cool moment, even after the fact.

It's great to see when spouses and family members fight and never give up, for injured veterans they love (with TBI, for example, or amputation injuries from IEDs).  There are some spectacular stories out there of love, support, courage and tenacity.  But not everyone has people who can pull for them; and sometimes, veterans with PTSD have actually worn the most likely candidates out.  Even so, it may be possible for them to get better, "against all odds" -- because, who knows, it may turn out to be like the stories of survival from the book.  It may come down to something ineffable that never gives up, even when circumstances appear to be completely against you. Something like...what's already in your heart.