Healing Combat Trauma

Too Long a Sacrifice Can Make a Stone of the Heart: The Tao of Self-Care

"Too long a sacrifice can make a stone of the heart," wrote Irish poet William Butler Yeats. He wasn't necessarily a caregiver to anyone, like a veteran, with PTSD -- but he sure seems to understand the predicament. 

The "365 Tao" book that I'm so fond of -- what's not to love about an item at Amazon that has 65 ratings, and they're ALL five stars?! -- had a wonderful item today about how caring for another appropriately is wonderful, but that there is "too much" of a good thing, and it can backfire terribly on the caregiver. Read what it says:

CARING

"Don't go out looking for good deeds to do

But if one comes your way, do not refuse.

If you meet someone who is suffering, you must help them."

And then, importantly:

"Those who follow Tao believe in using sixteen attributes on behalf of others : mercy, gentleness, patience, nonattachment, control, skill, joy, spiritual love, humility, reflection, restfulness, seriousness, effort, controlled emotion, magnanimity, and concentration. Whenever you need to help another, draw upon these qualities. Notice that self-sacrifice is not included in this list. You do not need to destroy yourself to help another. Your overall obligation is to complete your own journey along your personal Tao. As long as you can offer solace to others on your same path, you have done the best that you can."

It's so crucial to note what the author says about "notice that self-sacrifice is not included in this list." (And, previously, that non-attachment was.) So many people on this path or journey, trying to help vets with PTSD, in their own families, their brothers and sisters they served with, etc., are bound to follow the completely self-sacrificing path. We understand that impulse...but see where it leads? It leads to personal disaster. Please take better care of yourself than that. It's not necessary to give your complete and entire all to do your best, to give your best. There has to be a "you" left at the end of the day, or the night. Please find and treasure that self...and don't let it be destroyed, even in the guise of being...the care-giver. 

What can you do for yourself today to improve your health and stress level? What nurtures you and gives you peace of mind? Is it exercise, spending time with friends, having alone time -- what is it? There are many things you can do for yourself that are inexpensive and take good care of you. Please make a list for yourself of what those are, and find a way to bring them back into your life. It will make a world of difference. Some of the very same recommendations or suggestions for veterans with PTSD are ones you might like yourself. A simple exercise like Qi Gong, which creates a feeling of being "relaxed, balanced and energized" -- is just one example of positive self-care, and there are many others.

At the opposite extreme, of not taking care of yourself, what can we guess happens with too long a sacrifice, for others, no matter how worthy, needy or deserving? According to the poet, it can "make a stone of the heart." And following this along...what happens to a stone heart? It shatters and breaks. Keep a soft heart...take care of yourself first...so you can continue to care for others. Not instead of yourself. Importantly, after yourself. So that you can give the best care of all...and not be depleted, broken or crushed. 

The Beneficial "Moving Meditation" of Qi Gong

When April Fool's Day rolled around, one world-famous T'ai Chi teacher had this as his status update: "April 24th is 'World T'ai Chi and Qi Gong Day. (It is, by the way.) Brazil has declared it a national holiday, Utah has recognized it, and [name of giant pharmaceutical company] has filed a preliminary injunction against it."

(Anyone who's ever observed the battle between Western medicine and Complementary and Alternative medicine or "CAM" would get that joke... We've come to expect peace of mind in a pill, not in a lifestyle practice or an exercise that can reduce stress and improve immunity.)

T'ai Chi and Qi Gong are both ancient Chinese practices. T'ai Chi is more correctly a type of martial arts, and Qi Gong is often termed "a moving meditation." "Qi" is the word for what the Chinese see as the "life-force energy." This same Qi (or Chi) is what acupuncture moves along energy meridians. Qi Gong is one of several practices, including T'ai Chi and Yoga, that are effective at relaxing "body, mind and spirit." Unlike the other two, however, Qi Gong is less demanding physically, so can be done by a broader range of people, including seniors and the disabled.

In "The Complete Illustrated Guide to Chinese Medicine," Tom Williams, Ph.D., writes about these arts, "In many ways Qi Gong and T'ai Chi represent the paradox that is central to the whole way of thinking in Chinese medicine. These practices are so gentle and apparently effortless, yet they are in fact inordinately powerful and bring tremendous benefit to anyone who adopts them as part of a regular healthcare strategy."

As the Wall Street Journal reported last year, "Alternative medicine is mainstream. The evidence is mounting that diet and lifestyle (including practices such as Qi Gong, T'ai Chi and Yoga) are the best cures for the worst afflictions."

There's much to be said on behalf of this multi-thousand-year-old practice, which 100 million Chinese who practice it daily in parks, both morning and evening. It's a low-cost "health care system" that's available to all. Unlike the more rigorous T'ai Chi, Qi Gong can be done standing, or even sitting in a chair. It can be learned in a class, or at home with a DVD. There is a selection of DVDs likely to be found at your local library; and online at Amazon.com, at Gaiam.com, and at ExerciseToHeal.com. 

Lee Holden, who had a show on PBS about Qi Gong, talks about how Qi Gong leaves you "relaxed, balanced and energized." When I asked Holden which of his dozen or more DVDs he would suggest for people struggling with PTSD, he recommended "Stress Relief Qi Gong," among others. (His DVDs are available on his website, linked here.) 

Why would Qi Gong practice be particularly beneficial for veterans with PTSD? Holden clarifies:

"Qi Gong switches the nervous system from the stress related ‘fight or flight’ mode to the restorative healing mode of the parasympathetic branch. EEG shows that, in people practicing Qi Gong, the cerebral cortex enters a state of calm that few people experience, even in sleep."

(Holden is also the author of "Seven Minutes of Magic: Recharge Your Body Each Day with Qi Gong," linked here.)

Here's a sample from that DVD:

Aspects of Qi Gong, especially its less rigorous nature, combined with its health benefits, including stress reduction, make it a good fit for veterans. Leading a Vietnam combat veteran through some a Qi Gong routine, as we both followed along with a Lee Holden DVD, I asked him how he felt afterwards: "Great!" was his response. He had tried T'ai Chi, but found that he and other vets could not adapt quickly enough to it.

In my own battle with chronic fatigue syndrome years ago, after trying the best of Western and Eastern medicine, I found that it was T'ai Chi and Qi Gong that "built energy" and "moved energy" that allowed me finally to recover.I had the good fortune to take instruction in person from a wonderful instructor who adapted her instruction to even those in chronic pain, and I remember that we could do the Qi Gong exercises sitting down, and yet still experience the benefits. If you're in the Seattle, Wash. area and you can go in person to a class, I recommend Kim Ivy at Embrace the Moon, because I know her work. But if you have to get your instruction from a DVD, Lee Holden and Francisco Garripoli are highly recommended.

For more information about Qi Gong and its health benefits, there's one website in particular that's a treasure trove of information: the Qigong Institute, and it's linked here. I would also suggest reading what Lee Holden has written about it, linked here.

(Note that you may find Qi Gong spelled several different ways, including "Qigong" and "Chi Kung.")

Finally, here are two informational videos that describe a little bit more about what Qi Gong is and what the experience of practicing it is like:

and

"Just in Time for the Holidays" -- Stress-Reduction Exercises for PTSD

Various stress-reduction or relaxation exercises and techniques are available these days in a number of places, online and otherwise; and at least a few of them make a passing reference to PTSD (though rarely combat trauma). 

Relaxation at first may seem to be an impossible goal for those with combat trauma, because jumpiness and hypervigilance appear to be hallmarks of the experience that also have helped keep troops alive. 

However, the continual wearing-down and weakening of the nervous system over years from adrenaline surges and frequent experiences of "fight or flight" shows just how important it is to develop greater familiarity and experience with relaxation exercises. 

Like riding a bike, it's a much better (and more effective) idea to DO these things than just READ about them -- especially if you want to give yourself a chance to "feel" the effects in your own body, and "test" for yourself whether these techniques really "work."  (And don't forget the caregivers, partners or spouses of those suffering from PTSD: They also carry around a fair amount of stress... )

The emerging field of Mind-Body Medicine (ironic since the idea of mind-body medicine is actually quite old) is full of techniques and tools for stress-reduction and relaxation.  Yoga and meditation, among others, are known for their ability to reduce stress.  But occasionally on the Web there's also a good guide for sufferers about how to relax and renew.  Just such a "technique" guide exists here: The subject is "Relaxation and Relaxation Exercises," and the guide was produced at the Trauma Center, with the funding of the Massachusetts Office for Victim Assistance (MOVA), under a federal Anti-Terrorism Supplemental Grant (ATSG), to aid Victims of and Responders to the 9/11 Terrorist Attacks.  Click here for a link to the guide online.

Also look on the left-hand column of this blog to see a number of resources in the form of books, CDs, and DVDs for stress-reduction and relaxation, including music designed to help people relax and de-stress. A section called "Healing Multimedia" is located about 3/4 of the way down the page (if you think of the blog as a single page, and just cursor down to that), or you could do a search (Cntrl F on most computers, or Apple F on Macs) for "healing multimedia" to find that section of recommended resources. Enjoy!

Learning to Bounce Back: Helpful Hints for Increasing Personal Resilience

"Resilience" or the concept of "increasing personal resilience" is something we're hearing about more and more in connection with PTSD.  For combat veterans and their families, the greater the amount of personal resilience, the more fully they'll be able to "bounce back" from trauma (hence the image of the boomerang, which quickly returns to its source.)

 

According to the dictionary, "resilience" is "The ability to recover quickly from illness, change, or misfortune; buoyancy;" and the intrinisic "property of a material that enables it to resume its original shape or position after being bent, stretched, or compressed; elasticity."

According to the National Center for PTSD, and its PowerPoint presentation on PTSD 101, presented by Fred Gusman, M.S.W. and colleagues, three keys to resilience are the "ABC's" of "awareness" (of one's limits, emotions and resources); "balance") among personal and professional activities [their presentation was to clinical caregivers, so that's explains the inclusion of that sentence]; and "connection" (to one's inner self; to others, and to something "larger" (typically spiritual).) A connection with others, in particular, "breaks the silence of unacknowledged pain; offsets isolation; and increases validation and hope."

 

The short, pithy presentation also offers these

 

Helpful Hints for Personal Resilience:

• Make connections/relationships;
• Avoid seeing crises as insurmountable problems;
• Accept that change is inevitable;
• Set goals and actively move toward them;
• Take decisive actions;
• Look at problems as triggers for personal growth;
• Don’t blow things out of proportion;
• Remember and use past coping, success, strengths. 

-- Source: APA Task Force on Resilience, 2002, quoted in National Center for PTSD’s "PTSD 101," linked here.

Coming Out of the Darkness, One Step at a Time

I was having a conversation recently with one of my favorite veterans (and which veteran is not?!) about how we were going to take a look at his past in a way that wouldn't also cause him some sort of setback, which I wouldn't want (and nor would he).  I'd done a little digging on his behalf, and found a bunch of "the missing link" type information about what happened to his platoon that he served with in Vietnam, during a particularly vicious battle which had left very few of his buddies alive. 

 He was away from the field at the time, recuperating at a naval hospital in the U.S., and his finding out casually about the entire wiping out of his company of Marines has been the single hardest episode of his life.  What with one thing and another, I'd managed to find out much of the information he wanted to know, but was loath to share it with him, lest it cause him any more horror than it already had.  So I wanted to proceed gingerly with him, not just set him on the slippery banana peel of reflection, as it were, and give him a push.  Vietnam had already been plenty hard for him to process, and its explosive tentacles reached all the way into his present.

We discussed the methods back and forth for a while, of what would be comfortable to share with him, and what the pace could be, and then I asked him, was there anything "good" for himself that he could be doing, so that the material might be absorbed in as successful a way as possible? Was there any special place he could go to, music he could listen to, anything therapeutic he knew to do for himself, while he tried to take in bits and pieces of information about the most troubling time in his life, that has plagued him for the 40 years since it happened.  This is what he wrote back in response:

So, what I need is a very sunny mildly cool day, no monsoon weather or rice-paddy heat; a quiet place in the woods (back forty) with my three dogs; and a print off of the material to read, meditate on, cry, scream, cuss, and read some more; AND my cell phone with your number on speed dial.  That arm and hand reaching down to pull me up out of the darkness. 

 

You know when you save someone’s life, you own that life, until they save yours.  So if you save me, you own me…

(Can you tell why I just adore him?!)  But it did also put me in mind of one other "therapeutic" item we haven't talked about much on the blog yet, but which I know about from my previous writing life.  There's a former cancer nurse named Valerie Cooksley, who's written a number of books for Prentice Hall and others on aromatherapy, but from the scientific end of things, not the frou-frou end.  For a while she was a consultant to Tacoma General Hospital, among others, and their ICU, and she developed some essential oil blends (her term) or "potions" (mine), that have therapeutic aspects.  The ones I'm remembering, because they were directed to the dying and their families, were blends that attempted to enhance people's ability to both grieve the past, and to let it go.  Somehow I can't help thinking that essential oil blends like that would be of some potential value here, too.

It would be hard to quickly go into why and how medicinal aromatherapy works -- it has greater credibilty in Europe, where Cooksley's trainers were trained -- but the concept, in a nutshell, is that essential oils have properties that can modulate people's emotional states, and they're very effective "drug delivery" models, because they quickly cross the "blood-brain barrier" through the nose, directly into the brain's mood receptor sites. I've probably just botched the science by trying to explain it in two sentences and get back to the point, but that's the gist of things, and Cooksley knows what she's talking about.

If you're a fan of the Bible, you also remember essential oils in use with the "We Three Kings of Orient Are" types, who allegedly came to visit Jesus.  "Anointing people with oil" is a practice that dates back at least to Biblical times.  "Gold, frankincense and myrrh" were the three gifts the Wise Men brought (why do they sound like Mobsters, at this remove? Too much "Sopranos") -- and of those, two were rare, costly essential oils.

Just to be very clear on this, I by no means think that dabbing or sniffing a few essential oils is going to be a cure for PTSD.  However, as a pleasant adjunct to what you're already doing, or a lovely relax-i-fier that can be put into use at any time?  Great stuff, and a nice addition to life, in the way that a massage is, or great sex -- not curative in itself, but a nice and pleasant and stress-reducing aspect to life, that's wise to incorporate into your life as much as possible.

Herewith some lovely blends of Cooksley's, along with her notes as to why those particular choices.  Although she's focusing on "death and dying," expand the definition of that as you read these blends to include situations that would also bring up horrifically charged emotions around that topic, such as revisiting combat trauma, and those who were dead and dying there, plus the resultant grief, shame, guilt and confusion that typically surround these episodes.  (This may explain why my "lavender sleep pillows" for returning combat vets and their families, made from a Cooksley recipe, and blogged about here, were consistently such a big hit.)  The last two she mentions are the two I would particularly want to focus on.  You'd have to "read the directions" elsewhere on how to use essential oils (externally, obviously), but sometimes even a drop touched to the underside of your nose, at the point where it meets your upper lip, or waved underneath on a tissue, can give you an immediate "read" on whether the remedy might have some value for you. 

It's also fair to say that anyone I've ever made essential oil blends for, after Cooksley's recipes, has become a fan for life: they're "delish," and this is just lovely high-touch, low-tech stuff.  Women tend to be bigger fans than men -- they're six times as able to "notice" the scents themselves, though this isn't necessary for the scents to do their work -- but both sexes have been able to see the value, once they've tried a few of these for themselves.

“Serenity Blend”: Lavender 15 drops, Bergamot 6 drops, Mandarin 3 drops.

“Anti-depression”:  For depression or grief; useful for back or hand massage. 

Lavender 9 drops, Ylang-ylang 9 drops, Basil 2 drops, Geranium 2 drops, Bergamot 2 drops.

“Joyful Hope”:  Anti-depressant blend.  Uplifting and purifying, to encourage a healing and caring environment.  Orange 4 parts, Ylang-ylang 2 parts, Bergamot 1 part, and Lemon, 1 part.

“Grief and Bereavement”:  For dying patients and their families.  Lavender 4 parts, Marjoram 1 part, Hyssop 1 part.

“Ceremonial Oil”: A nurturing, peaceful blend, to be used with terminal patients.  Helps with feelings of fear, encourages faith.  Grounding hand or foot massage, solar plexus, or used to anoint head.  Lavender 10 drops, Ylang-ylang 8 drops, Sandalwood 4 drops, Frankincense 2 drops.

Another book on the suitably "grand and broad" topic of Aromatherapy and Healing the Spirit, mentions this blend for helping soothe "sudden psychological trauma" -- perhaps, in this case, as it is revisited in memory:

Lavender 3 drops, Frankincense 2 drops, Spikenard 1 drop.

And there's also an item that has a long therapeutic history in Complementary and Alternative Medicine, a blend of Bach flower essences called "Rescue Remedy," available, like essential oils, both online from Amazon.com and places like Whole Foods, Wild Oats, and other natural grocery stores.  Rescue Remedy is a low-tech, non-drug remedy for calming nerves that has an enthusiastic following among a diverse group of CAM adherents, including veterinarians. (I highly doubt even the skeptics suggest that animals are susceptible to the Placebo Response ;-).

 

I wonder if we can add one of these to the list of what my friend will be taking into the woods with him, when he wants to try processing his trauma from the past, in manageable bits and pieces; I hope so.

 

I'd actually like to see him outfitted with many of these items, some soothing, restful music, and Thomas Day Oates, Jr.'s spectacularly-soothing DVD, "Pacific Light," which we blogged about earlier, here.  Maybe he'll need a little red wagon, too -- to carry all that stuff into his healing space into the "back forty" of the woods, with the dogs running along beside him, hoping for the best.

 

In a perfect world -- ahh, I can dream, can't I? -- veterans healthcare options for PTSD would include scented oil massages with just the essential oils necessary for helping speed healing, or take the edges off the particularly hard memories.  As no less an authority on health than Hippocrates, the father of Western medicine, once said:

 

"The way to health is to have an aromatic bath, and scented massage every day...healing is a matter of time, but is sometimes also a matter of opportunity." -- Hippocrates, father of Western Medicine (460-377 BCE)

 

Here's hoping that my adored veteran buddy gets his healing, and his opportunity...

Editor's note: Update...he certainly seems to have. Read the "before and after" of his story, here.

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 among trauma survivors and veterans with PTSD.  If you want to read more about Reque-Dragicevic's marvelous book, Close to Home: A Soldier's Guide to Returning from War, click here.  Her book is endorsed and recommended by Dr. Edward Tick, among others.  At a mere $10 as a download on the Web, you really can't go wrong.  (We'll be quoting from Reque-Dragicevic's book on this blog in the future, with her permission, because it's wonderful stuff and she really "gets" it. Veterans and their families need to experience this.)

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If you have $10 to spare, or as a gift for someone else, buy Britta Reque-Dragecivic's book.  It's a download, and you can have it in your hands within minutes, from anywhere in the world, and start the healing process today.  If you have about $18 and shipping, buy Dr. Gordon's book, and start the healing process when it arrives in the mail -- or at your local bookstore.  If you have about $40, buy them both :-)