Healing Combat Trauma

Holiday Gift: Rudy Reyes' Hero Living

If you're stumped for a holiday gift this year, think about the new inspirational book by Rudy Reyes, called "Hero Living: Seven Strides to Awaken Your Infinite Power," linked here.

Rudy Reyes is an inspirational "everyman" -- former Marine 1st recon, star of Generation Kill, who grew up admittedly hard and has honed, ever since, a set of internal values modeled on attributes of classical warriors. While Reyes, a former world martial arts champion, has honed his body to a superlative degree, it's his inside that's even more interesting -- how he's dealt with, and is still in the process of dealing with -- assaults on his soul, from childhood through combat.

Reyes has much in common with his childhood hero, Bruce Lee, from the unparalleled attention to fitness, to the equal attraction to the philosophical underpinnings of what success really is.

There's something for everyone in this book, and best of all, it reflects someone who's inspirational, yes, in his attitudes towards obstacles -- systematically conquering them all, in a focused way, one after another -- but is also, even by his own admission, very much "still a work in progress." Go, Rudy!

Editor's Note: For a recent article in "Military Times" about Rudy Reyes, entitled "The Hero Life: For Rudy Reyes, Inspiring Others is a Full-Time Job," click here.

After Combat: Too Much Time on My Hands, Missing the Action

Among the many first-person narratives to come out of the wars in Iraq and Afghanistan, a few start to address their growing awareness that they came back from the war with symptoms of PTSD. The recent warriors, now writers are just beginning to come to terms with the their experience, and both figuring it out and giving it effective voice is a difficult task that may get somewhat easier to accomplish in the years ahead. It's remarkable and positive to see the shortened cycle time in play as these warriors realize they may have PTSD, and it's also educational to hear how they describe what their concerns are, and what their adjustment has been like.

In former Marine sergeant Clint Van Winkle's recently published autobiographical work, "Soft Spots," he talks in one section about the experience so common to warriors -- that back in the "safety" (and boredom) of civilian life, they both have more time on their hands to think and revisit the past; and also an increasing sense that they miss tremendously the amped-up experience of war and their buddies -- the living and the dead.

Van Winkle, a Marine sergeant who first went to war on Valentines Day, 2003 was, according to the book jacket, "among the first wave of troops that crossed into Iraq, and his first combat experience was the battle of Nasiriyah, followed by patrols throughout the country, house-to-house searches, and operations in the dangerous Baghdad slums."

Here's how Van Winkle describes this collection of feelings and impressions, in an extended passage we've cut and spliced together somewhat for easier reading. The phrases in bold for emphasis are ones you hear again and again from combat veterans, in one form or another. With love and appreciation for the recent combat vets who are still processing these issues, and may be for years to come, here's what Van Winkle had to say about his own struggles to re-adjust:

“In war, no one asks you if you killed anyone.  You don’t have to say anything after a firefight.  You just come back and sit around with your fellow Marines. All you have to do is nod and they know. The questions are answered because you were there together.  They know and you know.  Nobody asked why one of us shot into that window or why the unit in front of us ripped into that bus or why I shop the group of men hiding behind that wall.  Everything was understood.

Maybe it wasn’t the war itself but the people who were in the war with me that I missed. Perhaps all I really wanted was to know it was all right and worth it and that my actions were justified.  I wanted to be back in the company of others who understood what it’s like to pull the trigger.  Wanted to get away from the questions and the made-up answers – to get back to a place where I felt normal again.

...

Names of the war dead for the week scrolled across the bottom of the big-screen television. … No matter how many times I saw the different list of dead troops, I never got used to it or the feeling that maybe I should have been included.  I wasn’t familiar with any of the names, but that hardly meant anything to me.  I didn’t have to know the dead personally to know what kind of stuff they had participated in.  I mourned each as if he had been a personal friend, and the grief took a toll on me.

...

I had too much time on my hands.Even though I was taking classes…I was bored – like being stuck in Kuwait without anything to do.  It was easy to understand why Gunny always had us doing something…. He must have known that boredom brings problems, allows too much time to think….

In some messed-up way, being home produced withdrawal symptoms. I’d experienced the most exciting events of my life. Nothing could ever compare to the feelings war induced.  Nothing. I’d never get the same adrenaline rush or create the kinds of bonds we Marines had with each other.  Civilian life was dull compared to what I’d done.

...

But I wasn’t being unappreciative. If anything, the war had made me appreciate life more, helped me see what was important. It was just hard to express that appreciation when all I could think about was Iraq.  There was no escaping it.  Iraq was everywhere.

...

True, it was over.  But in some respects the war had become more real than it had been while I was in Iraq.  There wasn’t much time for reflection while we were in country. I never stopped to think about what it all meant, or really even cared.  It wasn’t until I got home and started to talk to the dead, revisiting the war, that anything started to sink in. Was it worth it? I don’t know. That’s up to the dead to decide.

When I’m an old man and all the dreams and sights have left my head, when the memories are stolen from me, then historians will tell us whether it was worth it or not – if the war really helped anybody.  Until then, I’ll live with the dead.  We’ll carpool together.  Do lunch and late-night snacks.  Slumber parties and drinking binges.  It really won’t matter what anyone says, or if the whole stinking operation finally gets labeled a “good war.” It was too late for me. The dead and I were together.

From the book jacket:

Clint van Winkle, Soft Spots: A Marine's Memoir of Combat and Post-Traumatic Stress Disorder. Winkle was a sergeant in the U.S. Marine Corps. While in Iraq he served as an Amphibious Assault Vehicle section leader attached to Lima Company 3rd Bn 1st Marines. After completing his enlistment, he earned a B.A. in English, and then a Master's in Creative and Media Writing.

Editor's note: The illustration for this post is a wonderful drawing by Marine combat artist Michael D. Fay, of Lance Corporal Nicholas G. Ciccone, who suffered from PTSD and later sadly took his own life.

Rudy Reyes Has a New Book -- Hero Living -- Coming Out

Rudy Reyes, former Marine recon, multiple tours of duty, and consistent inner warrior, has his first book out, called "Hero Living: Seven Strides to Awaken Your Infinite Power."  You can pre-order it now on Amazon, here.

Editor's note: We've talked about Rudy Reyes before on the blog, here and here. To his credit, as a warrior who's seen intense combat, Rudy understands that not all wounds are physical -- and he's done what he can, throughout his life, to strengthen and balance his inner self with his outer. You can find Rudy's own web site, here. (The slideshow of his life is really quite striking. That's linked here.)

The Real Meaning of Memorial Day: Remembering the Sacrifice

For the real meaning of Memorial Day, remembering the sacrifices that have been made, there's a powerful essay written by a trauma surgeon in Iraq about the tragic death of one Marine he treated that might be worth your while to read.  Beware: it's completely gruesome, and spares no detail, though is done respectfully.  And it has an even doubly tragic ending (you'll have to read it to see what it is.) If you have been to war, you might not need to read this -- you're already plenty in touch with what carnage and sacrifice are all about.  If you haven't been, though, it might be a little more eye-opening about what those who serve go through and ultimately sacrifice.

The most impressive part of the story to me, besides the great care the trauma surgeon takes with every battlefield injury, is his love and respect for those he's working for -- and on, a love and respect shared by everyone involved in the course of his workday.  The sheer magnitude of what they go through, and its power to numb the human heart and psyche, is astronomical.  The fact that they fight through for it not to numb them is even more remarkable.  It's a complex human reaction, best expressed by the doctor himself, but it's also summed up centuries ago in the following quote, which we've used before on this blog:

"Anyone who looks with anguish on evils so great must acknowledge the tragedy of it all; and if anyone experiences them without anguish, his condition is even more tragic, since he remains serene by losing his humanity." -- Augustine of Hippo, quoted in One Bullet Away: The Making of a Marine Officer, by Nathaniel Fick.

If you want to read a gory but powerful reflection on the true cost of sacrifice, read "A War Surgeon's Perspective on Memorial Day," by John P. Pryor, M.D., quoted in full on the blog, The Kitchen Table. The reflection is linked here.  It's well worth reading, though completely sobering and sad.

Editor's note: For more material along the same lines, there's an OEF/OIF memoir by another doctor who served, "On Call in Hell: A Doctor's Iraq War Story," by Cdr. Richard Jadick, which is linked here.

PTSD, Suicide and the Primary Importance of ... Sleep

There's a great article in today's San Antonio Express-News by Sig Christenson, called "War Lingers, GI Suicides Rise."  (The article is linked here.)

It quotes my favorite, retired Veterans Affairs psychiatrist, Jonathan Shay, M.D., Ph.D., and it quotes him on, among other things, the absolute primary importance of SLEEP, which we've talked about many times on the blog before. (Click here for a link to those posts, many quoting Shay himself.)

Quoting Christenson's article, from today:

"The armed services' high operational tempo for the past decade definitely is part of the problem, said (Jonathan) Shay (M.D., Ph.D.). Though alcohol abuse “is a major risk factor,” he said the military's rapid training and deployment cycles short-change troops on the one critical ingredient to good physical and mental health: sleep.

“I've been agitating for years the importance of getting truly realistic policy on sleep,” Shay said. “This is a slow slog because it is so contrary to the macho culture and so contrary to the self-sacrificial culture, which sees self-care like sleep as self-indulgence.”

Let's recap some absolute basics about sleep:

• It's absolutely necessary for mind and body healing, and down regulation of bodily systems;
• It's vital for decision-making and mental health. Studies on drivers who operate on lack of sleep of sleep show that it impairs functioning to the level of alcohol intoxification.
• It's hard to get in a war zone, for any number of reasons: from the operations that go on for days and nights at a time, to the noises of combat, etc.;
• It's hard to get after combat, thanks to nightmares, hypervigilance and arousal, and often the desire to avoid sleep (which brings on intrusive memories, nightmares, night sweats, and the like);
• Chronic lack of sleep impairs mental, physical and emotional health;
• And yet without adequate, nightly sleep -- how is healing going to take place?

There's a great story told about beloved Marine veteran, Travis Twiggs, who we've written about in other contexts.  Apparently his nickname was "War Pig," and it was given to him during a tour of duty at Guantánamo Bay, where after being up for umpteen hours straight, and finally getting a break, he had fallen into such a heavy sleep that he couldn't be roused, and a passing a general had stuck over his sleeping form a sign that said, “Here Lies the Mighty War Pig.”

I know another hardcore combat veteran and former Marine who came with me once to a program that was designed to help people learn how to sleep better.  He bitched and moaned while we were there, quite a bit, about how this wasn't really suited to combat veterans like himself, but whatever -- he persevered, and tried what they had to offer.  The next day, after he flew home, I worried about him because I hadn't heard how he was doing. A day later, he called me back. "I came home and slept for 31 hours straight," he said.  "I hadn't been able to sleep more than two hours at a time since before I left for Vietnam." So my guess is that the method was of some help to him ;-) But imagine not sleeping for more than two hours at a time?  How well would you be able to heal?

Editor's note: Read the rest of the articles we've included about sleep, from previous posts, linked here.

When the Darkness Has Fallen...Just Me, in the Wake of Battle

I've been reading Tyler Boudreau's "Packing Inferno: the Unmaking of a Marine."  Probably a wise choice, in light of the news recently about combat stress and how servicemembers do and don't tolerate it.  I was drawn to reading Boudreau's book because I'd read several of his essays recently, and pretty much felt like they didn't go far enough -- and I was trying to understand the backstory.  His backstory, that is.  And how better to do that, than to actually read his book.  Boudreau comes across well, as he earnestly attempts to untangle the ordeal of his experience, both serving and (more to our point), coming home.  Within the first ten pages of the book, he's already described his PTSD, and it's a nice, succinct, almost poetic expression, which will help others who don't quite understand it yet.  Here it is, in Boudreau's own words:

"I’m hemmed into the night.  My brain has come to prefer the darkness.  I can’t say with any certainty if this is a product of never sleeping – that is, if it’s just a bad habit I’ve got to break – or if there’s something else going on, like the systematic avoidance of those bloody dreams.  I told the doc I wasn’t sleeping when I got home, and he glanced (up) casually from his desk and said, “That’s normal.  It’ll pass.”

Normal, he said.  When I told him I was just about jumping out of my skin every time I heard a loud noise, he said that was normal, too.  Normal, as in commonplace, as opposed to, say, pathological, like it would have been abnormal not to jump out of my skin.  It’s what they expected from me.  They figured I was in good working order, I guess.

Then they blew off my rage with the same line. “Everybody’s got that,” they said.  I wonder if they’d call me normal now, with all that I’ve got to say.  Three years later, my heart was still pounding, I was still raging, and I still wasn’t sleeping.  I was up, thinking about the war.  I finally told myself it’s like a bad back or a trick knee; you just learn to live with it and you walk. on.  So as I’m walking on, night after night when the darkness has fallen, and the rest of the world is silent, I go looking for my narrative."

(The narrative is something we've talked about earlier, here, and in Boudreau's case, we'll also talk about again -- but later, in another post.)  Suffice it to say, he finishes the foregoing description with a very potent, and poignant, explanation of who he is right now:

"The Marine Corps made a schizophrenic out of me, figuratively speaking.  I used to have only one voice, one point of view.  All right, so I’ve got a new perspective now. It happens.  But it’s not like I changed my mind.  My mind changed.  It split, two, three, and four ways over.  Now there are voices coming at me from all sides.  There’s no coherence to them, and no clear distinction either.  There’s the angry voice, and there’s the broken-hearted one.  There is the tender me and the savage.  And of course, there is the Marine.  There will always be the Marine, standing tall inside me, speaking smartly about values and patriotism.  There there’s all the rest of me, the part of me that was left over when I left the Corps.  He has no name, no identity, or credentials, or skills.  He has no title or rank.  He has no cause.  He is just me in the wake of battle."

With these words, both simple and profound, Boudreau expresses many, many combat veterans' experiences, that they will often spend decades trying to come to terms with, often failing, sometimes succeeding, and sometimes also killing themselves, in a forlorn attempt to, ultimately, attempt to bring resolution to that exact conflict.  Not the external one, in which they were involved as a warrior; but the internal one, with the battle that continues to rage, that they often feel they cannot escape.  Good for Boudreau for putting words to his experience, so that others -- veterans and the public at large -- can relate.

Editor's note: Boudreau's book, "Packing Inferno: the Unmaking of a Marine," is linked here.

Combat Veterans, PTSD and Acupuncture

We've written about acupuncture before on this blog, in posts linked here. And an article in the current issue of "Acupuncture Today" magazine (May, 2009) discusses -- tangentially -- the use of acupuncture for PTSD.  It especially emphasizes the costs savings, particularly when used as a form of pain control (a typical use of traditional acupuncture, known as TCM). Here's a story, though, that shows the human side of acupuncture's worth for a combat veteran.

Recently I met a Marine who was part of a wounded warriors unit.  I won't say who he was or where he was located, to protect his privacy, but he had completed several hazardous deployments in Iraq and had come back to the Marine base to continue his service. I happened to learn that he sampled a few modalities from the "complementary and alternative medicine" spectrum we've discussed on this blog before, and one of the therapies he'd tried was acupuncture.  I happened to catch him in an unguarded moment, when he had his mind on other things (what amount to pain control, at the time) and I asked him to describe his experience, because I wasn't sure who he'd seen or what type of acupuncture it had been.  He described that he'd been interested in checking it out, but that the commanding officer  had considered it to be some form of "voodoo," so was pretty much against it.  But there was one acupuncturist from the town near the base who was willing to come on base and offer it, and do that for free.  So that removed some of the initial barriers to trying it, and the commander okayed it.  With those circumstances in mind, I asked him what his experience was like.  This is what he said:

"After she stuck me (needled me), I went back out to my truck, and I just sat there, for about an hour and a half, just GLOWING (his words.)."  His eyes moistened briefly as he said, "I realized it was the first time I had felt happy in two and a half years," he volunteered, continuing, "I had forgotten what it was it like to feel real joy."

I couldn't leave well enough alone -- I had to track down the acupuncturist he'd seen.  I figured out who she was, called her up, she answered the phone, we identified him as the patient in question, and then had a brief conversation about what he'd shared.  She told me she had goosebumps from hearing the story, which she hadn't known before, and added, "this is why we do what we do."

With all the lip service -- and, one hopes, quite a bit more than that -- these days being paid to treating combat veterans in more comprehensive ways that meet their needs better, I hope ancient methods will merit due consideration.  When I remember this short conversation with the very much moved Marine, it's hard not to appreciate its merits. Neatly, there are several types of acupuncture -- one which specializes in addiction treatment, one which focuses on treating body, mind and spirit, and a general, all-pupose form (along with many others).  With many offerings to choose from, and increasingly more research to support its efficacy, acupuncture truly deserves a place at the table in treating the hidden wounds of combat veterans.  I have only to remember the glow in this Marine's retelling of his experience to remember why.

Travis Twiggs: The Un-Happy One Year Anniversary of Combat PTSD's Perhaps Most Visible Death

Just a brief note to mention, it was one year ago today that Travis Twiggs passed from this earth, by his own hand, the veritable poster boy of combat-based PTSD.  It also marks his brother Willard's passing, who left this earth with Travis, apparently by Travis' hand.  It's an absolute tragedy, for any number of reasons -- from the family members and friends the Twiggs brothers leave behind -- to the fact that Travis, personally, was making an impact as a Marine who broke the code of silence, so to speak, and spoke openly about his PTSD.  Twiggs wrote about his ordeal in the January, 2008 issue of the Marine Corps Gazette, in an article that has been widely circulated, and is still available on the Web.

Travis Twiggs' suffering was something that really stood out to me -- perhaps because of his very willingness to speak openly about his struggles, something Marines.Just.Don't.Do.  We actually broke the news of his death on this blog, before the mainstream media had reported on it -- and in fact, the early reports were wrong on the facts but widely repeated, making the damage that much more painful.  (He and his brother were reputed to be hardened criminals, for example, which they were not, although they had been -- at the last -- involved in a carjacking, as part of their initially ill-fated but ultimately successful desire to end their lives.  In fact, Twiggs was a much-decorated Marine with multiple combat tours behind him, who had recently met the president, and whose Marines (and his family) deeply loved him.  His brother, Willard, was well-loved as well.  A year later, not a day goes by that people don't find this site out of a search they're doing for Travis or Willard; and in the days after their death, searches for Willard were almost as popular as those for Travis, though Willard was obviously shyer and less well known. And these tragedies were not the only ones the Twiggs family suffered in a very short amount of time: their beloved grandmother also passed away within days of the Twiggs' brothers' deaths. Hard, hard times for the Twiggs' family, and for all those who loved Travis and Willard.

It's hard to explain my own involvement in this saga except to say, I had a bad feeling about how Travis was really doing, without even knowing him, just based on reading what he wrote, and how it didn't seem to add up.  So the month before, without realizing he'd already been confined to an inpatient PTSD program at Bethesda Naval Hospital, and was therefore unable to answer, I repeatedly tried to get ahold of him and/or the Marine Corps Gazette, which had published his somewhat optimistic article months before.  When neither would reply, I started to really worry that something was amiss.  Then when the first news reports came out of the National Park Service about the "armed, tattooed and dangerous" Twiggs brothers, involved in a carjacking, I just knew it had to be Travis, and that things had somehow gone terribly wrong. Hoping to offset the "bad news" (and mistaken news" about who Twiggs really was -- not a lifelong criminal, but a decorated Marine, who everyone loved, who'd struggled mightily with PTSD -- I went out on a limb, and wrote, as I realized he was dying, what became a "PTSD obituary" to this at the time unknown Marine, who'd undoubtedly died from the consequences of his uncured, but not untreated PTSD.

In the days that followed, as I waited for any national attention to be focused on his case -- none was -- the blog here received heavy, heavy traffic, as those who loved Travis and his brother came to essentially pay their respects, much as I had tried to myself, and also tried to come to terms with the brothers' passing.  Over time, various reporters kicked into gear and started covering the Twiggs' story in lengthy pieces. (I had to put the "use with attribution" notice up on this blog when one reporter spent, no joke, 40 hours mining this site, without acknowledging where he got his information.  Ugh.) Richard Ruelas wrote about the saga for the Arizona Republic (the brothers had died in Arizona), Bill Finnegan's at the New Yorker magazine, and there was a two-part series in the New Orleans-based Times Picayune. CNN, to its discredit, never once mentioned the brothers' passing.  I think once they missed the initial window, it was too embarrassing to catch up, but to this day, they never have, whereas pretty much everyone else has had something to say about it -- or them.

While many, many aspects of being the one to break this story -- on a blog, not in a newspaper or a wire service -- have been exceedingly frustrating, I'll spare you my angst on that one.  The blessings have also been there -- getting to "meet" online and sometimes in person, some of the key players in the brothers' lives, and have them express their appreciation for what I did to help to humanize their brothers, while the rest of the print world was essentially doing the opposite (at least initially). I'm still concerned for how Travis' wife, now his widow, Kellee, to whom the news of Travis' whereabouts and obviously his death, came about as a shock, as well as for the Twiggs' parents, whose loss of two sons at once is just incalculable.

In the New Age-y world, people do talk about being careful about what your intention is, and how your intention will carry the day.  Without going into what "intention" means, overmuch, it can be simplified to say, whatever the vision is of an outcome, that you carry in your heart, or that you express to the world.  In this case, it was very, very clear.  Back exactly a year ago today, as Travis Twiggs and his brother were in their last moments, and time was running out, I wanted the world to NEVER FORGET who Travis Twiggs was, and what the legacy of unresolved PTSD looks like.  If ever there were a poster child for PTSD, it was Travis Twiggs.  He took the first step when he told the world his secret in that powerful, much-read article in the Marine Corps Gazette, when he broke the silence for his Marines, and the rest of OEF/OIF veterans.  What I held in my heart that day -- despite the professional disappointments that may have followed -- was that when people thought of PTSD, they would think of Travis Twiggs.  And given that his legacy is still very much alive, one year later, I do believe that intention accomplished exactly what it was supposed to.

As Twiggs himself said, he was willing to come forward and talk about what he went through, because he wanted no other soldier, sailor, airman or Marine to suffer like he had -- in silence.  With his death, and that of his brother, unfortunately for the much-beloved Twiggs brothers, but mercifully for the rest of us -- it's a conversation we will all keep having.  RIP, Travis and Willard Twiggs. You are not forgotten.

---

Editor's note: The original blog entries about Travis Twiggs from a year ago are: "One Marine Reflects on His Battle with PTSD," linked here (before his death); "PTSD -- "The War Within" -- Claims Another Victim," linked here; "RIP Travis N. Twiggs, USMC PTSD Sufferer," linked here; "The Ballad of Travis Twiggs," linked here; "Travis Twiggs' Suicide - Only Questions Remain," linked here; "The PTSD Obituary for Travis Twiggs," linked here; "Bleeding Green with PTSD," linked here; "Twiggs' Wife: 'The PTSD Drove Him Crazy'," linked here; "The Tragic Last Days of Travis 'T-Bo' Twiggs," linked here; "Travis Twiggs' Widow, Kellee, Puts a Human Face on the Suffering of PTSD," linked here;and, finally, "SSgt. Travis Twiggs - Well-Loved U.S. Marine and Hurting PTSD Hero - the Update," linked here.

"I Have PTSD," But "I Am Not PTSD"

This conversation goes back a while ago with a combat veteran of the Vietnam era, who has been trying various therapeutic methods for addressing his decades-long case of severe PTSD, and finding, by degrees, some actual and substantial relief.

Over the past few months, as his situation has greatly improved, aspects of his PSTD have fallen away, symptom-by-symptom.  But lest this lead you to believe that such progress, or success, is all "positive" -- the reality is, it doesn't always feel that way to the veteran, who has become habituated to seeing the world through the context of their having PTSD.  PTSD, of course, affects virtually every important aspect of their lives: from how social they are, to relations with their family, to how they can hold a job, how much pain they are in on a daily basis, how much stress they can manage, and how many medications (with their attendant side-effects) they take.  Psychological symptoms, physical symptoms, even "social" symptoms: they're all there.

And after a lifetime of identifying yourself as a "crazy, f*cked-up Vietnam vet," f'r instance, if that "identity" should start to fall away -- as you progress towards actual health and wholeness...mmmmnn, what do you replace it with?  Because there needs to be something.  Having relied on one identity for years (even decades) to manage life, and keep others at bay, suddenly that "crutch" or that "coping system" is no longer there.  And with all the other problematic pieces stripped away, piece by piece, what's actually left is a raw, brand new...baby. At least in terms of trying to cope with who you are in the world.  Amazing stuff.  And as great as it might be to get some symptom relief, and some ultra-positive life changes, at the same time...fear comes into play.  Who will I be without this shell I've learned to rest upon for so long?

Even the Bible talks about, in a slightly different context, how if you're going to sweep a place clean and remove all the demons, you have to immediately replace the empty space with something good, lest more demons come by (boy, the Bible is awful cheery; I'd forgotten...) and, finding the place vacant, immediately seek to fill it up with something "ten times worse" than what had been removed.  Mmmm. Lovely.  But the principle is a worthy one: If you're been relying on one thing, for a long, long time -- and you suddenly remove it -- you'd better find a way to be comfortable with the new self, because it's what's you have from here on out.

Having been privy to these struggles with one veteran as he walks his path, it's been surprising to me to see how "upsetting" the concept of healing can be -- initially upsetting, that is.  There's an old Tony Robbins line that human nature will do much more to avoid pain than they will to seek pleasure, and I think that comes in to play here, too. Change is painful; growth is painful; heck, even healing -- in that context only -- can be painful.  It's all new; it requires new skills; a new outlook; even new hope.  But ultimately, it's (obviously) the best way.  Most ironic of all is when the combat veteran, for example, has been the one to pursue the healing so radically -- and then when it starts to happen, in shock, he draws back, startled, as if realizing, ahhh, this is going to be my new life: how strange. I wonder if I recognize me in this at all.

Of course, over time, the progress coming in waves, as more methods are tried and proven useful, the experience gets better, and the veteran gets to be more at peace in his own skin.  Symptoms with which he has lived for decades start to abate, and be replaced by ... peace... and better experiences with himself, his family and loved ones. Overall, though the process is bumpy, the progress is sure.  There's no turning back: the combat veteran continues to WANT his healing, and his healing is happening.

And suddenly, the revelation, at least in his mind: "I have PTSD," he declares, decades into the fight, "but I am NOT PTSD."  Previously, of course, the unspoken assumption was that there was no distinction.  PTSD so consumed his life than in fact he WAS PTSD.  Now, he can say that he has it -- increasingly, even better, that he HAD it -- but that it is not him.  Wow.

The Double-Edged Sword Called "HOPE"

"Got hope?" the Obama bumper sticker asked.  (Hey, we're non-partisan here, it's just an illustration to make a point.)

The reality is, hope turns out to be VITAL, not optional, in someone's struggle to "heal."  And "healing," of course, is not specifically an end-result, a "one and done" event -- but a progress along a continuum. 

Even the Bible talks about how, "without vision, the people perish."  Emily Dickinson, who it's easy to imagine as a profoundly depressed, but nevertheless highly imaginative New England poet, referred in one of her more famous poems to hope "as a thing with feathers."  Meaning, pretty airy, light-weight, and able to fly away.  Hard to trap and catch, hard to hang onto.  If you put the two concepts together, though, hope is both necessary AND hard to hard to hang onto.  No wonder it's so important.

Over the last few months, I've been watching as a hardened combat veteran, with severe PTSD, has stepped out of his comfort zone, and put his "hope" to the test: Hope that there was a life for him outside the realms of severe combat trauma.  It's been incredibly interesting and refreshing to see what's happened to him since.  And hope shows up at every turn.  Without going into it in much depth here -- there'll be another time and place for that -- I've been able to see his physiology as well as his psychology change, in just a few short months -- and I've seen the renewal of "hope" this has caused within him.  For one thing, hope to be considered more than just another "crazy, effed-up combat veteran" -- the mask he's apparently worn for society for years (decades, in his case).  Hope that he can have an actual life and happiness beyond what he had been reconciled to, by virtue of "throwing off" some of what's hindered him (the Biblical wording here is purely incidental.)

The deal about having a mask that you wear, as a combat vet, because it's what society expects of you -- and it's also what allows you to keep other people at bay -- is a very interesting concept in its own right.  It helps, but it also hinders. It frees, but it also constrains.  And suddenly, with better health, comes the realization that it may be time to consider laying that mask down, at least part-time.

Whoa.  Strangely...that turns out to be a tad problematic.

Because there is comfort to be found behind that mask, and safety, and worst of all -- familiarity.  We all struggle with, "better the devil you know...than the devil you don't know."  And even a self-imposed mask offers a modicum of comfort, though at great cost (what you miss out on, wearing it).

The combat veteran and I had a conversation the last few days that mirrors several others we've had over time, as he's received extremely positive -- surprisingly positive -- news from his medical providers.  The sum of it is, he seems to feel he had an easier time picturing he was going to fade out and die...than actually revive and live.  Strange, isn't it -- the rest of us just want to get well.  But to the combat vet with PTSD, sometimes there's a fair amount of comfort (from the familiarity) of knowing things are bad...and likely to stay the same or keep getting worse.

What I've seen with this very courageous individual, as I've watched him fight to take this new hill, called health, is how hard it's been to reconcile himself to having hope now for an actual future, unmarred substantially by the PTSD that's dogged him so much from the past.  Not that he'll ever be "over" it completely -- but getting quite a bit better, and healing both on the outside and on the inside?  On the one hand, priceless. On the other hand, definitely scary.  Stay tuned...this has been an incredibly interesting journey to watch, and it will continue to be.