Managing Traumatic Stress and Combat PTSD Through The R-E-C-O-V-E-R Approach*
TEN FUNDAMENTAL TRUTHS ABOUT PTSD: 6-10
Fundamental truth #6: Many People Develop PTSD In The Military Who Are Not Exposed To Combat: There are many situations in a combat theater of operations in which even non-combatants are exposed to traumatic stimuli that are sufficient to cause PTSD. In fact, some of the people who are most likely to develop PTSD are vulnerable PRECISELY BECAUSE THEY ARE UNARMED, and are therefore helpless to defend themselves. Just a few examples are cooks and other personnel who work in DFACs (dining facilities) that are a regular target of enemy fire. Those who work in motor pools may not be exposed to fire, but may have to clean body parts and remains out of armored vehicles. Medical personnel are exposed to the gruesome results of combat even if they are not in combat. Military photographers may be called on to document the atrocities of war, even though the camera, not the M4, is their professional "weapon."
Fundamental truth #7: Many People Have The "Building Blocks" of PTSD In Their Life History, Before They Enlist: Our society has become increasingly violent, at the same time that our economy is failing. Many young people experience serious or repeated instances of traumatic violence or abuse in their families and communities-of-origin. In fact, many of these young people choose to join the military in order to escape poverty as well as dangerous and traumatic environments. "It seemed to me like Afghanistan was safer than East L.A." one solder said to me. As a result, their nervous systems may already be highly stressed, or "primed" to be vulnerable to PTSD once they enter military service. As a result, the combination of their prior history, and one or more military events, causes their equilibrium to be lost more quickly.
Fundamental Truth #8: There Are 3 Major Symptom Categories In PTSD. Although we may describe these categories in terms of the outward behaviors that they provoke, virtually all of them also have a bio-physiological and bio-chemical root. In addition, virtually all symptoms make "sense", if you see your body as the "home" for what operates like two separate people: (l) the person in you who does the rational thinking about things, and (2) the person in you who exists below your level of conscious awareness, and whose job it is to do whatever is necessary to protect you from danger or impending death.
A. Re-experience of traumatic episodes: Traumatic episodes are life threatening, and therefore take precedence over almost everything else in order of importance. Much like football players and other athletes who spend countless hours watching game films, your brain watches and replays the event over, and over, and over, trying to "figure it all out", so as to protect you better the next time. It does so in a way that is so detailed that the personoften cannot distinguish between what happened in the past and what is happening in the present. This is what is known as "flashback."
B. Symptoms of avoidance: PTSD sufferers are usually thought to avoid people , especially their loved ones. This causes deep hurt within families and relationships. In truth, it is not usually the PEOPLE themselves that the PTSD sufferer is avoiding. Rather, the PTSD sufferer is avoiding the traumatic stimuli that other persons may carry with them, or a characteristic of the person that reminds someone of a traumatic event, or a psychological trigger that may be in their vicinity. This avoidance is a natural protective mechanism of the brain, in order to prevent the nervous system from becoming overly exposed to things that are associated with old traumas. For example, the veteran may not really be avoiding his child. He may REALLY, UNCONSCIOUSLY be avoiding the fact that his child's little league game is played at a ball field where helicopters fly overhead, which may create feelings of terror or endangerment. In other words, the father is avoiding triggers that are present in the child's vicinity. Likewise, John may look as though he is avoiding his wife Mary. In truth, Mary's eyes may remind John of a civilian female whom duty forced him to shoot and kill at a vehicle checkpoint. It is not Mary herself that John is avoiding, but a characteristic of Mary which John associates with a traumatic event.
C. Symptoms of Increased Arousal: In order to protect your unit when you are on guard duty, or are walking point, you must be aroused. This means you cannot be safely relaxing; if you were, you might overlook a risk that would put your unit in danger. You must be up, functioning and alert to the smallest detail that could put you, or others in your care, at risk. PTSD sufferers continue to live on "high alert" for many years. This may involve sleeplessness or sleep disorder, razor-sharp awareness of sights, sounds and smells, ultra-fast reactions including super-startle response and reflex-responses which occur before the person can actually stop and think about them. Anger is the word we use to describe the physical and emotional processes that help people to marshall these protective responses. As a result, anger and irritability are also symptoms of increased arousal.
Fundamental Truth #9: PTSD Symptoms Can Usually Be Managed. The belief that all PTSD sufferers are stuck with their symptoms for life is false. Most can be managed, with proper care and case planning. How easy or difficult this process is will be affected by several factors, including the life circumstances of the patient, their personal commitment to managing the illness, and whether they suffer from another co-occurring illness which complicates their condition (such as alcohol or drug dependency, biopolar disorder, major depressive disorder, etc). Generally speaking, however, there are a number of ways that symptoms can be managed or, over time, eliminated. See our articles on treatment and care plans for more information.
Fundamental Truth #10: Why You Should Be Educated About The Other Nine Fundamental Truths: If you do not have accurate information about the condition you must live with each and every day, you will not understand it. It you do not understand it, you will not be able to manage or control it. Instead, you will be likely to either avoid treatment, or simply "leave everything to the doctor", who may not be acting on complete information from you and may therefore not provide you the proper treatment you really need. If you make yourself nothing more than an uneducated bystander in your own treatment, your treatment will not be likely to succeed.
CONCLUSION: A Little Knowledge Is Never Good Enough, When It Comes To Your Mental Health. This site, and our book, both exist to provide you with sound and current information that will help you become knowledgeable about your condition. This, in turn, will make you the "consulting expert on your own life" that your doctor needs.For more information, read Chapter 2 of "I Always Sit With My Back To The Wall", entitled "Educate Yourself About PTSD", and look for new articles on this website on this important topic.
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