I saw El Diablo’s grin

Smelt the sulphur on his breath

He was in ecstasy

The battlefield spoilt him for choice

He never chose me that cold day in June

Greedily he ate up my brothers souls

Not a few hundred yards in front of me

Gone in a fiery holocaust of flames and screams

Hell had spewed from the bowls of the earth

Laughing at me he waved goodbye

I was told how lucky I was

Thirty years have passed

I have traded insults with him

He left me not out of pity

But to further punish me

Waking in a sweat filled nightmare

I scream for him to take me

He wags his finger at me like a lap dog

“Not yet, Not yet”……

I envy my fallen brothers.

© Tony McNally

 

Tony’s Poem El Diablo nails the pain of survival to the mast of our souls and lashes it with the terrible truth that time is no healer of this wound.

I turned to one of the Trauma Warriors I most respect in this life, Steve Critchley, of CanPraxis.  A healer of warriors: all trauma warriors – spouses of, families of, trauma survivors and the trauma survivor themselves.  I have written this post as a conversation, it was in fact by email under the eyes of other Trauma Warriors who quietly save warriors around the world, men and women dedicated to making sure that no matter how terrible “waking in a sweat filled nightmare” is, El Diablo never succeeds in his quest for our combat veteran’s souls.  These men and women shun the limelight, shun the pompous: silently, stealthily they fight El Diablo.

Steve, what are your thoughts on anxiety?

Not an easy one to answer: each situation is different and the reactions/responses can vary tremendously. Important to understand the difference between a REACTION which is emotion based, and a RESPONSE which is grounded in logic.

Anxiety is a reality for every living person…PTSD/OSI magnify it disproportionally.  What works for one person may trigger a different person.  It requires experimentation of many different techniques to learn what works best for each person… keeping in mind as a person overcomes these injuries the techniques may need to change.

So patience and perseverance are the two weapons any Trauma Warrior is going to need.  

If I understand this, ANXIETY takes two forms: one emotion based “reaction” the other is cognitive (as in sequencing brain fully operational) and based in logic “response”.  The ideal is to work with a fully functional brain and logically, cognitively respond to the situation that is causing anxiety?

Yes.  Important to remember that to get to a logical, or as you call it a functioning cognitive, sequencing brain, you need to acknowledge the emotion and then move from there, avoid getting stuck in a cycle of emotions.

Over the years I have supported and connected with a number of combat veterans, first responders and civilians who feel the immense weight of survival, as Tony’s poem says, “I envy my fallen brothers”.  I have so often heard “why did I survive and they didn’t?”  When a battle buddy, colleague, friend dies by suicide it often sets off a cascade of anxiety within them that is hard to derail.  What would you say to somebody who’s anxiety is ramped off the scale by this kind of news?

Comfort and acknowledge their experience, get them to a qualified therapist as fast as you can.  “Dwelling” on suicides via social media is harmful and should be discouraged.  When a conversation about suicide appears it is important to acknowledge the situation and move onto production situations.  Steer people towards therapy and proper peer support.

Steve, can you clarify what “proper peer support” is?  I often fail to encourage this.  Whilst I am honoured to connect with and walk by somebody’s side, I know my limitations.  For example, there is significant resistance especially in LEOs to connect with fellow LEOs, even ones from different services carefully sifted and guaranteed confidential, respectful, healthy and motivated not by ego, but deep empathy for others sharing this injury.  What does “proper peer support” look like and why is it so important to have in your tool chest to fight this injury?

The desire is to be part of a facilitated peer support group with a trained facilitator that can keep the conversations focused on forward movement and can ensure all participants feel heard, understood and acknowledged.  No judging.  The conversation must not be allowed to become stuck in the negative past only.  Those type of conversations require specialized training and qualified therapists.  Avoid peer support groups that focus only on war porn or where alcohol is involved.  Alcohol is a crutch and not your friend.  Peer support can also mean just sitting with a person who helps you feel at ease where you feel “safe”.  Talk is not always necessary, just having someone there can be of great comfort.  Peer support can also mean getting involved in a physical activity with others in the same situation….in other words, getting out and simply doing something outside of your home.  Basically avoid groups centred on alcohol, war porn, or focused solely on prolonged negative stories.  Also give yourself time to become comfortable within a peer support group keeping in mind no single group works for everyone.  There is one out there that will work for you.

In my time building #PTSDChat and PTSDChat.org I’ve come across some gob smacking individuals who claim to be the be all and end all of PTSD/OSI.  Magic wands in hand and for $$$ they can CURE it!  What is your experience and your thoughts on harmful therapies and practices out there?

Anything that claims to be a “cure” is destructive and to be avoided.  Additionally be careful about “feel good” programs.  These are programs that create artificial feel good moments without teaching any life skills and/or generate productive healing.  They create a dependency on these type of Feel Good programs which become addictive.  The only time they “feel good” is in an artificial environment and it becomes a hiding place from the real world.  This is very destructive.  Be extremely wary of any program that loudly asks for people with a VAC claim or case manager.  There are many programs out there looking to simply profit from Veterans.  Hugging a horse will not help you any more than petting a rabbit.  The act itself may create calm, that in of itself is not therapy.  We have had a female Veteran come to us suicidal resulting from a equine therapy program that wanted her to go nude in a sweat lodge.  The idea of a horse walking around and sniffing you while you lay on a table is unadulterated bullshit.  Many programs are popping up where unqualified and poorly educated people offer fantastic results.  The greater the results offered by these “programs” the faster you should run from them.  Also people should be aware what factual empirical evidence exists to support any particular program.  Stay away from purely anecdotal promotions. 

I sincerely hope folk listen to that advice.  But it brings to the “What does work?”  

An extremely important measure is to ensure your therapist works for you.  Your therapist should talk to your spouse/partner/family member approximately every 6 weeks.  Some sessions should be as a couple.  Nine out of ten Veterans openly tell us they lie to their therapists.  The only ones who really know what is going on is the spouse/partner/family member.  If your therapist will not do this FIRE them. 

If you have been with the same therapist for several years and there has been no improvement, FIRE them and get a new one.

A major challenge with Therapists is their fragile ego and that most of them are trying to heal themselves.  I work with several who are not comfortable taking their concerns to any of the therapists they know as they have no faith in their abilities.  By adding spouses into the mix many therapists feel they may be questioned and held accountable.  Also some are just pure lazy and/or burnt out.  We stand firm, if your therapist will not talk with the spouse, get a new therapist.

Additionally give yourself and your therapist time to get to know each other.  Your therapist can’t help you if you won’t talk.  And be honest as it does take time to start making headway.  You’ll recognize a good therapist when you meet one.  Therapists are vital in your recovery.

Thanks Steve.  On the point around ‘spouse’.  It raises two issues I have noticed that make me a tad scratchy.  Firstly, I have seen deeply worrying relationships where a spouse appears to live for their partners injury: there is an unhealthy focus and reliance on the injury which is encouraged by the treating therapist.  From the peanut gallery I sit in, it looks pretty toxic.  Secondly, and here I step trembling with fear and trepidation, is the toll on the mental and physical health of a spouse.  The guilt I know many feel at the treatment they meted out to their spouse and families is terrible; I have heard both sides often and I feel deeply for them.  It is to me, one of those nobody wins situations.  What are your thoughts?

On just about every program we hold there is at least one suicidal participant.  What has us greatly alarmed is that we are now seeing suicidal spouses.  Below I have included comments made by Veterans during Phase 2 potion of the programs.  This is their words regarding spouses/partner/family member.

An alumni working on overcoming PTSD helped to explain the evolution of healing as they pass through our program. The first stage is taking part in Phase I and then returning home with their spouse. Using the tools taught in the program there is improved communication in the home and family. As this improved communication and healing progress the Veteran begins to find their way through the fog of PTSD and realize just how much they have depended on their spouse. The Veteran realizes their Spouse has regarded them as a hero and stood by them through thick and thin, when friends and family are saying ditch the bum you deserve better. Now the Veteran begins to feel like a zero and sees their Spouse as the hero. 

The Spouse knows the true Veteran and knows that friends and family are very much mistaken as this Veteran is more than worth the challenges of recovering from PTSD. The Veteran then becomes depressed for all the troubles he has caused his family and then makes a decision to move forward for the sake of their hero, their Spouse. At about this stage the Spouse sees improvement in the Veteran and begins to feel tired and worn out. Now the Spouse begins to lose strength and becomes resentful and depressed. In other words they are finally allowing themselves to feel all the effects of being so strong for so long. Roles start to become reversed. The Veteran recognizes this and becomes the care giver for the Spouse. The Spouse NEEDS to be the one to heal with focused support from the Veteran. As the Veteran supports their Spouse they both finally begin to heal together. 

They battle and overcome the evils of PTSD together as EQUALS and as a TEAM. This ends with both treating each other like heroes and as equals and neither is a loser. This generalization helps to explain the up and down nature as well as role reversals that occur during the healing of PTSD. It’s never easy and ALWAYS worth it.

 

Wow! That is pure magic.  I’ve never heard it described like that and until recently have never experienced anything but the toxic.

 

What about self sabotaging practices that increase anxiety and need to be recognized, to be avoided?

As for sabotaging tendencies, anything that prevents continued healing etc is self destructive.  Coping is a temporary measure to stabilize a situation so people can move forward from there.  Anything that allows a person to get stuck coping is destructive.

I have had the immense opportunity of talking at length with Dr Jonathan Douglas and Dr D Rajska on Avoidance vs Exposure to triggers as it affects anxiety and coping skills.  What are your thoughts on this?

When it comes to triggers each situation is different and what could work for one person could be harmful for the next one.  With a proper therapy program it takes time to identify the triggers.  Then a plan must be put into place on how to deal with those triggers.  For some the plan can be simple, for others it could be complex.  These should always be under a therapists care.  It also requires forming new habits for the brain to focus on.  Service dogs can be of assistance with this.  Service dogs must NOT become a permanent crutch.  Additionally spouses can be helpful in helping people learn when they are triggering.  We teach a technique between a couple that helps them know when each other is starting to trigger and to gently remove themselves from the situation.  The proper therapists can help individuals learn basic coping skills with this.  Coping skills are a temporary measure to create a stable place where you can improve from and not a place to take up residency.  It takes time to find the right therapists and meds along with educating spouse/partner/family member about triggers and creating a plan on overcoming them.

Are there any other issues around this topic that concern you?

What is proving to be a harmful situation is Family Doctors getting in the middle.  A GP providing powerful mood altering meds usually makes things worse.  Two reasons…it’s not their area of expertise and they don’t get paid to talk to the therapists.  There SHOULD ALWAYS be conversations between the person prescribing the meds and the therapist.  These drugs can cause things to go sideways real fast and then inflame or even create new triggers. These powerful mood altering medications should come from a team that constantly talks to each other involving a psychiatrist and a psychologist.  NOT A GP and SOCIAL WORKER as they do not have the experience, knowledge or training. 

Here in Ontario the wait to see a Psychiatrist is 8mths to a year.  Leaving the patient with no alternative but to seek out a GP and hope his Psychologist can assist him with his medication regime.  However, I have heard from a number of PTSDChat community members who feel utterly lost as their GP and Psychiatrist disagree on medication.  I had always assumed that a GP would step back and take the Psychiatrists view of things, regardless of their personal views.  Apparently that is not the case.  It clearly is an issue that needs to be addressed, globally.  This is not a Canadian only issue, the stories are repeated across the world.

Any last words?

Trial and error with a whole lot of patience WILL bring improvement.  Nothing of real value in life is free, what you truly value takes hard work and determination including recovery.

These are only quick replies to your questions and meant to provide a rough guide only.  Each question can require an answer quite different for each person.  This stuff is messy and complicated.  The reality is people need to try different things in order to find out what in particular works for them.  Hope this helps.

 

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