This is a version of presenation that I give for free around the state of Oregon. My intent is to change the way the military and veterans talk about combat stress injurie and PTSD, to make it more of an open topic. Currently we hear the term and we 'tune out' and don't seek the help so many of us need. Understanding what is happening in the brain and soul, with respect to our uniform and our warrior ethos, has helped many soldiers/marines begin treatment. I am always reworking this to make the message better. I try to relate to the audience and use my credentials as infantry instructor and combat vet to that effect.
2. Personal Considerations This presentation will contain images, and topics about combat and Post Traumatic Stress Disorder (PTSD). I intend to evoke an emotional response. If you feel uncomfortable at any time you may leave without comment or question. 3. Joes are divorcing Soldiers Around Me Lots of beer drinking Risk taking (fights) and not caring about consequences Drug and Alcohol Abuse Joblessness Nightmares and lack of sleep Attrition of NCOs 4. Driving at night at 30 MPH a trigger Myself Easily irritated Hyper vigilant- very wearisome Startle response Merging onto the freeway and driving Relationships ended Easy to get into a fight No memory/concentration Strange emotions unexpected 4th of July was no fun 5. 2005 Oregon Violent Death Report 6. 2000 to 2006, 1,066 male veterans in Oregon took their lives. In 2005, 19 Oregon Soldiers died in combat in Iraq and Afghanistan.That same year, 153 Oregon Veterans, of allages, serving in various wars, committedsuicide. Nationwide, after five years of war inIraq, Marine suicides doubled between2006 and 2007, and Army suicides are atthe highest level since records were firstkept in 1980.Reported suicide attempts jumped 500 percent between 2002 and 2007. 7. 6 years 72 months 288 weeks1066 Oregon Suicides 3.7 Suicides a Week 8. A 2003 New England Journal of Medicine Study found that more than 60 percent of those showing symptoms (PTSD) were unlikely to seek help because of fears of stigmatization or loss of career advancement opportunities. 9. According to the PDRHL from the Department of Defense Behavioral HealthSurvey 43% of 2000 National Guard Members had readjustment issues after returning from the war zone(s). 10. I would be seen as weak by my unit members65% My unit leadership might treat me differently 63% My unit would have less confidence in me59% My leaders would blame me for the problem 51% It would harm my career 50%Difficulty getting time off for the problem 55% It is difficult to schedule an appointment45%I dont trust mental health professionals 38% Mental health care doesnt work 25%I dont know where to get help22% 11. Red Badge of Stephen Cranes book aboutthe Civil War contained themes Courageof masculinity symbolized bywar.Where are the mental wounds?We discount them becausethey are invisible counter to our notions ofmasculinity secondary 12. I dont rate feelingthis way 13. A Veteran 14. And what about when your warriors anger goes home? What is it like with his wife and children? Is it useful then, too?Cicero 15. PTSD from Ancient Greece to thePresent Sophocles, Homer Nostalgia Hysteria Bibles Job, Joseph, David Shellshock Buck fever Combat fatigue Battle reaction Disorderly action of the heart Soldiers heart Homesickness Irritable heart 16. Called combat fatigue and it was a serious problem. WWII In the European Theater, 25 percent of all casualties were serious PTSD cases.In the Pacific Theater, like Okinawa in 1945, it accounted for over a third of all 17. Iraq andAccording to a more recent Post-Deployment Health Afghanistan Reassessment 38 percent of regular soldiers, 31 percent of Marines, and 49 percent of National Guard report psychological symptoms.Those who had served repeated deployments were at extremely high risk of problems and the toll on their family members was great. 18. What is going on? 19. The Brain 20. Phineas Gage On September13, 1848, PhineasGage wasforeman of a workgang blasting rockwhile clearing theroadbed for a newrail line. 21. Conditioning Pavlov in 1904 Skinner developed further into Behavioral engineering Rewards and Punishments develop automatic behaviors 22. Train Like You FightMethods used to train isan application ofconditioning techniques todevelop quick shootability. The modern soldier trainsin full gear, shootingblanks at realistic targetsuntil reflexive fire isobtained. 23. Train Realistically This muscular, life sized male upper torso body form is intended specifically for precise marksmanship training. The cavity in its back holds red balloons to resemble vital organs. The body drops when a red balloon is shot. 24. The Unnatural Act of Killing Another It is estimated that inWorld War II, 75 to 80percent of riflemen did notfire their weapons at anexposed enemy. In previous wars nonfiringrates were similar. In Vietnam the nonfiringrate was close to 5 percent 25. I yelled kill, kill til I was hoarse. We yelled it as we engaged in bayonet and hand-to- hand combat drills. And then we sang about it as we marched. I had stopped hunting when I was sixteen. I had wounded a squirrel. It looked up at me with its big, soft brown eyes as I put it out of its misery. In 1969 I was drafted and very uncertain about the war. I had nothing against the Viet Cong. But by the end of Basic Training, I was ready to kill them. -Jack, Vietnam VeteranOn Killing 26. To survive and be victorious on the battlefield, our warriors must aggressively seek out the enemy and kill them. This has far reaching spiritual and psychological implications. In order to be successful the warrior must not miss a beat in pursuing and eliminating adversaries one after another. When they attack the enemy, they are trained to go one step beyond personal moral boundaries and take the life of another human being. This eventually becomes their personal horror of war- this is one primary aspect that damages the soul. The killer instinct that is so energetically thrown around in locker rooms and corporate sales meetings becomes a very real impulse to soldiers in the heat of battle. Without this instinct the warrior is very lucky or very dead. Down Range: To Iraq and Back 27. Amygdala Connection with lots of areas of the brain Emotional stamping of events Increases reflexive reactions Signals sent upward are checked by prefrontal cortex. 28. Amygdala 29. Almost all service members returning from the war zone will experience some of these behaviors and reactions. Its vital that you remember that having these reactions does NOT automatically mean you have PTSD. It would be abnormal if you didnt experience some of these feelings and behaviors following what you have been through in the war zone.It isnt an Either/Or it is a spectrum 30. Signs & Symptoms of PTSD Flashbacks, or reliving the Self-destructive traumatic event for behavior, such as drinking minutes or even days at a too much time Hopelessness about the Shame or guiltfuture Upsetting dreams about Trouble sleeping the traumatic event Memory problems Trying to avoid thinking or Trouble concentrating talking about the Being easily startled or traumatic event frightened Feeling emotionally numb Not enjoying activities Irritability or anger you once enjoyed Poor relationships Hearing or seeing things that aren't there 31. Anxiety The mind stays on Physical symptoms vigilant, ever on alert. Emotional fatigue This keeps emotions and the body aroused. Mental fatigue Chronic or severe arousal Spiritual fatigue changes the nervous system. Smaller threats than usual Exaggerated stress sound the alarm. response Takes longer to return to Avoidance is hallmark resting state. 32. Dissociation Perceived detachment of Traumatic memories are the mind from emotional walled off states or even the body. Dissociated material is Dreamlike state or unreal highly emotional and place.relatively non verbal Poor memory of specific Triggers can be the event sense, body DID, Fuguemovement, dates, stressf Fragmentedul events, strong emotions, cognitive State-dependent patterns, behaviors, out memoriesof the blue, and combination. 33. What is Dysfunctional? Impaired in function;especially of a bodilysystem or organ (of a traitor condition) failing toserve an adjustivepurpose. If a person is behaving inways counter-productiveto their own well-being 34. B Buddies VSWithdrawalAAccountability VSControlling Inappropriate T TargetedVSAggressionT Tactical AwarenessVSHyper-vigilanceL Lethally ArmedVS Locked and LoadedEEmotional ControlVSDetachmentMission Operational M Security VS Secretiveness I Individual Responsibility VS Guilt Non-defensive Driving N (combat) VS Aggressive Driving D Discipline and Ordering VSConflict 35. Medication Many Treatment PsychotherapyOptions Exposure Therapy Cognitive BehavioralTherapy (CBT) Eye MovementDesensitization &Reprocessing (EMDR) Memory Work Art Therapy Thought Field Therapy Healing Rituals Group Therapy And More 36. Call of Duty 4U.S. Army medical researchers have noted thatsoldiers that play violent video games, are betterable to handle the stress of combat. Moreelaborate (virtual reality) combat simulations arenow being used to treat combat veterans whoare suffering from severe stress reactions fromcombat (PTSD, post-traumatic stress disorder).www.strategypage.com 37. Pathologizing It is important that therapists who work with veterans be educated in the warrior tradition and its rituals in order to recognize and help veterans identify with [the use of] warrior traits. Ignoring these traits is harmful to the veteran, for then the inner warrior remains invisible. Pathologizing the traits is also harmful, for then the vet is further wounded by reductionist interpretations that may minimize their importance to him or empty them of their spiritual potency. -Edward Tick, Ph.D. War and the Soul 38. Strengths of our warrior tradition 39. What is a HERO? 40. I am an American Soldier. I am a Warrior and a member of a team. I serve the people of the United States, and live the Army Values. I will always place the mission first. I will never accept defeat. I will never quit. I will never leave a fallen comrade. I am disciplined, physically and mentally tough,trained and proficient in my warrior tasksand drills. I always maintain my arms, my equipment andmyself. I am an expert and I am a professional. I stand ready to deploy, engage, and destroy, theenemies of