Emotional Intelligence and Psychology
What is PTSD?
An interview with Joseph Bobrow a clinical psychologist, psychoanalyst, and Zen Master about his newest book “Waking up from War: A Better Way Home for Veterans and Nations”. What are some common issues faced by 3m returning war veterans who served in Iraq and Afghanistan integrating into civilian life?
Except where noted, all quotes are from Bobrow, J. (n.d.). Waking up from War: A Better Way Home for Veterans and Nations. Pitchstone Publishing.
What is PTSD?
In “Waking Up from War – A Better Way Home for Veterans and Nations”, clinical psychologist and author Joseph Bobrow describes what he’s observed after working over a decade with Veterans. Bobrow describes that he has seen two forms of PTSD with elements of each kind of PSTD in “proportions”.
The first form of PTSD represents a cluster of debilitating anxiety symptoms. The roots are with a nervous system dysregulation through a cumulative exposure to war-related trauma. Humans are all programmed to feel fear and have the appropriate physiological response which is to either to fight, flee, or freeze. This “fight-or-flight” response is our response to protect us from harm. In PTSD, this reaction is changed, damaged and no longer regulated properly, which means that people who have PTSD may feel stressed or frightened even when there is no danger.
The second form of PTSD includes the emotional stress and burden that is carried by the veterans. It is the moral injuries felt when returned, or the guilt or shame associated with harming others.
VIDEO: Dr. Bobrow describes PTSD
- 0:41 What is PTSD?
- 3:08 What are the nuances and different types of PTSD?
- 6:07 What dysregulation happens with PTSD that affects our body, mind, and soul?
- 1:39 What are the symptoms of PTSD?
- 16:32 What are the moral injuries or soul damage that happens with soldiers?
What are physical Symptoms?
According to May Clinic, the symptoms of PTSD can vary in intensity over time and can start within weeks, months, or years after the originating traumatic event. The symptoms can show up when you are stressed, or when there are triggering events that remind you of what you experience in the past. Mayo Clinic groups the symptoms into: intrusive memories, avoidance, negative changes in thinking and mood, or changes in emotional reactions. Here’s the list from Mayo Clinic on symptoms:
Intrusive memories – Symptoms of intrusive memories may include:
- Recurrent, unwanted distressing memories of the traumatic event
- Reliving the traumatic event as if it were happening again (flashbacks)
- Upsetting dreams about the traumatic event
- Severe emotional distress or physical reactions to something that reminds you of the event
Avoidance(Denial) –Collective denial –Symptoms of avoidance may include:
- Trying to avoid thinking or talking about the traumatic event
- Avoiding places, activities or people that remind you of the traumatic event
Negative changes in thinking and mood Symptoms of negative changes in thinking and mood may include:
- Negative feelings about yourself or other people
- Inability to experience positive emotions
- Feeling emotionally numb
- Lack of interest in activities you once enjoyed
- Hopelessness about the future
- Memory problems, including not remembering important aspects of the traumatic event
- Difficulty maintaining close relationships
Changes in emotional reactions: Symptoms of changes in emotional reactions (also called arousal symptoms) may include:
- Irritability, angry outbursts or aggressive behavior
- Always being on guard for danger
- Overwhelming guilt or shame
- Self-destructive behavior, such as drinking too much or driving too fast
- Trouble concentrating
- Trouble sleeping
- Being easily startled or frightened
Source: Post-traumatic stress disorder (PTSD) (Symptoms): http://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/basics/symptoms/con-20022540
What are the emotional effects returning Veterans feel?
While the physical symptoms may be easier to observe, there are symptoms that effect us emotionally and are less easy to detect. Bobrow explains that the most entrenched, profound, and treatment-resistant problems are those related to a loss of purpose, and meaning. Soldiers go off to war in the act of service, but return to see their battle victories get erased over time and the war continue. Bobrow shares his observations from a group discussion with veterans:
“ Veterans do not want all that they and their loved ones have gone through, all they have lost, to have been in vain. They want it to mean something. In one veterans’ small group the theme became, “What do we got to show for it?” . The inner conflict was so profound that even broaching the topic made some of the participants test and defensive, as though others were blaming them just b bringing it up. Today, we see this dynamic emerging in many Iraq war veterans. As the country they found to save falls apart, many are experiencing a resurgence of emotional pain linked with a sense of meaningless. Feeling like it was all for nothings is a terrible blow. When we factor in the element of betryal- a leader, a government, or healthcare system- we have a potent mix. Add the emotional and moral reverberations of having killed, and having witnessed death and grave injury, or having acted in a way that is at odds with one’s sense of right and wrong and the mix is turbocharged. Shame, guilt, and self-loathing stroke the fires”. P33
Bobrow describes this as PTspD, where “sp” refer to the spiritual register. The injury happens not on the physical level, but Bobrow describes the “D” (Disorder) in more detail. He has observed the disabling of our capability for reflecting and processing trauma; dispirited, the evaporation of basic aliveness; disbelief, as in the crises of faith that are generated when one’s entire assumptive world, including our religious beliefs, which affects one’s sense of meaning; disrespected, despair, a loss of hope, an sense of being helpless to remedy the situation, and disaster, with the existential angst.
How does it affect the person returning from war?
Joseph Bobrow explains that in previous wars, the whole country was at war. This is quite different for the three million people who went away to Iraq and Afghanistan war. These soldiers went to fight in countries torn apart from war, and then had the surreal experience of returning back home where everything seemed just as they left it.
No longer in uniform, these veterans integrate back into society. Perhaps, returning back to get a college degree indistinguishable from other students in a class room. Soldiers feel both alienated and isolated when they return. This NY Times article covers the story of a solider returning after service and his experience after six of his friends in the battalion commit suicide
While soldiers attempt to get help from PTSD, often their needs are not met or understood by the medical community and society at large resulting in a sense of ethical betrayal and loss.
“We will help our country, even, if necessary giving our lives. If we return, we expect to receive the care and services we have earned”. P 33
Video Answers
Click on timestamps to hear answer
- 17:57 Why veterans feel so isolated when they come back form service?
- 22:24 How do we address invisible injuries, like TBI, that happen with shoulders?(mood, memory)
Veteran Voices
Here are a sample of veteran voices that Joesph Bobrow gathered over the course of his retreats with veterans. Here is how they expressed to their family of “What did deployment feel like?”
“ I feel isolated and lonely, even though I had my comrades with me. It was a void, being away from my family.
I felt agonized, as if my heart had been ripped out of my chest. Sad. When I got to see my kids on Skype, I was happy and proud.
I felt this was my last go-around, my last dance on this planet.
I felt like I was betraying my children for my country.
I was afraid that when I said goodbye to my kids, I wouldn’t see them again.
I felt un-included because I missed my son’s first words, first steps, first everything. I was stuck in limbo, and my family went on with their life without me.
I hated that my wife didn’t get more support” p131
The book also includes what veterans want to say to their families:
“ It’s hard to take off my uniform; I’m sorry.
I feel responsible for what I put you through.
When you and mom waved goodbye to me, I put you both away. When I returned home, I didn’t know how to come back.
I’m sorry that I can’t be there with you all for the 45th of July. It’s because in my mind the bombs and missiles are still going off.
I didn’t write or call as much as I wanted to, but I was trying to protect you.
I did everything I had to, including some crazy stuff, to come back to you.
I so enjoyed putting together that birthday package for you. It pulled me out for that moment.
When I read your letter it made me cry: “Dad, what happened to you?” you wrote. “When you left you were so much fun. But when you got back, I didn’t know who you were.
The faded picture in my vest gave me strength. Sorry, I didn’t call; I didn’t know how to explain the pain.
When I was away, I was scared for you. I hope I never have to go back.“ p133
Effects on PTSD on Families
Bobrow explains that repeated war trauma unravels connections with families , their peers, and their communities. A saying within military families is “ When a service member deploys, the whole family deploys”.
“Unless we wake up and see, hear, and recognize the story of our veterans, and their families, children, and caregivers as our story, we will surely repeat those past errors, with similar or more grievous costs” p 32.
VIDEO: Dr. Bobrow describes PTSD
Effects on children
War often means separation from parents and children feeling the loss of protection or safety. This is compounded by multiple separations caused by being called out to duty several times. The spouse that stays at home is often stressed and overwhelmed. Wives of soldiers sent to war, suffer at higher rates with 18% higher rate of depression. Children of deployed parents suffer more emotional issues especially when separations are long or when the parent at home is struggling.
Effects on spouses
As part of Bobrow’s family retreats, he’s talked to the spouses left at home and he shares their experiences of scary and shameful feelings. Some were terrified that their loved one would not return home or would come home irreparable damaged. Some felt a sense of utter helplessness. Others fantasized about new love interests or had affairs.
spouses Voices – What did deploayment fee like
Here are a sample of veteran voices that Joesph Bobrow gathered over the course of his retreats with veterans. Families shared their feelings on “What did deployment feel like?”
“ I kept asking, “Why am I always the one who has to be strong?
While he was gone, our daughter almost died. I had to go to the ICU and had to go through all that alone. I was angry that he wasn’t there.
I found myself looking at the kids and thinking “Wait, stop!” They were growing up so fast and I didn’t want him to miss it.
I had to keep really busy to make it through.
I was product of him, but scared of having to be mother, father, and everything all together.
I felt a little guilty, because I did get to witness all those moments, but, since I was there, I was also the one who got balmed. That was hard.
I would sometimes laugh at moments when I wished he was there. Like when I blew up the lawnmower.
When you were away, I cried every night.
The longer you were away, the longer my agony.
Every time the phone rang I was frightened.” P 131, 133
Who can get PTSD
According to the National Institute of Mental health, PTSD is something that anyone can get any age. Generally speaking, PTSD is something that someone gets after seeing or living through a dangerous event. Joseph Bobrow noted that anyone who serves when at war can get PTSD, whether it’s the firefighters that were called during 911, the mental health professionals serving veterans, or the health providers who work with returning veterans.
War veterans, as well as survivors of physical and sexual assault, abuse, accidents, disasters, and many other serious events can get PTSD. Some people may get PSTD after a friend or family member experiences danger or is harmed or when there is a sudden, unexpected death of a loved one.
VIDEO: 1:48 Who can be affected by PTSD? Is it only veterans?
Treatment of PTSD
Treatment can be a long road,here’s a passage that Bobrow shares from a patient:
“ I’ve started going backwards again. All the emotions and nightmares are coming back. I ahd stopped drinking and now I’m drinking again, trying to hide it. I can’t sleep at night. It’s hard to find yourself again, bacuse you’re never going to be the same person. I am trying to figure out how to forgive myself for everything I did over there, and it’s hard to figure out. I’m messed up. I’m fired of just taking pills”. P 198
Bobrow shares his thoughts on current approaches to PTSD:
“The strategies utilized are commonly one-dimensional , symptom-driven, one size fits-all, and despite the rhetoric about “gold standard” are unproven. Programs like Comprehensive Solider fitness that costs hundreds of millions of taxpayer dollars are re-upped without reliable evidence. Planner and leaders can’t, don’t and won’t stop to think about what vets really need and want. Here, too , the press of trauma and our maladaptive reaction on the one hand and concealed self-interest coated with unctuous honorific talk on the other seem to rule the day.” Page31
After experimenting and trying many methods, here’s what Bobrow shares his thoughts on the most effective treatments plans are those that involve:
- More than just veterans. It is critical to involve family members not just the veteran alone. This enables veterans to share their true experiences with their partners, other family ememebers, and colleagues.
- Calming practices: Practices that build regulation such as quigong, yoga, and meditation help veterans when they encounter feeling of remorse, sadness, memories of traumatic vets, and dreams, practices. (Note: Check out EFT too).
- Discussion among Communities: Group work where people share their stories, sitting with one another in safety, listening deeply and respectfully without judgment, or trying to fix anything. Bobrow explains that this kind of dialogue helps heal war trauma and preventing future destruction by allowing soldiers to express their fears without feeling ambushed, or being left with their guard down.
VIDEO: Dr. Bobrow shares treatment plans
