The Pain of PTSD
(Oh, God! No! No!)

I have one brief moment each day without pain,
The morning's flash when I first open my eyes.

Then I awake - Oh, God! No! No!

I am engulfed. A heavy, oppressive weight
pulls my shoulders into my stomach.

Where does this pain come from?

I throw up. I want to escape. I need to die.
I speak to God seeking relief.
I offer Him my hands in exchange for deliverance.

I try breakfast, but am unable to consume.
Every task must be done by rote:
shower
shave
lace my boots
greet people
answer questions
give orders.

Today is another tough day.
Existing in an abominable robotic shell.

The attacks of paranoia descend.
I am unable to look in anyone's eyes
nor socialize in anyway.
I want to curl up tight in my bed
the room completely dark.

Each night I pray, today is an aberration - it is an aberration!

Tomorrow the pain will be gone. Let it be gone when I awake.

I awake - Oh, God! No! No!

By Alan Lubke, PTSD survivor

From the Peak of Honor to the Depths of Despair, A Soldier's Struggle with PTSD (From the Fort Worth-Star Telegram)

Nate Self sat in the Capitol gallery, just two months before the invasion of Iraq, as a guest of the president and first lady during the 2003 State of the Union address.

He was a Waco boy (although he lived two years in Benbrook), a handsome Army captain, decorated with a Silver Star for valor and back home to recount the bravery of his Rangers on a 10,000-foot mountain in Afghanistan during a 15-hour fight against al Qaeda.

But Self, a devout Baptist and 1998 West Point graduate, represents more than heroism in battle.

He now also epitomizes the hidden toll that war can take. Recovering from suicidal-level post-traumatic stress from combat, Self, 32, wrote a book called Two Wars: One Hero's Fight on Two Fronts - Abroad and Within.

His story begins in March 2002 during Operation Anaconda, launched by U.S. forces to prevent the escape of thousands of al Qaeda and Taliban fighters into Pakistan. Self led a "quick reaction force" of Rangers to the snow-capped Takur Ghar mountain to bring back a missing Navy SEAL named Neil Roberts.

He and the other men never suspected that they were flying into an ambush. His helicopter was shot down by a rocket-propelled grenade, and five of the 21 men aboard died. He still relives that day frequently, but the battle and its aftermath have left him a much different man.

Collected moments from an interview at Self's home in Temple:
"The Rangers on the left and the right of me were killed. As we exited the back of the Chinook, there were two dead men on the ramp. We were in a saddle, and the high ground was around us. It was a close-in ambush with the enemy. There were only a few guys who could even fight, but we fought back and took control of our crash site. Then we started calling in air strikes. We eventually succeeded in assaulting and killing all the enemy. We were shot down at dawn, and we left when the sun went down."

"When I came back from Afghanistan, I changed jobs, left Savannah [Ga.] and moved to the school environment. I started to notice I was a little different. I never had wanted to talk to my family about what I'd seen. I wanted to protect them. But in the school, I was with peers, but I still felt a distance from them. I didn't like being around them. I didn't like being around anybody."

"I started having nightmares in Iraq [he served there with the 101st Airborne in 2003-04], re-experiencing the events, intrusive thoughts. Then I started to get kind of scared. I was scared I wasn't going to come home."

"I had been a faith-centered person. I prayed about decisions and read Christian books. But when I got scared about my future, I turned my back on all that. I was afraid if I prayed about it, God would tell me to stay in the Army, and I didn't want that answer. So I made a couple of rash decisions and left the Army when I got back from Iraq."

"I had a total lack of purpose after I left the Army. I had been a rifle company commander, and it was jarring to suddenly be a sales rep in a hospital. That was alienating. I started to feel really guilty I abandoned the Army."

"It seemed that my mind finally had room to explore everything that had happened. My nightmares weren't just about combat. They were about the safety of my family. I was so paranoid that someone was going to get my family. I thought people were in my house. I had trouble completing tasks. I was very easily startled. I didn't feel like I could feel anything, except anger. It was like the person I was died on that mountain, and the new person wasn't me."

"I would think about ways I could kill myself. On more than one occasion, I sat with a pistol in my hands. It was actually a pistol the Rangers had given me when I left the unit."

"I kept thinking about my family and that my kids would have to grow up knowing that my suicide would hang over their lives. They didn't deserve that. That was a way I could hurt myself and escape my problems, but it would have been pushing my problems on them."

"I reached a point after a few months that my family was going to disintegrate. My wife and I realized I needed help. My father made a call to a friend who worked at the VA and got me to see somebody. I started counseling and picked up my Bible again and started praying and talking to my wife."

"I got involved in a church in Belton with a lot of Army families. I started teaching Sunday School, and I started a small counseling group for PTSD at the church. We started doing writing therapy, and I started writing on my own. It ended up being the book."

"I can tell you this, anecdotally; there is more of it than people say there is. I talk to guys who were there with me, and I know they're having problems. You can repress and suppress for a long time, but when guys finally slow down and let their guards down, they will have to make sense of their experiences. Look at the number of divorces, suicides, abuse. Those are the lagging indicators of combat stress."

"It's combat. It's war. We're killing each other. In the end, it's that simple. There is no way to prevent that from having an effect on the human brain. You can help them cope with it on the back end because guys have to make sense of what happened. But if you go to combat and see those things or do those things and it doesn't do anything to you, that's more of a disorder than PTSD."

Posted on Sunday, July 6, 2008

PTSD - An Engineering Overview
By John Schreiber

In English, Please….

In the document "PTSD: An Engineering Overview", I provided a discussion of what PTSD is in a manner appropriate for scientific discussion. This was required since "I think it is this…" rarely passes scrutiny. I had to create a model of the brain, show a flaw and illustrate how the brain compensates for this error. Through this I was able to show that the method the brain uses to compensate for the flaw matches the symptoms of PTSD. The problem is that most people do not have degrees in Engineering, and the discussion is a little over their heads. One prominent psychiatrist even noted that most professionals would get lost. Fortunately, it is the proof which is difficult and not the actual explanation. It is possible to describe what PTSD is in much simpler terms.

Those reading about PTSD might have heard a term like "the reptile brain". While we may think ourselves highly evolved, the truth is that portions of our mammalian brains are similar to those of reptiles. This portion, lying beneath our conscious mind, is commonly referred to as the "sub-conscious". We do not know what muscles make our heart beat. It is performed automatically by the subconscious. We need sleep because this reptile mind must perform routine maintenance, and the tests to ensure everything is fine are interpreted as dreams.

Little thought is given to the subconscious by the vast majority of individuals on this planet. It simply does what it is supposed to do. But the reptile portion of our minds has a huge logic error in its design. Nature knows about this error but, rather than fix it permanently, adds a mechanism to account for this error. When the subconscious detects that the error condition exists, it triggers this mechanism. This mechanism changes the way the brain functions, and the symptoms that result have become known as "Post Traumatic Stress Disorder".

The first question which must be answered is "What is this flaw?"

To answer this we must first discuss the effect of knowledge. While a little knowledge may be a dangerous thing, a lot of knowledge is quite cumbersome. Imagine if there was a single phone book for all of the world. It would be too big to sit on a desk. Knowing everything may be a scientific goal, but in the animal kingdom, the mass of this knowledge slows an animal down. Nature is content with providing an animal with enough knowledge of survive and reproduce. Everything else is a burden.

The next issue is one of timing. Imagine the plight of a teenager starting to work at McDonald's. At first there is a lot of information to learn such as where each button is on the register. Have you ever stood in line with such a teenager who is trying desperately to find where the Apple Pie button is? After a week or so, everything that needs to be learned has been learned. The teenager must then just repeat the same procedures over and over again.

Nature noticed this pattern in animals where their first few months of this earth are a desperate search for the knowledge needed to survive. After that, the animals just repeat the same procedures. There is no requirement for a simple animal to learn throughout its lifetime. A short interval after birth would be sufficient to learn what they need to survive. After that, learning is stopped, and the animal uses its knowledge to live its life.

What benefit does this system provide? After learning has stopped, the response time of the animal is decreased. In English, it has faster reflexes. In a world where survival is often measured in tenths of a second when lions pounce, the animal with the fastest reflexes survives. Like the old joke says, when hiking in bear country, your greatest protection is to walk with a partner your can outrun.

In humans, this period of learning lasts for about 5 years. Children lose the ability to learn quickly at about the same time as they are sent to school to learn. Thus, educators stress the importance of parents taking the time to teach their children by reading to them, teaching them to count, etc. at a young age. There are even some things which cannot be learned after that short period in one's youth. Language is one such example. If a human were actually raised by apes, that human would never be able to speak. The effects would not merely be Tarzan's bad grammar. Tarzan would never be able to communicate through language. Conversely, I have seen a documentary where researchers are trying to teach a gorilla to communicate using icons on a board. The gorilla never understood what the researchers wanted. They were about to declare the program a failure when the young gorilla the mother carried reached out and communicated using the icons.

There is a another issue of knowledge which must be examined. This issue is that of out-smarting your opponent. The smarter you are, the more likely you are to survive. How do you keep razor sharp reflexes but retain the ability to learn? You add a second portion of the brain which can learn through an animal's life. That portion is known as the conscious which is the part of our brains we are aware of. Our conscious does not know how to make our hearts beat, but our subconscious does. Our conscious knows how to do long division, but our subconscious does not.

For those who may be confused between the conscious and a conscience, the conscious is the part of the brain you are aware of. The conscience is that part of your brain which questions whether doing something is wrong is a good thing.

I have stated that there is a flaw in the reptile mind which must be fixed using a mechanism called "Post Traumatic Stress Disorder". Thus, there is no need to delve into the conscious any further. The important issue is the flaw.

In simple creatures with only the reptile mind, they learn for a short period and then cannot learn any more. This system works extremely well only if the animal has met all possible threats to its existence during the time of learning in its youth. What happens if a new predator comes along afterwards? The animal cannot remember the predator is a threat even after it has seen a companion killed and eaten. The reptile mind requires a means of adapting to threats to its existence after its short period of learning. Therefore, after a traumatic event, the mechanism will be used to incorporate the new threat into the reptile mind.

Since it will take some time to complete, the mechanism provides an interim solution. It increases the sensitivity of the emotions to the point of pain. This is done since an encounter with another animal will provide an emotional response. By amplifying the emotional response to the point of pain, the animal will run away regardless of whether the other animal is a threat or not. It is this interim solution which causes the anti-social behaviour amongst PTSD sufferers.

The next thing the mechanism must do is provide a permanent means of identifying the new predator as a threat. No longer able to learn quickly, the mind is forced to use the same technique students have used for countless years to remember important information: it memorizes the event. And how does one memorize an event? Repeat the event over and over again in one's mind. The memory of the traumatic event is replayed constantly through the mind of the PTSD sufferer because the reptile portion of the mind is memorizing the traumatic event.

Once it has memorized the encounter and passed all tests to ensure the memory is firmly in place, the mechanism reduces the sensitivity to emotions to the normal level. It then stops repeating the memory. All the person is left with is the association of the traumatic event with danger. For reptiles of old, this was the association of the new predator with danger and the immediate response to fight or run away. For soldiers on modern battlefields, the new association is warfare with death and the inability to return to the fight. Pilots now identify flight with danger, and they cannot fly again. Sailors, a fact that I can readily identify with, see danger on the waves and are not able to return to sea.

For those witnessing the individual who has gone through PTSD, this outcome often leads to branding the individual as a coward. What they do not realize is that the individual has not just gone through the incident once. The PTSD sufferer has lived the event a hundred thousand times or more. Imagine if a pilot were to crash his plane, drag himself from the wreckage, get into another plane and promptly crash that one. He then repeats this curious pattern thousands of times a day, seven days a week for months on end. If a pilot were to actually do this, news reporters would arrive for a humorous human interest story on the pilot who would not give up. The world would not see the man as courageous. They would think he was crazy. No sane person would repeatedly get into an airplane after crashing so many times in a row.

And yet people who have gone through PTSD are thought to be cowards or crazy because they let a single incident change them. It is not the single event that changes their minds. People going through PTSD relive their traumatic event hundreds of thousands of times as their reptile minds memorize the incident. The individual who has the courage to stand up and refuse to continue is the sane person. They are the ones making the correct decision.

PTSD has a number of other symptoms. One of these, the flashback, is a good example to illustrate how completely the person is reliving the memory. Someone going through PTSD is really living two lives. One is the current reality with data supplied by the five senses. The other is the memory of the traumatic event as it was experienced through the five senses. Normally it is possible to distinguish between them. However, if current reality becomes similar to that of the traumatic event, the person will be unable to distinguish between them. A combat veteran may hear a car backfire which would provide a similar sound to that of gunfire. Current reality seems to indicate there is gunfire and so does the memory. Suddenly he finds himself unable to distinguish between reality and memory. He has, in effect, flashed back to his time in combat.

If PTSD is a natural mechanism built into the subconscious, why do humans have such difficulties with it? That arises from the fact that PTSD developed long before there was a conscious mind to take over the learning process. In the subconscious, PTSD will proceed rapidly and without difficulty. It is the conscious mind which plays havoc on the mechanism.

The conscious portion of our minds can generate huge amounts of stress independent of what is going on in our surroundings. It is possible for the conscious to generate enough stress to trigger the PTSD mechanism without any external trauma. Guilt is often the driving factor in such cases and leads to a condition commonly referred to as a "nervous breakdown". If you can accept this statement, then all of the randomness which seems to surround PTSD disappears.

The conscious has the ability to generate enough stress to trigger PTSD on its own. Therefore, it also has the ability to generate enough stress to keep the switch which triggers PTSD in the "On" position. What should only take a few months to process can, if the stress in the conscious is high enough, continues indefinitely because the PTSD mechanism is repeatedly triggered. For someone to minimize the time PTSD takes, it is important to reduce stress to the minimum level possible.

I personally believe our society has problems with PTSD because the individuals are being sent to the wrong specialists. I would rather send someone to a specialist who teaches people how to live with chronic pain rather than a psychiatrist (or teach all psychiatrists how to deal with chronic pain). The techniques I developed for myself to reduce the stress work so well that I can literally ignore a pounding headache. I just relax and divert my attention to some physical work. As long as I do not think about the headache, I am not aware of it. Such techniques will work well for individuals who are merely feeding back the stress caused by the incredible pain associated with PTSD.

Those individuals who have problems coming to terms with the event which triggered PTSD must use a different method. They must talk out their problems or write them down if they are alone. Such individuals should avoid reviewing the memory internally since this causes the conscious to generate too much stress. They should use the techniques for dealing with pain in between verbal sessions with the option of writing the memory out if they are alone.

For soldiers who have seen combat and are reading this, my recommendation is to stay in close touch with your comrades. Meet with them regularly and discuss what happened. Do not keep it bottled up inside. If one is having problems, let the group keep a close eye on that individual. Check with the family to see how he is while away from the group. Make sure he does not pull away from his comrades for that will only cause him greater agony.

I would also caution the wives of combat veterans to be careful when their husbands return. Emotional hypersensitivity is like having a really bad sunburn. Even the gentle touch of a lover brings excruciating pain. Keep a "Buddy List" close to the phone and, if there is ever a time where you feel in danger, call one his buddies. Let his buddy come over and talk to him. Do not try to do it yourself for that will only cause him greater pain.

To finish, I would like to address those readers who know someone going through PTSD, but have not experienced it themselves. I will begin with an event which happened to me last week. I was walking along when I saw a man laying on the ground in agony. I saw a bone sticking out of his leg, so I bent over and said, "Abracadabra!" Immediately the man leapt to his feet and shook my hand vigorously while thanking me profusely. He then skipped off merrily whistling a happy tune.

No one in their right mind would believe that story for the simple reason that there are no magic words which will immediately heal a broken leg. There are no words you can say which will make the pain go away. People with broken legs need to be taken to the doctor to have the bone set and a cast put on.
As I have shown, PTSD is a mechanism built into the brain designed to account for an inherent logic error. It is not something the sufferers just make up. Like any physical injury, it takes time to heal. They need support and encouragement, not magic words which belittle their pain. If all it would take to make PTSD go away was a good swift kick in the seat of the pants, I would gladly have bent down to receive the therapy. No one would expect Christopher Reeve to jump out of his wheelchair and "get back onto the horse" simply because someone told him to do it. Then why do so many people expect PTSD sufferers to do so?

And to the psychiatrists who deal with PTSD, when someone comes into your office describing an incident which injured 18 sailors, had one suicide attempt and very nearly killed 5,000 (a similar incident five months after mine killed over 2,000), please do not ask him why he hates his father. Freudian psychobabble has no place when treating those with PTSD. Not every mental problem is sexual or the fault of the parents.

John Schreiber