Invisible Wounds
"I understand that it’s not sexy to talk about treatment. But the maddening thing about PTSD is that it’s completely fucking fixable. The narrative about it has got to change. PTSD is not Uncle Joe from Vietnam. It’s not homelessness. It’s not a heroin addiction. It’s not the end of the world and it’s certainly not suicide. PTSD is an anxiety disorder and we can treat it. But you’ve got to get help. In the military, you hear things like ‘shake it off’ or ‘rub dirt on it.’ And those are great messages for people at war. But you’re home now. You’re back with your families and the warrior mindset is no longer appropriate. If your nervous system is broken, it needs to be fixed. Just like a broken leg needs to be fixed. It’s that simple. You may have served with guys who don’t have issues-- that’s great for them. But that doesn’t mean they are stronger than you. It means they don’t have the same nervous system as you. It’s not weakness. It’s science. And it can be solved."
“PTSD results from an overactive sympathetic nervous system. It’s the same part of the brain that kept our ancestors alive when lions jumped out of the bushes. It’s ‘fight or flight.’ If a soldier’s mind stays in that mode for too long, it doesn’t always come back. Everyone expects veterans to return to normal when they come back home. The kids are so excited that Daddy’s back. Their spouse wants them to get a good job, and join the rotary, and save for a bigger house. But it’s only the veteran’s body that has returned to safety. Their nervous system is still living in a dangerous place. PTSD creates the feeling that something terrible is always around the corner. It can cause anxiety, confusion, and isolation from loved ones. But worst of all, it can make it seem like things will never get better. Most of my clients report a sense of foreshortened future. And that’s the first symptom I treat. Because the stakes could not be higher. Everything else can wait. First and foremost, we're a suicide prevention program.”
“Trauma causes the brain to malfunction. During a traumatic experience, memories cannot be processed correctly. So a person with PTSD is still carrying those traumatic experiences around in their body. Because those experiences were never filed away into the ‘past tense,’ the brain continues to operate as if the trauma is happening in the ‘present tense.’ It’s like a computer with a program that's running constantly in the background. The idle is way too high. And it’s an exhausting way to live. So those memories need to be revisited and processed. And we have an amazing way of doing that. It’s called EMDR. I won’t explain it here, but it works. It takes away symptoms. It won't turn you into a yogi who sits on the beach. But it will take away panic attacks. It will take away insomnia. And it will take away suicidal idealizations. We aren’t changing anyone. But we are getting people back to their best self.”
“This works feels very familiar. I ran an AIDS program for twenty years before I started working with veterans. Both jobs involve a highly stigmatized diagnosis. And both involve counseling people who have had a horrible, unexpected experience. I began working with AIDS during the 1980s. It seemed like we were losing an entire generation of gay men. We had no fucking idea what was happening. It was terrifying. The moment I shook a new client’s hand, I’d steel myself for his death. My clients never lived more than two years and I had 125 at a time. I tried to reassure them as much as I could. I tried to help them with their shame. But mainly I just tried to manage their terror. Our support groups could be gruesome. Participants would come in with IV poles and we were losing people every single week. Group members could look around the room and see the specter of their own future. It was horrifying. But they came anyway. They came every week because it was better than facing it alone. This work has always been more than professional to me. Because after work every single night, I’d go home to my partner, and care for him. Because he was dying too.”
“I tried to make it as comfortable as possible for him. We tried everything. We went to every trial and appointment. Larry really thought he was going to make it. And I encouraged him as much as I could. Even when he went blind. Even when I had to carry him to the bathroom. We still thought he was going to make it. We were always moving forward. Then one night we were lying in bed. And I knew it was over. He was covered in ulcers, and dehydrated, and emaciated. And I told him that I loved him, and that we’d get through this, but at that moment I knew it was over. Five days later he stopped breathing. I never talked about Larry in our support groups, but my patients somehow found out what happened and a bunch of them came to the funeral. So this is has always been more than professional to me. I know about trauma. And I know the treatment works. Because I’ve been through it.”
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