December 28, 2013

Helping Others Tell Their Stories

Darby being awesome!


I hope all of our readers have enjoyed all of our regular posts, but you might not know that Scott, Travis Martin, Michelle Monte, and myself all spend a lot of our time helping others tell their own stories. Writing helps us a lot so we try and take time to help others do the same. If you enjoy the regular posts here then there is no reason why will not enjoy our Blue Nostalgia.

It is free to read and free to join Military Experience & the Arts online writing workshops.  We are always accepting new submissions and you will never be turned down without someones helping you finish your writing. The most impressive thing about this issue is not how many views it has already received in less than forty-eight hours, but how everyone of the writers wants to continue participating in the online community. Even those whose writing never makes it online, often take advantage of online support groups and being apart of a community of veterans all going through the same things. I often think about the Military Experience & the Arts's online community as this generations version of the WWI expatriate writing community in Europe. We may not live up to that generation's legacy, but there is the same sense of community, and we are always welcoming and training a new generation of trauma writers. For me it is an honor to know all these people let alone playing a key role.

November 28, 2013

Managing the Low Points "Come on Joe, Let Yourself Have a Good Day" (Thriving)


Fa thump, fa thump, fa thump was the sound of my forefoot and mid sole strikes echoed by the rhythm of my breathing ha whoo, ha whoo, ha whoo and finished with the feeling of my heart beating kwa fump, kwa fump, kwa fump. It is hard for the rhythm of contact with the land, lungs and heart beat to synchronize so effortlessly, but that was how I felt as I powered through the thirtieth mile of the JFK 50 miler. That is the point when I know I can finish, but something different occurred this year. I was having an amazing day with nothing noteworthy to complain about. My legs hurt, but I had no heat cramps, I was tired, but extremely motivated, my brain was so taxed that I could not remember the names of the people around me, but somehow I was managing the math for all my mileage splits in my head. Everything was as it should have been for the strongest run in my life.

Usually this point is a reckoning and the finish my sole motivator, but this year I went into beast mode. I grunted in a primal desire to push forward. I was right where I wanted to be, still very tired, but from worthy effort and I repeated a mantra that had gotten me to mile thirty so strong physically and mentally. "Let yourself have a good day." Sometimes it is hard for me to have positive outlook. It is hard to believe that I can have good days. Sometimes in races like this my worry over an unmanageable low point will sap my energy, slow my pace down, and make something I love to do burdensome. People tried to pull me out of my race though.

"If your were in track club you would definitely run intervals and you could run sub 9 hour pace... I usually run that pace."

I am always annoyed with people who tell you they are having a bad day when you pass them. I could have got in my own head, but I waited for a rugged downhill, pulled away and said:

"Well, I run trails, mountains and stairs because that helps with me PTSD. My biggest issue is preventing panic attacks on runs so I focus on that. I seem to be doing great today, and I am just happy that all the causes of my panic attacks left me with my life, arms and legs. I am lucky to have days like today." He was apologetic, but I was too focused on the trail to acknowledge it. I did enjoy nothing-ing his attempt to correct his previously callous statement.

Most of the time I think it is in poor taste to over share these sorts of personal details with some random person on the trail, but in this case I was pissed off. However, like my injury at Bradbury Mountain in August I had earned a great day through all my hard work. Just because that guy ran harder last year didn't give him a pass on this year's lower level of training. I thanked Chick Hill again for all the rugged 7 minute mile paced rocky downhills that made this separation so easy and a conversation that could have been unsettling gave me a lot of confidence. It was a real battle this year to shave 55 minutes off of last year's finish. It took so much focus and discipline to run the first leg of the Appalachian Trail (AT) in a way that maxed my ability to climb with the fact that an elevated heart and the thick fall air were common triggers for me.

I ran on the razor's edge between hard effort and the prevention of a panic attack. I could do this because I trained myself on the terrain that most reminded me of combat and the explosion that gave me mTBI that inevitably made me a civilian. I wasn't going so far as criticizing someone's performance, but I had worked so hard and through real adversity. I wasn't going to have some track club split counter tell me how to train and run my race. On my second ultra I has used that style of training plan, but it landed me in an Intensive Care Unit for three days, so nothing was taking me off my plan.

PTSD and panic attacks were becoming a bit of an advantage. Running your best race without burning yourself out is a similarly difficult balancing act. A life that revolves around managing my anxiety was actually making me better on race day. But it was more than that.

I seemed to be gliding along effortlessly on the first section of the AT and the pace was not difficult until the late forties. I continued to run effortlessly on the first half of the C&O Canal. My deep longing to transcend and merge into the place I live in Maine had made my greatest strength running on rough and rocky trails. My feet slammed into rocks several times at JFK, but my balance kept me on my feet. On the single track trail my movements were light and I passed people with ease. The whole year I needed those rough trails because they were the only place I could stay in the moment. People kept complaining and I held my tongue until the last section of the AT.

"I love this shit so much... I am so happy to be here."

This made me look a like sadist, but it was true and this attitude was helping set the conditions for a great day. It had been hard and my biggest problem was consuming enough calories to keep going strong. I would eat PowerBar apple sauce and get sick for a few minutes while my digestion was competing with my quadriceps for energy. This would be worth it when the more slowly released applesauce carbohydrates paid dividends late in the race.
28.4 miles in at Antietam Aqueduct

I was running my race plan perfectly. Get off the AT (15.5)  a little behind on pace and make it to Antietam Aqueduct on pace. I came of the AT at 12:49 pace and by Antietam I was at 11:49 splits, 14 seconds under 12 minute mile 10 hour pace. I gained about 5 minutes and I was so pumped. I recognized my pace earlier in the day, but I would wait till the last twenty miles to really grind at max effort. I can't describe the joy that comes when you do something as hard as run fifty miles in under 10 hours, and how amazing it feels to still have the fortitude to push harder in the last twenty miles. I invite anyone who thinks PTSD is a syndrome of the weak to line up with me next year and call me weak on the back twenty. At this point going that hard simply maintained my pace at 11:49. I was outside of myself, though the last 8 miles of road and high winds was miserable. I was tired, cold and on cloud nine. I kept a run down hill and straightaways, and walked uphill until I reached the last mile and a half. I must have clocked a 10 minute last mile because the finish line came quickly. I looked at the clock and it was 9:50(:32).



My wife was waiting for me and we were so excited. I let out a guttural yell, as if I was some medieval knight after vanquishing all my foes. I waited for, one of my living heroes and founder of Team Red, White and Blue, Mike Ervin to cross and as I cheered his equally amazing accomplishment. I never thought I would ever be able to stay in front of such amazing runners and leaders on veterans issues, it is still hard to believe that the day was not something I imagined.


http://teamrwb.org/

When life is miserable it is so much easier for me get stuck, but it is often what I do in the low points that sets the conditions for when I feel stronger. Its hard to run my race, suck down my applesauce and just let my legs keep going. Having PTSD feels like running on a gnarly, rocky and mountainous trail when everyone around you is on a smooth surface. Yet when I am on rocky trails I am in my element, and everything feels easier when I recognize how much harder life is for me. I need that perspective. At the JFK 50 Miler most the people around me left the AT demoralized while I left fired up, and easily made up my pace before my toughest push. I had time in the bank and chipped away a little more time in the last ten miles. PTSD keeps me in the doldrums a lot more than others and I often have to say things like, "just manage this low point Joe." Sometimes when I am in the toughest place on my path and its important to let those momentary set backs be momentary setbacks. Sometimes I struggle because the path is rocky, but when I manage my low points I sometimes find myself at Antietam Aqueduct with time in the bank, feeling amazing and surging forward because I did everything I could when the path was harder and everything was a lot more difficult. The contextually accurate positive self talk that guided me to an amazing day was just a representation of a coping mechanism that I have developed over months of practice. Managing PTSD is extremely difficult but it has taught me how to thrive in some of the most challenging of circumstances.

*Ultra Runner Geoff Roess is known for focusing on the low points on 100 mile races. It keeps me going every time I have a rough day.

October 14, 2013

I Wasn't Ready for the Smell...

This describes violence and will trigger PTSD symptoms. In the Terrible Moments I purposefully omitted smell because it was too much to write in one installment. I will return to it in the following post.

As a platoon leader I was ready to lead my soldiers, even in the most trying of circumstances, but when I arrived to the aftermath of a suicide bomber detonated on a crowd of civilians I wasn’t prepared for the smell. In my experience blood doesn’t have a smell at first, although it is very visible, tends to flood your memory and when it stains clothing that smell imprints itself on the memory event as it were there in the moment. In honesty that street corner mostly smelled like dirt and dust, because the explosion had picked it up off of the ground. The smell of explosives was present, I was used to those smells, but the smell of burning flesh was much more apparent and different then anything I had ever experienced (still this was muted by the overwhelming smell of scattered dirt and dust). The smell of burned flesh was like smell of burnt hair, yet exponentially grown by the scale of that terrible day in northern Iraq. This mixed with the smell of burning meat, though completely unappetizing and unseasoned. The only way I can describe the smell of peoples skin is that it was as if leather was left out in the rain long enough to fester slightly, and then it was burned, or at least how I image that would smell. The addition of the burnt clothing created an earthy smell, which was a mixture of burning leaves and grass/marijuana.

Still, no matter how traumatic the stench of death and violence was I mostly inhaled the terrible smell common in the urban centers of Iraq created by the burnt trash, raw sewage flowing through the streets, and the awful smell that the dirt and dust made as it lodged itself into your nasal passages. A not so insignificant part of the awful smell of Iraq was my body odor, because I lived in an outpost and showered weekly at best. Only that day the smell of Iraq was amplified by an explosion that wafted it through the air. Despite the stench, I refused to throw away my flesh stained boots, because I would spend a lifetime, if necessary, walking that smell away. After nine years and thousands of miles it is still there in my boots, so are the bloodstains, and the barbwire scratches I got rushing to that intersection on another night. That smell has also stained my very being as an unmovable and unalterable weight on my memory. Even during exercise my sweat pours more profusely than it did before and rather than overpowering the stench of that day the sweat contributes to it as if my every pore was endeavoring to recreate the smells of that moment. Stress sweat is more pungent than normal thermal regulatory perspiration. My body remains attached to the muted ammonia smell of muscle deterioration that comes with the body's processing of the stress chemical cortisol. I have smelled fresh cow brands and had a terrible panic attack. Anytime I smell burning hair, unseasoned meat, grass, warm sewage in a portable toilet, marijuana or the dust of the desert I am back there again: only naked, unarmored, helpless, and alone. My heart races and I can't seem to breath.

The stench combined with the chaotic sights, sounds, my internal dialogue, and physical sensations, though the smell was by far the worst of all my sensations that day (well that and feeling the weight and limpness of a dead flesh). Smells today are forever different and can send me into PTSD symptoms, often simply sicken me, or worst give me terrible migraine headaches. A lifetime of therapy and doing the right things to manage PTSD will never make that memory less burdensome. Although, I am still proud that I have refused to get rid of those boots because they are like my tattoos, a symbol of my commitment to deal with the violence I witnessed: to face my PTSD. Preserving my boots, even if they still smelled like that day in the hopes of walking them clean, was the first gesture of my efforts to face my burdensome memories no matter how terrible, with as much honor and strength as possible. The smells are certainly less pungent now, and the memory is too, at least with every attempt to understand and accept them. As if taking the time to remember that awful stench, or any sensation for that matter as it was, or as they were, reduces their terrible grasp on my life.

October 3, 2013

Another Knife in the Back: I Feel Like I did in Combat, a Pawn in a Unreal Political Game

Disclaimer: This has profanity, and contempt for politics on all sides. However, I am a person who currently supports one party over another, that has not always been the case, and try as I might to remain objective some of my bias might come through. If I could control my triggers I wouldn't have PTSD. I apologize if my descriptions, of how current politics are triggering my PTSD, appears as an attack on anyone's beliefs.

I usually have uplifting things to write, about and I am as positive as possible, but I can't get past what is going on right now. I am having a terrible week. I am getting the somatic fevered symptoms common in my worst months. It started when I presented a paper at a conference this weekend. Don't get me wrong the scholars were so inviting, supportive and did everything they could to encourage a graduate student, but public speaking is always a burden for me.

When it ended I did what I always do. Run stairs until I stop panicking. It usually takes a few terrible, nauseous, slow and miserable days to get through it, but whats going on in the country right now is making it harder this week. This week all I can think about is how Congresspersons are using my livelihood and benefits as pawns in a game. Like many other vets all the cuts may or may not hit me in my paycheck while I struggle to create a new start in a more appropriate career field. Worse it reminds me of how George W  purposefully held off offensive operations in Iraq during his reelection (a fact that was most frustrating to me at the time because I voted for him), and all the heavy fighting it caused on my first deployment. I remember the faces of men and women that died, because we weren't real to politicians. Just pawns in a game.

But like then, now we aren't pawns: we are real and we are struggling to get by. Suicide numbers had to get to 22 times a day to make the VA start taking its backlog seriously and now, because of partisan nonsense the overtime in the VBA to combat the backlog is over. All the advocacy seems to be meaningless because politicians don't actually care about anything, but political ideology. My advocacy and openness about PTSD has cost me my relationship with my father, yet all that sacrifice can be wiped away as a chip in the game for a group of politicians unhappy with a law that can be combated with an infinite amount of other strategies. Whatever your beliefs about the affordable care act or Obamacare you can't believe that taking people off of working the backlog won't create terribly real and measurable loss in the lives of American veterans and their families. How many vets have to kill themselves a day for our earned services to cease being a chip in some partisan battle.

Though we probably won't lose our benefits we, who have major anxiety disorders that at times result in death by suicide, have to hold our breath and fight new mental battles about what Congresspersons, who clearly don't give a shit about the secondary effects of their current political battle, who only see our hard earned benefits as something to leverage in a political battle. All while safeguarding their own salaries and healthcare. I can only say what I have to say. Fuck Congress (regardless of political party)! I hope you will join me in my absolute contempt for what is happening today, but I hope that you are all doing better during this very frustrating and tenuous time.

September 24, 2013

Darkness Visible, Depression, and Suicidal Ideation

By Anonymous
Him the Almighty Power
Hurld headlong flaming from th' Ethereal Skie
With hideous ruine and combustion down
To bottomless perdition, there to dwell
In Adamantine Chains and penal Fire…
As one great Furnace flam'd, yet from those flames
No light, but rather darkness visible
Serv'd onely to discover sights of woe,
Regions of sorrow, doleful shades, where peace
And rest can never dwell, hope never comes… 
~ from Milton’s Paradise Lost, Book One (1674)
Wikimedia Commons
In the passage from Paradise Lost above, Satan has launched his unsuccessful war against God and heaven and rightfully been cast down into the pits of Hell. He finds himself chained in unbreakable chains to the floor of a fiery pit without even the comfort of light from the flames. In “darkness visible” he sees only “sights of woe, / Regions of sorrow, doleful shades.” In the absence of God’s presence he flails about in pain, doomed to never know peace, rest, or hope again.

It was on a beautiful spring day—birds chirping, sun shining in through the window, adoring, four-legged friends at my feet—that I used the passage above to describe to my girlfriend how empty and defeated depression made me feel.

We have different names for these things now, but “sights of woe” sound an awful lot like intrusive thoughts; “doleful shades,” to me anyway, accurately described the synesthesia of strength-draining darkness that had creeped over me. With all promise of “rest” and “peace” dashed by medical science and the constant voices of doubt in my head, I had certainly lost hope.

Worst of all? The closest comparison I could come up with to describe myself was that of Satan. A lot of doctors would call that “a poor self-image.”

Fast forward a few months.

Not many people talk about suicidal ideation. It seems they’re either embarrassed, worried about alarming their loved ones, or afraid of being locked up. These reasons are all valid, of course. But I made a promise a long time ago to be open and honest about what I’m going through because I think it makes me stronger while helping those around me. So, again, here it goes.

The other night I was lying in my bed, completely in the dark, waiting to fall asleep. The self-effacing negativity and spitting of curses at myself ran rampant as it had for a while. It was something I’d grown accustomed to since quitting my medications in the spring. For me, not having medications is a tradeoff where I can better control my impulses at the expense of increased depression. When I’m alert, the dark thoughts are easier to push away. But when I’m tired, about to fall asleep, it is often a different story.

For me, as a man who experienced a suicide in his immediate family, it will never be an option. I realize on both an emotional and intellectual level that it only hurts the ones you love. But that doesn’t stop the theatre of the macabre from acting itself out my head. Thoughts and images of hurting myself flash before my eyes faster than I can stop them. I know I will never act on them. I know I am physically in control. Still—and I doubt I am alone on this—simply having the thoughts can be discouraging.

I find that flashes of self-harm occur vividly and alongside waves of self-deprecation and doubt. The slightest slip-up or failure can trigger them. Those who know me well have learned that I vent this negativity through jokes and creativity. I used to be able to pop a VA-prescribed pill when I felt down or anxious. I used to be able to PRN-my-way through about any situation. But since going cold turkey I’ve been forced to find more and more behavior-based methods to deal with PTSD and its aftermath.

I’ve been grappling with this issue both intellectually and spiritually over the last couple of months. My goal has been to symbolically represent the causes of the condition through language and understand—beyond the limits of medical science—the role of my soul. But learning causes didn’t result in the ability to produce effects. So, each day I’d learn something new. Each night, I’d lie in the dark, struggling, waiting for that ability to come to me.

Suicidal ideation is like being strapped to a chair and forced to watch a really graphic movie of your own death. Here’s the catch: You’re both the protagonist and the antagonist—literally your own worst enemy. The voice you hear, the one screaming that you’re “pathetic” or “weak” or “disgusting,” it’s your own voice. And, after a while, you become convinced that you are the one doing the talking. Why wouldn’t you? It’s your voice. Your brain. You are the one conjuring up these thoughts because you are “sick,” right?

I’m no longer convinced.

On the night in question, I looked up. There hung my trusty shotgun—the one that PTSD tells me to keep ready for intruders at all times. Then came a flash of me shooting myself and collapsing on the bed. It lasted less than a second. But it was so disturbing and graphic that it wounded me. It was like being punched in the gut.

In its shocking repetition, suicidal ideation makes you feel very much like a victim of abuse. But you’re the abuser. What gives?  I was in control, but the thoughts weren’t going away. I felt like I was losing the battle—that it would just get worse and worse until I wasn’t in control. That was what knocked the wind out of me.

I said to myself, “You know...if you’re thinking about blowing your head off, the responsible thing to do would be to lock the gun up in your safe.”

“Yeah, I don’t want to do that. What if someone breaks in?”

I tried to be rational. It dawned on me that the safest alternative to locking up the weapon would be to crawl over to the corner of the bed and sleep there. That was the furthest spot away from the gun. I wouldn’t have to risk getting near it but could if someone broke into my house. Then it hit me that I’d just told myself to curl up in the fetal position on the corner of the bed.

“How did it get to this point? Listen to yourself!”

In the background during all of this, that vile, contemptuous voice kept talking. It had been telling me to “do it” and reinforcing its previous points about my being weak, pathetic, and disgusting. In my mind’s eye I stepped back for a minute and asked myself something I hadn’t before:

“If I’m listening, who’s doing the talking?”

I created a representation of the scene the best I could in my brain. I saw myself stepping away, outside of a circle of white light. Inside the circle, crouching and holding a severed head like a puppet, was the thing that had been talking. It was black like venom with skin the texture of a smoky-ink. The head it was holding, and by extension the voice, was my own. But I was clearly on the outside of the circle. I was listening.

“There you have it.” It wasn’t me talking at all.

I’d describe what happened next as an epiphany, but it wasn’t really that. It was more like something remembered—something I used to know but had forgotten. I paid particular attention to the voice: it tapered off; its tone described someone who’d just been caught. And it muttered something to the effect of “this doesn’t change anything.”

But I knew better. I made one conscious decision to listen and, for the first time in months, the voice shut its mouth.

What ensued was astounding: my head and face tingled. I felt a distinct crunching feeling in the tip-top of my brain—as if the folds of my cerebral cortex where tightening and strengthening themselves. I’m used to getting headaches, but a new, different one presented itself at my forehead. I welcomed it. I knew something big was happening. That some new—or old and forgotten—pathway was being opened up and I was (re)learning how to use it.

In “darkness visible” I opened my eyes.

Since then, I’ve come to call that voice the “Puppet-Master.” It was like he had his hand in the back of my neck, making me spout off terrible obscenities and lies about myself. The sound of my own voice did a lot to convince me. But so did the constant message that there was something wrong with me.

There might be something wrong with my brain. There might be something wrong with the way I live my life or the decisions I’ve made. There’s definitely something wrong with the things that have happened to me. But those things are not and have never been me. I held somewhere deep down inside the view that there was something defective with my soul—that I deserved the constant torment. It was a lie, and now that I’ve learned to put a muzzle on the liar, it’s one that makes me burn with a healthy anger rooted in self-respect.

I’m sure that the Puppet-Master reinforced that lie. He still likes to catch me unawares and slip in self-hate and violence when he gets the chance. But I’m onto his game now. When I catch him, I get angry. I step out of the circle, locate him, and drag his wretched ass to a nice box I constructed in the corner of my mind. I borrowed the box metaphor from my fellow veterans. Now I know what to put in there.

What should you make of all of this? I don’t know. You might think I’ve lost my mind or that I’ve used too many psychedelic drugs. To me, it seems like a lot of veterans and people struggling with mental illness believe lies about themselves. What I’ve done, in my best estimation, is find a way to represent the source of the lies—a Puppet Master—and a way to control it. Some people achieve this through medication and therapy, others through exercise, and still others through religion and service. My journey has been a combination of all of these things and it isn’t over. But I just won a major battle.

For now, I’ll just keep listening. I’d encourage you to take the time to listen to yourself, too. You might be surprised at what you learn.

September 18, 2013

Ty Carter's Advocacy in Context

The most recent Medal of Honor recipient has perhaps one of the most impressive citations in the War on Terror. As a participant in a battle that nearly overwhelmed a small Combat Outpost (COP) named Keating, Army Staff Sergeant Ty Carter repeatedly braved danger, injury and certain death to aid fellow wounded soldiers. When running to the assistance of wounded comrades his fellow soldiers attempting to aid others were killed. Carter provided first aid and ammunition so the wounded could maintain a desperate stand, Carter stated that the outpost lacked water, necessary medical supplies and ammunition. Despite hunger, thirst, and injuries and, in some cases mortal wounds, they continued to fight. In a battle that carried multiple valor citations, Carter’s performance carried the most accolades....

See full post on Khronikos here.

August 23, 2013

(Thriving) Chick Hill

The Peaked Mountain and Little Peaked Mountain faces.

On a hot, but manageable August Sunday I found myself in Bradbury Mountain State Park running the toughest race of the year. The course's 1450 ft elevation gain and equal loss in only 9 miles makes it one of the most challenging in Maine without factoring all of the roots, rocks, and New England rock-wall obstacles you traverse to get to the finish. Ian Parlin is a sadist in the way that any good trail race director should be. He decided to cut out some downhill switchbacks to add about 400 more feet of gain and let us all know that at the starting line. That's why I run his races. So while getting to the boundary road with the addition of a strong climb I was excited about my pace without any panic attacks. After two days of rain  the course was wet and slippery, and I was still in a large crowd of people. As we started the first real climb (on the old course that is) my left foot landed on a rock was deceivingly wet and slippery. My left leg slipped, and from the bruising it appeared to have slammed into another rock or stump: a fact I was oblivious of at the time. What I was intimately aware of was the movement of my leg.

I have broken my ankle before, and I have never felt my leg move like it did at Bradbury. The ankle rolled so extremely that my knee snapped by the strain. I was instantly sickened in the way that you feel when ice breaks underneath you. "Fuck! Its time for six months of rehab." My brother-in-law was behind me and he later said that he thought I broke my leg. For a few seconds I knew that I broke my leg. The pain and nauseous feeling put me into a walk before my mind even fully reacted. I needed to walk as far as I could with the adrenaline I had because I was in the most remote place on the course (another runner passed out nearby and it took hours to get him off the course). "How was I walking though, my leg was broken right? It had to be." I walked up the hill. It hurt but my leg was working. "How was it working?" Sick and crying from the shock and the pain I started to run. I didn't know how I still could, but I'd worked too hard to run my best time. I deserved this and it might be my last run of the year, and I knew that, for some reason, my body takes three to five hours to swell up. Let's go! (Oh By the way Let's Go is the modo of my of my Airborne Infantry Regiment. Glider up son!)

The view from Little Peaked Mountain.
Chick Hill is not actually the title of the mountain that I have been climbing a lot lately, but it is what here everyone calls Peaked Mountain, which is situated near Chick Hill. I like that about Peaked Mountain. A lot of people climb it, but few really know its actual name. Even fewer truly appreciate it. Most of its trails are overgrown, its rocky road up to the cell phone tower is the only thing that is, albeit reasonably, well maintained. Its older, perhaps better, ridge-line trail has been absorbed into the forest. The fire break/road like surfaces are as technically difficult as any trail in the area. This would be where I would reconnect to my strongest mentality. The drive to Clifton Maine has become an obsession of mine lately. The whole week I am be excited about my sole foray to the mountain. I read maps, look at Google imagery to try and find new trails to run. I was working out, exploring and fusing with the place.

Birds eye view of Acadia National Park.
Peaked Mountain felt right, it was poorly managed, in places grossly clear cut, in others the forest had claimed the trail, and it was small and underrated. It felt like me, and I was building a relationship with a place. Not the tired and common unrealistic anthropomorphizing of a space, rather I was falling in love with its flaws as well as its charms. I'd come home covered in its tall unchecked grass, at times bleeding with little bits of mountain inside my knee and palms. Weeks later I would vacuum little bits of mountain from under the door mat for almost 10 minutes. I've bled and swet into the place and carried a little of it home with me with every trip. Too many people try to shape the land, or possess it, but few are shaped by it and let themselves be possessed by the space they live in. Even fewer would feel that way about a place with a man made road, a large cell phone tower, and beer bottles strewn about at the summit. Not me, I loved the place because that felt more like me. I could see Acadia to the south and the larger peaks to the west. Running goals that this place would help me meet, but I was deeply attached to the imperfections of the space. This was life and space that defied narrative: imperfectly appropriate. It was so much more like myself, in its beauty, its unkept and unfinished nature, yet at its summit was one of the most beautiful scenes in vacationland (Maine). Peaked Mountain had recharged me in ways that I haven't felt since I went to war.

Check the wince. Image Credit Maine Running Photos.
Bradbury was decidedly frustrating because of the sprained ankle, but I'd been here before. I'd sprained my ankle at my first 100 mile attempt and I went 29 miles on it before deciding it wasn't worth it to risk worse injury (my main effort that year was JFK and I wanted to get to the line uninjured). I'd sprained my ankle early on Bradbury's 12 mile Bruiser and finished. In Ranger school I had the worst sprain of my life on the march to Darby and made it through the whole phase (I recycled because I was too weak with that ankle). My wife says,"if Joe's gonna sprain his ankle its gonna be in the first two miles and he's gonna finish;" she just gets me. I was frustrated because I was doing so well and I thought that I wasn't going to have an improved time.

Bloodied compression socks. TRWB
No, I was ready for this and I could still do it! I'd spent too many days on Peaked Mountain and I'd earned an excellent performance. That was different, for the first time in years I felt like I owed myself a victory. I was worth it, and I might have even owed it to Peaked for all the time I spent on it. More pragmatically the way I'd run Peaked Mountain prepared me. On my toughest 8 miler, I started by climbing the grade 8, 1.5 mile, 800 ft gain, category 3 climb up to the summit. After catching a toe I scraped up my knee and it was initially bleeding pretty bad. I pulled my compression socks over it to stop the bleeding and ran down the mountain. Halfway down the mountain I checked my leg and the bleeding had stopped. Let's go! I wanted to add some to speed to my total pace so I turned unto a firebreak that led to the actual Chick Hill. I took a left hand turn down what, I guess, was a logging road that wasn't on the map and didn't make it to Chick Hill. The initial climb made my calves all but useless so I had to rely on my quadriceps to ensure that I could hike up the summit and still be at a good ultra pace (12 minute miles).

I was busting my butt (literally) and quads to maintain nine minute miles so that my ending split would still be at running pace with all the hiking involved. I pushed up Little Peaked Mountain's summit at a good hike and ran up Peaked again. My pace on that 1900 ft total climb was faster than last years Breaker. I began to realize that I needed both the climbing calves and quads to manage the terrain at the Chick area so I started adding faster flatter running with my dog Darby and my mountain days got better and better. I felt awesome, and fulfilled.

More importantly I'd hiked so much at racing pace. Just minutes after my sprain came the south ridge of Bradbury Mountain. I was not feeling up to running that kind of grade just yet so I leaned forward put my hands on my knees and hiked. To my surprise my walking wasn't only keeping pace, but gaining on most of the runners around me. The descents were more difficult. I had my ankle fully extended when it twisted so it seemed to only really be acting up on steep downhill terrain. The down hill was easier physically, but I couldn't shred and gain speed. It was frustrating to basically lose all the calf strength I gained climbing Peaked, but I'd also focused on hiking and quad strength. Two out of three wasn't bad.

Last climb. Ian Parlin in left corner. Image Maine Running Photos.
On the descents I just kept telling myself "10 minute miles, push with quads. Run with quads on the flats, don't waste a second when your ankles don't matter." Still I was very practical about my climbs. The summit trail is foolish to run anyway. Its 200 ft gain in maybe a tenth of a mile. I just ate an Espresso Love Gu, hands on knees hiking, and I lost very little on the worst climbs. There is about a mile of descent afterwards and I would hold onto the others as long as I could and then back to my ten minute mantra. When I saw the top of the last climb I was ecstatic. I ran up ignoring the pain. I held my pace on this descent, "who cares about pain in the last mile. The pain will subside a lot more when I stop running right?" At the beginning of the last climb I'd looked at my watch and saw that I was at about an hour twenty. My best finish was 1:51:20 so I think I was also charged by what I'd done. I ran at full speed, ten minute pace be damned at that point, and caught two who closed up on me after the last descent. 1:42:21 was my finish nine minutes faster than my best time.

Where's the medic?

"I can't believe you finished the race" was how my brother-in-law greeted me. He'd beaten me and I didn't want to steal his thunder by complaining about the sprain, and imply that he'd won by default because I think he would have prevailed regardless. We made our way to a fireman who checked to see if I'd broken my ankle. Apparently I hadn't broken it and as I sit here drafting this post icing my swollen ankle, I am surprised at how well it is healing. I have subsequently ran my fastest two splits to the the top of the mountain, back to back with only time to refill my bottle so it seems like I've recovered. At Peaked I'd gotten better at small quick steps and the only good thing about the sprain was that I hadn't fell. A quick small step pulled my leg up before all of my weight was placed on my precarious ankle and it was relieved of a break or worse injury. In remembering those moments when I felt like I owed myself a great race regardless, I am reminded of why it is I race on trails. It reminds me of how tough I can be in a crisis.

No matter how much writing, research, and advocacy I do for PTSD I still deep down feel weak. Races like Bradbury, and days like on Peaked when I hurt myself, but still pushed on, remind me of how I respond to injuries. They remind me that I finished the Darby Queen a day after a minor surgery once and another time without all the skin on one of my heals. They remind me that I am excellent at finishing physical challenges even when I am injured. They remind me that all the stereotypes and perceived stigma about PTSD being a result of weakness are bullshit. I don't know how to be a tougher person than I am (sure there are tougher) and I have PTSD. I am both the 90% disabled vet and the guy who finished one of the toughest races in Maine despite an injury. Better, perhaps even tougher, runners called it quits for the same kind of injury that day. Physical injuries are so much easier for me, because they are concrete and have time tested solutions. Rest, Ice, elevate, and compress. With every sprain, fall, cut, and painful day on the trail I am reminded the value of recuperation, and it helps me value and manage my invisible injuries a little better. I also feel like I owed it to Peaked/Chick for what I'd learned and becoming closer to a space is helping me with all my triggers in ways that I wouldn't have expected. By getting attached to this space I am having an easier time remembering that it is not Iraq, and that helps a lot. Transcendence for me comes with effort that pays dividends in every facet of my life, but it also helps me see a place for what is is and not idealize it in ways that are unrealistic. Home was never the ideals I shaped in my mind to escape the the hell that is war, and it takes time, for me miles, and effort to recreate my sense of safe space. I'll still sprain ankles, get bloodied and bruised in my safe spaces, but every-time is an opportunity to get a little stronger, push a little harder, and value the same recovery from the wounds no one else can see.

August 9, 2013

(Thriving) The Stigma in Me: Remembering that My Strength Ultimately Caused My Disorder

My climb includes 5 total climbs and 6 of the lower section.

I have very little patience for people who believe that lessor people suffer from mental illness, especially scholars, but if I am honest with myself then must I recognize how my shame has shaped my homecoming. Lately, I have been working really hard to reintegrate the training techniques I used prior to going to war. For the last four years I'd been avoiding my old training regimen as if there was something wrong with it. A good friend of mine turned me onto ultra/mountain runner Anton Krupicka's blog and it reminded me that I was at my fastest when I lived and ran in the mountains everyday. I used to run hills exclusively, do a lot of two-a-day workouts, take few supplements, I did very little with my nutrition, save for good wholesome meals, and run in the worst environment possible, like rain, heat and cold with as little cloths as I could stand. I've never been faster than with that mentality, yet I was reluctant to re-embrace them because, at least subconsciously, I felt like my invisible wounds were the result of my weakness. I also felt like after three tours in Iraq, Ranger and Jumpmaster school that I had nothing to prove. I might have nothing to prove to the world, but I still have a lot more to prove to myself. Recently, I have been employing those older strategies and I am beginning to see some of the chains that were holding be back on runs fall off, and, more importantly, it has reminded me how my courage, strength and determination brought about my PTSD: not my weakness.

Care of Maine Running Photos.
As a kid I was always happiest playing sports. I especially loved summer street hockey and soccer because I had games on the same day. I was a halfback in soccer and forward in hockey, so those days included a great deal of running and skating. My soccer games would come first, so the first few minutes of the hockey game were the toughest. All the fresh skaters were difficult to keep up with. I could usually hold my own until the heat of the day wore on every player. Georgia summers are particularly hot, and the black top courts amplified the heat significantly, yet every game I would get a surge of energy when sweat began to cloud my eyes. Though I was certainly suffering, this would signal to me that others were as well and that is when I played the hardest. I came to remember this on Monday the 15th of July. It was the day after a PR finish (despite two pretty shitty panic attacks) at the first race of the Bradbury Mountain trail running series. Proud, but unsatisfied with my performance, I was climbing the Alfond Stadium at the University of Maine. When I began my workout no one was there, but as I continued the football team started to do some sprints.

The heat was incredible because the aluminum bleachers absorbed and reflected the sun's rays as if I was running in a sauna. It was one of the hottest couple of days in Maine this year and many people were hospitalized at races the day before. When I looked down at the all the younger football payers I was impressed with their vigor, youth and ability, but I was most captured by their impression of me. All of these athletes, in their prime, looked at me at me with respectful head nods, and were questioning why this crazy thirty year old asshole was climbing the stadium during the hottest hours of the hottest day of the summer. These were all stronger, and in most cases tougher athletes than me, but not that day. Again the reflection of the sun off of the aluminum, the salty sweat and sunscreen combined to blur my vision, but I was on cloud nine. I was the kid playing hockey again. I began to love every minute of that misery. I became even more confident when the football team, left and I was still climbing stairs. On my last lap, I was wiped out, tired, and what I like to call wobbly (ultra runners more commonly refer to this as bonking because when your body runs out of fuel you start feeling loopy and hypoglycemic, but I think wobbly better captures how I feel), but in that almost delirium haze I knew that I'd gone as hard and as long as I could: then a little bit farther.

Somewhere in all the diagnoses and medical treatment I'd lost some of the key aspects of who I was. Sure I have been running ultras to reconnect to who I am, and in many ways I am tougher than I ever was, but I'd lost my old mentality. I just remembered running ten milers at Bragg, full out the whole time at sub seven pace without recognizing what philosophy and training regimen brought that ability. I thought I was tougher after war, but I was tough because of who I was preceding war and my mentality is what brought me through. For some reason I'd come to believe that I was weak before war and that is why I was taken out by invisible wounds. Nothing could be further from the truth. I was tough and that is why I endured so much trauma and still sought to be on the line fighting the war. My resilience is helping now, but it also caused a much more severe syndrome. I realized that I have PTSD because I am tough, not because I am am weak. It stems from my character not my weakness.

 
One handed summit pic with 2 liter hydration pack.
It is at the juncture between who I was before war and who I am now that I can see the nuance in my life that has changed. Recognizing this change is a vehicle for my growth. I still like to run as minimally as possible, but I sweat more because of PTSD and dehydrate faster because of medications. I carry a lot more water now, and I use sugar to to keep my muscles going in ways I wouldn't have when I was younger. This is a disadvantage sometimes that also helps me stay more self aware when I run. Now I am more in the moment, and that helps me appreciate doing something I love as long and as hard as I can. This is more than a metaphor for my writing, it is the same, it is fuel, and a constant reminder of who I am. More specifically, the elevated heart rate and heavy breathing triggers panic attacks, and my quest for longer runs at a faster pace forces me to stay on top of my treatment.

I get better at managing my PTSD with every improved time, longer and harder run because it helps me face the panic attacks that I suffer on runs, and it has also been my mechanism for grief. Most importantly, it reminds me of how, who I was before and who I am now, are different, yet my mentality prior to war has had a lot of bearing on how I survived. After seeing all the death and loss I have in Iraq I'll never fully regain that child I once was, nor would I even want to be that naive again. However, because of PTSD I'd abandoned all of who I was because I felt like I'd done something wrong to have mental illness. In remembering that sweat in my eyes, the love of climbing everyday, and wearing as little as possible I've been able to reconnect to a mentality that will surely help me grow with PTSD. Probably the mentality that saved my life in Iraq and at home.

Honeymoon Piton summit with Piton Lager. My wife has the same drive to climb mountains and run races together.
I'd ask all the readers to try and remember those moments in the time prior, to your service in combat or traumatic experiences, that inspired you to push on, work harder and generally be a better person. Though our younger naive selves may have been lost to the battlefield, at the hands of rapists or in experiences that rocked the very nature of ourselves, that doesn't mean we must lose the aspects of ourselves that helped us survive those terrible days. In our process of grief we all tend to blame ourselves, and we lose sight of what we did right. While re-embracing my own mentality I've come to realize how valuable it has been to my survival, and I would urge you all to find your stadium at the heat of the day, your mountainside, or canvas. That thing that makes you want to feel the pain of becoming better and put in the time it takes to be great. By recognizing the strength you abandoned because of PTSD you might see the ways that stigma has seeped into your life as well. Shame and blaming yourself is natural stage in growth that we'll continually deal with, but by understanding it we can find a way to climb past it when it impedes our progress. Just don't be ashamed of who you were, because those who have PTSD have suffered and survived. The aspects of your life before PTSD helped you survive and there is a lot more merit in our pre PTSD selves than naivety. Re-embracing the positive aspects of your life, before trauma, that you have abandoned afterwards will help you move forward by helping you to recognize the stigma that has creeped its way into your own outlook. At least that has been the case for me.
   

July 19, 2013

Thriving

My view of Acadia during a trail run.
The other day I was speaking to my friend and editor of the Blue Falcon Journal, Dan Buckman, about incorporating more of my life beyond the PTSD narrative into the blog. After discussing this further with Scott Lee, we've decided to start a new series called "Thriving" that will highlight everything positive in our lives. My part in the series will showcase the hobbies, activities and professional success I enjoy in order to challenge the preconceived notions about people with war's invisible injuries. My hope is that the combination of this series with our more typical posts about confronting PTSD will illustrate that we here at PSTD: A Soldier's Perspective are not solely pessimistic. We take the good with the bad. So in the same month I might post about suicidal idealization, survivor guilt and triggers as well as the hiking, trail running, beer brewing, publishing articles, presenting papers and other crazy things I do to make myself feel worthwhile.

In most cases, people with PTSD did everything right and they still do all they can to be happy, but continue to struggle with a very challenging condition. It is a myth that those who don't suffer are more resilient and that those who have PTSD are less mentally tough. I have certainly pushed myself to longer and tougher physical challenges after suffering PTSD than I have before. I hope that by incorporating all the positive things I do to keep myself happy, and to lead a life worthy of the gift I have in surviving in concurrence with the daily slog that is PTSD and mTBI that it will become apparent that even the best of us struggle and thrive at the same time. If we wait for all of our issues to subside, for all our baggage to disappear, and for our weights to be lifted; then our lives will pass us by before we ever move forward.

I know its blurred. I think it better captures trail running.
My greatest hope is that people struggling will realize that they can still feel joy and happiness even as we suffer from a difficult and painful disorder. We can have great days even when they are filled with triggers, panic attacks and nightmares. We won't be able to shed those issues, but that doesn't prevent us from living our lives to the fullest. The future of PTSD and mTBI is not predetermined, it is what we do that matters. If you think the groups that should help you the most, will provide all the help you need then you obviously don't read the newspaper, or haven't filed any claims. The more we do to make our own lives better the more we will enjoy our lives. We certainly can't sit on our butts waiting for the military and Veterans Administration to get better. It doesn't make it right that we have to do it ourselves, but that doesn't change the fact that we do. Thriving with PTSD and not despite it is ultimately our own choice. A choice that will bring as much pain, and more difficulty, as it does joy, but all meaningful joy comes from effort: PTSD or not.

If anyone reading this has anything great going on in their life please tell us in the comments. If you're on twitter, use the #ThrivingwithPTSD Hashtag whenever you meet with some success, or let me know and I will tweet about it for you.

July 1, 2013

I Feel Both Grateful and Guilty to be Alive: the Both Matters


In June 18th 2005 Lieutenant Noah Harris's Humvee was attacked by a Rocket Propelled Grenade and he died of wounds. Days later one of his Infantry Officer Basic Course classmates, the author of this post, got the news and did not know what to do. He started by running Forest Gump style. He had been out the last night being an infantryman, drinking to hard and staying up too late. Getting shot done by women, and being OK getting told no. The heat seared into his being. He sweat profusely, but he still pushed on until he felt heat cramps. He turned off of the Fort Bragg firebreak and headed home. A Mortar live fire exercise was clearly off target because he had to push it the last two miles because he knew damned well rounds were striking within the minimum safe distance. His body was bone tired but he felt nothing except anger so he slammed some water, threw on a camel back and jumped on his mountain bike.

I spent five hours on the trail bitter and angry, pushing on despite a terrible headache and being hung over.  I'd recently survived my first tour of duty, and had shot and RPG gunner- if circumstances were a little different I'd have likely lost my life too. I felt guilty for shooting the gunner when I did, and influencing his miss. Perhaps the serendipity that made me raise my weapon prior the gunner's exposure could have helped Noah. As if some sort of national karma preserved my life, but allowed him to die. I ran because I was angry. I was mad at the world, but mostly at myself. Mad because I'd survived and better soldiers died. I was angry because he had a wife and I didn't.

I've survived so much and I can't for the life of me figure out why. It doesn't seem to be merit, although on occasion it has been. I am proud to have endured so much, but I am also ashamed that I am here and others are not. But like that 1st Lieutenant who lost his friend to an event that he had recently survived, I think that I am mad at myself because I am trying to mourn. It is just hard to when no one else around me is too. The loss of other lives and my survival exist together paradoxically. I can't seem to balance my willingness to trade my life for theirs, with my powerlessness to do so. So I run, angry and in pain, but mostly because that pain is the easiest thing to feel. Its negative, but its how I feel. More importantly, when I push through that pain I am reminded that I can do it.

Flash forward to the 23rd of June 2013. I was running on the isthmus off of Quoddy Head State Park (the Eastern most point of the United States) and I could see the mouth of the Bay of Fundy and Lee Brice's "I drive your truck" played. I generally hate all of the MERICA country music because it is so idealistic and it rarely captures the realities of service rather it just glorifies war. But, that song is such a great message about mourning. When I was running in this truly amazing and beautiful place I felt a wash with guilt, gratefulness and mourning. I was doing something truly challenging and in an one of kind place. I was living my life on my own terms the way I always wanted too. I was following my heart and my dreams, and as happy as it made me I felt guilty because of all those I knew who couldn't be there. It was affirming because I felt like I owed them days like this, and I knew that I was leading a life that recognized what I'd survived. Still I was here and they were not: so I was angry.

While most authors would simply describe the positive aspects of this event and place it into a triumphant narrative: I will not. It doesn't capture the conflict and paradoxical nature of both my gratefulness in that moment, but also the guilt I felt for being there and living my life while others can't. A few miles later I realized that I'd forgotten to take my hydration supplements and I started having heat cramps. The medicine I take for PTSD and mTBI dehydrates me at a much faster rate, and an excellent race, at a great pace, and the first without a panic attack in years became the most difficult race of my life. This for some reason felt better, and I felt less guilty. Joy in moments like on the isthmus is always accompanied by suffering, and guilt, so the misery of 18 miles of heat cramps felt more authentic.

More importantly, I was going to finish. I wouldn't die trying, but I could work my nutrition and hydration in a way that would not injure myself again. I'd be miserable, but I could get to the line. When you can find contentment in suffering the word has no prisons. I was hurting, but alive and that felt more natural. It felt right. I got through with my worst marathon time. But, I failed to finish my last 26.2 race, because of panic attacks, so all the exposure therapy seems to be working. The supplements would have helped, but my legs have to work harder now that I am not stopping to rally during panic attacks. It was hard and my worst race, but it happened because my life was moving forward positively. The but matters, because it demonstrates paradox and conflict. Like other vets I get mad when people tell me at least I survived. That is correct, but it is half correct. We survived and we feel guilty for it.

All the physiological steps forward aside it is more important that this weekend demonstrates how much I have grown emotionally. When Noah died all I felt was anger and guilt. Now I feel those things, but I also feel grateful. Feeling grateful to have survived when others didn't used to make me feel even more guilty. In war you see so many people killed, and so many innocent maimed that there is not a funeral service that can help with all that loss. Families take years to recover from the loss of one of their members, and it can take a lifetime to mourn loss on the scale of war. Few join to take lives rather than save them, and coming home when others did not is bitter sweet. Allowing the moments like on the isthmus to represent both gratefulness and grief is important. I for one am lucky to have found strength in suffering this weekend. That suffering made me better and happened because I am getting stronger, both physically and emotionally. I feel both amazing emotionally because of it, but at the same time it is a shame that I could not step in to save all the people who I have loved and lost. I am OK with that paradox, and I just wish society would be too, and let me feel conflicted instead of all the careless and blind thank yous for my service that only serve to pick at an old complicated wound. Maybe say sorry for your loss and thank you at the same time, because that would be more authentic.

June 18, 2013

Why the Mount Dessert Island Historical (MDI) Society Matters for PTSD: Another Fundraising Opportunity


As I have indicated before, I use running to manage my anger, to keep my weight down while taking miztazapine, to help me stay present, and to connect with others who like to push themselves further everyday. Occasionally I am asked to run in order to raise money for a worthy charity and I am compelled to do what I can. Also, it is great to support established charities in order to gain more experience fundraising. I hope I can carry the lessons learned into fundraisers for the The Military Experience and Arts and Team Red, White and Blue in the future. With all the cognitive problems I have with mTBI, I need to practice things a few times before I can get the hang of them and these charities both help worthy causes and teaching me the ropes of fundraising.

In addition to my running I try to hit the trail every weekend with my wife and our dog Darby, because I think making new memories and observing beauty is as valuable as therapy. I used to think you could replace old memories with new ones, but I think that is impossible with trauma. However, getting out on mountains, pushing myself physically and being rewarded with their beautiful summits centers me as well as anything else. Living less than two hours away from Acadia National Park, has made MDI one of the most significant places in my life and for my family. I proposed to my wife on Cadillac Mountain, we were married in Northeast Harbor, and out favorite post hike restaurant knows us by name-it helps to bring a giant Rhodesian Ridgeback every visit.

Darby on Cadillac Mountain

While it is great that this location is significant for my life and my renegotiation of place following Iraq, it may seem unimportant to others suffering from PTSD, and the family members that support them. Nothing could be further from the truth. My colleague, Tim Garrrity, who works there is exploring a topic vital to our understanding of the difficulties suffered by military spouses. His research explores a spike in women's deaths during the Civil War and popular notions of death as a result of broken hearts. While MDI's population was far to small to justify general claims about military spousal deaths after Civil War it provides local context for a phenomenon that could have occurred more broadly. His small study, if emulated by other scholars, has a lot of potential to broaden our understandings of the difficulties suffered by military spouses. This coupled with the research of Erick Dean Jr, and Diane Miller Sommerville on Nostalgia and Confederate suicides as a forerunners to PTSD has the potential to provide deeper understanding of how trauma affected Civil War actors.

My wife is raising funds too.
For me it was a no brainer to support this cause. I love local history, I think the exploration of war's affect on the home is as important as its affect on the fighters, I love MDI, I love running, and I love helping out friends when they ask for it. For you it may be harder to justify helping the MDI Historical Society, but history is important and there is such a narrow field of scholars, and a slimmer number of historians, that value the study war's affect on the home. These posts can average over 500 views and if everyone gave a couple of dollars it would reach the society's goal and really make a difference. I know money is tight for vets, but just $2.62 (donate here) from several people will go along way to support such a worthy cause led by a scholar committed to studying women's history in relationship to war. If you can't support it financially share the post with others and maybe others can help. For me I have found that supporting worthy causes reminds me that my life was always committed to service, and that I should not change just because of the burdens caused by previous service. If nothing else find a cause to support and raise some money for it or give it your time and effort. Giving makes you feel good no matter how hard life gets. Sometimes I get so stuck on my own baggage that I forget to do the basic things that bring you the most joy, like charity and helping others.

June 10, 2013

Congressionally Mandated Longitudinal Research on Traumatic Brain Injury

To improve our understanding of TBI in a military cohort by developing a data repository that contains clinical interview, neurobehavioral, neurocognitive, neuroimaging, blood specimen, and sensory/motor data on service members who were injured since October 2001 during deployment to OIF/OEF.



June 9, 2013

Key to Writing

By Michael Lund,

On a small table in my living room sits the Underwood standard typewriter I purchased as a high school senior in 1963 from a fleet of used machines being sold at an auction. Mechanical, black, ridiculously heavy, it's a tool I found you must engage tactilely, pounding the individual keys with fingers, hitting the space bar with thumbs, sending the carriage flying back with a flip of the wrist at the sound of a bell. This Underwood is a key to my stability.

Michael Lund's Underwood
I carried - perhaps lugged is a better word - this monster to college with me and on to graduate school. It traveled with me in my brief Army career. though not, obviously, to Vietnam, though there was a mate there for me to use as an Army correspondent. At my first teaching position, I typed tests, scholarly articles, and drafts of stories I would later write about my military experience. Each finished piece was a material object. The key I pounded levered an inverted piece type up and smacked it onto a ribbon soaked with ink, leaving the shape of a letter on paper flattened against a patten. With my hands I struck the keys in the necessary order to produce words, arranged those words into sentences, shaped the sentences into paragraphs. They all represented ideas, but ideas literally hammered into place by me with the Underwood standard.

When the personal computer became available sometime in the early 1980s, of course, I switched to the new technology. I still had a tendency to bang the keyboard and to reach up to return the carriage; but the speed of editing, the easy of producing (and saving) multiple drafts, the reduced cost of paper (one clean copy at the end) were obvious even to traditionalists. The Underwood was put away in a closet, forgotten for some years.

The machine that had proven necessary to my academic and professional career returned as an objet d'art, something for children and even young adults to inspect next to old pocket watches, a few first editions of hardbound books, memorabilia form my parents' and my own lives. A key to the past, it sits appropriately in a house built in 1905.

When I see my Underwood, I am reminded that writing is a labor to overcome disorder, an effort to gather into one structure disparate, sometimes warring elements of our world and selves. To impose structure on my thoughts, feelings, and desires I have put them into words and those words into familiar shapes--letter, essay, memoir, short story, novel.

When I hosted a writing seminar for veterans in my rural community last summer, I hoped I would be able to encourage the six participants - all about my age - to achieve the same settling of things that matter into a comforting shape. I offered advice from my more than 35 years of teaching about shaping an argument, narrating an experience, describing a character. I explained, however, that the process would at times be challenging, roadblocks might occur, it was possible to veer off course. They, too, would have to hammer words into patterns, even if their fingers were just tapping a touchpad. Still, whatever the effort, their sense of personal and communal history would be strengthened, I predicted, their approach to the future made more clear, the sense of who they are and what they've done become more sure.

Though all achieved these ends, I will refer to only one individual: a military wife whose son lost a leg in Iraq. That admirable young man had recovered to the point of skiing, completing college, running marathons, helping other veterans, marrying, starting a family. So the story was not about him, but about his mother, who flew from Virginia to Germany to be with him immediately after he was wounded, who lived at Walter Reed as he went through rehab, who wrestled procedure, paperwork, and regulation for him long after he was released. She knew she had a story to tell: the trauma of a mother who almost lost her son.

That story is not done. She finished one fine chapter, drew up drafts of several more, and continues to work as her busy schedule allows. Her family has entered into the process, reading drafts of different sections, offering memories, encouraging her to get it all in, to get it all right. She laughs when she tells me the project may expand to a series of books, not just one, with many collaborators. She has been pleased at each stage of the process, satisfied at the growth she has found in herself and in others through the process of writing.

If my Underwood standard no longer has a function in producing documents, it serves as a key reminder to me of the solidity, the weight, and the staying power of experience put into words. Writing benefits the writer (in my friend's case, the writers) and readers. I encourage those who have carried the burden of service to produce products of their experience in words, coming to terms with and growing from traumatic events they have had to endure for their country.

*****

Michael Lund, a retired professor of English, lives and writes in Virginia. He volunteers as an editor and writing instructor for the Veterans' PTSD Project. An Army correspondent in Vietnam, 1970-71, he is the author of a collection of short stories, How to Not Tell a War Story, and a novel series inspired by The Mother Road, including Growing up on Route 66 and Route 66 to Vietnam: A Draftee's Story.

Read more by Michael Lund

Congressionally Mandated Study on Caregivers for Veterans with TBI

If you are a caregiver of a service member or veteran who served in OIF/OEF and returned with a moderate or severe TBI, you may be eligible to participate in a study requested by Congress. If you or someone you know may be interested, please call 1-855-821-1469 or email caregiver.study@dvbic.org.


Caring for Caregivers

May 29, 2013

Did Not Finish: Accepting Failures is Key to Growth (Volume 1)

"Time Jumpmaster! You are a sequence violator. You placed your fingers inside the rim of the ballistic helmet during the rear head tilt on the first and second jumper...." Those were the words that brought my failure of the fifth parachute inspection during my first iteration of Jumpmaster school. I had recycled both Darby and Rudder phases of Ranger school, but this was the first course I ever failed. I lost it for a second, I let down my platoon, my unit, myself and I thought I would never get another opportunity. My senior parachutist wings and hard earned Jumpmaster armband tell a different story, but for a few hours I thought I lost the opportunity of a lifetime.
Jumpmaster Armband

A few hours later I walked into my company commander's office with my head held low. "Sir, I failed on a sequence violation. It was a petty gig, but I should have done it right and there is no excuse." My commander Captain (now Major), Joe Blanton was outstanding. "Well Lieutenant Miller, you're in good company." He began listing company commanders in my battalion who failed Jumpmaster school on their first and sometimes second attempt. The First Sergeant gave me a lecture on how my platoon was going to be without a Lieutenant for another three weeks and that I better not waste six weeks at Jumpmaster school because officers needed to pull their weight on airborne operations. I have often forgot about this major failure between my first and second deployment, in regards to how I judge mistakes that I make at home.

I came back to Jumpmaster school the next Monday, and the instructor who failed me walked up to me and asked me "are going to try an cheat this time?" Another Lieutenant told me couple of tricks to make parachute deficiencies stand out. I owned up to my mistake. He responded "well hopefully you learned your lesson and you have already paid the price. Trust the training we are giving you, don't cut corners and you will get through. Your instructor should have warned you, but don't do it again or I will make sure you fail." Two and a half weeks later I passed with the same instructor. He saw me take the lesson to heart and use my extra training to help the other people in my squad pass. He was excited because he helped me become a strong Jumpmaster, but, more importantly, I gained a life lesson about failure. Don't forget failures own them, learn from them, and don't waste your mistakes.

When we try to moralize success we also unwittingly demonize failures. We forget that we all fail and accepting our failures regardless of the causes is the first step towards growth. PTSD and mTBI can be a valid reason for any of us to fail to meet our own goals. We tend to also equate all of our failures as life or death when they are not. Even if we have made mistakes that cost lives, that was not always because of moral failings, but because we are human beings who make mistakes. I know that if I lost a soldier for every mistake I made in combat, then I would have lost legions of soldiers. This process of moralizing or systematically preventing mistakes helped us cope in combat not by actually eliminating failure, rather it was a way to assure ourselves that we did everything we could have after a traumatic event. We all drop balls, but you know when you have given your all and when you have not. It would be burdensome task to catalog every minor error in your life, rather than ones that taught you the most. When we demonize our failures, we reject their potential utility to make us better people. Worse, when we moralize success and failure we become defensive about our most obvious flaws.

Instead of tossing the shirt I wrote DNF and traded the 5 for a 4
This last year I experienced a few failures, and I am trying really hard to learn the right lesson. PTSD is often difficult because of the vast comorbidity of other mental illnesses and physiological responses, associated with it. One of the most frustrating aspects is figuring out what setbacks are just natural and which ones stem from PTSD. I run marathons and ultras in order to manage anger, stay my kind of fit, and to manage the high amounts of weight gain that comes with the anti-depressants I take. On two races I DID NOT FINISH (DNF) and in another race I finished at thirty miles rather than my goal of one hundred. It is important to note that on two DNFs that I inevitably did the right thing. I made the right long term decision at the cost of short term disappointment. I tend to try and Ranger through things. You can't pass Ranger school without driving on with an injury: you often cause more harm to yourself than good. It has been a real struggle to figure out when I am going too hard, and my tendency to be a stubbornly stoic Army Ranger goes too far. I am still failing at this, but I have been moving forward.

"Mr. Miller I am pretty sure you're going to be on a ventilator before night is over. You have the highest toxicity that we have ever seen and we have another patient in renal failure with much lower stats.” To be continued....

This will be the first post in a series on my relearning to embrace failures in relationship to the guilt of survival that comes with PTSD, obviously I have survived last year's ordeal.

May 21, 2013

Preparing for Therapy


So you are ready for therapy but don't know what to expect. What's the difference between all the mental health professionals? A psychologist has a PhD, they use a variety of therapies but do not prescribe medications. They usually run programs, in rank they compare to captains. A psychiatrist is a medical doctor who specializes in mental health, they use a variety of therapies and prescribe medication. They often run departments, they would be considered a colonel or appropriate rank. Therapists would be the high-ranking Non-commissioned officers the military could not run without. They are usually clinical social workers with a master's degree and often have specialties. My therapist is a nurse-practitioner. You may need a Marriage and Family Therapists for help with your partner and relationship. But, more than likely if you are reading this you will need a therapist who practices evidence-based therapies to treat posttraumatic stress disorder, military sexual trauma and traumatic brain injury. In therapy you will need an empathetic hand to guide you through the wreckage of your mind.

Empathy is the ability to identify, internalize and experience another's emotional state. It's imperative to find a therapist you can connect with. The nature and structure of trauma leaves internal conflicts; the kernel of trauma-based disorders rest in the most recessed parts of our minds. The most important aspect of therapy will be an empathetic connection with your therapist, a therapeutic window between the therapist and the patient to reach the deepest compartments. To access this information safely, we must bond with our treatment provider. To begin the journey of recovery we must find a therapeutic window into our minds substrate. Without developing a rapport with your therapist, therapy will not work. Read that again.

Become an advocate for yourself and learn some basic information on how the Veteran's Administration works. You can fire any doctor or therapist in the VA by going to the counter and asking for a Change of Provider form. Write the reason you don't want this provider and you don't trust them. Generally it will take up to 3 months to get a new appointment so make sure you want to change. Go to at least 3 or 4 visits before you decide to fire your mental health practitioner. I fired a therapists because she talked about her issues and was more depressed me. I fired a psychiatrist due to her inability to discuss my medications with me or her unwillingness to listen to what I had to say. I've changed therapists because they were not certified in Cognitive Processing Therapy (CPT).

There are many kinds of therapy and the one you will probably engage in the most is psychotherapy or talk therapy. Talk therapy consists of sharing about psychological distresses, social, life in general and family issues. The therapist listens, gives feedback and psychoeducation on your condition along with teaching coping skills to manage symptoms. Talk therapy focuses on maintaining equilibrium and balance in life. The most effective treatments for the mentally wounded with the diagnosis of PTSD, MST and TBI is evidence-based therapies. The front-line treatments are Cognitive Behavioral Therapy (CBT), Cognitive Processing Therapy (CPT) and Exposure Therapy (ET). Ask your mental health provider if they use these therapies and if they have certification.

We'll cover two, since they are the most used. CBT examines the relationships between thoughts, feelings and behavior. By identifying beliefs that lead to self-destructive behaviors the therapist can offer coping strategies to help change thinking patterns over time. The therapies will be problem-focused and goal-directed for symptom reduction. Expect to have homework and if you want to heal actively participate.

Cognitive Processing Therapy, an exposure therapy, focuses on accessing trauma memories, identifying and challenging faulty beliefs about the event and resulting over-generalized beliefs in self. According to Cognitive Theory, trauma impacts our belief structures and how we categorize the world. That two types of emotions follow trauma, natural and manufactured. Natural emotions are universal such as fear, anger, joy, happiness, sadness and loss. They have a natural course to run unless we feed into them, then they can become stuck points. Manufactured feelings result from the way we interpret events and not fact based. I know a combat medic with four tours and many medals, the purple heart included. She was unable to return to active duty because of extensive damage received from an Improvised Explosive Device. She's fighting the belief that she let soldiers down because she couldn't return to her Mobile Army Surgical Hospital and deploy outside the wire under fire where she belonged.

Cognitive Processing Therapy starts with psychoeducation about your condition and symptoms, then therapy goals and identification of stuck points, and then 12 sessions centered around challenging beliefs and meaning of the event. The structured sessions center around identifying thoughts, feelings and stuck points associated with the event. They challenge problematic thinking and address safety, trust, power and control, esteem, intimacy and meaning. This is an exposure therapy, a writing component starts with an impact statement and then writing about the trauma again from each perspective safety, trust, power and control, esteem, intimacy and meaning. The therapist and patient will examine the writing together with worksheets and writing exercises. I've used this therapy and it's the best one so far.

Keep a therapy journal. Write a list of questions and reminders to keep track of what to talk about. Write about your insights and revelations. Write about your feelings, thoughts and trauma. In doing so you begin to take back your mental health one session at a time. A journal will keep you from forgetting the issues you want to discuss and a place to share your inner self. Trauma telling is an important aspect of healing, it enables us to re-contextualize our experiences and find meaning where we once thought was none.