I have thought about this for a couple of days and did not know what to say for a minute. But then I started thinking about why I was not persistent with receiving help. My initial help seeking came from the insistence from ex-wives, on a conscious level I did not believe that I needed help even in the face of my insanity. It took many years of my flailing about to become convinced of my need for assistance.
I believe the reason for many veterans reluctance to receive help, on the internet or in the office has to do with the inherent denial of PTSD coupled with the stigma attached. We survived the most intensive environment that a human can endure; combat, killing and mayhem. How can we succumbed to an unseen foe? Unimaginable and enduring ghosts that chase us unrelenting, a perfect machination for denial.
If I do not acknowledge it, I will not have to deal with it. Except that when we do not fully realize a part of our selves then we run the risk of being led by an unrecognized part of self that now becomes an entity within, influencing our thinking and behavior. A self perpetual and elusive presence populating the mind.
Another key issue we have, trust. We have an aversion with trusting anyone that do not think like us. In combat we formed the most intense bonding that a human can experience, a total and unrelenting commitment to a guardianship between squad members. I refer this as the "troop organism", we feel great pain in the loss of our appendages, both in a KIA and in going home without the "rest of us".
The mystifying experience of posttraumatic decline involves a sense of confusing reexperiencing and intrusive thinking from a disowned side of the personality. The part of us that we do no accept as our own, we deny its existence, we cannot accept that we have a killer inside of us. This disassociated self, the combat self, insists on interjecting itself into our daily life. In a battle with no solid enemy and no apparent battleground the warrior having been trained to combat the physical comes in contact with a foe that can overshadow the imagination. A pitched battle between denial and acceptance can rage for many years.
Even after many attempts to receive help, I was not equipped to begin therapy, so I would quit before a diagnosis could be assigned. In the VA before a service connection can be determined the veteran must endure many forays into the stressors that caused the posttraumatic stress reactions. Doing so without many months or even years of psychoeducation and cognitive restructuring therapy can be detrimental and harmful to the veteran, exacerbating their condition.
I think another factor can be that a psychological wound is viewed in a similar way to a physical wound - sometimes picking at it allows the practitioner to get a salary, but it doesn't heal any faster. Sometimes a scab is best left un-picked at for a while so it can get better inside, then fall off on its own. Of course this could be correct in some cases and not in others; the point I'm trying to make is just that this could be an idea they are entertaining, not whether it's correct or not.
ReplyDeletePC, I feel that your comment has some merit. In a way that therapist should have specialized training in trauma therapy, especially in combat trauma therapy. You are correct to assume that many practitioners go into deep psychological therapy to soon.
ReplyDeleteThe private practice model concentrates on brief therapies that usually only work with the less complicated end of the pathology spectrum. They do this not because the evidence expresses itself so, but dictated by insurance policy. In other words, although brief therapy can and usually does work for less comprehensive classifications. The more elaborated diagnoses should compel the practitioner to begin with psychoeducation and cognitive restructuring therapies. First concentrating on educating the client about their particular pathology. Identifying emotions and values, coping strategies, self depreciating statements and their impact and a host of other foundational psychological restructuring.
All of this developmental preparation should be construed in a systematic and fluid interpretation designed especially for the client. Much of this work for the combat variety of PTSD should take many months. I went through similar therapies for approximately 14 to 16 months before I started to address combat issues. During this time I was in an inpatient facility for 20 months, receiving around 10 hours of therapy a week. After the 20 months I still only touched briefly on my combat experiences and then decided to take a break from therapy due to the intensity and starting college.
I am now back in therapy and seeing my psychiatrist regularly. I was recently hospitalized for suicidal ideation and started a new regimen of antidepressants and Prazosin for PTSD.
So my point is that combat PTSD in all probability will require many months if not years of therapy to get to the point that a "normal" life can be experienced.
I have revised my stance on brief therapies, Cognitive Processing Therapy is one I have taken and responded to well. Better than any therapy I have taken before, I still ascribe to practitioners preparing their clients before though.
Delete