This is my latest presentation about PTSD from a warrior's perspective and an attempt to turn the traits that are important for us (courage for example) into a means to help deal with PTSD. Note, this presentation has some disturbing images in it.

1. PTSD:a warrior’s perspective Eddie Black USMC Oregon Army National Guard

2. Personal Considerations This presentation will contain images, and topics about combat and Post Traumatic Stress Disorder (PTSD). I intend to evoke an emotional response. If you feel uncomfortable at any time you may leave without comment or question.

3. Women in combat

6. Soldiers Around Me… ‘Joes’ are divorcing Lots of beer drinking Risk taking and not caring about consequences Drug and Alcohol Abuse Joblessness Nightmares and lack of sleep Attrition of NCOs

7. Returning Veterans.org

8. Stupid People Doing Stupid Things

9. Myself Driving at night at 30 MPH a trigger Easily irritated Hyper vigilant- very wearisome Startle response Merging onto the freeway and driving MANY relationships Easy to get into a fight No memory/concentration Strange emotions unexpected 4th of July was no fun

10. Iraq and Afghanistan According to a Post Deployment Health Reassessment 38 % Army soldiers 31 % of Marines 49 % National Guard report psychological symptoms. Those who had served repeated deployments were at extremely high risk of problems and the toll on their family members was great.

11. European & Pacific Theater 25% - 33% of casualties

12. PTSD from Ancient Greece to the Present Sophocles, Homer Nostalgia Hysteria Shellshock Buck fever Combat fatigue Battle reaction Disorderly action of the heart Soldier’s heart Homesickness Irritable heart

13. A 2003 New England Journal of Medicine Study 60 percent of those showing symptoms (PTSD) were unlikely to seek help because of fears of stigmatization.

14. I would be seen as weak by my unit members 65% My unit leadership might treat me differently 63% My unit would have less confidence in me 59% My leaders would blame me for the problem 51% It would harm my career 50% Difficulty getting time off for the problem 55% It is difficult to schedule an appointment 45% I don’t trust mental health professionals 38% Mental health care doesn’t work 25% I don’t know where to get help 22% Hoge, et al. 2004

15. Military Psychology

16. Psychology is about fluffy bunnies and hugs Therapists are all hippypacifists Some myths and misunderstandings about PTSD and Psychology You either have it or you don’t Only WIMPS have emotions* *all emotions is same as crying

17. Greedy Individualistic Consumerist Lazy Emotionally Shallow Controlling Violent Preoccupied by Sex Competitive

21. I don’t rate feeling this way

22. A Veteran

23. A member of the Seventh Army, 3rd Division, 15th Infantry Regiment, Company B, he rose from private to first lieutenant in nearly 30 months of combat. He was wounded three times. On one occasion, he stormed a German-occupied hill alone, killing 15 and wounding 35; later he captured, singlehanded, an enemy machine-gun nest. In the battle for the Colmar pocket in eastern France, he mounted a burning tank destroyer and with its .50-cal. machine gun held off an attacking Nazi force of some 250 men and six tanks. It was for this action that he was awarded the Medal of Honor. Medal of HonorDistinguished Service CrossSilver Star with First Oak Leaf clusterLegion of Merit Time Magazine, 1971

24. Always an advocate for the needs of veterans, he broke the taboo about discussing war related mental problems after this experience. In a effort to draw attention to the problems of returning Korean and Vietnam War veterans, Audie Murphy spoke-out candidly about his personal problems with PTSD, then known as "Battle Fatigue". He publicly called for United States government to give more consideration and study to the emotional impact war has on veterans and to extend health care benefits to address PTSD and other mental health problems of returning war vets. Time Magazine, 1971

25. Honor Courage Commitment Leadership Duty Respect Selfless Service Honor Integrity Personal Courage Justice Judgment Dependability Initiative Decisiveness Tact Integrity Enthusiasm Bearing Unselfishness Courage Knowledge Loyalty Endurance Integrity Loyalty Commitment Energy Decisiveness Selflessness virtues of our military

26. Honesty Persistence Bravery Teamwork

28. Ares God of War

29. Aggression beyond what would normally be acceptable within society is a fact of life that is encouraged in the military, particularly among infantry… where close combat is more likely to occur. This acceptance of controlled aggression… becomes a part of the culture within the military. During combat training, it may seem as if every action or word is laced with aggression. Individuals who cannot tolerate or adapt to this environment will not succeed in most military organizations. Furthermore, individuals who do not succeed in training are often deemed to be personally defective by the group (Shroeder, 1984) Christian, Stivers, Sammons p. 43

30. “To survive and be victorious on the battlefield, our warriors must aggressively seek out the enemy and kill them. This has far reaching spiritual and psychological implications. In order to be “successful” the warrior must not miss a beat in pursuing and eliminating adversaries one after another. When they attack the enemy, they are trained to go one step beyond personal moral boundaries and take the life of another human being. This eventually becomes their personal horror of war- this is one primary aspect that damages the soul. The “killer instinct” that is so energetically thrown around in locker rooms and corporate sales meetings becomes a very real impulse to soldiers in the heat of battle. Without this instinct the warrior is very lucky– or very dead.” Down Range: To Iraq and Back

32. The Unnatural Act of Killing Another It is estimated that in World War II, 75 to 80 percent of riflemen did not fire their weapons at an exposed enemy. In previous wars nonfiring rates were similar. In Vietnam the nonfiring rate was close to 5 percent

33. “Train Like You Fight” Develop ‘quick shoot’ ability. The modern soldier trains in full gear, shooting blanks at realistic targets until reflexive fire is obtained.

34. Conditioning Pavlov in 1904 Skinner developed further into Behavioral engineering Rewards and Punishments develop automatic behaviors

35. Translation for grunts… Pain is Memory

36. Spot the danger…

40. Kevin Carter (1993)

41. Pain is Memory

42. The Brain

43. Phineas Gage On September 13, 1848, Phineas Gage was foreman of a work gang blasting rock while clearing the roadbed for a new rail line.

44. Amygdala Connection with lots of areas of the brain Emotional stamping of events Increases reflexive reactions Signals sent ‘upward’ are checked by prefrontal cortex.

45. ? Amygdala Visual

46. Almostallservice members returning from the war zone will experience some of these behaviors and reactions. It’s vital that you remember that having these reactions does NOT automatically mean you have PTSD. It would be abnormal if you didn’t experience some of these feelings and behaviors following what you have been through in the war zone. It isn’t an Either/Or… it is a spectrum

48. Reduced awareness of surroundings

49. Derealization

50. Depersonalization

52. Feelings

53. Conversations

54. Activities and other cues

55. Reduced interest or participation in activities

56. Feelings of detachment

58. Increased irritability and anger outbursts

59. Difficulty concentrating

60. Hypervigilance

61. Exaggerated startle responsePTSD

63. What is Dysfunctional? Impaired in function; especially of a bodily system or organ (of a trait or condition) failing to serve an adjustive purpose. If a person is behaving in ways counter-productive to their own well-being

64. 29 Army Officers deployed to Iraq and Afghanistan Asked to rate each of 24 character strengths on 5-point scale. Teamwork Honesty Courage Persistence Judgment Peterson and Seligman (2004)

65. It is important that therapists* to be educated in the warrior tradition and its rituals in order to recognize and help veterans identify with [the use of] warrior traits. Ignoring these traits is harmful to the veteran, for then the inner warrior remains invisible. Pathologizingthe traits is also harmful, for then the vet is further wounded by reductionist interpretations that may minimize their importance to him… or empty them of their spiritual potency. Edward Tick, Ph.D. War and the Soul

66. Anybody can become angry, that is easy; but to be angry with the right person, and to the right degree, and at the right time, and for the right purpose, and in the right way, that is not within everybody's power, that is not easy. ~ Aristotle

67. What makes a good guard dog?

68. I will never accept defeat I will never quit I will never leave a fallen comrade

69. Resiliency Flourishing

70. It is what it is Eat the pickle

71. Teamwork Honesty Courage Persistence Virtues…

72. I swear to myself that I will measure up to it. I may be branded by war, but I will not be defeated by it. Gradually it becomes clear. I will go back. I will find the kind of girl of whom I once dreamed. I will learn to look at life through uncynical eyes, to have faith, to know love. I will learn to work in peace as in war. And finally– finally, like countless others, I will learn to live again.

73. Quick Rundown Training has given you faster reflexes for combat actions Experiences give emotional shaping to memory It is normal to have mixed feelings about wartime experience Having some symptoms does NOT automatically mean you have PTSD Only a clinician can diagnose you with PTSD PTSD is not permanent and many treatments are available There are MANY resources available for treatment If left untreated it will negatively impact everyone around you Healing is found via community

74. http://returningveterans.org www.soldiersangels.org