Resources - Combat & PTSD

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The following resources may be helpful to those who wish to better understand the role of PTSD in veterans.

[b]Veterans & Their Families [US]

PTSD - Veterans Affairs [Canada]

PTSD Support [UK]

Effects of Serving in Afghanistan & Iran

Returning From the War Zone: A Guide for Families

PTSD Combat: Winning the War Within

Iraq War Veterans Organization

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Guidelines for Listening to War Veterans
by Al Siebert, Ph.D

The main problem for many war veterans and survivors of torturous experiences is not what they went through. Their problem is that very few people have the emotional strength to listen to them talk about what they went through. The poor relationships that survivors often have with spouses, children, relatives, neighbors, employers, and co-workers are not merely a result of delayed reactions to stress. The feelings of isolation and poor relationships with others are, in part, from having bad experiences with people who are poor listeners.

Pictures of the war in Iraq did not show the gruesome carnage caused by the bombing. "Most people would go weird," one combat veteran says, "when they hear about what I saw."

People who have survived highly distressing experiences will usually talk with a good listener who will take time to hear the whole story. If you are willing to listen to someone speak truthfully about all their experiences, here are useful guidelines to follow:

1. Don't ask about a person's experiences unless you can handle honest answers. When Vietnam combat veterans returned home they found that very few people had the emotional strength to listen to their stories. Don't open someone up and then "chicken out" when the story gets too rough. Tell yourself that a reasonably strong human being ought to be able to at least listen to what another person has lived through. Survivors of horrifying experiences will usually talk to a person who has the courage to listen.

2. Give the person lots of time. Vietnam veterans found that the average person could listen for only several minutes. When a veteran is willing to talk to you, it is important to allow him or her plenty of time to talk. Don't interrupt to state your feelings about the war. This is not a time for discussion! Plan to listen for hours. Expect to have some follow-up sessions. When people open themselves up to relive strong emotional experiences, additional details and feelings may flood into their minds in the days that follow. It is typical for combat veterans to have nightmares and periods of emotional turmoil.

3. Be an active listener. Ask for details. Ask about feelings. Ask questions when you feel puzzled about facts or incidents.

4. Remain quiet if he or she starts crying. It may help to touch or hold the person if it feels right to both of you. Don't tell the person to not feel what he's feeling. Don't suggest a better way to look at it. Leave his or her thoughts and feelings alone. Your quiet presence is more useful than anything else you can do.

5. Listen with empathy, but minimize sympathy. It is easier for combat veterans to reveal what they went through if they don't have to put up with sympathy. ("What a horrible experience! You poor man!") Survivors of horrible experiences talk more easily to a person with calm concern. Control your imagination and resist letting their feelings become your feelings. Don't make the veteran have to handle your emotional reactions as well as his or her own. If you need emotional support, seek it elsewhere.

6. Ask if he or she sees anything positive about being in combat. It is not accurate to think of most war veterans as having a post-traumatic stress disorder. Some do. The majority do not. Research shows that many who served in Vietnam became significantly more mature and developed a healthy personal identity. The same extreme circumstances that cause emotional trauma for some people cause others to become stronger.

Source: Listening to War Veterans

"2. Give the person lots of time. Vietnam veterans found that the average person could listen for only several minutes. When a veteran is willing to talk to you, it is important to allow him or her plenty of time to talk. Don't interrupt to state your feelings about the war."

The telling is hard to initiate. One time when I was first able to tell a little bit of my story, a guy who I thought was very concerned listened and listened. The longer he listened, the more interested and caring I thought he was. I poured out a lot of "stuff" that had been held secret for years.

A couple hours this "caring friend" gave me a friendly tip. He said he was just telling me as a friend ..."Don't tell so much. I can't relate to all that military stuff and other people can't either. Don't go on story after story. It all started with a simple question and 20 minutes later I'm trying to find a way to get out of there. Bless your heart, just friendly advice."

I felt like a total heel, like the scum of the earth we were so often called by our drill sergeants. This remark coming from someone who gave all the body language that meant he was interested and caring. Wow... could I ever trust anyone again? Not too soon, I can tell you that ...

troy

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Just an observation... I've noticed that people who can't deal with their own pain usually can't deal with the pain of others either. It makes them real wretched listeners because what they end up doing is pushing it away, invalidating your experience or redecorating it instead of allowing it to be just exactly what it is -- a great big pile of pain.

Troy: ..."Don't tell so much. I can't relate to all that military stuff and other people can't either.

If we go in with the assumption that we're all human and we're all capable of feeling pain, fear, terror... then, it's not so hard -- it's just a matter of degrees.

You are so right ...

I was very angry with this guy for awhile, then he fit into the category of people who need my help in understanding all of this ... I forgave him and made an overture of apologizing so he could comfortably speak with me again.

Hopefully, I can again trust him someday. Hopefully, i will be able to listen to his stories as well, because we all have stories of some kind that we've kept secret.

Troy

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spiritual_emergency said:
<blockquote>
Guidelines for Listening to War Veterans
by Al Siebert, Ph.D

The main problem for many war veterans and survivors of torturous experiences is not what they went through. Their problem is that very few people have the emotional strength to listen to them talk about what they went through.

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Thank you for posting these guidelines. Since I have never been in war combat I find this very helpful.

I have made the experience too, that people cannot endure listening to tales of traumatic life-events when they are not emotionally strong and solid and stable. But then I thought, well, it is not their fault and I did not insist. Comes the time comes the right listener.
Meanwhile, I have become a patient listener myself, and I am glad about that, since it means that I have grown stronger.

Take care,
bluna

The emotional strength to listen ... that is exactly right.

Thanks for being a strong person and listening. This is not a negative remark about those who cannot listen because they have other things going on. It's just that i appreciate those who can listen.

some of the stuff is so horrible that ... *tears.. . I cannot even express it. *( panic........and that's without even thingking of the detaiols, just the general thoughts. ... Arghhh... thanks for walkinhg this road with me.

Tory

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Troy: some of the stuff is so horrible that ... *tears.. . I cannot even express it. *( panic........and that's without even thingking of the detaiols, just the general thoughts. ...

I would like to believe that one day, the idea of engaging in warfare will be considered absolutely unthinkable and this is because war not only extracts a brutal price in the field, its effects are lasting and far-reaching. Until that day arrives however, the wounded will keep coming and it's important that we, as a society, culture, country -- however we define ourselves -- not immune ourselves to the depth of that pain. You, (Troy) are still feeling the rawness of your own wounds all these many years later, and today, there are thousands of young men and women who are only just beginning to feel theirs.

Another resource I came across...

Healing Combat Trauma: [i]Resources for and about healing combat trauma. The focus is on effective medical, psychological and legal care, and the slant is apolitical.

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The conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma

When the truth is fully recognized, survivors can begin their recovery. But far too often, secrecy prevails and the story of the traumatic event surfaces not as a verbal narrative but as a symptom.

Denial exists on a social as well as an individual level... We need to understand the past in order to reclaim the present and the future. An understanding of psychological trauma begins with rediscovery the past.<blockquote>The fundamental stages of recovery are:

1. Establishing safety

2. Reconstructing the traumatic story

3. Restoring the connection between the survivor and his/her community.</blockquote>It is very tempting to take the side of the perpetrator. All the perpetrator asks is that the bystander do nothing. He appeals to the universal desire to see, hear, and speak no evil. The victim ask the bystander to share the burden of the pain. The victim demands action, engagement, and remembering. (A tendency to render the victim invisible; to look the other way.)

Traumatic Neurosis of War

The soldier who developed a traumatic neurosis was at best a constitutionally inferior human being, at worst, a malingerer and a coward. They were described as moral invalids. Hysterical symptoms such as mutism, sensory loss, or motor paralysis were treated with electric shock; threatened with court martial. The goal of treatment was to return the soldier to combat.

In WWII, it was recognized that any man could break down under fire and that psychiatric casualties could be predicted in direct proportion to the severity of combat exposure.

There is no such thing as "getting used to combat." Each moment of combat imposes a strain so great that men will break down in direct relation to the intensity and duration of their exposure. Thus, psychiatric casualties are as inevitable as gunshot and shrapnel wounds in warfare.

In their quest for a quick and effective method of treatment, military psychiatrists once again found the mediating role of altered states of consciousness in psychological trauma. They found that artificially induced altered states could be used to access traumatic memories.

As in earlier work on hysteria, the focus of the "talking cure" for combat neuroses was on the recovery and cathartic reliving of the traumatic memories with all their attendant emotions of terror, rage, and grief.

Combat leaves a lasting impression on men's minds, changing them as radically as any crucial experience through which they live. It points to the need for integration.

After Vietnam, the diagnosis "post traumatic stress disorder" included in the APA's DSM, giving it legitimacy.

...

Psychological trauma is an affliction of the powerless. At the moment of trauma, the victim is rendered helpless by overwhelming force. Traumatic events overwhelm the ordinary symptoms of care that give people a sense of control, connection, and meaning.<blockquote>Certain experiences increase the likelihood of harm.

1. Being taken by surprise

2. Being trapped

3. Being at the point of exhaustion

4. Being physically violated or injured

5. Being exposed to physical violence

6. Witnessing grotesque deaths</blockquote>Trauma occurs when action is of no avail--when neither resistance nor escape is possible.

The traumatized individual may experience intense emotion but without clear memory of the event--or may remember everything in detail but without emotion. Traumatic symptoms have a tendency to become disconnected from their source and to take on a life of their own (dissociation).<blockquote>The Main Categories of Post Traumatic Stress Disorder

1. Hyperarousal: Persistent expectation of danger

2. Intrusion: The indelible imprint of the traumatic even returning unbidden.

3. Constriction: The numbing response of surrender

In Hyperarousal: The system of self preservation goes into permanent alert as if the danger could return at any moment. (Symptoms: Startle easily, reacts irritably to small provocations, sleeps poorly). It is the constant arousal of the autonomic nervous system.

In Intrusion: Long after the danger is past, traumatized people relive the event as though it were continually recurring in the present. The trauma interrupts daily life. (Symptoms: Flashbacks during waking; nightmares during sleeping)

Traumatic memories lack verbal narrative and context; rather they are encoded in the form of vivid sensations and images. They resemble the memories of young children.

Traumatized people find themselves reenacting some aspect of the trauma scene in disguised form without realizing what they're doing (e.g., putting themselves in dangerous situations this time to make the end come out differently (a version of the repetition compulsion).

Seen as a possible attempt at integration--to relive and master the overwhelming feelings of the traumatic moment(s).

Attempts to avoid reliving the trauma too often result in a narrowing of consciousness or withdrawal from engagement with others and an impoverished life.

In Constriction (numbing): The system of self esteem shuts down completely (a state of surrender). The helpless person escapes not by action, but by altering her/his state of consciousness.

Events continue to register in awareness but its as though these events have been disconnected from their ordinary meaning (similar to trance states).

Those who cannot dissociate may turn to drugs or alcohol for their numbing effects.

Adaptive during the trauma, numbing becomes maladaptive once the danger is past.

In an attempt to crease some sense of safety, traumatized people restrict their lives.

In avoiding any situation reminiscent of the past trauma or any initiative that might involve future planning and risk, traumatized people deprive themselves of those new opportunities for successful coping that might mitigate the effect of the traumatic experience.</blockquote>
Because post traumatic symptoms are so persistent and widespread, they may be mistaken for enduring characteristics of the victim's personality.

Disconnection: Traumatic events breach the attachments of family, friendship, love, and community. They shatter the construction of the self that is formed and sustained in relation to others. They undermine the belief system that gives meaning to human experience. They violate the victim's faith in a natural or divine order and cast the victim into a state of existential crisis. It is a shattering of "basic trust." A sense of alienation, disconnection pervades every relationship.

Damaged Self: Trauma forces the survivor to relive all earlier struggles over autonomy, initiative, competence, identity, and intimacy.

The developing child's positive sense of self depends upon a caretaker's benign use of power.

Traumatic events violate the autonomy of the person at the level of basic bodily integrity (Body ego -> first sense of "I")

The belief in a meaningful world is formed in relation to others and begins earliest life. Basic trust, acquired in the primary intimate relationship is the foundation of faith. Trauma creates a crisis of faith.

Damage to the survivor's faith and sense of community is particularly severe when the event themselves involve the betrayal of important relationships.<blockquote>Survivors oscillate between:

Uncontrollable outbursts of anger and intolerance of rage in any form.

Seeking intimacy desperately and totally withdrawing from it.

Self esteem is assaulted by experiences of humiliation, guilt, and helplessness.</blockquote>

Vulnerability and Resilience
Individual personality characteristics count for little in the face of overwhelming events. With severe enough experience, no person is immune.

Individual differences play a part in determining the form PTSD will take. It is related to individual history, emotional conflicts, and adaptive style.

Highly resilient people are able to make use of any opportunity for purposeful action in concert with others, while ordinary people are more easily paralyzed or isolated by them.<blockquote>Some features of highly resilient people:

1. Alert, active temperament

2. Unusual sociability

3. Good communicating skills

4. Strong internal locus of control

and

GOOD LUCK!

Increased vulnerability is enhanced by:

1. Disempowerment (children, adolescents)

2. Disconnection from others

3. Lack of social supports

4. Poor or absent communication avenues[/b]</blockquote>

The Effect of Social Support
The survivor's social world can influence the eventual outcome of trauma.

The emotional support that is sought takes many forms and changes during the course of resolution.

In the immediate aftermath, rebuilding of some minimal form of trust is the primary task. Assurances of safety and protection are of the greatest importance.

Then, the survivor needs assistance of others in rebuilding a positive sense of self. Others must show tolerance for the oscillating behaviors of the survivor. It is not blanket acceptance but the kind of respect for autonomy that fostered the original development of self esteem in the first year of life. (Movement toward self-regulation).

The survivor needs the assistance of others in her/his struggle to arrive at a fair assessment of her/his conduct. Harsh criticism or ignorance or blind acceptance greatly compounds the survivor's self blame and isolation. Realistic judgments include a recognition of the dire circumstances of the traumatic event and the normal range of the victim's reactions. They include the recognition of moral dilemmas in the face of severely limited choices. This, hopefully, leads to a fair attribution of responsibility.

Finally, the survivor needs help from others to mourn her/his losses. Failure to complete the normal process of grieving perpetuates the traumatic reaction.

The Role of Community
Sharing the traumatic experience with others is a precondition for the restitution of a meaningful world.

Once it is publicly recognized that person has been harmed, the community must take action to assign responsibility for the harm and to repair the injury. Recognition and restitution are necessary to rebuild the survivor's sense of order and justice.

Source: Trauma & Recovery (Excerpts)

Purchase the book here: Trauma & Recovery - Judith Herman


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I offer this without knowing if it will be of any use to others. I suggest that any readers take it if they find it to be personally useful and if they don't, to leave it be.

Regards.

Transforming Our Terror

in the sticky section we will be posting links and new treatments that might be available in the treatment of combat ptsd. please feel free to browse them and add to them if you have something not posted there.

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A Recovery Bill of Rights for Trauma Survivors
By Thomas V. Maguire, Ph.D.

By Virtue of Your Personal Authority You Have the Right to . . .

- Manage your life according to your own values and judgment.

- Direct your recovery, answerable to no one for your goals or progress.

- Gather information to make intelligent decisions about your recovery.

- Seek help from many sources, unhindered by demands for exclusivity.

- Decline help from anyone without having to justify the decision.

- Believe in your ability to heal and seek allies who share your faith.

- Trust allies in healing so far as one human can trust another.

- Be afraid and avoid what frightens you.

- Decide for yourself whether, when, and where to confront fear.

- Learn by experimenting, that is, make mistakes.

To Guard Your Personal Boundaries You Have the Right to . . .

- Be touched only with, and within the limits of, your consent.

- Speak or remain silent, about any topic and at any time, as you wish.

- Choose to accept or decline feedback, suggestions, or interpretations.

- Ask for help in healing, without having to accept help with everything.

- Challenge any crossing of your boundaries.

- Take action to stop a trespass that does not cease when challenged.

For the Integrity of Your Personal Communication You Have the Right to . . .

- Ask for explanation of communications you do not understand.

- Express a contrary view when you do understand and you disagree.

- Acknowledge your feelings, without having to justify them.

- Ask for changes when your needs are not being met.

- Speak of your experience, without apology for your uncertainties.

- Resolve doubt without deferring to the views or wishes of anyone.

For Safety in Your Personal Dependency in Therapy You Have the Right to . . .

- Hire a therapist or counselor as coach, not boss, of your recovery.

- Receive expert and faithful assistance in healing from your therapist.

- Know that your therapist will never have any other relationship with you— business, social, or sexual.

- Be secure against any disclosure by your therapist, except with your consent or under court order.

- Hold your therapist's undivided loyalty in relation to all abusers.

- Obtain informative answers to questions about your condition, your therapist's qualifications, and any proposed treatment.

- Have your safety given priority by your therapist, to the point of readiness to use all lawful means to neutralize an imminent threat to your life or that of someone else.

- Receive a commitment from your therapist that is not conditional on your "good behavior" (habitual crime and endangerment excepted).

- Make clear and reliable agreements about the times of sessions and of your therapist's availability.

- Telephone your therapist between scheduled sessions, in urgent need, and receive a return call within a reasonable time.

- Be taught skills that lessen the risk of re-traumatization: <blockquote>* containment (boundaries for recovery work);
* control of attention and mental imagery;
* systematic relaxation.</blockquote>- Enjoy reasonable physical comfort during sessions.

Source: Recovery Bill of Rights

See also: Choosing a Therapist to Work With



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Vietnam Veterans Guide on PTSD

PURPOSE

The purpose of this guide is to assist you, the veteran, or your survivor(s), in presenting your claim for benefits based on exposure to psychologically traumatic events during military service that has resulted in post-traumatic stress disorder (PTSD). It is always best to seek the assistance of an experienced veterans service representative when presenting a claim to the U.S. Department of Veterans Affairs (VA).

This guide describes the VA's current programs for providing disability compensation to veterans who suffer from PTSD, as well as for the survivors of such veterans. Under current VA regulations, you can be paid compensation for PTSD if you currently have a clear medical diagnosis of the disorder, evidence that a sufficiently traumatic event (called a “stressor”) occurred during active military service and medical evidence that the in-service stressor is causally related to your PTSD. Once the VA determines that your PTSD is service-connected, it will then decide how seriously your symptoms impair your social and industrial abilities (i.e., your capacity to start and maintain personal relationships and your ability to work).

This guide does not address treatment techniques, but does provide suggestions for obtaining the appropriate care. Additional resources are available to help you to better understand what other VA programs may be available to you.

Source: Vietnam Veterans of America: Guide on PTSD



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here is a link to a great site for mobility problems. it is a great site. hope it helps someone!

http://www.segs4vets.com/

www.ncptsd.org

Best,

Peter

Peter thank you so much for posting this. I will put it in the sticky section. great info there. again thanks

My pleasure, bebop.

I would like to add to this VA information. I am a Veteran (USAF Jan.1974-78), and I have looked into many of the residential programs that are offered for PTSD by the Veteran's Administration. There is a program for Female and Male Military PTSD in Menlo Park, CA, Cincinnati, OH, and a few others. These are NOT co-ed programs usually. It is difficult to find out about these programs (why??? I don't know) and I will comeback and give the information. It is very late and I just saw this. THERE IS HELP AND HOPE IN THE VA believe it or not, but many times you have to find out from vets who are going or have gone...again, WHY???

Please include in resources Iraq and Afghanistan Veterans of America

I am unable to post a link just now, but you can search for their name and then click the "get help now" link on the homepage.

Iraq and Afghanistan Veterans of America is doing some incredible work for veterans with PTSD. They now have case workers on staff and train everybody in their office in how to handle calls from veterans. They can help connect you with the help you need, when you need it.

This is a community by veterans, for veterans.

Thank you, Spiritual_Emergency. Originally, I joined PsychCentral for my own benefit, because I do have mental health diagnoses that I struggle with. Today, however, I am here to learn more about combat PTSD for my boyfriend. Reading the above post, I cried. All of this stuff that he does that I think is just him being a "jerk" or "insensitive" is actually because of that... You seem knowledgeable, and I'd love to talk to you sometime. Thank you so, so much for that post!