Combat Veterans and Fireworks

33-1196545384The neighborhood where I live has its own Facebook page where people post announcements and searches for lost cats. Last year, about this time, a post appeared from a neighbor who said he was an Iraq War veteran. Fireworks triggered his PTSD, he said, so could we please refrain from shooting them off?

By the time I saw this request, many had already commented, saying thank you for your service and, no, of course they wouldn’t shoot off fireworks if it bothered him so much. I wasn’t planning on shooting off fireworks anyway, so I had no problem complying with his request, but I did want to write into the comment section and ask if he had competent mental health care. I was concerned he didn’t. Continue reading

How to Re-Traumatize Yourself

First, a bad thing happens. Rape, murder, combat, abuse. You don’t have a lot of control over it. That’s the point. Something happens way, way out of your control. You barely make it. Now you’re left with the memories. That’s the trauma.

Second, the memories come up. You don’t have a lot of control over them, either. They come up when you come across something you associate with the trauma. A plastic bag on the highway that looks as if it may be an IED. A dark alley like where you witnessed the murder. A program on TV too similar to the incident. I knew someone who had a hard time every Saturday throughout her adulthood because, when she was a kid, her step-father would creep into her room Saturday nights. You find yourself caught up in the memory and start feeling as though it was happening all over again. It’s like a trance you are in, a spell you are under.

You’ve learned to do things that’ll break the spell. You found a dramatic action will do it, the more outrageous, the better. It has to be extreme enough to compete and overpower that memory. You’ve got to drive fast, run hard, take a risk, get a good, stiff drink, or fuck the living daylights out of a stranger. You pick a fight, get some blow, or find a high, high place, hang your toes off, and flirt with death. Maybe, you don’t go quite that far. Maybe you just go over the incident, again and again. Maybe you feel everything you had been feeling. Maybe you reenlist and return to the war zone, find another abusive man, or return to the old one, one more time. Maybe you blame yourself for what was out of your control. Maybe you figure you deserved it.

Congratulations, you’ve just re-traumatized yourself.

It gets to be that the original trauma is nothing; it’s just the beginning. The bulk of the injury occurs over the years afterwards. If, for instance, you were raped while walking through your college campus, that, in itself, is an evil thing. But, if for years afterwards, every time it comes up in your mind, you feel terrible, then you are not only traumatized, but re-traumatized. If you can’t have sex with your husband because you feel the shame and the terror of that rape, then you are not only traumatized, but re-traumatized every time you try to have sex. If you cannot be reminded of it without getting blind drunk, driving recklessly, shoplifting, yelling at your kids or doing something regrettable, just to break the spell, you are not only traumatized, but re-traumatized. If you watch Law and Order – SVU, go to the scene of the crime, confront the rapist, sleep with a hundred men just to get over it, but feel that terror all over again, you are not only traumatized, but re-traumatized. It gets to be that the original trauma is just a small part of the pain you feel.

If you go to a therapist to get treatment for PTSD and tell the story, only to fall again into that pit of terror, you are not only traumatized, but re-traumatized.

It seems as if you can never get past it. It seems that every effort to straighten out the mess only ensnares you more thoroughly. It seems as though people are right when they try to deny it ever happened and avoid anything associated with it.

However, you can get past it. PTSD is one of the most readily treatable conditions there are. Plenty of people get past it. ONE – STEP – AT – A – TIME.

The first step is not to tell your story. Don’t go into your therapist’s office and get into the whole thing all at once without first considering what will happen when you are done. Oh, you have to say a little bit about it, just so your therapist knows the issue is there, but don’t go into detail. Talk first about what happens when the issue comes up; how have you coped with it so far.

For example, many traumatized people will turn to alcohol and drugs as a way to cope with their trauma. But, if you’re going to need a stiff drink or to shoot up after leaving your therapist’s office, then nothing will be gained. You will only have succeeded in re-traumatizing yourself by adding one more drink you don’t need, one more relapse to the series of problems associated with this trauma.

Therefore, the first step is to take a look at the ways you have been re-traumatized, not traumatized, and get control over that. Let’s be sure what your reaction will be to dealing with the trauma before we try to deal with it.

The second step is to tell your story, but maybe no second step will be necessary. It may never be essential that you go over the original injury. It’s not like you’re going to change what happened, anyway; and it’s not like you were responsible. What you want to change is how you respond to the triggers. That’s something you can change. In the case of the woman raped on her college campus, she probably wants to be able to watch Law and Order without freaking out. She wants to be able to have sex with her husband, be free of nightmares, visit her old college, and see her daughter off to college. She doesn’t want to have the need for all those crazy, dangerous, unhealthy behaviors that she used to turn to in order to break the spell. Really, all the important stuff is in step one. It’s essential to end the re-traumatization.

By the time you get to step two, you may want to tell your story, anyway; if only because now you can. You are no longer silenced. You can speak out, testify, warn others, and join with those who’ve had the same experience. You no longer have to be alone with the secret because there is no longer the risk of re-traumatization.

If you take step two and tell your story, then tell it in a place, at a time, and with a person who can contain it. You’ll want to be able to leave the room in better shape than when you walked in. You let some feelings out as you tell the story; you may not be able to contain them within you, but we want to keep them contained in the room.

When you are done telling the story, the story is told. You, at last, may have been able to fit the pieces together in a way you haven’t been able to fit them before. You couldn’t complete the story because you were getting re-traumatized. The hurt would start all over again, so you had to drop it. This left it unfinished and scattered in pieces all over. When you end the re-traumatization, it becomes a story and not just fragments, jagged pieces of memory that poke you all over.

Step three? Step three is up to you. Step three is living your life as you want to live it. Something awful still happened. You still have a memory, but it doesn’t matter as much. You no longer are getting re-traumatized, you no longer have to bear a secret, unless you chose to, and the story is complete. You’ve reached the end of trauma.

When Madness Takes Cover

So, you’ve stopped drinking, or drugging, or gambling, or sleeping around. Your depression seems to have lifted. You haven’t been violent. Your anxiety no longer makes all the decisions. You’re up in the morning and dressed when you need to be. The madness seems to have gone away.

Has it, really?

Madness takes cover sometimes when it feels threatened. It’ll hide in the bushes and come roaring out when you least suspect it. Make no mistake, madness is cunning, baffling, and very, very patient. While you’ve been collecting key rings at your NA meeting, the madness has been doing pushups in the dark.

Madness prefers the dark. It likes to perform its dirty deeds in secret. The night belongs to Michelob. However, madness is rarely ever a real secret. It’s kidding you when you believe it leaves no trace. You can tell when madness is still afoot if you are willing to read the signs.

These are the signs:

You haven’t done the things promised for your recovery

If the problem behavior is gone, but you still haven’t been to see a therapist, attended meetings, written that letter of apology, changed associates, or done any of the things you promised, then the madness is just hoping you won’t notice.

The behavioral changes have been minor

The more serious the madness has been, the more excited you’ll be when there’s been a slight improvement.

You were drinking every day, now you’re thrilled that you cut down to once a week. You used to gamble away all of your paycheck, now you only buy a few scratch-offs. You used to beat your wife, now you only puts holes in the wall. The underlying attitudes towards drinking, gambling, or violence have not changed; the only thing changed is the frequency and severity.

When gardeners trim bushes back a little, they call it pruning; it doesn’t destroy the bush, it makes it grow more. The same thing happens when only minor changes are accomplished. You wouldn’t be satisfied with your surgeon if you had a mastectomy and he left some cancer behind, so don’t fool yourself by minor behavioral changes.

Other problems have arisen

Sometimes the illness plays whack-a-mole by extinguishing one problem behavior, only to transfer it to another. We see this frequently with addicts who will use one drug until the heat is on, and then switch to a different drug. Instead of scoring heroin on the street and using dirty needles, they get their narcotics from a doctor. You’ll think that’s an improvement, until you start to abuse those pills, too. The underlying issue remains.

Thinking has not changed

If the rationalizations that have justified the madness are still in evidence, then the madness has not gone away. You used to say you needed to drink, so you drank. Now, you don’t drink, but you still say you need to. Guess what? You’ll drink again. If the madness was truly gone, you’d no longer believe you needed it.

No fence has been built

It is not enough just to change the problem behavior to eradicate an illness. You also have to know the route that it takes before it arrives. You need to put up a gate and shut out behavior that, in itself, is not problematic, but leads up to the problem.

Madness comes masquerading as something harmless so that you will not see it coming. Pedophiles start off by making friends with a child. There’s nothing wrong with making friends with a child, right? But, then they gradually groom the child to accept more and more sexual behavior. We protect children from pedophiles by not permitting them to live near schools. This is not because it is bad to live near a school, but it is bad for pedophiles to live near schools.

Authentic recovery means that you see through all the disguises.

History is minimized

If the story you tell about the illness differs significantly from your partner’s, then the madness is still lurking about. If you talk about your depression only in terms of your suffering and leave out how it affected others, then you’ve not incorporated other points of view into your own. Your limited perspective is still all you have. You have an incomplete appreciation of the costs of your choices. You should be able to tell your partner’s side of the story as well as your own.

You’re withdrawn

If your partner complains that you’re virtually unreachable, emotionally inaccessible, or sexually uninterested, then the madness may be in hiding. It doesn’t want people to ask too many questions, know too much, or get too close.

You’re always angry with your partner

You may be blaming other people for calling out the madness and challenging it. you may be using anger as a way to keep others away, off balance, and uninformed. You may still be taking sides with the madness, against your partner.

Your partner is working harder at recovery than you are

Your partner has been on you like white on rice. Ever since you had that affair, she’s been monitoring your phone, checking your whereabouts, scanning your emails, opening your letters. She met every single female acquaintance you have and gave them all the stink eye. She scrutinizes your expression when every waitress approaches. She tried every new position you wanted in an attempt to reawaken your sex life. She found a therapist for you, set up the appointment, went to every session, paid, and did the homework assignments. Your partner is working harder than you are.

If you have not taken responsibility for change, then you will not make the right choices the moment your partner’s back is turned.

You say everything is changed

You’re not the one to judge whether anything has changed. When your madness fools people, it fools you first.

You want to move on and not get stuck in the past

That’s the madness talking, trying to convince you to not learn from the past. Truly recovering people remind themselves of the past regularly, so that they’ll not repeat it.

You want credit for improvements

An adult straightens the house every day. He scrubs the toilets when they need it and mops the floor when it’s dirty. He doesn’t expect a medal for it. He just does it because it needs doing.

A toddler tickles the furniture with a feather duster once in a while and everyone will fall all over him, saying he was very helpful. That’s what they do for a child. Are you a child?

When madness takes over: the less you do, the more credit you think you deserve.

In a healthy world: you don’t earn special points for doing what you should have been doing all along.

It’s still all about you

Not only have you stopped the problematic behavior, but you’ve been going to therapy, attending AA, writing in your journal, and getting in touch with your feelings. These are all good things, but you’re still as self-involved as ever.

Real change means taking action towards becoming more loving, generous, caring, and empathetic towards others.

There are no signs

You looked over this list and you did not find a single thing that indicates madness may be lurking. There seem to be no signs. Well, that’s your sign. If you aren’t seeing signs, then you’re fooling yourself. There are always signs.

The road to recovery is the same road as the road to ruin; you’re just traveling in a different direction. You pass by the same markers as when you were heading to ruin. You should be seeing them now and recognizing them for what they are. You should also be seeing some signs that indicate you are heading in the right direction. You should be seeing meaningful change.

Cook the Negativity

You learn a lot quicker from negative experiences than you do from positive ones. The stick is more damaging than the carrot is enticing. There’s a good reason for that. If you get whacked hard enough by the stick, it won’t matter how many carrots you have. But, the result is that you will continuously look for bad news, zero in on the negativity, and lose sight of the big picture. You take for granted all the blessings you have, are ignorant of your resources, and blind to grace.

When people come in for counseling, they can often see all their problems very clearly. They can talk for hours about the terrible things that happened to them, the effect the problems have on them, and why they can’t change. They make the same mistakes over and over again and believe that, if only they could feel badly enough about themselves, they would do differently. They don’t. Heaping guilt upon themselves and reproaching others does nothing other than burden them with guilt and anger, it does nothing to free them.

When I see people in counseling, I’m always on the lookout for the exception to the problems presented to me. If you have problems with your anger, I want to know as much about the times you did not have an outburst as the times you did. If you are addicted, I want to know about the times you found another way to cope. If you’re in for marriage counseling, I want to know when you get along. This is not just because I like to look on the sunny side of things, or whistle in the dark, or don’t take your concerns seriously. I do this because I like to cook.

If you’re going to change and live a more hope-filled life, you will have to learn to cook, too. It’s easy, just follow the steps. First:

Gather Kindling
To cook, you need a fire. To start your fire, you’re going to need kindling. Find some dry leaves, some twigs, a little bark. You don’t need a big, honking piece of wood to get your fire started, as a matter of fact, it’s better if you don’t try to ignite one directly. All you need is a small exception, a minor victory, something you might not notice.

Notice the exceptions to the behavior you want to change. If you are usually depressed, notice the few times you manage to smile. If you’re anxious, find when you are brave. Don’t let these instances pass unnoticed. They’ll all get your fire started.

Ignite the Kindling
The next step is to ignite the fire. You do this by calling your own attention to the exceptional occurrence. Focus on it a little bit. If you are depressed, be more mindful of that smile. If you are anxious, don’t let your bravery fade into the background.

Add Fuel
Now add fuel to the fire. Sustain the positive experience a few seconds longer. Cherish it in your mind. Let the experience be as intense as possible. Make it a multimedia experience. If you’ve smiled, then laugh. If you’ve stood up for yourself, then actually stand up, put out your chest, and strengthen your spine. Look for what is new in this experience. Does a feeling of relief follow closely behind? Are you relaxed? Is your heart beating slower? Let the experience, no matter how minor it might be, matter. Call it the first step, a new beginning.

Feel the Warmth
Next, put out your hands and feel the warmth of the fire you built. Absorb the experience. Let it sink in. This will prime and sensitize your neural networks. It will create an actual change in the brain. The pathways of delight will be easier to find. The road to responsibility will be clearly mapped.

There, you’ve built the fire and are enjoying it. It’s already making a change in your life. It’s warming you up, giving you cheer, signaling help, frightening the wild animals away. You could stop there and it would be complete; but you don’t have to stop. You can use your fire to cook.

Cook
When you cook something, you are generally taking something that is really not very good; something unpalatable, tasteless, and indigestible, and turning it into something that sustains life and tastes great. It’s magical, if you think about it.

So, you have some negativity in your life; a disappointment, a betrayal, a despair. Take it and apply it to the fire you built. Hold both the positive and the negative together in your mind. The positive will begin to associate with the negative and, if you’ve built up your fire enough, will begin to overwhelm the negative. The positive will start to sooth, reduce, and replace the negativity.

Here’s an example. I knew a guy who was abused as a child and developed this belief that he was unlovable. He could come up with a million examples of how he was incapable of being loved, but he could only come up with one example of how he was loved. He had a son who looked up to him and wanted him to be around. That was enough.

It wasn’t enough at first, because he dismissed the love he felt from his son as childish, but, when he built a fire from it, and permitted himself to have a positive experience, enrich it, absorb it, and link it to the negativity, then he was able to heal.

Would you look at that! It’s an acronym:

Have a positive experience
Enrich it
Absorb it
Link the positive experience to the negative memories

It spells HEAL.

When he put the positive experience of being loved by his son together with the negative experience of being abused, he did heal. Being loved once changed everything. The abuse of the past took on a new meaning, one that deepened and strengthened the love of the present.

What is Madness?

Someone asked why the name of this blog is Madness 101. Shouldn’t I call it Mental Illness 101? Isn’t mental illness the proper, politically correct term?

It is, but it’s not really mental illness that I’m writing about. I’m writing about the related subject of madness.

Illness is something that happens to you beyond your control. Some diseases are inherited, like Huntington’s; others are transmitted, like Ebola. Mental illness is thought to involve a multi-factor genesis called the Diathesis-Stress Hypothesis. (I love saying that. Try it yourself. Once you learn how to say it, you’ll love it, too. Diathesis-Stress Hypothesis.)

The Diathesis-Stress Hypothesis states that people are born with a genetic predisposition which is then activated by stress. You may have schizophrenia written into your genetic code, for instance, but it is not until you encounter the peculiar stress of adolescence or early adulthood that the symptoms of schizophrenia emerge. You may tend towards depression, on one hand, or anxiety, on the other. Most of the time you are fine, but when that decisive straw lands on your camel’s back, the camel falls one way or the other.

Other conditions are normal reactions to abnormal experiences. Almost anyone who smokes enough tobacco will become addicted to it. Addiction is the result of ordinary physiological processes whereby the body changes as a result of the substance ingested. All addictions are just as inevitable if you use the substance enough, although studies suggest that the path towards addiction may be speeded up or slowed, depending on genetics.

Post Traumatic Stress is another normal reaction to abnormal experience. It is true that not everyone who experiences a particular horrible event develops post traumatic stress over that event. However, we do believe that the accumulation of stressful events, or experiencing a single event in early childhood, when you are particularly vulnerable, will lead to the development of the condition.

The Diathesis-Stress Hypothesis is a powerful theory, but it leaves out one important factor: personal choice and responsibility. I’m not saying people choose to be schizophrenic; but the person with schizophrenia does choose whether or not to isolate himself, take his medication, and work with the people available to help him. The depressed person has a choice about whether to stay in bed all day or open the blinds to let the sun in. The anxious person can decide whether to avoid or face that which makes her anxious. The alcoholic chooses whether or not to drink.

When an alcoholic doesn’t drink, he is still an alcoholic, but he is not adding, through his own actions, to the condition. Similarly, the depressed, anxious, or psychotic person can do a lot towards addressing their conditions. They do not have to simply be passive victims.

I am aware that people with mental illness are subject to extreme social prejudice. I know that they often get blamed and blame themselves for things that are out of control. I work with them intimately on a daily basis. However, I am a counselor and it is my business to help people identify the ways that they contribute to the problems they face and the things they can do about them. It does them no good to tell them that they are the unlucky recipients of flawed genes or a chemical imbalance or have too much stress in their lives if they do not also address how they unnecessarily add to that stress.

Madness is my word for the things ill people do to make themselves more ill.

Having alcoholism is not madness, but drinking when you know you have alcoholism is madness.

Being depressed is not madness, but not getting up to start the day is madness.

Having anxieties is not madness. It’s very normal, and even may be desirable, to have anxieties; but, letting your fears control you is madness.

You are not responsible for having an illness, but when illness takes over your life and controls you and the people around you, that is madness.

In this series, I will describe the ways of madness and the things you can do about it.

The Shrink’s Links: Sam Baker

Bringing you the best of mental health every week.

cat on computer
This week’s shrink’s link is to a musician:

Sam Baker

Baker was in a train in Peru when a terrorist’s bomb blew it up. What followed was years of recovery. If you have experienced trauma  and don’t have the words to describe your pain, he might.