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Barriers to Getting Home..."All The Way Home"

By Dr Mike Colson

No. 1 Barrier - New age babble and pop psychology: I have spent 22 plus years attempting to provide useful human services to military, combat, and other veterans who find themselves traumatized by the circumstances of their work. Without a doubt the biggest barrier to making the post-trauma transition to good health is poor information. It seems that every person we meet knows more about the problem than the sufferer. In a society where it is tempting to reduce complicated subjects to slogans that fit on bumper stickers (e.g. “Save the Whale”, “Make Love not War”, or “Visualize Whirled Peas”), important information gets left out. For instance, in psycho babble, PTSD sufferers are often referred to as weak, crippled, or somehow unable to cope. You can see how this would be a barrier to getting some assistance?

We do not need to be pitied by the well-meaning or treated like damaged goods. Rather, we need to do everything we can to get the facts about the chemical changes that trauma wreaks on the body, how those changes affect biological processes, and how best to address these physical concerns early with good results.
Solution to well-meaning psycho babble: Get advice from competent medical resources that have experience in treatment and care of the kind of trauma experienced.

No. 2 Barrier – Fear: Men are sensitive about sharing anything from their personal lives, but women are quickly closing the “secrets gap” especially when it comes to harassment, assault, or other sex-based trauma. In my experience stigma and breaches in confidentiality create fear and prevents or delays a trauma sufferer seeking resources for support. Some career types – like police and firemen, security, senior managers, government or other public/community employees DO NOT want anything to interfere with the persona they project on and off the job.

Solution to fear: Find a professional health care provider who has a professional and legal mandate to keep any intervention or information private in accordance with recent HIPAA regulations. And, make sure your records are left in written format and NOT entered into an electronic data base.

No. 3 Barrier – No end in sight: When trauma sufferers begin the process of “stinking thinking” – caused by chemical changes, poor sleep, and even some self-medication (think BEER!) – it can be overwhelming and appear permanent. Of course, it is not and will get better when sufferers take that first step to find helping resources and begin getting up everyday thereafter knowing that life has to and will get better.

Solution to the “No End in Sight” feeling: Call and make an appointment and commit yourself to making your own personal health and well-being a priority.

No. 4 Barrier – Lack of Self-care Priority: Trauma sufferers often puts their own needs behind other people and circumstances they feel responsible for. The New England Journal of Medicine’s recent report on PTSD sufferer’s from Iraq and Afghanistan mark those with the HIGHEST incidence of trauma to be the LEAST likely to seek help. Since January 2005 I have debriefed over 10,000 National Guard and Reserve “War on Terrorism” veterans and this rule holds true across the board. As each goes through the demobilization process, they have a mental list of priorities to complete as they transition home. And, few put themselves and their own personal needs on that list. Why? Many people who get traumatized are in jobs that create trauma – almost like being a sufferer is a self-fulfilling prophecy. As true as that might be, everyone has to care for personal needs. I’ll prove it. Do we share mouthwash, toothpaste, a favorite hat or jacket, or more than a small taste from the 3-taco special meal deal? NO!

Solution to poor self-care: I often use the example of flying on commercial aircraft: “In the unlikely event of cabin depressurization the oxygen masks will drop from the console above and you should quickly place one on all the faces of all the people around you…so they can watch you suffocate.” You’ll say, “Dr. Mike, that is preposterous.” I agree and offer that making self-care a priority, while not often a matter of life and death, is a major factor in living a balanced and fulfilling life.

No. 5 Barrier - Thinking we are crazy or something? Are we crazy? Well, it sure does seem like we are at times. Our blood pressure seems to rise and lower at will, we react to things that in retrospect are very small, we shake, often sleep poorly, develop some poor habits with hygiene, communication, and relationships, and we sometimes drink more than we ought to. So, you wouldn’t blame anyone for thinking that “crazy is as crazy does”. But the point we have to hard wire into our thinking is that the body will react normally to abnormal circumstances. Let me clarify this as best I can. Women and men who serve this country are America’s highest quality youth. To be inducted into military service we undergo health, psych, academic and educational, social, and community examinations. This not only establishes our ability to serve, but also verifies that we are normal – above normal in most cases. But a veteran of war, combat, deployment, and extreme conditions can often be put in some abnormal circumstances. Can anyone really say Iraq, Afghanistan, GWOT operations worldwide and deployments at sea and elsewhere are normal? So, when confronted with these abnormalities – whether they happen to you, others, while you are there, etc – the body will adjust itself (a normal process) in the face of those abnormal experiences. So, on the crazy question…are we? The answer is no. Out bodies are doing what normal bodies do everyday day…but those normal body reactions like those mentioned earlier can and will change you if left examined and untreated. I think we’re crazy when we think the symptoms will all go away by themselves. Vietnam-era veterans taught us that this IS NOT the case.

Solution to crazy: Recognize that feeling like we are turning inside out is normal…and even expected! Accept that these changes are part of the readjustment process and seek out support to understand what your options to make it all go away.

No. 6 Barrier - Failure to sleep well: Everyone needs sound and restful sleep. A major by product of war and deployment for many is a type of sleep that is best described as disorded. In point of fact it more like slumber than sleep. Slumber is not a deep sleep, is not particularly restful, and it does not have all the normal bits and pieces associated with rest. Many veterans drink or medicate themselves to get to sleep, finding that this approach can help in the short term. The problem with sleep – or the lack thereof – is that it is accumulative and can create sever physical – and behavioral – reactions when you constantly get up tired…and angry!

Solution to the Post-War Sleep problem: Find out if you have disordered sleep, pursue getting a referral for a sleep test that might help diagnose a common medical ailment called (sleep apnea) (www.sleepapnea.org). This ailment and other factors associated with symptomatic PTSD and readjustment need to be addressed as a top priority for returning veterans – before it creates long-lasting physical concerns. See your doctor immediately.

Barrier No. 7 – Family: When we return to families and loved ones attempting to fit back into the groove of our former lives, not worrying or scaring anyone about how and what we feel, and even the families needs we find upon return can redirect our energies away from taking care of ourselves. The problem with moving on to other peoples needs – vce our own – limits our access to help and resources – and – can signifucantly reduce our post-wat and deployment life expectancy. A recent New England Journal of Medicine survey found that PTSD sufferes, left untreated, can have their post-military life expectancy reduced by some 50 percent. While family is a priority, it makes sense that you being there for your family is very very important.

Solution to Family – Explain to them what is going one, what steps you are taking to make the readjustment home, find ways they can help you, and bring them on board as your “readjustment assistants.” Family and loved ones are a great source of support, and while they cannot be your medical or readjustment professional, they can help you craft solutions to readjustment on a day-to-day basis.