PTSD Unplugged: How to Leave the War Behind Us

By Pamela Hall, PhD LP QME

PTSD Unplugged is a guidebook for combat survivors and their families that will help us all leave the war behind. It is written by a forensic psychologist who has seen too much undiagnosed, misdiagnosed, or under-treated PTSD and too many people stuck in a loop of blame, shame, and avoidance. PTSD basics in less than 100 pages, including planning for recovery. Unquestionably, those of us who deploy to war have been directly affected by the battlefield. Many have lost buddies in combat, or to suicide after the war. Some returned injured. They want and deserve recovery. Those of us who didn’t deploy have worried about those who did. Some of our loved ones never returned. Many of us welcomed back loved ones who returned injured or changed. We must all take ownership of the substantial effort required to recover from war. Most of us are opposed to war. We must not also be opposed to, nor neglectful of, those who fought in the war. Combat-related PTSD is part of our communities now, as it always has been.
1: Cyndi describes her relationship with her grandfather, Dot, a World War II veteran who suffered from undiagnosed post-traumatic stress symptoms. Here is one family’s experience of the disruption that combat exposure can cause. Their story is too common.
2: PTSD symptoms develop when a violent event leaves a trauma memory, causing changes in the brain and psyche. Other stressors do not form a trauma memory and are not associated with a diagnosis of PTSD. Those who have experienced war, have been sexually assaulted, or have worked as first responders are most likely to have suffered a trauma event that could lead to PTSD.
3: War is uniquely traumatic, with 18-35% of combat veterans experiencing PTSD symptoms at some point in their lives. From battlefield scenarios to life back home, this chapter focuses on the reality of those living with mild to moderate or severe and complex PTSD. Stereotypes are debunked. The VA Benefits Examination, the first step in seeking treatment back home, is also discussed.
4: The symptoms and behavior that define PTSD are focused on survival and self-protection. They serve to maintain safety and prevent further violence exposure. This chapter explores what it’s like to live with post-traumatic stress. Trauma memory and its impact doesn’t care if we’re strong, brave, stoic, smart, experienced, or lucky. This can happen to any one of us.
5: Chronic pain from injuries sustained in battle, traumatic brain injury, adverse childhood experiences, substance misuse, and other mental health conditions will worsen PTSD. When they become the focus, trauma recovery is put on hold or neglected.
6: PTSD is not treatment-resistant. The target is to learn to control the trauma memory, remove it from the present and place it in the past. To be an informed consumer, it is important to be aware of what is effective to reduce or eliminate symptoms.
7: CPT, PE, and EMDR have received the most support in PTSD recovery research. CBT, CT, group therapy, and medication focus on relief from frustrating trauma-related symptoms. Innovative approaches continue to be explored by individuals and the research community.
8: Our loved ones had a battle buddy downrange, who watched them and defended them from unnecessary harm. They need and deserve a buddy back home who does the same thing. Cyndi did this for Dot. Being nonjudgmental is the key.
9: Disconnection between veterans and their home communities contributes to negative stereotypes about PTSD. Veterans protect us from war by not talking about the war. We don’t want to upset our veterans. Talking about war is mostly avoided. We can break through this impasse through practical, targeted conversations.
10: You can become an expert in your own recovery and growth after violence exposure by taking these steps: finding an experienced professional; learning about medication resources; re-establishing safety; and reconnecting with others. We a

• Language: English
• Publisher: Pamela Hall, PhD LP QME
• Release date: May 31, 2021
• ISBN: 9780578916361

Pamela Hall, PhD LP QME

Ever since Dr. Pam started her career in psychotherapy over thirty years ago, she’s born witness to the patterns of PTSD. It’s pain, shame, blame, avoidance. She’s facilitated and witnessed recovery. She knows there are solutions. Recovering from PTSD is hard. Living with PTSD is harder.Dr. Pamela Hall is a Forensic and Clinical psychologist and a subject matter expert in Post Traumatic Stress Disorder. She's spoken with thousands of veterans. And although their stories are all unique, PTSD is not. It doesn't care how stoic, brave, smart, quick, commanding, or strong you are. It doesn't care what came before or what the violent exposure was, where or how many times. Any violent event can cause a trauma memory, and that trauma memory will not loosen its hold until it is mastered. Not an easy task.That's why she and her colleagues wrote PTSD Unplugged. So those who are trauma-affected can become trauma-informed consumers of recovery resources.One of a small number of women to complete graduate certificates at the St. John’s University Postdoctoral Forensic Psychology program, Dr. Pam is also a Qualified Medical Examiner, bringing her unique expertise to worker’s compensation examinations in psychology. Trained in providing treatment and therapies for trauma-related injuries including Post Traumatic Stress Disorder and Traumatic Brain Injuries, Dr. Pam has worked for and with hundreds of clients over the years. She has examined thousands of veterans and service members for VA benefits examinations. And experience with the affects of violence? She has managed domestic violence offender programs and worked with with sexual assault survivors. She has been a requested speaker for lunch and learn events as an employee assistance provider for many years.Smart, compassionate, and a deep listener, Dr. Pam continues working today to empower those living with PTSD. To learn more check out our Facebook pages PTSD Unplugged, Project PTSD Connect, and Dr. Pamela Hall, or her website at www. laforensicpsychologist.com

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Copyright 2021 Pamela Hall

Published by Pamela Hall at Smashwords

with

Cyndi Mathews, First Chapter

Lynne Bertram, Creative Editor

Smashwords Edition License Notes

This ebook is licensed for your personal enjoyment only. This ebook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each recipient. If you’re reading this book and did not purchase it, or it was not purchased for your enjoyment only, then please return to Smashwords.com or your favorite retailer and purchase your own copy. Thank you for respecting the hard work of this author.

Cover Graphics: Alex Henderson

Your past does not need to be your future…

Table of Contents

Prologue

Dedication

Acknowledgments

Chapter One: Bringing the War Home

Chapter Two: PTSD: What it Is and What it Isn’t

Psychological Trauma Defined

What Causes PTSD and What Doesn’t

PTSD Diagnostic Criterion A - Traumatic Stress Exposure

PTSD: Not Just a Label

Chapter Three: The Special Case of War

Traumatic Responses to 9/11

Combat-Related Traumatic Stress Events

Snapshots of Post Combat Distress

Mild to Moderate Post Traumatic Stress

Complex and Severe Post Combat Distress

Not All PTSD is Severe

Getting Diagnosed: the VA Benefits Examination

Chapter Four: Making Sense of PTSD Symptoms

Injured - Not Weak, Not Crazy

Criterion B - Re-experiencing Symptoms

Criterion C - Avoidance

Criterion D - Negative Mindset

Criterion E - Hyperarousal Symptoms

Criterion F, G, H - The Chronicity of Post Trauma Symptoms

Chapter Five: PTSD is Real; Some Things Make It Worse

My Thirty Years of Learning to Recognize and Treat PTSD

Post Traumatic Distress is Visible to All of Us

PTSD in the Military since 2001

What Makes PTSD Worse?

Substance Abuse

Chronic Pain from Battle Injuries

Traumatic Brain Injury

Adverse Childhood Experiences and Concurrent Mental Health Conditions

Inadequate Treatment

PTSDunplugged

Chapter Six: Mastering the Memories

PTSD as a Treatment-Resistant Condition

Disproving the Resistance

Establishing an Effective Approach

Pacing Psychotherapy to Unravel Memories of Violence

Chapter Seven: Evidence-Based Psychotherapy Techniques

Finding an Expert in PTSD Recovery and Growth

Cognitive Processing Therapy (CPT)

Prolonged Exposure Therapy (PE)

Eye Movement Desensitization and Reprocessing (EMDR)

Cognitive Behavioral Therapy (CBT)

Cognitive Therapy (CT)

Medication for Symptom Relief

Self-Medication

Group Psychotherapy - Benefits and Limitations

VA Mental Health Services

Special Issues for Severe PTSD

Residential Treatment for PTSD

How Psychiatric Hospitals can Help

Innovative Treatment Approaches and Future Research

Chapter Eight: Bridging the Gap between Us

The Gap Between the War and Home

Encountering the Disconnection at Home

Get a Job

Employers as Allies

Vet Centers and other Veteran Service Organizations (VSO)

Chapter Nine: Reconnecting with Conversations

Building the Bridge

Memory Formation in Personal and Shared, Non-traumatic Life Experiences

Find a buddy back home

Establishing Safety

Self-management Techniques for Symptom Relief

Establishing Effective Life Management Skills

A Guide to Discussing Trauma Memories

Chapter Ten: Planning to Recover

Getting Started

Is it PTSD?

Be Your Own Expert

Helping Yourself

Finding a Professional

The Value of Medication

Getting Away from it All

Reconnecting with a Community

Getting the Word Out

Addendum

Perspectives from the Civil War to the Eve of World War I

Civil War Veterans - Soldier’s Heart

Exposure to Railway and Industrial Accidents - Railway spine

Exposure to Childhood Trauma and Abuse - Hysteria

Perspectives from World War I to World War II

PTSD Packaged for the Public

Let There Be Light - The Lost Documentary about Post Combat Distress

Post Traumatic Stress in the Movies

Perspectives from World War II to Vietnam

Post Traumatic Stress Disorder (PTSD)

About the Author

Prologue

I have been working closely with people experiencing post-traumatic stress since 1981, as a clinical psychologist and, more recently, as a forensic psychologist. By the 1990s, it was becoming generally accepted that violent events can have a profoundly adverse effect on the survivor, regardless of their emotional or psychological resilience. This was a substantial shift in understanding that there is a direct effect of violence on the brain and psyche in some survivors that made them vulnerable to anxiety and depression following violence exposure.

Previously, medical providers, military leadership, corporate liability managers, and the general public, either openly or quietly, held the opinion that a person who was altered substantially by a violent event most likely already had a personal or psychological defect. They were weak or cowardly. Many service members who complained of prolonged emotional distress following combat exposure were perceived as taking benefits from those more deserving. Civilians affected by traumatic events were believed to be complaining only to obtain compensation from corporations.

Self-protective reactions (flight, fight, freeze) occur naturally as violence is happening. A mental health condition can occur when these reactions, and the memory of the trauma, don’t go away. Known as Post Traumatic Stress Disorder (PTSD), this condition has been negatively stigmatized by out-of-date, inaccurate stereotypes. neuropsychological research, which studies how the nervous system affects behavior, now supports that PTSD happens at least 20% of the time when people are confronted by violent, life-threatening situations. Anyone, regardless of personal strengths or weaknesses, can be psychologically injured in this way. There are evidence-based practices that are effective in reducing the severity of this injury. Some violence-affected individuals have reported full recovery. I reject the stigma that you cannot recover from PTSD.

I also reject the claims that combat veterans make up or exaggerate post-combat distress for personal gain. I do not believe that it is possible to pretend to have PTSD. Such deception would be quickly exposed when they are examined by a professional, who is an expert in trauma-related diagnoses and treatment. Veterans and their friends and families can trust what they see with their own eyes, and experience in their own skin. It is not possible to pretend to have this pattern of self-protective behaviors over the long haul.

Just as looking at a map is a limited picture of a place, so also is a diagnosis a limited picture of a person’s life. The PTSD diagnosis has been field-tested for 40 years and continues to provide an adequate anchor for assessment and treatment planning. I don’t think this diagnosis, or any other diagnosis suggested since the Civil War, can capture the pervasive impact of violence exposure on well-being. Where once a person lived as though life was basically peaceful and safe, post-trauma symptoms are an indicator that life has come to be experienced as threatening or dangerous. So, the diagnosis, while helpful, is merely shorthand. PTSD is more profound than a mental health problem. Survivors are both negatively affected and resilient.

It is also not true that exposure to violence makes a person prone to acting violently. A person with post-trauma symptoms is prone to see the world as dangerous, rather than becoming dangerous themselves. This negative stereotype came out of the observable agitation and angry outbursts that occur because the violence-affected person is either defensive and self-protective, or is weary and fatigued by sleepless nights and chronic fight or flight impulses. While there have been instances in which significantly violent trauma from the past has obscured judgment in the present, resulting in violent acts, this is an uncommonly severe symptom.

My experiences as a treating psychotherapist since 1981 and as a forensic examiner since 2008 do not fit with these negative stereotypes. False information like this has powerfully constrained prior generations of combat and other violence-affected veterans from speaking about what they have survived, and then recovering and growing from it. Before yet another one of you endures decades of nightmares, sleep disturbance, and the chronic fight, flight, or freeze of survivalist reactivity, you need to know what we know now about PTSD. Become informed about what you can do to find your way out of the trauma memory that haunts you.

It is hard to recover from PTSD, but living with PTSD is harder.

Pamela J. Hall, Ph.D.

[e-mail]

Dedication

To my nephew who came home from the sandbox

To my cousin who came home from Vietnam

To my dad who came home from Korea, RIP

To my father-in-law who came home from Europe, RIP

To Captain Chet Graham who came home from Normandy, RIP

Acknowledgments

To my Mom, Rosemary. I was 27 years old and asked her if it was worth getting a doctorate since I would be 35 years old when I finished. She immediately responded, You’re going to be 35 anyway. Always my greatest support.

To my Dad, Larry. He would get on the phone, tell me his woes, and ask me, the psychologist, for the $9.99 special. My script was to tell him to get over it. He showed me that anyone can become their better self with a little kindness and a lot of humor.

To my creative editor, Lynne Bertram. She eliminated my pomposity, verbosity, and chronic repetitions. During COVID, she courageously reduced the manuscript by fifty pages. You would have to wade through a lot of extra words without her substantial effort.

To my contributing writer, Cyndi Mathews. Her life with her grandfather, Captain Chet Graham, is an example for all families who want to live connected with their loved ones after they return from war. I honor her choices as Dot’s granddaughter.

To all the veterans who have come through my office in the past twelve years. You and all who came before you and followed after you. This book is for you. I hope you know how much we have worked to understand what PTSD is, what it isn’t, and how you can leave the war behind you.

Chapter One: Bringing the War Home

by Cynthia Mathews

I miss my grandfather, Dot, every day. As a toddler, my attempts to say, Chet, sounded more like Dot. The name stuck. Maybe that was the start of the special relationship we shared.

Captain Chester E. (Chet) Graham was a paratrooper with the U.S. Army’s 82nd Airborne Division. A D-Day veteran, he dropped from the dawn skies into Normandy in France on June 6, 1944, D-Day. The D stands for Day, and the term is used by the military to signify the start of an important campaign. D-Day was the biggest assault the world ever mustered. My grandfather was a Jump Commander on one of the last planes in the squad that, in the early morning hours, crossed the English Channel and headed into ferocious battle. He was one of the 20,000 Allied airborne soldiers called into action.

By the time I joined the family, two decades had passed since his deployments. In those twenty years, his behavior and his wartime friendships and memories had pretty much alienated the rest of our family. He was aware of this and it did not seem to concern him. But, it wasn’t like that for me. I was the first grandchild. I lived with him, listened to him, traveled with him, and was the only family member who spent time with him in his Normandy shrine in the basement.

Dot spent hours in the basement of his home in affluent Piedmont, California; his windowless, basement office with its bare, cement floor. The walls were lined with mementos from his numerous return visits to France — photographs, maps, magazine covers, paintings, poems, cartoons, letters, and handmade gifts from the eternally grateful people of Normandy. In that dark office, he could revel, unfettered, in the ‘best time of his life,’ which was making that jump into the Normandy countryside as an Airborne officer, serving in World War II.

He sat down there and reminisced about the battles, the decisions, and the soldiers who fought alongside him, while safe in his own post-combat world. While he was down there, if she needed something, his wife, my grandmother, Nancy, would yell at him from the top of the stairs. But really, except for alerting him for dinner, my grandmother seemed relieved when he was out of her way. She cultivated her own life and her own friends.

Even as a child, I could sense their separateness. They slept in the same bed, but I never saw their closeness. On the nights I spent there, I would hear him wandering the house. I could hear his footfalls on the stairs as he headed down to his office. I don’t believe he ever enjoyed a solid night’s sleep after the war. He’d listen to KCBS traffic and weather for hours. His was the first flesh-colored headphone I had ever seen. It stuck out of the little AUX port of his bedside AM radio.