Our understanding of trauma and PTSD is continually evolving. In the past, some theories argued that PTSD was like an injury to the brain with identifiable damage to cortical structures. However, despite considerable research over the past 15 years, the evidence has not been convincing. In the past several years, the focus has shifted to the roles of emotional dysregulation and attachment relationships, especially when it comes to the differences between acute (lasting up to about 6 months) versus chronic PTSD (may continue for years or decades). In sum, what we do about the things we feel deeply can work for or against us. There are differences between those people with short-term PTSD who recover and those who remain chronically traumatized. These studies suggest that people who recover are able to work through and make sense of their feelings, use social supports, and remain connected to important relationships in the process. The people who avoid emotions and compartmentalize bad memories as if they never existed seem to remain stuck in a closed loop: strong emotional arousal → avoidance → intrusive memories/nightmares → further emotional arousal, and so on.
We know that blocking negative emotions (sadness, grief, shame) tends to amplify them – they get worse. Unfortunately, blocking positive emotions works in the opposite direction – they go down in intensity. Early developmental experiences seem to play a role in learning to block emotions but I think we have to consider the roles of training and military identity when it comes to the practice of downplaying and avoiding ‘soft’ emotions. To be clear, I am not suggesting that early life causes military PTSD. Unfortunately, some people learned the hard way that parents or friends could not be trusted so they had little choice but to keep their inner thoughts and feelings bottled up. When they are upset or distressed as adults, usually the last thing they want is support from other people because it can bring back the old betrayals and anger, and fears of being let down again. Instead, they tend to struggle to stay in self-sufficiency mode – including, the alphas and the lone wolves. This does not mean that they can’t get well; it just means they often have a tougher time admitting to vulnerability and lowering their guard.
Many veterans who had some pretty extreme backgrounds but risked trusting someone again and opened up their old secrets and inner emotions have become much better in the process. They can learn to understand and manage their inner emotional lives without things becoming a big ordeal or going out of control. It can be a tough challenge and scary for people who are not used to just being human. But, this can be the way forward for people who may think there is no hope of change.
I will be hosted by Chapters, Kenmount Road for book signing on August 1 from 1:00 - 3:00 pm. Looking forward to meeting people in St. John's which also happens to be home turf.
Please tell your friends and military buddies who may be in town on Saturday.
Yesterday, I was hosted by Chapters/Indigo in Halifax and later in Dartmouth for book signings. The events also gave me an opportunity to meet with many people; some vets and family members of serving and retired military/RCMP and even a clinician considering a position with our military mental health system. There were also guys who picked up the book, read some parts and simply walked away without a word. I knew they were military - we can pick each other out fairly quickly - but I respected their need for anonymity, whatever the reason. Maybe, they'll be back at some other time when nobody is around.
While it was re-assuring to hear people speak openly about their concerns for the mental health of military/RCMP, they do not know how to have this conversation with the person in thier lives. They don't want to upset them or 'trigger' them so their concerns and worry are never said out loud. It struck me that while we are focusing much needed education towards military and other first responders about mental distress signs and resources, often family members are left out. It is also important to include family members in these efforts and discussions. In terms of long-term success in resolving trauma reactions, healthy relationships and open communication within families are the main antidotes to the shame that often accompanies trauma reactions. My sincere thanks to everyone who stopped by for a chat.
A recent magazine article by Sharon Adams focussed on Veterans Affairs Canada and struggles among our military veterans. If there was ever a need for two federal departments to work hand-in-hand it would be CAF/DND and VAC. Astonishingly, at the bureaucratic level they seem to operate as if the other one does not even exist. With the recent appointment of two military veterans to the most senior positions at VAC, an attempt to change the culture is underway. There is reason to hope that these efforts can help bridge the institutional divide. But, historically injured veterans crossed this chasm alone to face the pension application claims and appeals processes for injures directly related to their military service. Many were caught in no man’s land. It is very difficult to understand how applicants can be treated as unknown entities walking in off the street when VAC has one clientele - military and RCMP veterans.
As many people know, the origins of VAC began after WWI and rose to departmental status following WWII to accommodate soldiers returning home. Among other things, it was given the responsibility of separating legitimate claimants from other soldiers who were faking injuries. Despite the passage of 70 years, this mandate remains enshrined within VAC philosophy as evidenced by the complex application and appeals processes that many veterans have complained about bitterly. In the meanwhile, the military’s health system is vastly different from the ‘battlefield medicine’ focus of the 1940s. Since the 1990s, hundreds of millions of dollars have been invested within the military, and personnel of every conceivable speciality are available to it for the administration of health. This is particularly true in determining physical and mental injuries that result in recommendations for medical release. Our military’s healthcare system has been described as unparalleled in Canada and the envy of some of our allies.
If CAF/DND medical personnel and clinicians deem a member unfit medically to serve, one would think that this would warrant automatic disability status as a VAC client without any need for application. On the other hand, when a medically released member is denied or delayed disability status by VAC, in my mind, this represents a challenge to the competence of DND personnel to make a determination of service-related injury. In discussion with my military friends, I agree with their argument that the two departments should retain independence because of the risk of funding re-allocations during times of fiscal constraints upon the military. Even so, I believe that much closer bureaucratic ties and mutual respect can occur to avoid duplications that are costing millions of dollars annually and putting many veterans through a needless process.
Instead of an adjudication and claims management focus, the efforts at VAC could be ground-breaking with a shift in focus to the development and evaluation of substantive rehabilitation initiatives. This may require building an entirely different structure. In our current situation, too many men and women in their 30s and 40s are languishing without any clear direction forward in their lives.
John J. Whelan
John J. Whelan, Ph.D., is the author of Going Crazy in the Green Machine, available now on FriesenPress.