Wednesday, April 9, 2014

Why the Suffering / Treatment for the Sacrifice.

I have served my country in a number of tours overseas in combat. I am one of a long line of family members who’ve landed on the beaches in France, or have parachuted behind enemy lines in Italy. They have served in Iraq, in Afghanistan and in Beirut.  They have served in their respective units’ through-out the world. There will never be a lack of men and woman motivated by the American ideal to protect and to serve and keep the freedoms we enjoy.  Because of that, there will also never be a lack for need to treat these same men and women as they return and attempt to re-acclimate back into the society they fought to preserve.

This raises questions as to how to treat these men and woman, and in the end, after these soldiers have returned home, they are individuals, they are moms and dads, brothers and sisters, children of you and me, and they are confused. They are scared and they are unsure how to navigate a world without having to fight for their life every moment of the day. They are suffering from PTSD, and that’s where I propose EMDR (Eye movement desensitization and reprocessing) in the use of treating PTSD, either in conjunction with other cognitive behavioral treatments or as a successful stand-alone form of natural treatment. 

“There is a shared dream in all trauma therapy professions, which is to find a faster way to shorten the days our clients spend in agony”.  - Dr. Francine Shapiro (1999)

The loud hum and rumble of the tires from our squad vehicle washed over my ears as I rode along. I had my eyes closed, my head resting against the door and my face exposed to the open window so as to let the sun warm my face. No matter where you are in the world the warmth of the sun will always remind you of home. I was picturing my girlfriend back home standing in the cafeteria of my unit’s processing center, in her tight jeans and blue jean shirt and her chestnut hair. She looked at me, her steel blue eyes smiling, but her face was contorted, she tried to hide the desperation she felt as I picked up my duffle bag and stepped onto the bus. That was the last time I saw her until I returned from Southwest Asia, I missed her.

Suddenly I heard an explosion and before I could open my eyes I was thrown against the dash of my truck, our tires screamed and chirped as we slid sideways into a sandy ditch near a small village somewhere between Iraq and Saudi Arabia. When I opened my eyes we were surrounded by black smoke, I grabbed my helmet and jumped out the truck. I yelled at my driver to get on the radio and check in with the other vehicles. I grabbed my turret gunner and threw him into the ditch ahead of me and called out for a count of my squad members. We were escorting some signal corpsman and our lead vehicle hit a roadside IED, tore the rear passenger wheel right off the truck ahead of us, breaking the hand of the machine gunner as he flew out of the turret when the truck flipped over.

We immediately set up a perimeter around the vehicles and began taking inventory. Then I looked up and peered through the smoke. Standing alongside the road were three young children, and they couldn’t have been more than eight years old. They just stood there watching us. Often as you pass through these little villages it is normal to see children standing alongside the roads yelling and screaming and begging for candy, and it was customary for the soldiers to throw candy to them. Sometimes though, the children are positioned there as a distraction to draw the soldiers’ vehicles closer to the edge of the road in order to trigger IEDs placed there earlier. That seemed to be the case on this particular morning, I struggled to find some sense in using children in this way, but there is no sense to it. I saw that in Panama as well when Noriega’s troops would hole up in elementary schools and shoot out the windows at American soldiers from behind the school children. There’s no sense to the thinking of desperate men on either side.

There was always a sense of eminent danger lurking around every corner, near every building, behind every smile on a stranger’s face. You don’t forget that first experience, the next one just nails deeper into your subconscious. And when you think it can’t get any worse, that you’re in the shit now and you’ve experienced the most awful, there is always more. When the sun goes down and things get quiet, that’s when your mind really gets edgy, your eyes play tricks on you and you see things that aren’t really there, but sometimes they are, and you just can’t see them. Until they take a bite out of your leg just before you hear the actual shot.

This was my life for a period of time in a foreign land far from anyone I knew or loved, don’t get me wrong, I knew who my soldiers were, I knew who they had to be at the time, but like me, that wasn’t who they were before then. And we loved each other on a different level; we depended on each other for our lives.

Experts say the months just after a service member leaves the military can be a particularly disorienting and even dangerous time. When these vets operated in theater among their colleagues, they were housed and worked in a very tight knit community, and once they return home, that is no longer the case, they are among so many in a society whom don’t understand what it means to be a veteran, or know little about the military. And it’s under these circumstances that these vets must learn to live again. So now we stand in the grocery store trying to decide which milk to get. It seems like such a simple task, and it would be if our lives depended on the outcome of that decision.

Survival was ingrained in our minds for so long at such intensity that we have become lost, maybe forgotten how to operate under every day, mundane, civilian circumstances. And once in a while if I am walking along and a car backfires or there is a really loud noise I know to stop, drop down and seek shelter, click safety off and scan my AO for the enemy. The trouble is I don’t have my weapon, and I am huddled down in the corner of the Holiday Station Store in Hopkins.

This is a common scenario for many returning soldiers both men and woman from overseas. They have sustained either MTBI (Mild Traumatic Brain Injury) and/or are suffering from PTSD (Post Traumatic Stress Disorder). So what happens with these soldiers then, some go on to being treated at the VA medical center or seek help threw a private therapist. Some can’t keep a job and end up homeless or worse, commit suicide because they can’t get the help they need or are just too paralyzed by the trauma that haunts them and they can’t function even on a basic level. As was reported by Bill Chappell in an article in NPR online recently, there were 349 suicides among returning soldiers, that’s 54 more than the 2012 combat death record.

Those whom seek out and find help; often times are subject to a traditional form of treatment called Exposure Therapy. The idea here is that by emotionally and consciously exposing them to the effects that caused there affliction, they will eventually succumb to a numbness of that responses they would normally show, like standing them in a dark room and flicking the light on and off repeatedly, after a while the light won’t bother them and they will be able to function with that flicking of the light on and off. The problem is that treatment doesn’t quell the cause of the affliction, only the symptoms. The response will still be there, just more subdued…along with their other cognitive functions. This is also used in basic training to make the soldier more comfortable in combat; again, the problem here is that once they’ve completed their tour(s) and return home, these skills don’t serve them well in regular society. This way of processing is adverse to that of the way society operates.

Soldiers are trained and accustomed to searching out the obscure, looking through the trees at the trees that are slightly different than the others. Their survival depends on seeing the hidden, working in difficulty. That is not how the majority of society operates today. Walk into a department store and everything is obvious, these are the jeans on sale, everything is laid out so that you can walk in and purchase what you came for without having to decipher complex decisions. That is not always an easy transition for soldiers to make. That causes stress, trust is not given freely, and suspicion is rampant.

So how does one help a veteran, a soldier, someone suffering from PTSD? The studies suggest that EMDR (eye movement desensitization response) may be the very thing they need, as a stand alone or in addition to cognitive behavior therapies. EMDR seems to have a broader positive result and shorter treatment period as shown in a study conducted by the Journal of Clinical Psychology, wherein it was stated; using participants with PTSD have found significant decreases in a wide range of symptoms after two or three active treatment sessions. Treatment effects are well maintained at follow-up assessments. For example, one study reported an 84% remission of PTSD diagnosis at 15 month follow-up.

It seems that most of the treatments used today focus on the symptoms and triggers for the effects of PTSD as opposed to treating the source or the physiological switches in our brains. Think of the trauma trigger like a light switch, exposure therapy might have you flicking the light on and off rapidly, exposing you to the strobe effect therefore numbing you to that experience. EMDR might work like removing that switch eliminating the experience altogether. This would make EMDR though arguably in some circles, superior to the other in that it affects the root cause of the dysfunction.

In my own treatment of PTSD I tried to focus on the root cause of the symptoms, I had been treated by various facilities using differing methods, only after implementing EMDR into my treatment program did I experience extensive and positive results. The triggers had a less of an effect on me, as an example if  a car were to backfire I wouldn’t simply be numb to the sudden noise but would process the experience differently, noting it, even responding to it but not in a hyper sensatory manner. I think the power and proven results of EMDR for so many is too valid and important to not incorporate it in a much wider spread approach than it is today. It does not require the client or veteran in this case to conduct homework and it has been suggested repeatedly that fewer sessions might be in order to enact fruition. According to Spector and Read in The current status of eye movement desensitization and reprocessing, EMDR has increasingly been proposed as an effective therapeutic procedure for post-traumatic stress disorder.

Although medications such as a selective serotonin reuptake inhibitor (SSRI) has been used to treat PTSD with some success, along with Prozac and Zoloft, particularly when treating depression there can be lots of side effects to using medications, and these tend to only address the symptoms and not the core issue, the very body of the cause to PTSD. According to the Center for PTSD, EMDR therapy can lessen the symptoms of PTSD (National Center for PTSD 2011), though the actual contributing factors of the treatment are fodder for argument among clinical and psychological professionals.

EMDR has been used and well documented to treat the rescuers and emergency personnel after the 9/11 terrorist attacks in New York and the Oklahoma Bombing. In fact, it’s inexcusable that many Americans will experience PTSD at some point in their lives. The question we all need to come away with some sort of conclusion to is whether or not EMDR as a treatment option is better than no treatment, and there are case studies after case studies that suggest this to be the case. Furthermore as with any treatment, the outcome is only as fruitful as the patient is motivated to be well. EMDR used in conjunction with other treatments or as a stand-alone treatment doesn’t require drugs, or live-in therapy centers, and the effects of the treatment have shown in just a few sessions, and often times dramatically, with far reaching and positive outcomes.

That is why I propose that we enact a program to train personnel to work in the VA centers and satellite offices nationwide through-out the Veterans Affairs system, to use EMDR in their therapy programs. EMDR has shown very short term positive effects without medicinal treatments. With enough of the properly trained staff we could positively affect so many more of our brothers and sisters, fathers and children and families’ in need.


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