PTSD was a Huge Part of the Wild West

I am presently in Southern Arizona and went to Tombstone to check it out. The old west has always been an interest of mine. Tombstones historical significance and the lore it has is what drives people there, me included. While there I had a realization while walking around and going into the saloons. I noticed the huge mirrors behind the bars and thought to myself, I know why that’s there. So many of the gunfighters, lawmen, and cowboys during Tombstone’s heyday had to have Post Traumatic Stress Disorder (PTSD). Their actions and behaviors look familiar to people who have PTSD today. The hypervigilance of the gunfighters, lawmen, and cowboys are legendary and documented. Those who lived in the old west and were willing to discuss their upbringing disclosed some tough situations they had been in before they came west. Most of these men and women were tough customers and brought up in a world of violence either by war or circumstance. Most of them had their lives threatened and had seen the carnage of war or life. America was a violent place and folks died young from the civil war until the turn of the century. Many of them had their parents die at a young age placing them in horrible where they were often treated like slaves. Some were old enough to find their own way but that too had its own issues and dangers.

Those who came west usually had some type of trauma in their past. A lot of those who came west served in the civil war on both sides and found an uneasy complacency once they got there. The west was lawless at the time and many of the lawmen had been or were gunslingers themselves. The evidence that surrounds the lore of their hypervigilance is numerous. During most of the firsthand stories, novels, and movies there is an indication that the gunslingers of the old west had PTSD. They sat with their back to the wall so they could see the door and who was coming and going allowing them to feel safe. This is a sure sign of their hypervigilance and an indication that their PTSD was alive and well. The huge mirror in most bars were present allowing them to see behind them helping them feel safe. They had to be hypervigilant, they had been taking risks and needed to be aware of their surroundings. Gunslingers and lawmen had a lock on taking chances. Their risk taking has been written and described by authors and screen writers for over 150 years. What can be riskier than being a gunslinger or lawman in the wild west. Many of the noted train, bank, and stagecoach robbers were taking huge risks with their lives. The constant threat to their lives is a sure sign they were searching for the adrenaline rush they needed in their lives because of their PTSD. It did not matter which side of the law the gunslingers where on, they were reaching for the rush they needed.

When you take a closer look, you can see how the gunfighters, lawmen, or just those who came west had similarities to today’s veterans with PTSD. The hypervigilance and risk takingexhibited by those from the wild west and today show how long PTSD has been around. When we think about survival and PTSD, we don’t think about what the old west was like and how parallels existed between those who had PTSD in the old west and our veterans of today. There are a lot of similarities when you take a closer look, and a lot can be learned from those who lived to tell the tails of the old west. To some their PTSD kept them safe, they utilized their resources and hypervigilance to survive. Just as those who have PTSD now can do.

The 24-Hour News Cycle and PTSD

Sean came into the office discussing how he struggles with getting out of his house due to his Post Traumatic Stress Disorder (PTSD). I have been working with Sean for a couple of months,but he continues to struggle to leave his house even to get groceries. Because of his severe paranoia and deep seeded trust issues Sean struggles to leave his house and doesn’t have an ytype of relationships. He was married once, before he went to Iraq, but once he returned his lack of trust and paranoia drove his wife away. He disclosed that every time he leaves the house, he has a panic attack for fear of something bad happening. Sean said that there is so much “evil “out there that he does not want to leave his house fearing something bad will happen. I see a lot of paranoia and trust issues with people who have PTSD. But what is the reason for the irrational fear. I have a theory.

My theory is the 24-hour news cycle causes a lot of stress on people who have PTSD and feeds into their trust and paranoia issues. The 24-hour news networks have opened the floodgates of hostility in the world to everyone. Before the 24-hour news cycle we were sheltered and only saw what the media decided to show. Now we can see the horrors happening in real time where we never saw or heard about it in the past. It has not been until recently, the last 30 years or so, that we have seen such an issue with PTSDand its symptoms. It has always been around and written about as far back as medieval times, butPTSD issues have exploded in the last 40 years or so. People have always had PTSD, but it was not classified as a mental issue until 1980. Simultaneously the 24-hour news cycle started. It is an interesting coincidence that the advent of PTSD as a mental disorder and CNN starting to have news 24 hours a day started in the same year. It looks like they grew up together and affected the way we see things and the way we live our lives.

Before the 24-hour news cycle the television, stations went off the air around 2 am, depending on where you lived. We did not have access to the news like we do now. There were only 3 or 4 stations, news was not their main concern. Now we have stations who have news 24 hours a day and watch terrible events happening live. If someone can’t sleep because of their nightmares they can turn on the news and feed into the negative energy that woke them up. What happens on the East coast can be seen in real time on the West coast and gets played over and over in a loop to cover the 24-hours. The 24-hour news cycle feeds the PTSD in some people making them have disproportionate paranoia because everything looks so bad. But the statistics show that crime is down, it’s not as bad as it looks.

According to the Brennan Center for Justice the national crime rate is about half of its peak in 1991. Since then violent crime has fallen 51 percent and property crime has fallen by 43 percent.The 2013 violent crime rate was the lowest it has been since 1970. Since 1993 the violent crime rate has dropped from 79.8 percent to 23.2 percent per 1,000 residents of the United States. With the violent crime rate at such a low level those with PTSD should be struggling less with their PTSD symptoms because of the lower crime rate, they should feel safer. So, what is causing the increase of PTSD disabilities?

The only thing I can think of is the access to news through the 24-hour news cycle. Before the 24-hour cycle most cities and areas would get about a half an hour of local news and weather and another half an hour of national news. News organizations did not have 24 hours to program for their news. Then came CNN who was able to make money with having 24 hours of headline and “breaking” news. So many kidnappings and murders were not seen on the TV in the past. They could not fit in the half an hour of news. The 24-hour news cycle made us aware of all the “evil”out there. I truly believe the 24-hour news cycle and the 24-hour news channels has played a part in the uptick of people’s PTSD symptoms. This is making it harder for them to live their lives because they fear the “evil” they see on TV. Of course, that is not all that has caused the increased in PTSD symptoms but that’s for another column.

Veterans need to support their VSO’s

I have been going to the American Legion meetings for about 2 years now. I am starting to see why they are falling apart and don’t have much support from local veterans. It appears they struggle with multiple issues, and only veterans can stop the decline. The Veteran Service Organizations (VSO’s) are the main lobbyist for veterans’ benefits. The VSO’s are key to the success of veterans getting and maintaining their benefits. They also do public projects, volunteer to do road cleanup, support and have youth groups, have auxiliaries, and support local veterans and their need. The VSO’s do a lot of good for veterans and the community, but that is declining. The issues have been growing for years. There are so few veterans who want to join and participate in the activities the VSO’s promote, hurting all veterans.

Local VSO’s are closing at an alarming rate, the biggest issue is the lack of participation. We are a part of the problem by refusing to adapt to the needs of the younger veterans. The VSO’s were at their peak after WWII and Korea. As we have started to lose our WWII and Korean war veterans the Vietnam era veterans started to take over. Part of the problem has been the resistance to change. The elder statesmen from WWII and Korea have been resistant to the changes, and it appears the Vietnam era veterans are following suit. I know this is a controversial statement, but it appears to be factual. I have heard where the WWII veterans would treat the Vietnam veterans awful because Vietnam was not a “war” according to them. Because of this some Vietnam era folks quit trying to be a part of the organizations and never went back. But now the Vietnam folks who came back are viewed as the Grumpy old men by the new veterans, and the tradition continues.

One of the major issues we see today is the clash of the differing generations. The Vietnam veterans don’t understand the new veterans and the new veterans don’t want to sit around with a bunch of people who they feel don’t want them around. A lot of the younger generation veterans don’t want anything to do with a military associated organization even if they found the time. For them it is difficult to work a full-time job, have a family, and volunteer with the VSO’s. On top of that most VSO’s do not have anything appealing to the newer generation of veterans. That needs to change if the VSO’s are going to survive. There are few internet cafes, game rooms, or just places to hang out that are catered toward their wants and needs. Most VSO’s are a bar with a part time restaurant where people sit and drink, talk crap, and a place to not be judged and feel safe. The issue is some of the new vets don’t drink and don’t want to be in a room with a bunch of folks who just sit around drinking and make rude comments. I had one friend, who is an Iraq war veteran who went to a VSO for dinner, trying to support fellow veterans and deciding if he wanted to join the VSO. After dinner was over, he sat there to check it out. An older veteran looked at him and said… if you’re not a member get out! He was not asked to join the VSO, he was not told politely we are closed for non-members, he was just told to get out. It might surprise you, but he did not join or ever go back. In my opinion this is not acceptable and giving the younger veterans a reason not to join. This behavior gets out and is a part of the decline and participation in membership. It needs to be known that the elder statesman who rudely talked to my friend is not the norm, he is an outlier. It has been my experience that most members are good people who want to help their fellow veterans and the community.

For the VSO’s to survive they will be needing new members. It appears they will continue to go under if some changes are not made. If you are a veteran, please consider looking into a local VSO. You can be the one to change the culture if you are willing to be around a lot of good veterans and some grumpy old men. They need your help! The VSO’s are in business to help veterans and keep the idea of service before self-alive in the veteran community. By supporting the VSO’s, you are supporting other veterans, helping keep the benefits we have earned alive for future generations of veterans.

TBI and mTBI Needs to Be Taken Seriously

On January 7, 2020 Iran launched a retaliatory attack on a US facility at Al Asad airbase in Iraq. The Iranian missile strike was in retaliation for the US drone strike which killed General Qasem Soleimani, the top military commander for Iran. After the missile attack directed at US military troops in Iraq the White House stated there were no injuries in the attack. After the dust had cleared it was discovered that up to 11 troops were flown out of the country to be treated for possible Traumatic Brain Injury (TBI). After the attacks on US troops by Iran there were multiple service members who displayed signs of having a TBI. TBI injuries can take weeks to be discovered, and it was not abnormal for the severity of the injuries to not be known until later. I will give a pass on the first statement by the White House because it is feasible that no major injuries were noted at the time. But later, after the incident had been sorted out, the White House was told of the injuries and the President discounted the injures service members TBI symptoms, he described the injuries as a headache. When asked about the injuries during a press conference the president said.

"I heard that they had headaches, and a couple of other things, but I would say,and I can report, it's not very serious," Trump replied

The reporter pressed, "So you don't consider potential traumatic brain injury serious?"

"They told me about it numerous days later, you'd have to ask Department of Defense," Trump replied.

The commander in chief continued, "I don't consider them very serious injuries relative to other injuries that I've seen."

"I've seen what Iran has done with their roadside bombs to our troops. I've seen people with no legs and with no arms. I've seen people that were horribly, horribly injured in that area, that war," Trump said.

"No, I do not consider that to be bad injuries, no," he added.

As a mental health professional, I was appalled that something so serious could be blown off by the president. I see the consequences of TBI and mTBI every day in my office. I have had to modify my office for my clients who have TBI. I presently have a client who the VA refuses to diagnose his TBI. He possesses every long-term symptom. It is well known that service members usually hide their symptoms or don’t even know they have TBI until years later. When asked most with TBI have trouble with short term memory, trouble with concentration, thinking clearly, headaches, sleep patterns, dizziness,sensitivity to light, balance issues or blurry vision. These are some of the long term affects of TBI and can be discounted and overlooked as something less serious. Concussion, also known as mild traumatic brain injury, mTBI, has been the most common serious injury to U.S. military personnel since 2000, with more than 408,000 cases diagnosed. Most who have been diagnoses with mTBI have had multiple concussions over their life and the accumulation can equal out to the same symptoms of TBI over time.

Most people who suffer from concussions can recover within seven to ten days with proper care. But we all know military service members don’t get the care they need, just like the president they look at it as a headache and don’t want to be labeled a whiner or a slacker. It is known that severe or multiple concussions can cause a host of other issues over time. According to the Department of Veterans affairs Boston Healthcare system the degeneration caused by the concussions can increase the chances for dementia, Alzheimer’s, Parkinson’s disease, and other neurological conditions causing a host of issues down the road. It is important these conditions get proper care when they happen. Because it is blown off by the president there is no wonder that TBI is not being taken seriously by the VA, DOD, or medical community. TBI and mTBI is the signature injury for the most recent wars. The blast and explosions faced from Improvised Explosive Devices (IED) are a key reason for large TBI and mTBI numbers in our service members.

It is important that the healthcare system take TBI and mTBI seriously. As usual itappears that the VA is behind in addressing this issue. Even though there are studies and research being conducted as I type, it is not helpful that the President of the United States discounts this serious injury as a headache because you can’t see it. The one thing I know for sure, TBI and mTBI is more serious than bone spurs.

Signs of TBI

 Difficulty remembering new information (short term memory)

 Difficulty concentration

 Seizures

 Throwing up after incident

 Depression

 Irritability

 Changes in smell

 Difficulty thinking clearly

 Headaches

 Abnormal sleep patterns

 Dizziness

 Sensitivity to light

 Balance issues

 Blurry vision

Integrity is Important to Most Veterans

It appears that there are a lot of military veterans who have either quit, been fired, or speaking out about their time serving in the White House. It appears that the constant lies, unwillingness to adhere to presidential norms, and consistent bullying on twitter and in rallies is playing a part in why so many veterans are publicly leaving the current Presidential Administration. It appears that the White house has been emboldened to do what they want with no one being held accountable for their actions. This lack of integrity appears to be making some veterans struggle with supporting the President on many issues.

Steve is one of my clients who is struggling. He came into session fuming about the way the President is disrespecting the office, military, and veterans. Steve is an Iraqi veteran with Post Traumatic Stress Disorder (PTSD) who struggles with the Presidents consistent tweeting and attempted bullying of veterans who oppose him. Steve now questions what he had fought for. Military members and veterans who serve in the Presidents administration are being fired and criticized for doing their job and what is right. Steve made the statement; this is not how a President is supposed to act, it is not what is best for the country. I work with a lot of veterans and most of them, even those who support him, struggle with the way the President is handling himself and the office of the Presidency. Veterans appear to also be concerned about national security issues released by tweet. Causing confusion and a disruption among our allies and the military. Many of the moves and decisions the President has made has turned a lot of veterans away from supporting him.

Steve is not the only veteran to speak out while talking to me in sessions. The President’s actions appear to be causing a lot of anxiety in the veteran’s community, especially with the younger veterans. With the President appearing to involve himself in legal issues and trying to use other countries to gain information on his opponent’s veterans are beginning to question the President’s loyalty to the country. The known conversation with the Ukrainian president looks like the President is using his office for personal gain, even if it wasn’t. It was questionable enough to make an Army officer to speak up and risk his career over. It is also not helpful when the President pulls money from military projects for the border wall. Veterans are starting to question the Presidents support of them and the military. These are just a few of the issues, there are a lot of more questionable things the President has done.

With all the issues the President has dealt with it appears the last straw for some veterans was the treatment of Lt. Col Vindman. I believe the firing of the Lt. Col. for doing what he felt was right and following his oath of office has made a lot of veterans uneasy. The subpoena from congress, right or wrong, was something Lt. Col. Vindman had to do if he was going to follow his oath of office. By following military protocol, the Lt. Col. drew the wrath of the President. As history has shown, this President publicly removes anyone who he feels does not support him, disagrees with him, or does anything he feels is not in his best interest. The President also appears to be trying to get the US Army to investigate the Col’s motives, which to me was clear. Most of the veterans I have talked to believe the Col’s motive was clear… he did what he thought was right and appears to be paying the price for his integrity.

The definition of integrity according to the military I served in is doing the right thing even when no one is looking. That is in its simplest form, the dictionary defines it as the quality of being honest and having strong moral principles; moral uprightness and that is what the Col. did, and it appears to have cost him. The fact that Lt Col Vindman did what he thought was right is something that most veterans can get behind. Almost all veterans believe that integrity is a key piece of their lives, and most veterans feel it is a key element to who they are. They feel that what is going on is detrimental to the US and what they had fought for. I know most politicians appear to lie, and are in it for themselves, but I also know that most politicians will not do anything to destroy the country for their ego. I believe as a mental health therapist, and retired Air Force NCO that the lack of integrity in the oval office has caused a lot of veterans to question what they fought for.

Could it be C-PTSD?

I have been working with an Army veteran who has a different form of Post-Traumatic Stress Disorder (PTSD). He has never been to combat, has never been beaten, or had a single event that, by definition, might have caused him to have PTSD, even though he has most of the PTSD symptoms. Steven is a 35-year-old Army veteran with a tough childhood. Steven was a military brat whose father was in the Navy and always gone on long deployments. Steven was left at home with his alcoholic mother who left him alone with a babysitter who locked him in the basement and fed him little food while his father was deployed, and mother was partying. Steven has a lot of holes in his memory and does not remember much of his childhood. It appears Stevens PTSD symptoms come from his childhood but exacerbated by the military. This upbringing has caused him to have a different form of PTSD called complex PTSD (C-PTSD). Instead of a single event that can cause PTSD, C-PTSD is a series of traumatic events, or one prolonged event, it appears Stephen fits that bill.

Presently the American Psychiatric Association (APA) does not recognize C-PTSD as a diagnosis. This does not allow mental health therapist to “officially” diagnose a client with C-PTSD. Recently C-PTSD has been accepted by mainstream psychological therapist even though the APA does not accept it as a diagnosis. Many clinicians accept the diagnosis because of all the trauma we see in our practices that does not meet the official diagnosis of PTSD. The Diagnostic and Statistical Manual (DSM) covers the (APA)’s recognized disorders and is slow to adapt to this new diagnosis. This leaves a lot of Americans with C-PTSD to not be diagnosed or incorrectly diagnosed, at times with personality disorders. However, C-PTSD is recognized by the World Health Organization and made the decision to include C-PTSD as its own separate diagnosis in 2018.

Combatting C-PTSD is comparable to treating PTSD. The complexity of C-PTSD adds different layers to the disorder and treatment, but it is similar. Steven has a lot of trauma in his life but no single incident that can be defined by one traumatic event required for a PTSD diagnosis. He has a lot of smaller traumatic incidents that have built up over time making it more like CPTSD and not PTSD. In the United States there is a lot of childhood trauma not meeting the criteria for PTSD but match the requirements for C-PTSD. Steven has a lot of trauma to unpack, but it can be done. According to the International Classification of Diseases revision 11 (ICD-11), in addition to experiencing all of the normal symptoms of PTSD, people with C-PTSD may also experience:

Difficulty Controlling Emotions

•  Experiencing an emotional flashback. This is when you have intense feelings that you originally felt during the trauma, such as fear, shame, or sadness.

•  Experiencing severe depression, thoughts of suicide, or have difficulty controlling your anger.

Detachment from Trauma (Dissociation):

•  Dissociation is the mind's way of coping with an intensely traumatic experience. Those who experience dissociation may feel detached from their surroundings, their actions, and their body.

•  Experiencing gaps in their memory surrounding the original trauma or an everyday task that reminds them of the trauma they experienced.

Changes in Self-Perception

•  Complex PTSD can cause a person to view themselves in a negative light. This negative self-image can include feeling as if they are different from other people and feelings of helplessness, guilt, or shame.

Preoccupation with Perpetrator

•  It is not uncommon for people with C-PTSD to become fixated on their abuser. This can include becoming obsessed with the abuser, dissecting their relationship with the abuser, and becoming preoccupied with revenge.

Difficulty with Personal Relationships

•  Someone with C-PTSD may develop unhealthy relationships because they find it difficult to interact with and trust others.

Changes in Beliefs

•  People exposed to chronic or repeated traumatic events may lose faith in humanity and previously held beliefs.

Veterans are Better Equipped to Emotionally Deal with Coronavirus

I was talking to Jordan about the hysteria surrounding the corona virus. We discussed how the military handles stressful situations more effectively than the civilian population. We found it interesting that most military veterans handle stressful situations better than their civilian counterparts. Veterans are taught in the military how to handle a crisis, make quick decisions, and have backup plans. As we talked, I was remembered when I had to put on the chemical warfare suit during Desert Storm, and exercises, reminding me of how wearing the suit limited my mobility even though we still had tasks to do. I know how folks who work with this pandemic feels. It is not easy, but it can be done. Even though not all veterans have had to put on chemical suits we all have trained for situations like what our country is dealing with now. The training we had has prepared us to handle a crisis like this. A veteran's ability to make solid decisions can be a life changing event while were serving. We have been taught that life and death situations can happen because of decisions that we make.Most veterans are taught to have a backup plan and know how to handle a stressful environment. It would be in the best interest of the civilian sector for them to look to veterans for help when dealing with this epidemic. I know I'm a lot calmer that many people around me because I've been trained to handle certain situations that can be too stressful for some.

Veterans also know what it's like to sacrifice. There have been times that we have been stranded on our bases on lockdown for various reasons. This is not abnormal for many veterans. We also know what it’s like to do without. One of the biggest issues many veterans have with some civilians is their inability to adapt to a crisis. So many veterans, while deployed have gone without food and forced to make do with what they have utilizing the C-Rations (c-rats) or Meals Ready to eat (MRE’s). There were a lot of complaints along the way, but we all knew we were in this together to help each other out. Jordan was telling me this morning how he was stranded on a forward operating base (fob) for five days without the ability to get resupplied. They were running out of food and water and had to ration what they had. Jordan was complaining how so many civilians do not notice what it’s like to truly go without. We spent quite a lot of time being amazed at what people were freaking out about. We still have not concluded why people feel the need to hoard toilet paper and paper towels. I understand the need for hand sanitizer and cleaning supplies, we both struggle to understand the toilet paper thing.

Hopefully what we learn from this, once it is over, is sacrifice is a part of life. Being able to go to a local restaurant, concerts, sporting events are a privilege that so many takes for granite. This may be a long-haul thing. This coronavirus outbreak may last for months and we don't know when it will end. But what we do know is those of us who served in the military are way better equipped to emotionally handle the situation. When it comes to survival, we all know what to do.This just might be the catalyst that society needs in order to readjust what is important. This just may be what our country needed to bring us together and work to help each other. To all my yellow veterans I would encourage each one of you to help where you can, use your training to make things better for everyone around you. Do what we do best, don't panic because this too shall pass, Keep a good since of humor, and lastly, if you are elderly or take care of someone elderly STAY AT HOME.

Please Look Out for Our Elderly

I have been talking with several veterans and discussing the need to take care of those who are at higher risk during the covid-19 pandemic. Many of those veterans who are more susceptible to getting the virus served in Vietnam. With the Covid-19 pandemic in full swing I have been thinking about our older veterans and how this is affecting them. Our Vietnam veterans appear to meet a lot of the risk factors that can lead to getting the covid-19 virus and it concerns me. Their age and the use of Agent Orange in Vietnam could increase their risk for catching this deadly virus.

The biggest thing that worries me about our Vietnam veterans is those who suffer from the use of Agent Orange in Vietnam. With all the health issues that came with Agent Orange these veterans are a prime target for the virus. Many of the diseases known to be associated with Agent Orange are risk factors for the covid-19 pandemic. The issues associated with Agent Orange is bad enough, but that combined with this virus could make it a death sentence for our veterans who were subjected to the herbicide. People with chronic lung diseases, asthma, and have a compromised immune system are especially susceptible to the virus. More issues include having had or in the process of cancer treatment, severe obesity, and type 2 diabetes are also high-risk factors. It is true that most young people get over this virus without an issue, but their behaviors can pass it on to their parents or grandparents without even knowing it or knowing they have it. But one thing that might help our at-risk veterans during this pandemic is the high number of Vietnam veterans with PTSD.

This might be a case where having PTSD can be a good thing. Many of those who have PTSD do not like crowds and prefer to stay at home. The rules for this pandemic fit right in for their lifestyle. William, who has PTSD came into session last week and said, “being a hermit is finally paying off”. He said his life has not changed but everyone around him is struggling because they can’t go anywhere. Being at home is his normal. William just has a different outlook on life. Having a positive attitude can go a long way in getting past the pandemic, and he feels his PTSD is helping him. For those who have PTSD this is the time where they can point out to others that this is their normal. Not wanting to be in crowds and being worried about a constant threat are a hallmark sign of PTSD. This pandemic might make those who don’t have PTSD understand what having PTSD can be like.

It is our job as veterans to keep an eye on anyone we see who might need help. I am calling on all veterans to step up and serve again. It could be as small as getting groceries for an elderly neighbor, taking them to the store, or just checking up on them. Our elderly folks deserve to be treated well. Many of them have fought for our rights to be free, the least we can do is treat them with respect and take precautions to help them stay safe. I encourage everyone to keep an eye on our elderly veterans and neighbors, especially those that are over 65 or have chronic diseases, and please be careful to not spread the virus to them. Take your own precautions and protect yourself. We will get through this; we have faced bigger challenges as a country. Please take care and stay safe!