The Lone Survivor and Combat PTSD: What you can expect

The Prep

After my Weekend War Movie Blitzkrieg I finally got to see Lone Survivor. I felt my mental preparation all weekend, and then all day, set me up to experience Lone Survivor deeply. Earlier in the weekend I sat with many very uncomfortable emotions and let them linger so I would not re-experience them unexpectedly in the theatre.  It was not easy, but thankfully CPT and PET worked.  I gained a lot of interesting insights about particular triggers (I mean, I already know I dont like seeing other people cry, but there is some nuance developing.)  If this post is a bit rambling, I apologize in advance, I wanted to crank it out before too much time has passed.

Battle Buddies

I went with a civilian friend. He is more of a deep thought intellectual type and afterwards provided a good perspective on what had the greatest impact from movie to him. As I sat in the theatre, I could feel other people’s tensions rise and fall throughout the movie. Everyone was uncomfortable watching the events unfold. Some people laughed half-heartedly at one liners the SEALs made while they faced the impossible odds. Others squirmed in their seats with every new wound, and there were a lot of opportunities to squirm.

Overall, I focused on being mindful and present when facing the visual and auditory triggers throughout the movie. No matter how good a makeup artist is on a movie, it is still not the real thing. It is close enough to make me remember.  Thankfully, though very convincing, it was easy to tell myself these were actors. That is not to say I did not jump a few times at sudden explosions or cracks of gunfire. And unlike when I watched “Zero Dark Thirty”, and perhaps because I just recently watched it, I did not face the anxiety of anticipation of the final and emotional events in movie.

Without a doubt a singular word I would use to describe “Lone Survivor” is intense. A large contributor to that intensity for me was the attention to detail.  The detail on props and uniforms brought the realism to a high level.   It is worth mentioning that “real” and combat definitely equate to intensity .  Everything on the set, from Plywood CHU’s to Iridium Phones to Marky Mark’s Under Armor chonies (underwear), is all typical and accurate gear for a service member of the period. In one scene you can even see the camouflage paint used on the M4 weapons was worn from use around the trigger.  That is attention to detail!

The other convincing point was the attitude, persistance and approach of the SEALs in the movie.   The dialog was realistic   Their treatment of each other under extreme duress was accurate.  With odds severely stacked against them, the never quit attitude, even to my civilian battle buddy, rightly did not seem fictional. Wave after wave of attacking Taliban kept the suspense high as the gunshot wounds and epic mountain falls cut away at the bodies of the SEALs, but not their spirits.


I think most importantly the film made me proud to be a Veteran and a Grunt. I hung up my boots and blue cord long ago, but I still love the Grunts and Scouts.  They hold a special place in my heart.  The “get it done” attitude in the face of steep odds is something I feel I still carry in my corporate job.  When work does get stressful, my perspective and approach to dial down the swirl around myself and others is valuable.  I don’t think I am able to do that without my time in combat and I feel my co-workers appreciate my “other 1%” view on it too. (At least I hope they do…)  I have heard this experience from my other friends who have moved on to the civilian workforce.  I walked out of the theatre sombre, but with my head held high.


I held it together for virtually the whole movie. I daresay my battle buddy squirmed and yelled while I was much more stoic.  But, I lost it when they tied the fictionalized account back to reality. The afterword displayed some information of the Pashtunwali code to explain the final fight scene where Afghans fought off Afghans.  However the next afterword the film showed a slide show Soldier by Soldier of the heroes lost in Operation Red Wings.  It was tastefully done and very emotional.  They showed many service pics along with a montage of wedding and family pictures. “Gut wrenching” is an understatement, but the pictures effectively closed the loop and powerfully brought home the message that this movie is a tribute to their ultimate sacrifice and all those who sacrificed in these wars.  I can honestly say that this movie inspires me to want to help my fellow Service Members and Veterans more.  I hope it does for you as well.

How to watch the Lone Survivor with Combat PTSD

lone-survivor-posterDisclaimer up front, I am attempting to watch the Lone Survivor movie after consulting with many family, friends and confidants.  I am not acting on a psychologists advice, or warning, but instead dusting off my skills developed from Prolonged Exposure Therapy and Cognitive Processing Therapy.  The idea is to engage in comprehensive preparation for watching movies with stressors and triggers.   I expect the result that I am better prepared to watch Lone Survivor, and subsequently better prepared to handle life. I do not recommend this approach without the guidance of a therapist the first time.  Let me say that again, go get a therapist for PET or CPT.  (here are some great therapy services). Do not try and read a book or blog and do it yourself.

I am attempting this because I feel that, like many skills in life, the ones PET and CPT taught are perishable.  I completed both courses and have used their techniques and coaching effectively for some time.  Still, tools need maintenance.  I do not doubt this will be an unpleasant experience.  My first past through Prolonged Exposure Therapy brought me up close to “Restrepo”.  It was a very emotional experience.  Both Prolonged Expose and Cognitive Processing therapy force you to stare down and confront the worst days.   And while each day is getting better, part of gaining control over this is not avoiding everything with trigger potential like it is the plague.

A Quick Review of Prolonged Exposure Therapy

The flavor of Prolonged Exposure Therapy I undertook used the Subjective Unit of Distress level or SUDs to measure progress.  From the start, even though it was a subjective feeling, it was quantified and tracked. Over the course of many weeks, after I established my SUDs scale, my therapist and I would systematically tackle and monitor my distress level for my “homework”.

We started at the bottom of the scale and worked our way up.  The objective of each session was to address and unwind the spike in feelings and raw emotional memories that uncomfortable situations brought out.  After enough exposure with positive outcomes, we were able to lower the barrier to gain a level of comfort.

For example,  for a long while I would avoid at all cost a crowded place, especially the subway.  Being around that many people made me extremely uncomfortable and put me on high alert.  There were more than a few days in Iraq where a crowded market or labor line brought a bomb and chaos. We were trained to be on the lookout for anyone suspicious and disperse crowds.  Well, Manhattan doesn’t care about my view of crowds or suspicious people.  If I was forced to ride, I would come home exhausted for days.

So, as part of my homework, I had to ride the subway.  For an hour.  During the peak.  No, this was not an intentional sadistic exercise. I went in with a plan and had a release valve to pull.  The point of the exercise was to gain comfort with the SUDs level.  The emotions behind my extreme discomfort were just that: emotions.  Logic tells me that there is not reason I should not be able to ride a subway.  I will admit, it was almost unbearable.  But, after a few trips, I realized I could gain my composure quicker and that the danger was in my mind.

My SUDs for the subway halved by the end of my therapy sessions.  That was only part of the homework, but overall, as a follow on to CPT, Prolonged Exposure was the most challenging and rewarding therapy.  The initial gains were exponential, though those skills are now a little creaky.  It is time to stare them down.  As one of my favorite Crossfit terms says “Get comfortable being uncomfortable.”

Bring on the War Movies

OK, here is the hits list of what I watched and am watching:


Restrepo_poster Continue reading

The Lone Survivor, The Worth of Fallujah and PTSD

Photo by Greg Peters - © Universal Pictures

Photo by Greg Peters – © Universal Pictures

With the news of Fallujah I can’t shake a gnawing emotional agony from reflection. There are a lot of great articles, (here, here, and here) and while most people are grabbing the Marines, it can be viewed as the high-profile early-bird view of the potential fate of every city across Iraq. I think the question resonates deeply with everyone who fought:  Was it worth it?

On top of the Fallujah questions, I have seemingly more people than ever wanting to talk to me about my service because of the movie Lone Survivor. I have not seen it yet. I am by no means close to the caliber of the SEALs and SOAR aviators who fought and died in Operation Red Wings. Still, because of the current Veteran’s place as “the other 1%”, I am the closest thing most people know to compare to those stellar Soldiers. I don’t know how to respond.  I told my wife I wanted to see it, but I am honestly afraid of what my reaction will be, and that makes me want to see it more.  (As a side note, if you have seen Lone Survivor and it is fucking you up, don’t hesitate to reach out.)

Most days, if I get cocky, I think I have this PTSD shit licked. Then the real world interrupts and the collision of these two public events sends me back to Earth like and Airborne trooper with a cigarette roll. This past week I am mostly just pissed off and melancholy.

I find myself desperately searching for positives from my war. I turn and look to Vietnam and the similar history of a war both won and lost at the same time. I look to their subsequent actions and their activism to baseline where we have “progressed”.  Should I even try to find a positive in such an evil thing as war?  Is that the only way to make sense?

Did less people died in Iraq and Afghanistan than Vietnam? Statistically I think there is data to support that notion. Though it makes me sad to think of the hundreds of thousands of Iraqis dead because of our intervention, the advances in medical technology certainly saved more people on the battlefield and that can be seen as a positive right? But despite my fondness for metrics, those numbers don’t mean shit to me when the smell of blood and cordite still haunt me in my nightmares. The numbers now do not help the amputees. How many children are now parentless?

Is there strong enough causality to the change this war initiated back home?  Equality got a boost because of this war.  The men and women sacrificing while having their rights ignored pushed many debates into the open.  Hypotheticals became actuals.  There is a whole other blog post about just those effects alone.  But was it worth it?

We suspected this would be the case. We told ourselves that what we did had meaning and lasting impact and would not be in vain. I remember one of my LT’s pointedly questioning the Colonel about the history of “defeating” insurgencies. What made us so special? How were we different? His question echoes today.

Was it worth it?

I resort to the idea that anything anyone thought they went looking for or thought they went fighting for was erased with the first bullet fired in anger. All that was left was the men and women you went to hell with and doing what was asked to get them home. Unfortunately, there is only a small section of the United States who can and will ever understand the sacrifices made by a voluntary few. At this point in history, if I try to understand the value of worth of our efforts beyond that, my head explodes and I am left picking up the pieces.

Was it worth it? At this point, I don’t know. I may never know. And that is part of the extreme mind screw.

How many with PTSD did we leave behind?

I often think about firing engagements. If I think hard, I believe I can remember most of the times I shot my weapon in combat. With all the action in Fallujah heating back up, I have been replaying a few in my mind. American forces are no longer in Fallujah (that I know of), yet there is still tremendous violence flaring up. I cannot help but think of civilians in harms way now, or civilians in harms way then, or what we accomplished, or didn’t.  Worse yet, I shudder over the rippling effects of our actions.

The account below is fiction (mostly). After one raid we came upon a teenager that had shrapnel of some sort in his leg. I can’t say for sure I shot him, but I definitely shot at him and in his direction. Then again, a few of us did. Hindsight and an overactive imagination can be such a mother fucker.

“Yousef, get your gun.”

Papa woke me from a half sleep. We had barely finished working the field for the night and I was trying to rest before the heat of the day arrived. I knew something was wrong because it was odd for him to come to the roof.

Times were no more tight than normal, but there had been more food available on occasion. It was not until now that I started to piece the two together. Some parts happened so quickly. Others lingered in agony.

The rumble of the American tanks was constant each day, but this time was different. Rubbing the dust from my eyes and still waking up, I didn’t realize the rumble was louder until Papa yelled.

“Yousef now!” The urgency in my father’s voice quickened my step as I stumbled for my gun.

On occasion people would visit late a night. Papa would tell stories about hard times when the Mujahideen would pull people from their bed’s during Saddam’s Qadisiyya. We started to hear more of those stories since the American’s invaded.

I fumbled my gun in my hand as Papa pushed me out the door. My brothers had already started to run into the field ahead of me. I followed quickly. I didn’t have a limp then. The American vehicles were very close and in my haste I tripped a few times over the ruts in the field.

I caught up with my brothers and Papa was right behind me. There were six of us total. Now that we stopped, I started to panic as I heard lots of footsteps. The air was cool but burned my lungs. My heart raced. I turned around and the light from our front door cast long shadows.

Suddenly, shooting erupted all around us like fiery rain. Hussein and Hakim hit the ground and I quickly ducked and started to crawl away. The ground spat dirt as the sounds of large machine guns and bullets cracked all around me. A large and terrifying cannon shot fireballs. I lost track of Hussein, Hakim and Pappa. I clawed my way into the ground as deep as I could scratch. Then, hot deep pain leapt through my thigh. I was hit!

As quickly as the gunfire started it stopped. I dare not move though my thigh burned. It felt like I laid there for days. It was quiet except for the muffled sound of the American tanks.

Eventually I could hear the Americans. They were trying to find us. My terror grew. Would they shoot me? I was wounded. We never even saw tanks that shot at us. The rumors of American weapons was stuff of magic. They could see and shoot at night. Their drones dropped bombs without warning. I heard a few boys say they would hire Jewish militants to torture you for information.

There was no moon and I could hear them just a few meters away. Hakim was moaning though I could not see him.

After a while longer, as the sun started to rise the Americans found me. I could hear them before one of them climbed on my back. They put plastic hand cuffs and a blindfold on me and yanked me off the ground. While they walked me over to their trucks they noticed I was limping and called their doctor over to look at me. They walked me over to the doctor tank where their doctor put a bandage on my thigh. As the doctor worked on me he took off my blindfold. I could not understand what he was saying, but I heard a few Americans say Hadji in some broken Arabic. While I sat, they took pictures of me and a gun that was not mine, but never asked me a question.

Pappa and some others sat on the truck with us, but Hussein and Hakim did not join us. The doctor was now near them on the ground. I was not scared they would kill me now, but the fear of going to jail began to grow. The stories of Abu Gharaib were worse than the Zionist torture.

With my blindfold off I could see dozens of Americans climbing around our house. Two were using a long red and white stick to poke through the cow feed. One had a long device with a circle on the end whom many followed. My blindfold was put back on as they put me back on the truck.  Mama would tell me later they did not find anything.

Hussein and Hakim did not come to the truck before we drove away. It was not until a few days later that I learned they were killed by the Americans. That was the day I joined the jihad.

The VA Still Lobotomizes Veterans with PTSD

imagesThe Lobotomy Files

If you have not followed the Wall Street Journal’s “the Lobotomy Files” I highly recommend it to watch and read. The project chronicles the storied controversy over the use of lobotomies on Veteran Patients just after World War II in the VA system. In a flurry of trying anything to treat then undiagnosed PTSD, over two thousand Veterans were lobotomized. The stories are both chilling and sad. What I find most troubling is that this is not just a look into the past, but also a glimpse into a report of our future. Tales of failed shock treatment, water treatment and finally a lobotomy depict a horrible life for a returned and committed Veteran with PTSD into the VA system.

Some of the more horrific outtakes:

Shock treatment THEN the lobotomy:

“Within a month, VA headquarters set guidelines. It ordered doctors to limit lobotomies to cases “in which other types of treatment, including shock therapy, have failed” and to seek permission of the patient’s nearest relative.”

“At the VA, Dr. Freeman pushed the frontiers of ethically acceptable medicine. He said VA psychiatrists, untrained in surgery, should be allowed to perform lobotomies by hammering ice-pick-like tools through patients’ eye sockets. And he argued that, while their patients’ skulls were open anyway, VA surgeons should be permitted to remove samples of living brain for research purposes.”  

I wonder how many of us are lab rats for the latest batch of lobotomy drugs?

What’s in a Lobotomy?

When I came home from Iraq and got linked into the VA, like countless others, I was prescribed a cocktail of drugs.  At any given time, I was on no less than two and at most six different drugs.  They were the only alternative to the nightmares and mood swings, as well as the spiraling depression. They propped me up, but I eventually realized that their use was no long term solution. Looking back, I was a blunted shell of my former self. If I did not fight to get off of them, I could easily see myself similarly described as the Veterans in the Wall Street Journal articles.

I am not a doctor. I am not a psychologist. But, I feel that these drugs over the long term are harmful. My opinion is they have a window of effectiveness before they become a harmful dependency. Unfortunately, the VA is not mindful of that window and instead hands out drugs like candy.  The VA tries to help those that can muster the strength to kick them. These drugs effectively lobotomize a Veteran. At first the effects are temporary and really do help in giving a Veteran a fighting chance at staring down the issues. However, if over the long term, a Veteran with a lobotomy and a Veteran on a cocktail of drugs have the same net behavior, then the VA is still in the business of Lobotomies.

Getting Off the Drugs

I knew that I would not be able to live a normal life without addressing and managing the symptoms of PTSD. It became apparent through that process, that I couldn’t live a normal life with these drugs either. I developed a plan with my therapist to get off the drugs and it was not only a personal goal, but a goal of therapy as well.  Coming down off of my meds was horrible. I could hear my heartbeat in my ears. I was even more irritable than normal. When I found that I was coming down and I was having a hard time, I often ran right back to the medicine cabinet. Cold Turkey was painful, so I started cutting my pills. It was so bad and I was such a bastard, my wife could tell when I was coming down and would often ask. Ultimately, I went through the full withdrawal by talking with my doctor and flat stopped ordering them from the VA. It was a harrowing month for everyone in my house. Headache’s, nausea, the ringing in my ears, erratic heartbeat. Getting to sleep was hell. But, I am so glad now that I was able to kick them. Losing weight was easier. My concentration improved. My creativity returned. Instead of an emotionally blunted existence, I was able to feel deeply again.

The Substitute

The short and easy answer to a drug alternative is pretty simple: stay in therapy (I transitioned out of “one on one” and into group), exercise regularly, and eat right. All of those things make a difference. I was and am regimented about therapy, exercise, and food. When any of them slip, I feel off balance. Attack those three with vigor and you will be well on your way to kicking the meds and living a more fulfilled Post Traumatic life.

Please comment if you are a Veteran or family member and still under the influence of the VA meds or had a similar story.   As always, please share and thanks again for reading.

Thank you!

To everyone who is reading along and sharing, I just wanted to say a quick note of thanks!

This has been an emotional ride, but knowing that there is support out in the real world is very comforting.

Thanks again!

Andrew Asks Anything is out

In one of the more serendipitous moments of my life I met Andrew Sullivan at an Equality Diner at West Point earlier this year.  My first splash on his website that references this blog on “The Daily Dish” is “A Veteran Vents”.

He then gave me a huge shout out as I put a team together for Suicide Prevention Awareness.

At one point he asked me to join him in a conversation as part of a podcast series he was putting together.  I obliged and it was a great experience.  After listening to it again, I realize I use the royal “we” more than I should have, and I have a few tin foil hat moments, but that is all me and I stand by it, warts and all.

You have to be a subscriber to listen to the podcast, a modest $1.99 a month, and the link to the article on “The Dish” is here.

I hope it spreads awareness and frank conversation.  As always, a huge thank you is in order to my family who keep me on the level.  Especially my wife and my Mom.  Love you Mom.  Thanks again for reading.



The Vet’s Day Hangover & 3 easy steps to kick the next 7 Weeks in the Ass

Veteran’s Day Recap:

Well, I’m glad that is over. Veteran’s Day is as emotional to me as Memorial Day. Generally speaking, my wife and I hunker down and drag ourselves through the day. This year we both took off from work and that brought its own set of challenges, especially when the Veteran’s Day Parade and ESPN wouldn’t let us avoid as much as we desired.

The best article I read far and away was in The Atlantic by Alex Horton. The title summarizes the sentiment and is worth the read: “Help Veterans by Taking them off the Pedestal”

“That’s the problem with viewing something on a pedestal: you can only see one side at a time, and rarely at depth. It produces extremes—the valiant hero or the downtrodden, unstable veteran.”

My general approach, which has been more refined as years pass, is talk less, do more. (or in a more monosyllabic and brute fashion: Get. Shit. Done.) I appreciate Alex’s frank reasoning to drop the self applied super hero label.

On Veteran’s Day I also had the privilege to participate in WOD for Warriors with Islip Crossfit. If you live on Long Island I highly recommend three Crossfit Boxes: Islip Crossfit, Crossfit Undivided and, of course, Crossfit Lindy. Erica Pollack, of Islip Crossfit asked me to say a few words, and those words, as my family will support, invariably turned to tears. But, I think the message was well received and the WOD was a burner. If you want to get involved, I highly recommend checking out Team Red White and Blue for year round Veteran interaction and community building.


On to the Ass Kicking

These next six weeks, as merry and bright as they are at times, are also peak for lots of heart ache, stress and general self inflicted misery.

I have formulated a simple plan that has helped me get through. It requires a little time set aside for introspection, but on the whole, if I have put in the work it has allowed me to sprint into the new year. You will need a piece of paper and a writing implement.

Step 1: Visualize the optimized refreshed you of January 2nd 2014. For me, this is a lighter stronger person. When I say lighter and stronger I am not just referring to physically, but mentally and spiritually too.

Step 2: Pick three attributes that if you could fast forward to the new year you would want to manifest(poof like magic) and that can be tracked empirically. Certainly the tricky part of step 2 is assigning something that can be tracked to an empirical observation. “Happy” can be an attribute, but you have to link it to something that you can measure. Smiling for me is a good link to happiness. For an empirical tracker I would track smiles per day. “Lighter” and physical weight is my favorite for keeping away the holiday poundage.

Step 3: Write it down, sign it, keep it with you and look at it every day. The key to success for the three attributes is the ability to answer a yes or no question on January 2nd. For instance, “Lighter: I workout often and weigh less than I did on 15 November 2013 (192#)”. The question is “do I weigh less?”. Hopefully in January, it is a resounding “yes!”

Here are my other two:
“Happier: I think of my family everyday and smile.”
“Giving: I donate each week to my favorite charities and attend one fundraising event.”

See, three easy steps. When that line gets a little long, when the day drags, or traffic is a nightmare, when some one is snarky or mean, take out your little slip of paper, focus on those attributes and keep moving.  Let me know if you take on this little task. Charge into the new year by kicking ass the next seven weeks!

The burden of the Family and PTSD

They family doesn’t always know what to say to the Veteran. Whispering the event of the day so as not to rekindle the spark that ignited the rage, the violence, and finally the shame.

The family doesn’t always see the Veteran. The Veteran has withdrawn into isolation. The holidays bring too much emotion to feel safe. Too much anxiety to feel normal.

The family doesn’t always hear the Veteran. Yet they know he struggles and cries out in his sleep. His angry outburst is not directed at them but a manifestation of the grief that lingers and interferes.

The family doesn’t always hold the Veteran. They stand to the side, though they long to hug the boy that left for war. His Soldierly pride prevents their warm embrace.

The family will always love the Veteran. He wishes he could show them and tell them how much more he needs their love. He loves from a distance. The pain of losing more is too great to face. The family tries to understand.

The Internal Voice and PTSD

“Learning to stop negative internal voices has tremendously positive implications for anything you ever want to do in your life.” ~ Greg Glassman, Crossfit Founder

I just finished a half marathon.  The last time I ran one the Walkman was the main music engine and this thing called an iPod had just been launched. (That last sentence makes me sound so old… yeesh). One thing I particularly noticed was the majority of people run with headphones. I did not run the half marathon with a group and I tried to strike up conversation wherever I could. I only spoke with a few people. For most of the race, since most people were buried in their headphones, I actually took to tweet and converse with friends and family. (@mikeypiro by the way).

Since I had a few hours to reflect, I thought hard about the quote above from Coach Glassman. I have been going to Crossfit for about two years now. I credit Crossfit with assisting me in my final push to get off medication. I still rely on Crossfit to purge my mind after a long stressful day. But I think that one aspect Coach Glassman is not explicit about in the quote above is the importance of external voices and community to help when those internal voices start to bring you down. Every once in a while the internal voice need the external voices. Whether that is in therapy, screaming encouragement from the sideline of the races, or during the end of a WOD, those voices need to connect.

In the past the most dangerous place I could be was in my own head. I wanted to escape and avoid the barrage of negative thoughts. It proved nearly impossible to do alone. I leaned hard on my family, my friends and my therapist to talk about and work through everything that happened between my ears. One of the most successful therapies I completed, Prolonged Exposure Therapy, essentially forced my internal voice out. I then listened to it over and over. It helped me realize over time that the emotions bundled along side my description of a traumatic event warped my perceptions.  Before I sought therapy and long after returning from combat, those perceptions and experiences greatly and negatively impacted how I thought and acted.

I cannot stress enough how important it is to keep the internal voice positive and challenged. I returned to the quote above because I recently found myself coasting or dogging my Crossfit workouts.  “That is good enough” or a split second thought of “Shit we are only half way done” was not only killing my scores, but effecting my world outside of the workouts.

There are many justified reasons for pulling back from time to time.  But, when I stopped challenging myself, my self esteem and mood suffered because of it. After a few particularly difficult workouts, I knew I had to really search inside to rework my internal voice. I also knew I could rely on my support network to encourage and motivate me.

The last mile of the half marathon again tested the tone of my internal voice. I focused on the positive affirmations. I listened to the cheering crowds. Thanks to that mindful effort I finished and felt great. I wish more people would put away their headphones and let the voices merge. It is great practice for when you are all alone.

7 Down, 4 to go.  Thanks for reading.