Monthly Archives: January 2014

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.

Pride

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.

<Spoilers>

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:

ActofValorblack_hawk_downSaving_Private_Ryan_posterZeroDarkThirty

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.