![PTSD Awareness Month in June. Post Traumatic Stress Disorder. Celebrated annual in United States. Medical health care and awareness design. Poster, card, banner and background. Vector illustration PTSD Awareness Month in June. Post Traumatic Stress Disorder. Celebrated annual in United States. Medical health care and awareness design. Poster, card, banner and background. Vector illustration](https://substackcdn.com/image/fetch/w_1456,c_limit,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F6eb74102-005f-4c1b-9ae1-d8ad7dcedc03_2235x1341.heic)
Recently, someone T-boned our SUV at a four-way stop, hard enough to roll it over onto its roof. As my wife and I rolled on our side and then settled upside down and hung from our seatbelts, my mind left that intersection and that fall Sunday in Maryland. Our SUV became a Humvee in Iraq. Its interior changed from blue and soft to green and metal with black equipment. Scrubland and an Iraqi road rotated in my mind until they were upside down. Fortunately, the flashback didn’t last as long as it would have five years earlier. I returned to my wife and the present as we struggled to release our seatbelts. But emotions from my past lingered. I feared our SUV would catch on fire. Part of me was panicking because it had happened before, but not our vehicle, not even to one I’d been in. The wreck was pulling me backwards to a past someone had shared with me.
I never experienced a Humvee rollover in the military, outside of training on my way to Iraq. I’d heard many stories from soldiers and Marines who’d been in vehicle rollovers in Iraq and Afghanistan. I’d treated them for PTSD as a Navy psychiatrist. I’m sure that’s where the images came from. Remnants of their stories remained in my mind. Some saw their buddies burn alive. That’s where my certainty and anxiety about our SUV’s potential for a fire came from. I can remember someone’s story much easier than I can a face. It helps for being a psychiatrist, but can also feel like a curse.
Officially, you have to experience a near-death situation or sexual violence, witness it, or hear stories of such situations to have PTSD. The psychiatrists who revised the official definition about ten years ago added the last one after research on what’s called vicarious traumatization. That’s where hearing the stories from survivors of trauma overwhelms you. I have PTSD from that, from the cumulative effects of treating hundreds of service members, if not a thousand or more, with PTSD during my twenty years in the Navy. I also have it from my own experiences in Iraq from 2008 to 2009.
The car accident brought up memories from Iraq and the military. My wife and I talked about that time as part of processing the car accident and its effects on us. She told me that, when I returned from Iraq, I wasn’t the same. I kept my distance emotionally. I never smiled as much or became as happy as I did before. She also said I no longer seemed as present. Part of me lived somewhere else.
Many people with PTSD say the worst feelings come back with an idle mind. Without distractions, time collapses back to those moments when you faced your own mortality, whether from combat, a car accident, or a personal attack such as robbery or rape. In my experience, service members and others who’ve endured traumatic experiences want to avoid remembering them but they can’t forget them. They often bury themselves in either work or alcohol or drugs, or all of the above. I chose work.
In the military, it’s easy to bury yourself in your work because there’s always more to do and because most of your co-workers also have PTSD. They’ve deployed, too. Among my psychiatrists colleagues, they’d also heard the same stories I did. I felt more understood among them, almost at ease. Like others who’ve found a group with similar traumatic experiences, I believed no one else outside that world could understand. Police officers and others in violent or risky professions have similar experiences. One of my mentors in treating PTSD calls this phenomenon “siblings in the same darkness.” Another calls PTSD itself a disease of forgetting. I, just like others around me, couldn’t forget but also didn’t want to remember.
I lived in such a world at Walter Reed for about a decade from 2009 until I retired from the Navy in 2019. There was comfort there, probably why many people who’ve served often take government or contract jobs in the same place after they retire. By 2019, I had no interest in that. My wife, a psychologist, did a good job reconnecting with me, and through her, I reconnected to the civilian world. I’m lucky her love saved me. Many service members face divorce because they give up that connection, or they and their partners don’t know how to revive it.
I once had an argument with a Marine regimental commander. He was in charge of a regional recruitment command. We were the same rank. I was treating one of his Marines for PTSD. Aaron had sought help because he was struggling as a recruiter. It’s a very tough, high stress job to begin with, and all enlisted Marines have to do a tour of either it or Drill Instructor duty to enhance their career progression. Aaron had deployed several times, lost buddies. He chose recruiter duty to keep from deploying again, not to recruit. Working in small towns in a northeastern state, this was his first duty away from large Marine bases. He didn’t have his siblings in the same darkness for support.
Aaron struggled because he hadn’t processed much of his traumatic experiences from combat. He hadn’t comes to terms with any of it. He couldn’t connect to civilian life and high schoolers anymore. When he did start to see their perspectives, these kids who’d never seen bad shit, he didn’t want them to sign up. He didn’t want them to experience the things he had and then live in a traumatized state. It also didn’t help that some of their mothers yelled at him for talking to their kids about joining the Marines. Paradoxically, the unprocessed trauma kept him in the Marines to be among people who understood, but he couldn’t do Marine work anymore because of the unprocessed trauma, or PTSD.
His regimental commander didn’t believe in PTSD. He called it a moral failing. After I held my ground and explained its symptoms and how Aaron exhibited them and how they were causing him to fail at his job, the commander finally said, “Well Doc, if he has it, then we all have it. And what am I supposed to do then?”
That was the problem. They likely all had PTSD and couldn’t connect with the civilians around them. I imagine many of his Marines were suffering in silence, drinking heavily, and at risk of taking their own lives. But with labeling PTSD a moral failing, a weakness, he showed that he couldn’t tolerate it in them or in himself. They were all struggling, including him. Unfortunately, he wasn’t ready for himself or the rest of his command to try to deal with it, so he wanted to keep them all buried in their recruitment quotas. Ironically, I was burying myself in my work to avoid dealing with my own PTSD. Eventually, he allowed Aaron to leave recruitment duty, but told me I was ruining Aaron’s career. He refused any help for his other Marines.
If Aaron had stayed in his job, alone, without a way to process his traumatic experiences, he likely would’ve killed himself. PTSD often causes suicide among veterans. It’s not necessarily the traumatic events themselves, but living alone with them. We’re social beings. We need each other to process events. We laugh together and cry together. When service members leave the military, they return to a civilian world where they feel no one can understand what they’ve been through. The same can happen within the military, when service members move or change commands or go into recruitment duty like Aaron. They lose the connections they have.
Staying where I had siblings in the same darkness is one reason I fought to remain at Walter Reed for those last ten years I was in the Navy. I felt connected to people there and the place itself where I’d helped treat service members with horrible injuries. When such ties are lost, someone with PTSD struggles to make new connections. They turn inward, into their memories and all the feelings from them, such as anger, shame, and guilt. Such isolation can crush and destroy anyone, and sadly, it has killed many of our active duty service members and veterans.
I experienced such devastating isolation and shame myself when I first returned from Iraq in 2009. The unit I’d worked in, an Army Combat Stress Control Unit, remained on bases in northern Iraq. I still felt connected to its members, and also to my patients there. I’d lost a patient to suicide in Iraq, and I blamed myself for his death. While everyone I knew there remained in danger, I felt guilty for leaving them and returning to my family and safety. And during my last few nights there, I’d endured mortar attacks that killed Americans around me. Those moments of near death remained on my mind and reinforced my guilt for being safe.
With my mind stuck on people I knew and had lost in Iraq, I couldn’t reconnect with my family when I returned. I felt nothing for them, which frustrated me further. Their joy on seeing me, their emotional needs and love overwhelmed me. I couldn’t feel anything in the present, and believed I had nowhere to turn. As part of PTSD, I convinced myself there was no one around me who could understand. I felt too ashamed to try to explain to others my lack of feelings for my family. Suicide started to make sense. I thought of crashing my car. Fortunately, I no longer had the pistol I’d carried in Iraq. After nearly a week, I reconnected with our young son when he hurt his hand in an accident. I saw how much he needed me. I fought my desire to die in order to be there for him. My thoughts of suicide passed.
What to Do
People with PTSD find others who have it too because they intuitively know that processing the traumatic events is the only way to come to terms with them. It’s important to accept the vulnerability, the moment of facing your own death, in order to return to the present. That can feel painful and counter-intuitive. Even as a psychiatrist, it was for me. But it’s really the only way to keep the past from haunting and controlling your life.
People reconnect with the present through other people. You have to find someone you trust. They might be close friends or your spouse. It might be a therapist or perhaps clergy. It needs to be someone who can listen and be there for you while you process and feel what you don’t want to feel. You must allow what you’ve experienced to be part of your life, to accept it as part of you and part of the world we live in. Otherwise, those experiences remained pushed away, rejected, partitioned off. From there, they keep pulling you backwards into the past, just as some unprocessed part of my past came up during the car accident. If those memories remain powerful enough, they cause emotional numbness, deadness, and isolation.
If people close to you can’t tolerate hearing, or don’t want to hear, your experiences, then find a good therapist who knows how to work with traumatic experiences. But be aware that the work isn’t easy and can take a while. Be patient with yourself and the process. Don’t fall for anyone claiming they have a quick fix for PTSD. Those one-session fixes, or drug-assisted therapies, don’t work. If it sounds too good to be true, it probably is.
Medications can help with some symptoms, but not with resolving PTSD itself. Be careful not to allow a psychiatrist to put you on too many medications. It’s easy, particularly for an inexperienced psychiatrist, to chase your symptoms while trying to help. You end up on four or five meds but still have problems. Therapy is where you will get the most help.
Even with good treatment, the experiences stay with you and can return unexpectedly as my car accident showed, but the flashbacks aren’t as intense. The past doesn’t take over your life as much as before.
If you are fortunate, as you process your experiences and live more in the present, you might find a new direction and meaning for your life. It might be related to your experiences, such as advocacy work, or it might mean rededication to your family. I found some of both.
As I remained at Walter Reed and slowly processed my experiences, my family and writing became my new priorities. I no longer felt a pull to remain in the military with others who’d endured similar traumas. I needed my family. I made time to attend my son’s school functions and track meets in middle school and high school. Even as that change occurred for me, my prior excessive focus on work led to me being selected for promotion to Navy captain, the equivalent of Army colonel. I turned it down and retired.
In those final years, a soldier I was treating told me he’d decided to pursue what he wanted to do before someone “turns off my lights like I did to so many.” I heard advice in his words. He helped me listen to that voice in my gut on what I really wanted. I began writing again after stopping it for medical school years earlier. It’s helped me process my experiences and share them with others.
I hope by reading this, you’ve learned some about the experience of PTSD and, if you or someone you know has it, what’s necessary to do in order to return to the present and develop a sense of having a future again.
My father, who was a WWII veteran, was recalled to the service for Korea and stayed in the Air Force. He was fine and happy as long as he was stationed with his friends. His, our life unraveled when he took a posting as a military liaison at a plant that built nuclear missiles. It was hard for me because I was accustomed to other military kids and the considerably more cosmopolitan atmosphere of a base that we traded for a small southern town. A few days before his death he asked my mom if she’d support him if he checked into a hospital. She had no idea what he was going through and said she would. I think the shame of it and the potential impact on his career led him to choose death. This one really resonated with my personal experience. Thanks.
I went through a period of thinking of 'crashing my car' as well. After my medical discharge, I lost the people who were my support system, my military brothers and sisters. It was like they just unplugged themselves from my life.