Thoughts from the Frontline of Treatment for Veterans and First Responders With PTSD
"Whilst safety depends on numbness, the cost is connection, relationship, support and community, the very things that sustain human life and promote recovery. For people who dedicated their life to the preservation of human life, saving their own life requires a significant gear shift, and the calling up of a very alien form of heroism."
In recent years I have worked with a number of veterans and first responders whose lives have been all but crippled by PTSD, and whose recovery journeys have touched me so deeply that it is difficult to put into words the sense of privilege I experience in working with these people. These are people who have made immense emotional, psychological and physical sacrifices in service of rescuing and protecting their fellow citizens, but who rarely see it that way. In the aftermath of those sacrifices, these incredible people live with a permanent sense of unsafety and an ever-present state of hyper-vigilance, and in the cruellest of paradoxes, the emergency that they once hosed down, policed, or stretchered people out of,….the war that they once walked into to keep the rest of us safe,…now lives within them, a terrifying and sickening internal reality that they cannot escape from.
In my eyes, these people are unsung heroes every day of the week, long after their service in the military or the emergency services has ended. The word trauma often gets bandied about and misused, so out of respect for what our veterans, police officers, fire fighters and ambulance officers actually face when they develop PTSD, I want to clarify that PTSD is next level trauma. The heroism required to live with this condition is a heroism that exists in a class of its own. These are people whose lives have been ravaged by trauma and who are in the fight of their life just to survive it, let alone learning how to thrive beyond it.
The suicide rates amongst veterans and first responders speak very clearly to this. Every day is a battle. A retired paramedic recently said to me, “I wish that people around me could understand the relentlessness. There is very little respite. It’s like having an aggressor in your life, only the aggressor is inside you. 24 hours a day, 7 days a week, any innocent, benign moment can instantly turn into a nightmare. Just a word, a sound, a smell, a touch can trigger a violent flashback or dissociative event, and you never know when it’s going to happen, so you can’t trust your own mind and body. It’s like a cancer of your threat system.”
Veterans and first responders with PTSD also struggle significantly with the transition from a life filled with the pride and purposefulness of being of service to others, to one where they are not of service to anyone. For some, they have drawn almost their entire sense of self from their service, and then to end up in a place where not only does acting in that role become untenable, but the need for so much help from others has unthinkably become the new status quo. For people whose entire reason for living has been to serve and protect others, becoming so dependent on the help of others is like the world tilting on its axis, and the sense of emptiness and burdensomeness and lack of purpose can feel like torture. A vital aspect of recovery lies in finding meaning and purpose elsewhere, and in learning how to experience a sense of value beyond being helpful to others.
But first, the dial on the person’s threat system has to be turned right down, the traumatic memories processed and integrated enough so that engaging with life and being connected to others becomes viable again. Most withdraw from the world of human relationships and shrink into isolation, numbness and a ‘barely there’ existence in an effort to protect both themselves and others from their PTSD. Bessel Van der Kolk says “Intense and barely controllable urges and emotions make people feel crazy, and like they don’t belong to the human race. Feeling numb during birthday parties for your kids or in response to the death of loved ones makes people feel like monsters. Shame becomes the dominant emotion.”
Veterans and first responders need above all to be safely re-homed within their own minds and bodies so that they can bear to be inside their own skin and risk feeling again. Whilst safety depends on numbness, the cost is connection, relationship, support and community, the very things that sustain human life and promote recovery. For people who dedicated their life to the preservation of human life, saving their own life requires a very significant gear shift, and the calling up of a very alien form of heroism…one that involves including themselves in their call of duty.