This is a version of presenation that I give for free around the state of Oregon. My intent is to change the way the military and veterans talk about combat stress injurie and PTSD, to make it more of an open topic. Currently we hear the term and we 'tune out' and don't seek the help so many of us need. Understanding what is happening in the brain and soul, with respect to our uniform and our warrior ethos, has helped many soldiers/marines begin treatment. I am always reworking this to make the message better. I try to relate to the audience and use my credentials as infantry instructor and combat vet to that effect.

1. PTSD from a Veteran

2. Personal Considerations
• This presentation will contain images, and
topics about combat and Post Traumatic
Stress Disorder (PTSD).
• I intend to evoke an emotional response.
• If you feel uncomfortable at any time you may
leave without comment or question.

5. • ‘Joes’ are divorcing
Soldiers Around Me…
• Lots of beer drinking
• Risk taking (fights)
and not caring about
consequences
• Drug and Alcohol
Abuse
• Joblessness
• Nightmares and lack
of sleep
• Attrition of NCOs

6. • Driving at night at 30 MPH a trigger
Myself
• Easily irritated
• Hyper vigilant- very wearisome
• Startle response
• Merging onto the freeway and driving
• Relationships ended
• Easy to get into a fight
• No memory/concentration
• Strange emotions unexpected
• 4th of July was no fun

7. 2005 Oregon Violent Death Report

9. 2000 to 2006, 1,066 male veterans in Oregon took their lives.
In 2005, 19 Oregon Soldiers died in combat
in Iraq and Afghanistan.
That same year, 153 Oregon Veterans, of all
ages, serving in various wars, committed
suicide.
Nationwide, after five years of war in
Iraq, Marine suicides doubled between
2006 and 2007, and Army suicides are at
the highest level since records were first
kept in 1980.
Reported suicide attempts jumped
500 percent between 2002 and 2007.

10. 6 years
72 months
288 weeks
1066 Oregon Suicides
3.7 Suicides a Week

11. A 2003 New England
Journal of Medicine Study
found that more than 60
percent of those showing
symptoms (PTSD) were
unlikely to seek help
because of fears of
stigmatization or loss of
career advancement
opportunities.

12. According to the PDRHL
from the Department of
Defense Behavioral Health
Survey 43% of 2000
National Guard
Members had
readjustment issues
after returning from the
war zone(s).

13. I would be seen as weak by my unit members 65%
My unit leadership might treat me differently 63%
My unit would have less confidence in me 59%
My leaders would blame me for the problem 51%
It would harm my career 50%
Difficulty getting time off for the problem 55%
It is difficult to schedule an appointment 45%
I don’t trust mental health professionals 38%
Mental health care doesn’t work 25%
I don’t know where to get help 22%

14. Red Badge of Stephen Crane’s book about
the Civil War contained themes
Courage of masculinity symbolized by
war.
Where are the mental wounds?
We discount them because
they are
• invisible
• counter to our notions of
masculinity
• “secondary”

17. I don’t rate feeling
this way

18. A Veteran

19. And what about when
your warrior’s anger
goes home? What is
it like with his wife
and children? Is it
useful then, too?
Cicero

20. PTSD from Ancient Greece to the
Present
• Sophocles, Homer
• Nostalgia
• Hysteria
• Bible’s Job, Joseph, David
• Shellshock
• Buck fever
• Combat fatigue
• Battle reaction
• Disorderly action of the
heart
• Soldier’s heart
• Homesickness
• Irritable heart

21. Called combat fatigue
and it was a serious
problem. WWII
In the European
Theater, 25 percent of all
casualties were serious
PTSD cases.
In the Pacific
Theater, like Okinawa in
1945, it accounted for
over a third of all

22. Iraq and According to a more recent
Post-Deployment Health
Afghanistan Reassessment 38 percent of
regular soldiers, 31 percent of
Marines, and 49 percent of
National Guard report
psychological symptoms.
Those who had served
repeated deployments were at
extremely high risk of problems
and the toll on their family
members was great.

23. What is going on?

24. The Brain

25. Phineas Gage On September
13, 1848, Phineas
Gage was
foreman of a work
gang blasting rock
while clearing the
roadbed for a new
rail line.

27. Conditioning
• Pavlov in 1904
• Skinner developed
further into
Behavioral
engineering
• Rewards and
Punishments develop
automatic
behaviors

28. “Train Like You Fight”
Methods used to train is
an application of
conditioning techniques to
develop ‘quick shoot’
ability.
The modern soldier trains
in full gear, shooting
blanks at realistic targets
until reflexive fire is
obtained.

29. Train Realistically
This muscular, life sized
male upper torso body
form is intended
specifically for precise
marksmanship training.
The cavity in its back
holds red balloons to
resemble vital organs.
The body drops when a
red balloon is shot.

30. The Unnatural Act of Killing Another
• It is estimated that in
World War II, 75 to 80
percent of riflemen did not
fire their weapons at an
exposed enemy.
• In previous wars nonfiring
rates were similar.
• In Vietnam the nonfiring
rate was close to 5 percent

31. I yelled “kill, kill” ‘til I was hoarse. We yelled
it as we engaged in bayonet and hand-to-
hand combat drills. And then we sang about
it as we marched. I had stopped hunting
when I was sixteen. I had wounded a squirrel.
It looked up at me with its big, soft brown
eyes as I put it out of its misery. In 1969 I was
drafted and very uncertain about the war. I
had nothing against the Viet Cong. But by the
end of Basic Training, I was ready to kill them.
-Jack, Vietnam Veteran
On Killing

32. “To survive and be victorious on the battlefield, our
warriors must aggressively seek out the enemy and kill
them. This has far reaching spiritual and psychological
implications. In order to be “successful” the warrior must
not miss a beat in pursuing and eliminating adversaries one
after another. When they attack the enemy, they are
trained to go one step beyond personal moral boundaries
and take the life of another human being. This eventually
becomes their personal horror of war- this is one primary
aspect that damages the soul. The “killer instinct” that is
so energetically thrown around in locker rooms and
corporate sales meetings becomes a very real impulse to
soldiers in the heat of battle. Without this instinct the
warrior is very lucky– or very dead.”
Down Range: To Iraq and Back

33. Amygdala
• Connection with lots of
areas of the brain
• Emotional stamping of
events
• Increases reflexive
reactions
• Signals sent ‘upward’
are checked by
prefrontal cortex.

34. Amygdala

36. Almost all service members returning from
the war zone will experience some of these
behaviors and reactions. It’s vital that you
remember that having these reactions does
NOT automatically mean you have PTSD. It
would be abnormal if you didn’t experience
some of these feelings and behaviors following
what you have been through in the war zone.
It isn’t an Either/Or… it is a spectrum

37. Signs & Symptoms of PTSD
• Flashbacks, or reliving the • Self-destructive
traumatic event for behavior, such as drinking
minutes or even days at a too much
time • Hopelessness about the
• Shame or guilt future
• Upsetting dreams about • Trouble sleeping
the traumatic event • Memory problems
• Trying to avoid thinking or • Trouble concentrating
talking about the • Being easily startled or
traumatic event frightened
• Feeling emotionally numb • Not enjoying activities
• Irritability or anger you once enjoyed
• Poor relationships • Hearing or seeing things
that aren't there

38. Anxiety
• The mind stays on • Physical symptoms
vigilant, ever on alert.
• Emotional fatigue
• This keeps emotions and
the body aroused. • Mental fatigue
• Chronic or severe arousal • Spiritual fatigue
changes the nervous
system.
• Smaller threats than usual • Exaggerated stress
sound the alarm. response
• Takes longer to return to • Avoidance is hallmark
resting state.

39. Dissociation
• Perceived detachment of • Traumatic memories are
the mind from emotional walled off
states or even the body. • Dissociated material is
• Dreamlike state or unreal highly emotional and
place. relatively non verbal
• Poor memory of specific • Triggers can be the
event sense, body
• DID, Fugue movement, dates, stressf
• Fragmented ul events, strong
emotions, cognitive
• State-dependent patterns, behaviors, out
memories of the blue, and
combination.

40. What is Dysfunctional?
• Impaired in function;
especially of a bodily
system or organ (of a trait
or condition) failing to
serve an adjustive
purpose.
• If a person is behaving in
ways counter-productive
to their own well-being

41. B Buddies VS Withdrawal
A Accountability VS Controlling
Inappropriate
T Targeted VS
Aggression
T Tactical Awareness VS Hyper-vigilance
L Lethally Armed VS Locked and Loaded
E Emotional Control VS Detachment
Mission Operational
M Security
VS Secretiveness
I Individual Responsibility VS Guilt
Non-defensive Driving
N (combat)
VS Aggressive Driving
D Discipline and Ordering VS Conflict

42. • Medication
Many Treatment • Psychotherapy
Options • Exposure Therapy
• Cognitive Behavioral
Therapy (CBT)
• Eye Movement
Desensitization &
Reprocessing (EMDR)
• Memory Work
• Art Therapy
• Thought Field Therapy
• Healing Rituals
• Group Therapy
• And More…

43. Call of Duty 4
U.S. Army medical researchers have noted that
soldiers that play violent video games, are better
able to handle the stress of combat. More
elaborate (virtual reality) combat simulations are
now being used to treat combat veterans who
are suffering from severe stress reactions from
combat (PTSD, post-traumatic stress disorder).
www.strategypage.com

44. Pathologizing
It is important that therapists who work with veterans
be educated in the warrior tradition and its rituals in
order to recognize and help veterans identify with [the
use of] warrior traits. Ignoring these traits is harmful
to the veteran, for then the inner warrior remains
invisible. Pathologizing the traits is also harmful, for
then the vet is further wounded by reductionist
interpretations that may minimize their importance
to him… or empty them of their spiritual potency.
-Edward Tick, Ph.D.
War and the Soul

45. Strengths of our
warrior tradition

46. What is a HERO
?

47. I am an American Soldier.
I am a Warrior and a member of a team. I serve
the people of the United States, and live the
Army Values.
I will always place the mission first.
I will never accept defeat.
I will never quit.
I will never leave a fallen comrade.
I am disciplined, physically and mentally tough,
trained and proficient in my warrior tasks
and drills.
I always maintain my arms, my equipment and
myself.
I am an expert and I am a professional.
I stand ready to deploy, engage, and destroy, the
enemies of the United States of America in
close combat.
I am a guardian of freedom and the American
way of life.
I am an American Soldier.

49. You might feel you can go it
alone, but….
Post Traumatic Stress
Disorder (PTSD) is not
only an individual
problem but also a
family and
community
problem.

50. Family Members
• Provide opportunities to • Do not pressure to talk
talk • Do not stop them from
• Don’t be afraid to ask about talking
the war • Try not to make judgmental
• Accept your limitations statements
• Offer • Avoid telling what one
attention, interest, and care ‘should’ do
• Educate yourself • Watch for clichés or easy
• Find available resources answers (war is hell)
• Be supportive with • Avoid giving advice without
expectation that fully listening
readjustment will occur • Don’t rush things

51. MyHeroesAtHome.com

52. Community
• Join the local VFW or
American Legion
• Battle Buddy
• Create a book club
• Mosaic.com
• Welcome home every
vet you see
• Join Vets4Vets.com
• Volunteer, even though
you don’t feel like it

53. Quick Rundown
• Training has given you faster reflexes for combat actions
• Experiences give emotional shaping to memory
• It is normal to have mixed feelings about wartime
experience
• Having some symptoms does NOT automatically mean you
have PTSD
• Only a clinician can diagnose you with PTSD
• PTSD is not permanent and many treatments are available
• There are MANY resources available for treatment
• If left untreated it will negatively impact everyone around
you
• Healing is found via community

54. warriormyth.blogspot.com

55. Thank You

56. Hotlines