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Mark Goulston M.D., F.A.P.A.
Mark Goulston M.D., F.A.P.A.
Post-Traumatic Stress Disorder

Having Horror Heard Helps Heal Hurt

Fixing PTSD from the inside out

Having Horror Heard Helps Heal Hurt

“Take out that house! That’s where the sniper fire is coming from!” You do that and then you discover no sniper, but you have killed an entire family complete with a grandfather holding a grandchild and dog, many with lifeless eyes open asking you “Why did you do this?” And with no sign of a sniper it’s on to the next house or village to repeat all over again.

Or “If they won’t get off the road just run them over (followed by the bump and crunch as your Humvee tires snuff out another human life).”

Ghastly? Pretty horrendous? Unimaginably gruesome? There is no statute of limitations nor training manual to get you over or even beyond the horrors you can inflict on another human being in the name of war that you then have to then live with the rest of your life.

Welcome to the world of wartime PTSD and its aftermath.

Horror affects us by causing our thinking (upper human brain), feeling (middle mammalian brain) and doing (lower reptile brain) parts of our minds to decouple (functionally break apart and not communicate freely) from each other. That is because the horror is so much that we can’t tolerate it in its totality so each part of our mind – thinking, feeling and doing tries to process it in chunks. That is why it’s no coincidence that expressions like: “Losing my mind,” “Flipped out,” “Wigged out,” “Out of my mind” are used so frequently to describe it. Despite our minds coming apart we can still go on to function if we are well trained. The training forms a kind of exoskeleton that does what it habitually does even while all our mental innards have come apart.

In actuality the period where your three minds have functionally broken apart are just in the beginning stages of reconfiguring with themselves to adapt to the new reality as it is. The problem is that when your three minds pull apart you don’t know that they will come back together again. In fact it feels more like the next step is that you will fragment and then shatter and never come back together again.

It is in that pre-fragment period that pushes most people to panic and reach for anything to take the unbearable pain away by using drugs and alcohol, throwing oneself into indiscriminate sexuality, running away, getting into fights and when it becomes completely intolerable to thoughts of and to actual suicide. In fact nearly all the symptoms of PTSD are a way to manage the terrified feeling that your mind has started to come apart and the next step is for it to fragment and shatter from where there is no return.

What is the answer?

If you perpetrated an awful horror on the world and you were a child and ran to your parents who you were fortunate enough to feel safe and trust to say what you did, just having your horror heard by them would begin to heal the hurt. The clearer you can put into words the horrific things you saw and did, the closer you can re-feel them (which will not be pretty to feel or to hear). The key on your side is to describe exactly what happened so clearly that the person you are telling can see it and feel the impact. The key on their end is to hear you out until you have fully expressed whatever you are thinking, feeling or feel pushed to do, before they offer any solution or advice. If they jump in with solutions too soon, it means they couldn’t bear hearing what you had to say, because they couldn’t bear feeling the horror that you felt and that can leave you exposed, vulnerable and out on a limb alone. When you see the tears or fear or sadness in that other person’s eyes, you are feeling felt and no longer feeling alone. It’s in that state of re-experiencing your feelings, having them heard (and not merely listened to) and feeling felt by the other person that the way your mind is configured to that event can begin to reconfigure according to the present situation.

But telling your parents this time or anyone else who has not personally experienced what you are describing will not do the trick. Anyone who has not committed the same act does not know how it really feels and what it is to live with the nightmare of it nightly and daily.

What it takes is sharing the stories upward as in a fire bucket brigade with others who did exactly what you did, but who are one or two steps beyond you in getting better and over it. And the parallel of using that brigade to put out a fire is more than just symbolic. Someone who is too far over it won’t work because you can say to yourself, “Well that worked for him/her because they’re strong and not crazy like me, it’ll never work for me.”

This was exactly the effect that 500+ returning Marines who went through a Marine Civilian Transition Program from 2006 – 2008 had. That program helped them develop a personal mission and gain insight into themselves, but hands down the most valued part of it was the one on one time each Marine had with the program’s co-founder, Lt. General Marty Steele, former COO of the Marines. When I asked General Steele what did you and these Marines talk about. He said that he asked them what’s going on Marine and looked deeply into their eyes, it took them a while but they began to say, “Sir, I saw and did a lot of bad things and I can’t stop thinking about them.” General Steele listened even more so that each soldier could not only feel understood, but “feel felt.” It was after the latter that these soldiers were able to then heed his words and advice, “War is necessary, but it’s not pretty. You did what all soldiers do and then have to live with it. That is who we are and makes us special. But you need to let this go for the good of your family, friends and your future. You have earned the right to let it go, you deserve to let it go.” And when you get a direct order from a Three Star General, you tend to listen.

Years later General Steele continues to receive letters from grateful veterans and their spouses some saying that he saved their lives. He did.

We have known for centuries that culture is transferred by stories. Doesn’t it make sense that healing from the horrors of war might be aided by doing the same?

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About the Author
Mark Goulston M.D., F.A.P.A.

Mark Goulston, M.D., the author of the book Just Listen, is a Clinical Assistant Professor of Medicine at UCLA's Neuropsychiatric Institute.

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