Recovery from PTSD and TBI is a topic I’ve been avidly learning about for the past five or six years, as regular readers of this irregular blog can attest. And over these years, I think I’ve gained some insights.
One of the most important is that traditional PTSD is frequently accompanied by a sense of moral injury that the medical community has not yet come to recognize – but should.
Traditional PTSD is a hyperarousal based on the knowledge that people are trying to harm you: to kill you, to wound you or to drive you mad with their unrelenting hostility. And you must stay vigilant constantly to prevent these things from happening to you.
But moral injury (or a wounded soul) is the opposite. It’s a sense of guilt about what you have done to your enemies or about what you have failed to do for your friends.
And recovery requires some very different therapies.
Recovery from traditional PTSD involves a concept known as neuroplasticity, which is based on the premise that all of our experiences change our brain. It makes sense that after we’ve been ducking bullets or avoiding roadside bombs, our brain will continue to recognize that such dangers can exist anywhere, even in the supposed safety of our own hometowns.
Having a soul wound is harder to treat because it adds some other elements that must be dealt with.
First is the issue of atonement. We must be willing to repay whatever harm we have done. Many vets are finding atonement in helping other vets. Others are working with at-risk teens. Some have returned to third-world countries to build schools or hospitals. Since there’s no way or righting the wrongs we may have committed, it’s important just to find a way of contributing positive energy to the world around us.
Second is the issue of forgiveness. Jehovah God promises to forgive all our sins if we truly repent of them (that is, to ask forgiveness and change our bad conduct). As humans, we must be willing to do the same. That may involve forgiving the government for sending into combat with no moral justification for it. It may involve forgiving our buddies for letting us down.
Most difficult, however, is self-forgiveness. After having made atonement, we must be willing to forgive ourselves for what we have done, or failed to do. We have to free ourselves to live life again. And after that, we can let neuroplasticity work its gradual magic.
It turns out that exercise is an important component because it lessens anxiety. Researchers are finding that people who exercise regularly build new brain cells and that these new neurons are instrumental in reducing anxiety. I see that constantly in vets who are hiking, paddling, swimming, or practicing tai chi or yoga.
Another important understanding is that traumatized brains lack the ability to process that trauma. Researchers are finding that trauma shuts down the prefrontal cortex of the brain, leaving the decision making to the amygdala, the limbic fight-flight-or-freeze center.
One crucial part of the prefrontal cortex that shuts down is called the Broca’s area, and it is where our language is processed. That’s why I often hear vets say, “I don’t have the words to describe what happened.”
So one vital therapy is writing about what happened. It’s slow and it’s painful, but it forces a trauma victim to think about what happened and put it into words. Processing such painful memories is a form of healing.
All of this is a long way of saying that I need to take a break to put this material together into a book to help vets and their families. I envision it as a sequel to Faces of Combat: PTSD & TBI, and I’m planning to call it Faces of Recovery. My friends at Idyll Arbor are interesting in publishing it, and I hope to have it in bookstores next year.
Until then, thanks for thinking here with me.