Keeping Things in Perspective: Holiday Edition

 

The holiday season is here and there is a lot going on right now. For many of us (including me) life feels overwhelming,  everything feels phenomenally expensive, and our "to do" lists are never-ending. On top of this, the world is a bit... crazy.

How can we stay grounded in a crazy world and keep first things first? Let's start with perspective. 

My favorite version of the Serenity Prayer goes like this: "God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know that that is me." 

It's a short prayer, but there is a lot packed in it. Serenity, acceptance, courage, and wisdom are simple concepts, but they are not easy. In order to find serenity, or peace, I have to practice recognizing what is and is not in my control (again, this is simple but not easy). 

In this overwhelming season, I have been reaching out and connecting with others - and it has helped. 

I can get stuck in my own head and lure myself into a self-condemnation spiral easily. I have a strong therapy group I'm in and I work hard to surround myself with supportive people. My support network took a while to build, and here are some resources we can access from the comfort of our own homes right now:

Warmlines are peer-run listening lines staffed by people in mental health recovery themselves. Sometimes, we all need someone to listen but we know that a call to a crisis line may not be appropriate. Warmlines fill this gap. Here is a directory of warmlines across the U.S. 

12-step programs are powerful in terms of providing social support and accountability, and there are anonymous groups for any number of addictions. In addition to AA, NA, and Al-Anon, Codependents Anonymous (CoDA) is a powerful change agent, as are groups for Gambling and Survivors of Incest. Not everyone is a fan of the program, and I get it – there are plenty of lousy groups and crappy sponsors. There are also dynamic, inspiring groups and amazing sponsors. Since the pandemic, many groups have gone online and meetings are on Zoom. Here is the line to AA Online Intergroup for a list of online meetings. (The only requirement for AA membership is a desire to stop drinking).

Support groups bring together people who are going through similar experiences. Visitors are welcome to share as little or as much as they like. Support groups can be powerful because it reminds us that we are not alone and that others have also persevered through challenges. Support groups can help us feel less isolated, especially when we can relate to others in a similar situation. NAMI.org lists support groups for mental health issues and SAMHSA.gov lists many resources for alcohol and substance use, as well as mental health and other important topics. Survivors of Loved Ones' Suicides (SOLOS) is an especially powerful peer-led support group.

Online groups. Full disclosure: I have not fully leapt into the 90s in terms of keeping up with social media, but I am impressed at the amount of social support my clients have found available online in chat forums and social media groups. To find one, try using a search term like “online support group PTSD." 

F   Friend, this is a batty season for lots of folks - you are not alone. And what do you have to lose by trying one of the suggestions here?

How are you keeping first things first right now? We value your feedback and ideas! Reach out on our Community Facebook Page!

*****

“If you believe change is possible, you want to change, and you are willing to do the work, you absolutely CAN get your life back.”

Get your copy of The Soldier's Guide to PTSD, The Soldier's Workbook, 

or Acknowledge & Heal, A Women's-Focused Guide to PTSD

Holidays are Hard: Healthy Boundaries

For many people, strong social support fosters recovery, and toxic relationships usher in relapse. To manage the latter, we need to talk about boundaries. 

Boundaries protect you. They let the people around you know how you define what is acceptable or unacceptable. For people who have been through traumatic experiences, however, this task is a tough one. Experiencing trauma makes you feel unsafe, and can challenge your sense of self-worth, leading trauma survivors to lean back on their placating or maladaptive tendencies to avoid conflict. 

Healthy boundaries are the ultimate form of self-respect. They say to us and the world, “I deserve to be honored, respected, and valued.” Boundaries denote confidence. Since confidence is often one of the casualties of PTSD, we have to relearn (or maybe learn for the first time) how to make a healthy, reasonable boundary, how to maintain it, and what to do if someone chooses to ignore it. 

Making healthy boundaries seems like it should be easy and intuitive, but it’s not. Let’s start here:

Ground Rules

1. Healthy boundaries make healthy relationships.

There is no such thing as a healthy relationship without boundaries, whether it is a marriage relationship, a friend, colleagues, or the relationship you have with your children. Healthy boundaries say, “I deserve to be honored, respected, and valued” and this is important for any healthy interpersonal relationship. 

           2. People do not know our boundaries unless we state them clearly and succinctly.

Yes, in a perfect world, people “should” know how to act, but suffice it to say that not everyone is great at adulting. Some people do not know that racist comments are not okay. Some people do not understand that unsolicited touching is creepy. Let’s not waste time getting mad about what “should be.” Instead, let’s remember that half the people we meet are below average and common sense is not common. Boundaries are not intuitive. We must state our boundaries clearly and concisely—out loud—to other people.

 3. Reasonable people respect reasonable boundaries.

The inherent problem with this is that not all people are reasonable. Sad news of the day: the world is full of psychopaths and assholes. When people choose to ignore reasonable boundaries, they are sometimes the former and usually the latter. The problem is not our boundary, it is their choice. 

         4. Our boundaries, their choice.

We create healthy boundaries, and we have absolutely no control over other people or how they act. When we state our healthy boundaries—out loud—clearly and concisely, other people then choose whether they want to respect our boundaries or not. 

*****

“If you believe change is possible, you want to change, and you are willing to do the work, you absolutely CAN get your life back.”

Get Your Copy of The Soldier's Guide to PTSD, The Soldier's PTSD Workbook, 

or pre-order Acknowledge and Heal: A Women-Focused Guide To Understanding PTSD

Social Support: The Key to Lasting Change

 

“Social Support.” This is what mental health professionals call “friends” and researchers have shown over and again the importance of social support in treating PTSD. Our therapist is part of our support team, and we have to build on this foundation. Making friends is difficult, especially if we have PTSD. So, let’s talk about it... 

Back in the day, making friends was easy. As a kid, we made friends in school or in our neighborhood, and in the military, we have our unit. Making friends gets harder as we get older. We realize that for guys, it’s weird to approach another dude and say, “want to hang out?” Women are different in this regard, but we also tend to isolate ourselves in the face of PTSD, saying things like, "I don't want to bother them with this. they have their own crap they're going through. My friends are just all so busy. I don't want them to think I'm a drama bomb." 

Real talk: if you would drop everything for a friend that is going through what you are going through, then give them the same respect to come and help you. 

Even when we know that making friends and building networks helps us recover from PTSD, it is an anxiety-inducing idea. Some people are natural extroverts (and yay for you), but normal people worry about making new friends, especially if our PTSD has poisoned our other relationships. It’s normal to worry. “What if new people learn about my PTSD and freak out? What if I have a melt-down, or if I hurt someone by accident? Maybe I’m better off protecting the world by keeping to myself because people have their own problems and they don’t need mine.” 

We hear you, friend, and want to put this into perspective. Trying to make friends is a big risk. We can be rejected, others can judge us and be crappy, and we might be terrible at making new friends—but we also know that social support is a major determining factor in our recovery from PTSD. In other words, to get better, this is a risk we need to take. 

Because this is important, we want to take you back to the Big Two questions:

(Q1) Do we believe it’s possible?

Do we believe it’s possible that we could get out of our comfort zone, break out of that Criterion C of avoidance, and connect with another person, either in-person or virtually? Is it possible that there is another person in this world who is not crappy? Is it possible that we can use this powerful—and proven—tool of social support to fight our PTSD symptoms? Is it possible that we deserve to be loved and cared for by others?   

Moving on to...

(Q2) “Do we want to change?” (but rephrasing it differently)

The second question can’t be, “Do we want to make friends?” Because we already know the answer: NO. With PTSD, we want to avoid other people. This is good old criterion C: avoidance. It’s like asking, “do we want to go to therapy?” Big NO.

So, we need to look at the bigger picture of Q2. Do we want to do the work it will take to recover from PTSD? Do we want to lessen our symptoms? Do we want the people we love to know that we love them? Do we want to build, and possibly rebuild, relationships?

It’s okay to be on the struggle bus about this. Going to therapy and making connections is difficult when we have PTSD, but we have to do it if we are serious about getting our lives back. 

*****

“If you believe change is possible, you want to change, and you are willing to do the work, you absolutely CAN get your life back.”

Get your copy of The Soldier's Guide to PTSD, The Soldier's Workbook, 

or Acknowledge & Heal, A Women's-Focused Guide to PTSD

Trauma Comparison is Shitty

 I want to talk to you for a minute about trauma comparison. This is when we "one-up" each other's trauma experience. For example, "I went to Iraq and Afghanistan," or "I got blown up twice! "

One-upsmanship is not something I hear among survivors of other kinds of trauma, probably because it's sincerely messed up to engage in this type of comparison. It would be unreal if, when working with survivors of domestic violence for example, one survivor turned to another and said, "you think you had it bad? I went to the hospital three times!" I hope we can agree that no one is trying to win the trauma lottery here.

Saying "my trauma is more traumatic than your trauma" is unhelpful and, unfortunately, I hear this among military members and Veterans. 

I want to be clear: I don't think there is any ill will behind trauma comparison. We don't know what we don't know. 

So many times when we finally get the courage up to get help, we are not believed, or we are dismissed outright. The first time I poured my heart out to a psychiatrist, a male colonel at a large military treatment facility, he straight-up told me that he could not help me because I was "lying." To clarify, he stated, "we all know women don't serve in combat." 

This was in 2008. I was at my absolute worst with my PTSD symptoms, I was drinking daily, and I was acutely suicidal. This licensed mental health professional and field-grade military officer belittled me, dismissed me, and labeled me with a personality disorder. He kicked me while I was down. I reported it, and no one with any power chose to do anything about it. 

Chose. To. Do. Anything. About. It.

I'm not mentioning this for pity, but to promote awareness. So many of us who share our experiences are just not believed — by our doctors, our chains of command, by family members, and even our fellow service members — and it hurts like hell. 

Trauma comparison is shitty. It keeps other people from getting the help that they deserve because it belittles and diminishes their experience. What is shittier is choosing not to believe someone who survives trauma. 

Trauma comparison is an easy correction we can make. But choosing not to believe someone when they share their trauma experience makes you an asshole. 

*****

“If you believe change is possible, you want to change, and you are willing to do the work, you absolutely CAN get your life back.”

Get your copy of The Soldier's Guide to PTSD, The Soldier's Workbook, 

or Acknowledge & Heal, A Women's-Focused Guide to PTSD

Boundaries and PTSD

Healthy boundaries are the ultimate form of self-respect because they say to the world, I just deserve to be honored, respected, and valued. Boundaries denote confidence. 

Since confidence is one of the casualties of PTSD, we likely have to relearn (or maybe learn for the first time) how to make a healthy, reasonable boundary, how to maintain it, and what to do if someone chooses to ignore it. 

Making healthy boundaries seems like it should be easy and intuitive, but it's not. So let's start.

1. Healthy boundaries make healthy relationships

There is no such thing as a healthy relationship without boundaries, whether it's a marriage, a friend, a colleague, or the relationship that you have with your kids. Healthy boundaries say I deserve to be honored respected and valued and this is important for any healthy interpersonal relationship.

2. People do not know our boundaries unless we state them clearly and succinctly

In a perfect world, people should know how to act, but this is not a thing. Some people think that offensive comments are okay some people don't understand that unsolicited touching is creepy. Let's not waste time getting mad about what "should" be. Instead, let's remember that half the people we meet are below average and common sense is not common. Boundaries are not intuitive. Therefore, we must State our boundaries clearly and concisely, out loud, to other people.

3. Reasonable people respect reasonable boundaries

The inherent problem with this is that not all people are reasonable. Sad news of the day. The world is full of psychopaths and assholes. 

4. It's our boundary and their choice

We create healthy boundaries, and then we have absolutely no control over other people or how they act. When we state or healthy boundaries, out loud, clearly and concisely, other people then choose whether they want to respect our boundaries or not.

This is hard to hear, so I'm saying this with a lot of love and empathy: when people choose to ignore our reasonable boundaries, they are saying in no uncertain terms, loud and clear, I do not respect you and I do not want a relationship with you that is not on my terms. No exceptions.

Boundaries are vital to relapse prevention for PTSD. You can read more about boundaries in The Soldier's Guide to PTSD.

*****

“If you believe change is possible, you want to change, and you are willing to do the work, you absolutely CAN get your life back.”

Get your copy of The Soldier's Guide to PTSD, The Soldier's Workbook, 

or Acknowledge & Heal, A Women's-Focused Guide to PTSD

Finding the Right Therapist for You

I want to take a moment to talk to you about how not every therapist is the right therapist for you.

Having a therapist we can trust is an important cornerstone for social support network, and it is vital to our recovery from PTSD and moral injury. In counseling, this is called the therapeutic relationship, and it is incredibly important.

Healing from PTSD requires radical authenticity on our part and skill and expertise on the part of our therapist. It may take a while to find the right therapist for you, and that's okay. It doesn't mean that you are beyond help.

In 2008 when I was at my worst with my own PTSD, I was command-directed to see a psychiatrist. This was at a military treatment facility and the psychiatrist was a white male colonel. I was suicidal, vulnerable, and frankly, I was desperate. I didn't understand what was happening to me and I believed that I was going crazy. I talked with this psychiatrist for the better part of an hour, and then he said to me, "Virginia there's nothing I can do to help you if you can't be honest with me." I was bewildered. He then qualified his statement by saying, "women don't serve in combat and I can't help you if you're not telling me the truth."

I wish I were making this up. I was labeled with a personality disorder and my experience was completely dismissed. This took a terrible situation and made it worse.

I'm not sharing this story with you for pity; I'm sharing it for awareness. After I became a therapist myself, I found that the experience of being belittled and dismissed is more common than I could have imagined, especially for female military members, persons of color, and those who identify as part of the queer community. Even in the current environment of me too and racial reckoning, clients have reported to me that they have not been believed when they reported their experience during active service or after, even with a therapist. 

And I want to be very clear: that is absolutely not okay. There is no excuse for this behavior from a mental health professional. 

Jennifer Freyd, with the University of Oregon, researches and writes about institutional betrayal and I recommend her work to learn more about this. 

But I say all that to say this: some therapists are unprofessional or simply not good at their jobs. I'm not trying to be ugly; it is what it is. 

If a mental health professional chooses not to believe your experience, that probably says a lot more about them than it does about you. And I know the outcome can be devastating. 

I encourage you to advocate for yourself and keep leaning forward so that you can get the help you deserve to reclaim your life.

We've created a Free Workbook to help you identify your symptoms so that you can make an informed decision to reclaim your life from PTSD and Moral Injury.

*****

“If you believe change is possible, you want to change, and you are willing to do the work, you absolutely CAN get your life back.”

Get your copy of The Soldier's Guide to PTSD, The Soldier's Workbook, 

or Acknowledge & Heal, A Women's-Focused Guide to PTSD

Reader Questions: Is PTSD Treatable?

Dear Virginia, 

I am a Veteran who served in Vietnam class of 68/69. My MOS was 8404 or fleet marine force Navy Corpsman attached to the US Marines. I also lead a support group for Veterans. I am in the process of reading your book and using it to stimulate conversations. Your book is aimed at younger Veterans and rightfully so. You say you can be cured. Two questions: first what is your interpretation of cured? The second is what about us older Veterans who held it in and practiced PTSD for 30-40 years? 

Thank You in advance.

Rich Jakubczak “Doc Jake“

Dear Doc Jake,

Thank you for taking the time to reach out to me; I value hearing from you. This is an opportunity to discuss what treatment can do and what it can't.

I'm going to start with the latter. Treatment does not mean that we will forget about our traumatic experience. I understand that this is our wish though, and I get it. Who wants to remember losing a buddy, being raped, being trafficked, or any number of traumatic events? Unfortunately, treatment for PTSD does not erase our memories. 

The purpose of treatment for PTSD is to reduce our symptoms. Intrusive memories, nightmares, avoidance, and hypervigilance can get to a point where they affect our walking, talking everyday lives — and we're not able to function the way we once used to. "Cured" means that our symptoms reduce to the point where we can function in our roles again effectively. 

The goal of treatment is not to change the past (I wish we could do that, but it's not a thing), but to get our symptoms under control to the point where they no longer screw with us daily. We can reclaim our lives and function in our roles — as a parent, a friend, an employee, a brother, or a battle buddy. 

I am especially thankful for your second question, especially because it is not something I thought to address directly in the book and I think it's important. YES, I have personally worked with my brothers and sisters who served during the Vietnam era, and they have experienced incredible success in reducing their PTSD symptoms; it is damned inspiring. 

Evidence-Based Treatments (EBTs) like prolonged exposure, cognitive processing therapy, and EMDR work for chronic PTSD. The data are clear; whether we've been dealing with our PTSD for five years or 50, EBTs work. 

The hardest part of treatment for chronic PTSD is answering the first of the Big 2 Questions: "Do I believe that I can recover from my PTSD, even if I've been carrying it for decades?" 

I know that recovery is possible for Vietnam-era Vets because the research is clear and because I have seen it myself. In your support groups, I imagine that you get to see some incredible breakthroughs as well. The bottom line is that YES — recovery is absolutely possible, and EBTs make it damned likely. 

THANK YOU, Doc — your continued service as a peer support group leader and leader in your community is inspiring.

Virginia

*****

“If you believe change is possible, you want to change, and you are willing to do the work, you absolutely CAN get your life back.”

Get your copy of The Soldier's Guide to PTSD, The Soldier's Workbook, 

or Acknowledge & Heal, A Women's-Focused Guide to PTSD

A Note to Our Vietnam-Era Veterans

As I've talked with readers, I have most enjoyed the opportunity to connect with our Vietnam-era Veterans. I did not expect that our book would have an impact on this community, and it's been a joy to hear the candor and enthusiasm. 

For me, this connection has taken an extra meaning; it is personal. My Dad was a Vietnam Vet and he died in 2019. He didn't talk a lot about his experience, but I know that his deployment haunted him until the day he died. 

When I was going through the worst of my own combat-related PTSD, my Dad was the only one who "got it" and didn't press me. We never discussed it, and I regret that now. If there is one thing I would want to have told him, and that I will now tell you, it is this:

When you came home from Vietnam, you were spit on, disparaged, denied civilian work, and very actively bullied. I can't even imagine what that was like after surviving suck a total cluster of a deployment. What happened to you is not okay and it is absolutely inexcusable.

I recognize that our Vietnam Vets are the very reason that my battle buddies and I were able to redeploy and be welcomed at the airport by my family and loved ones. Complete strangers cheered for us at the airports and gave us food and coffee; I saw your hats and your biker vests and your tee shirts, though — you were not strangers. I know it was our Vietnam Veteran brothers and sisters who ensured that this wrong was not repeated. I am very deeply thankful for that and I get choked up to this day remembering that. 

The second thing I would want to have said is that treatment is for you, too. The data are clear that evidence-based treatments work for Vietnam Veterans with chronic PTSD. Even if you have been experiencing symptoms for decades, the data show that it is never too late to reclaim your life.

You allowed us to come home, and you were the first to extend a hand in solidarity. If I had a wish for you it would be that you get the help you need to reclaim your life — because you are worthy of being whole. 

Bangor, Maine 2003 — Maine Troop Greeters: I have never forgotten you. Read more about this amazing group at http://themainetroopgreeters.com/getting-to-know-us/maine-troop-greeters-mission-statement/