On Memorial Day: Support Troops Returning with Post Traumatic Stress Disorder

PTSD – Post Traumatic Stress Disorder – is a form of anxiety created after witnessing or experiencing an event that involved threat of injury or loss of life. In recent years, PTSD has gained more notice as troops from Afghanistan and Iraq returned home, sometimes after multiple tours of duty. While they were grateful to be back safe and sound, the events of combat created PTSD and resulted in troubled re-adjustment to civilian life. In extreme cases, PTSD has been noted in cases involving homicide and suicide.

You’re not morally or psychologically “weak” if you have PTSD

We expect too much from our soldiers. We can not expect them to shrug off the horrors of war without needing some form of therapy or group counseling with other veterans. In fact, the presence of PTSD in a soldier is evident of a healthy mind that suffered extreme stress, opposed to someone who returns with little perspective other than the number of enemies they killed. The latter case would be an instance of sociopathic tendencies that should immediately raise red flags. There is a difference between doing one’s duty and having callous disregard for human life; enemy or not.

Troops from World War 2, Korea, and Vietnam didn’t have PTSD – is this pop psychology or the result of coddling our youth?

No. Not in the least. The fact to the matter is, PTSD in troops has occurred in every war, we just didn’t recognize it as a sign of psychological stress until recently.

Sadly, our relatives who returned from major wars in the past few decades had little to no psychological support. What inevitably resulted? Alcoholism. Extreme depression. Suicide. Family dysfunction. Paranoia. Flashbacks. Extreme anxiety.

The fact that Uncle John “drank World War 2 away with Jim Bean and Jack Daniels” is neither healthy nor ultimately productive for his family. What might have been a typical case of PTSD went unchecked, and it resulted in an immense toll on John’s family, his relatives, friends, and children. Ask any child of a troubled former soldier what their father or mother should have done after the war, and most will say “get counseling”. Drinking, drugging, and denial ARE NOT viable solutions.

Mental Illness Still Has a Stigma Attached to it in the USA, particularly for our troops

In the USA, we like to think we are super strong, super confident, super tough, go-getters who feel nothing other than our own success and pride. The fact is, buried beneath this jingoistic hubris, we are still all human beings with feelings, emotions, and souls.

That you feel disturbed after watching your platoon mates dismembered during an IED detonation is completely NORMAL.

That you feel intense fear after losing a limb or taking a bullet in the line of duty is completely NORMAL.

That you can’t wrap your head around “normal American life” after spending several intense months witnessing the awful effects of war is completely NORMAL.

Those who deny these feelings are kidding themselves. They are compartmentalizing their lives and will eventually deteriorate, or spend the rest of their lives in a diminished state of living, forever haunted by what they experienced.

PTSD and other post-war psychological stress is best treated immediately, regularly, and among other veterans who know what you experienced. You don’t have lie on the couch of a psychiatrist and spill your guts. Instead, look for support groups, stay in touch with your military friends, and promise yourself you will do everything humanly possible to work through the stress.

One particularly successful method of treating PTSD doesn’t involve traditional notions of therapy at all. In fact, veterans are instead teamed with a trained dog who acts as a companion and helper. It might sound a little flaky to some people, but it has been extremely successful for some of the worst cases of post-war PTSD. Best of all, having an animal companion with you to help navigate day-to-day activities is nothing unusual or suspicious to other civilians: they see a man or woman with an attentive pet, not someone who is “weak” or otherwise deficient in character.

Before setting foot on the battlefield, our soldiers were unique individuals with various personality traits, personal histories, and stressors in their lives. Adding a traumatic experience to anyone’s “psychological history” will undoubtedly cause some disturbance in what is perceived as reality. Some of the toughest people on the outside are actually terrified inside. Their rough exteriors seems impressive and encouraging to others, but there is a cost to faking your way through life as if nothing bothers you.

If you or a family member has recently returned from war and are having trouble re-adjusting to life, you are NOT alone and NOT weak. Talk to other veterans and find the nearest meeting, support group, or PTSD screening clinic for a review. You wouldn’t return home with a physical wound left untreated and festering. Don’t ignore your mental struggles either.

Coming off Welbutrin XR, Adding Celexa for time being – Let’s see what happens

How long have I been on Welbutrin XR 300 mg? 10 years. That’s a while. It’s literally part of my body now, and I’ve forgotten what it felt like to be off it.

Welbutrin XR (Extended Release) is meant to treat depression, slowly releasing its dosage throughout the day. It is an selective serotonin reuptake inhibitor (SSRI). Before everyone leaves the room (those damn SSRIs!) Welbutrin has been helpful to me: it has had a stimulant effect on me that gets my day moving and gives me a little extra nudge to be productive. Lately, however, due to increased anxiety in other parts of my life, the Welbutrin has pushed me a little too far. I’ve felt very cranked up (or “wired”), mentally zooming around my life. This sensation teamed with anxiety produces a nervous stomach. I’ve actually had diarrhea and vomited multiple times in recent months. Enough of that.

Now I’m tapering off with 150 mg Welbutrin XR generic (buproprion). My doctor also started me on an introductory dosage of Celexa.

Celexa is also a SSRI ( YIKES! 🙂 ) that has indications for depression, but can be used off-label for anxiety. The thought is to slowly ween myself off the long dependence on Welbutrin and use a minimal dosage of Celexa to balance the anxiety. Celexa should help slow my mind down during the day, without making me too listless or sleepy.

I’m only a couple days in so I can’t judge how the change has affected me yet. The first day I took Celexa, I did notice my feelings and physical sensations of anxiety (nervous stomach) were muffled. They were still alive and well within me, but not screaming me into a panic. That was actually quite pleasant.

The second day on the Welbutrin draw-down and Celexa introduction, I began to feel a little less focused during the day. The “go-go-go” sensation I had previously that amped up my anxiety levels was decreased. This sensation was new and not troublesome (yet). If my drowsiness increases during the day I will have to either take the Celexa at night or drop it altogether. I don’t have time to waste experimenting with new meds. I need to be productive throughout the day, without going over-the-top and becoming unhinged.

Will I be on SSRIs / anti-depressants forever?

That’s a complicated question. My parents would like me off all medication. They seem to either not trust them, or feel embarrassed that their son is on them in the first place. In reality, that embarrassment is their own: they were part of the reason I ended up needing therapy and meds for 10+ years.

That said, naturally there may come a time when medication is NOT necessary even though it feels safer to take it “just to be sure”.

I asked my new doctor about the “permanence” of taking anti-depressants, and she said it depends on the individual. Some people can eventually come off all medication and lead productive lives provided their symptoms are under control. Others need to take them indefinitely. Meds are taken to balance chemical deficiencies or excesses in the brain, so it would follow that the only time to stop them is if one’s physiological condition has changed. This is actually possible in some cases, particularly if therapy is also utilized to ward off unproductive behavior and thought patterns.

Of course, this is where all the anti-SSRI crowds and conspiracy theorists jump in. There have been many instances of people who have been over-medicated simply because the science of psychiatry is imprecise short of running expensive, time consuming brain scans each time a new med is prescribed. As a result, when new science or therapy emerges that relieves someone from taking medication, they tend to harp on about how their mind was being controlled and day-to-day life ruined.

They fail to realize that the best treatment available to them – given the science at the time and their financial constraints – was being “over medicated”. It is easy to criticize in hindsight but the fact remains that those who DO criticize don’t realize a very simple truth: they are still alive and well to speak their mind, and the meds DID prevent them from committing suicide, losing a job, loosing their temper, or otherwise acting out.

A couple hundred years ago, leeches were used to suck blood out of the bodies of sick patients. The thinking was primitive but logical: the leech would absorb the diseased blood, and then the body would replenish itself with “clean”, healthy blood. That was the best one hope for.

Nowadays a doctor prescribing a leech for the stomach flu would be laughed out of his medical practice. Science improved and we now have anti-bacterial medication and treatments to fight viruses.

Psychiatry is evolving and will continue to evolve. Perhaps it’s still in the “hang a leech from your ear” phase, but in time it will improve if we give it a chance. I’ve been on SSRIs for a decade plus and the government does not control my mind. I also have not killed myself either. 🙂

HLN Dr. Drew On Call – WRONG About Development of Borderline Personality in Jodi Arias

Edit 06/17/2013: I originally labeled the victim as “husband” in error. He was Arias’ boyfriend.

I have ignored the Jodi Arias trial in the USA up until last week when she was found guilty. Arias – of Mesa, Arizona – stood accused of shooting, stabbing, and slashing the throat of her now dead boyfriend, and the evidence against her was overwhelming. I wasn’t surprised that she was found guilty, but I was surprised that so-called “medical professionals” on TV were making completely outrageous statements about her psychological condition.

During the trial, Jodi Arias’ psychiatrist testified that Jodi had an Axis 2 diagnosis of Borderline Personality Disorder. I didn’t know that until last week when the hacks on HLN’s Dr. Drew On Call were trying to quarterback her psychological state. Arias now faces the penalty phase of her trial during which she might get sentenced to death. Naturally, she was put on suicide watch and was temporarily transferred to a psychiatric prison where doctors denied all visitation requests and had her medicated.

To be Clear: I do not excuse Arias from murdering her boyfriend because she has mental illness. I do not condone what she did because she has Borderline Personality. Dr. Drew and others held her solely responsible for her actions and that is not unreasonable.

That said, the picture they painted of how BPD *might* have developed and *why* it had such horrific consequences for Arias was completely unprofessional and misleading.

First of all, Dr. Drew was trying to explain BPD in a 4 minute segment with 3 other “doctors” (used loosely), a co-host, and 2 lawyers. Like most shows on HLN, one person says something and then the rest yell at each other like bratty kids having a roid rage. There was no thoughtful debate about Borderline Personality: it was more like “it’s not our problem – hang her high”.

I respectfully disagree with their assessment. They understandably suggested Arias was a manipulative, melodramatic, moody, unpredictable b*tch who was not worth the bother of saving. They never considered for one moment that there may have been environmental factors early in her life that made her BPD so profound and violent.

As someone with BPD, it is my responsibility to get treatment and to behave appropriately.

The upsetting part of the entire dialog was that neither Dr. Drew nor his “experts” failed to explain how Borderline Personality actually develops. Dr. Drew said “genetic and environmental factors” and that was it. I don’t think it is that simple.

We can not choose which circumstances we are born into, which parents we get, which family, and their ability to nurture us as children. Some families get lucky and have even tempered kids. A happy childhood leads to productive adult life. Some families get troubled kids but have the foresight to get psychological help long before problems metastasize. Then, there are troubled families with troubled kids who never get help (because they are in denial, abusive, or irresponsible) and psychological problems explode as adolescence begins, at which point they simply say “You’re becoming an adult, it’s your problem to deal with.”

Guess what? It sure as hell is my problem, but I’m not necessarily at fault for it. What Jodi Arias did was unforgivable and horrific. I don’t believe for one second that murdering your boyfriend in such a gruesome manner is at all inline with proper recovery from borderline personality disorder.

While we CAN cast blame on Arias for her present actions, we can NOT also blame her for developing a mental health problem.

My own parents ignored all the psychological problems their children had, and disclaim any responsibility for not getting help early on. They are also under the impression everything they did as parents was “always right” and that our childhood was “wonderful”.

Really? Both my brother and I have self harmed on several occasions, have been on meds for more than a decade, and need constant therapy. Another brother has sought treatment for attention deficit disorder and concentration, but in reality he was in need of therapy and medication as needed to get through college. The only brother who escaped the mental problems was – not surprisingly – the one they spent the most time on and found the most amenable to their own personalities.

Beyond that, my parents lived vicariously through their children, ignoring obvious warning signs of mental health problems. Instead, they chose to be “so proud” (in my mother’s words) when we achieved something and “so embarrassed” when we screwed up. My Mom would feel ashamed if one of us sneezed in church. Otherwise, when the honor roll came out she was all for taking compliments from other parents and being told “what a great mother she is”.

I beg to differ. My problems with depression, anxiety, and BPD could have been addressed much earlier in life when they initially surfaced in grammar school. But my parents refused to realize they were doing anything wrong, and that their children might need counseling to be happy, well situated adults.

What has resulted?

Years of torment, self abuse, uncontrollable rage, bad relationships, emptiness, acting out, suicidal gestures, gambling and substance abuse problems, depression…the list goes on.

Guess what, it IS my problem to deal with, but I’m NOT the one purely at fault.

In fact, one of the more reasonable doctors on Dr. Drew’s show – amid the screaming match – suggested that Arias had displayed suicidality earlier in her life that was obviously ignored by those around her. Why wasn’t Arias committed for treatment? Why didn’t someone suggest a support group? Why didn’t her family coax her into the office of a good therapist?

Who abused her? Why aren’t they locked up? Many females with BPD have histories of being sexually abused, many times by people within their own families. Why did that problem go unchecked? Why does everyone get to wash their hands in the name of “that’s history” and expect Arias to be a model citizen?

Dr. Drew and his colleagues know better (at least I hope). During Britney Spears’ troubles a few years back, he famously said “Her only way out is suicide”, in the context of what might happen if she didn’t get help. That is perhaps the most disgusting thing a doctor can say on TV about anyone. Now he’s ready to pull the switch on Arias without having the least bit of scientific (or human, for that matter) curiosity about why she ended up such a train wreck.

Here’s my advice for TV doctors, who obviously work on TV because they are ineffective clinicians: before you speak, think first as a human, then as a doctor, and after that as an outraged citizen. More importantly, don’t bullsh*t for an hour on TV yelling back and forth with wholly unqualified guests who are only interested in promoting their latest book. You might actually give people hope if you’re positive.