'I Always Sit with My Back to the Wall'

RECOGNIZING WHEN PTSD IS IN YOUR LIFE

I once asked the wife of a veteran who was my patient, “When you go into a fairly empty restaurant, where does your husband sit? Without hesitation, almost as if it should be perfectly obvious, she answered, “In the farthest corner of whatever place we are in, with his back to the wall.” When I asked if she understood why, she had not a clue; all she knew is that sitting in any other place was disastrous. She had no idea that, in the traumatized mind of her husband, sitting in that corner was like adopting a safe position in combat -- one that allowed him an unobstructed vantage point of the lurking danger that he always expected to enter the place at any moment.

Today, millions of Americans feel their lives have gone terribly wrong, but they don’t know why. Statistically, if they are veterans, it is likely that many of them have Post-traumatic Stress Disorder, or PTSD. For most of them, it is a problem that will go unrecognized and therefore unresolved.

Resolution of a problem begins with its recognition, not just by name but in terms of how it affects one’s life. If a person suffers an amputation or contracts a chronic disease or loses some significant physical function, for example, he or she can usually tell you right away how their medical condition has impacted their life. Strangely, PTSD seems different. PTSD is a disorder that causes either significant emotional distress or impairment in the day-to-day functioning for the persons who suffer it. However, it is like a ghost that one knows is present but cannot quite see or touch. Even though the lives of almost all of the veterans whom we have seen with PTSD have been radically changed by it, few of them can express in words exactly what has happened to them as a result of their disorder. Like the veteran in the story above, they spend their lives with their backs to the wall without ever understanding why. All they know is that they are, now, somehow very different.

For many people affected by PTSD, the symptoms of the disorder are unrecognized, simply because they may have been present for so long that those who suffer with it -- as well as their families, friends, and co-workers -- have come to accept their posttraumatic behaviors as normal for them. Many Vietnam-era veterans became aware of their symptoms almost immediately after their return home from the war. But others, including many of the veterans of the Iraqi and Afghanistan wars, suffer a slow kindling of the disorder, in which the process starts slowly and worsens as time goes by, producing more and more severe symptoms. Known as late onset PTSD, it builds with time and chronic exposure to multiple traumatic stressors and multiple deployments.

Still others, it is now known, had PTSD before they even enlisted. During periods when recruitment requirements were pressing, waivers of the traditional standards for enlistment were conferred, in order that many might be permitted to volunteer. Today’s volunteer military became a Mecca for young men and women seeking to leave social environments and family lives marked by abuse, neglect, drugs, or domestic and gang violence. But this emotional baggage continued to burden them throughout their military careers and made it more likely they would develop combat-related PTSD.

Whatever their personal situation, many veterans and their families have learned over the years to shape their lives around the illness in ways that were usually intended to gloss over and deny the major impact it was having upon them. The illness has made them strangers to their families and -- what is worse -- strangers to themselves.

“John went to the war,” said Cindy, a pretty strawberry blonde woman with sad eyes. “Some other man, masquerading as John, returned home.”

As difficult as it often is for people to explain why they are different now, it is rarely difficult for them to remember what they were like before. Often, the memories of what life was like before PTSD developed provoke tears and recollections of a way of being and of living that have slipped like sand through the fingers of affected people and disappeared.

“You know Doc, BEFORE I went to Vietnam, I was happy-go-lucky. I was social. I was in athletics. I loved people. I was active in church and a lady’s man. Now it’s all different. I’m not the same person. I just go through the motions of life. I have few friends and get little joy from life. I keep everything inside and don’t feel much of anything anymore except for the anger. Sometimes I feel so depressed that I wish my life was over. I wonder if my family and everyone around me wouldn’t be better off if I just wasn’t here.”

Of course, the answer to that question is decidedly “No.” They would not be better off with you dead. But they and you would both be better off if your PTSD were treated effectively. So we end here with one strong and sincere admonition:

IF YOU ARE EXPERIENCING SUICIDAL THOUGHTS -- EITHER WITH OR WITHOUT A PLAN FOR KILLING YOURSELF -- PLEASE GO TO YOUR NEAREST EMERGENCY ROOM, VA CENTER, OR MEDICAL CARE PROFESSIONAL AND GET IMMEDIATE HELP. YOU ARE ENTITLED TO IT. YOU NEED IT. AND YOU DESERVE IT.

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Harry Croft, M.D. is an Army veteran who has evaluated over 6,000 veterans. Rev. Dr. Chrys Parker, a trauma therapist, has worked with over 2,500 trauma survivors and was the first civilian chaplain invitationally deployed to a combat theater. Together, they have written I Always Sit With My Back to The Wall is a sound, authoritative book that provides you with the straight story on combat trauma and PTSD, written by a former Army doctor who has treated 6,000 veterans for PTSD and a trauma therapist who has worked with over 2,500 trauma survivors and spent time in Iraq. For more information, visit www.mybacktothewall.com/.