In this piece titled, Combat PTSD, the artist, Silverider, dramatically captures the loneliness that often accompanies a soldier returning home from war. Of the 2.3 million combat veterans in the United States returning from service in Iraq and Afghanistan, twenty per-cent are said to suffer with PTSD, according to a study conducted by the Rand Corporation.*
This is a staggering statistic, considering Rand published these findings in 2008. Running the numbers, this equates to almost 500,000 human beings in the United States alone living the inner torture we see in the artwork of this piece.
The numbers themselves create heartbreak enough. This image, depicts the suffering and loneliness of this illness in brilliant detail. A veteran, still wearing his combat clothes. His boots, worn and caked still with the grime of the desert, dirt brought home from a world he likely will never want to see again. His dog-tag, still hanging around his young neck, his identity on a chain. The images of further art behind him, makes one wonder: is this artwork part of a process this young, broken vet uses to help heal his invisible wound?
Post-traumatic Stress Disorder is an emotional illness that can develop when we are exposed to horrifying situations of violence. Classified in the Diagnostic and Statistical Manual (DSM V) as an anxiety disorder, the condition disrupts our internal fight-or-flight, survival processes in the body and mind. One stricken with the condition lives a life wrought with barriers to living a quality life. While not all who experience a traumatic event in life will develop PTSD, soldiers are highly susceptible given the nature of the chronic stress imposed upon them during combat. (***Wikipedia contributors. "Post-traumatic stress disorder.”)
Art therapy in mental health practice is a treatment modality in which a veteran, facilitated with the help of the art therapist, uses art media to explore the conflicts PTSD creates in it's manifestation. The creative process, and the resulting artwork created, is used to explore a veteran's feelings. Through this process, the intent of this and other therapeutic treatments is to help reconcile emotional conflicts, fostering self-awareness as to the nature of the torment living inside the troubled soul of a soldier confused by the experience of carnage he's endured.
Such therapy can help to manage behavior and addictions. It can develop social skills and improve a soldier's orientation to reality. The creative process of art therapy, can reduce anxiety and increase a veteran's self-esteem. (**Enari: PTSD & Art Therapy: 2009).
Researching the story behind this image, it's surprising to learn that the artist at the time of this creation was just entering military service as a U.S. Marine. This artist hasn't yet experienced combat. Yet, his depiction is hauntingly accurate as a representation of the illness characterized in the piece.
When PTSD strikes, as shown in this image, the after-effects of traumatic experience reach far beyond the one suffering directly with symptoms. Behind this broken young man we see more of the truth of PTSD. A Welcome Home sign, and likely the soldiers wife standing off in another room, staring into the cave our veteran needs now to feel safe.
It is a separate room of isolation, where he must now retreat to sort out all that he has seen and done. The families of veterans are often vicariously traumatized along with our returning soldiers. Many families are torn completely apart due to the influence of this often obnoxious, inner-demon.
PTSD can ruin lives. A sad additional struggle for most who develop this disease is the struggle of addiction that comes along for the ride. To numb feelings, so out-of-control and frightening, many turn to substance and alcohol to find relief.
Hair-trigger survival instincts, groomed to perfection during training for combat, leaves a returning soldier with PTSD lost as he attempts a return to civilian life. Tragic consequences come home with our soldiers who often find themselves dealing with levels of rage so hard to keep under control, they often unintentionally cause harm to others, both emotionally and sometimes physically.
When it comes to understanding PTSD as public citizens, we aren’t very well informed. Many of us will judge those with the disorder, not fully understanding problem behaviors from one stricken with PTSD. We aren’t aware that a veteran isolating himself like this, is actually demonstrating to us a normal response, given the circumstances.
With the experience of combat, PTSD alters a returning soldier’s perception of danger. Given the repeated nature of the trauma he's faced, the images of battle haunt a veteran with PTSD. Many veterans find their way to a prison cell after they return home. Most tragically, suicide is far too often the final outcome for many of our service personnel when treatments are either avoided or unavailable in home communities.
What do we do, with the truth that is conjured up in our own minds from this image? One thing we can choose, is to attempt to understand the brokenness that often befalls those who stand up to defend us and our freedoms. We can argue all we want over the morality of nations still choosing to rise up against one another. The facts remain, as this image so brilliantly depicts, war continues and war is hell, both during conflict and obviously after the battles are done. It is true that a picture can grant thousands of words we might not otherwise be able to find to depict the tragedy of war. This artwork, does just that.
Hidden wounds. This is the truth of war. Some in battle lose limb. Some return disfigured in other more gruesome ways, with visible burns and scars upon faces once innocent of such things. Some veterans of war are wheelchair-bound for the remainder of their life. Physical wounds, as heart-breaking as they are, are not the same animal as damaged minds can be. Without a functional mind, nothing in life can really work out all that well again in terms of quality.
We need a functional intellect to process the hidden wounds that come with PTSD. Another sad result of a human survival mechanism being broken like this, is that the brain while working in survival mode shuts down blood-flow to the cerebral cortex, the reasoning area of our brain, making decision-making next to impossible.
As a defense as well, symptoms of avoidance of any reminder of the trauma suffered keeps many veterans from seeking appropriate treatments, such as art therapy could provide. Art therapy is a way to open things up and helps to create new neural pathways in the brain. The creative process of working with paints, chalk, drawing pencils or scribing as an author can offer a means of expression of the pain, often so difficult to express.
We need to know in our society that this is the truth coming home from our most recent human conflict. The more the general population can grow in understanding this illness, the greater the likelihood full recovery will be for our soldiers. We need to understand this for our veteran's sake, this is true. However we need also to understand the nature of this illness for the sake of ourselves.
Trauma, knows no boundaries. War and soldiers are just one combination in our human life experience that leads one to suffer PTSD. Three out of four of us on the planet will experience at least one traumatic event in our lives. Victims of physical, emotional, or sexual abuse in childhood, often manifest PTSD later on, sometimes years following the experience. Emergency Services personnel, develop PTSD at rates of thirty-percent above those cases diagnosed in the general population.
PTSD is not only a soldiers disease. We all are at risk, should trauma invade our lives, of living the inner-torture depicted in this piece of art - the tragic nature of Post-traumatic Stress Disorder coming home to us from war.
*Tanielian, Terri L.: Invisible wounds of war : psychological and cognitive injuries, their consequences,and services to assist recovery: 2008: Rand Corporation Health Research Division (http://www.rand.org/content/dam/rand/pubs/monographs/2008/RAND_MG720.pdf)
**Enari: PTSD & Art Therapy: The Importance of the Self-Body Image in Survivors of Sexual Assault with PTSD Using Art Therapy Techniques: 2009: Pandora's Project Online (http://www.pandys.org/articles/PTSDarttherapy.html)
***Wikipedia contributors. "Post-traumatic stress disorder." Wikipedia, The Free Encyclopedia, 18 May. 2014. (http://en.wikipedia.org/wiki/Posttraumatic_stress_disorder)
****Veterans statistics: PTSD, Depression, TBI, Suicide: VeteransPTSD.Com (http://www.veteransandptsd.com/PTSD-statistics.html)
Image: Combat PTSD: Silverider: 2012: Deviant Art.Com
'We’ve evolved to be smart enough to make ourselves sick'
~ Dr. Robert Sapolsky
Trauma impacts us at every level of our body. Every human cell, is connected to all others as a network of sensory input structures that feed information to the brain for interpretation and action.
When we experience trauma, we see it, smell it, taste it, feel it on our skin, and the stress hormones released into the body under the negative stress of trauma, feed our entire system with chemistry that creates an over-all experience for us that is super-learned. The Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition (DSM-V) specifies this symptom of PTSD as, intrusive memories.
Every sensory cell, organ and system, plays an integral part in holding the memory of our traumatic experience. This is part of the human body's natural defense system. We learn, through traumatic experience, an emblazoned set of sensory memories in order to protect ourselves from experiencing such trauma again. One could argue that every cell in the human body, remembers the moment of trauma.
Therefore with a traumatic experience, sensory input is hyper-imposed into memory, and is therefore stored as such in the human brain and throughout the human body, preparing a traumatized human to avoid a similar fate in the future.
Ultimately, one could further propose, with PTSD it is the memories themselves, once the traumatic event has passed, that causes us further harm over time. We recollect upon the trauma, when we've not yet found way to resolve the psychological harm and intrusive memories the trauma has left behind. Recollection, reignites the dump of stress hormones into our systems, further reinforcing the trauma experience for us as a strong memory of danger for future consideration and action.
It would be nice, if all this took place within our conscious awareness. However, the nervous system dictates for us this fight-or-flight response. Our survival as human beings, depends on the instinctual nature of fight-or-flight for protection. The negative feelings and emotions that come up for us as we are reminded (often-times incessantly) of the psychological trauma we've lived through, are actually caused not by the memories themselves, but by the re-releasing of the stress hormones as part of re-experiencing the fight-or-flight, traumatic stress response.
According to science, we are mammalian creatures. We share fight-or-flight reactions with all other mammals, the closest in relationship to us being primates. One person who studies stress in the animal kingdom, is Dr. Robert Sapolsky, of Stanford University.
A professor of biological sciences, neurology and the neurological sciences, Sapolsky has spent more than three decades studying the physiological effects of stress on health. His pioneering work includes ongoing studies of wild baboons in the African Savanna, highlighted in the National Geographic Special: Stress, Portrait of a Killer. As well, he is the author of the best-selling book, Why Zebras Don't Get Ulcers: The Acclaimed Guide to Stress, Stress-Related Diseases, and Coping(2004).
In a 2007 interview with Stanford Report, Dr. Sapolsky states that all invertebrates share the same brain and body-chemistry, associated with the stress response:
"The stress response is incredibly ancient evolutionarily." . . . "Fish, birds and reptiles secrete the same stress hormones we do, yet their metabolism doesn't get messed up the way it does in people and other primates." (Stanford Report, 2007).
Sapolsky goes on to further state that the metabolic responses we often feel in situations of stress, comes to us through our nature as humans as sociable, highly-intelligent creatures in the animal kingdom. Our intelligence, our ability to reason and to think through our traumatic experience, accents in us the metabolic flooding of stress-hormones, released through psychological, intellectual attempts to make sense of something tragic having happened in our lives.
In other words, Sapolsky suggests, it is our ability of intelligence and inner story-telling, that then becomes our nemesis in recovery. The traumatic event for us has passed. Memory recollection is responsible for the ultimate damage in our lives associated with PTSD. The feelings associated with our traumatic memories result when our brain signals a flood to our systems again with hormones. What we experience as feelings, is the doping of our body with naturally produced stress hormones, now automatically engaged through thought, triggered by memory: the fight-or-flight, stress response.
There are three identified hormones that are released in the stress response, each triggering specific functions in the body necessary for surviving any threat.
Adrenaline, produced by the adrenal glands, floods into our system after receiving a message from the brain that a stressful situation has presented itself. Adrenaline acts to increase heart rate, breathing rate and muscular readiness, granting us the surge of energy we might need to run away from a dangerous situation.
Adrenaline also serves to ignite and place our immediate attention upon the threat itself, enabling us to better fight in response to perceived or actual danger. We feel adrenaline when we are startled. The butterflies we feel in the stomach with even a simple fright, is actually due to adrenaline release, pouring into our bloodstream from the adrenal glands.
Norepinephrine, a hormone similar to adrenaline, is released from both the adrenal glands and also from the brain. Like adrenaline, the primary function of norepinephrine is arousal. It also helps to shift blood flow away from areas where it might not be so crucial, like the skin, and toward more essential areas of the body, including the areas of the primitive brain used for processing information for survival.
If you've ever tried to remain logical and rational under threat, in panic or when angry, think for a moment how clearly you were able to think and process information during these times of intense stress. When we are traumatized, we are in shock. The response of the body in shock is to create an environment in the body, solely concerned with the bodily functions necessary for survival. It is our primitive brain that deals with survival, not the per-frontal cortex and other brain regions responsible for reason and logic.
Although norepinephrine might seem redundant, given that adrenaline (also called epinephrine) fuels the same needs in the body, theory suggests that we may have both hormones as a type of backup system. Nature, some would argue, makes no mistakes, therefore nature provides for us, this back-up system of care. Should our adrenal glands not be working well, norepinephrine release from the brain takes care of the same needs for protective response in the body.
The third stress hormone associated with fight-or-flight is cortisol. In survival mode, optimal amounts of cortisol are necessary to save our lives. Cortisol helps to maintain fluid balance and blood pressure, while regulating other body functions that aren't crucial in the moment of threat. These functions include reproductive drive, immunity, digestion and growth, to name a few.
Many studies now suggest that too much cortisol can suppress the immune system, increase blood pressure and blood-sugar levels, often requiring medication to correct these issues in the human body. High levels of cortisol in the system can decrease libido, produce acne, and is recognized as a contributor to obesity. Cortisol is continually flushed into our systems when we are under threat, and studies also suggest a direct co-relationship between levels of cortisol in the system and the development of physical diseases such as diabetes and even cancer.(The Cortisol Connection, Shawn Talbot, PhD: 2002).
Dr. Sapolsky's work in the wilderness of Africa, supports that high-levels of cortisol is present in the most stressed members of the baboon populations he studies. This directly mimics similar levels of cortisol found in highly stressed human populations. (Stress: Portrait of a Killer, National Geographic: 2010).
These are powerful chemicals. More powerful, some would argue, then any street drug available to man. I'll stress again, when we feel the emotions of trauma, it is the surge of this chemistry that is actually felt.
Our bodies are amazing machines. With it now understood that PTSD is the result of our survival-mode in the body being stuck in an open position, what we feel in response to memories of trauma, are these hormones, racing through our systems, often on a constant basis. We feel this chemistry as anxiety.
This is a very unhealthy situation for our bodies, to be constantly emotionally engaged for battle like this, with memories producing such powerful chemistry in response to a threat that is no longer before us. As stated in the beginning of this article, it is these three hormones, along with others in the stress response, that fuels emblazoned memories of trauma in a misinterpreted effort to protect us from future harm.
If we learn anything while under the spell this chemically induced emotional attachment drives with it into memory, the lesson in the threat, will be super-learned, as identified in the PTSD diagnostic literature as intrusive memory. With the amazing power of our bodies to provide for us when we are under threat, it's reasonable to accept that the body would produce a countering action to the chemistry of the stress response.
Dopamine, serotonin and oxytocin, are three such chemicals now identified as producing feelings of happiness and well-being in humans, that counter the more negative effects of stress hormones in human body. We call these counter-chemicals, (neurotransmitters) endorphins.
How do we naturally counter stress hormones in the body with endorphins? We do so by learning to practice wellness. Recovery efforts, therefore, must contain components of practice that focuses our attention on reducing stress hormones, while at the same time, making way for natural endorphins to do their work towards assisting our bodies in a return to balance, or homeostasis.
As I hope by now is evident, trauma-induced PTSD is a complex disorder, requiring complex and blended interventions to ensure such a return to balance. The first order of business, is to apply treatments to help us restore balance by resetting our nervous system from the open mode of survival, created with our stuck mechanisms of fight-or-flight. One of the most powerful and now accepted treatments in recovery from trauma, is EMDR.
Eye-Movement, Desensitization and Reprocessing, is a technique pioneered by American psychologist and educator, Francine Shapiro. In 1987, she made the chance observation that moving her eyes from side to side appeared to reduce the disturbance of negative thoughts and memories she was having at the time. This experience led her to examine this phenomenon more systematically, leading ultimately to the EMDR technique.
Working with volunteers, she developed standardized procedures to maximize therapeutic outcomes. Shapiro then conducted additional research and published a randomized controlled study with trauma victims. After further research and development of most effective methods, she went on to publish a textbook on the subject. EMDR is now recommended as one of the most effective treatments for trauma. It is accepted as the go-to treatment by the American and Canadian psychiatric communities, as well as by the Canadian and U.S. departments of National Defense.
EMDR, along with other, less-studied treatments (such as Trauma Release Exercise, pioneered by Dr. David Berceli, and Somatic Experiencing, developed by Dr. Peter Levine) assumes that the human body has an innate knowledge of healing from trauma. A forth technique, Self-Regulation Therapy, also understands the bodies own abilities in naturally resolving traumatic experience in resetting our nervous system.
Although some who suffer trauma will resolve trauma on their own, many of us with PTSD will need to rely on such treatments as these to assist us in resetting our nervous systems. To burn-off stress hormones and to release endorphins, physical exercise is another key component we must consider applying to our recovery efforts. Nutrition as well, is key to establishing well-being in life. As discussed in previous blog entries, meditation, specifically working towards practices of mindfulness, is another key application to apply to trauma recovery efforts. Meditation can teach us about any attitudes, perceptions or beliefs that may be negatively impacting our treatment and recovery plans.
An acronym recently passed the desk, W.E.L.L.N.E.S.S.