Healing Combat Trauma

Coming Out of the Darkness, One Step at a Time

I was having a conversation recently with one of my favorite veterans (and which veteran is not?!) about how we were going to take a look at his past in a way that wouldn't also cause him some sort of setback, which I wouldn't want (and nor would he).  I'd done a little digging on his behalf, and found a bunch of "the missing link" type information about what happened to his platoon that he served with in Vietnam, during a particularly vicious battle which had left very few of his buddies alive. 

 He was away from the field at the time, recuperating at a naval hospital in the U.S., and his finding out casually about the entire wiping out of his company of Marines has been the single hardest episode of his life.  What with one thing and another, I'd managed to find out much of the information he wanted to know, but was loath to share it with him, lest it cause him any more horror than it already had.  So I wanted to proceed gingerly with him, not just set him on the slippery banana peel of reflection, as it were, and give him a push.  Vietnam had already been plenty hard for him to process, and its explosive tentacles reached all the way into his present.

We discussed the methods back and forth for a while, of what would be comfortable to share with him, and what the pace could be, and then I asked him, was there anything "good" for himself that he could be doing, so that the material might be absorbed in as successful a way as possible? Was there any special place he could go to, music he could listen to, anything therapeutic he knew to do for himself, while he tried to take in bits and pieces of information about the most troubling time in his life, that has plagued him for the 40 years since it happened.  This is what he wrote back in response:

So, what I need is a very sunny mildly cool day, no monsoon weather or rice-paddy heat; a quiet place in the woods (back forty) with my three dogs; and a print off of the material to read, meditate on, cry, scream, cuss, and read some more; AND my cell phone with your number on speed dial.  That arm and hand reaching down to pull me up out of the darkness. 

 

You know when you save someone’s life, you own that life, until they save yours.  So if you save me, you own me…

(Can you tell why I just adore him?!)  But it did also put me in mind of one other "therapeutic" item we haven't talked about much on the blog yet, but which I know about from my previous writing life.  There's a former cancer nurse named Valerie Cooksley, who's written a number of books for Prentice Hall and others on aromatherapy, but from the scientific end of things, not the frou-frou end.  For a while she was a consultant to Tacoma General Hospital, among others, and their ICU, and she developed some essential oil blends (her term) or "potions" (mine), that have therapeutic aspects.  The ones I'm remembering, because they were directed to the dying and their families, were blends that attempted to enhance people's ability to both grieve the past, and to let it go.  Somehow I can't help thinking that essential oil blends like that would be of some potential value here, too.

It would be hard to quickly go into why and how medicinal aromatherapy works -- it has greater credibilty in Europe, where Cooksley's trainers were trained -- but the concept, in a nutshell, is that essential oils have properties that can modulate people's emotional states, and they're very effective "drug delivery" models, because they quickly cross the "blood-brain barrier" through the nose, directly into the brain's mood receptor sites. I've probably just botched the science by trying to explain it in two sentences and get back to the point, but that's the gist of things, and Cooksley knows what she's talking about.

If you're a fan of the Bible, you also remember essential oils in use with the "We Three Kings of Orient Are" types, who allegedly came to visit Jesus.  "Anointing people with oil" is a practice that dates back at least to Biblical times.  "Gold, frankincense and myrrh" were the three gifts the Wise Men brought (why do they sound like Mobsters, at this remove? Too much "Sopranos") -- and of those, two were rare, costly essential oils.

Just to be very clear on this, I by no means think that dabbing or sniffing a few essential oils is going to be a cure for PTSD.  However, as a pleasant adjunct to what you're already doing, or a lovely relax-i-fier that can be put into use at any time?  Great stuff, and a nice addition to life, in the way that a massage is, or great sex -- not curative in itself, but a nice and pleasant and stress-reducing aspect to life, that's wise to incorporate into your life as much as possible.

Herewith some lovely blends of Cooksley's, along with her notes as to why those particular choices.  Although she's focusing on "death and dying," expand the definition of that as you read these blends to include situations that would also bring up horrifically charged emotions around that topic, such as revisiting combat trauma, and those who were dead and dying there, plus the resultant grief, shame, guilt and confusion that typically surround these episodes.  (This may explain why my "lavender sleep pillows" for returning combat vets and their families, made from a Cooksley recipe, and blogged about here, were consistently such a big hit.)  The last two she mentions are the two I would particularly want to focus on.  You'd have to "read the directions" elsewhere on how to use essential oils (externally, obviously), but sometimes even a drop touched to the underside of your nose, at the point where it meets your upper lip, or waved underneath on a tissue, can give you an immediate "read" on whether the remedy might have some value for you. 

It's also fair to say that anyone I've ever made essential oil blends for, after Cooksley's recipes, has become a fan for life: they're "delish," and this is just lovely high-touch, low-tech stuff.  Women tend to be bigger fans than men -- they're six times as able to "notice" the scents themselves, though this isn't necessary for the scents to do their work -- but both sexes have been able to see the value, once they've tried a few of these for themselves.

“Serenity Blend”: Lavender 15 drops, Bergamot 6 drops, Mandarin 3 drops.

“Anti-depression”:  For depression or grief; useful for back or hand massage. 

Lavender 9 drops, Ylang-ylang 9 drops, Basil 2 drops, Geranium 2 drops, Bergamot 2 drops.

“Joyful Hope”:  Anti-depressant blend.  Uplifting and purifying, to encourage a healing and caring environment.  Orange 4 parts, Ylang-ylang 2 parts, Bergamot 1 part, and Lemon, 1 part.

“Grief and Bereavement”:  For dying patients and their families.  Lavender 4 parts, Marjoram 1 part, Hyssop 1 part.

“Ceremonial Oil”: A nurturing, peaceful blend, to be used with terminal patients.  Helps with feelings of fear, encourages faith.  Grounding hand or foot massage, solar plexus, or used to anoint head.  Lavender 10 drops, Ylang-ylang 8 drops, Sandalwood 4 drops, Frankincense 2 drops.

Another book on the suitably "grand and broad" topic of Aromatherapy and Healing the Spirit, mentions this blend for helping soothe "sudden psychological trauma" -- perhaps, in this case, as it is revisited in memory:

Lavender 3 drops, Frankincense 2 drops, Spikenard 1 drop.

And there's also an item that has a long therapeutic history in Complementary and Alternative Medicine, a blend of Bach flower essences called "Rescue Remedy," available, like essential oils, both online from Amazon.com and places like Whole Foods, Wild Oats, and other natural grocery stores.  Rescue Remedy is a low-tech, non-drug remedy for calming nerves that has an enthusiastic following among a diverse group of CAM adherents, including veterinarians. (I highly doubt even the skeptics suggest that animals are susceptible to the Placebo Response ;-).

 

I wonder if we can add one of these to the list of what my friend will be taking into the woods with him, when he wants to try processing his trauma from the past, in manageable bits and pieces; I hope so.

 

I'd actually like to see him outfitted with many of these items, some soothing, restful music, and Thomas Day Oates, Jr.'s spectacularly-soothing DVD, "Pacific Light," which we blogged about earlier, here.  Maybe he'll need a little red wagon, too -- to carry all that stuff into his healing space into the "back forty" of the woods, with the dogs running along beside him, hoping for the best.

 

In a perfect world -- ahh, I can dream, can't I? -- veterans healthcare options for PTSD would include scented oil massages with just the essential oils necessary for helping speed healing, or take the edges off the particularly hard memories.  As no less an authority on health than Hippocrates, the father of Western medicine, once said:

 

"The way to health is to have an aromatic bath, and scented massage every day...healing is a matter of time, but is sometimes also a matter of opportunity." -- Hippocrates, father of Western Medicine (460-377 BCE)

 

Here's hoping that my adored veteran buddy gets his healing, and his opportunity...

Editor's note: Update...he certainly seems to have. Read the "before and after" of his story, here.

There's a Revolution Going On: Users Rate Their Drug and Non-Drug Treatments for PTSD

We're just about to wrap up our series here -- a cycle of blog posts about the various treatments available for PTSD from the pharmaceutical, Complementary and Alternative Medicine ("CAM"), and mind-body medicine worlds. We've talked about bodywork therapies that show promise. Heck, we've even talked about street drugs like marijuana and ecstasy that appear to have some beneficial effects as well! (Sheesh -- we're not recommending them, per se -- we're just trying to do a comprehensive look at everything reasonable that's out there, that might help sufferers.)

We started this cycle of blog posts back in the beginning of June, with one about how the military was expanding its concept of treatment options to include some "revolutionary" non-drug approaches, linked here.  (We'll add to the cycle of posts over time as the need indicates, but the bulk of it is already done on this topic. This post also builds on a previous post, which talked about how a layperson can learn more about the effects and side-effects of medications prescribed, as well as where to learn about possible warnings when used in combination with other medications.  That post is linked here.) 

One of the most interesting developments is something I get to share with you now -- that a year or so ago when I first learned about it, was not robust enough to be of much value to PTSD sufferers.  Perhaps by now it really is.  The "it" I'm talking about here is something called "Revolution Health," the brainchild of AOL co-founder and marketing genius Steve Case, a project he began in 2005, after he left AOL.

Revolution Health is a number of things, but particularly for our purposes here's it's an online "community" of other patients who give their impressions, pro and con, of the treatments they're using for various illnesses and conditions -- including PTSD -- and not just of all the popular pharmaceutical medications, but also the non-drug therapies as well.  Finally, in one place, patients can check out what other people's experiences of the same drugs or therapies they've been prescribed, along with more straightforward information about the treatments themselves, the possible side-effects.  Clearly, for something like this to work, there need to be a LOT of people checking in and providing their impressions. 

When I first checked out the site, those numbers just weren't there.  It's not so exciting, interesting, or frankly even helpful to learn what three people think of a medication or a non-drug treatment like acupuncture or craniosacral therapy -- it gets a LOT more interesting as more people participate.  Such seems to be the case these days (no pun intended) -- but act quickly -- the site has been experiencing layoffs, and with Web businesses, even those founded by geniuses like Steve Case, you never really can count on how long they'll be around.  So be sure to check out what interests you while you still can.

This is what the site said a year ago about itself, which is still good advice:

This service is in its infancy, but our philosophy is that if millions of people participate, it will emerge as a useful tool for people as they consider their treatment options. Please note that treatments include a mix of some that are designed to directly treat a condition, some that treat side effects, some that provide symptomatic relief.

While individual real-life experiences can be a valuable health resource, they must be viewed in the context of evidence-based data and are not a substitute for medical advice. You should always consult a qualified health care professional before beginning, changing or stopping a treatment.

Now let's get down to business:

Want to learn how other participants rank, rate and review the various treatments for PTSD, both drug and non-drug? (Currently there are dozens suggested!), say, Duloxetine? Click here, for a list of the various, searchable treatments. (Better yet, click herefor them ranked by users in order of effectiveness!)  Want to take a look specifically at the pharmaceutical drugs for PTSD? Click here.  How about the various non-drug treatments for PTSD?  They're there, too, by name.  (You can sort either set of results by "most helpful," "most recent," and "highest effectiveness" on any individual treatment (of the 363) or on the category as a whole.)

Note: Be aware that not everyone who's weighing in with their opinion on what treatment they're loving or hating for PTSD has combat trauma-induced PTSD.  They may have PTSD from some completely other cause.  However, as far as relatabilty goes, this is the best we're gonna get for now -- a "Revolution Health" for veterans only does not appear to be in the works.  Ahhh, but we can dream, can't we?!

To reinforce the warning, though -- given the fact that nothing's permanent on the Web, especially "revolutionary business models," get in -- get your information -- and get out -- in case the website goes away, and/or the company goes out of business.  We sincerely hope that Revolution Health sticks around, because it's performing a useful AND innovative, visionary function --  but even more than that, we want YOU to get the information you're looking for, while you still can.  Oh, and if you sign up to be a member -- I believe that it's free -- you can also contribute your ratings to the user-generated rankings.

There's a Revolution going on...in health care.  Get yours now, while it lasts.

Editor's note: The usual "yada."  Be sure to consult with a qualified health care practitioner before changing or implementing a course of treatment, to make sure that the choices you make are appropriate and best for you.  We are presenting this material as information only, and it's not to be construed as medical advice.  If we could, we would; but we can't, so we won't.  There, we've said it.

Army Broadens View of Possible PTSD Therapies, Includes Complementary and Alternative Medicine

A Military.com article published on May 29th reports on the U.S. Army's increasing openness to non-traditional therapies to treat PTSD.  The article by Bryant Jordan is called, "East Meets West in Army Mental Therapy," and it quotes Col. Elspeth Ritchie on the Army's increasing openness to options beyond traditional counseling and medication, to include items like yoga, acupuncture, meditation, and of course, virtual reality. The headline is positive, but in truth, the Army may be taking only baby steps towards including nontraditional therapies, often known as Complementary and Alternative Medicine (CAM).

(Some "definition of terms" is in order.  "Alternative medicine" means treatment choices other than conventional medicine, to be used instead of conventional medicine; "complementary medicine" means treatment choices to be used in addition to conventional medicine -- so the term "CAM," or "Complementary AND Alternative Medicine" is meant to be inclusive of both approaches.  This ends up being an important distinction, because responsible M.D.s are often more in favor of patients adding complementary therapies in to their treatment protocol, rather than replacing a conventional treatment protocol with fully alternative therapies. "Complementary" is misspelled in the Military.com article as "complimentary," which further confuses the terminology.) 

The article states that "Therapies that are "kind of tried and true" remain at the forefront of treating Soldiers with behavioral problems, [Col.] Ritchie said. These include behavioral therapy and exposure therapy -- where patients are "exposed" by degrees to scenarios that may be at the core of the problem -- and medication."  And it further quotes Col. Ritchie as saying that although CAM therapies "are interesting, we don't have the hard data to show which therapies are useful for what population. So we're really in the research phase of this for yoga, acupuncture and some other therapies."

The Military.com article is linked here.  A previous article by Noah Shactman in Wired magazine on March 25 discussed similar material, and mentions a Department of Defense grant opportunity with a closing date of May 15, providing $4 million in funds to study therapies with possible benefits for PTSD and/or TBI, including but not limited to "music, animal-facilitated therapy, art, dance/movement, massage therapy, EMDR program evaluation, virtual reality, acupuncture, spiritual ministry, transcendental meditation, yoga and other novel approaches."  (The grant opportunity announcement is linked here.)  According to the Wired article, reading from the grant application, the Army is willing to contemplate as well the potential effectiveness of "biologically-based treatments, botanicals, and nutritional supplements for enhancing cognitive function and mood in patients with trauma spectrum disorders, including TBI and/or PTSD, depression, anxiety, and/or substance dependence/abuse," and adds, "Even proposals for wild-sounding "therapies using bioenergies such as Qi gong, Reiki, distant healing and acupuncture" would be accepted."  The Wired article is linked here.

I'm unclear whether the Army is leading the way of all the military branches in considering the potential of CAM for PTSD; but whether it is or isn't, kudos to it for being reasonably open-minded.  One of the problems that seems to keep coming up with PTSD is that no one obvious choice comes up in treating it, that works every time.  There are a variety of pharmaceutical drugs that are prescribed, but no one remedy in particular appears to be the wonder drug, or cure-all.  (You hear the frustration about this when you listen to the stories of combat veterans who are taking a handful of pills to combat PTSD, sometimes as many as 20 or 30 separate medications - a scary cocktail, indeed.)  Other approaches for PTSD, such as talk therapy, cognitive therapy, EMDR, etc., all have their place in the pantheon of treatments, and each has their adherents/proponents, but again, there doesn't seem to be a one-size-fits-all, cure-all for PTSD.  In the absence of the medicinal "silver bullet" that cures all PTSD, it's great that the Army is at least embracing the concept of possible adjunct therapies, while asking them to prove themselves clinically, as much as possible.

In the following weeks, we will report on complementary and alternative therapies that appear to have some benefit in treating PTSD; in addition to the more mainstream approaches that are already in use.  (Virtual reality is another type of treatment entirely: dependent on technology, it doesn't fit the typical rubric of CAM, nor should it.)

Read All About It: Helping Healthcare Providers Recognize PTSD

The Department of Veteran Affairs has made available something called the Iraq War Clinicians Guide, 2nd Edition, intended to help healthcare practitioners recognize and diagnose Post-Traumatic Stress Disorder ("PTSD") in their patients.  Although the material is intended for mental health care providers, in reality, it's probably useful information for most clinicians to have handy.  A link to the guide's contents is here.

(The Iraq War Clinicians Guide was developed by members of the National Center for PTSD and the Department of Defense, and it was developed specifically for clinicians and addresses the unique needs of veterans of the Iraq war.) 

If you have the latest version of Adobe Acrobat Reader, you can download the entire guide, or you can download specific chapters of interest.  Kudos to the VA for making this information available on the Web. 

Back from Hell: Treating PTSD with Massage and Other Bodywork Therapies

An interesting article recently published online talks about the therapeutic benefits of touch (massage therapy, in this case) for PTSD, without making it seem like either a panacea, or a complete walk in the park.  Kudos to the article's author for acknowledging the difficulties faced by this client population, and the special sensitivities needed.  Bodywork modalities like massage therapy, craniosacral therapy, possibly even Reiki and therapeutic touch, hold some promise for treating combat veterans, provided the practitioners are educated about the special challenges of that population, and provided the participants are willing.  (The attached photo is of a crayon drawing, done by one appreciative child patient, depicting his practitioner's healing hands.)

The article is well worth reading, and is excerpted in part below:

Traumatized in war, often faced with family and job relationship difficulties, and also frequently confronted with government bureaucracy, veterans deal with high levels of anger. One study stated, "Anger management intervention is an integral part of post-traumatic stress disorder treatment in the Department of Veterans Affairs facilities across the country."11 The presence of intense anger, along with other deep emotions, can cause a veteran -- triggered during therapy -- to undergo an explosive emotional release. "PTSD may cause a person to fly into a rage for no apparent reason or strike out in fear at inappropriate targets."12

"Vets tend to have a more violent type of reaction if a memory comes up," explained Chris Smith, director of education at the Colorado School of Healing Arts in Lakewood, Colorado. Smith, who is also a massage therapist and instructor for the school's 100-hour program in Trauma Touch Therapy, explained, "It takes a therapist who can stay grounded and isn't afraid of the intense emotional outbursts." Because of their war-time experiences, she said, veterans in therapy may tend to be "less resourced" in how to handle stress and "more hyperaroused" than other trauma clients.

According to some therapists who work closely with veterans, the VA and other group programs provide only limited help for veterans. After a certain amount of time has passed, these therapists say talking about the trauma in a group setting can become a useless "rehashing" of the horrors. To emerge from the sense of victimization may likely demand hard, individual work in therapy on the part of the patient. It generally requires facilitation by an extremely grounded and well-versed therapist. If the veteran chooses to try an alternative therapy, such as massage, the process will likely necessitate participation not only in bodywork sessions, but also in simultaneous sessions with a psychotherapist.

One massage therapist who has worked with veterans visited a VA hospital to learn more about PTSD and observed that many of the veterans were in extremely serious condition. "For many vets, the only answer is a great deal of isolation and seclusion and often medication that can have so many other side effects. They often cope by removing stimulation as much as possible," she said.

It seems like a good time to re-mention the fabulous Claude Anshin Thomas passage in his book, At Hell's Gate (see sidebar), about suffering not being the enemy.  Click this link to bring back that earlier blog entry.

Acupuncture and Healing Trauma

The University of New Mexico is studying acupuncture and Post-Traumatic Stress Disorder (PTSD).  An article on the ongoing study is linked here.

An excerpt from the article follows:

Researchers at the University of New Mexico are continuing work on a $250,000 two-year study of the effects of acupuncture in treating PTSD. The study, which began in May, was made possible with a grant from the National Institutes of Health. If successful, it could lay the path for larger trials that incorporate Eastern and Western approaches to treating the condition.

"This is the first study I'm aware of to look at acupuncture as a modality for PTSD," said Dr. Michael Hollifield, an associate professor of psychiatry and family medicine at the university's department of psychiatry and the study's principal investigator. "To date, our research supports using acupuncture for treating PTSD symptoms, including insomnia, anxiety and depression, in addition to some pain disorders. It may do so by stimulating the body's internal opiate system, though much more research on this issue is needed."

Aiding Dr. Hollifield in his research are Nityamo Sinclair-Lian, DOM, and Teddy Warner, Ph.D., who will serve as co-investigators. Drs. Hollifield and Sinclair-Lian collaborated previously on a study on the effects of trauma in Vietnamese and Kurdish refugees. Dr. Sinclair-Lian also runs a public health pain clinic for Vietnamese refugees, and provides acupuncture detoxification for substance users at a local outreach shelter for the homeless.

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Anecdotally, as they say in the medical biz, acupuncture and other traditional healing modalities, are known to offer comfort and relief to numerous health conditions.  We'll list individual acupuncturists here on this blog as we come to learn about ones who are interested in the topic; and in general, check out a comprehensive directory of specialized acupuncturists here, of a type that treats conditions affecting the body, mind and spirit.