February 2018 Philadelphia Chapter of Pax Christi U.S.A.
The experience of trauma affects different parts of the brain and therefore the mind. The hippocampus is a data bank for memory. It organizes memories according to time and place and connects them to emotions where the amygdala monitors the memory and emotional input and instructs the body to respond. In PTSD the hippocampus gets the time and place confused and stores the memory as a fragment not a whole. The amygdala may perceive the way the memory and emotional data are mixed as dangerous. Individuals with PTSD have no “off switch,” so a perceived threat leads to dysregulation between the hippocampus and the amygdala. These parts of the brain become overwhelmed, signal distress to the body, and the mind “knows” there is danger.
Over the past eight years, I have learned that service men and women experience trauma in unique and different ways. There seems to be no end to the complexity. Every person has a different limit as to how much trauma he or she can tolerate but, when experienced, it is always unique. Two recent examples brought this “uniqueness” to my attention. One case I read about and the other I listened to.
Story number one
I read a former colleague’s report of a patient who was involved in a nighttime landing of tanks on shore. As an infantry man, he was guiding the offloading of the tanks from a special landing craft. Somehow under reduced light and adverse conditions, the situation deteriorated.
“Suddenly, one of the rackety monstrosities was right in front of him. He fell to the ground and lay as flat, straight and motionless as he could, parallel to the approaching machine’s treads. He was terrified, lying between the tracks as the tank clanged over him, thankfully without causing physical injury.” (1)
He survived physically unscathed. Many years later the soldier had back problems unrelated to this experience. Referred for an MRI he became “paralyzed” with fear. The potential claustrophobia and “notorious clamor” of the MRI overwhelmed his brain, his body, and his mind.
Story number two
I listened to a 40-year-old soldier as a patient for a number of months. He had Attention Deficit Disorder since elementary school yet functioned well. He spent about 20 years in the Army as a military police officer and had a several deployments. The medication he takes allows him to be appropriately attentive at his job and concentrate. He has an older daughter and his wife was expecting a baby. He is now considering retirement and possibly moving to the area where his wife grew up. Recently he went to that city to interview for a position on the local civilian police force. His father in law happens to be the chief of police so that augments his chances for the job. The tests went well, the security clearance will take some time, but he is optimistic he will be offered a position. The transition from military to civilian life is complicated, but he is taking many appropriate advance planning steps. He and his wife seem to be in agreement, and their family life is going well.
About two months following the birth of his son, he returned for an appointment. Distressed, disheveled and distraught he said he could not sleep. In response, I made some inane comment about how the sleeping habits of young babies can be hard on “older “parents.
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“No,” he said, “not that, it is the nightmares, of gathering up body parts.” Having no record of these symptoms I asked him to explain. He said, “It happened a little when my daughter was born but the birth of his son has triggered nightly multiple nightmares of my deployments.” I again asked him to explain.
His military police job in Iraq had been to secure the streets and ensure safe passage for both civilians and the military. IEDs (Improvised Explosive Devices) used by insurgents to kill almost two-thirds of our soldiers were a constant problem. IEDs may be conventional military explosives but they are used in unconventional ways such as roadside bombs attached to an “unseen” detonating mechanism.
One day he watched two Iraqi families packed into a small Toyota Corolla drive by on their way to the grocery store or for religious worship. As they passed under a nearby bridge their vehicle was suddenly exploded. Parts of the vehicle and body parts flew everywhere. His job of ensuring security then became one of collecting body parts into body bags. Collecting fragments of children was especially difficult.
And now while changing diapers on his new born—handling those small, flexible, vulnerable body parts—this service member is reminded of that awful work his job required. He ponders, “One moment a happy family the next moment just body parts.” There is no explanation. “Their car just drove over the wrong spot.”
Those of us who are fortunate enough to have children, change diapers—regularly. Not always pleasant, but it is a routine and an accepted part of being a parent. This soldier who served on our behalf has a much more difficult job being a parent than the rest of us do.
Changing diapers or getting an MRI should not be such a difficult ordeal. These daily tasks can overwhelm the soldier, fresh from the work of cleaning up the devastation of IEDs while serving and protecting our country.
(1) Lacoursiere, Roy MD, “Military Trauma’s Unusual Appearance,” The Journal of the American Academy of Psychiatry and the Law, Vol 45, number 2, 2017 pages 221-222
Ted Beal
Edward W. Beal, MD, Psychiatrist, Department of the Army, Department of Tele-Health, U.S. Army Medical Department Activity, Fort Meade
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