What Veterans have taught me about love

It has been said that soldiers fight mostly for love of their comrades in arms. As both a civilian and military physician, over the last 34 years I have heard hundreds of stories from the people who serve our country. The following is an attempt to give a voice to those whom I have had the privilege to serve and to showcase the valuable lessons they have taught me on the subject of love.

Dr. Markus Besemann just retired as Head of Rehabilitation Medicine for the Canadian Armed Forces. He is one of our Project Trauma Support physicians. This is an article he had published in the Atlas Journal. The “Atlas” was previously known as the “Centre for Excellence for PTSD”

In October 1991, I was posted to the National Defence Medical Centre (NDMC) in Ottawa. We were told to stand by for the admission of some of the survivors of the ill-fated Hercules 130322 Boxtop 22 crash, just kilometres away from Canadian Forces Station Alert. As those requiring medical care were admitted, we heard stories of the courageous pilot Captain John Couch, who gave up his own cold-weather clothing so that others would live. This selfless gesture led to his own death from exposure just hours before the search and rescue team reached the scene. This moment marked the beginning of my understanding of the depth of self-sacrifice that military personnel and Veterans are no strangers to. In my young officer’s mind, this was nothing short of Biblical love.

Several years later, I was walking alongside a senior submariner who, with tears in his eyes, told me all about the Chicoutimi submarine disaster and how with few exceptions, those who saved the day were some of the less polished “bad apples.” Their rough and ready backgrounds had inadvertently prepared them for the unexpected. In other words, what caused them and others distress in peacetime served them very well when catastrophe hit. Another lesson on love: Don’t judge a book by its cover. It is what is hidden inside a man or woman that really counts, no matter how this strength of character is acquired.

Another story that deeply affected me came from a combat medic in Afghanistan who was tasked with carrying a casualty on his shoulders during an ambush in the darkness of night. Given the load he was carrying, he lost sight of his platoon. Bewildered and lost, he searched for direction, until he eventually saw another brother in arms at the end of the road pointing the way home. He successfully reunited with his unit, only to find out later that the brother pointing the way had been killed earlier that evening in a firefight in another village. Soldiers do not desert their comrades, even after they die.

“And though they did hurt me so bad…You did not desert me My brothers in arms.”

Brothers in Arms, Dire Straits

Stories such as these are not uncommon in the context of war. They have been well described in the diaries of soldiers from previous conflicts. They help illustrate the extreme paradox that is present on the battlefields of life. Despite the horrific destruction and death, love persists and rises above it all.  As a medical doctor, I have personally heard countless such stories over the years and I have been drawn to ask myself, who am I to question these lived experiences and the messages they convey?

Many military personnel appear to know from a very young age that they wish to serve. This may be the result of a dream passed on by military Families or one borne out of a sense of somehow feeling that they were called to be the protectors of society. The dedication with which service personnel pursue this life calling never ceases to amaze me.  It is the deepest form of love. The conflicting tragedy and beauty of this incarnation, which benefits many of the more privileged in society, is that it comes at a tremendous cost to the Veteran. Many Veterans elected to put on the uniform and swear an oath to make the world a better place. This however can often leave them with many unanswered questions and harsh self-judgment for choices made or not made.

Veterans have taught me that self-love is one of the hardest “missions” they have ever undertaken and that this can be a long soul-searching and sometimes gut-wrenching journey. Given that the definition of mission success is expressed in extraordinary acts of bravery, it is often difficult for Veterans to put themselves first and love themselves unconditionally because of the morally conflicting decisions they have had to make in the line of duty. The challenge over the long term for the Veteran is to realize that this acquired identity does not define them. One of the greatest obstacles for Veterans in their healing journey is to learn to embrace their authentic self despite the possibility that this process might lead to a completely different narrative about who they are and how others might view them. Only when they can reconcile their identity as a soldier and their true essence as a human being can they begin the journey towards forgiveness. It has been said that true forgiveness occurs when you finally realize that there was nothing to forgive in the first place.

Love is often difficult for Veterans to demonstrate. Sometimes their love is shown when they volunteer to take another’s place on patrol or lay out a comrade’s air mattress at 3 a.m. because their fire team partner is still on sentry duty. Veterans’ expressions of love can be rough around the edges and displayed in brutal honesty and dark humour. The tough love they express for their comrades and their steadfast commitment to their core beliefs and values often goes unrecognized by many civilians and is often misunderstood. It is the deepest form of love I have ever had the privilege to witness. In its sheer rawness, it shaves away all the fluff we so often mistakenly take for signs of love, but that in reality is so far removed from what love actually is. Ultimately, what unites us all —whether civilian or military — are our individual struggles with loving and forgiving ourselves unconditionally, understanding that we all at some point in our lives fall short of our idealistic expectations, but that we restore balance by expressing compassion to ourselves and to others.

This is amongst the most important lessons learned, that despite the suffering Veterans have endured and continue to endure, there is value and a purpose to all of it. If embraced, it can teach us all more about how to love and be loved. If I were to try and summarize as succinctly as possible the essence of what it is that I am trying to convey in the name of those who have sacrificed so much, it would be the notion of embracing the paradox of life. The world our Veterans have seen and experienced is as horrific as it is beautiful. At the end of the day, they have shown us and continue to show us that ALL of it is love in its various manifestations.

LCol (Ret’d) Markus Besemann CD, BSc, MD, FRCP(C), Dip. Sport Med. (CASEM)

Learn more about moral injury, the impact of events or acts that a person performs, witnesses or fails to prevent, which conflict with one’s own deeply held moral beliefs and values.


Dr. Markus Besemann just retired as Head of Rehabilitation Medicine for the Canadian Armed Forces. He is one of our Project Trauma Support physicians. This is an article he had published in the Atlas Journal. The “Atlas” was previously known as the “Centre for Excellence for PTSD”

Funding Request

To those who share our concern for the mental health and wellbeing of our military members, veterans, first responders, and front-line health care workers,

As you are likely aware, we are seeing an escalation in the need for mental health care for our emergency and front-line responders. Those we rely on to keep us safe and healthy are facing significant new challenges in today’s world. There are increasing numbers of calls for service and professionals are working overtime and short-staffed due to colleague burnout and budgetary cuts. In addition to this, some first responders, especially police officers, are facing criticism and condemnation from the public more than ever. Media reporting of the performance of emergency service providers is increasingly negative, adding to less job satisfaction.

Project Trauma Support (PTS) has developed a six-day residential experiential program that helps our uniformed professionals and our front-line medical personnel process their painful experiences so that they may remain actively engaged in service. Since 2016, we have had over 700 graduates of our program. Many have indicated that their experience with us was life changing and even life saving. Many have either returned to work or have been able to stay at work as a result of completing the PTS program. Families have reported that they have seen lasting positive changes in their loved ones returning from the program. More recently, we have added ketamine assisted psychotherapy to our programming. Again, staying at the developing edge of new methodologies and emerging evidence, we have developed protocols to safely administer ketamine sessions in both group and individual format with medical supervision and expert psychotherapeutic support.

Our physician led, peer mentor driven program has the advantage that effective, targeted treatment can be delivered in a short time frame, limiting both the cost and the length of time a participant is away from work and their families.

We wish to ensure that we remain adequately funded so that we may continue to offer the benefits of our work to many who are suffering and have not been able to access effective care. We are receiving increasing numbers of referrals from not only past participants who want to send their colleagues, but also from their mental health providers who have seen the benefits. To be able to continue, we need your financial support. As Project Trauma Support is a registered charity in Canada, all donations receive a tax receipt.

We wish to continue to develop the PTS programming, backed by sound research, to demonstrate that the work we are doing is safe, effective and ground-breaking.

Our goal is to scale up our work by teaching our findings and our methods to other physicians and mental health providers across Canada. We believe that we can be part of an effective and affordable solution and that our work can contribute to establishing the standard of care for ensuring the mental health and resilience of those who hold the front lines and are the first and last defense of our country.

Donations can be made through our website: www.projecttraumasupport.com or through searching for Project Trauma Support on the Canada Helps website: www.canadahelps.org

For more information, please contact us at info@projecttraumasupport.com

Sincerely,

Manuela Joannou M.D. CCFP(EM) FCFP
Medical Director, Project Trauma Support

You Cannot Heal From PTSD Alone

How does one regain peace of mind and joy for living when Post Traumatic Stress and Moral Injury have set in?

We cannot go back in time and rewrite our histories. We cannot wipe out the fact that we have seen horrific things and witnessed the unfolding of events that are just plain wrong. We cannot pretend that we didn’t do things that continue to give us a jolt of shame and guilt whenever the memory sneaks in.

The only way to return to a path of equanimity and hope is to reprocess the way we have judged ourselves, others and the world that has allowed atrocities to occur. We must find an attitude about our experiences, our observations, and our choices that we can live with, in peace.

This may sound simple, but it is far from being easy. This is generally not work we can do on our own.
When our most predominant emotions are fear, shame and disillusionment, our tendency is to isolate. But we need the companionship, support and love of our family and our comrades to restore order in our world. We also need to feel that we can reciprocate and show up and be useful in the lives of those we love.

When we are yearning for forgiveness, we need atonement.

We can try to convince ourselves that we can be absolved of guilt but the arguments ring hollow without the acknowledgement and support of others whose opinions we value.

We may be battle-scarred and battle-scared, but our new assignment is to gain wisdom from our experiences that can be shared with others. We are also called to find new meaning in our life stories, that can energize and direct us to more purposeful lives.

We can be the change we wish to see in the world.

We can direct or energies to making our world a safer place in both physical and emotional terms for those we love, and even perfect strangers.

The symptoms of PTSD are often devastating and crippling. We most likely need professional help to overcome them.

If we could gain command over intrusive, painful thoughts, the other symptoms would dissipate. We could calm our hyper-vigilance. We could sleep without our psyche being hijacked by senseless terrors. We could boldly step out of our homes to run errands or socialize. We would have lots of patience to be supportive of our friends and families. We could happily dream and plan for our futures and look forward to a fulfilling life of work and leisure.

How do we gain command of our thoughts? The evolving field of metacognition, or noticing what you’re noticing, guides us on this path. To gain mastery over our minds, we must become aware of the specific sorts of thoughts and thought patterns that tend to take up residence in our brains. Very often, they are strong enough to dictate how we live our very lives.

It can be useful to take a step back and become a witness to our exact thoughts, as a passive observer. With a detached curiosity, we can inspect what notions our troubled psyches are thrusting in the forefront of our awareness, without attaching any emotion or reacting to them. This is the practice of mindfulness and it does take practice.

When we recognize intrusive thought patterns, we can start to challenge them by replacing them with new attitudes we have decided to adopt through our reprocessing of our experiences. We can displace fears and limiting beliefs by taking on new challenges that are driven by the resolve that comes from new meaning we attach to our histories.

Sitting at the unintended crossroad imposed by PTSD, we have a choice.

We can become victims of our traumas and our automatic thoughts that come from them, or we can realize we did not go through all this for nothing and do the work to push through to new vistas of post traumatic growth.

The other dragons to slay on the path to recovery may include depression, loneliness and relationship issues, health considerations, financial and insurance concerns and general life challenges.

All of these can and should be addressed by a professional team along with peer support guides. As Joseph Campbell stated, there is a psychic unity of mankind. We heal from our traumas that are part of our human condition by tapping into this human connection.

Project Trauma Support: Addressing Moral Injury in First Responders

Download the research paper
Download the research paper

Abstract

Post-traumatic Stress Disorder (PTSD) amongst military, police, Royal Canadian Mounted Police and first responder personnel often includes a moral injury component. The Project Trauma Support (PTS) program is designed to address moral injury in the emergency service personnel population. The Kessler scale of psychological distress (K6) and a new Life Challenges survey (LCS) were administered pre-and post-course to three cohorts undergoing the PTS program, providing a within-subject design examining 8 males and 8 female emergency services personnel, in 2016. All participants were above K6 threshold for distress upon entry into program. Positive improvement was noted in both instruments, and
across all K6 subdomains (p < .001) and across 8 of the 10 LCS subdomains. The results indicate that the PTS course shows promise to provide a holistic therapy for military veterans,
police, Royal Canadian Mounted Police and other emergency personnel suffering from PTSD.

Introduction

There has been an increase in prevalence of Post-Traumatic Stress Disorder (PTSD) in military personnel returning from Afghanistan [1-3]. Studies have shown that PTSD is a major risk factor for suicide in the military veteran population [1,4]. Police and paramedics encounter similar traumatic events as the military population, and studies have shown the emergency services have an elevated risk of suicide [5-7].

Moral injury has been implicated in PTSD outcome [8], and includes anger, shame, inappropriate guilt and social alienation that manifests after witnessing or engaging in traumatic events that defy a person’s sense of humanity [9]. Project Trauma Support (PTS) is a new initiative started in Canada that seeks to address moral injury associated with PTSD in Military/Veterans and First Responders (police officers, firefighters, paramedics). Moral injury is difficult to treat and also a more likely component to drive those suffering from PTSD to suicide [10-12].

Prolonged exposure therapy and cognitive processing therapy have been studied as the favoured treatments for PTSD in military veterans by Veteran Affairs in USA. These modalities have shown only modest benefits, perhaps because they do not address the physiological, psychological and sociological disintegration arising from PTSD [13]. Recently some complementary holistic approaches such as yoga, equine therapy, music, and art therapy have shown promise in the treatment of PTSD [14-16]. It has been our belief and experience that combining traditional therapeutic modalities with some of the more experiential therapies in an intense, brief residential treatment program can have significant positive outcomes. Furthermore, shared experiences and group psychotherapy stemming from shared experiences may be invaluable when it comes to reprocessing the memories (cognitive and physical) and lasting impact of trauma, thus helping to alleviate or minimize the symptoms of PTSD [13-16].

The Project Trauma Support (PTS) program is designed to address moral injury in the emergency service personnel population. The focus of the PTS program is to provide a safe environment where defences may be dropped and authentic emotions may be processed in the presence of supportive comrades who provide unconditional positive regard through
shared experiences.

This paper reports on the results of a pilot investigation of the PTS program on three cohorts of participants in 2016. Results from this project will help inform healthcare providers
of potential complementary therapies to aid in the rehabilitation process.

Download and read the research paper.