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.

Winter Blues, Blahs or Buoys?

My friend just sent me a poster saying “January was a tough year, but we got through it!” We know that Seasonal Affective Disorder (SAD), or the “Winter Blues” is a real thing causing feelings of depression for many people.

Shorter days and cold and inclement weather make travel or even just putting the garbage out less enjoyable. People already battling mental health issues can certainly find the winter to be something akin to a long, lonely sentence. If you are struggling with PTSD or another Operational Stress injury, we know that the worst thing you can do is to isolate. Yet the lethargy and decreased mood that comes with SAD and the cold weather can easily drive you to do just that.

For those of you who are lucky enough to be snow birds and can escape to the south for the winter, good on you! For the rest of us that have to stay here and slog out another Canadian winter, here are some things to contemplate.

Nature, working with the physics and chemistry of life, constructs the seasons. Spring is the season of new growth and expansion, summer the season of vibrancy and brilliance, fall the season of reaping and storing, and winter the season of rest and submission. There are other cycles of life as well. A mighty oak grows with oxygen, sunlight and nutrients, but when its life cycle is over, it returns to the earth
Although it may look like things are at a standstill in the winter, there is actually much going on in preparation for the new growth season, which is only (How many weeks away? What happened to the groundhog this year, anyone know?) The apparent dormancy we see over the winter in nature is much more than a period of suspended animation. Seeds in the ground are still metabolizing, but at a slower rate. After a period of time, hormones trigger initiation of new growth, which can happen if the conditions are favourable (ie enough water around). And this time of year, all the gardeners are starting to plant seeds indoors, looking forwards to spring.

As many of you have probably figured out, we are always either growing and expanding or retreating ourselves. We are never staying at a standstill. You can feel like you are getting into better physical shape or deconditioning. You can be learning new skills and keeping up in your field, or falling behind. You can be improving mentally, or isolating more and becoming more anxious and despondent. If you pay attention to your thoughts and energy levels and where you place them, you may become more aware of what is actually going on with you.

When you are expanding, you feel excited, optimistic and energized. You feel focussed and driven. Creative ideas abound. When you are in a contracting, retreating state, you feel listless and more depressed and anxious. You may sleep too much or not enough. You feel hopeless and too often you will tend to use your thoughts and the energies you have to mentally punish yourself.

But what if you use this quiet winter time like seeds underground, to build yourself up to get ready to spring? What if you put your energies into winter sports to improve physical fitness and the time you invest in your family? What if you go into hibernation to do some serious research on courses you might want to take, projects you might want to tackle, a new business you might want to look into?
And if you are seriously in a place where you are finding yourself spiralling down, gather your energy to pull yourself up. Call your doctor and ask for an extra appointment to talk about how you are feeling and what you can do about it. Or read some good books on improving your mental state.

Call a friend and go for coffee. Go to a peer support group. Maybe there are others who are also struggling and could use your support. Maybe feeling compassion and caring for others is just the distraction and boost you need.

Winter is a great time to meditate on what is truly important. It is a time to nurture yourself and your loved ones. It is a time to be optimistic about the future and to plant those spring seeds.

Vision by Ryan O’Meara


By: Ryan O’Meara, Advanced Care Paramedic

Paramedicine is an amazing profession, and is always changing. You can have incredibly rewarding experiences that leave a lasting sense of positive energy one minute, only to end up humbled and emotionally trashed the next. I sit here writing this having just had one of the latter.

I’ve just watched the life drain unexpectedly out of a patient’s face knowing that things would never be the same for them ever again. And I was the only one present to observe it. Not a loving partner, adoring children, caring parents, or their cherished friend, only me… a stranger, in a strange environment, who’s trying to do what I can to help but I’m failing. All I can do is prop them up on the stretcher and try to keep their airway clear of the vomit recently expelled.

I’ve just seen a great deal of care, concern, and hard work, by a professional health care team to bring life back into that face. Some life, any life, would be considered a victory. But instead, despite the marvels of modern medical science, there was no life to return.

I’ve just spied the looks on the faces of that caring team as news of the defeat is delivered and processed. It’s hard to accept the result. We train and prepare with victory always in mind. Optimistically we assume every situation will end in victory, otherwise the weight of constantly expecting defeat would crush us. Someone has just become overwhelmed with emotion at the gravity of the proclamation and can no longer restrain their tears.

I’ve just witnessed the sadness that follows when the family is present in the room. There’s a look on the faces of family when they first enter the room. Before laying eyes on their loved one their faces hold an expression of unwanted trepidation that will shortly shatter into raw emotion. As they visit, weep, and console one another, their grief amplifies the weight of failure hanging about the room. This is when I must leave, for I fear if I am here any longer that weight might crush me.

I’ve just looked back on the events of the previous hours and seek to engage my partner ensuring there is nothing we missed, nothing we overlooked, nothing in which we find fault… nothing. Nothing is precisely what I now feel we accomplished. We should have been able to do something. All of our training, all of our experience, all of our gear, medication, and equipment, amounted to nothing. At least that is what I believe after we leave the hospital. Time passes and thankfully I’ve now seen through the fog of emotion and realize that we did accomplish something after all. We were there in those first moments of sheer panic, lending reassurance. We gave them the best possible chance. We helped to give the family time to gather together and wish their loved one swift travel to the next life. We did make a difference, even if we can’t see it at the time.

Scenes like this will play out over and over again in our Paramedic careers. They have the potential to break us, but also the potential to help us grow and become better. If we dwell only on the dark we can get lost in it. It can consume us if we allow. Try not to let yourself become mired in the dark. Seek out people who care and are willing to help and listen. Take the time to TALK. TALK to your partner. TALK to someone on the peer support list. TALK to family. TALK to a counselor. TALK to a support group. IT DOESN’T MATTER WHO YOU TALK TO, JUST TALK! Speak up and you’ll soon realize this is something you don’t have to go through alone.

Optimism and Curiosity: Buffers for PTSD and Burnout by Dr. Manuela Joannou

Life is difficult. This is one notion that not many would refute. We are all faced with responsibilities, challenges, stressful situations and difficult decisions to make. Our life story lines include love and loss, triumph and defeat, success and failures. We are surrounded by examples of loyalty  and betrayal, valour and cowardice, scrupulousness and dishonesty. We deal with difficulties in our personal lives, our professional lives, our physical health and our emotional wellbeing. How do we stay centred, productive and sane? How do we move forward in our lives making meaningful contributions and setting good examples for our children and others who look to us for care and direction?

It is our perceptions and our attitudes that will make us or break us.

Living a life filled with opportunities and challenges is nothing new; it is the essence of the human condition. The props and the costumes may be different, but the themes, the archetypal characters and the plots in which we find our protagonist selves are few in number.  These plots have played themselves out over and over again in the history of mankind.

When we are slapped with another unwanted assignment or a disappointing piece of news, it is easy to slide into a state of resentment. Why should I be the one who has to do this? Why are the kids so annoying and messy? Why are there always more bills than money to pay them?

The truth is that conditions and circumstances, which we judge as good or bad, will always appear. We have little control over most of them. What we can control, however, is how we choose to perceive them. This will determine how  we approach our life’s journey in its entirety.

Victor Frankl, in his landmark book “Man’s Search for Meaning” wrote “everything can be taken from a man but one thing: the last of the human freedoms-to choose one’s attitude in any set of circumstances, to choose one’s own way”.

Psychologist  Martin Seligman has spent his career studying positive psychology: what particular mental attitudes lead to enhanced psychological and emotional wellbeing. He has identified optimism as being the one trait that can enhance the experience of life. He believes that everyone can learn optimism. Learned optimism is the opposite and antidote to learned helplessness.

It appears that some people tend to be naturally optimistic while pessimism is a strong tendency in others. Both stances are associated with energies that come with them. Optimists can have seemingly boundless energy because they naturally expect that all their undertakings will have positive outcomes. Pessimists, on the other hand, may be reluctant to invest their energy into projects as their belief is that no good will come of their efforts, or what good results they initially experience will eventually be sabotaged ( usually by the stupid people that they feel make up the world).

Disappointments in the optimist’s world are  seen simply as feedback, giving the opportunity to start again, with more knowledge and wisdom. Disappointments in the pessimist’ s world are yet another reinforcing validation of their view that life sucks.

The optimist will view challenges and difficulties as a chance to grow. They will attach hope of goodness to even the most dire situations. They will look for strategies for damage control, the opportunity to alleviate suffering, and find meaning and purpose in their willingness to serve in natural disasters. Even when death is inevitable, the optimist shifts to a hope for a serene passing with contentment and closure. Pessimists will crumble much faster in the face of adversity. They will lose hope and resent the energy they expended that led to disappointments or disaster. This is of course an exaggeration, but we can all move further toward the optimist’s side of the scale and find more satisfaction in life.

The one quality that is closely related to optimism that is not as well known or studied is curiosity. If one is optimistic, he or she brings a natural curiosity to new circumstances, believing that all will unfold as it should and result in happy endings. The pessimist, on the other hand, will tend to slap negative judgment on all new happenings and be less likely to engage.

The optimist will be curious about the implications of meeting new people and will contemplate the forces that have made them cross paths with new souls. The pessimist will assume that new assignments with new people are an unwelcome chore and will result in further frustration.

It is little wonder that optimism is the one trait that is identified as the most important to predict success, whether in business or in life in general.

Seth Godin, American author and entrepreneur writes “optimism is the most important human trait because it allows us to evolve our ideas, to improve our situation, and to hope for a better tomorrow”.

When it comes to addressing PTSD in first responders or compassion fatigue and burnout in helping professionals, optimism and curiosity are the best buffers. Optimism toward humanity and the human spirit allows one to believe that the ills of society, and the plight of its individual members can improve. It allows one to find abundant energy to keep funnelling into one’s work at a one on one, group, or societal level.

Optimism that “you did not go through all this for nothing”, and that there is wisdom, meaning, and power to be gained from bouncing back from difficult situations keeps one’s spirit alive and fighting. Curiosity allows us to seek the lessons that are to be learned from our difficulties.  It leads to a willingness to be shown the path to emotional and spiritual growth as a result of our struggles.

Difficult relationships and difficult situations abound. The curious optimist will understand that every relationship is an assignment. Each difficult  experience takes us into an unknown world where we should remain curious. It gives us opportunity to seek out  the elixir, that precious all powerful wisdom that we can  share in our known world to help and enlighten others.

Following Basic Principles to Address the Dilemma of Moral Injury

Author: Manuela Joannou

The definition of a warrior is someone who is willing to put themselves in harm’s way for the benefit of others.

In the lives of our first responder and military warriors, intense, dangerous and critical scenes and incidents occur regularly. The daily stress combined with one too many tragic circumstances can lead to physical and psychic injury in caring individuals. This is what we call operational stress injury or post-traumatic stress. Very often the condition involves ethical dilemma or moral injury. This can occur if one must helplessly bear witness to unjust human suffering or is left wondering if they could have or should have done more or better. With a split second to decide, a police officer may do what he has been trained to do following exact protocols, and then may face criminal charges for having done so. A soldier may have been carrying out orders when he or she caused untold suffering. The feelings of guilt and resentment may be compounded if it is believed that the war had no noble cause.  Moral injury occurs when we veer off the course that is charted by our moral compass, either by choice or by order.  Feelings of guilt, sadness, anger or resentment at having been put in certain situations or being treated unfairly often combine to create an emotionally messy situation. Suicides can be the outcome of suffering caused by a seemingly unsolvable moral dilemma, leading only to more tragedy for those of us left behind.


When you are caught up in an emotional tornado, it is sometimes difficult to see the possible ways out. It can be even more difficult to choose the best one.

I learned long ago that the best way to deal with an emotionally complex and messy situation is to break it down into “basic principles”.  Basic principles are those dictated by our deeply held values: love, respect, freedom, loyalty, integrity, compassion, honour, humility, peace. These trump matters of preference such as personal ease and comfort, pleasure, being “right”, winning the argument and getting our own way.

As parents, we try to teach our children right from wrong. We want them to grow up to be mature, successful, law abiding citizens who function well in society, who can sustain loving relationships and be employable. Ultimately we want them to be happy and at peace. We teach our children these basic principles by instructing them not to hit or bite others.

We encourage them to share in the sandbox and not steal other’s toys. If they have been mean to others, we make them apologize. If they destroyed someone’s property, they are made to clean it, repair it or replace it. We teach them to say things like: “thank you”, “I’m sorry”, “how can I help?”, “how are you?”, “want to come over?” We instill in them the Golden Rule. Life is difficult. Life is therapy. Our life story is a movie where we are the star character. We have many supporting actors, some who play major roles throughout our movie.

Some just make cameo appearances but may be integral to very significant scenes and plots that deeply affect us. Throughout our life movie, we are given many lessons in which to apply our basic principles. Some of us show up for these and do the homework. Some of us just don’t bother.

If we learn our lessons well, we evolve into centered, mature, wise and peaceful human beings. If we don’t heed them, we stay stuck, and because our lessons seem to come with ever increasing intensity, we often end up miserable.  Sometimes the lessons are brutal. Tragic events, unfortunate choices, unforeseen circumstances, crimes inflicted upon us through the use of free will by others, all are the crux of the intense plots of our life stories.  To a certain extent, we can’t avoid them.

Going back to basic principles can lead us out of the quagmire of messy emotions. You will note that most of the values that make up our basic principles involve our interactions with others. This is no accident. We are hardwired for struggle, but this is mitigated because we are also hardwired for connection.

Harboring feelings of guilt, regret, anger and desire for revenge are a waste of psychic energy and often times destructive.

They arise from a feeling of separation from others, from a desire to protect or punish the ego and the self, not from an empathic place of connection. But we have the choice to stand down.

  • We can always choose peace.
  • We can let go of our drive to be always “right” and drop the argument.
  • We can allow ourselves to be vulnerable.
  • We can make amends by saying we are sorry.
  • We can do our best to atone for serious transgressions or soothe painful empathy by personally addressing the victims if appropriate, or by honouring them through meditative acknowledgment and mentally sending them apologies and blessings.
  • We can pour our energies into restitution by making sure the same things don’t happen to others in the future. We can lobby politically for awareness and change.
  • We can get better and “pay it forward”.

When we follow what is dictated by basic principles, we are offered a more gentle and sensible way through the emotional tornado. Because basic principles arise out of time honoured values, they are steeped in the noble choices recorded in the great stories of history and mythology. We honour the stories of our brave warriors who faced danger, loss and adversity but who ultimately did the right thing. We honour ourselves and our own stories when we also feel we are doing the right thing in the circumstance of trials and tribulations. Making good choices about one’s attitude and best course of action is difficult, especially when post-traumatic stress symptoms affect judgement and lead to isolation.  Traditional societies did not let their warriors reconcile and process their experiences alone. Tribes celebrated their returning warriors and honoured their war actions with the acknowledgement that difficult choices were made for the good of the community. Ceremonies retold the stories of courage, strength, and victory but also the stories of sacrifice, loss and hardship. These are the themes of human existence, where the richness of human experience truly reside. Contemplation of the human condition in the supportive environment of a closely knit society where all members are granted unconditional positive regard leads to psychologically healthy processing of psychic and moral trauma.  Sadly, our warriors do not experience this in our current social climate. The good news is that they can.

Project Trauma Support is a new Canadian initiative that promotes connection and honours the warrior story and spirit. Promoting time tested values and unconditional acceptance, the program helps participants transition from post-traumatic stress to post traumatic growth.