“Apple. Cotton. Movie… Ummmmm... Darn!”
“Nope. Darn was not a word,” I replied.
“Apple. Cotton. Movie… Man, why can’t I remember this?”
A patient I'll call Eddy had been referred over to me from one of the physical trainers in the Canadian military.
Eddy had retired from the military shortly before the world of Covid ever existed. He was suffering from what his trainer said was a “mix of PTSD, depression, and pain.”
He came into the clinic on a day that was particularly chaotic. That morning a pipe had burst in the ceiling and one of the treatment rooms had become a kiddie pool. Folks were leaving the clinic and my assistant was firing off emails as appointments were being deleted into the abyss. Eddy walked in and went straight to work.
“Hey guys, I’m Eddy. What do we have here?”
And with that, he was in the treatment room, throwing towels on the floor one minute, climbing my step ladder and tearing down pieces of drywall the next.
I remember thinking to myself, could this really be the same guy? The guy who had attempted suicide a mere five months prior? The guy who reluctantly moved back home with his aging parents to be “watched” as he could no longer be trusted by himself.
Something didn’t compute. How could a guy walk into a crappy situation (no pun intended), take immediate control, fire off tasks, and act so decisively, be the same guy that didn’t leave his house for weeks on end? I knew the answer but my brain kept wanting to tell me it wasn’t true.
Post-traumatic stress disorder (PTSD) is a psychiatric disorder that occurs in people who have experienced or witnessed a traumatic event. Folks with PTSD have disturbing thoughts and feelings related to those experiences that persist long after the event has ended.
Eddy had received a PTSD diagnosis from a military physician as well as an outside psychiatrist years before showing up at my clinic. He wasn’t convinced. He admittedly struggled with excessive symptoms of fear, anxiety, sadness, and felt increasingly detached from everyday people in everyday scenarios. He attributed these feelings to pretty much everything except his time in the military. But he made a valid point:
“I’ve been struggling with undiagnosed depression and anxiety since I was a teenager, and the time I spent in the military just made it worse.”
Research into the links between depression and PTSD are firmly on Eddy’s side. Many overlapping symptoms such as sleep disturbance and trouble concentrating exist (1). The relationship then dives deeper into overarching behavioral characteristics where a heavily weighted tug-of-war often emerges between internalizing (negative affect) and externalizing (positive affect) emotional factors.
Research has taken this one step further and is now demonstrating the biological similarities shared between the two disorders via genetics.
But before you start thinking that a faulty mutation on some newly discovered gene is solely to blame, the risk of developing PTSD is higher on average for those who are poor, single, or socially isolated. The environment is a huge factor that is only beginning to be understood.
As researchers and scientists continue to tease out the molecular, behavioral, and environmental underpinnings of PTSD, clinicians are doing their best to “treat” it. But the sheer impact of these overlapping disorders is overwhelming.
Remembrance & Veterans Day
Whether you call it Remembrance Day or Veterans Day, the ethos is the same. In North America, November 11 is the day we collectively honor the men and women who served our country.
We dust off our rote memory skills and recite poems. We wear poppies, host tributes, and pause for a moment to pay our respects. Numbers run ticker-tape style along the bottom of television screens showing us how many people lost their lives during World Wars I and II. We perform our own mental mathematics as the number of deaths attributed from Vietnam right up to Afghanistan are compounded like a macabre savings account.
I can appreciate the recognition. The unwavering emergence of a collective gratitude and respect devoted to those individuals who have provided us with the freedoms and opportunities we enjoy today.
But there is a flip side. An invisible, almost silent trend that continues to materialize. Those that suffered without valor or praise, as well as those that continue to suffer without adequate resources or the appropriate voice.
The Battle Within
A shocking research paper was published a few months ago: An estimated 7,057 service members have died during military operations since 9/11, while suicides among active duty members during that same time period have reached 30,177 (2).
Stop and think about this for a moment. The data is showing us a stark reality; the battle that active duty members struggle with internally has been more than four times as deadly as the battlefield itself.
While it’s tough to determine the exact factors on what actually makes someone commit suicide, the risk factors are an intertwined mix of biological, psychological, and social variables that vary from person to person.
Back to Eddy
In listening to Eddy tell his story, two themes wedged into my brain:
1. Stress: Not just the physical stress of repeated deployments, but also the psychological and environmental stressors. IEDs were on his mind “all the time”, and while he may have been lucky enough to have all his limbs intact, the same could not be said for friends of his.
“How then can I have PTSD when I’m not the one with my arm blown off?”
Or how about the growing angst that he felt brewing inside him? Over a period of three plus years he questioned his reasons for ever joining the military. To make it worse, his family had those same questions.
2. Polytrauma: There were numerous instances of Eddy having his “bell rung” thanks to what is now known as blast-induced head trauma, where the excessive forces and pressure from a blast can alter the neural architecture and function of the brain. He had felt symptoms similar to post-concussion syndrome on at least three separate occasions in training, and at least one occasion while being deployed on assignment.
He developed chronic neck pain after the second blast incident that still remains today. This was followed by increasing episodes of erratic behavior as well as worsening memory and focus. He had the classic polytrauma overlap of a brain injury related to blast trauma, chronic pain, and behavioral issues, but this went largely unaddressed (3).
As his jenga tower of errant physiology continued to build, the only thing tossed his way were prescription medications. He was offered physical therapy and accepted. He was offered behavioral therapy and refused.
When I asked him why, he refused; he said it boiled down to “culture” and not wanting to look mentally weak in front of his fellow soldiers and superiors.
Day by Day
Eddy still struggles with what he calls “PTSD and friends” to this day. He’s made many improvements and is living what he would say is a “pretty okay life”. He is in treatment, he works, lives on his own, and hangs out with friends on a frequent basis.
But he is still haunted by unwanted memories and reminders. He is still plagued with pain and a sense that he still hasn’t found the optimal way to integrate into society the way he integrated into the military. I am hopeful that these feelings will change, but part of me has to accept that they may not.
I wish for him to go beyond an “okay life” into an extraordinary one, but I realize this is trivial and selfish on my part. Maybe the confluence of biological and beyond factors has altered his neural architecture in a way that makes an “okay life” exactly where he needs to be right now. He lives day-by-day and focuses on the things that work best for him. Most importantly, he recognizes when he needs to ask for help which in and of itself is a massive accomplishment.
I will think about Eddy on Remembrance Day. I think about him everyday. I asked if I could post a picture of him for this article, but he said he wanted to remain invisible. Like many of his service member family, he doesn’t want our attention. But he and those like him need our attention, and it is our collective job to give it.
https://suicidepreventionlifeline.org/ National Suicide Prevention Hotline
https://www.mentalhelp.net/ptsd/hotline/ PTSD hotline