I recently came across a really interesting and important article — Beyond PTSD: Soldiers Have Injured Souls. It says a lot of really important things, including:
The trauma of war doesn’t just harm your body and mind. It also damages the soul. When you regularly violate your own inner moral code, you harm yourself in a deep and lasting way. From the article:
The psychological toll taken by war is obvious. For the second year in a row, more active-duty troops committed suicide in 2010 (468) than werekilled in combat in Iraq and Afghanistan (462). A 2008 RAND Corporation study reported that nearly 1 in 5 troops who had returned from Iraq and Afghanistan reported symptoms of post-traumatic stress or major depression.
Since the American Psychiatric Association added post-traumatic stress disorder, or PTSD, to its diagnostic manual in 1980, the diagnosis has most often focused on trauma associated with threats to a soldier’s life. Today, however, therapists such as Jonathan Shay, a retired VA psychiatrist and recipient of a MacArthur Foundation “genius” grant; Edward Tick, director of the private group Soldier’s Heart; and Brett Litz, a VA psychologist, argue that this concept is too limited. What sometimes happens in war may more accurately be called a moral injury — a deep soul wound that pierces a person’s identity, sense of morality and relationship to society. In short, a threat in a solder’s life.
“My colleagues and I suspect that the greatest lasting harm is from moral injury,” says Litz, director of the Mental Health Core of the Massachusetts Veterans Epidemiological Research and Information Center. He and six colleagues published an article on the topic in the December 2009 Clinical Psychological Review, in which they define moral injury as a wound that can occur when troops participate in, witness or fall victim to actions that transgress their most deeply held moral beliefs.
While the severity of this kind of wound differs from person to person, moral injury can lead to deep despair.
“They have lost their sense that virtue is even possible,” Shay says. “It corrodes the soul.”
In Europe, post-traumatic stress disorder researcher Ulrike Schmidt even seeks evidence of the moral injury in brain tissue itself. As she told Miller-McCune.com recently, “They need to know that it’s a recognized disorder. They are not weak, they’re sick, they have a spiritual wound. … And it’s important that they aren’t treated like outsiders, which is how many soldiers were treated in Europe in the ’40s and ’50s.”
The article goes into more detail about specific instances of moral injuring, and then it wraps up with some descriptions of what individuals have done to heal from their moral injuries, including centuries-old ceremonies for returning soldiers, visits to religious sites, and other concrete steps soldiers have taken to overcome their trauma. I really recommend you read – and really digest it.
Now, I’m not a soldier. I’ve never been in armed combat, and I’m not part of the armed forces. Yet this article speaks to me on a deeper and wider scale.
The traumas that these soldiers experienced came from a part of their innermost selves being violated in some fundamental way that made them unrecognizable (and sometimes unforgivable) to themselves.
And that sounds eerily familiar. Because what do you often get when you experience a TBI (or head injury or concussion or ABI, etc) that erases fundamental parts of who you are and understand yourself to be?
Precisely this: a wound that can occur when [individuals] participate in, witness or fall victim to actions that transgress their most deeply held moral beliefs.
I’m really happy to find people talking about this — even if it’s specific to soldiers and military situations. To be honest, now that it’s sinking in and I’m getting it more and more, I’m fighting back some tears. Because this is true. I really believe with all my heart that this is a critical piece of what happens in TBI / concussion / head injury — you can lose parts of yourself that you have long relied on, and which make it possible for you to live in ways that are consistent with your moral code. And when those parts are damaged or harmed or disappear completely (for short or long periods of time, maybe even permanently), you can find yourself doing and saying things that are just not you. And you can find yourself doing and saying things that go directly against who you are, what you believe is right and good – your moral sense and identity.
You can’t seem to control it. You try, but it’s just not working. Your mouth isn’t doing what you tell it to. Your actions aren’t doing what you want them to. Your behavior isn’t being like you know you are. Your reactions are way off the charts, to the point of being unrecognizable.
And that causes a deeply traumatizing wound that no amount of talk and analysis will fix. Talk therapy won’t repair it. Neurologists won’t repair it. Even loving friends and family won’t necessarily make it right again. These are wounds we need to address within ourselves, with concrete actions, rituals or ceremonies of some kind (preferably the kinds of rituals and ceremonies in groups of like-minded individuals, which have taken place with traumatized people, including soldiers, since the beginning of time) — conscious acts which help us get our souls back.
PTSD soul loss doesn’t just happen on battlefields in faraway countries. It happens in the kitchens and family rooms and cubicle farms and factory floors and bar-rooms and train stations of the world. It happens in banks and football stadiums, on little league baseball sidelines, at the grocery store, on freeway on-ramps and in shopping malls. It can happen in public and in private — whenever we seem to betray our deepest-held beliefs and moral code, with behavior we cannot control or understand. It happens when we blow up over stupid little shit that shouldn’t bother us at all.
It also doesn’t only happen in pitched battle. It can happen in quiet, seemingly “normal” moments when the disconnect between what IS and what “should be” is as deep and as wide as any Utah canyon. It happens when we lose our cool over trivial things that somehow turn into massive sources of panic. It happens when we forget to do important things we have been entrusted with doing. It happens when we fail to be adequate team members to people who are relying on us. It happens when we stop doing the things that used to define us — keeping a well-maintained car or home, taking care of our appearance, conducting ourselves in a respectable manner, and/or making a decent living at work we enjoy.
It happens when we lose our shit. It happens when we lose our keys. It happens when we lose our perspective on the most important things in life and are cut loose to wander through life, wondering why the hell everything is so f’ed up for no good reason. It happens when we attack those closest to us and betray their trust and love with behavior and actions and attitudes that don’t reflect who we know ourselves to be, yet we cannot seem to control or even understand.
I think there’s a very good reason that TBI rage, anger, and temper are some of the highest ranking search terms here at BBBM — it’s eating away at the souls of many of the 1.7 million TBI survivors who enter the US population yearly. It undermining the lives, loves, and livelihoods of thousands upon thousands of individuals, many of whom have no idea that they need help — or they know they need help, but they don’t know what kind, and they don’t know where to get it. And even the people who are trying to help them, don’t fully understand the extent of their hurt.
Because it IS hurt. It is a wound of the soul. It’s a wound of the heart, yes — of the mind, yes… and of the body, most certainly — but most problematic of all, is the harm to the soul, the spirit, the very core of what makes us human, that makes us believe we are worth something.
Working through this has not been easy. The healing of my spirit, my soul… dealing with the ongoing, recurring traumas of a life that’s very different from how it used to be, has by far been the biggest challenge for me in my own recovery from TBI — and I will say recovery, because I believe that when we come back from TBI, we have to regain both specific functions and fundamental parts our very selves. And I believe we can.
This effort-ful repair also been the area where I’ve been most on my own. People just don’t get it. Not my spouse, not my neuropsychologist, not my former therapist(s), not my friends. They don’t understand what it’s like to be totally screwed in this invisible, unpredictable way — looking fine on the outside, while things inside are a tangled jumble of confusion and disorientation and rising panic. They don’t seem to get what it’s like to watch your life take on qualities that you never, ever thought they would have — and watch yourself inexplicably become something you’ve worked very hard for many years to NOT be like.
Not everyone knows what it’s like to become a raving lunatic, an unwitting “liar”, a problem… a monster… against every single one of your own wishes. And thank heaven for that.
They don’t get it, and they often don’t take it seriously. But this IS serious. It’s probably the hardest, most frustrating, most defeating experience that comes with TBI. Forget about the headaches and pain and light/sound/touch sensitivities for a moment. Forget about the panic and rage fits and anxiety for just a little bit. What’s beyond that? What’s beneath that? The self. The soul. The spirit. The very essence of who you are. When you take that away, even if there is no pain or panic or rage bubbling on the surface, what then is life all about? What foundation do you have? What hope can you have for your future?
Indeed, based on what I know about the human system and the effects that mental experience can have on the physical — and vice versa — I’d have to say that this traumatic loss of soul could very well form the basis for other physical/mental/cognitive/behavioral conditions. For when you have lost your sense of self – SOS - it can plunge you into an abyss of serious despair. And that can contribute to a “cascade effect” of all sorts of other conditions. The confusion and frustration and loss of sense of self feed into anxiety and panic, which can heighten physical issues, as well as cognitive-behavioral ones, as well.
Here, let me draw a picture of it…
It’s all related, no matter what the specializing experts may say. And it’s a real bitch. Even the smallest things can set that cycle in motion.
For example, TBI can screw up your sleeping patterns, which in turn can screw up your ability to think. The brain needs a lot of rest to not only repair damage but also to recover from the added load of having to work harder at certain things. And fatigue is a major factor in agitation and anger issues with TBI. Being tired can make you confused and/or make it harder to think, period. So, you end up getting turned around and lashing out at others for no apparent reason, which adds to the stress of living – both for yourself and others. Which then leads to more problems… including sleeping.
Here’s another picture:
So no, you’re not crazy, while you’re feeling your whole life falling apart, and you feel like you’re losing the very essence of who you are… you’re caught up in a whole cycle that starts with TBI and has unidentified stresses incorporated into the whole progression. And because your injury is hidden from others, and everyone wants to believe you’ll be okay (and/or they don’t want to think about the possibility you’ve got something bigger going on with you), managing it is very difficult… and you end up pulled into the cycle of losing yourself, your sense of self, your very soul, in the process of trying to get back to some semblance of normalcy.
The BIG problem is… there are all these unresolved issues behind the scenes that are slowly but surely sucking away at your understanding of who you are and what you’re about. And as you go through each day, watching yourself do and say things that don’t seem like “you” and who you understand/need yourself to be, you feel farther and farther removed from yourself. You feel like your soul is slipping through your fingers, like sand out of a broken wicker basket. And there’s nothing you can do about it. Every day, you get up an vow to try again … and the same shit happens all over again. You’re losing it. You’re losing your spirit. You’re losing your soul. You’re losing everything that ever meant anything to you.
Or so it seems.
What’s really happening, is that you’re fashioning a new understanding and version of who you are. All the while, patterns emerge in your behavior which “inform” you about who you now are. And it’s not all good news. When you keep screwing up, it can be easy to think that, “Well, this is me now — I’m a screw-up, and that’s that.” The fact of the matter is, that can change. But we TBI folks can be quite rigid and literal in our thinking, so we may never give ourselves the chance to come up with a different idea. And we re-inforce our misunderstanding of ourselves, creating a self-fulfilling prophecy in the meantime, getting farther and farther away from our core selves, wounding our already aching souls even more in the process.
Who we think we are is not always the truth. But by God, we’re sure we’ve got it figured out. And so, we cheat ourselves of a larger truth… and everyone around us pays the price, along with us.
I say this because I know what it’s like. I’ve lived it. And in many ways, I still do live it each day. I don’t know when I’m going to learn that I am not the same person I was, ten years ago… Even five years ago (anybody who says mild traumatic brain injury is not a progressive condition, is welcome to speak to me anytime). But I still keep making assumptions about my capacity, my abilities, based on what I “knew” about myself before. Those things have changed, sometimes imperceptibly. But even the slightest deviation from what I “know” to be “true” about myself, is enough to plunge me into a crisis — and send me off the deep end.
So… to finally get to the gist of this post “Putting my soul back together, one act at a time” here’s what I’ve been doing to help myself rebuild and address the loss of my soul, my sense of self, my “center” (as some of my more alternative friends call it):
First, I get clear on what my values are and what matters to me. I identify my core values, my beliefs, my commitments, my principles. I figure out what makes me “tick” and what gives meaning and purpose to my life.
I write it all down periodically, and I remind myself what my values are all about. My neuropsych has been working with me to help me get these clear in my head. I have actually always done this (perhaps as an instinctive response to my neuro challenges over the years), but after my last fall in 2004, I pretty much stopped doing that, and I have felt the ill effects. It was really then, that I started to lose myself (though the whole story is bigger than just this one aspect).
I addition to writing my values and ideals down, I try to repeat them in my head while I go about my daily business. I think about them while I am driving to and from work. I think about them after I am done with work for the day. I really meditate on them, when I get a chance. They are my lifeline.
Some of my core values are:
- Treat all (including myself) with dignity and respect, as creations of a loving God/Spirit/Universe.
- Devote myself to purposes that are larger than myself — the success of my co-workers and teams at work, the different projects I help others with.
- Make the world a better place (by treating others well, and by offering them something of myself that helps them live their lives a little better).
- Stand up for what I believe in, no matter what people may say at work or in life.
- Hold true to my dearest beliefs and defend them from cowards and cheats and liars and others who seek to undermine me.
- Remember my ancestors, my grandparents, all those who have gone before me, who look to me to continue the values and beliefs they held, and to continue and protect the world they helped to build before me. Stay true to their legacy, and do them proud. On some level, they are watching… waiting for us to do great things.
Next, I take concrete action. I do things that I know are consistent with my beliefs and values. These things are not always easy to do, and I have to keep that in mind. Part of me thinks, if something is difficult, that must mean there’s something wrong with me. I’m not good enough, or I’m not capable enough. But I believe that all important things are difficult to do, so the fact that I’m challenged actually means I’m living up to my potential — and beyond. All important, complex things take time to learn, and I am learning and practicing each day.
Some of the concrete things I do are:
- Exercise regularly.
- Eat good food.
- Keep to a daily schedule as much as possible — get up, exercise, have breakfast, then get on with my day.
- Go out of my way to be especially patient and courteous with my spouse.
- Try to treat everyone I encounter with respect and dignity.
- Stand up for what I believe is right at work – and don’t give in to peer pressure to cut corners and make excuses.
- Connect with others who share my beliefs and communicate with them regularly.
- Take time to plan my activities, so that I can make the most of them.
- Do my best to follow through on my promises and what others expect of me.
- Be easy with myself, give myself the benefit of the doubt.
- Don’t get caught up in making up stories about what things mean or what people are all about. Don’t get paranoid and defensive just ’cause of what I think might be going on.
All these things are important to me. And all of these things help me take steps each day to getting back to where I’m comfortable in my own skin. I don’t do them perfectly each day, but they’re a priority with me, so I keep trying.
Most of all, I try to be patient with myself and give myself the benefit of the doubt. Rebuilding a life that you feel like you’ve lost is not easy going, but I try to keep focused on taking things a day at a time (sometimes an hour at a time). Sometimes I get in over my head, and I have to shovel out from under all the “compost” I’ve acquired, but I’ve gotten in the habit of telling myself that means I’m doing better. If I weren’t doing better, I wouldn’t be taking on the challenges that get me turned around, confused, and frustrated.
That’s how I do it – a little bit at a time. And with concrete steps. When I slip and fall and feel like I’m back to Square One, I check myself and make a list of all the things I have to be grateful for. And I focus objectively and realistically on the progress I have made.
The fact of the matter is, my anger isn’t constantly out of control anymore. My spouse is not afraid to be in the same room with me, anymore. I am not bouncing from job to job, leaving positions quicker than people can figure out that I’m faking my way through and I really don’t know what I’m doing. I am not spending money hand over fist without regard to my future. I am not waking up at 3 a.m. every night, unable to get back to sleep. I am not staggering around like an adrenaline-hopped-up zombie, fueled on pure agitation and nerves. I am not picking fights with police officers. I am not going for walks in the woods down deer trails during the early morning hours of deer hunting season.
I am absolutely positively getting better. Through concrete, definite steps that run contrary to the out-of-control live I once lived on a daily basis.
When it comes to getting my spirit back and healing my injured moral soul, that counts for something.