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The Star: An "Investigation" into Afghanistan and Violence in Canada

Stigma Busting (because Stigma is an issue the Corporal brought up. . .)

From:  http://www.ptsd.va.gov/professional/manuals/manual-pdf/iwcg/iraq_clinician_guide_app_j2.pdf

When they are happening, traumas often create feelings of intense fear, helplessness, or horror for those who experience them. In the days and weeks that follow, they often create longer-lasting stress reactions that can be surprising, distressing, and difficult to understand. By understanding their traumatic stress re-actions better, Iraq War veterans can become less fearful of them and better able to cope with them. While reviewing the list of effects of trauma below, keep in mind several facts about trauma and its effects:
It is very common to have problems following exposure to war or other trauma. But traumatic stress reactions often become less frequent or distressing as time passes, even without treatment.

Veterans with PTSD often worry that they are going crazy. This is not true. Rather, what is happening is that they are experiencing a set of common symptoms and problems that are connected with trauma.

Problems that result from trauma are not a sign of personal weakness. Many mentally and physically healthy people experience stress reactions that are distressing and interfere with their daily life at times.

If traumatic stress reactions continue to cause problems for more than a few weeks or months, treatment can help reduce them.

(my emphasis added)

Canadian Government:  see pie chart, conceptual representation of directions (intended, work in progress. . .?) re: dealing with health issues, stigma is mentioned:
http://www.veterans.gc.ca/eng/sub.cfm?source=mental-health/health-promotion/framework

From US Marine Corp, showing USMC standards (first paragraph) and in point-form, some issues that soldiers can experience re: stigma and reluctance to seek help:
http://www.usmc-mccs.org/LeadersGuide/Deployments/CombatOpsStress/generalinfo.cfm

Why Marines May Not Seek Help
Some Marines are reluctant to admit to themselves or anyone else that they have been affected by the stress of combat or other operational experiences, and some are reluctant to ask for help for stress injuries that don’t heal quickly on their own. Such reluctances are often due to the stigma that surrounds behavioral health and stress problems, particularly among Marines, who pride themselves in their ability to endure extreme stress. Stigma is the number one enemy of combat/operational stress control. Therefore, it is the duty of every Marine leader, at every level and at all times, to fight stigma — to reduce its interference with stress-injured Marines getting needed help. Fighting stigma begins with understanding its causes, which include:

Not understanding that stress injuries are like other physical injuries — treatable and not the individual’s fault

Believing that adverse reactions to stress are a sign of weakness or personal failure

Not knowing that even the strongest Marine can suffer a stress injury

Fearing that having an emotional problem or getting help for it will negatively impact their careers

Fearing that other Marines will think less of them because they got help for a stress injury

Fearing their peers or leaders won’t trust them as much in future tough situations if they admit to having suffered a stress injury

Not understanding that the longer they wait to get help for stress injuries that don’t heal quickly on their own, the less likely they are to heal fully

Not realizing that avoiding getting help may place their unit members at risk because of decreased readiness and performance caused by untreated stress injury symptoms

Not realizing that avoiding getting help for persistent stress injuries can hurt their careers, relationships, and future health more than accepting help will

A command climate that discourages getting help or tells Marines to just “suck it up” or “get over it”


(Emphasis mine)  Maybe a few things the Corporal wasn't realizing at the time, and seccumbed to more intense addiction issues (self-medicating to cope) as time went by from his first tour. . .?  I think some of the above seems to mirror some of the sentiments the Corporal addressed in his Star interview.

Therefore, it is the duty of every Marine leader, at every level and at all times, to fight stigma — to reduce its interference with stress-injured Marines getting needed help.

Maybe this is a reasonable standard, duty and responsibility?  Is there a similar type of directive from the CF side?  I hear it's been progressively changing for the positive and I've heard some good news way back (before I found this place) about good treatment and I was happy to hear that.

What Percentage of Veterans Have Received Help for Mental Health Problems?
47% of all veterans have sought services at VA
Top 2 reasons: Muscle and Joint Problems and Mental Health
Of the 48.5% who have sought mental health care:
53.3%: PTSD problems
37.8%: depression
(VA data as of 01/2010)

(Source: http://www.ptsd.va.gov/public/reintegration/guide-pdf/FamilyGuide.pdf)  VAC acknowledges anxiety disorders as well (in the presentation from earlier link).  I don't know what CF stats are?  But regardless, this should let others know it's not an abnormal thing. 

Link to a support line: http://www.cmp-cpm.forces.gc.ca/cen/ps/mho-smb/osi-ssb/index-eng.asp
OSI support line. . .

I thought the USMC site was informative, straight-foward, cohesive and realistic strategy re: Combat-OSI (COSI), best attempts. 
 
An Afterthought re: resistence/barriers to seek help. 

One anxiety/fear I faced was a result of 'physical threats' if I talk. . .  A few things helped.  I used the confidentiality and anonymity of crisis line to discuss some of those issues (not using names) to help me understand more, generally about confidentiality practices, and limitations of confidentiality.  And when I sought help, and finally found some, I didn't use names (without names, they legally can't do anything, or anything that could put my safety at risk by their following limits of confidentiality, fear of a legal process I wouldn't be equipped by enough recovery to handle [court and blinking in and out/disociation, lowers credibility as a witness, just means more victimization, wasn't in a strong enough place to handle that).  I'm not chicken or weak, because I did speak up when others didn't (but that was dangerous, so maybe not smart to do, but I didn't anticipate that escalation and it was shocking)

It was good to know that there were options on a continuum of actions (where I could do the 'right thing', but lower risks to my safety).  I made sure confidentiality issues were cleared and it was safe enough to talk.  I could have maybe got access to help via a clinic, but they film sessions (student clinic) and that didn't feel safe for me (threats on top of trauma can be really constricting, hard for words to leave the mouth re: those particular issues).  Looking back, maybe I could have contracted an agreement-- this doesn't go on film, I don't consent to that one. . . but that was hard to wrestle with rationally at the time of crisis. 

You can have control over the process.

A lesson is learning how to use supports, use anonymity of crisis lines, choosing among appropriate ones per trauma.  You can talk about the traumatic impacts, get help for managing the trauma, but not have to use names (or 'identifyers') if that doesn't feel safe.  Helps to have clarity re: counsellor's procedures, mandates ahead of time then you can know how to work around that, while still able to get some help, to help stablize.  Often some of the 'bad traumas' can also have legal implications (or fear of that process, confusion even because of the traumatic impacts, etc., one thing was on the line re: witnessing, pieces, but not the whole and it was hard to sort out on my own) but there are ways to keep safe.  One situation had already been investigated, but it's not a perfect world (others can be sophisticated, sociopathic, etc.) and that's a lesson too and re: one's locus of control over events beyond one's personal control (despite wishing that one did have the power to stop those actions by others). 

It's hard chit to live down, shatters illusions of safe, fair, reasonable world, etc. and when one also carries a high sense of personal responsibility (and success at handing and managing other tough situations but with better outcomes) and duty and some crimes are not tolerable, offend on a very deep level.  You think the system works, have some faith in it, until you happen to face one of those instances where it doesn't and there's no way reasonable course through it, forced to accept what is not truly acceptable.  There's grief about that to work through, it's invariably loss of innocence, breach of basic trust and it can be wounding.  Solace is in knowing one did the best that that could, and tried where others didn't and to borrow from AA, ". . .grant me the serenity to accept the things I cannot change, change the things I can, and the wisdom to know the difference".  It's a wound, but there is still living, doesn't have to poison every day and every moment of one's life-- enjoy the good moments, because it's still deserved (there were just bad circumstances). 

I guess, this part relates to a wound of "survivor guilt" which can arise from difficult situations, some can be fairly complex.  Good to give the mind lots of rest-periods, don't over-ruminate, remember to practice self-care: routines, hobbies, exercise, relaxing reading, see people (even if it's just for 5 minutes, it can be a healthy distraction to help prevent getting over-stuck in the head); be involved in family, etc.  It's okay to feel pain and accept that (sometimes it's a quality of good character, human, has a good function, even if can't control results, it can just hurt a bit).  The challenge is learning to bare it, build tolerance for difficult painful feelings, without having to resort to numbing, deliberate or automatic.  One you know things about breathing and grounding skills, and further away from the 'crisis stage' of ptsd, new opportunities for healing can occur

In a way this takes courage, to stop fighting it (builts up anxiety, exasperates symptoms), and learn that you can just allow it to pass.  Facing it, not running from it, not over-reacting to it.  Mindfulness training IME, helps with this, it can help build resilience through difficult grief.  Know it will be okay, have faith, trust resilience in others even(CBT training, "don't catastrophize").  I tell myself this, "where there is breath, there is still hope" ;). . . "and when there is not, well that's in God's hands".  If you listen closely, and in a calm space, sometimes the words you need to hear come from within.  Inner resilience, stuff you might not know is there even, till challenged, tested. . .so it's sometimes a matter of "Trust the Process".  Having a spiritual faith can also be another factor in resiience (I think about the story of poor Job, that guy had it rough ;) )
 
I don't think I'm in the mood to go over risk factors atm.  But the USMC link, I think did provide a pretty good list, re: combat-related/OSI risk factors.

For people coming back from Afghanistan, some could experience some post-traumatic stress effects (acute-pts) that can normally clear up in some weeks on their own.  It's good to review some of the symptoms of what can be expected (to know you're not actually losing your mind, it's more about just recall of trauma, and it's normal, till things can settle down) and know it can pass.  It helps to be able to have some perspective to put the experiencing into perspective.

This link provides a good context of what to expect, a good guide for both families and returning service member:
http://www.ptsd.va.gov/public/reintegration/guide-pdf/FamilyGuide.pdf


Bringing this back to our corporal here, maybe he wasn't prepared, homecoming post-first-tour-deployment back in.  If you think you're going crazy, it might be tempting to try to drown it out with some excessive alcohol consumption to numb it (the danger is when that becomes habitual coping with that, because it can catch up), or that can be an already existing habit among others.  Maybe even works short term out in the field (not on duty) and maybe not altogether a bad idea (?), but there's also some adjustment time happening post-deployment and re-orientating to new surroundings, contexts, relationships, etc.  I had some VA links for that re: Homecoming and it's just FYI, can read it, put it away, forget about it, but know where it is if/when needed (for self or if concerned about others).  Normalize things.

I think this is a good link re: coping with post-traumatic stress effects which can be normal early post-deployment, these two especially give a comprehensive review of what sort of things can be expected in post-deployment adjustment to being back.  Good guides for both family and service members :
1) http://www.ptsd.va.gov/public/pages/coping-traumatic-stress.asp


2)  http://www.ptsd.va.gov/public/reintegration/guide-pdf/SMGuide.pdf

Self-Care and Coping: http://www.ptsd.va.gov/public/pages/fslist-self-help-cope.asp

(They even have PTSD-Apps for I-phone, the “PTSD Coach“--  That sounds pretty cool.  “Uh, experiencing a symptom. . . What to do. . .” ;) and out pops up some coping options for symptom relief-- sounds handy  ;D)

Anyway can be handy to familiarize with the basics beforehand.

There is also the CF OSI support line:
http://www.cmp-cpm.forces.gc.ca/cen/ps/mho-smb/osi-ssb/index-eng.asp
It's manned by experienced members and so that's maybe a good resource to check things by.

I don't mean to obsess over the Corporal, just treating it as a learning opportunity (and also with some respect, you never know if he comes here, or someone else out there is facing similar challenges, or others at risk for experiencing some difficulty-- knowledge can be power, put things in a context, less panic if symptoms are being experienced, to know they're actually fairly normal and can pass, and likely will).

People have to make their own choices, it's just good to know there are a range of choices to chose from and know you can get through the tougher times and that they‘re normal experiences (but can feel freaky-- when I first got hit with PTSD hard, I had major panic attacks, because I didn’t know WTF what was going on, it just freaked me out, I had no context to understand what was happening-- it was a lot of ‘shocking‘, rapid, overwhelming-- I wish I had had more understanding before hand then I could have eased my way through it better, equipped with skills, what I can do to relieve symptoms in a healthy way.  Having knowledge, some contextual framework, helps with being able to detach from overwhelming experience, re-experiencing.  It felt insane, “losing my mind“, panic attack, heart-rate way up, and shakes and felt alarmed and further panicked, if this happened in public [exit to nearest restroom, splash face with water, try to calm down], it was happening post-trigger-to-flashbacks, but I didn‘t understand that at that time).


I haven’t tried this one (would have to be in the mood for it), but it’s a self-assessment tool that can be used when finding oneself thinking about something traumatic, or it’s been recalled:

http://cust-cf.apa.org/ptgi/

Not sure how good it is. . . If feeling adventurous or for entertainment purposes to check it’s validity against your experiencing. . .

I think I can leave this for now.  It can also get exhausting for me to think too much about PTSD (it‘s good to do sometimes, definitely not all the time).  I’m glad I did a bit, because in the process,  I found some handy links I can use myself.  I wanted to respond to feelings from a few sides re: stigma and stigmatizing behaviours and also to the Corporal and others re: respect and care for hidden injuries.  I’m not actually comfortable with personal disclosures, sharing some pieces, it’s one of those risks and it does feel a bit uncomfortable and I know it’s also possible it can put others off (“WTF is this crazy chick on to.” . .;) ), but for some others who are going through it, it may help validate and normalize some of the challenges and sometimes a shift in attitude can make it easier to bear and it can be done, and found and it’s a matter of learning to trust oneself, that’s the most important, above all and know that within your circle of support, who you feel safe discussing things with, test the waters, go slow. 

"I'll pass the torch" ;). . . look out for your own health and take care of it, and look out for families and fellow service members
 
This book was written by a Canadian psychologist. Obviously controversial, but it may be of interest.
"Manufacturing Victims: What the Psychology Industry Is Doing to People":
http://www.amazon.com/Manufacturing-Victims-Psychology-Industry-People/dp/1552070123

National Post  2000:
http://tanadineen.com/psychologist/interviews/WhoAreTheseGriefCounsellors-National%20Post.htm

It discusses critical incident stress management CISM. CISD > CISM.
 
mariomike said:
This book was written by a Canadian psychologist. Obviously controversial, but it may be of interest.
"Manufacturing Victims: What the Psychology Industry Is Doing to People":
http://www.amazon.com/Manufacturing-Victims-Psychology-Industry-People/dp/1552070123

National Post  2000:
http://tanadineen.com/psychologist/interviews/WhoAreTheseGriefCounsellors-National%20Post.htm

It discusses critical incident stress management CISM. CISD > CISM.

From the National Post article (http://tanadineen.com/psychologist/interviews/WhoAreTheseGriefCounsellors-National%20Post.htm)

Dineen, the author of Manufacturing Victims: What the Psychology Industry is Doing to People, wrote an adamant opinion piece in the Ottawa Citizen in the wake of the SwissAir crash at Peggy's Cove about counsellors roving that landscape in search of traumatized witnesses. "It seems that we have been persuaded that those who witness a tragedy, no matter how indirectly, are themselves victims, because they might be upset by what they saw or felt. And because they were upset, they need professional counselling to recover from the 'trauma' of feeling upset," she wrote.

Is this what your main concern is that CISD "manufactures victims", creates conditions for malingering?

 
kstart said:
Is this what your main concern is that CISD "manufactures victims", creates conditions for malingering?

After ten years of developing "inner resilience", we were suddenly being taken out of service by some dude in the radio room.
The truth was, we were young guys having fun. My partner used to say, "It's you and me against the world tonight!"  :)

I liked to think that the families we served received the support they deserved.

We were / are well taken care of:
http://www.torontoems.ca/main-site/service/psychological.html

"Another nail in CISD's coffin: The facade of that fairy tale we call CISD continues to crumble under scientific scrutiny. Now the Canadians (bless their souls) are getting in on the act and denouncing it as bull$hit.":
http://www.emtcity.com/index.php/topic/2961-another-nail-in-cisds-coffin/
 
mariomike said:
After ten years of developing "inner resilience", we were suddenly being taken out of service by some dude in the radio room.
The truth was, we were young guys having fun. My partner used to say, "It's you and me against the world tonight!"  :)

I liked to think that the families we served received the support they deserved.

We were / are well taken care of:
http://www.torontoems.ca/main-site/service/psychological.html

"Another nail in CISD's coffin: The facade of that fairy tale we call CISD continues to crumble under scientific scrutiny. Now the Canadians (bless their souls) are getting in on the act and denouncing it as bull$hit.":
http://www.emtcity.com/index.php/topic/2961-another-nail-in-cisds-coffin/

In that discussion thread, some criticism re: CISD about it's potential to harm, did make sense, by some of the examples given.  A common exposure event (same event), a potentially vulnerable time (critical incident) +  witnessing a co-worker's traumatic reactions to the event, can have a further traumatizing effect, because it can pull out not only empathy for the other worker, but over-identification with that worker's pain-- and that can create further confusion.

I had some experiences, front-line work and also witnessing effects of burnout among co-workers and supervisors, and it was dramatic and painful to witness, people coming in strong, optimistic, competent, full of hope, gifted people, but the general pattern was not to last longer than 2 years at it.  Some got smart and pulled before extreme breakdown-- the organization was really sick.  I don't know if this was covered in the book you recommended, re: manufacturing victims, but the "Karpman Triangle" pattern-- when those dynamics get activated, toxic and it can be drawn out under certain experiences/situations/contexts-- I think it exists.

The report that was referenced in that thread re: "Rescuer" presumption, not only flawed and over-generalization but it's not a static thing, IMO, because certain situations, stressors can bring out it's companions as well (Karpman Triangle: victim-persecutor-rescuer"-- and these roles can shift and oscillate among a traumatized group of people into sequences of maladaptive acting and reacting and not healthy coping, trauma adaptations (inwardly or outwardly), but cause a lot of pain and confusion-- I think probably happens in organizations, families, units, under extreme stress, maybe an indicator of later-stage burnout-- something that is preferably prevented, or addressed earlier.

I'm really glad to see your organization has a smart expert on the scene and I like especially that she researches, oversees issues of organization structure. . . you guys shouldn't have the additional types of problems, added toxic crap, destructive stuff

I've experienced situations of that level of toxicity in a few contexts.  I didn't get help for the trauma of that, because no access to a specialist to help with that overwhelment/confusion, but struggling with the damage to career trajectory, and struggling to put the effects of those experiences into a context, "that's what that was, I can avoid that in the future, by. . . it can be safe to seek out employment with. . . I know when I should get out when. . .  this presents. . .and continues, and response of organization is poor. . .situation unlikely to be corrected when. . .". 

Books that helped me piece together some conceptual understanding of that type of trauma and toxicity were Pat Carnes' Betrayal Bonds (addresses workplace trauma dynamics, connection to other toxic dynamics situations) and works of Charles Figley, re: other types of traumatization, including "compassion fatigue"/*vicarious traumatization* (witnessing extreme suffering, extreme traumatization in others, e.g. if a parent has PTSD untreated, unstablized, or in other contexts of group traumatization), "simultaneous traumatization", "famlial traumatization",-- direct traumatization vs witnessing types of trauma.  I need these to help me with clarity, and sorting out what happened, why the impact, what's causing this stuckness-- important, because it made me afraid of work-- and obviously I can't live like that (one could laugh at that, but for me, it's genuine, constrictive hurt, stuck. . .real grief to move through).  I came from a bad situation and I walked into a few and didn't get out on time.

As an outsider, but I can see ways in how militaries have evolved and sensible planning and organization of roles, job specialization-- there's lots of things already built into it which can prevent those kinds of severe secondary traumatization.  It also interesting even in ancient texts (e.g. Art of War; Bagavagita [Khrishna dialogues], Way of the Samurai, etc.; martial arts training-- which included meditation), eastern origins, some mindfulness, perspectives, character/leadership development, strength and resiliency training. 


I had good training pieces to handle the work I did and effective use of it, I was grounded in a professionalism and ethics (not over-rigid, but the training was the right guidance for handling situations of crisis, etc.), but I had no preparation for what happened at the organization level-- it totally caught me off guard, and I was student working in it, low on the ladder. . . it was an unfortunate choice of organization, but live and learn. 

I had no preparation for PTSD either, nothing would fully prepare, but it helps to have a context and in learning practical coping for symptoms-- and the 'flashback management" techniques are key to that, IMO, IME.

Without that training, flashback can cause severe dissociation, like what we hear about, combat trauma and acting as if right back there at the time of trauma (e.g. "combat-soldier[or medic, etc.]-in-afghanistan-ego-state)-- it is like that-- I've had flashback experiences of earlier trauma, and freaky to be in a child-ego state-- dissociated back to that (makes it scary if it's happened downtown, and am suddenly and literaly a lost child, can't remember where I was going and where I came from-- very disorientating and a frightening experience-- I can be consciously aware of it, but there's a brain stuck, and can't get the 'right in the brain' ego state to come back, but it does-- no memory of the trigger though. . . but I care less, as long as it's over and I can regain functioning).  Flashback management technique is a tool that can be utiized which I think can prevent flashback from progressing to more extreme dissociative states.

My case, I've needed to do some grieving, the most important function of that was to correct maladaptive coping and decision making affected by things like survivor guilt and had become a pattern, not getting out of bad situations that are unnecessary, don't need to be there. . . it's to correct trauma-repetition, trauma-compulsion-- had bad programming, needed debugging

Aside from that, I like Babette Rothschild's work on PTSD, the best is she said, you don't even need to do memory retrieval to heal from PTSD.  I think it has to do with mastering the "flashback management techniques"-- which for me seemed to be a core of the problem, and the major symptom not addressed by the quack helpers I encounted (OHIP covered psychiatrist) and if it's managed, a lot of other PTSD symptoms are more manageable, prevented even from becoming debilitating, more complicated dissociation, etc..  It seems, IME/IMO to correct body-brain disregulation, freeing up mind again (it's not free in dissociative states, IMO).

http://www.amazon.com/Keys-Safe-Trauma-Recovery-Take-Charge/dp/0393706052/ref=sr_1_1?s=books&ie=UTF8&qid=1311834298&sr=1-1#reader_0393706052

I got some intel from Homewood (been on the waitlist a long time. . . ;) -- only because I don't have specialized private health insurance-- not the same for CF-- be glad about that-- they are trying to look out for our CF, and other crisis workers) a view of some of their approach and I think it's really sound.  Even more elaborate grounding techniques, which is good, because in the past, trying to restablize from flashback, didn't spend enough time on the grounding-- it's a learn from experience, as you go kind of thing, what actually works best for you. . . experiential learning, but the guidance is good.  If body-brain not restabiized, can get side-swiped by more flashback/dissociation, IME.  It takes good self-discipline to practice, an adjustment to patience to work at it.


 
kstart said:
What sorts of resilience training did you guys get? 

There was none of that when I joined. The culture was different then. They sent us through the old Department of Emergency Services academy downtown. They closed it in 1975 when the community colleges took over in Ontario. Psychology is on their curriculum.
 
mariomike said:
There was none of that when I joined. The culture was different then. They sent us through the old Department of Emergency Services academy downtown. They closed it in 1975 when the community colleges took over in Ontario. Psychology is on their curriculum.

Curious. . . has anyone considered introducing Mindfulness-Based Stress Reduction, it makes sense as something that could be useful, reducing stress, re-stablizing stress response if that has become problematic. . .?  It would have to be studied. . .

http://ottawamindfulness.ca/Programs/English/tabid/208/Default.aspx
Mindfulness-Based Stress Reduction program, some freely offered for low-income and/or if there's extra spaces. . .

Based on Jon Kabat-Zinn’s work, Full Catastrophe Living
http://www.amazon.ca/Full-Catastrophe-Living-Wisdom-Illness/dp/0385303122

What I like about these approaches is that IME, it's empowering-- so it's not about focusing on deep processing (which can be too much reminding, too much victimization-pain), it's simple awareness, not feeding into story-lines, combat-exposures.  It teaches brain-body to let go, without mind getting in the way (normally mind can focus on problems/pain because it wants a resolution, some relief, some power and control over what's causing discomfort but it can create more discomfort, and exasperate stress symptoms).  I think it has therapeutic value,  because it's a way of re-establing connection with internal safety and it can calm stress physiology, re-stablize.  It feels good, good relief, IME.  It's being used in some clinical settings, hospital settings e.g. for things like chronic pain.

US military literature are acknowleging benefits of meditation and yoga as assistive re: stress, OIS, etc.

------------
IME, through the experience, I noticed my mind's tendency to cling to things, attach to thoughts, images, etc. (problem normal, but also problematic re: PTSD symptoms, flashback).  IME, it's a good bridge, supportive re: practice of 'flashback management'-- possible to stop it before it leads to dissociation-- the idea is stabilizing body's physiology and re-orientating to present moment.  The meditation, "savasana"/progressive body scan, not only is cool e.g. if suffering chronic pain, because can notice parts that are experiencing pain and in those moments can get momentary relief-- which is very empowering (cause mind can focus on it, when it's hard to ignore and that can a sense of victimization by it-- same with PTSD reminders, the frustration re: intrusive symtoms, fatigued by it, feeling disempowered by it, impeding functioning, not appreciating opportunities where things are working okay, which can build hope and resilience from).  PTSD-- when physiology is over-booted, not re-regulating, I find I'm more suceptable to futher flashbacks, and 'tremors', e.g. earlier panic attack bites back, heart-races up again for no reason (I need to quit smoking too).

I struggled re: teaching myself CBT, because the tendency of avoidance (which is just automatic, about trauma stuff), but MBSR seems to make it easier, after some time practicing it, making it easier to work with other tools.

I think Judith Herman, in her book Trauma and Recovery, hit an important point re: the importance of Safety and Stablization-- supporting coping skills development for symptoms and deep processing attempted too early can cause more problems, add to them.  I think this supports some of the concerns re: CISD, pushing people to talk.  Self-empowerment via stress reduction techniques would seem more useful as a response to critical incident or just that as a form of resilience training.

Also critique re: a lot of practicioners didn't spend that time with clients, doing that important work-- and not helping them develop symptoms-coping techniques, created bad dependence, and some of those people have been in therapy for years and they phone their therapist at all hours, years, non-stop-'therapy'. . . sad, not apparently that helpful (nor for either client, nor therapist. . . potentially sick and toxic).

It's abuse, IMO.

I think that the results of that sort of conduct and poor research, poor appropriation of methods, also made it less likely re: government cost-benefit anaylsis, re: funding of provincial health care to cover therapy for PTSD.  I lost big time.  But I hope things can catch up and see the cost-effectiveness re: symptom management training-- the other stuff, yes, using other supports, sparingly is fine, some can relate to feelings, thoughts about things-- have some moments of grief, move on, pace it, nothing gets resolved all at one-- that's normal stuff, the human experience.

I had an 'idiot psychiatrist' and I think he claimed to be competent to handle PTSD-- I think just to keep his job (so he wouldn't admit to anything like needing some updating, re-training. . .) .  It was at the university clinic (not a univeristy with any good psych programs-- research-oriented, not clinical.  Not sure about all his  motivations: maybe self-deluded, burnout, sick attachment, narcisstic/voyeuristic, etc.  Trauma teacher I had recommended I fnd a female psychiatrist (so, maybe sick dynamics re: rescuer-night in shining armour delusions of the psychiatrist--- sick things can happen-- maybe he didn't want me to get better, because he liked feeling important. .  I don't really know. . .).  Ran into an even sicker one, still allowed to practice depsite past findings-- predator-- and used "PTSD" as an excuse for it-- which was total BS.  Really slim pickings re: civilian help, with no private health ins.

I do know, it was Not what I needed, nor was asking for.  I asked very specific questions, what can I do when this happens; how can I stop it?  He had nothing to offer and said the PTSD would "go away on it's own eventually. . .", but it had been past weeks, months and years, post-trauma and a fair bit of accumulation that came to a head, including presenting situation, of burnout happening at workplace. . . which I guess he had no conceptual understanding.  Pushed me to keep fighting it, but I had no power over it, nor expertise, but I recommended they get a consultant in to help clean up some problems, re: roles negotiation, reasonable expectations, properly thought-out-- so there is effective functioning, not overwhelmed, stressed and burnt-out people-- suffering that was preventable.  Anyway, whatever it was, he was not very reality-oriented.  He probably got sick because of lack of training, and learned helplessness because not skilled.

I had few options re: PTSD help, and that's been a structural problem, not my fault.  I didn't need to lose those years, but it wasn't my fault, either.  Some bad choices because of unresolved grief, true (and sticking habits, and needing to re-evaluate what is right, and with respect to my own health), but I didn't know.

The PTSD injury is real, and IME the flashbacks were the main problem, relief of those, changes things significantly, frees up freedom, choosing, learning, functioning. . . more ability to 're-join the human race" ;)

Talking about PTSD too much, not healthy for me and I guess it brings up grief (and a triggering mental process), re: impacts of secondary traumatization, underneathe my concerns, and my hopes that access to PTSD treatment is available for those who really need it. 

I hope things can change for the better for civilian community re: provincially funded care when they can realize cost-effectiveness of newer techniques vs. on-going disability.  I think if I had that flashback management introduced to me way back when the PTSD had become chronic and debiitating, I would have been able to get back up quicker and a lot less problems, stone here gathering moss-- I can manage the rest and I can manage symptoms better.  I know grief, comes and goes, and doesn't have to stick, let go of a little bit at a time-- I think the MBSR is also beneficial orientation that way as well. 

It was the debiitation by caused by symptoms that was the hardest re: that creating the worse sense of victimization (by the PTSD, losing essential freedom over my time and space when it interupts, and not knowing how to recover from those), draining-- it was hard to plan things, follow up on committments, keep routines, get out more, see people, etc..  Less to do with story-lines or horror, terror and all that muck, if the flashback can be managed, can feel what one needs to feel, to help let go, once stablilized post-symptom/flashback and not going into the dissociative ego-state (re-living the hell).

I don't see how PTSD can be misdiagnosed, if the practicioner is in-tuned with symptoms presentation and focused in that way, re: delivery of support, teaching coping for the presenting symptoms?
 
kstart said:
I'm really glad to see your organization has a smart expert on the scene and I like especially that she researches, oversees issues of organization structure. . . you guys shouldn't have the additional types of problems, added toxic crap, destructive stuff

There is also a departmental chaplain.
But, in my opinion, leadership was / is the most decisive factor in the morale of any organization.
I worked for men I had loyalty and respect for. Many were non-cerebral types from the old school. Getting "reamed out" by some of them was worse than any call I ever did. But, they were real role models for me. I was 18, so perhaps more easily "moldable" than some of the older and wiser individuals who were later recruited from the community colleges.
Later, I learned that some of my role models were less than perfect, but neither was I.
Others, I couldn't take seriously as leaders because I had little respect for them.

To me, stress would mean standing in line hoping for a job, and fear of layoff once you had it.
 
mariomike said:
There is also a departmental chaplain.
But, in my opinion, leadership was / is the most decisive factor in the morale of any organization.
I worked for men I had loyalty and respect for. Many were non-cerebral types from the old school. Getting "reamed out" by some of them was worse than any call I ever did. But, they were real role models for me. I was 18, so perhaps more easily "moldable" than some of the older and wiser individuals who were later recruited from the community colleges.
Later, I learned that some of my role models were less than perfect, but neither was I.
Others, I couldn't take seriously as leaders because I had little respect for them.

To me, stress would mean standing in line hoping for a job, and fear of layoff once you had it.

I can agree with all that you have said here.  And I can relate to your feelings of feeling put off by "academic types"-- I've experienced this as well.  University, there were a few professors who were exception and what made the difference was they didn't make a life of 'academica' and had their feet planted in the real world, relevant work-experience which made their delivery of knowledge much more grounded, realistic, authentic vs. theory-lost academics.  When I took courses at college, on program I completed, they all had their foot in the real world and spent years at it-- grounded, reasonable, rational intelligence and the character that was shaped by real world challenges.  I felt way more motivated to learn when I had that type of teacher and the learning experiences were much more pleasurable and didn't jar me.  I had a foot out in the real world, and to experience blunted headed, overly attached to their own theoretical investments. . .closed to opening up issues and seeing them from different viewpoints. . .block-headed intellectuals, not truly rational, reasonable.

I've just seen situations of good people falling hard and leadership at the top was a major problem IMO, the source of the trickle-down and the spread of burnout, fatigue (stress leading others to enable, cover for the missed work, poor job performance of others-- which can be common place in many work environments, but not acceptable and harming when the work is responsible for safety of lives of others).  It wasn't deal with sensibly, consent, formal processes of shifting job roles-- all kinds of factors of burnout and trauma.  It can happen anywhere, but strong leadership, direct, honest, responsible can make a huge difference-- to deal with problems, not let things go on until everyone gets sick. . .

It's often observed in some organizations, a great-divide between 'front-line' workers vs, on high, and problems in decision-making structures as a result, ignoring the ground-level concerns, knowledge of issues from direct-experiencing and being responsive to that. . . potentially worse in non-unionized work (even though have to put up with some bs-- my roommate attended a meeting recently. . . but they got cookies ;)  An academic psychologist made them go through these exercises which really did annoy them. . . things blew up and she ran away. . . ;)).  It was a situation which needed outside consultation to clear up the mess, better distribution of roles, reduce unnecessary, frivolous stressors. . . (so people had time off to care for themselves better), etc.

I've done a lot of spewing here, even experienced some grief, but that I've learnt some PTSD-grounding skills, able to feel the grief I was needing to feel and let it go.  Feels better.  That's when things are working the way they should be.  The grounding skills, key to stopping spread of PTSD, fried physiology, IME.

I've just had some really bad experiences of the "help" out there, people who were self-deluded about their competencies, abilities and limitations and it harmed, made my illness worse, aggravated it, forced/encouraged process when body physiology not grounded, made the PTSD worse.  I trust people who stick to some professionalism, are properly trained and supervised-- the others were more narcissistic (wrong assumptions about 'having seen it all', voyeuristic. . .?  A bias, faulty pressumptions, no reality checks. . .).

To me, stress would mean standing in line hoping for a job, and fear of layoff once you had it.
Facing homelessness due to disability, loss of income-- not too fun either.  I went through all my savings, lost everything, was hoping I'd get better before the savings ran out, but I didn't and I was a wreck ( I worked before university for some years too).  Also had a problem taking the 'assistance', something I avoided to the end-- I really didn't want to wind up in this situation, I didn't want to become like what I saw in how I was raised, I wanted to do better.  I was hard-working as soon as I was old enough-- worked full time all through full time school-- I didn't want to waste my time, independence was really important for me.  But some relief, because from this far down, can only go up and that's my full intention.  Still healing from an ice accident, might need physio (ankle healed, not shoulder/collarbone, limited movement), if it's covered.  I was hoping for physical labour work-- fitness, exercise good for PTSD health and earn income and get out of this hole.  I enjoyed volunteer work, carpentry, building stuff, being outside. . . as a re-start. . .stave off arthritis if I can. . .hereditary, mom can barely walk.  Having education in social sciences-- yeah, expect layoffs. . . if can even get employed!  My brain is too fried for excessive brain demands (sick for too long).
 
"I came to realize that my work was less about saving lives than about bearing witness. I was a grief mop."
From the book by Joe Connelly.

Kstart, the way I looked at it, we were sent into people's homes to help the families. Sometimes, it was enough that we just showed up. Sometimes, they wrote thank-you letters to the department that would be forwarded to us. I still have them. That, and a paycheck, was enough for me.
I am disappointed to learn that victims of childhood trauma do not receive the support they deserve. Perhaps that is why I felt a bit guilty about getting paid to go to CISD.
 
mariomike said:
"I came to realize that my work was less about saving lives than about bearing witness. I was a grief mop."
From the book by Joe Connelly.

Kstart, the way I looked at it, we were sent into people's homes to help the families. Sometimes, it was enough that we just showed up. Sometimes, they wrote thank-you letters to the department that would be forwarded to us. I still have them. That, and a paycheck, was enough for me.

Great quote.  For sure it makes a difference, sometimes a short brief intervention, even 5 minutes is all it takes, as a witness which helps others re-ground.  That's powerful.  I've appreciated that via crisis line, short, brief, but what was needed.  And life before I got completly unable to function re: PTSD, with the work, I found it very satisfying and rewarding, as witness and seeing things move through to re-stabiization.  I got some good feedback too.  I have a treasure of a drawing a Vietnam Veteran drew (Mohawk-- a longer time for their benefits to kick in re: Canadians who served there. . .), was intense my partners were afraid of his anger. . . I was experienced re: witness to my brother's anger, and respecting it, giving it space, safe expression of it, and it disipates (and giving person the choice, if he wants to be left alone-- street outreach--options for that. . . ).  The drawing he had been working on, just blew my mind away, a symbol that I related to re: flashback falling down and hitting, another symbol for healing, the movement in it, change of state 'medicine animal'.  He asked for interpretation, and I just said what I saw of it, owning that it's only an I-interpretation and answering honestly (without going way out there on it, just observations). . . he awarded it to me, simply tools were used, scrap of poster board and pen.  I've reflected on it, dreamt about it, movement of pen, emotion it it. . . seems like it was an amazing way to express flashback and the 'forces that are happening' with that, it feels like just lands on me suddenly and I struggle to find an anchor (which he had in that drawing) and the intensity, mixed feelings of grief.  It's really trippy, kind of wonder to have received that (he wouldn't know that I was beginning PTSD, I didn't talk about that-- it's not about me when I'm focussed on being present to others, then again, a lot of the people we met in outreach were very perceptive, had gone through long struggles themselves. . .).  A Native way of expressing it, "a lot of 'medicine' in that drawing. . ."

I've also had experiences of running into others, sometimes years after the fact, and they remember me, have been really happy to report to me that things are going better, got housing, employment, etc., proud to say they 'made it'.  That's an honour to see and hear.

Thankfully our sick organization disbanded and something much better replaced it.  There's been a lot of improvements, housing improvements makes a huge difference-- street is too distracting for others to get focus, stability to make other changes.  There are competent mental health workers, who have good support, more advocacy powers (things I had also been asking for, re: improving effectiveness).  Funding though is also precarious, subject to political whims of powers that be. . . affects waitlists, etc.

Also, it is important to trust and have faith in the resilience of others (despite a very imperfect world and imperfect system where people have and do slide through the cracks of social safety net) and I noticed this a lot in that work (sometimes some inspiration), I take less for granted, the gift of that is appreciation. 

Children also do have a lot of resilience, innate survival capabilities to cope with unsafe environments as do some adults in difficult situations.  Learning to anticipate, predict; if absolutely trapped, dissociate to get through it.  Making it out alive in a persistently dangerous situation, I can look back with some amazement, the scale could tip one way or the other. . . that's luck, but also some impressive sophistication.  Problem is, is that when reach adulthood, those coping habits can be automatic, and not serve well.  Similar idea to what returning from deployment, members will experience, a need to shift gears, re-adjust, but that there's been some grounding in normal, away from the theatre experiences to re-aquaint with. . . the transition can be challenging, a bit of stress is a given.

I read a story recently about Vietnam POW, they weren't allowed to talk to other inmates, so they developed a code of communation, re: tapping on walls.  One guy survived the mental difficulty of it, by 'building a house' inside his head, all the plans, tools, etc. and when he made it back home, he got to it, built his house.  That's an innovative adaptation to being in a trapped, highly repressive situation for years.

I encountered a situation in my life where there were simply not enough 'state reources' to get someone out safely enough-- that hurt, death threats, dangerous, unless those threats could be contained and not enough re: legal test of powers initiate that, but I had pain-- a trauma expert would understand what I witnessed re: risk factors, behaviours, etc., state investigated, but the abusers were sophisticated sociopaths-- that re-traumatized too along with awareness of horror.  I tried to get help on that, I couldn't accept, didn't feel closure-- not something I could handle on my own without help and support.  My mind couldn't accept it because it was unacceptable to me.  I got treated really badly in the hospital "medical model", when trauma validation may have equally helped me re-stablize from that, but that's not how they play here.  While still very painful for me, witnessing disturbing behaviours over time, partial recognition by the state, but not full re: another victim.  It tore me up.  I've had to settle with it, and try to have faith in that person's resilience to survive it safely.  I did what I could, I confronted abusers, intense, high key stress, and resulted in safety risks, mine and others. . .

I don't know why I've had to be tortured like this, I would have walked away from situations, but concern for others kept me there, but turns out there are things i don't have power over, I can't control the choices of others, or the pathologies of others when they choose not to get help for themselves (denial of harm, or minimization of harm).  I guess I have a more realistic sense of my limitations and now I avoid situations.

I was really moved by General Romeo Dallaire's (book and documentary, Shake Hands with the Devil) re: accounts re: Rwanda, what kept him there when the orders were to withdraw and try to make a stand, but ouch.  I identify emotionally with that pain, different scales of exposure and extremes, but I'd say I have encountered some evil out there in the world. . . Devil might have won the battle, but at least not my soul.  It's probably not a bad experience to experience this once in one's lifetime, it's sobering, to feel through it at least once in a lifetime, that depth of pain.  But it's dangerous self-sacrifice and can have lasting effects, painful ones, ptsd. . .  It's also hard to stomach and it can be painful being aware of things that aren't right.  I pushed my limitations, realized things that were beyond my personal control.  With anyone's life, there are a lot of things that can be going on, and are simply beyond our personal control and about their choices and sometimes some unfortuante circumstances, complications.

[quoteI am disappointed to learn that victims of childhood trauma do not receive the support they deserve. Perhaps that is why I felt a bit guilty about getting paid to go to CISD.
][/quote]

Crisis services, even though the system is imperfect, does save lives, gives a person a chance to survive another day.  I've struggled for a lot of years trying to find PTSD help.  Support from the crisis lines helped me to survive, even though I couldn't get help for the underlying PTSD for a long time.  I'm glad I survived, it's still worth it and I'm recoverying and I will be back up on my feet.  I've let go of 'material loss', financial losses, realizing they're not that important as long as I have safe shelter and food to eat, and my brother is safe-- I can rebuild, I'll never be 'well-off'. . . having a cottage/place to live on a lake would be a good thing, good to have some dreams anyway.  Some services have improved, but nothing is very stable, it depends on the powers that be.  I struggled, I didn't fit the criteria of some programs geared to age, or ethnicity, etc.  It was hard trying to self advocate while in a crisis state, begging at places, being declined because lack of space, ridiculously long waitlists, of several years. . .

It was really piecemeal-- there are some organizations that work really hard, fundraising and are good organizations.  I could work through one trauma at one place. . . get a coping skill from another. . . really long waitlists, hampering recovery. . .but the central problem was the flashbacks, because that threw everything out of whack (dissociation, losing time, hard disorientating suffering. . . avoiding others so I'm not re-victimized in a vulnerable state and to preserve relationships, be a safe and stable pillar for my brother who has also had a hard time and was younger.)

I've actually done a fair bit of healing here-- there's things others won't understand, unrelateable re: crisis work, burnout.  The issue of good leadership preventing trauma, burnout, hit home.  I've had confusion, not realizing the other connection to not good 'leadership' as in parental strengths, resilience growing up (they're falling apart, while really low general functioning, really sick, and no access to healthy adults).  It's a piece of it, a factor in how it was traumatizing and re-traumatizing re: toxic work environment.  It booted up hypervigilance which makes sense to me now.  What I saw there were trauma adaptations, spread ill-health in the organization, not unlike what happened in a traumatized family and the help just wasn't very good back then either, and it would have relied on parental cooperation and I'm not sure the parent would co-operate.  But children are resilient, can have good survival skills for chaotic situations.

I try to read books, novels of strong characters and build inspiration up from that.  It's important to nurture and build on positive exposures and experiences.  I am through the worst of it.  I have more understanding about the layers of traumatization, the pieces and I can calm myself about it (understand its effects, why is this happening, what is it-- being able to name it, makes it possible to detach enough from it), while being able to face it, and feel what I'm feeling without avoidance/numbing or excessive anxiety.  I've developed some skills on my own, by what I could teach myself.  I've had exposure to some awesome professors, teachers, some truly exceptional people and they're meaningful inspiration, same with some other experiences.  Moments of grace that kept me going, spirituality, etc.

I stumbled into Mindfulness Based Stress Reduction-- it's now getting a lot more attention re: help for PTSD and I know it's really helpful-- I'm glad I had some exposure to that, it makes it easier to adopt flashback management techniques, benefits recovery in a lot of ways re: ptsd, anxiety, depression, other uncomfortable states, chronic pain, etc. IME.  I hope they keep this accessible for others.  I hope they can fund a PTSD program so everyone who needs it can access it, e.g. something like Homewood's program, even if it was available out-patient, a group. . .?  I had access to a women' s group for a trauma, and facilitators could catch when I was starting to flashback/dissociation and remind me to breathe-- need a bit of a mirror because that helps me recognize it better when it does happen when I'm on my own.  Those types of experiences help integrate the coping technique (traumatized self, ego states, hard to access coping skills without some bridge made by a witness who can notice it and let me know-- sometimes I rock slightly, body trying to soothe, automatic reaction-- learning to breathe, reminder to breathe helps [anxiety, breath becomes shorter, not enough oxygen, heart rate affected, more flashback prone, etc.]).  I tried to learn through books for it, but was really limited in how I could approrpiate it.

Some help, but long waitlists inbetween, and brief (4 months max), complicated, re: multiple traumas, different ages, etc.  Crisis support helped lots, 5 minutes on phone could help me get through flashback or other troubling symptoms, and also the effect built a bridge between traumatized ego states and present moment.  When lost in it, it's hard to find 'home' present moment (where there's more power to choose, freedom of the will, apply appropriate coping, etc.).  I'd say there's been some improvement in services vs. when I first broke down-- maybe?  I also wasn't aware, I trusted help that wasn't help, so I missed out on doing harder searching back then.  I mean, actually getting a call back after 2 years waiting, is a big improvement.  Access via Community Health Centres for crisis counselling, also relatively new, past few years (some affordable help)-- it's hit and miss, funding there sometimes, sometimes it's not, so have to keep at it (have a list and go through it and check it monthly, yearly, etc.-- harder to do when cognitively impaired, crisis state. . .but I did get online support, which helped me stick to that and I worked hard at it, stuck with it, despite ptsd distractions).  Resources crisis lines weren't aware of, a lot of research and searching.  It was luck that I finally found a social worker who had some knowledge re: PTSD treatment and could teach me flashback management-- has made a huge difference.

 
@mariomike,

Thank you for being a witness and for that spot of validation.  I feel relieved and I can let some things go.  "there it is, accept, move on. . .re-focus. . .".  (It was sometimes hard to figure out 'what the h was that?", lol).  There's a balance between being realistic, accepting 'what is' and maintaining positive outlook and to re-build where necessary.  I need to continue to build on wellness and moving forward.  I hope I've been able to help others about understanding PTSD a bit, maybe in expressing, validating some experiences of others coping PTSD and other OSIs.

Definitely the others, CF members and their families, and related fields,  remain in my heart and prayers.  :yellow:  I respect a lot about CF, many virtues, I truly admire.  :salute:

I don't comment on all the threads here, but there's some good laughs in here (good humour, etc.-- and needed :) ), and stimulating discussions :salute:

My sincere gratitude-- thank you (and for keeping it real).  :salute:
 
It goes back to what we said about psychological first-aid, Kstart. I remember one night when I was much younger a lady saw the shocked expression on my face. She took me back downstairs and sat me down in the living room with a glass of water. She could have humiliated me for showing weakness. I was grateful to her. It only took a minute, and I was ready to go back up and do my job. I was determined that it should never happen again.
So you see, sometimes the shoe is on the other foot!  :)
 
mariomike said:
It goes back to what we said about psychological first-aid, Kstart. I remember one night when I was much younger a lady saw the shocked expression on my face. She took me back downstairs and sat me down in the living room with a glass of water. She could have humiliated me for showing weakness. I was grateful to her. It only took a minute, and I was ready to go back up and do my job. I was determined that it should never happen again.
So you see, sometimes the shoe is on the other foot!  :)

Yeah, went a long time without that 'first aid', several 'shock' events, and chaos, w/o first aid, so it did fry some of my "circuitry" but is healable.  I try to move on and keep positive, but I also know I do get bit back ayway, so I just try keep prepared for that (I've had some 'false starts' and it's been disappointing).  But nothing wrong with "Hope for the Best, expect the worse'' ;)  But what that lady did for you was a good thing and it works and sometimes that's all we need, to pull it back together. 

And that kind of good support is a lot of hope for our returning CF.  There's power, when others are able to lend their presence, ability to listen (often it's not like that way, people get uncomfortabe, lack courage and perspective, but that might not be the case, e.g. CF, or other professional realms).  Good people like that who are available can do lots to prevent ptsd from setting in.

I get aftershocks still (and other's don't get that, e.g. "it happened years ago", but it's recalled as if it just happened, hence some 'shock'-- I wish it wouldn't irk people  :(, and if it was just understood as 'shock' and no big deal :( . . . but the crisis line gets it, so that's a lot less stress for me), but less frequent relative to before, so I should be able to pick things up to get employable again-- I hope to find a decent work environment.  I'm going to do my best.  Processing some things helps me desensitize from it, some flashbacks-- can still have but they don't overwhelm, nor cause shock-- that's progress.

I heard back from Homewood, still waiting for that OHIP-covered ward bed (they called re: updating my info). . . I find out that the funding for that is come and go-- that's part of what's been going on (and ever 3 months, there's shifts re: gender they serve, etc.). . . but there should be more, or better soon. . . but no idea how many more years waiting it would be. . .  I can't count on it obviously, I believe I can pull through anyway, it's just been a slower process, but what's time, a drop in a bucket.  So, I'll just deal with it. ;)  "Keep Calm and Carry On" ;)

I get that you've had lots of experience  ;), and you're stronger for it :salute:  That's good  :salute:  And the psychological first aid is good stuff and if it happens earlier, can probably prevent PTSD from setting in.
 
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