Tales from the first tee
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Tales from the first tee
Re-Release Warriors Come Home: Understanding PTSD and the Mission to Save Veterans' Lives
Dan Gaeta from Operation VetFit discusses PTSD in veterans and their revolutionary approach to preventing veteran suicide that has resulted in zero suicides among their members.
• Clinical definition of PTSD including exposure to traumatic events, intrusion symptoms, avoidance behaviors, and negative alterations in cognition
• The "masculine warrior paradigm" that creates challenges when veterans return to civilian life
• Success story of Thomas Burke who went from a suicide attempt to earning a Doctorate in Divinity from Yale
• Operation VetFit's approach includes exercise as a therapeutic modality, which is underutilized in mental health treatment
• Cognitive restructuring helps replace negative traumatic associations with new positive memories
• Color-coded intake system (red, yellow, green) developed by Colonel Neil Shuley helps assess and prioritize veterans' needs
• Veterans helping other veterans creates a sustainable model - "jumping in the hole" alongside struggling peers
• Scientific assessment of anxiety, depression, PTSD symptoms, and pain creates an effective risk factor evaluation
• Exercise is a crucial but often overlooked component of mental health treatment
If you work with veterans or know someone struggling, visit operationvetfit.org to learn more about their approach and resources.
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Welcome to Tales from the First Tee. I'm your host, rich Easton, recording from beautiful Charleston, south Carolina, in this segment with Dan Gaeta and again it's dan at operationvetfitorg. He talks extensively about PTSD, the symptoms and the solve. He also speaks to the masculine warrior paradigm, which is exactly what we train a soldier to be a warrior. But what happens when a warrior comes back home and he's not expected to be a warrior anymore? But tell me, like what are the symptoms? And I'm sure there's a wide array, but there are probably some triggers for an individual to identify they might have it or for their loved ones or others around them to identify. These are behaviors that you might want to look at, sure.
Speaker 3:Let me do this the most confident way I can, and that is literally using the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5. This is the gold standard for mental health clinicians.
Speaker 1:So those of you that are listening, since this is not a video. Dan has a pretty thick book, 600 and something pages. Right, yeah, six, what was that?
Speaker 3:Almost 900.
Speaker 1:Almost 900 pages, and he has a lot of yellow and orange stickers in them to refer to it. So I'm sure this is something that he uses all the time. Yeah, so he's not just doing this all from memory, although I would bet he has a lot of this memorized.
Speaker 3:Yeah, absolutely. I could probably put this to the side and go right through most of this stuff. What I end up would miss is the small little subtleties. So what is post-traumatic stress disorder? First of all, there has to be an exposure to a traumatic event. All right, and the DSM-5 identifies a traumatic event category as directly experiencing the trauma. Witnessing in person the events as it occurred to others. Learning that the traumatic event occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the events must have been violent or accidental. Experiencing repeated or extreme exposure to aversive details of the traumatic events first responders collecting human remains, police officers repeatedly exposed to details of child abuse. So that rate, there is your criterion, a right must have met one of those things.
Speaker 3:I just said, for it to be considered a traumatic event then we go to the presence of one or more of the following intrusion symptoms. See, this is what separates PTSD from just generalized anxiety or just anxiety or just a major depressive disorder. You're going to hear the moving parts here Recurrent, involuntary and intrusive distressing memories of the traumatic events. Recurrent distressing dreams in which the content and or effect of the dream are related to the traumatic events.
Speaker 3:Then there's in some cases, dissociative reactions, flashbacks, in which the individual feels or acts as if the event is actually reoccurring right now. Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings. So that is not one that everyone has, but that's one of them. That's one of the more severe ones that we see. One of the criteria yeah, criteria and see, ptsd is complex.
Speaker 3:I'm going to continue. Yeah, so the first one we know it's got to be one of those things you have to be exposed to. And the second criteria this presence of one or more of the intrusion symptoms I just identified, one or more of them Intense, and this is another one of them intense, prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of a traumatic event. For me, diesel fuel out of the back of a five ton got it brings me back every time.
Speaker 1:Yeah, could be a smell, it could be a sound. Yeah, sight, yeah.
Speaker 3:I will pick up my seven-year-old from school. Before COVID, outside there was this walk-up and the kids would come running out to their parents inside this fenced area the sounds of the children screaming. I would sit there and start crying. It's bizarre, bizarre, because I remember the kids playing in Mogadishu and then knowing what happened, it's just bizarre.
Speaker 1:So that's another example of that.
Speaker 3:Marked psychological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event. So they have to have one of those B categories. Aspect of the traumatic event. So they have to have one of those B categories. Right Now, listen to this C this is a C category persistent avoidance of stimuli associated with the traumatic events beginning after the traumatic event or as evidenced by one or both of the following Avoidance of or efforts to avoid distressing memories, thoughts or feelings about are closely associated with traumatic memory. That is, uh, cinematic of our just not talking about anything right. Avoidance of our efforts to avoid external reminders, people, places, conversations, activities, objects, situations that arouse these distressing memories.
Speaker 3:So what you're starting to see is this pattern. Ptsd is something that literally pulls the individual away from the world in which he's living so that he can avoid the pain that he or she is feeling. I understand.
Speaker 3:And then we go into criterion D, which is negative alterations in cognition or mood associated with a traumatic event, such as the inability to remember an important aspect of the traumatic event, like a blackout experience. That's typically due to what's called dissociative amnesia. A lot of times, rape victims will not be able to remember, as long as it's not related to alcohol, drugs or other substance. Persistent and exaggerated negative beliefs or expectations about oneself or others, like I'm bad, I can't be trusted, or the world can't be trusted.
Speaker 3:Many of us feel this way as it is, but this is just one of the things that people with PTSD are dealing with Persistent negative emotional state, horror, guilt, anger, shame, markedly diminished interest and participation in significant activities, feeling of detachment or estrangement from others, persistent inability to experience positive emotions, inability to experience happiness, satisfaction or loving feelings Flat affect.
Speaker 1:Got nothing to give, so this is what relatives are starting to see. Yes, People are coming back from war campaigns and these are some of the behaviors they're starting to notice in them that they didn't see before. Correct because there was no reason for them.
Speaker 3:Before there was nothing that had to be, but we're.
Speaker 3:I'm going to keep going because ptsd is it's profound I want to hear more so, marked alterations in arousal and reactivity associated with the traumatic event, beginning or worsening after the event occurred, as evidenced by two, are more of the following irritable behavior, angry outbursts with little or no provocation, typically pressed as verbal or physical aggression towards people or projects. That's where people are objects one of the most common ones. Reckless or self-destructive behavior. Hypervigilance, always being on alert, always having to face the door, face the windows and not have vulnerable access behind you. Exaggerated startle response. Problems with concentration, sleep disturbances, difficulty falling asleep, staying asleep or restless sleep.
Speaker 3:The duration of the disturbance for all of those B, c, d and E criteria that we just went over has to be at least more than one month. So it's not something that is some acute impact. This is affecting you for more than a month. The disturbance causes clinically significant distress or impairment. This is the most important one, because if you don't meet this one, you don't have PTSD. The disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning, and it's not related to another psychological disease, drugs or alcohol. So let me go back to Thomas Burke, the guy who's gun didn't go off.
Speaker 3:Yeah, yeah he comes home to give me key to the gym. He's trying to work with our areas veterans advocates. We're trying to help him out. He's trying to figure out how he can get his GI Bill back. He figures it out, gets it back, goes to school Sacred Heart University, graduates with a bachelor's degree, but he's not done yet. What the hell he applied to Yale he applies to.
Speaker 5:Yale Divinity.
Speaker 3:School Accepted Graduates Doctor in Divinity from Yale, and he's now a pastor, a pastor. Doctorate A doctorate in Divinity at Yale, and he's now a pastor, a pastor doctor a doctorate divinity at Yale so he's doctor now a.
Speaker 1:Methodist pastor right, yeah, right yeah, so how about that?
Speaker 3:from sitting on the banks of the Euphrates trying to kill yourself to preaching the word of God?
Speaker 1:I think it's great, fucking awesome. Yeah, I think it's a great success story, but obviously he got help.
Speaker 3:He got lots of help. He fell into what we have tried to recreate at Operation VetFit the net. He fell into the net. He had the coaches at the school allow him to come in and work with the kids and coach. He had our gym. He had other resources, another free place to use. He had people helping him pay his electrical bill. He fell into the net and it's up to us to create that net. This is what Operation VetFit's mission was to stop veteran suicide. That was 2012. It's 2021 and we are the only organization in this country that has stopped veterans suicide. We do not have one suicide amongst our hundreds of veterans within our organization that are all combat theater or combat veterans Not one.
Speaker 1:So how do we expand VetFit? How do we? And you were saying earlier, you're okay and I agree with this if other organizations try and duplicate what you're doing, because high tide rises all boats.
Speaker 3:We're handing it out. Everything we do is on our research page on our website. The issue I have found now with research in publishing is protectionism. Universities, institutions, want their name to be the one that solved the problem. Our name's on that. Everybody's fighting for credit and funding. Yeah, that makes sense, everybody's fighting for credit and funding.
Speaker 3:Nobody's fighting for the fucking solution. That's where we come in. We're focused on the solution. We're surgical. We're not a large organization. We're surgical. But if I can get those other big organizations that have all these billions of dollars of funding to fight veteran suicide to just do what we're doing, we solve the problem and we're doing a lot. It's not some cut and paste. There's a lot involved with what we're doing here. There's a lot of reasons why we're successful. We brought in if you look at our advisory board on our website, we brought in a broad, eclectic collection of Armed Forces veterans and they have given me so much information at various levels on how to eat this elephant, one bite at a time, colonel Schuhl, oh, go ahead, I'm sorry.
Speaker 1:The numbers are very clear, that the suicide rate for veterans enlisted veterans, is higher than the population average by far, like four times, five times, a significant number. That suggests this is a real problem that we have in our society probably all societies and the mindset of a Marine is it is a warrior type of mindset. You are trained to do one thing or to do a few things, but you are following orders, you are going to accomplish an objective, there are tasks, you have to do it, and so emotion is, and being self-reflective when you're a Marine is not something that is part of the skills training. So now you come out, you're a warrior. Part of being a warrior is not to say, hey, these things are bothering me, and so it's got to be.
Speaker 1:Very symptomatic of not only Marines but other armed forces is how do we help individuals, because when they're going through all these things, other people are saying it, they are holding back, they're repressing a lot of emotions, they're repressing a lot of things that have happened, because that's what you do as a Marine how do you help them convert from a warrior to now a citizen who has been a warrior and can still accomplish things but yet can be self-reflective and identify. These are issues that if they don't address them, things get really bad. Oh man?
Speaker 3:it's a great question. Let's see how we can tee up an answer here. So the term that we used in our conversation was the masculine warrior paradigm.
Speaker 5:Across cultures and across different times in history. Warriors could not go right back into society as if nothing had happened and they have to do a particular process, a ritual, spiritual process, so they could be reintegrated with the rest of their tribe.
Speaker 3:Something that is just a component of our trained behavior, because it is the Department of Defense's job to do what? Protect and defend the Constitution of the United States of America. So we are not planning for an emotional synaptic fire story with our friends while camping.
Speaker 3:We are planning to not die and to kill those that are trying to kill us. Yeah, right, feeling has no place there, other than the ability to use fear to your benefit. Right, but we are trained to fight to accomplish the mission, and that's our goal. That's what we're trained to fight to accomplish the mission and that's our goal. That's what we're trained to do. So, when you're in, feeling really doesn't have a place, and this is the problem the DOD is having right now. How do we maintain mission readiness to kill the enemy but also maintain mental health and counseling?
Speaker 5:mental health and counseling. Not to have any process that helps veterans to reintegrate themselves in society and society to welcome back the veterans is very dangerous.
Speaker 4:Until you start looking at basic training as the way the whole concept of killing is implemented and start working at ways to reverse that training, it's really difficult to have any significant impact on military suicide rates.
Speaker 3:Let's face it, joining the armed forces is insane. You're signing a contract that says you're willing to go die in defense of this country. That's not rational. So let's understand that to join the armed forces requires a certain personality that is then built and reinforced through the inculcation of what the Marine Corps gives you or the Army gives you, that's years of history, of battles fought and won, of names like Chesty Puller, dan Daly, smedley, butler. These are names that we are learning to remember in Paris Island and boot camp. These are the shoulders we stand on, these are warriors. So you get out and your wife, your sister, your brother, your parents are like yo, what's wrong with you, bro? The way we make that disconnect, which is this, is now trying to answer your question and come around. So there's the why right, why we're the way we are. And then how do we change it?
Speaker 2:In all actuality, you are broken. You've done things that you probably shouldn't have done, seen things that you probably shouldn't have seen. If they can engineer me one way to fulfill this job, that means we can also reverse engineer you the other way. It's totally possible to do.
Speaker 3:Well, one of the ways I do this in my clinical practice is I remind people, when you wake up and it's civilians now, when you wake up what's your job. When you wake up and it's civilians now when you wake up, what's your job? Oh, I'm a pharmaceutical rep, okay. Does that involve hunting human beings that are trying to kill you? No, does it involve being shot at? Normally no. This is also called cognitive restructuring, reframing, cognitive reframing. So what you do is you help the person identify that all those things that caused you all that trauma are over there and you're over here. So how do we change the symptoms that are coming from it? Right, we reassociate new positive memories and replace them with the things we're trying to avoid thinking about.
Speaker 3:For instance, a father one of my clients goes to a haunted house with his kids. Now, his wife has been saying you need to get some help, you need to talk to somebody. He's been reaching out, but he's too busy. He's a he's one of. Anyway, he's really busy. So finally, we start to work together and he tells me about this experience.
Speaker 3:He's like bro, I'm at the haunted house and all of a sudden, I'm starting to get that tightness in my chest. I'm starting to get really like hypervigilant. What the hell is going on? I'm feeling in my body I think I'm going crazy, right, and I'm like, well, what did you do? He goes. Well, you know, I did the exercises, I did some deep breathing, I took myself out of the situation, focused on the fact that I'm here with my kids to have fun. You nailed it Goes through the haunted house.
Speaker 3:They're laughing, giggling, having a good time, right. So what has this Marine just done? He's created a new positive memory to kick the frick out those negative associations with crowds, because this time it was a fun experience in the crowd, nobody got blown up. Each time you replace the negative memory area with a positive memory, you're diminishing the impact of the symptomatic expression of that bad memory. Emdr, eye movement, desens, sensation and reprocessing. You can actually tap into somebody's earliest trauma, effectively, neutralize it and it'll fall down the chain of life traumas and put them right back in place. Emdr is amazing.
Speaker 1:Yeah, so I looked at that. I was actually.
Speaker 3:I wanted to understand what that was, and you know what it's as complicated, as scientific and as much as they have marketed this to be its own product. Francine Shapiro was walking along a path and realized that when her attention was shifting left and right to the different bushes, trees and birds, the symptoms that she was feeling during that current mind state were dropped and she began to investigate that. And that was decades ago. And now we have this understanding of utilizing what's called this dual attention stimuli, this adaptive information processing that our brain has our brains amazing. It's amazing. Our brain isn't just in our head. I'm not going to get all far out, but we're all connected, man sure everything is connected right um.
Speaker 3:So as soon as we learn to think outside of the way that we've been thinking our whole life, my body, my brain, my existence, everything is me, me, me and we start to realize that, no, there's an absolute interconnectedness between everything, especially people sharing the same space. This is why these in-person things are so important, and we're going to find out if these zoom meetings are deteriorating. You know, human connectedness it's a trade-off, yeah or is it? Or are we just as able to communicate through the airwaves, through eye contact? As we are in person?
Speaker 1:we don't know yet yeah, what I would, you know, just in my experience experience is because I did a lot of video conference calls in my previous business life. It's a substitute because you can't be there for whatever reason. It's not the same to me of having the energy transfer that you have when you're in the room with somebody. You know, I did sales for 30 years and I found the most effective way to connect with somebody, understand what their problems were, you could solve them, is to be in the same room. But you know, it's the best substitute In a worldwide pandemic. It's better than just a conference call, Correct, you know, because you could see somebody and at least you're getting that back and forth with them.
Speaker 1:But I think it's um, yeah, you use it when you can use it, but if you could substitute it for real face to face, um, it has greater value. But once we're out of this pandemic we'll see. Yeah, how does somebody who is a vet now, um, how do they know about you and how? How does the process work of either you reaching out to them or them reaching out to you for them to want to live?
Speaker 3:Grassroots or the mouth. One veteran or somebody sees that a veteran's doing great and asks them hey, what's going on how you been? Oh, I'm doing much better. This organization, operation Vet, vet, fit. They set me up with a gym membership, they're helping guide my exercise program and they're providing them psychotherapy and they take a chance and that's how it grows we're not going to take donor dollars and resources to advertise and promote.
Speaker 3:We are going to let, because we're surgical, we're small. Because we're surgical, we're small, but we're also handing out what's worth millions, billions in research funding.
Speaker 1:It's worth. Life is what it's worth.
Speaker 3:We're handing it to the hospitals, the institutions that want it. We can't make it any easier. We have the system that works. Part of it starts with intake. So to give you a little brief description on how our intake system works now, we use a color-coded intake system red, yellow, green, red. This guy needs some regular clinical mental health counseling. Let's, let's, do a suicide assessment. Check on on this guy. Yellow, hey, this guy's doing all right. Green, no problems, no problems.
Speaker 3:Now, where the hell did this color coding system of common sense and simplicity come from? Where else? The Marine Corps Colonel Neil Shuley, who was setting up the 1st Raider Battalion, I believe. Sometimes I confuse all the stuff he's done, but he's the real deal. He's became a mentor, he's on our board and he told me about, when this thing was just starting to percolate, what his unit was doing. And see, we just have the. You know the commanding officers, the staff, ncos, just during formations. How are the guys doing? Go talk to your guys. You know, with a formation, there's 70 people in a platoon and it breaks down to. You know squads of 12 to 16, which break down into. You know fire teams of four or five and that fire team's got a fire team leader so everyone's checking on everybody. That's when you're in, everyone can check on everyone. So they've decided to create this color code system so they can get right after the problem, so they wouldn't have suicides.
Speaker 1:And now they get out, okay.
Speaker 3:And now they get out Okay, and now they get out. Where's the formation, where's the platoon sergeant, where's the CO? That's where we come in, because when you get out you have to understand. Your thinking is what it was instructed, trained and skilled to be. Now you have to retrain the brain to understand. I do not have to sit and wait for being killed or killing somebody. I can actually sit with my child and have fun. This traffic isn't going to kill me here. This is America. There's not a roadside bomb on the side of the road usually, okay, so you can kind of start to dampen some of the things that would cause a lot of the symptomatic expression. That becomes more troublesome Because where PTSD really deteriorates society is in that avoidance aspect, the inability to go to work, be around people sit in office, drive down the road, drive down the highway, talk to people, make new friends or have any affect or good time. I mean, why live if everything just sucks? Why live right?
Speaker 1:so we talked about that. What one of the things we talked about was, particularly when you leave the marines and you're not an officer, so you have been taking orders for as many years as you've been there and you have had to deal with all this strife, and my existence, while grotesque and incomprehensible to you, saves lives. Now you get out, and I think what we talked about is a lot of people. They don't want to take orders, they don't want help, they don't they want, and which makes it tough for them to reenter society. Because you have bosses, you have whatever coaches, whatever that is. You know everybody has to report to somebody and so they have that syndrome that you explained to me is of not wanting to engage.
Speaker 3:Post-service behavioral regression. We're the first agency to dub that term and I went through it. That was getting divorced, walking onto UConn and being a 24-year-old.
Speaker 1:So you don't want help. You don't want to be told you might want a better feeling and a better life, but you don't want to be helped, but will sure as hell help.
Speaker 3:So we have changed the paradigm. They're helping us help other veterans who need help by helping them help us help other veterans. So you see, it's not just that hand out, it's that hand up. Let's walk hand in hand. There's another great, I'll tell you real quick. It's about the combat veteran or combat soldier. He's in a hole and the squad leader comes over and says hey, marine, what are you doing? Get out of the hole. I'm having some trouble getting out. Get up, get out. Walks by. Guy still can't get out of this hole. Staff Sergeant comes up.
Speaker 5:Hey Devil Dog, why are you down in that hole, man, let's go, let's go, I can't get out.
Speaker 3:Staff Sergeant. Well, figure it out. Master Sergeant comes by, same thing happens. Lance Corporal walks over hey, what's up, brother? What's going on? I can't figure it out. Jumps in the fucking hole with him and they figure it out together. We are the agency that's jumped in the hole with our veterans and we're figuring it out together with them.
Speaker 3:The color coding case intake came from Colonel Shuley. How we measure anxiety, depression and pain comes from all the scientific-based subjective measures that we have at our disposal. So we use science to create a formula which uses the GAD-7, the PHQ-9, and the PCL-5 that measures anxiety, depression and PTSD symptoms, and then we throw in pain as the fourth variable. In this formula we add the sum of those up. The sum of those four variables gives us our risk factor. If it's at a certain level it's red, yellow, green.
Speaker 3:So we're using science and experience, combining them together to create a rating system that's allowing us to say we need to be honest, dude, like now. This guy's all set, he's good to go. How can we get him to help us? Help other people? Because the dude that needs help now the last fucking thing he's thinking about is helping anybody because he's in darkness. All these symptoms have manifested themselves in a way that he or she is no longer able to even function. They're not eating right, they're not sleeping right, they're sure as hell not exercising. And exercise, as you know, is a huge part of what we do and is perhaps, I think, one of the most important therapeutic modalities in the mental health community. That's never even been considered as an evidence-based intervention Shameful. We already know. We've got decades of science of what exercise does in the brain to affect emotion, resiliency, strength, bone density, health. How the hell our mental health practitioners not us not assigning?
Speaker 3:exercise to their fucking clients.
Speaker 1:It's insane you know, well, that's just our whole because they're not qualified they're not qualified, and I think that's our health system in general is we wait till things break and then we go, instead of trying to keep things from being broken. You've been listening to Tales from the First Tee and the Dan Gata story. I'm your host, rich Easton, recording from beautiful Charleston, south Carolina. Thank you.