Speaker 1: Special Operations, Cobert Ohs Spionage, The Team House with your hopes,
Speaker 1: Jack Murphy and David Park.
Speaker 2: Everybody, Welcome to episode three fifty six of The Team Mouse.
Speaker 3: I'm Dave. This is Jack.
Speaker 2: Our guest tonight is doctor Chris free, the author of
Speaker 2: The Operator Syndrome, which is I feel like a seminal book,
Speaker 2: like it pulls in so many things that people are
Speaker 2: ignoring now or they're getting misdiagnosed, or just kind of
Speaker 2: lumped altogether.
Speaker 3: Thank you so much for joining us. It's really great
Speaker 3: to have you.
Speaker 4: Oh well, thanks for having me. I'm excited to be here.
Speaker 2: So real quick, before we go into your origin story
Speaker 2: and your can you just give us a real quick
Speaker 2: teaser on what operator syndrome is?
Speaker 3: Yeah?
Speaker 4: Sure, So.
Speaker 3: Operator syndrome is not a diagnosis per se, but think
Speaker 3: of it as a framework for understanding the very complicated
Speaker 3: and interrelated injuries and impairments that develop over time during
Speaker 3: the career for many high risk professionals. So obviously operators
Speaker 3: for military special operator operations are an extreme end of that.
Speaker 3: The framework is relevant for first responders, firefighters, law enforcement,
Speaker 3: for soldiers from other parts of the combat arms. Quite
Speaker 3: a bit of my work has been with paramilitary intelligence
Speaker 3: adjacent operators, and so the concept is that these professions
Speaker 3: involve an enormous amount of physiological strain on the human body,
Speaker 3: and we call that alostatic load. So that static or
Speaker 3: physiological strain affects all of the physiological systems in the
Speaker 3: human body nervous system, endocrine system, respiratory system, metabolic system,
Speaker 3: muscular skeletal et cetera. And we have failed, in my opinion,
Speaker 3: we have failed, you know, generations of soldiers and first
Speaker 3: responders now by over relying on the diagnosis post traumatic
Speaker 3: stress disorder. So we've used for decades now, we've used
Speaker 3: PTSD as the easy button. And when we do that
Speaker 3: to a hyper risk professional, we're saying, oh, all of
Speaker 3: your problems that you think you have all fit into
Speaker 3: one bucket. We call it PTSD, and we only treat
Speaker 3: that with two issues to treatments, psychotherapy and a bucket
Speaker 3: full of psychiatric medications. And so the concept of operator
Speaker 3: syndrome is that that is that that's a fail and
Speaker 3: that we need to be looking at brain health, traumatic
Speaker 3: brain injuries, hormonal dysregulation, sleep dysregulation, sleep apnea, chronic joint pain,
Speaker 3: chronic headaches, cognitive problems that develop over time, and yes,
Speaker 3: some psychological issues anger, depression, general anxiety, addiction, and even
Speaker 3: a little PTSD. Although let me say this, what I
Speaker 3: don't see and the guys I work with and the
Speaker 3: gals I work with, I don't see the fury activity
Speaker 3: or the avoidance of triggers that are.
Speaker 4: Associated with PTSD.
Speaker 3: So for myself, I don't really although I'm a so
Speaker 3: called PTSD expert. According to some people, I don't see
Speaker 3: the I don't see it. That's not the problem. It's interesting. Yeah,
Speaker 3: I don't want to derail.
Speaker 2: But about the postmatic stress stuff, I'll talk about that later.
Speaker 3: But first off, please tell us your origin story. Where
Speaker 3: did you grow up? How did you get into medicine? Oh? Okay, well,
Speaker 3: so I grew up in a lot of different places.
Speaker 3: My dad was a physician. He joined he commissioned in
Speaker 3: the Air Force in the early sixties, so he was
Speaker 3: a Vietnam He became a veteran in Vietnam, a veteran
Speaker 3: of the Vietnam War.
Speaker 4: A few years later.
Speaker 3: As a physician, we lived all over I think of
Speaker 3: the Midwest is primarily my home.
Speaker 4: Although I was born in New York City.
Speaker 3: I went to high school in Missouri, Wisconsin, Michigan. I
Speaker 3: did my graduate training in Ohio, and then I got
Speaker 3: a PhD in clinical psychology in South Florida, Tampa, Florida.
Speaker 3: And that was the kind of the beginning of my
Speaker 3: journey of my career working with veterans and service members.
Speaker 2: So can what like around what year was that, and
Speaker 2: then like what was your initial impressions of veterans at
Speaker 2: that time, and then how if that changed over the years,
Speaker 2: how did it change?
Speaker 3: Yeah, yeah, okay, Well, let me go back to my childhood.
Speaker 3: So I was I was probably about five years old
Speaker 3: when my father was served in Vietnam, and I think
Speaker 3: that was sixty eight, sixty seven sixty eight. My great
Speaker 3: grandfather who lived until who died when I was fourteen,
Speaker 3: so I knew him very well. My great grandfather was
Speaker 3: a veteran of the Spanish American War and he fought
Speaker 3: at the Battle of San Juan Hill.
Speaker 4: So from both my.
Speaker 3: Father and my great grandfather, I developed a sense of,
Speaker 3: you know, what it meant to serve, what it meant
Speaker 3: to be a soldier, and as well as that there
Speaker 3: is a cost associated with that that endures for years
Speaker 3: after the war and for many people, many soldiers, and
Speaker 3: that was kind of my why for why I wanted
Speaker 3: to be a psychologist. So I went to graduate school,
Speaker 3: started in nineteen eighty seven, graduated in nineteen ninety two.
Speaker 3: And to put a little that into a little bit
Speaker 3: of context, the diagnosis of PTSD was added in nineteen
Speaker 3: eighty was added to the psychiatric nomenclature in nineteen eighty.
Speaker 3: So when I started graduate school and was already thinking
Speaker 3: about my dissertation with PTSD, it was a new diagnosis.
Speaker 3: It only been.
Speaker 4: Officially books for about seven years.
Speaker 2: Was prior to PTSD was shell shock like was it
Speaker 2: a diagnosable thing or was it just like parlance battle fatigue?
Speaker 4: Yeah, I think it was parlance.
Speaker 3: And I don't you know, I wasn't practicing prior to
Speaker 3: nineteen eighty, so I don't really know how it was
Speaker 3: handled in terms of like VA coding or insurance.
Speaker 4: Billing and those sorts of things.
Speaker 3: But we can trace it all the way back to
Speaker 3: the Civil War, and in the years after the Civil War,
Speaker 3: there was a syndrome that was described described by a
Speaker 3: doctor named DaCosta. It became known as either a soldier's
Speaker 3: heart or Dacosta's syndrome kind of interchangeably, and the idea,
Speaker 3: the concept of it was where Civil war soldiers were
Speaker 3: going in to see doctors post war and they were
Speaker 3: describing cardiac problems for which there was no path of
Speaker 3: physiological basis that could be identified, and guys were dropping
Speaker 3: dead of cardiac problems.
Speaker 4: They were just.
Speaker 3: Describing shortness of breath, tightening chests. Guess what, that's probably
Speaker 3: panic disorders. And so that was the very beginning of
Speaker 3: really modern medicine, going wait a minute, there might be
Speaker 3: something going on here.
Speaker 4: With regard to post war experiences.
Speaker 3: In World War One, a different, different term kind of
Speaker 3: came out of that.
Speaker 4: Shell shock.
Speaker 3: The concept of shell shock at the time was a
Speaker 3: veryalogical and it was the idea that soldiers on the
Speaker 3: front lines were exposed to these bombardments of artillery, so
Speaker 3: flashing blinding lights, loud booms, vibrations of the earth, and
Speaker 3: they were needing to be pulled off the line. And
Speaker 3: then actually they were generally sending them back to Britain,
Speaker 3: or at least the Western Allies were sending them back
Speaker 3: to Britain dressed homes.
Speaker 4: And it became known as shell shock.
Speaker 3: And it was thought of at the time as being
Speaker 3: a neurological condition, and then it was promptly forgotten when
Speaker 3: the war was over. There's some really classic writings of
Speaker 3: some of the neurologists at the time who laid out
Speaker 3: a research agenda for how we could understand this better.
Speaker 3: But with the war over, nobody followed up on it
Speaker 3: until we got to World War Two. In World War
Speaker 3: two we came up with a different conceptualization of it.
Speaker 3: So in World War Two we called it combat fatigue,
Speaker 3: and the concept was soldiers over time would just get fatigued,
Speaker 3: and in a sense, they normalized it as a normal reaction,
Speaker 3: not an extreme reaction. It's just, you know, you can
Speaker 3: only spend so many days at the front line in
Speaker 3: combat and then we've got to pull you off. Now,
Speaker 3: what they didn't do, they didn't send people to far
Speaker 3: away rest homes for six months or a year. They
Speaker 3: pulled They pulled soldiers back from the front lines just
Speaker 3: a few miles where they would be in a camp
Speaker 3: in a tent with a cot, warm, dry, reasonably good food,
Speaker 3: and just three to five days with nothing to do
Speaker 3: other than to rest and sleep. But then they would
Speaker 3: be sent back to their units, and the concept of
Speaker 3: that was actually turned out to be very effective from
Speaker 3: the from the perspective of war fighting, we had very
Speaker 3: few site We had very few psychiatric casualties during World
Speaker 3: War tw using this concept of giving soldiers rest periodically. Now,
Speaker 3: if we carry that forward to the combat fatigue concept
Speaker 3: to Vietnam, that had implications for how we fought that war.
Speaker 3: So we created the US military created the de ROS system.
Speaker 3: DeRos is an acronym for date of expected return from overseas,
Speaker 3: So it was a one year tour of duty. You
Speaker 3: were if you were in the army, well, Marines are tougher,
Speaker 3: so they had to do thirteen months. But if you
Speaker 3: were an army it was twelve months, Marines thirteen months,
Speaker 3: but you knew when you were coming home, if you lived,
Speaker 3: if you survived, and if you weren't injured to the
Speaker 3: point of needing to be medevact out of country.
Speaker 4: The idea was any.
Speaker 3: Soldier could go and fight for a year knowing that
Speaker 3: on this date they were going to be they were done.
Speaker 3: And so that was a strategy that the military used
Speaker 3: to mitigate psychiatric casualties. And they included R and R
Speaker 3: for so many soldiers got R and R midway or
Speaker 3: part way through their year, like a Hawaiian vacation or
Speaker 3: a trip to Japan or the Philippines. It's fascinating.
Speaker 2: And then you know because shell shock almost did you
Speaker 2: read this story about the marine unit, the artillery unit
Speaker 2: in Syria, They fired off so many rounds that guys
Speaker 2: when they came home, we're.
Speaker 3: Seeing ghosts, thinking demons were after them. Like it was yeah, yep, yes,
Speaker 3: And so I think where you're going with that is
Speaker 3: they got it right. Yeah, they actually got it more
Speaker 3: right than not. And we have spent now one hundred
Speaker 3: years where we went off in a different direction, really
Speaker 3: a very Freudian direction. The concept of trauma is very Freudian,
Speaker 3: and I'm not a Freudian. It doesn't mean that that
Speaker 3: trauma doesn't have a conditioning effect or a condition to
Speaker 3: reaction to traumatic experiences.
Speaker 4: I do believe that.
Speaker 3: But we really pulled way back and we went very
Speaker 3: psychological with our concepts here, and we left neurology out
Speaker 3: of the picture, we left brain health out of the picture,
Speaker 3: and we turned it all into the psychological thing.
Speaker 4: And all of our treatments focus on.
Speaker 3: The psychology of responding to trauma experience, and part of
Speaker 3: the problem there is everybody responds differently. There's genetic differences,
Speaker 3: there's upbringing differences, there's training differences. We know that soldiers
Speaker 3: who are really well trained and are surrounded by tight
Speaker 3: you know, spree to core within their units. That that
Speaker 3: right there is a huge protective factor for any kind
Speaker 3: of psychological or psychiatric reaction during the war, during the deployment,
Speaker 3: as well as after words. So we we've actually lost
Speaker 3: a lot of the good common sense that we used
Speaker 3: to have in medicine one hundred years ago, and hopefully
Speaker 3: we're bringing our way back around to get to picking
Speaker 3: up where we left off from twenty seven.
Speaker 2: Yeah, when you mentioned PTSD, it reminded me of an
Speaker 2: article I had read before the global were on terror,
Speaker 2: and it was it was a medical study that they
Speaker 2: had checked the brains of people who had made it
Speaker 2: through SFA, especially force assessment selection, that they had a
Speaker 2: higher or lower amount of some neuropeptide.
Speaker 3: I don't remember the specifics now, but.
Speaker 2: They said that basically it created sort of like this
Speaker 2: teflon layer where they didn't like revivify memories. They didn't
Speaker 2: you know, when something happened. It just kind of was gone.
Speaker 2: And so there was this idea that these guys would
Speaker 2: have a lower incident of post traumatic stress. But then
Speaker 2: after the GWATT, it left me wondering, you know, watch
Speaker 2: all this post aumatic stress. But you know, you're saying
Speaker 2: that it's not just that. You know, there's a combination
Speaker 2: of all these things.
Speaker 4: It's not it's not just that.
Speaker 3: I mean, let's go to the extreme nature of what
Speaker 3: it means to train to be an operator or anything
Speaker 3: adjacent to that. It involves an enormous amount of physicality, rucking, lifting, running, combatives,
Speaker 3: jumping out of airplanes, repelling, maybe diving, tactical driving.
Speaker 4: So these are all things that are.
Speaker 3: Not easy on the body. Then you add on top
Speaker 3: of that the sleep deprivation, which is both necessary for
Speaker 3: training and combat. I mean, it's an inherent part of it,
Speaker 3: but it's also part of the selection, an assessment strategies
Speaker 3: of youah, you got to go, you got to stay
Speaker 3: awake for five days, and we're going to see if
Speaker 3: you can do that and keep functioning part of the selection.
Speaker 3: Then you have the blast exposures, and I think blast
Speaker 3: exposures are the signature injury of global war on terror.
Speaker 3: We haven't admitted that, but I think I think we are.
Speaker 3: If we get right, we're going to come around to
Speaker 3: that understanding. Training with with with demolitions, with shoulder fire rockets,
Speaker 3: breaching sniper rifles, even handguns involved microblasts. And now we
Speaker 3: know for about eight years now, nine years now, we've
Speaker 3: we've we've we have some inkling of what blasts do
Speaker 3: to the brain, which is very different from anything we've
Speaker 3: ever understood before, and it's a different type of injury
Speaker 3: than an impact impact force is. So blasts have a
Speaker 3: shearing effect through the body and what we what was
Speaker 3: what was revealed in a study published in twenty sixteen,
Speaker 3: is that the sheer aring effects leave the glial cells
Speaker 3: in the nervous system scarred. So each neuron in our system,
Speaker 3: those are the messenger cells, has about ten glile cells
Speaker 3: as its support network. They hold the neurons in place,
Speaker 3: they protect them, they insulate them, they take out the toxins,
Speaker 3: and they get damaged from blast exposures. So you get
Speaker 3: this scarring pattern in the brains. It's very different from
Speaker 3: the amyloid plaques, the tauel proteins that can develop and
Speaker 3: build up after an accumulation of impact force blows to
Speaker 3: the head.
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Speaker 3: So, you know, and that's like you said, we're just now.
Speaker 2: Starting to understand lassgers, or at least understand the effect
Speaker 2: that they've had.
Speaker 3: That's very new.
Speaker 2: And like, has the VA or a lot of other
Speaker 2: organizations caught up with that or is everything still just
Speaker 2: post traumatic stress?
Speaker 3: Well, so I'm not in the VA right right, I
Speaker 3: don't know exactly what happens in the VA, but I
Speaker 3: talked to a lot of people who either work there
Speaker 3: or veterans like yourself who may have tried to use
Speaker 3: the VA. VA has for since the night teen eighties,
Speaker 3: has invested heavily in PTSD treatment programs. There are there's
Speaker 3: a network called the National Centers for PTSD, and there's
Speaker 3: seven or eight of them around the country in the VA.
Speaker 3: They're funded by Congress, so they have separate funding. And
Speaker 3: so we've built a huge industry in the VA around PTSD.
Speaker 3: And the people that run these centers, that run these networks,
Speaker 3: many of them are scientists, clinical scientists, and so when
Speaker 3: you look at even NIH funding, NIH grant panels often
Speaker 3: have many VA investigators on there. When you look at
Speaker 3: the journals, the medical journals, the psychology journals related to trauma,
Speaker 3: many of them are led by VA employees. So the
Speaker 3: VA is a very very powerful force of for supporting
Speaker 3: the construct of PTSD and the treatment for it. And
Speaker 3: they've been very influential on DoD and every other part
Speaker 3: of our Western mental health systems. Law enforcement, firefighters when
Speaker 3: they have trouble, they get if they're having difficulties, they
Speaker 3: often are almost immediately diagnosed with PTSD. And so maybe
Speaker 3: rephrase your question again. So we've kind of gotten away
Speaker 3: far away from where we were in nineteen seventeen. We
Speaker 3: know TBI is a problem for soldiers, we know it,
Speaker 3: know it, but we don't really act on that knowledge
Speaker 3: very efficiently. You go out of here TB and PDSD
Speaker 3: clumped together as if they're the same thing, right, they're similar,
Speaker 3: we can't tell them a part.
Speaker 2: Do you think do you think that one of the
Speaker 2: reasons it like TV isn't in blast exposure, isn't as
Speaker 2: recognized it because they don't really know what to.
Speaker 3: Do about it right now. Maybe in part we don't
Speaker 3: understand it very well. It's hard to evaluate in a
Speaker 3: truly objective fashion. I mean, I can talk to you
Speaker 3: in half an hour, I can figure out if you
Speaker 3: probably have TBI, but I would be asking questions that
Speaker 3: other doctors might not ask. And in terms of like
Speaker 3: doing an MRI and cognitive performance testing and getting that
Speaker 3: kind of data, that's both expensive and complicated and highly
Speaker 3: imperfect because an MRI doesn't necessarily show us brain damage,
Speaker 3: especially at the cellular level. So when we talk about
Speaker 3: the TAUL proteins or the glial cell scarring associated with
Speaker 3: chronic traumatic encephalopathy or what's now been called interface astral
Speaker 3: glial scarring. The only way to really know that and
Speaker 3: look at that as post mortem. So we have to
Speaker 3: wait till somebody's dead before we could actually go into
Speaker 3: their brain at the level of that pathologists do. So
Speaker 3: we are hampered by ignorance, we are hampered by a
Speaker 3: lack of really good.
Speaker 4: Technology to really explain things.
Speaker 3: We're also hampered by what I'll call referred to as
Speaker 3: a little bit of a deep state in the VA system.
Speaker 3: So when the Global War on Terror started twenty almost
Speaker 3: twenty five years ago, the VA system was what it
Speaker 3: was and hasn't really evolved much since everybody who had
Speaker 3: the power, who had the empires, who had the clinics
Speaker 3: and the centers and the research funding, they weren't immediately,
Speaker 3: they weren't changing directions or switching lanes very rapidly, if
Speaker 3: at all. And so I think the problem we have
Speaker 3: today is and PTSD is the number one injury that
Speaker 3: you see, may be careful of that. It's one of
Speaker 3: the top injuries that you see in VA disability claims.
Speaker 3: So it's been so deeply ingrained and codified in the
Speaker 3: VA's policies, in the clinicians and even in the veterans
Speaker 3: and the patients. It's a term that gets, you know,
Speaker 3: that gets thrown about and used widely. Could we do better, Absolutely,
Speaker 3: we absolutely can do better. And where is the VA changing?
Speaker 3: I'm not sure but I do know they have five
Speaker 3: polytrauma centers what they call polytrauma Centers, and one of
Speaker 3: those centers I think is soon going to incorporate the
Speaker 3: word or the phrase operator syndrome into the name of
Speaker 3: their program. And they're certainly using the concept, the construct
Speaker 3: and the framework and what they're doing. Now that's fantastic.
Speaker 2: Yeah, when we get further on, I want you to
Speaker 2: like kind of give the give us more on the
Speaker 2: VA because you mentioned some really interesting things in your book,
Speaker 2: But so you start out your focus on post traumatic
Speaker 2: stress when it's relatively new, and really, what did people
Speaker 2: know about the postmatic stress from the movies in the
Speaker 2: seventies and eight isn't even up till today, is that
Speaker 2: somebody has flashbacks. They think that, you know, Charlie's in
Speaker 2: the wire and Huey's openside and they kill everybody in
Speaker 2: the office.
Speaker 3: Right Yeah, Yeah, and really interesting question that we can
Speaker 3: wonder about here. Did Hollywood create the PTSC that we
Speaker 3: have today? Did all those movies in the seventies that
Speaker 3: used flashbacks as a plot device, did that create what
Speaker 3: we now have as a symptom of PTSD. I have
Speaker 3: never had a patient, even in my years at the
Speaker 3: PTSD clinics who really had what you what you often
Speaker 3: saw in the movies where through flashback that involved them
Speaker 3: acting as if they were back in that scenario. And
Speaker 3: an interesting study that was done probably fifteen or twenty
Speaker 3: years ago by the Brits. We got some of the
Speaker 3: great research happening with veterans as comes out of Britain.
Speaker 3: And what these guys did was they got all of that.
Speaker 3: They got the medical records from the Boer War fought
Speaker 3: at the very end of the nineteenth century, early twentieth century,
Speaker 3: so they got the military records of British soldiers who
Speaker 3: fought in South Africa and they went through them just qualitatively,
Speaker 3: reading through them looking for symptoms of PTSD. And they
Speaker 3: found a lot of symptoms of PTSD, but notably, there
Speaker 3: was one thing they didn't find any reports of in
Speaker 3: the medical records, and that was flashbacks. They didn't find
Speaker 3: any evidence of people describing these dissociative episodes where they
Speaker 3: thought they were reliving or re back in, you know,
Speaker 3: in a moment of combat and acting accordingly.
Speaker 4: They didn't find it. That may just be a modern invention.
Speaker 3: Yeah, thank you all.
Speaker 2: Yeah, And it's interesting because uh, like people, they're still
Speaker 2: very influenced by that idea today.
Speaker 3: I remember when the.
Speaker 2: Whole I don't know, maybe during Trump's first term, maybe
Speaker 2: I don't remember, maybe it was Obama, but you know,
Speaker 2: there was a school shooting and there was the armament
Speaker 2: about like arming veterans, you know, to guard schools, and
Speaker 2: you know, a couple of people that I knew in
Speaker 2: New York were like, no, they can't do that because
Speaker 2: the veterans might have postraumatic stress and I'll shoot all
Speaker 2: the kids.
Speaker 3: It's like, that's not how it works at all. No,
Speaker 3: that's a you know, that's a sad well, that's a
Speaker 3: sad uh outcome of the of the fact that half
Speaker 3: of all veterans of the guy, it's probably more than
Speaker 3: half now are are rated disabled by the VA for PTSD.
Speaker 3: If anybody who served in a war zone, that's the
Speaker 3: diagnosis that they can very easily get, and it does.
Speaker 3: It is compensable. The problem there is what kind of
Speaker 3: message does that send us with society. We have a
Speaker 3: whole society who's now walking around with this wrongful notion
Speaker 3: in their heads that soldiers, the soldiers who deployed to
Speaker 3: war are broken, damaged, likely to snap, risky, dangerous, and
Speaker 3: we don't think of them as likely to be good fathers, good,
Speaker 3: good husbands, good members of a community, good, good workers,
Speaker 3: good spouses, And nothing can be further from the truth
Speaker 3: if we look at the data, But most people just
Speaker 3: go with the stereotypes. One thing that I that really
Speaker 3: disturbs me, and I see this a lot nowadays is divorces.
Speaker 3: A mother going through a divorce with somebody who's formerly
Speaker 3: you know, an operator or another high risk professional often
Speaker 3: will report to the court, to the judge that their
Speaker 3: husband is a risk, is dangerous and they're afraid of
Speaker 3: them because of PTSD, and judges seem to look at
Speaker 3: that and go, okay, yep, that makes sense. So maybe
Speaker 3: there's a restraining order, Maybe visits with children only happen
Speaker 3: on a very limited basis with supervision.
Speaker 4: And I just I can't even begin.
Speaker 6: To to extol the tragedy of of veteran and responder
Speaker 6: fathers who are losing enormously in their divorce, divorced settlements
Speaker 6: and custody settlements because of some wrong, wrong full.
Speaker 3: Myths or beliefs about PTSD and how their service, how
Speaker 3: their work may have affected them.
Speaker 2: Yeah, and you know, and like we're trying to normalize
Speaker 2: the idea of postraumatic stress operators and drone you know,
Speaker 2: blast exposure things like that. But what veteran is going
Speaker 2: to come forward, what male veteran is going to come
Speaker 2: forward when that's a looming possibility. It's like red flag laws,
Speaker 2: you know, it's like red flag laws. And what veteran
Speaker 2: is going to like, say they have postraumatic stress or
Speaker 2: anything else going on, if they might not ever be
Speaker 2: able to own a weapon.
Speaker 3: Again, that's right, that's right. So I have a good
Speaker 3: friend who is a DEA agent and he's in his
Speaker 3: early fifties. He actually spent five years as a DEA
Speaker 3: agent in Afghanistan, running and gunning with drug interdictions, functioning
Speaker 3: very much like an operator. Never mind, not to mention
Speaker 3: what he does in the US. And part of his
Speaker 3: story is a few years ago he raised his hand
Speaker 3: and said I'm not doing well and I need help.
Speaker 3: And he was one of the senior He wasn't the sack,
Speaker 3: but he was one of the senior agents in his
Speaker 3: regional office, and leadership there took his gun away from him,
Speaker 3: they put him on a desk, and he was told
Speaker 3: almost right off the bat by somebody in HR that
Speaker 3: he certainly, probably almost certainly had PTSD and they were
Speaker 3: going to refer him for PTSD treatment, which they did,
Speaker 3: and he went along with it, you know, he was
Speaker 3: trying to be a good team player. He went along
Speaker 3: with it for several months, and what he found was
Speaker 3: the diagnosis didn't make sense to him, the treatment didn't
Speaker 3: make any.
Speaker 4: Sense to him, and he just stuck it out.
Speaker 3: He went through the motions and about a year ago
Speaker 3: he read the Operators Syndrome book and I actually met
Speaker 3: him at an event and we became friends since then.
Speaker 3: And that's part of his story is he modeled for
Speaker 3: the younger guys in his region in his office that hey,
Speaker 3: it's you know, it's okay to say you need some help.
Speaker 3: And then he was punished for it, right, and so
Speaker 3: you know, he got slapped pretty significantly. For about two
Speaker 3: years now, he used the Operator Syndrome framework and he
Speaker 3: got some of the right treatments for himself, and he's
Speaker 3: now back functioning, operating again. He's back at the full
Speaker 3: duty that he wants. But that is such a common experience.
Speaker 3: And I'll even give you another example, probably about ten
Speaker 3: years ago, about ten years ago, there were some of
Speaker 3: the psychologists who who were with Naval Special Warfare out
Speaker 3: on the East coast. One was the lead, you know,
Speaker 3: they were leaders that some of the teams out there,
Speaker 3: including Development Group, and they had operators, they had cels
Speaker 3: and EOD technicians who they realized weren't going to talk
Speaker 3: to them because they didn't want to get pulled off
Speaker 3: of potential deployments. And so for a while there they
Speaker 3: were referring them my way, and you know, I'm not
Speaker 3: in the military, I'm not in the VA, I'm not
Speaker 3: in any of the command structures. So that was there
Speaker 3: was there thinking, hey, talk to this guy. He might
Speaker 3: be able to help, and he's not going to Nothing
Speaker 3: is going to be put into your official records. So
Speaker 3: you know, if I so to this point today, I've
Speaker 3: probably worked individually with six hundred, six hundred and fifty
Speaker 3: operatives over the last twelve years or so. Most more
Speaker 3: than half of that has been entirely pro bono. The
Speaker 3: other half of it are less than half of it
Speaker 3: has been through work I've done for some attorneys working
Speaker 3: with private defense contractors who needed to be evaluated for
Speaker 3: treatments and.
Speaker 4: For insurance claims.
Speaker 3: So I was able to take advantage of that to
Speaker 3: do full evaluations using the operators your room framework.
Speaker 2: So let's so you start out your Did you say
Speaker 2: your graduate thesis was on postraumatic stress or yes?
Speaker 4: Okay, yeah, it was my dissertation, your.
Speaker 2: Dissertation, all right, So yeah, you have to forget the
Speaker 2: uneducated amongst us who don't know the difference. But so
Speaker 2: your dissertation is on postmatic stress, and so what was
Speaker 2: what was post traumatic stress at that time?
Speaker 3: What did you learn? What did you discover? Well, I
Speaker 3: don't want to bore the world with my dissertation because
Speaker 3: that's that was not it was not a.
Speaker 4: Terribly important study.
Speaker 3: But maybe the question you're asking is from today, was
Speaker 3: PTSD different at that time in the nineteen eighties early nineties,
Speaker 3: And the answer is that it was different. We change
Speaker 3: the DSM every ten to fifteen years. We are currently
Speaker 3: using the fifth edition of the DSM, and I'm sorry
Speaker 3: I should say what the DSM is. DSM is the
Speaker 3: Diagnostic and Statistical Manual.
Speaker 4: For Psychiatric Illnesses.
Speaker 3: So it's put out it's a book that is created
Speaker 3: and put out by the American Psychiatric Association, and it's
Speaker 3: a catalog of all the psychiatric diagnoses that we recognize,
Speaker 3: and it says what their symptoms are and some other
Speaker 3: information about it. So PTSD was added to the DSM
Speaker 3: in nineteen eighty for the third edition. The fourth edition
Speaker 3: came out in ninety four, and the fifth edition came
Speaker 3: out in twenty thirteen, and each of those two times
Speaker 3: there's been significant additions or changes to the definition, And
Speaker 3: I think this is important. This is actually an important
Speaker 3: question that you've asked. The original definition of PTSD was
Speaker 3: fairly simple and straightforward. It involved a trauma that was
Speaker 3: considered to be quote outside the range of normal usual
Speaker 3: human experience, such as combat, such as being sexually assaulted,
Speaker 3: and it was primarily all the symptoms were around the
Speaker 3: concept of fear, fear reactivity, and avoidance of things that
Speaker 3: might stimulate or trigger that fear. It got watered down
Speaker 3: a little bit in in nineteen ninety four they took
Speaker 3: out some of the wording about outside the range of
Speaker 3: human experience, so now it's just a traumatic experience that
Speaker 3: involved the sense of fear, helplessness, or horror.
Speaker 4: At the time. In twenty thirteen they took even that out, So.
Speaker 3: Our current definition, while it involves, you know, you have
Speaker 3: to have trauma to have post trauma stress. The definition
Speaker 3: of trauma is very nebulous and it really left open
Speaker 3: to the interpretation of the individual. VA took it one
Speaker 3: step forward in twenty ten. They actually passed the lots
Speaker 3: in the federal registry that a veteran meets the criteria
Speaker 3: for PTSD. For the trauma part of PTSD if the
Speaker 3: veteran ever set foot in a war zone during their
Speaker 3: military career, doesn't say anything about what they do, what
Speaker 3: they did, what they saw, what they experienced. Just merely
Speaker 3: being there for a day or maybe even less than
Speaker 3: a day, just merely having been there counts as the
Speaker 3: criterion a trauma.
Speaker 4: For the diagnosis.
Speaker 3: We could go off, you guys know this, We could
Speaker 3: go off on a whole conversation about society and how
Speaker 3: everything now has become defined as stressful or traumatic.
Speaker 5: I mean, I imagine some of that is also a reaction
Speaker 5: to the huge number of veteran suicides that VA was
Speaker 5: getting a lot of bad press for at the.
Speaker 3: Time and hiding for a while. Yeah, and by the way,
Speaker 3: they still are. They've not brought that those numbers down
Speaker 3: at all. Yeah, those numbers they have stayed the same
Speaker 3: no matter what they've done. And I mean, we are
Speaker 3: in a society now where trauma seems to be political
Speaker 3: currency or social currency. Students, college students will proudly tell
Speaker 3: you they have PTSD and the childhood of trauma. Now,
Speaker 3: sometimes I don't, you know, I don't go digging or exploring,
Speaker 3: but I have certainly found many examples where somebody has
Speaker 3: described trauma and when they describe it, you have a
Speaker 3: little bit of a.
Speaker 4: Sounds stressful, It doesn't sound traumatic.
Speaker 3: Though, So I think we've changed the threshold of what
Speaker 3: trauma is.
Speaker 4: That's one thing. The other thing we.
Speaker 3: Did in twenty thirteen with the revised diagnosis of PTSD
Speaker 3: is we added a lot of symptoms in there related
Speaker 3: to general anxiety and depression. And if you take the
Speaker 3: questionnaire that's most commonly used, it's called a PTSD checklist.
Speaker 3: Everybody uses it. It's a one page, simple checklist form. You
Speaker 3: could give that to anybody who does not have a
Speaker 3: traumatic history at all, but if they have depression or anxiety,
Speaker 3: they're going to score as if they have high levels
Speaker 3: of PTSD. So we've turned it into a diagnosis that
Speaker 3: really doesn't have any sensitivity to separate one patient from another.
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Speaker 2: Yeah, it's uh, it's interesting, but I think it's like
Speaker 2: you say, it's sort of these this opening up of
Speaker 2: society so that everybody's lived experience is as equal to.
Speaker 3: The next person's lived experience.
Speaker 2: And you know, if somebody yelling at me in the
Speaker 2: street is traumatic, then who's to say.
Speaker 3: It's not if I say it is, right.
Speaker 2: So, as you were, like, you know, as the GAT
Speaker 2: was progressing and you were in this field, what were
Speaker 2: some of the things that you were seeing that would
Speaker 2: eventually lead you to to the operator the Operator Center.
Speaker 3: Well, so the story is pretty organic. I left VA
Speaker 3: in two thousand and six, so that was just as
Speaker 3: we were starting to get the veterans from the GAT,
Speaker 3: the first sort of wave of them coming into the VA.
Speaker 3: So I left just as we were starting to get
Speaker 3: GWAT veterans coming in, so I didn't clinically, I didn't
Speaker 3: have a whole lot of experience with them. In About
Speaker 3: six years later, I was working in.
Speaker 4: Houston, Texas.
Speaker 3: Actually, I had my job here at the University of
Speaker 3: Hawaii and I had a job at Baylor College of Medicine,
Speaker 3: So I was commuting every month, spending a week in Houston,
Speaker 3: and there's a small foundation that had just started up there.
Speaker 3: They had been started by a former Naval officer and
Speaker 3: a recently separated Navy seal who had been together and
Speaker 3: they had been kind of there the night that Extortion
Speaker 3: seventeen went down, and they were helping identify bodies and
Speaker 3: things like that.
Speaker 4: I think they kind of had a bond.
Speaker 3: So they started this small foundation that in Houston, which
Speaker 3: was at the time initially it was really just it
Speaker 3: was like a happy hour thing, you know, every two weeks,
Speaker 3: all of the soft community in the city of Houston
Speaker 3: were invited to come together for this. And it wasn't
Speaker 3: just Navy, it was Army, Marines, Air Force. They had
Speaker 3: a lot of guys from the intelligence world, including at
Speaker 3: least one guy who'd been on the bin Laden Task
Speaker 3: Force for many years, and it was really just intended
Speaker 3: to be a chance to get guys together just to
Speaker 3: kind of hang out and connect with each other and
Speaker 3: maybe make some job connections, employment connections and that kind
Speaker 3: of thing. And early on when they invited me to
Speaker 3: start at ten their meetings, what happened was a lot
Speaker 3: of guys would come up to me, you know, kind
Speaker 3: of one on one privately, ask if they could talk,
Speaker 3: and then we'd set that up and I would do that,
Speaker 3: you know, separately, and the typical complaint that I would
Speaker 3: that I would hear would be go something like this, Doc,
Speaker 3: I don't know what's wrong with me, but I don't
Speaker 3: feel like I used to feel. I don't force or
Speaker 3: perform like I used to. I'm tired, I'm apathetic, I
Speaker 3: don't want to work out, I don't really have much
Speaker 3: interest in sex. My girlfriend's beautiful, but just not that interested.
Speaker 3: Trouble concentrating, trouble motivating, not sleeping. And I assumed I
Speaker 3: did what psychologists did then and do still today. I
Speaker 3: assumed it was PTSD initially until I started talking with
Speaker 3: these guys and getting to know them, and at some level,
Speaker 3: you know, within probably the first month or two, a
Speaker 3: couple of months really realize this isn't PTSD, this is
Speaker 3: something different here. So traumatic brain injury with depression were
Speaker 3: kind of the two next big hypotheses. But did some stuff,
Speaker 3: some trial and error stuff that kind of shocked me,
Speaker 3: including we were getting blood panels and the testosterone levels
Speaker 3: that came back were really love hadn't did not expect
Speaker 3: that at all. Why does this thirty seven year old
Speaker 3: former Navy seal, who looks healthy, who looks well, who
Speaker 3: looks big and muscular, why does he have the same testosterone.
Speaker 4: Level of an eighty year old man.
Speaker 3: Sleep studies they kept coming back with sleep apnia, which
Speaker 3: didn't make any sense to me either. Why do these
Speaker 3: these thirty late thirties, early forty guys.
Speaker 4: Why are they having sleep apnia? That didn't compute for me.
Speaker 3: Also, through my research program, I had a ticket and
Speaker 3: all you could scan at the Baylor College of Medicine
Speaker 3: Brain Neuroimaging Center. So I was taking all of my
Speaker 3: research subjects from the hospital. We're getting their brain scanned.
Speaker 3: So let's try this with some of these operators. We
Speaker 3: put them through the same protocol and working with the
Speaker 3: neurologist friend of mine, looking at them. What his reaction
Speaker 3: was was, well, these it all.
Speaker 4: I told him, these are men. He didn't know what
Speaker 4: he was looking at, not really, so these are men.
Speaker 3: And he looked at him and he's just like, so,
Speaker 3: these look like relatively healthy brains, no lesions, no tumors,
Speaker 3: no great big white matter spots, relatively healthy brains for
Speaker 3: an eighty year old man. He thought he was looking
Speaker 3: at elderly brains because of the ventricle atrophy. So now
Speaker 3: it's like, holy shit, And I wasn't you know, these
Speaker 3: guys were not describing the index events of head injuries.
Speaker 3: They weren't. None of them were diagnosed with traumatic brain injury.
Speaker 3: None of them had any history being blown up like
Speaker 3: in an ied explosion, so they didn't. None of them
Speaker 3: were even had even been evaluated for a TBI.
Speaker 4: And so that became part of what we were doing.
Speaker 4: And then the more we the more, you know, the.
Speaker 3: More I talk with these guys, and then their friends
Speaker 3: and then their friends, it was a snowball thing that happened.
Speaker 4: All just had the same pattern over and over again.
Speaker 3: Every single guy had evidence of TBI, evidence of lotustosterone
Speaker 3: and other hormonal dysregulation, insomnia, sleep, apnea, chronic pain, chronic headaches,
Speaker 3: cognitive impairments, and then of course social impairments that you
Speaker 3: know that all bleeds out into your into your family life,
Speaker 3: your marital life, your work, other aspects of your world.
Speaker 3: And that's when I started in my own thoughts thinking,
Speaker 3: this is a syndrome. This is not a simple one diagnosis.
Speaker 3: These all go together, and when we go well, why
Speaker 3: does somebody have why would a man thirty seven year
Speaker 3: old seal have low testosterone? And then you go through well,
Speaker 3: why wouldn't he have low testosterone? And it's probably multiple factors.
Speaker 3: The brain injury, So the pituitary is the master land
Speaker 3: that's in the brain. The high op tempo of never
Speaker 3: taking a knee, of going going, going, never quit, you
Speaker 3: come back from deployment, you start training, you go through
Speaker 3: those intense training evolutions. So there isn't a time There
Speaker 3: just isn't time for those court for the cortisol and
Speaker 3: other stress hormones to normalize.
Speaker 5: Hasn't it also been linked to like sleep deprivation and
Speaker 5: poor diet stress, The burns out the deference.
Speaker 3: Right, so TBI sleep deprivation, sleep problems, that high op tempo,
Speaker 3: poor diet, alcohol, abuse, chronic pain, so all these things
Speaker 3: go together and teasing them out. Well, what percentage is
Speaker 3: related to blasts versus a high opt tempo?
Speaker 4: I don't know.
Speaker 3: I don't know that we're ever going to know that
Speaker 3: in me and at least for right now, it doesn't matter.
Speaker 3: We gotta we got to jump on this this body,
Speaker 3: this body of injuries and impairments and treat it now
Speaker 3: because guys are you know, they're hurting. Uh, They're losing
Speaker 3: the good things in their life, their marriages, their jobs,
Speaker 3: and we we we we do have a very serious
Speaker 3: suicide rate in all of the.
Speaker 4: High profession high risk professionals of Chris.
Speaker 2: Where does the sleep app being come from, because that's
Speaker 2: not something you think of, how a relatively fit guy
Speaker 2: having totally and I don't know, I don't know the
Speaker 2: answer to that, is it is a from Does it
Speaker 2: come from some aspect of the TBI. Does it come
Speaker 2: from some aspect of neck and head, you know, muscular.
Speaker 3: Injuries in this area. Is it something that builds up
Speaker 3: over time when you're just not sleeping and not getting
Speaker 3: enough quality sleep? So I'm gonna just like I'm ignorant,
Speaker 3: I don't know the answer to your question. Yeah, I
Speaker 3: don't know that anybody does.
Speaker 2: So how were you How were you putting together this
Speaker 2: framework as you were capturing it? Because in your book,
Speaker 2: like there are I don't remember how many chapters, but
Speaker 2: there were like twelve to fifteen chapters of like different things.
Speaker 3: How are you compiling that? Yeah? You know, early on,
Speaker 3: I wrote up a document for myself. It was just
Speaker 3: kind of notes, and then I thought, you know what,
Speaker 3: I need to something to educate and share information with
Speaker 3: the guys I'm talking to in their spouse. So I
Speaker 3: took that document and I gave it a title. I
Speaker 3: titled it the Operator's Sleep Manual. No operator wants to
Speaker 3: talk about mental health, and I don't blame them, So
Speaker 3: let's talk about sleep. And when you put everything it
Speaker 3: takes to sleep better, you're really taking care of everything.
Speaker 4: So that was the hook that was sleep.
Speaker 5: And the wormy gets them as they call it, like,
Speaker 5: what is it like performance enhancement or something like that,
Speaker 5: that we're evaluating you and to improve your performance and
Speaker 5: they can get guys into the clinic for that.
Speaker 3: Yeah, that's exactly right. You want to perform better in sleep,
Speaker 3: you got to do these things.
Speaker 7: Yeah.
Speaker 4: Yeah, And as.
Speaker 3: I was learning. I just that document was a living document.
Speaker 3: So it kept getting longer, it kept getting having things
Speaker 3: added to it. And at some point in twenty eighteen
Speaker 3: or nineteen, with some colleagues, we took that document and
Speaker 3: we turned it into a paper that we submitted to
Speaker 3: Medical Journal and it was probably and so that was
Speaker 3: that's the twenty twenty medical paper titled Operator Syndrome. And
Speaker 3: just for your readers, anybody can find that online if
Speaker 3: you just Google or search, do a search for operator
Speaker 3: Syndrome Medical paper. It should come right up.
Speaker 4: It'll be a PDF. You can print it off.
Speaker 3: It's actually pretty easy to understand because it was written
Speaker 3: initially as a as a document to help educate operators
Speaker 3: and their spouses. Now, Chris, you start running in.
Speaker 2: First off, you talked about the VA earlier, and one
Speaker 2: thing you mentioned in your book was you know is
Speaker 2: like I didn't know that the VA research in order
Speaker 2: to be a researcher you had to be a VA employee,
Speaker 2: like they don't take research from anyplace else. But you
Speaker 2: also ran into people who were like no, like uh
Speaker 2: soft guys like we don't like don't make them prema donnas,
Speaker 2: like social justice demands that they don't get any special attention,
Speaker 2: like people were trying to shut you down, right.
Speaker 3: Yeah, yeah, well.
Speaker 4: Maybe some people trying to shut me down.
Speaker 3: I certainly have been on the receiving end of some
Speaker 3: you know, smarrows here and there. The VA does not,
Speaker 3: I mean, some of the people from the VA PTSD world,
Speaker 3: I would say, really don't want to hear this. One
Speaker 3: of the leaders in the VA said to me in
Speaker 3: a meeting, she said, well, this is all kind of
Speaker 3: silly because their problems are really PTSD and I will
Speaker 3: I said, well, what do you base that on? She goes, well,
Speaker 3: they all have very high scores on the PCL checklist. Okay,
Speaker 3: so now we go down to this. We go down
Speaker 3: this little rabbit hole of PTSD. Checklist measures a lot
Speaker 3: of things, it's not very specific to PTSD. Also asked
Speaker 3: her about her about her data. Where you get these
Speaker 3: one hundred and fifty operators you say you have, Well,
Speaker 3: they come to our clinic. Okay, how do you know
Speaker 3: their operators? Oh? Well, they self identify. Do you know
Speaker 3: what brand? No, we don't have that. Do you know
Speaker 3: what kind of units? No, we don't have that.
Speaker 4: Do you have anything on their deployments.
Speaker 3: No, we don't have. So all she had is people
Speaker 3: saying that they had been an operator without any other details,
Speaker 3: and she didn't soon understand why that might be a
Speaker 3: problem or a concern. And I said, well, you know,
Speaker 3: most of the guys I talked to an interview and
Speaker 3: talk to you very deeply at length, don't report these
Speaker 3: symptoms of these very specific symptoms of PTSD. And a
Speaker 3: response to that was she just kind of smile, goes, Yeah,
Speaker 3: that's denial.
Speaker 4: They're all in denial.
Speaker 3: Wow. And so it's a no when situation with somebody
Speaker 3: like that, you either endorse all the symptoms and you
Speaker 3: have PTSD, or you don't endorse the symptoms and then
Speaker 3: you're in denial.
Speaker 4: And you have PTSD. Right, So, no matter what, you're
Speaker 4: going to have it.
Speaker 3: So there's a little bit of that. We were trying
Speaker 3: to get get a program funded at Houston Methodist Hospital
Speaker 3: some years ago and a large site visitor team came
Speaker 3: out and met with us. There were I think six
Speaker 3: or seven of them. This was the Marcus, the Marcus
Speaker 3: Brain Health folks. And in working with the Green Beret
Speaker 3: who was the veterans point person for this group, I'd
Speaker 3: been in calms with him for probably about six months
Speaker 3: by this time, and I thought we were going to
Speaker 3: be funded.
Speaker 4: I thought this was almost more of a formality.
Speaker 3: And it came out and the guy, the neurologist, and
Speaker 3: they're also named Jim Kelly, who was the leader of
Speaker 3: the team. In the first five minutes, literally the very
Speaker 3: beginning of the day. We had a whole day and
Speaker 3: an evening blocked out to spend with them, and as
Speaker 3: we were going through our sort of our opening introductions,
Speaker 3: when he realized that we were only proposing to treat
Speaker 3: operators in our program, he said, Nope, I won't approve that.
Speaker 3: And he didn't stand up and leave at that point,
Speaker 3: but mentally he did. He didn't participate in the discussions
Speaker 3: or the meetings the rest of the time. In fact,
Speaker 3: when we met with the hospital, the hospital, the CEO
Speaker 3: of the hospital later that day, he sat in this
Speaker 3: nice mahogany walled office and pretended to fall asleep during
Speaker 3: that meeting. What he said was, we're not going to
Speaker 3: do this. We're not going to fund this. It's not right,
Speaker 3: it's not fair. Operators have already been treated special their
Speaker 3: whole careers, and we're going to treat everybody we have socially,
Speaker 3: just to give the same treatment available to anybody. And
Speaker 3: his own point person, the green beret sitting at the table,
Speaker 3: said to him, wait, hold on, we're talking here about
Speaker 3: a group of operators as a group of people who
Speaker 3: have unique injuries, unique experiences, unique exposures. So the idea,
Speaker 3: I mean, he laid out what I had already given
Speaker 3: to him, which is, it's not about doing something special
Speaker 3: for somebody special special. It's about giving every patient the
Speaker 3: treatment they need to be well and healthy. And for
Speaker 3: somebody whose job took them to very specific certain types
Speaker 3: of of experiences that would reduce produce injuries, we have
Speaker 3: a we have a responsibility as a nation, as a
Speaker 3: society to give those individuals the treatments that they need.
Speaker 4: That did not fly.
Speaker 3: He was not persuaded by that, So that didn't so
Speaker 3: we didn't get the funding for that that It just
Speaker 3: just died right there.
Speaker 4: In that moment.
Speaker 3: And it's sad too, because.
Speaker 2: Just like in the military, things that you know, soft
Speaker 2: gets that the rest of the army does and or
Speaker 2: the rest of the military doesn't.
Speaker 3: Eventually, you know, trickle down, trickle down, That's true, that's right.
Speaker 2: So so had this gotten off the round with you know,
Speaker 2: with the operators, then it would have become a platform
Speaker 2: for you know, those infantry units that were out there
Speaker 2: hooking and jabbing all the time. And I see what
Speaker 2: you're saying though, also that you know, with with operators,
Speaker 2: you know, or soft guys. You you, you know what
Speaker 2: that group is, right, you know what they've been through.
Speaker 3: With everybody else in the military.
Speaker 2: There there are infantry guys and marines who were out there,
Speaker 2: like in it, right.
Speaker 3: Slugging away.
Speaker 2: But with this really broad, expansive thing of post traumatic stress,
Speaker 2: suddenly you guys get flooded with you know, people who
Speaker 2: spent their time, you know, behind the wire the whole time.
Speaker 3: Right, And so you're exactly right about that, and so
Speaker 3: that that becomes you know, that's that's also a real
Speaker 3: problem for the va IS, most clinicians, most people in
Speaker 3: civilian society don't understand that. When you think of the
Speaker 3: Department of Defense and the different branches, there are people
Speaker 3: there are soldiers who are in the combat arms, and
Speaker 3: then there are soldiers who are who do all the
Speaker 3: other things, very important things, critical things, But that doesn't
Speaker 3: mean they're being shot at or shooting at enemy, and
Speaker 3: we really have. I mean, I don't know the exact proportion,
Speaker 3: but I think it's about a third of soldiers or
Speaker 3: in the combat arms, and about two thirds are in
Speaker 3: play these very important support roles for those of the
Speaker 3: combat arms. And we never talked about that the difference there,
Speaker 3: never even heard about it. When I worked at the VA,
Speaker 3: I came to realize it myself because I read a
Speaker 3: lot and I talk to a lot of people. But
Speaker 3: I don't think your average VA clinician really has that awareness, right,
Speaker 3: And so when they get a patient who comes in
Speaker 3: and says, Doc, oh I have PTSD, and yeah, I
Speaker 3: served in Iraq for a year, there isn't an understanding.
Speaker 4: They even can't even picture what was in I Rock.
Speaker 3: They don't know what the bases or the fobs or
Speaker 3: the different regions were about the We don't know that
Speaker 3: if this person was a mechanic, they were likely to
Speaker 3: be doing certain things that would be very different from
Speaker 3: somebody who was infantry.
Speaker 4: And of course even.
Speaker 3: There, you know, we know that some of those mechanics
Speaker 3: did end up at it remote fobs, maybe stationed there
Speaker 3: or moving around and rotating. So those mechanics also may
Speaker 3: have experienced quite a bit of indirect fire or whatever,
Speaker 3: and so they may themselves be different from others who
Speaker 3: are not in the combat arms. We're just not We
Speaker 3: just haven't done a very sensible job of training medical clinicians.
Speaker 4: Right on these nuances.
Speaker 2: Well, and you know, and it's like you say, like
Speaker 2: with them opening up the definition of post traumatic stress
Speaker 2: and what trauma is. I mean, I'm sure somebody who
Speaker 2: is in one firefight one time at their base or
Speaker 2: got rocketed, and you know, maybe somebody who was heard
Speaker 2: or whatever, I'm sure that was traumatic for them, right,
Speaker 2: no question. But then but then to take that and
Speaker 2: then to try to compare that to like you say,
Speaker 2: the allostatic load that people who were doing it over
Speaker 2: and over and over every night.
Speaker 3: You know, it's so you know where you like, you have.
Speaker 2: To draw a line somewhere when you're starting out a
Speaker 2: pilot program like this.
Speaker 4: Yeah, yeah, yeah, that's right.
Speaker 3: Here's another here's another excerluience that happened kind of along
Speaker 3: these lines. So it isn't just the VA, and it
Speaker 3: isn't just the PTSD industry, folks. It's also I think
Speaker 3: officers in some corners of SOCOM so I had heard
Speaker 3: for a number of years from people who who you know,
Speaker 3: were a little bit on the inside, that the generals
Speaker 3: and admirals at SOCOM really didn't want to hear about
Speaker 3: operator syndrome. They weren't curious. It wasn't something they wanted
Speaker 3: to know about. I presented last year to a civilian
Speaker 3: foundation or to a foundation not active military, and in
Speaker 3: the room in the audience was a was a recently
Speaker 3: retired admiral and I say recent last five years retired
Speaker 3: admiral who had more than one star, and he stood
Speaker 3: up after my short presentation and he said, I don't
Speaker 3: like this. I haven't read your book, but your ideas
Speaker 3: seemed very dangerous.
Speaker 4: And he was in part talking about.
Speaker 3: Things he'd been thinking and hearing for several years because
Speaker 3: he referenced the medical paper, but he essentially said, you know,
Speaker 3: shame on you. These ideas are dangerous. They're going to
Speaker 3: hurt recruitment and it sends the wrong message about you know,
Speaker 3: operators and who they are and what they are. The
Speaker 3: very next person to stay to stand up in that
Speaker 3: room was I think she was a social worker from
Speaker 3: the Warrior of Care coalition, and she completely pushed back
Speaker 3: on him. She says, sir, you know, I got to disagree.
Speaker 3: We use this, it's relevant, it resonates, and it has
Speaker 3: been what we've used successfully to get so many guys
Speaker 3: to engage in various treatments that they need. And so
Speaker 3: by labeling it as a dangerous idea or a dangerous
Speaker 3: concept and just saying we're going to ignore it and
Speaker 3: not not even engage in the conversation, he's going to
Speaker 3: be really harmful to, you know, to so many people.
Speaker 5: I think the military has been very I was just
Speaker 5: I'll politely say, they've been very slow to recognize traumatic
Speaker 5: brain injury. And you know this part is I would
Speaker 5: speculate that it may be because they're concerned about personnel
Speaker 5: issues that they'll have to take people off of their
Speaker 5: positions to be treated and maybe discharged out of the military.
Speaker 5: Like I spoke to a senior he was a senior
Speaker 5: leader in Delta Force where they started putting the sensors
Speaker 5: on their bodies, you know, to measure blast over pressure.
Speaker 5: And he made he wasn't in denial about it. He's like, yes,
Speaker 5: this is a real thing, it's a real issue. But
Speaker 5: his point was, if we're gonna avoid blast over pressure.
Speaker 5: It becomes that we can't do our job from riding
Speaker 5: on helicopters, shooting guns, explosive breaches, all of these things.
Speaker 3: Well, we have to stipulate, of course, that we are
Speaker 3: not going to stop training. We have to do those things.
Speaker 3: Those those are you can't. You can't you don't have
Speaker 3: special operations. You don't have soldiers if you don't train.
Speaker 3: So there's no part of me saying we need to
Speaker 3: stop training. And I'm not even saying we need to
Speaker 3: train lasts or differently. I don't know.
Speaker 4: That's not my area of expertise.
Speaker 3: There probably are ways in which we could train smarter
Speaker 3: people will find smart people will find oh yeah, our
Speaker 3: people will.
Speaker 4: Find them, I think loud.
Speaker 3: We can do to mitigate those injuries along the way
Speaker 3: along during the career. There's there's many things we can
Speaker 3: do that don't involve you know that don't that aren't complicated,
Speaker 3: aren't expensive? Aren't aren't you getting the soldier's baseline? Yeah,
Speaker 3: that would be one, getting getting baselines of cognitive functioning,
Speaker 3: hormone levels, probably a handful of other things. One.
Speaker 2: It's interesting though, because that admiral was basically saying, fuck
Speaker 2: the guys, who are suffering. We need more guys, like,
Speaker 2: let those guys suffer, Like we're done with them, We've
Speaker 2: used them, we're not worried about them, but we don't
Speaker 2: want the bad pr And and it's very short sighted anyway,
Speaker 2: because like anybody who like saw Muhammad Ali when he
Speaker 2: was later on in life, they didn't that didn't stop
Speaker 2: the boxing injury or in the industry like uh, football,
Speaker 2: you know, never suffered from knowing all the things that
Speaker 2: those guys go through. When you're young, you think you're invulnerable.
Speaker 2: You don't think about the future. You're not worried about it.
Speaker 2: You're like, I want to do this thing. I'm going
Speaker 2: to do this thing.
Speaker 4: Yeah, yeah, And actually that you're absolutely right.
Speaker 3: I don't think I don't think the fear of death
Speaker 3: or injury keeps people from going into special operations, because
Speaker 3: if it did, there wouldn't be anybody in special operations.
Speaker 3: So it's kind of a it's almost a ridiculous argument
Speaker 3: to make. And we were a year ago we did
Speaker 3: have a recruitment problem in the US military, and then
Speaker 3: that has changed under the current presidential administration. So maybe
Speaker 3: the problem wasn't so much operator syndrome as it was
Speaker 3: other things. I you know, this this resistance anything new,
Speaker 3: certainly in medicine but probably everywhere, is something that takes
Speaker 3: a little time to fade away.
Speaker 4: What I'm seeing.
Speaker 3: Now is more of the leaders, the one in the
Speaker 3: two star office flag officers. Many of them are people
Speaker 3: that I may have known five or ten years ago
Speaker 3: before they got a star on their shoulder. So they've
Speaker 3: kind of almost like come through the ranks with some
Speaker 3: awareness and understanding, and their perceptions are going to be
Speaker 3: very different. So I have some level of optimism that
Speaker 3: there's going to be more openness. I did the last year,
Speaker 3: last May, I was invited to present it Softweek in Tampa,
Speaker 3: so I did that. That was kind of a marker.
Speaker 4: Of maybe a little bit of a change.
Speaker 3: And then in January of this year, I recorded a
Speaker 3: podcast for I did the Sokon podcast with Matt Parrish
Speaker 3: and it hasn't been published yet because something.
Speaker 4: Happened in the recording, so we got to re record it.
Speaker 3: But my sense of even being asked to be on
Speaker 3: that is also a Marre's There's more interest and there's
Speaker 3: more willingness to engauge this specific conversation, Chris.
Speaker 2: I want to check how we're doing on time, because
Speaker 2: all right, an hour in, I think, yeah, okay, because
Speaker 2: I actually want to ask you or just kind of
Speaker 2: go over a few of the things you mentioned, just
Speaker 2: for anybody who's watching. You know, maybe you know somebody,
Speaker 2: you are somebody, or knows somebody. So the syndrome you
Speaker 2: start out with TBIs sleep diservance of sleep disorders. How like,
Speaker 2: how big is the sleep diservance sleep disorder aspect of
Speaker 2: this massive?
Speaker 3: It's massive. Sleep is so important for our health. It's
Speaker 3: we can't think of.
Speaker 4: It as optional anymore.
Speaker 3: And what we know today we didn't know ten years ago.
Speaker 3: Sleep is critical for everybody bodily function. So if you're
Speaker 3: not getting enough sleep, your body is not going to
Speaker 3: regulate its metabolism.
Speaker 4: Well, so you're going to gain weight.
Speaker 3: If you're not getting enough sleep, your hormones aren't going
Speaker 3: to get produced and managed and regulated. Everything in our
Speaker 3: body has some aspect where it needs it needs sleep.
Speaker 3: And when we talk about sleep, we need several things.
Speaker 3: One is we need enough of it, So seven and
Speaker 3: a half or eight hours for most of us, we
Speaker 3: need time sufficient time in rem state and slow wave
Speaker 3: state sleep. Each of those states has very specific purposes
Speaker 3: that happen things that happen in those states, and we
Speaker 3: really need to sleep most more or less through the
Speaker 3: night without a lot of interruptions and awakenings so that
Speaker 3: we can go through our normal sleep cycles. Rem sleep
Speaker 3: is when our cognition is really being sharpened. Our experiences
Speaker 3: and things that we learned during the day are being
Speaker 3: sore it through and makes you know, and we're making
Speaker 3: sense out of things. When we're in slow wave sleep,
Speaker 3: that's when our testosterone is being produced. That's when our
Speaker 3: body is healing. If we're sick or fighting off an
Speaker 3: infection anywhere, that's that's very important time to have more
Speaker 3: time in slow wave sleep. We also know that during
Speaker 3: slow wave sleep that's when our brain.
Speaker 4: Is cleaning itself.
Speaker 3: Those glial cells are taking out the toxins that build
Speaker 3: up in the neurons.
Speaker 4: So we if we don't get enough of that good sleep.
Speaker 3: All of our physiological systems are getting wrecked and we're
Speaker 3: not recovering, and we're going to gain weight, and our
Speaker 3: hormones are going to be a mess, and our cognitive
Speaker 3: functioning is going to be very much suboptimal, and over time,
Speaker 3: we're aging ourselves and slowly killing ourselves if we're really
Speaker 3: really not getting the sleep we need. And you know,
Speaker 3: you mentioned, you know, people using pendrala.
Speaker 2: You brought up like ambient, the hypnotics and you know,
Speaker 2: and things like that, but none of those are good long.
Speaker 3: Term solutions, right yeah, right, your best bet.
Speaker 4: I mean, yeah, we have medications that will put you
Speaker 4: to sleep.
Speaker 3: The problem is they aren't going to give you the
Speaker 3: quality of sleep that you need, and they mean it
Speaker 3: may not be sleep that's any good at all. So
Speaker 3: just because you're unconscious doesn't mean that you're getting good sleep. Well,
Speaker 3: I mean, yeah, I was gonna say.
Speaker 2: The other problem with ambient is you end up with
Speaker 2: an Amazon order of like a whole bunch of D
Speaker 2: and D books or you know, you find out that
Speaker 2: you tried to make candy by putting a home whole
Speaker 2: bunch of honey.
Speaker 3: Well that happens if you're drinking too to get get
Speaker 3: to sleep.
Speaker 2: Yeah yeah, I mean the things I've done on ambien,
Speaker 2: like because I didn't fall right asleep.
Speaker 3: You say, D D books, Dungeons and Dragons.
Speaker 2: Oh yeah, yeah, yeah, a whole like stack of fifth
Speaker 2: books all yeah, yeah.
Speaker 3: But like cooking while I'm on it like crazy with
Speaker 3: no recollection. I've known guys that have woken up in
Speaker 3: the morning and discovered they cooked and ate an entire meal. Yeah,
Speaker 3: I've done that. I've done that.
Speaker 4: Shape off their beard.
Speaker 3: I have not done that, walked into the bathroom in
Speaker 3: the morning, looked in the mirror, and just jumped out
Speaker 3: of their skin.
Speaker 4: I know guys that have gone for a ride in
Speaker 4: the middle of the night. They wake up, why is my.
Speaker 3: Truck parked the front yard and are realizing, Oh, here's
Speaker 3: a receipt from seven to eleven. Yeah, I've bought some cigarettes.
Speaker 3: I don't even smoke. Why did I buy.
Speaker 4: Cigarettes and smoke two of them?
Speaker 3: Yeah? And there's take lightly and there's the panic.
Speaker 2: You check all your social media to make sure that
Speaker 2: you didn't like, but generally, even if you do post, it's.
Speaker 3: Unintelligible, like nobody knows what it is.
Speaker 2: Yeah, did I mention monkeys with wings?
Speaker 3: One time?
Speaker 7: Do you?
Speaker 3: Jack?
Speaker 2: I don't know anyway. Hormonal dysfunction, that's a big one too, right.
Speaker 3: Huge, huge for a man with low testosterone. It isn't
Speaker 3: just that that affects sex drive and sex performance. Low
Speaker 3: testosterone for a man is gonna mimic depression. That guy
Speaker 3: is going to feel tired no matter how much sleep
Speaker 3: he gets. Although low testosterone also contributes to insomnia, It's
Speaker 3: gonna affect his concentration, his muscle mass, his energy, his motivation.
Speaker 3: He's gonna be irritable and cranky. He's gonna look in
Speaker 3: the mirror and his face isn't going to look the same.
Speaker 3: He's going to be like, why do I have this
Speaker 3: extra flesh around my jaw and my neck? And maybe
Speaker 3: at the extreme end of it, kind of chomastia man
Speaker 3: boobs can develop in some guys. Now, that's usually when
Speaker 3: testosterone is down for a long time and estrogen is
Speaker 3: up for a significant period of time. But that's why
Speaker 3: I say get a full panel, not just testosterone, because
Speaker 3: it might be thyroid, it could be human growth hormone,
Speaker 3: It could be estrogen, and it could be testosterone.
Speaker 4: It could be all of them affected well.
Speaker 2: And like the next one is chronic pain and in headaches,
Speaker 2: and like it's all it's it almost seems like it's
Speaker 2: all this cascade and you don't know, like which came first?
Speaker 2: Am I not sleeping because like lying on either shoulder hurts?
Speaker 3: And then I.
Speaker 2: Can't sleep, so my testosterone goes down, which means that
Speaker 2: everything like it's it's just a non stop loop.
Speaker 3: Isn't it.
Speaker 4: Everything is interrelated.
Speaker 3: Yeah, and that's the bad news when you talk about
Speaker 3: an injury to one system, But it's also the good
Speaker 3: news when we talk about an intervention for one system.
Speaker 3: Uh huh. So if we can help you sleep better,
Speaker 3: there will be a ripple effective benefits if we treat
Speaker 3: your testosterone, whether that's with testosterone replacement therapy or something else,
Speaker 3: and there are.
Speaker 4: Other ways of treating it for many people.
Speaker 3: As the testosterone comes back up, we're going to start
Speaker 3: to see better sleep, which is going to lead to
Speaker 3: better brain health, better cognitive clarity. And we have treatments
Speaker 3: now that we know are really effective, not just for
Speaker 3: treating the psychological aspect of things, but for example, Stella
Speaker 3: ganglion block, ketamine infusions.
Speaker 4: These are treatments.
Speaker 3: That have pretty quick and profound benefits to existential concerns,
Speaker 3: to depression anxiety, but they also we're pretty sure now
Speaker 3: stimulate neurogenerativity. Interesting meaning we're now we're growing new neurons,
Speaker 3: we're growing new connections in the brain, and so we're
Speaker 3: not just like the Stelli Ganglion block is a one.
Speaker 3: It's basically a one stop, outpatient procedure, just takes a
Speaker 3: few minutes. Inject the medicine into the nerve Stelli Ganglian nerve.
Speaker 3: That's the sympathetic nervous system that brings was that fight
Speaker 3: or flight arousaled down, So a lot of guys and
Speaker 3: gals and the high risk professions are just baseline, day in,
Speaker 3: day out, somewhere out of seven eight nine on that
Speaker 3: physiological arousal. With this shot, it drops that down to
Speaker 3: a two or a three. So there's a sense of relaxing,
Speaker 3: of feeling calm, of actually thinking, being more sharp cognitively
Speaker 3: because all that noise isn't going on. But it also
Speaker 3: now we also see that this is creating physiological benefits
Speaker 3: to the brain, to the neurons and the glial cells
Speaker 3: in the brain. So we're getting better brain health from
Speaker 3: these interventions as well. That's fascinating.
Speaker 2: And then depression, anxiety, anger, hyper vigilance, I think is
Speaker 2: a big one that you know, and somebody explained it
Speaker 2: one time that I thought was really good. They said,
Speaker 2: it's like having one foot on the gas and one
Speaker 2: foot on the brake.
Speaker 3: All the time.
Speaker 4: Yeah, yeah, always in the red.
Speaker 3: Yeah red limon. Yeah. Oh please, yeah, I just that's
Speaker 3: just agree. That's good analogy.
Speaker 2: Yeah, post amount of stress, substance abuse. This was an
Speaker 2: interesting one to me was the perceptual system's empairment.
Speaker 3: Can you talk about that a little bit?
Speaker 4: Sure?
Speaker 3: Well, so if you're if you're playing with toys that
Speaker 3: go boom, that is going on to affect hearing. Blast
Speaker 3: exposures in particular may affect the delicate muscles around the eyes.
Speaker 3: TBI in general can affect vision, so a lot of
Speaker 3: some people describe blurry vision double vision. Tb I also
Speaker 3: can cause disequilibrium, so some people have trouble with their balance,
Speaker 3: and that can be mild the mild end, it looks like,
Speaker 3: well I'm just a little clumsier than I used to be,
Speaker 3: or I don't have the same hand eye coordination that
Speaker 3: I used to have. At a more extreme level, it
Speaker 3: can it can manifest as vertigo. Be this combined with
Speaker 3: nauseousness or vomiting, and that can be really miserable. Yeah,
Speaker 3: we have a treatment for that. It's called vestibular therapy,
Speaker 3: and that seems to be really powerfully beneficial for a
Speaker 3: lot of people, no medications, no surgeries. It's literally, I
Speaker 3: don't want to say literally, it's physical therapy for the interior.
Speaker 5: Basically, they did that too the guys that have Havana syndrome,
Speaker 5: whole other issue, but they did vestibular therapy and it
Speaker 5: did show a lot of results for at least a
Speaker 5: good number of those people.
Speaker 3: You know. Oh, okay, very interesting. Yeah, I just learned something. Well,
Speaker 3: so again, this is a treatment that is not expensive,
Speaker 3: it's not invasive, it does not involve a lifetime of
Speaker 3: being on medications forever. Why are we not making it
Speaker 3: for individuals who need it to get this intervention?
Speaker 2: It's uh, Now, would you consider both visual and uh
Speaker 2: auditory hallucinations as part of that or is that something else?
Speaker 4: Something else?
Speaker 3: Okay, hallucinations, that's that's more psychosis Okay, Okay. Cognitive impairments definitely, uh.
Speaker 2: Marital family concerns, intimacy concerns, milody of civilian transition concerns.
Speaker 3: Can you talk about that a little bit? Uh yeah, well,
Speaker 3: let me let me go back to the emotional intimacy. Okay, please, yeah,
Speaker 3: is it there's there's there's something I want to say
Speaker 3: that touches on a few of these. Physical intimacy sex
Speaker 3: is often a challenge. A lot of guys will do
Speaker 3: have a rec toile dysfunction, but also emotional intimacy is
Speaker 3: a challenge. A lot of guys describe feeling numb or
Speaker 3: they describe not not being able to feel the feelings
Speaker 3: they know people expect them to show in certain situations.
Speaker 3: So for some guys, that means they fake, they show it,
Speaker 3: They show fake. They smile when they know they're supposed
Speaker 3: to smile, They look sad when they know everybody else
Speaker 3: is looking sad, that kind of thing. A lot of
Speaker 3: guys get told by their intimate partners that they're just
Speaker 3: not very sensitive. Anybody ever told you you're not very
Speaker 3: sensitive or you're insensitive. I think there's emotion, there's an
Speaker 3: emotional intimacy peace around patience and sensitivity and empathy, and
Speaker 3: the empathy threshold gets reset for people who see death
Speaker 3: and destruction and the horrors that men do perpetrate on
Speaker 3: each other on a regular basis, and that can lead
Speaker 3: to I mean, the way the way I look at
Speaker 3: it is just like with anything else in our life
Speaker 3: that involves a little bit of learning or conditioning. What
Speaker 3: one person. What a civilian views is traumatic or stressful
Speaker 3: might be not that at all to somebody else. I'm
Speaker 3: not being very articulate here. If the three of us
Speaker 3: are sitting in a classroom with some of some undergraduate
Speaker 3: college students who are talking about the stress of being
Speaker 3: in college and having final exams and maybe having a
Speaker 3: sick grandparent at the same time, and they're stressing out,
Speaker 3: and they might use the word traumatized. Of the three
Speaker 3: of us, and you guys, you know seen and done
Speaker 3: and been a.
Speaker 4: Part of things I never have been.
Speaker 3: But I'll include myself on your side of the conversation
Speaker 3: here just because I've heard so much. Are we going
Speaker 3: to find these college Are we going to have much
Speaker 3: empathy or sympathy for these college students who are who
Speaker 3: are lamenting their stressful life with final exams? Probably not.
Speaker 3: Probably we might struggle to. Yeah, And I've learned to
Speaker 3: fake it with college with my undergraduate students. I've learned
Speaker 3: to fake being a little bit sympathetic. But so much
Speaker 3: of what we lament our first world problems, right, and
Speaker 3: you guys have seen the third world problems and then some.
Speaker 4: So how do you how.
Speaker 3: Do you connect emotionally with your wife or your girlfriend,
Speaker 3: with your children. How do you how do you come
Speaker 3: into a space that's your home, your loved ones, and
Speaker 3: yet you know there's a You've habituated to certain things,
Speaker 3: and so the things that cause other people to cry
Speaker 3: may not affect you in the same way. Now, let's
Speaker 3: take that and move that. You've gone from being a
Speaker 3: soldier to being a civilian. That transition the way. The
Speaker 3: way I've described this before is if somebody came to
Speaker 3: me and said, Okay, Chris, you were taking away your PhD.
Speaker 3: You can still have it, frame it, keep it on
Speaker 3: the wall, whatever, but you're no longer you can no
Speaker 3: longer practice as a psychologist. We're going to strip your license.
Speaker 3: Everything you've ever written before, we're going to put that
Speaker 3: in a vault somewhere. So that's that's not really relevant anymore,
Speaker 3: and good luck to you. Go find something new to do.
Speaker 3: Oh and by the way, everybody you're you're going to
Speaker 3: be with speaks the same language, but words don't mean
Speaker 3: the same things. Handshake doesn't mean the same thing. Trust
Speaker 3: and cooperation may be different, and a lot of the
Speaker 3: wage you're not even gonna be sure of what they're saying.
Speaker 3: Because the words are familiar, but they may have different meanings.
Speaker 3: Good luck see it. Oh, and try to do all
Speaker 3: this with a brain injury that makes it hard to
Speaker 3: learn new things. Try to do all of that with.
Speaker 4: A sense of cognitive impairments.
Speaker 3: Try to do that with a lot of anger and
Speaker 3: feeling in a short, short temper or short fuse. It's hard.
Speaker 3: Transition from the military out into or from any of
Speaker 3: the high risk professions to a civilian job or to
Speaker 3: a civilian life, massive challenge, massive stressor I tell guys
Speaker 3: that have done, you know, twenty years in the military
Speaker 3: to think of it, of the transition as probably being
Speaker 3: about a five year experience. And you're never going to
Speaker 3: truly not be a soldier, right, and nor should you
Speaker 3: try to be.
Speaker 5: The way I try to, you know, impart some advice
Speaker 5: on guys is to tell them, like, you know how
Speaker 5: hard you had to fight to get into special operations
Speaker 5: and go through selection and all that, Well, you're gonna
Speaker 5: have to work that hard to transition.
Speaker 3: Out of it.
Speaker 2: And and you know, and when you throw like mission
Speaker 2: and sense of purpose in there too, and that you
Speaker 2: know you were doing something that you that is a
Speaker 2: was a dream for many of us, right, and and
Speaker 2: you were doing it and then you get out in
Speaker 2: the civilian world and it's like that, I think that, uh,
Speaker 2: that's probably where like a lot of the Anhedonia Anaedonia
Speaker 2: am I saying that right comes from and everything that
Speaker 2: that Once you've like been where you wanted to be,
Speaker 2: it's like you have to dig really deep to find
Speaker 2: a new place that you want to be that brings
Speaker 2: that same sense of purpose.
Speaker 3: Yeah.
Speaker 4: Yeah, and let's add the tribe on there.
Speaker 3: Now you're now you're not Now you're trying to do this,
Speaker 3: but you're not part of a team of like minded
Speaker 3: people that you're doing it with.
Speaker 4: Now you're separate from that.
Speaker 3: You left the unit. Those guys are all still doing
Speaker 3: their thing. They're not even thinking about you. They're pretty occupied.
Speaker 3: Now you're back to wherever your home is, trying to go, Okay,
Speaker 3: how do I make how do I fit in here?
Speaker 4: And make sense out of this.
Speaker 3: We've also seen that even for those marriages are that
Speaker 3: endure to the point of retirement, that that first year
Speaker 3: after retirement is a stressor. It's a really challenging period
Speaker 3: for marriages. The wife is like, who is this stranger
Speaker 3: that's now in my house all the time, spur domain,
Speaker 3: she runs the place. She knows how everything goes and
Speaker 3: where it goes and how it works and who to call.
Speaker 4: You don't know anything, maybe, and.
Speaker 3: So so there's not just a whole new set of
Speaker 3: skills that have to be learned and developed habits, but
Speaker 3: how do you do that? How do you fit that
Speaker 3: together at the family level, And that's a real challenge.
Speaker 2: Yeah, toxic exposure to illnesses and cancers, existential concerns, suicide,
Speaker 2: and then we're go.
Speaker 3: Into part through the healing and recovery, which is phenomenal. Yeah,
Speaker 3: it's uh.
Speaker 2: Look, I recommend this book to everybody. It it puts
Speaker 2: so many things together that that I thank you so
Speaker 2: thank you. Uh, and then link is down in the description.
Speaker 2: I highly recommend it. It's for me. It put a
Speaker 2: lot of stuff together that I've been trying to figure
Speaker 2: out that I've been wrestling with.
Speaker 3: So, you know, yeah, very valuable. If can I have
Speaker 3: a favor to ask of you and your listeners if
Speaker 3: you do look at the book, One thing that it
Speaker 3: would be very much appreciated would be a review on Amazon.
Speaker 3: I've been a little concerned that some of my things
Speaker 3: have been kind of shadow band. I know they have
Speaker 3: been on social media when I was on social media,
Speaker 3: and so getting through some of the Amazon algorithms. It
Speaker 3: helps if you have some reviews for the book. I'm
Speaker 3: gonna do it right now, just because I'll forget if
Speaker 3: I don't. Thanks.
Speaker 2: But yeah, so what's what's next? Like where can people
Speaker 2: find you? What's next for the operator syndrome? And also
Speaker 2: if you know, obviously one of the things you mentioned
Speaker 2: is you know, taking that you mentioned to me before
Speaker 2: the show, take in the document to the VA, to
Speaker 2: your primary careac position and just pointing out like these
Speaker 2: are all things that I'm suffering from, Like they don't
Speaker 2: have to buy into the operator syndrome, but can I
Speaker 2: get these tests and things like that?
Speaker 3: This is a medical document. That strategy seems to work
Speaker 3: for a lot of people. I tell them, print the
Speaker 3: paper off, go through it with a highlighter, take it
Speaker 3: to your medical providers, educate them, and use it as
Speaker 3: a as a conversation starter to ask for what you need.
Speaker 3: And you know, more often than not, that seems to
Speaker 3: have a very positive effect. I would also say, you know,
Speaker 3: it is a challenge to find the treatments that that
Speaker 3: are that are helpful for me. The three kind of
Speaker 3: low hanging fruits are get a sleep study if you
Speaker 3: haven't had one, Get your hormones checked if you haven't
Speaker 3: already done that, and addressed if need be. And then
Speaker 3: the Stella Ganglian block is a very low invasiveness treatment.
Speaker 3: It's literally a one time only outpatient procedure takes just
Speaker 3: a few minutes. It's it's very similar treatment to when
Speaker 3: the dentist injects little novacane into a nerve tooth nerve
Speaker 3: before drilling on that tooth. It's a different nerve, it's
Speaker 3: a different medication, but it's essentially that's essentially what it is.
Speaker 3: Just it just it just kind of block that nerve
Speaker 3: for several months. Now, a lot of guys will get
Speaker 3: the benefit, and the benefits will endure for months and months,
Speaker 3: even years. Sometimes they never go back. Some people go
Speaker 3: and do it again a year later. But it also
Speaker 3: opens a window of opportunity because you're feeling relaxed, you're
Speaker 3: feeling better. It makes it easier to start doing some
Speaker 3: of the other things to take good care of herself,
Speaker 3: which might even include psychotherapy or journaling.
Speaker 4: But it's it's that's one of the few. It's one
Speaker 4: of the things I encourage people to look into.
Speaker 3: So that can you say those three things one more time?
Speaker 4: Please?
Speaker 3: Yeah? The three the three things that I would recommend
Speaker 3: right off the bat, sleep study, hormone, pianel and stellic
Speaker 3: ganglian block therapy.
Speaker 4: And then go from there.
Speaker 2: Okay, and then what because I know you mentioned protein
Speaker 2: you talked about you know that we don't we aren't
Speaker 2: get enough protein. And some people say up to one
Speaker 2: gram of protein per pound.
Speaker 4: Or pound of body weight.
Speaker 3: Yep, And it's it's probably slight correction there. On myself,
Speaker 3: it should be one pound one gram of protein per
Speaker 3: pound of desired body weight. If you weigh three hundred
Speaker 3: pounds but you're trying to get down to two hundred pounds,
Speaker 3: then you should have two two hundred grams of protein.
Speaker 4: And there is a there is there's different ways of
Speaker 4: getting protein.
Speaker 3: Obviously, different foods have different different types of different levels
Speaker 3: of proteins.
Speaker 4: But one thing you can use.
Speaker 3: To give yourself a jump start on the protein is
Speaker 3: essential amino acids EA's, which are the nine essential amino
Speaker 3: acids that our body cannot produce on its own.
Speaker 4: If you take about ten.
Speaker 3: Grams of essential amino acids with a big sixteen ounces
Speaker 3: of water in the morning.
Speaker 4: You're giving your your body.
Speaker 3: Not only are you hydrating yourself, but you're giving your
Speaker 3: body the equivalent of about fifty grams of protein you
Speaker 3: can get, you know, twenty five to fifty percent of
Speaker 3: your daily protein needs this way. It's cheap, it's easy,
Speaker 3: it's very effective, you get really good protein synthesis, and
Speaker 3: it doesn't break your fast.
Speaker 4: So if you're doing intermittent.
Speaker 3: Fasting, baas only have like four four calories, so it
Speaker 3: doesn't it doesn't end your fast if you're doing intermittent fasting.
Speaker 2: And then you also mentioned creating, which you know, like
Speaker 2: I used to use when I was lifting, but apparently
Speaker 2: it has more benefits than just.
Speaker 3: For working. I've come to believe we should all be
Speaker 3: taking creating at least five grams. I take fifteen grams
Speaker 3: a day, and it is important for lifting and strength training,
Speaker 3: but it's also a really good brain health supplement.
Speaker 4: And that's recent news. That's recent data.
Speaker 3: In the last three or four years, a number of
Speaker 3: studies come out showing how good creating is for our brain.
Speaker 5: Creatine is like I think it's considered the only supplement
Speaker 5: that really has like robust medical you know, academic backing.
Speaker 3: Yeah. Yeah, that plus plus megative B vitamins. But that's
Speaker 3: more complicated. Interesting. Yeah. One thing, one thing just to
Speaker 3: throw out there for you guys and your listeners. There
Speaker 3: is an online magazine called Havoc Journal, hav Okay, Havoc Journal,
Speaker 3: and they they are it's free, it's online, and they're
Speaker 3: mostly targeted towards veteran soldiers first responders. I just published
Speaker 3: essentially a super abridged version of the Operator Syndrome book
Speaker 3: on Havoc Journal.
Speaker 4: So it's in four parts.
Speaker 3: The fourth and final part just published today and the
Speaker 3: other three parts published each of the the previous three mondays.
Speaker 3: So if you go to have a journal search Operator Syndrome,
Speaker 3: this four part series should show up, and it's essentially
Speaker 3: a condensed you know, four magazine articles that condenses a
Speaker 3: lot of the book into one place. Yeah great, And
Speaker 3: where can people find you?
Speaker 4: What do you mean by that?
Speaker 3: I don't want to be Okay, Well, what I.
Speaker 2: Meant is, I mean, I know you mentioned that you
Speaker 2: weren't really on social media.
Speaker 3: I know you had.
Speaker 2: Unfortunatetion with LinkedIn and stuff like that. You know, are
Speaker 2: you anywhere where people can like follow your work or.
Speaker 4: I have I have a website.
Speaker 3: It doesn't necessarily change very often, so it's not like
Speaker 3: there's a web newslink or a newsletter there. Chris free
Speaker 3: dot com is the website. But I'm trying more and
Speaker 3: more to just kind of keep a low profile. I
Speaker 3: live in rural Hawaii. I don't be my house very often. Yeah.
Speaker 3: I want to do and want I do. It's not
Speaker 3: things I'm gonna I want to publish or put out
Speaker 3: there on social media. So I mean I maybe intentionally
Speaker 3: a little bit art art defined.
Speaker 2: Okay, yeah, and are there any follow ups to I mean,
Speaker 2: I'm sure you guys are constantly learning new things. I mean,
Speaker 2: it almost feels like it's going to be a living
Speaker 2: documented you know.
Speaker 3: Well, yeah, so I am working on a couple of
Speaker 3: papers right now. You know, there will be scientific publications,
Speaker 3: I hope at some point in the next couple of years,
Speaker 3: and that will add a little bit. I think the
Speaker 3: transformative research going forward is not going to come from me.
Speaker 4: It's going to have to come from other people.
Speaker 3: I'm I'm old, I'm not that invested in my in
Speaker 3: the academic world anymore. But there are people who are
Speaker 3: There's a psychologist in the VIA system who is who's essentially,
Speaker 3: you know, I think, trying to make that his career
Speaker 3: goal to collect the longitudinal not just the cross sectional,
Speaker 3: but the longitudinal data to begin to better understand operator syndrome.
Speaker 3: And he's at one of the polytrauma centers that may
Speaker 3: change their name to the to something something Operator Syndrome program.
Speaker 3: At least that's their tentative plan. Do we have questions? Yep,
Speaker 3: we got one from m Corbin.
Speaker 7: Could any treatments help address the negative cognitive effects linked
Speaker 7: to digital device addiction?
Speaker 3: M If I had a simple answer for that question,
Speaker 3: I would probably become a very very wealthy person. I
Speaker 3: don't know if specific treatments other than any the kinds
Speaker 3: of things that work for addiction.
Speaker 4: Might be relevant.
Speaker 3: The cognitive therapies the there's probably If you look at
Speaker 3: one series of books that I kind of like, are
Speaker 3: the Easy Way books, The Easy Way to Stop Drinking,
Speaker 3: the Easy Way to Stop smoking. I wonder if they
Speaker 3: have an easy way to reduce the digital But when
Speaker 3: it comes to digital porn addiction, things like that, those
Speaker 3: are those are those are medically different, physiologically different from
Speaker 3: building up tolerance and then experiencing withdrawal from a substance
Speaker 3: like alcohol or opiates. On the other hand, they have
Speaker 3: a lot of similarities, including how the brain brain, the
Speaker 3: reward centers of the brain fire. So I don't have
Speaker 3: I'm sorry, I don't have a really good answer for that,
Speaker 3: other than what's out there for addictions.
Speaker 2: Are there any emerging treatments that aren't really widely known
Speaker 2: yet that you're excited about or decide about the possible?
Speaker 4: Ah?
Speaker 3: Well, I think a lot of the things that we're
Speaker 3: looking at right now with related to psychedelic medicines, transcranial
Speaker 3: magnetic stimulations, hyperbaric oxygen therapy. I think those are some
Speaker 3: of the things we're going to know a whole lot
Speaker 3: more about in a few years. And there's some really
Speaker 3: promising things that we're learning in each of those areas.
Speaker 4: Hyperbaric oxygen therapy.
Speaker 3: Five years ago, I thought we kind of, you know,
Speaker 3: we kind of looked at it and then decided it
Speaker 3: wasn't worth it, it didn't produce enough benefits. We're going
Speaker 3: back to that now. I think it is in part
Speaker 3: because the Israeli research program. The Israelis have changed the
Speaker 3: protocol that they're using for hyperbarics and getting very very
Speaker 3: different and very good results with it. So I think
Speaker 3: for all people who've heard, well hyperbarics don't help with
Speaker 3: TBI or PTSD, maybe they do. We just haven't been
Speaker 3: giving enough of a dose. So more sessions and at
Speaker 3: a higher level of pressure, I think is what the
Speaker 3: Israelis are doing. Please go ahead. I'm just gonna offer
Speaker 3: one other thing. I mean, there's I'm sure there's many
Speaker 3: things I don't know of or understand. There are probably
Speaker 3: a hardly a month goes by when I don't have
Speaker 3: somebody reach out to me with a new product or
Speaker 3: a new gizmo or gadget the purports to do this
Speaker 3: or that. Some of those probably have you know, value
Speaker 3: right now, I think it. The part of the challenge
Speaker 3: is sifting through all the noois to find the signal
Speaker 3: there is something I'm intrigued by. There's a there's a
Speaker 3: mono keytne ester called Delta G and it was initially funded.
Speaker 3: The research on this was initially funded twenty five years
Speaker 3: ago by DARPA through their you know, their their super
Speaker 3: Soldier program, and then it got kind of shifted over
Speaker 3: and it was a scientists at Oxford University in Britain
Speaker 3: and with the NIH funding. Anyway, this thing is on
Speaker 3: the market now. You can go look for Delta G
Speaker 3: and you can find this keytne ester.
Speaker 5: And I took a Havy Tone energy drink before we
Speaker 5: started Delta Delta G key Tone Ester, Delta G key
Speaker 5: Tone Ester.
Speaker 3: It's there's a number of them on the market and
Speaker 3: I'm not trying to be a salesperson for this. This
Speaker 3: this product other than it's different from the other products.
Speaker 3: It will put you if you take about thirty grams
Speaker 3: of the stuff, it will put you into a very
Speaker 3: deep state of katosis in about fifteen to twenty minutes,
Speaker 3: so it's very happens very fast, and it will last
Speaker 3: for four or five hours, so a deep state, almost
Speaker 3: immediate and lasting. And one of the thoughts and I've
Speaker 3: I've gappled.
Speaker 4: With the stuff. I've used the stuff.
Speaker 3: It probably a pretty good two month run and found
Speaker 3: it to be very helpful in a variety of ways
Speaker 3: for myself, including cognitive sharpness. And part of what DARPA
Speaker 3: was looking for was to be able to take a
Speaker 3: soldier who sleep deprived and physically exhausted, give him a
Speaker 3: little shot of this stuff and have him him cognitively
Speaker 3: restored to be sharp again. There's another piece of this though,
Speaker 3: the deep katosis seems to produce a very an anti
Speaker 3: inflammatory response in the body. And so one of the
Speaker 3: things that I've wondered about, and this is just me
Speaker 3: spitballing here, but as a use case, could you use
Speaker 3: this with some operators that are going to go on
Speaker 3: let's say a breaching or a shoulder fire rocket training day.
Speaker 3: Take a dose of this stuff before the training and
Speaker 3: then maybe four or five hours later or maybe at
Speaker 3: the end of the day. If you do that while
Speaker 3: you're training and really reduce the inflammation in the in
Speaker 3: the nervous system, Yeah, that be neuroprotective.
Speaker 4: And I don't know the answer.
Speaker 3: This is a this is just me spitballing here, but
Speaker 3: there are things like that that I think we're we're
Speaker 3: going to be digging much more deeply into and as
Speaker 3: the as the years go by. The Delta g you
Speaker 3: can buy it, you can purchase it. You can get
Speaker 3: their website and purchase it, but it's very expensive, so
Speaker 3: there aren't many of us that are going to use
Speaker 3: it on a regular basis unless we have the DoD
Speaker 3: or the Tour de Frant's money supporting supporting our habit. Yeah.
Speaker 2: And one last thing that you mentioned that caught my
Speaker 2: attention because people have mentioned them before to me, but
Speaker 2: I don't quite understand them is peptides.
Speaker 3: Can you tell us a little bit about that? Not
Speaker 3: very much, because I don't know very much, but I
Speaker 3: will say. What I will say is one of the
Speaker 3: places where a lot lot of guys are finding relief
Speaker 3: or a regenerative medicine clinics or sometimes referred to as
Speaker 3: functional medicine clinics where they're using peptides X homes AD
Speaker 3: plus infusions stem cells to treat a variety of things
Speaker 3: related to brain health, joint health. A lot of these
Speaker 3: clinics also do the stelic ganglia and the aketamine infusions,
Speaker 3: so they can be one stop shops for a lot
Speaker 3: of the different kinds of interventions that might be useful.
Speaker 3: And they will do.
Speaker 4: A deep dive on nutrition and.
Speaker 3: You know, they'll get a full panel of all kinds
Speaker 3: of things like about your vitamin D levels, but with
Speaker 3: fifty other metabolic markers, and then they will tailor a
Speaker 3: treatment or a supplement regime for you, reasurement for you
Speaker 3: based on your numbers.
Speaker 4: So I think I think.
Speaker 3: Regenerative medicine functional medicine is going to be a place
Speaker 3: that we see much more important things happening for people
Speaker 3: with operators syndrome. Chris has been amazing. We really appreciate it.
Speaker 4: Thank you for having me. This has been good.
Speaker 3: Yeah, thank you for coming on.
Speaker 5: The book is amazing and winks will all be down
Speaker 5: in the description for people who want to find the
Speaker 5: book or want to find Chris's website.
Speaker 3: Yeah.
Speaker 2: Yeah, was there anything that we failed to ask you
Speaker 2: or anything that we left out there if you wanted
Speaker 2: to talk.
Speaker 4: About nothing comes to mind.
Speaker 3: We probably could sit here for another five hours, though,
Speaker 3: and find a steady stream of.
Speaker 4: Things to talk about.
Speaker 3: Oh I could.
Speaker 4: So you'll just have to invite me back another time.
Speaker 2: Absolutely, Thank you so much, Chris. We really appreciate it.
Speaker 2: You bet, Thanks, thank you, Thanks everybody.
Speaker 3: Good night. Hey guys, it's Jack.
Speaker 5: I just want to talk to you for a moment
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Speaker 3: Thank you,