WEBVTT 1 00:00:02.359 --> 00:00:14.039 Special Operations, Cobert Ohs Spionage, The Team House with your hopes, 2 00:00:14.960 --> 00:00:17.719 Jack Murphy and David Park. 3 00:00:22.440 --> 00:00:25.440 Everybody, Welcome to episode three fifty six of The Team Mouse. 4 00:00:25.480 --> 00:00:26.760 I'm Dave. This is Jack. 5 00:00:27.120 --> 00:00:30.600 Our guest tonight is doctor Chris free, the author of 6 00:00:31.079 --> 00:00:36.000 The Operator Syndrome, which is I feel like a seminal book, 7 00:00:36.039 --> 00:00:38.640 like it pulls in so many things that people are 8 00:00:38.640 --> 00:00:42.200 ignoring now or they're getting misdiagnosed, or just kind of 9 00:00:42.280 --> 00:00:43.240 lumped altogether. 10 00:00:44.399 --> 00:00:46.679 Thank you so much for joining us. It's really great 11 00:00:46.719 --> 00:00:47.079 to have you. 12 00:00:47.880 --> 00:00:50.200 Oh well, thanks for having me. I'm excited to be here. 13 00:00:51.280 --> 00:00:55.079 So real quick, before we go into your origin story 14 00:00:55.159 --> 00:00:57.320 and your can you just give us a real quick 15 00:00:57.320 --> 00:00:59.200 teaser on what operator syndrome is? 16 00:01:00.079 --> 00:01:00.399 Yeah? 17 00:01:00.439 --> 00:01:01.640 Sure, So. 18 00:01:01.799 --> 00:01:05.879 Operator syndrome is not a diagnosis per se, but think 19 00:01:05.920 --> 00:01:11.079 of it as a framework for understanding the very complicated 20 00:01:11.120 --> 00:01:17.359 and interrelated injuries and impairments that develop over time during 21 00:01:17.400 --> 00:01:21.959 the career for many high risk professionals. So obviously operators 22 00:01:22.159 --> 00:01:27.319 for military special operator operations are an extreme end of that. 23 00:01:28.239 --> 00:01:33.640 The framework is relevant for first responders, firefighters, law enforcement, 24 00:01:33.959 --> 00:01:39.799 for soldiers from other parts of the combat arms. Quite 25 00:01:39.799 --> 00:01:44.920 a bit of my work has been with paramilitary intelligence 26 00:01:46.159 --> 00:01:52.120 adjacent operators, and so the concept is that these professions 27 00:01:52.200 --> 00:01:57.040 involve an enormous amount of physiological strain on the human body, 28 00:01:57.120 --> 00:02:00.840 and we call that alostatic load. So that static or 29 00:02:00.879 --> 00:02:05.120 physiological strain affects all of the physiological systems in the 30 00:02:05.200 --> 00:02:10.319 human body nervous system, endocrine system, respiratory system, metabolic system, 31 00:02:10.439 --> 00:02:18.080 muscular skeletal et cetera. And we have failed, in my opinion, 32 00:02:18.120 --> 00:02:21.719 we have failed, you know, generations of soldiers and first 33 00:02:21.759 --> 00:02:26.919 responders now by over relying on the diagnosis post traumatic 34 00:02:26.960 --> 00:02:32.599 stress disorder. So we've used for decades now, we've used 35 00:02:32.639 --> 00:02:35.520 PTSD as the easy button. And when we do that 36 00:02:35.919 --> 00:02:40.199 to a hyper risk professional, we're saying, oh, all of 37 00:02:40.240 --> 00:02:42.879 your problems that you think you have all fit into 38 00:02:42.879 --> 00:02:46.280 one bucket. We call it PTSD, and we only treat 39 00:02:46.319 --> 00:02:49.759 that with two issues to treatments, psychotherapy and a bucket 40 00:02:49.759 --> 00:02:54.360 full of psychiatric medications. And so the concept of operator 41 00:02:54.439 --> 00:02:57.639 syndrome is that that is that that's a fail and 42 00:02:57.680 --> 00:03:00.439 that we need to be looking at brain health, traumatic 43 00:03:00.520 --> 00:03:08.520 brain injuries, hormonal dysregulation, sleep dysregulation, sleep apnea, chronic joint pain, 44 00:03:08.680 --> 00:03:13.759 chronic headaches, cognitive problems that develop over time, and yes, 45 00:03:13.800 --> 00:03:19.599 some psychological issues anger, depression, general anxiety, addiction, and even 46 00:03:19.639 --> 00:03:23.039 a little PTSD. Although let me say this, what I 47 00:03:23.080 --> 00:03:25.120 don't see and the guys I work with and the 48 00:03:25.120 --> 00:03:28.680 gals I work with, I don't see the fury activity 49 00:03:29.000 --> 00:03:32.560 or the avoidance of triggers that are. 50 00:03:32.479 --> 00:03:33.879 Associated with PTSD. 51 00:03:34.400 --> 00:03:38.080 So for myself, I don't really although I'm a so 52 00:03:38.199 --> 00:03:41.479 called PTSD expert. According to some people, I don't see 53 00:03:41.479 --> 00:03:46.759 the I don't see it. That's not the problem. It's interesting. Yeah, 54 00:03:46.800 --> 00:03:48.759 I don't want to derail. 55 00:03:48.800 --> 00:03:52.719 But about the postmatic stress stuff, I'll talk about that later. 56 00:03:52.759 --> 00:03:55.199 But first off, please tell us your origin story. Where 57 00:03:55.240 --> 00:03:59.919 did you grow up? How did you get into medicine? Oh? Okay, well, 58 00:04:00.360 --> 00:04:03.439 so I grew up in a lot of different places. 59 00:04:03.560 --> 00:04:08.319 My dad was a physician. He joined he commissioned in 60 00:04:08.360 --> 00:04:11.960 the Air Force in the early sixties, so he was 61 00:04:12.000 --> 00:04:14.840 a Vietnam He became a veteran in Vietnam, a veteran 62 00:04:14.879 --> 00:04:15.800 of the Vietnam War. 63 00:04:16.360 --> 00:04:17.279 A few years later. 64 00:04:18.240 --> 00:04:21.240 As a physician, we lived all over I think of 65 00:04:21.319 --> 00:04:23.199 the Midwest is primarily my home. 66 00:04:23.839 --> 00:04:25.480 Although I was born in New York City. 67 00:04:26.120 --> 00:04:32.079 I went to high school in Missouri, Wisconsin, Michigan. I 68 00:04:32.120 --> 00:04:35.560 did my graduate training in Ohio, and then I got 69 00:04:35.560 --> 00:04:40.800 a PhD in clinical psychology in South Florida, Tampa, Florida. 70 00:04:41.120 --> 00:04:43.480 And that was the kind of the beginning of my 71 00:04:44.560 --> 00:04:49.279 journey of my career working with veterans and service members. 72 00:04:49.680 --> 00:04:55.600 So can what like around what year was that, and 73 00:04:55.639 --> 00:04:58.600 then like what was your initial impressions of veterans at 74 00:04:58.600 --> 00:05:01.879 that time, and then how if that changed over the years, 75 00:05:02.040 --> 00:05:02.759 how did it change? 76 00:05:02.839 --> 00:05:06.240 Yeah, yeah, okay, Well, let me go back to my childhood. 77 00:05:06.360 --> 00:05:12.360 So I was I was probably about five years old 78 00:05:12.399 --> 00:05:14.879 when my father was served in Vietnam, and I think 79 00:05:14.920 --> 00:05:20.879 that was sixty eight, sixty seven sixty eight. My great 80 00:05:20.920 --> 00:05:24.720 grandfather who lived until who died when I was fourteen, 81 00:05:25.240 --> 00:05:27.360 so I knew him very well. My great grandfather was 82 00:05:27.399 --> 00:05:31.160 a veteran of the Spanish American War and he fought 83 00:05:31.199 --> 00:05:32.920 at the Battle of San Juan Hill. 84 00:05:33.680 --> 00:05:34.519 So from both my. 85 00:05:34.519 --> 00:05:40.199 Father and my great grandfather, I developed a sense of, 86 00:05:40.360 --> 00:05:42.199 you know, what it meant to serve, what it meant 87 00:05:42.199 --> 00:05:45.120 to be a soldier, and as well as that there 88 00:05:45.199 --> 00:05:49.879 is a cost associated with that that endures for years 89 00:05:50.279 --> 00:05:54.040 after the war and for many people, many soldiers, and 90 00:05:54.079 --> 00:05:56.600 that was kind of my why for why I wanted 91 00:05:56.639 --> 00:05:59.279 to be a psychologist. So I went to graduate school, 92 00:06:00.240 --> 00:06:03.480 started in nineteen eighty seven, graduated in nineteen ninety two. 93 00:06:05.120 --> 00:06:06.759 And to put a little that into a little bit 94 00:06:06.800 --> 00:06:09.959 of context, the diagnosis of PTSD was added in nineteen 95 00:06:10.040 --> 00:06:14.360 eighty was added to the psychiatric nomenclature in nineteen eighty. 96 00:06:14.720 --> 00:06:18.240 So when I started graduate school and was already thinking 97 00:06:18.240 --> 00:06:22.759 about my dissertation with PTSD, it was a new diagnosis. 98 00:06:22.759 --> 00:06:23.519 It only been. 99 00:06:23.439 --> 00:06:25.600 Officially books for about seven years. 100 00:06:26.199 --> 00:06:29.959 Was prior to PTSD was shell shock like was it 101 00:06:30.519 --> 00:06:35.120 a diagnosable thing or was it just like parlance battle fatigue? 102 00:06:35.600 --> 00:06:36.759 Yeah, I think it was parlance. 103 00:06:36.800 --> 00:06:41.040 And I don't you know, I wasn't practicing prior to 104 00:06:41.160 --> 00:06:44.800 nineteen eighty, so I don't really know how it was 105 00:06:44.839 --> 00:06:50.319 handled in terms of like VA coding or insurance. 106 00:06:49.720 --> 00:06:51.079 Billing and those sorts of things. 107 00:06:51.360 --> 00:06:53.199 But we can trace it all the way back to 108 00:06:53.240 --> 00:06:57.199 the Civil War, and in the years after the Civil War, 109 00:06:57.319 --> 00:07:00.639 there was a syndrome that was described described by a 110 00:07:00.680 --> 00:07:05.040 doctor named DaCosta. It became known as either a soldier's 111 00:07:05.120 --> 00:07:10.079 heart or Dacosta's syndrome kind of interchangeably, and the idea, 112 00:07:10.360 --> 00:07:13.279 the concept of it was where Civil war soldiers were 113 00:07:13.319 --> 00:07:16.040 going in to see doctors post war and they were 114 00:07:16.040 --> 00:07:21.199 describing cardiac problems for which there was no path of 115 00:07:21.240 --> 00:07:27.519 physiological basis that could be identified, and guys were dropping 116 00:07:27.560 --> 00:07:28.879 dead of cardiac problems. 117 00:07:28.920 --> 00:07:29.399 They were just. 118 00:07:29.360 --> 00:07:35.439 Describing shortness of breath, tightening chests. Guess what, that's probably 119 00:07:35.480 --> 00:07:40.360 panic disorders. And so that was the very beginning of 120 00:07:41.480 --> 00:07:43.959 really modern medicine, going wait a minute, there might be 121 00:07:43.959 --> 00:07:44.920 something going on here. 122 00:07:45.000 --> 00:07:47.959 With regard to post war experiences. 123 00:07:49.439 --> 00:07:54.319 In World War One, a different, different term kind of 124 00:07:54.360 --> 00:07:54.959 came out of that. 125 00:07:55.079 --> 00:07:55.680 Shell shock. 126 00:07:56.680 --> 00:07:59.560 The concept of shell shock at the time was a 127 00:07:59.680 --> 00:08:03.600 veryalogical and it was the idea that soldiers on the 128 00:08:03.600 --> 00:08:08.240 front lines were exposed to these bombardments of artillery, so 129 00:08:08.360 --> 00:08:14.399 flashing blinding lights, loud booms, vibrations of the earth, and 130 00:08:14.519 --> 00:08:17.040 they were needing to be pulled off the line. And 131 00:08:17.079 --> 00:08:20.000 then actually they were generally sending them back to Britain, 132 00:08:20.600 --> 00:08:23.439 or at least the Western Allies were sending them back 133 00:08:23.439 --> 00:08:24.800 to Britain dressed homes. 134 00:08:25.279 --> 00:08:27.120 And it became known as shell shock. 135 00:08:27.160 --> 00:08:29.160 And it was thought of at the time as being 136 00:08:29.160 --> 00:08:34.840 a neurological condition, and then it was promptly forgotten when 137 00:08:34.840 --> 00:08:38.559 the war was over. There's some really classic writings of 138 00:08:38.639 --> 00:08:41.320 some of the neurologists at the time who laid out 139 00:08:41.360 --> 00:08:43.799 a research agenda for how we could understand this better. 140 00:08:44.399 --> 00:08:46.440 But with the war over, nobody followed up on it 141 00:08:47.240 --> 00:08:50.639 until we got to World War Two. In World War 142 00:08:50.639 --> 00:08:54.399 two we came up with a different conceptualization of it. 143 00:08:54.600 --> 00:08:59.759 So in World War Two we called it combat fatigue, 144 00:09:00.159 --> 00:09:04.440 and the concept was soldiers over time would just get fatigued, 145 00:09:05.399 --> 00:09:08.720 and in a sense, they normalized it as a normal reaction, 146 00:09:09.320 --> 00:09:11.679 not an extreme reaction. It's just, you know, you can 147 00:09:11.759 --> 00:09:14.240 only spend so many days at the front line in 148 00:09:14.279 --> 00:09:16.879 combat and then we've got to pull you off. Now, 149 00:09:16.919 --> 00:09:19.840 what they didn't do, they didn't send people to far 150 00:09:19.919 --> 00:09:23.600 away rest homes for six months or a year. They 151 00:09:23.679 --> 00:09:27.080 pulled They pulled soldiers back from the front lines just 152 00:09:27.159 --> 00:09:30.960 a few miles where they would be in a camp 153 00:09:31.600 --> 00:09:36.919 in a tent with a cot, warm, dry, reasonably good food, 154 00:09:37.080 --> 00:09:39.720 and just three to five days with nothing to do 155 00:09:39.799 --> 00:09:42.639 other than to rest and sleep. But then they would 156 00:09:42.639 --> 00:09:46.279 be sent back to their units, and the concept of 157 00:09:46.320 --> 00:09:49.360 that was actually turned out to be very effective from 158 00:09:49.399 --> 00:09:54.480 the from the perspective of war fighting, we had very 159 00:09:54.559 --> 00:09:59.159 few site We had very few psychiatric casualties during World 160 00:09:59.200 --> 00:10:06.559 War tw using this concept of giving soldiers rest periodically. Now, 161 00:10:06.600 --> 00:10:10.679 if we carry that forward to the combat fatigue concept 162 00:10:10.720 --> 00:10:14.960 to Vietnam, that had implications for how we fought that war. 163 00:10:15.279 --> 00:10:19.000 So we created the US military created the de ROS system. 164 00:10:19.120 --> 00:10:23.519 DeRos is an acronym for date of expected return from overseas, 165 00:10:24.519 --> 00:10:27.559 So it was a one year tour of duty. You 166 00:10:27.639 --> 00:10:30.519 were if you were in the army, well, Marines are tougher, 167 00:10:30.600 --> 00:10:32.879 so they had to do thirteen months. But if you 168 00:10:32.919 --> 00:10:35.440 were an army it was twelve months, Marines thirteen months, 169 00:10:35.639 --> 00:10:38.320 but you knew when you were coming home, if you lived, 170 00:10:38.360 --> 00:10:41.039 if you survived, and if you weren't injured to the 171 00:10:41.080 --> 00:10:43.360 point of needing to be medevact out of country. 172 00:10:43.759 --> 00:10:45.720 The idea was any. 173 00:10:45.519 --> 00:10:48.840 Soldier could go and fight for a year knowing that 174 00:10:48.960 --> 00:10:52.120 on this date they were going to be they were done. 175 00:10:52.279 --> 00:10:56.159 And so that was a strategy that the military used 176 00:10:56.159 --> 00:11:00.679 to mitigate psychiatric casualties. And they included R and R 177 00:11:00.799 --> 00:11:03.840 for so many soldiers got R and R midway or 178 00:11:03.879 --> 00:11:07.720 part way through their year, like a Hawaiian vacation or 179 00:11:07.720 --> 00:11:12.279 a trip to Japan or the Philippines. It's fascinating. 180 00:11:12.559 --> 00:11:16.879 And then you know because shell shock almost did you 181 00:11:16.919 --> 00:11:19.840 read this story about the marine unit, the artillery unit 182 00:11:19.879 --> 00:11:23.200 in Syria, They fired off so many rounds that guys 183 00:11:23.240 --> 00:11:24.720 when they came home, we're. 184 00:11:24.600 --> 00:11:31.000 Seeing ghosts, thinking demons were after them. Like it was yeah, yep, yes, 185 00:11:31.080 --> 00:11:33.759 And so I think where you're going with that is 186 00:11:34.240 --> 00:11:38.279 they got it right. Yeah, they actually got it more 187 00:11:38.399 --> 00:11:42.559 right than not. And we have spent now one hundred 188 00:11:42.639 --> 00:11:46.360 years where we went off in a different direction, really 189 00:11:46.399 --> 00:11:50.200 a very Freudian direction. The concept of trauma is very Freudian, 190 00:11:52.159 --> 00:11:55.000 and I'm not a Freudian. It doesn't mean that that 191 00:11:55.120 --> 00:11:59.759 trauma doesn't have a conditioning effect or a condition to 192 00:11:59.799 --> 00:12:02.000 reaction to traumatic experiences. 193 00:12:02.960 --> 00:12:03.720 I do believe that. 194 00:12:03.919 --> 00:12:09.639 But we really pulled way back and we went very 195 00:12:09.679 --> 00:12:15.039 psychological with our concepts here, and we left neurology out 196 00:12:15.039 --> 00:12:17.799 of the picture, we left brain health out of the picture, 197 00:12:17.919 --> 00:12:20.360 and we turned it all into the psychological thing. 198 00:12:21.080 --> 00:12:22.759 And all of our treatments focus on. 199 00:12:22.759 --> 00:12:27.919 The psychology of responding to trauma experience, and part of 200 00:12:27.919 --> 00:12:34.000 the problem there is everybody responds differently. There's genetic differences, 201 00:12:34.159 --> 00:12:37.919 there's upbringing differences, there's training differences. We know that soldiers 202 00:12:38.480 --> 00:12:42.639 who are really well trained and are surrounded by tight 203 00:12:43.080 --> 00:12:46.080 you know, spree to core within their units. That that 204 00:12:46.279 --> 00:12:49.360 right there is a huge protective factor for any kind 205 00:12:49.360 --> 00:12:55.320 of psychological or psychiatric reaction during the war, during the deployment, 206 00:12:55.600 --> 00:13:00.559 as well as after words. So we we've actually lost 207 00:13:01.120 --> 00:13:03.559 a lot of the good common sense that we used 208 00:13:03.600 --> 00:13:07.519 to have in medicine one hundred years ago, and hopefully 209 00:13:07.519 --> 00:13:10.639 we're bringing our way back around to get to picking 210 00:13:10.720 --> 00:13:12.399 up where we left off from twenty seven. 211 00:13:13.440 --> 00:13:17.960 Yeah, when you mentioned PTSD, it reminded me of an 212 00:13:18.120 --> 00:13:22.000 article I had read before the global were on terror, 213 00:13:22.639 --> 00:13:25.480 and it was it was a medical study that they 214 00:13:25.480 --> 00:13:30.559 had checked the brains of people who had made it 215 00:13:30.679 --> 00:13:34.440 through SFA, especially force assessment selection, that they had a 216 00:13:34.559 --> 00:13:36.840 higher or lower amount of some neuropeptide. 217 00:13:36.840 --> 00:13:38.960 I don't remember the specifics now, but. 218 00:13:39.000 --> 00:13:41.399 They said that basically it created sort of like this 219 00:13:41.879 --> 00:13:45.360 teflon layer where they didn't like revivify memories. They didn't 220 00:13:45.399 --> 00:13:48.799 you know, when something happened. It just kind of was gone. 221 00:13:49.399 --> 00:13:53.240 And so there was this idea that these guys would 222 00:13:53.240 --> 00:13:57.919 have a lower incident of post traumatic stress. But then 223 00:13:58.320 --> 00:14:03.039 after the GWATT, it left me wondering, you know, watch 224 00:14:03.080 --> 00:14:05.639 all this post aumatic stress. But you know, you're saying 225 00:14:05.679 --> 00:14:08.960 that it's not just that. You know, there's a combination 226 00:14:09.080 --> 00:14:10.159 of all these things. 227 00:14:10.440 --> 00:14:12.159 It's not it's not just that. 228 00:14:12.279 --> 00:14:16.320 I mean, let's go to the extreme nature of what 229 00:14:16.399 --> 00:14:19.559 it means to train to be an operator or anything 230 00:14:19.600 --> 00:14:28.840 adjacent to that. It involves an enormous amount of physicality, rucking, lifting, running, combatives, 231 00:14:29.600 --> 00:14:36.399 jumping out of airplanes, repelling, maybe diving, tactical driving. 232 00:14:36.919 --> 00:14:38.360 So these are all things that are. 233 00:14:38.200 --> 00:14:41.600 Not easy on the body. Then you add on top 234 00:14:41.720 --> 00:14:46.080 of that the sleep deprivation, which is both necessary for 235 00:14:46.159 --> 00:14:49.600 training and combat. I mean, it's an inherent part of it, 236 00:14:50.000 --> 00:14:53.879 but it's also part of the selection, an assessment strategies 237 00:14:53.960 --> 00:14:55.840 of youah, you got to go, you got to stay 238 00:14:55.840 --> 00:14:57.480 awake for five days, and we're going to see if 239 00:14:57.519 --> 00:15:00.759 you can do that and keep functioning part of the selection. 240 00:15:02.200 --> 00:15:05.080 Then you have the blast exposures, and I think blast 241 00:15:05.200 --> 00:15:08.799 exposures are the signature injury of global war on terror. 242 00:15:08.840 --> 00:15:12.679 We haven't admitted that, but I think I think we are. 243 00:15:13.480 --> 00:15:15.919 If we get right, we're going to come around to 244 00:15:15.960 --> 00:15:22.960 that understanding. Training with with with demolitions, with shoulder fire rockets, 245 00:15:23.799 --> 00:15:30.799 breaching sniper rifles, even handguns involved microblasts. And now we 246 00:15:30.879 --> 00:15:34.000 know for about eight years now, nine years now, we've 247 00:15:34.480 --> 00:15:38.919 we've we've we have some inkling of what blasts do 248 00:15:39.159 --> 00:15:43.759 to the brain, which is very different from anything we've 249 00:15:43.799 --> 00:15:46.639 ever understood before, and it's a different type of injury 250 00:15:46.840 --> 00:15:50.759 than an impact impact force is. So blasts have a 251 00:15:50.799 --> 00:15:53.840 shearing effect through the body and what we what was 252 00:15:54.000 --> 00:15:57.960 what was revealed in a study published in twenty sixteen, 253 00:15:59.039 --> 00:16:02.279 is that the sheer aring effects leave the glial cells 254 00:16:02.279 --> 00:16:06.960 in the nervous system scarred. So each neuron in our system, 255 00:16:07.000 --> 00:16:11.600 those are the messenger cells, has about ten glile cells 256 00:16:11.759 --> 00:16:15.600 as its support network. They hold the neurons in place, 257 00:16:16.039 --> 00:16:20.759 they protect them, they insulate them, they take out the toxins, 258 00:16:21.559 --> 00:16:24.840 and they get damaged from blast exposures. So you get 259 00:16:24.840 --> 00:16:29.159 this scarring pattern in the brains. It's very different from 260 00:16:29.360 --> 00:16:34.799 the amyloid plaques, the tauel proteins that can develop and 261 00:16:34.840 --> 00:16:40.480 build up after an accumulation of impact force blows to 262 00:16:40.519 --> 00:16:40.840 the head. 263 00:16:42.039 --> 00:16:44.279 Hey guys, it's Jack. I want to tell you guys 264 00:16:44.360 --> 00:16:48.360 about the sponsor for today's show. It's Mando. Mando makes 265 00:16:48.559 --> 00:16:53.440 a whole series of male grooming products. 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That's 289 00:18:07.880 --> 00:18:12.400 s h O P M A N d O dot com. 290 00:18:12.839 --> 00:18:15.279 Please support our show and tell them we sent you 291 00:18:15.759 --> 00:18:19.240 Smell fresher, stay dryer, and boost your confidence from head 292 00:18:19.279 --> 00:18:20.200 to toe with Mando. 293 00:18:22.359 --> 00:18:26.559 So, you know, and that's like you said, we're just now. 294 00:18:26.480 --> 00:18:29.880 Starting to understand lassgers, or at least understand the effect 295 00:18:29.880 --> 00:18:30.319 that they've had. 296 00:18:30.359 --> 00:18:32.119 That's very new. 297 00:18:32.279 --> 00:18:36.359 And like, has the VA or a lot of other 298 00:18:36.440 --> 00:18:40.640 organizations caught up with that or is everything still just 299 00:18:40.720 --> 00:18:41.960 post traumatic stress? 300 00:18:43.720 --> 00:18:46.799 Well, so I'm not in the VA right right, I 301 00:18:46.799 --> 00:18:49.279 don't know exactly what happens in the VA, but I 302 00:18:49.319 --> 00:18:51.519 talked to a lot of people who either work there 303 00:18:51.680 --> 00:18:54.960 or veterans like yourself who may have tried to use 304 00:18:55.000 --> 00:19:00.720 the VA. VA has for since the night teen eighties, 305 00:19:01.160 --> 00:19:08.759 has invested heavily in PTSD treatment programs. There are there's 306 00:19:08.799 --> 00:19:13.839 a network called the National Centers for PTSD, and there's 307 00:19:13.920 --> 00:19:17.119 seven or eight of them around the country in the VA. 308 00:19:17.200 --> 00:19:21.279 They're funded by Congress, so they have separate funding. And 309 00:19:21.319 --> 00:19:27.279 so we've built a huge industry in the VA around PTSD. 310 00:19:28.200 --> 00:19:31.519 And the people that run these centers, that run these networks, 311 00:19:31.519 --> 00:19:35.759 many of them are scientists, clinical scientists, and so when 312 00:19:35.799 --> 00:19:40.319 you look at even NIH funding, NIH grant panels often 313 00:19:40.400 --> 00:19:44.559 have many VA investigators on there. When you look at 314 00:19:44.559 --> 00:19:48.799 the journals, the medical journals, the psychology journals related to trauma, 315 00:19:49.359 --> 00:19:55.400 many of them are led by VA employees. So the 316 00:19:55.519 --> 00:20:01.359 VA is a very very powerful force of for supporting 317 00:20:01.720 --> 00:20:06.799 the construct of PTSD and the treatment for it. And 318 00:20:06.839 --> 00:20:10.039 they've been very influential on DoD and every other part 319 00:20:10.079 --> 00:20:15.759 of our Western mental health systems. Law enforcement, firefighters when 320 00:20:15.759 --> 00:20:19.319 they have trouble, they get if they're having difficulties, they 321 00:20:19.400 --> 00:20:28.680 often are almost immediately diagnosed with PTSD. And so maybe 322 00:20:28.759 --> 00:20:31.960 rephrase your question again. So we've kind of gotten away 323 00:20:33.160 --> 00:20:39.599 far away from where we were in nineteen seventeen. We 324 00:20:39.680 --> 00:20:43.079 know TBI is a problem for soldiers, we know it, 325 00:20:43.240 --> 00:20:45.599 know it, but we don't really act on that knowledge 326 00:20:45.680 --> 00:20:49.480 very efficiently. You go out of here TB and PDSD 327 00:20:49.880 --> 00:20:53.400 clumped together as if they're the same thing, right, they're similar, 328 00:20:53.519 --> 00:20:55.759 we can't tell them a part. 329 00:20:55.359 --> 00:20:58.160 Do you think do you think that one of the 330 00:20:58.200 --> 00:21:03.279 reasons it like TV isn't in blast exposure, isn't as 331 00:21:03.359 --> 00:21:06.160 recognized it because they don't really know what to. 332 00:21:06.079 --> 00:21:11.839 Do about it right now. Maybe in part we don't 333 00:21:11.920 --> 00:21:16.440 understand it very well. It's hard to evaluate in a 334 00:21:16.799 --> 00:21:19.519 truly objective fashion. I mean, I can talk to you 335 00:21:19.559 --> 00:21:21.519 in half an hour, I can figure out if you 336 00:21:21.559 --> 00:21:25.240 probably have TBI, but I would be asking questions that 337 00:21:25.319 --> 00:21:28.880 other doctors might not ask. And in terms of like 338 00:21:28.920 --> 00:21:32.839 doing an MRI and cognitive performance testing and getting that 339 00:21:32.960 --> 00:21:37.680 kind of data, that's both expensive and complicated and highly 340 00:21:37.680 --> 00:21:42.279 imperfect because an MRI doesn't necessarily show us brain damage, 341 00:21:42.599 --> 00:21:46.599 especially at the cellular level. So when we talk about 342 00:21:46.640 --> 00:21:50.880 the TAUL proteins or the glial cell scarring associated with 343 00:21:51.039 --> 00:21:57.400 chronic traumatic encephalopathy or what's now been called interface astral 344 00:21:57.440 --> 00:22:01.279 glial scarring. The only way to really know that and 345 00:22:01.319 --> 00:22:04.480 look at that as post mortem. So we have to 346 00:22:04.480 --> 00:22:08.319 wait till somebody's dead before we could actually go into 347 00:22:08.400 --> 00:22:12.400 their brain at the level of that pathologists do. So 348 00:22:12.799 --> 00:22:15.720 we are hampered by ignorance, we are hampered by a 349 00:22:15.799 --> 00:22:17.799 lack of really good. 350 00:22:17.599 --> 00:22:20.920 Technology to really explain things. 351 00:22:21.480 --> 00:22:24.440 We're also hampered by what I'll call referred to as 352 00:22:24.440 --> 00:22:28.400 a little bit of a deep state in the VA system. 353 00:22:28.799 --> 00:22:32.359 So when the Global War on Terror started twenty almost 354 00:22:32.440 --> 00:22:35.720 twenty five years ago, the VA system was what it 355 00:22:35.880 --> 00:22:40.599 was and hasn't really evolved much since everybody who had 356 00:22:40.680 --> 00:22:43.160 the power, who had the empires, who had the clinics 357 00:22:43.160 --> 00:22:47.279 and the centers and the research funding, they weren't immediately, 358 00:22:47.279 --> 00:22:51.960 they weren't changing directions or switching lanes very rapidly, if 359 00:22:51.960 --> 00:22:54.480 at all. And so I think the problem we have 360 00:22:54.599 --> 00:23:01.599 today is and PTSD is the number one injury that 361 00:23:01.640 --> 00:23:04.240 you see, may be careful of that. It's one of 362 00:23:04.279 --> 00:23:08.519 the top injuries that you see in VA disability claims. 363 00:23:08.759 --> 00:23:12.640 So it's been so deeply ingrained and codified in the 364 00:23:12.720 --> 00:23:17.720 VA's policies, in the clinicians and even in the veterans 365 00:23:17.759 --> 00:23:21.400 and the patients. It's a term that gets, you know, 366 00:23:21.519 --> 00:23:26.480 that gets thrown about and used widely. Could we do better, Absolutely, 367 00:23:26.759 --> 00:23:31.160 we absolutely can do better. And where is the VA changing? 368 00:23:31.440 --> 00:23:33.680 I'm not sure but I do know they have five 369 00:23:33.960 --> 00:23:38.240 polytrauma centers what they call polytrauma Centers, and one of 370 00:23:38.279 --> 00:23:43.519 those centers I think is soon going to incorporate the 371 00:23:43.559 --> 00:23:46.960 word or the phrase operator syndrome into the name of 372 00:23:47.000 --> 00:23:51.799 their program. And they're certainly using the concept, the construct 373 00:23:51.839 --> 00:23:54.200 and the framework and what they're doing. Now that's fantastic. 374 00:23:54.279 --> 00:23:56.160 Yeah, when we get further on, I want you to 375 00:23:56.319 --> 00:23:59.640 like kind of give the give us more on the 376 00:23:59.720 --> 00:24:02.200 VA because you mentioned some really interesting things in your book, 377 00:24:02.599 --> 00:24:07.359 But so you start out your focus on post traumatic 378 00:24:07.400 --> 00:24:10.440 stress when it's relatively new, and really, what did people 379 00:24:10.440 --> 00:24:12.400 know about the postmatic stress from the movies in the 380 00:24:12.400 --> 00:24:14.759 seventies and eight isn't even up till today, is that 381 00:24:14.799 --> 00:24:17.960 somebody has flashbacks. They think that, you know, Charlie's in 382 00:24:18.000 --> 00:24:21.319 the wire and Huey's openside and they kill everybody in 383 00:24:21.319 --> 00:24:21.799 the office. 384 00:24:21.920 --> 00:24:28.440 Right Yeah, Yeah, and really interesting question that we can 385 00:24:28.519 --> 00:24:34.519 wonder about here. Did Hollywood create the PTSC that we 386 00:24:34.640 --> 00:24:39.279 have today? Did all those movies in the seventies that 387 00:24:39.920 --> 00:24:46.039 used flashbacks as a plot device, did that create what 388 00:24:46.079 --> 00:24:49.559 we now have as a symptom of PTSD. I have 389 00:24:49.720 --> 00:24:52.240 never had a patient, even in my years at the 390 00:24:52.240 --> 00:24:57.599 PTSD clinics who really had what you what you often 391 00:24:57.640 --> 00:25:03.759 saw in the movies where through flashback that involved them 392 00:25:03.799 --> 00:25:09.880 acting as if they were back in that scenario. And 393 00:25:09.920 --> 00:25:13.400 an interesting study that was done probably fifteen or twenty 394 00:25:13.480 --> 00:25:17.119 years ago by the Brits. We got some of the 395 00:25:17.119 --> 00:25:19.960 great research happening with veterans as comes out of Britain. 396 00:25:20.359 --> 00:25:23.119 And what these guys did was they got all of that. 397 00:25:23.160 --> 00:25:28.839 They got the medical records from the Boer War fought 398 00:25:28.880 --> 00:25:31.839 at the very end of the nineteenth century, early twentieth century, 399 00:25:31.880 --> 00:25:35.720 so they got the military records of British soldiers who 400 00:25:35.759 --> 00:25:40.839 fought in South Africa and they went through them just qualitatively, 401 00:25:40.880 --> 00:25:45.200