I have two recurring nightmares. In the first one, I’m on a basketball court and I am 16-years-old again. I’m playing my old point guard position. I am scared and dribbling the ball cautiously because I am not supposed to be here but my coach put me in the game. I’ve never dreamed long enough to find out if I make it through.
In my second dream, I’m on a rollercoaster at a theme park I visited often as a kid except I’m my 26-year-old self. I know it’s not safe for me to be there and I’m scared of how I will come out at the end of the ride. In this dream as well, I never dream long enough to find out.
It’s taken me years to realize my dreams are reoccurring. I understand now they are related to the part of brain injury I don’t like to talk about: how my brain injury impacts my mental and emotional health, how the act of being injured in itself is traumatic.
After a traumatic event, it’s common to have nightmares about the specific event or the circumstances surrounding the event. My dreams make sense, they are the manifestations of the trauma in traumatic brain injury.
My initial brain injury occurred during a basketball game. In the basketball dream, I’m the same age, playing the same position and in the same gym where I acquired my injury. I have the same coach who encouraged me to play despite having a brain injury. I know I shouldn’t be on the court and I’m afraid someone is going to hit me with their body or the ball, but part of me is happy to be there.
Despite my brain injury, I sometimes test the waters with new and old activities such as riding a bike, zip-lining and jumping rock to rock while hiking. Sometimes I do things I know I shouldn’t, such as not wearing a helmet while biking or rollerblading. Despite my willingness to test the waters and tempt fate, I would never try to go on a rollercoaster again. This is a former love that would likely cause significant damage to my brain and potentially kill me. It makes sense I have nightmares about being on rollercoasters.
After living with brain injury for ten years, I am still learning new things. This week, I learned I have recurring nightmares from the traumatic event that was my TBI.
Alyson is 26-years-old and acquired her first brain injury ten years ago. She graduated from Ryerson University and is a youth worker at a homeless shelter. In her spare time, Alyson enjoys writing, rollerblading and reading. Follow her on Twitter @arnr33 or on The Mighty.
It’s possible the expression, keep soldiering on was created for people just like Corporal David Macdonald. In recent years, Macdonald has climbed the Himalayas, run two half-marathons and he just completed his first full marathon. He continues to serve in the Canadian Forces as a reservist, while working as the national partnerships director at Wounded Warriors Canada.
It’s not a bad list of accomplishments, considering that just six years ago, Macdonald spent three weeks in a coma at the U.S. military hospital in Germany, with no fewer than 47 broken bones in his body.
“I was involved in a vehicle roll-over on a combat patrol near the end of my tour. I broke my pelvis, I dislocated my left leg, and that had to be surgically put back in,” Macdonald said. “And I had a traumatic brain injury.”
Beyond his injuries, Macdonald says that waking up in Germany, alone, having left his platoon behind, was worse than any injury he suffered.
“[You spend] two years, training, living together, we bonded,” Macdonald said. “To find out that they were still in Afghanistan and I was halfway around the world was just devastating to hear. I wanted to be back with my platoon mates.”
Today, Macdonald, like many injured members of the Canadian Forces, is living with effects of PTSD as well as his traumatic brain injury. He has no memory of the incident which changed his life forever. And while he is learning to accept the reality that some memories have disappeared (he says there are moments from his high school days which are gone forever), the fact that he can not remember this specific, significant moment in his life has been particularly hard to accept.
“My last memory in Afghanistan was orders the morning before the patrol,” Macdonald said.
Most brain injuries acquired during military service are the result of blasts from improvised explosive devices (IEDs). Motor vehicle crashes, such as Macdonald’s, and gun shot wounds, are the other leading causes of brain injury. Brain injuries, which are the result of blasts, have different symptoms than other types of traumatic brain injuries. Typically, post-concussion symptoms for military personnel last longer than civilian concussion symptoms, and members of the military are more likely to have concurrent symptoms such as PTSD and / or addiction issues, along with their TBI.
Macdonald knows the facts. Many of the initiatives and partnerships Wounded Warriors Canada supports are about helping members of the Canadian Forces, and their families, deal with PTSD. In his current position, Macdonald handles third party partnerships, events and fundraising for partner charities.
“Last year, we gave out $1.36 million in funding to these programs and it’s just growing from there,” Macdonald said.
“Your odds of developing a form of PTSD almost double for veterans, ” Macdonald said. “There is a certain stigma, because [some] people don’t understand you can recover from it, you can go on and live a normal healthy life. It’s not incapacitation by any means.”
Over time, Macdonald has come to accept his new reality. But immediately after he recovered from his injuries, he said he needed to prove to others, and to himself, that he could still be in the military. And while he was physically fit for duty, Macdonald said he continued to suffer physical and mental pain, “stereotypical” things, he says, people dealing with trauma experience. His marriage fell apart and he pulled away from his family and friends. He contemplated, and attempted, suicide.
“I was going through things like depression and I had a lot of anxiety issues, [but] I wasn’t recognizing them.”
Then a communication came through his unit. A documentary project, March to the Top, was looking for recovering soldiers to go on a climb through the Himalayas. Macdonald, who at the time was the only soldier in his unit who was wounded, was initially a bit sceptical of the project, which was described to him as a ‘good go’.
“Half the time a ‘good go’ means that … you get to do an amazing cause and you get to meet people,” Macdonald said. “Or it can mean that you’re shovelling dirt in Northern Alberta for six months.”
It turns out, March to the Top was a legit ‘good go’ and the experiencechanged, and possibly even saved, Macdonald’s life. Accomplishing the feat of trekking in the Himalayas made Macdonald realize that he needed help. He learned that what he was feeling was normal, and diagnosable. It was PTSD.
“It allowed me to open up and come forward in the military and say, ‘hey I have issues, I need help.’ And that’s what started the process for me getting the help I needed,” Macdonald said.
Macdonald’s attitude is one that accepts the realities of his injuries while allowing himself to thrive. He talks about post-traumatic growth, and feeling stronger as a result of experiencing injuries and trauma. It’s important to him that he is able to help his fellow veterans through his job, a duty he takes seriously. Until he accepted a paid position with Wounded Warriors this past February, Macdonald juggled volunteering as the provincial coordinator for Ontario while working full-time at a bank, and doing his reserve duties. The man keeps busy.
“I don’t necessarily see my PTSD as a weakness anymore,” Macdonald said. “I used to see it more as part of my life, now I can be stronger because of it.”
Macdonald says he doesn’t know the “future” of his brain injury. He says it can rear its ugly head at any time, and some days are harder than others.
“Something they ingrain you with in the military is never give up,” Macdonald said. “This is not a limitation, this is something that is now a part of you, but you can still excel, and you can still do amazing things.”
Meri Perra is the communications and support coordinator at BIST.
Travelling to a foreign country to engage in combat. Witnessing injuries, death and destruction on a regular basis. Forced to endure tough living conditions. Is it any wonder members of the Canadian armed forces who see action return home not only with physical, but with mental and emotional trauma as well?
Broken bones and musculoskeletal injuries can be healed. More challenging however, are the emotional afflictions men and women in the armed services can suffer, and surely among the most devastating is Post-Traumatic Stress Disorder (PTSD).
PTSD has been much in the news over the last few years, which could give the mistaken impression that it is a new condition.
In fact, PTSD has been around for a very long time, but under different names. Among these were “shell shock” or “battle fatigue.” I remember my mother telling me about a great-uncle of a friend of hers, explaining that he had seen action in WWII and was ‘never the same again’. “He was shell-shocked and couldn’t do much after the war was over,” she used to tell me, shaking her head. While the name has become more clinical, the symptoms remain the same., PTSD is defined as:
A debilitating psychological condition triggered by a major traumatic event, such as rape, war, a terrorist act, death of a loved one, a natural disaster, or a catastrophic accident. It is marked by upsetting memories or thoughts of the ordeal,”blunting” of emotions,increased arousal, and sometimes severe personality changes”.
Most people have been involved in a frightening situation at some point in their lives, and reactions vary from person to person. Some might feel nervous at times, while others might have a difficult time sleeping as they go over the details of the incident in their minds. Over time, symptoms usually decrease, and sufferers affected eventually return to their normal lives.
However, in the case of PTSD, the effects last a considerably longer time and can seriously disrupt a person’s life.
Doctors refer to three symptoms that define PTSD: intrusion, avoidance and hyperarousal. Intrusion is the inability to keep memories of the event that sparked it from returning. Avoidance refers to the attempt to avoid anything that may trigger those memories, and hyperarousal is the constant feeling that danger or disaster is imminent. These may also be accompanied by an inability to concentrate, extreme irritability or sometimes violent behaviour.
Those affected can experience recurring nightmares, flashbacks or recollections of the event or incident. They can feel “on edge” all the time, have difficulty in concentrating, be irritable and have problems sleeping . A common symptom among veterans is something known as nocturnal myoclonus, a sudden spasm of the whole body while sleeping or drifting off into sleep. It lasts for about a fraction of a second, but may occur several times in a single night. Often people with PTSD will sleep through such a spasm, but it can be extremely disturbing to their partner.
People suffering from PTSD may also feel disconnected from their thoughts and have a hard time expressing emotions. It can lead to depression, substance abuse and create problems in a person’s personal life. Suicide is often seen as the only way out.
Not surprisingly, those in certain occupations, such as policing, firefighting and the military have much higher rates of PTSD than those in other professions. And in some cases, trauma such as warfare can cause symptoms even beyond those commonly associated with PTSD, resulting in a state known as “complex PTSD.”
Brain Injury and PTSD
A study released by the University of Southern California, Los Angeles, in February 2012, reported of a possible correlation between acquired brain injuries and PTSD, suggesting that people who suffer even a mild brain injury are more likely to develop an anxiety disorder.
UCLA professor of psychology Michael Fanselow found that this relationship was particularly prevalent among veterans who had returned from overseas. The reasons for the connection are not yet fully clear. Nevertheless, in an experiment with rats, scientists used procedures to separate physical and emotional trauma, training the rats by using “fear conditioning” techniques two days after they had experienced a concussive brain trauma, thereby demonstrating that the brain injury and the experience of fear had occurred on two separate days. As Dr. Fanselow explained:
We found that the rats with the earlier TBI acquired more fear than control rats (without TBI). Something about the brain injury rendered them more susceptible to acquiring an inappropriately strong fear. It was as if the injury primed the brain for learning to be afraid.
According to Boston’s Mayo Clinic, the primary treatment of PTSD is psychotherapy but this is also frequently combined with medication. Psychotherapy can include any of the following types:
Cognitive therapy. This type helps patients recognize the ways of thinking (cognitive patterns) that are hindering the healing process.
Exposure therapy. This type helps patients safely face what is causing them such distress so they are able to cope with it more effectively.
Eye movement desensitization and reprocessing (EMDR). EMDR combines exposure therapy with a series of guided eye movements that helps patients react better to traumatic memories.
The Canadian military has come under criticism for its seeming neglect in both the recognition and treatment of PTSD ex-soldiers are still feeling the effects of combat. Last November, three veterans took their own lives over the course of a week, bringing the total to more than 22 since the mission in Afghanistan ended.
Nevertheless, a story from CTV News in March of 2014 reported a new treatment being tested that so far, is producing positive results. Developed by the Institute for Creative Technologies at the University of Southern California, it involves the notion of virtual reality in which a sufferer affixes a device to his or her head which simulates the circumstances that brought about the trauma in the first place. The therapist can then talk the patient through the ordeal, thus helping them to overcome it.
The federal government is now in discussion with ICT in order to develop a Canadian version. The ultimate goal is not just to treat afflictions such as PTSD but to also train soldiers before going into battle, helping them to experience the sense of combat before they embark on the real thing.
PTSD can be both debilitating and life-threatening, but there is hope. If you know someone you suspect is suffering from PTSD urge them to seek help.
Those afflicted may find it difficult, for stigmas surrounding mental health issues continue to persist. Yet seeking help is the first step to recovery and it is readily available through such organizations as Canadian Mental Health. Suicide is most definitely not the solution. Those who have served in the Canadian armed forces have served their country well, and deserve whatever we can give them to continue leading happy and successful lives.
If you think you or someone you know has PTSD or needs other mental health supports: