THE AGE OF TRAUMA
The United States has officially been engaged in a global war on terrorism since September 11, 2001.
Accordingly, there’s been a rapid increase in deployments, from the Middle East to Africa to our home turf, so that instead of serving in active combat for months, soldiers spend years in the field. When they are forced to go on a second or third term of duty, they will likely be more profoundly affected by their time on the battlefield.
Jerry Zuniga is one of those soldiers. An infantryman in the United States Marine Corps from 2005 to 2013, Zuniga was deployed twice to Iraq and once to Afghanistan and then served in a tactical training exercise combat group as an anti-tank training instructor for 220 marines. When he was honorably discharged, he was quickly labeled disabled.
“And basically that’s where my life started to really degrade,” Zuniga says. “I found myself trying to transition out of the military back into society with no real foundation. It was very difficult. I was homeless at one point, with my family. I was struggling financially. We were living from house to house, with my mother and uncles and basically wherever we could, coping with my post-traumatic stress disorder and a traumatic brain injury.”
Soldiers are separated by long distances from spouses and family members, work long hours, endure prolonged tedium and ethical challenges, suffer in the wounding or death of friends, experience the constant threat of violence and lose access to social support groups. These combined dynamics, compounded with the extended duration of a combat deployment, heavily tax the physical, mental, emotional and spiritual stores of any soldier.
As a result of these stresses, the number of suicides during deployment years has increased dramatically.
“I was trying to figure out how I could help myself so that I didn’t deteriorate within the next ten years,” Zuniga shares. “And I became an alcoholic. I drank myself to sleep basically every night, blacking out. I was drinking so much I was fighting everyone. I was isolating myself. I ruined a lot of friendships and relationships. I ended up in my recliner while my family was asleep in the bed behind me. With a gun in my hand. We have veterans committing suicide at an exponential rate, and I was about to be a number.”
But US soldiers aren’t just feeling the impact back at home and taking their own lives when experiencing PTSD. They’re increasingly dying by suicide before they get home.
Acts of courage
Zuniga is correct about the increase in suicides in his professional field. We don’t have statistics for every division, but what we do know is that in 2003 in the US Army alone, there were sixty suicides. In 2006, there were 102 suicides Army-wide. In 2007, there were 935 suicide attempts in the Army including 115 successful suicides; in 2008, 140 suicides of active-combat soldiers; and in 2009, as many as 160 suicides plus seventy-one soldiers who died by suicide after being taken off active duty at the end of their deployment.1 According to Pentagon statistics, in 2009, more soldiers killed themselves than were killed in active duty in Afghanistan and Iraq combined. By 2016, the last year for which the US Department of Veterans Affairs has provided statistics, soldiers in all divisions were killing themselves at a rate of twenty individuals per day.
“I’ve had three marines close to me take their own lives,” Zuniga says. “When I was sitting in the recliner, I was thinking that this is exactly how they felt before they killed themselves. I prayed that night, cried. I wasn’t sleeping at all, or if I was sleeping I was having nightmares and night sweats. In the daytime, I was hypervigilant, running my wife through scenarios in case anyone came into the house. I was going nowhere. You don’t understand that it’s PTSD.”
For soldiers coming off deployment in a war-torn country, sometimes suicide feels like the courageous choice, because there’s a fine line between fear and courage. It’s not just a matter of feeling incapable of coping but also feeling like you are a burden on your closest friends and family members. When PTSD affects your own life and those of your spouse and children (and, in Zuniga’s case, his elderly relatives as well), eliminating yourself from the equation may feel like the right thing to do.
Looking at statistics tracked for the last thirty years, the rate of suicide in the US military is the highest it has ever been. The US Centers for Disease Control and Prevention states that this rate of self-harm is more than twice that of the US population as a whole.
The most common form of psychological injury in a combat setting is trauma and related stress. According to the American Psychiatric Association, trauma can be categorized as exposure to a physical or psychological threat or assault to a person’s physical integrity, sense of self, safety or survival or to the physical safety of another significant individual in a person’s life.2 The result of trauma, which can be categorized as a singular or ongoing experience, is likely to be associated with PTSD.
Here’s why this has such a devastating effect on soldiers. Following exposure to combat, individuals may repeatedly re-experience the events through active dreams or hallucinations. This leads to depression and anxiety and, for many, social and psychological impairment. These soldiers feel the risk of danger, even when they are safe at home.
The impact of PTSD is not just related to mental health. The American Psychiatric Association states that physical reactions to PTSD after exposure to combat are common. These can include chronic sleep deprivation, cardiovascular disease, difficulty with fine motor skills and difficulties with cognitive performance. The hypervigilance that Zuniga describes is very common: those with the disorder find it necessary to constantly check and recheck what is happening to themselves and to family members in order to make sure that they are safe. PTSD can also lead to neuropathic pain, where the body simply shuts down some of its processes in order to cope with strain. PTSD can make it hard for people to make decisions, and it can make it impossible to complete detail-oriented work. It can also lead to challenges at home, as the person with PTSD increasingly withdraws from interpersonal conflicts in order to cope.3 It is therefore an incredibly difficult disease to treat, as it crosses physical, emotional and social lines, all of which have to be addressed in order for a patient to move toward wellness.
There's not just one trauma
You may know, or have guessed, of the impact of PTSD and its connection to soldiers. You may have long assumed that combat will result in this kind of mental and physical reaction, because we’ve seen these narratives played out constantly in the media, in real life and in fictional accounts.
What you may not know is that, just by living in the United States, you may also be affected by what’s called subthreshold PTSD.
There isn’t a clear definition of what subthreshold PTSD is from a medical perspective, simply because so much of it goes undiagnosed and untreated.4 But the medical community suggests that there are many more people who have been affected by traumatic events than those who have a clinical form of this mental illness. In fact, in the United States, you’re more likely than not to be a survivor of a trauma. Subthreshold PTSD is the kind of low-lying problem that comes up over and over again simply because it’s never treated.
If you’ve witnessed unforeseen violence, such as life-threatening accidents on the street or at work or natural disasters like Hurricane Katrina, you’ll be more likely to feel physically or mentally ill when you’re faced with stress at any point in your life. The same is true if you’ve experienced a physical or sexual assault, if you’ve been mugged or if you’ve been stalked or threatened at home or at work. If your loved ones have faced a life-threatening illness or injury, or a traumatic death, including those that take place during military service, you’re also more likely to have a trauma-based reaction to strain in your day-to-day life. Americans face as many of these triggers in their lives or more than the average human being on a global basis.
“One of the things that makes PTSD difficult to treat,” says Dr. Zach Walsh, “and also one of the things that makes it so fascinating is the diversity. It’s commonly associated with combat, but that’s not the majority of people who have PTSD. As someone who’s interested in mental health, it’s hard to avoid PTSD. I did a lot of work in jails and I worked primarily on violence, partner violence, domestic violence, and PTSD is always very prominent there as well.”
For example, it’s estimated that more than 16 percent of all people who lived in New York City at the time of 9/11 experience subthreshold PTSD.5 People who are first responders and regularly deal with stressful work conditions, such as firefighters and police, are likely to have it.6 People who live at a chronic level of low income have it, because of the strain of having to provide for a family or themselves every day.7 Those who are survivors of abuse or those who live with social isolation have it.8 The list goes on and on.
In a society that is increasingly affected by polarization between rich and poor, chances are that citizens of the United States are deeply affected by the trauma of simply having to survive, and their health burden and strain is increasing year over year as we move further from a solution to our health care crisis. The polarization between rich and poor has a significant effect on whether someone acquires a disease and can recover before it worsens.9 For example, because of hidden social barriers that prevent the homeless or the poor from seeking out the support that they need from the health care system, such as endemic forms of discrimination, these individuals are more likely to have long-term, acute health conditions and more intensive risks of mortality, most of which are connected with stress.
In fact, because of this subthreshold PTSD, and a lack of direct health care, there is as much of a disease burden in the United States as in the poorest countries in the world.10 Although the rich in our society have access to the best care in the world, the majority of Americans do not because we’re still mired in a debate about what our best health care options are, which is part of the reason we’re under so much stress on an ongoing basis, as the APA has explained. Think about it: we have created a system in which our health indicators show that we’re less able to care for our vulnerable people than the majority of countries in Africa and the Middle East. We have higher levels of alcohol consumption, childhood obesity and mortality due to interpersonal violence, self-harm and unintentional poisoning due to toxic opioid overdoses than any country in the Western world.11 We’re stressed, but we don’t put our significant resources toward preventing this problem in the first place.
Trauma is who we are.
Building our reserves
So how do we address it? In some ways, it all comes back to 9/11 and CBD. As Walsh tells me, as much as this horrific event traumatized the American public, it also galvanized research into trauma using cannabis.
“In one study,” Walsh explains, “where they looked at people who’d survived the World Trade Center attack and who developed PTSD and who didn’t, they found lower levels of naturally occurring cannabinoids in those who had PTSD following the attacks versus those who didn’t.12 So it seems like that natural endocannabinoid system plays a role in a human response to stress, and perhaps in maintaining that overactivity of the stress response that characterizes PTSD.”
In other words, Walsh says that it’s all about our response to fear. If our endocannabinoid system is working well, it provides us with a primal chemical response that calms our central nervous system. When we’re physically or mentally overwhelmed, however, our brains stop producing cannabinoids in a way that allows us to calm down. Walsh is researching how this actually takes place by studying the effect of CBD and THC on recovery from trauma, but he says that early findings in both animal and human brain studies show that there may be a link between the endocannabinoid system and whether or not we experience PTSD.
As he says, “It’s about the naturally occurring cannabinoids in the brain. People who have PTSD following exposure to a trauma suggest that this natural system, the endocannabinoid system, is implicated in development of PTSD following exposure to traumatic experiences. It’s a restorative system involved in maintaining and producing memories and relaxation and sleep. It’s involved in so many things that it’s hard to give you a comprehensive list. It’s one of the most prevalent systems in the human body, and the molecules that you make are not dissimilar from what is in these plants. And that’s why the plant molecules have an effect: they mirror what’s being made inside your own body.”
Walsh’s work investigating PTSD shows us that when it comes to trauma, CBD provides us with a uniquely effective shift toward wellness. But he’s not alone in finding out just how effective it can be. New field research published in 2018 shows that a CBD therapy plan can alleviate and even eliminate bad memories, also known as “flashbacks,” for those with acute PTSD.13 It can relieve the inability to sleep, as well as reduce anxiety, for children who have PTSD.14 Taken in combination with talk therapy, it can be helpful for families dealing with the effects of trauma.15
For Zuniga, CBD was the pathway to health he was looking for, but he came to CBD therapy in an unusual way. “I was on the path to becoming a number, and I had to make a decision not for myself but for my family,” Zuniga explains. “So, I quit drinking alcohol and I started using cannabis. Medical cannabis wasn’t even an option. But I was so far gone: with my PTSD symptoms and my brain injury combined with the alcohol, the not getting sleep, the sweats at night and being on constant watch at my house, I had to make a choice.”
His choice wasn’t CBD, but marijuana. As Zuniga tells it, he had heard about medical cannabis and assumed that smoking pot was going to be the cure he was seeking. “I was getting it down the street from an old guy; he grew his own cannabis legally and he was giving me it. I didn’t ask him what type of cannabis it was, nor did I care; I just said give it to me. I tried it for about three months, but I found myself getting lazy, so I quit.”
At that point, Zuniga felt that he had no other choice but to go back to using the pharmaceuticals provided to him by Veterans Affairs to address his PTSD symptoms so he could get through the day. He gave it another three months, at which point he gave up because he felt like he was just going through the motions, not feeling like a human being. “I made a decision to myself to never take any pills again,” he says. “On pharmaceuticals, you’re a zombie.”
It was at that juncture that Zuniga, like Siomara Melina and Janie Maedler and countless others, began to do his own research. When he did, he found Jason David. “I knew that the THC was the medical marijuana part,” Zuniga explains. “I never knew about the health benefits of CBD.”
Working with Jason, Zuniga started on a medical therapy plan with a 28:1 ratio of CBD to THC that offered him a freedom he hadn’t felt in years. He felt so much better that, within months, he created a registered US charitable organization, Tactical Patients,16 that offers medical cannabis care and other resources for PTSD-affected soldiers after they leave service so that they get adequate support. His goal is to prevent suicides by creating the right conditions for soldiers to thrive.
“CBD literally changed my life. CBD works in a way for me that no THC, no pill, no medicine, no alcohol, nothing can do for me. I do not take any pharmaceuticals at all. I was never going to go back to a pill that had fifty side effects instead of trying an organic CBD extracted oil that has no side effects but all the health benefits. After doing the research on CBD, you’ll find all the miracles. I don’t understand why it’s being ignored. It’s been here and we just need to start utilizing it,” Zuniga says.
Community and care
What we don’t often hear in our clinics and hospitals is that there is a deep connection between physical and mental health and large-scale social stressors. As we can see through the experiences of Zuniga and others, the challenge can be tied back to social injustices in access to care, as well as to the way in which social determinants of health can shape the way that people respond to stress in their lives. This is especially true for soldiers but also for all of us. The higher the level of environmental, social and economic stress that we experience, the more difficult it is for us to cope both physically and mentally. What this results in is a situation in which there are limited means by which people in trauma can care for their own needs. All of these barriers to care, such as those that prevented Zuniga from accessing CBD in the first place, may make it difficult for anyone seeking help from professional health care providers.
It is clear from American health care research that, for barriers to be broken down, a new approach to health care must be taken in which people are empowered to make choices for themselves.17
As American communities become more economically and socially polarized, the health of our most vulnerable citizens becomes more compromised. Patients who are affected by mental illness, including those who have given years of their lives in military service, often become more cut off from health services.
The problem isn’t just that we put up barriers to care, but that we are creating trauma in the first place through our policies, our actions and our social responses to fear. “PTSD will never go away. PTSD is stuck with me for life,” Zuniga explains. It’s something that he, and all of the people he supports through Tactical Patients, will have to face every day on the job, at home with their families and even in their dreams. There is no escape.
Zuniga has created a community of support that is filled with hope for soldiers and for himself. “CBD not only allows me to function, but it also allows me to be a leader now in the community,” he says. “It’s an honor to serve all these other veterans who are coming to our program. It’s giving them a chance to thrive, to participate in society, and giving me the chance to be a positive role model and give back.”
Everyone ought to have this kind of hope for their personal health and for their future.
Trauma does not need to be who we are.
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