Hello, this is Julianne Good and this is Psych One-on-One. Welcome. We are here to make psychology more understandable for you, your friends and your family to make your lives easier and better. Tonight, my special guest is calling in from Texas and this is Dr. Colin Ross. We are going to be talking about suicidal ideation among combat veterans. I'm going to dovetail off of the program from last week where I had two veterans talking about veterans benefits. So this is carrying on with the veterans theme for it. The month of November. Hi, Dr. Ross. How are you doing? I'm good. Thanks. Thanks for having me on. Thank you for calling in. Can you give us a little bit about your background? Sure. Well, I'm a psychiatrist. I was born in Canada, went to medical school in Canada from 77 to 81. Then did my psychiatry training also in Canada, 81 to 85. Was an academic psychiatrist in Winnipeg from 85 to 91. And then in 91, I moved to Dallas and I've been running a trauma program in the Dallas area since then. And I consult to another program in Michigan and another program in LA. And it's especially in the LA program that I do a lot of work with combat veterans, which I do mostly by video link. Oh, that's great. And I know that you were recently in San Diego. Yeah, I was there twice recently actually. And once talked on the... To the person who was there. I was there twice. Yeah, I grew up as a person and grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew grew benefits, very, very involved with the vets community. And I met him at the stand down last year in the L.A. area. And they're having a huge stand down here at the L.A. Coliseum within the next few weeks. And what's the main purpose or focus of that? The stand down is where many clinicians and agencies like the VA come in and they have booths and tables and they talk to the veterans about the benefits that they don't realize that they actually have because a lot of the veterans are unaware that they have more than just a GI Bill and housing benefits. Right. Well, that's a good thing to have. Yeah, it's great. They have these stand downs all over the country. They're becoming quite popular, which they should because the veterans definitely deserve to get all the benefits that they should be getting. There's no question about that. Yes. Yes. So. The paper that you wrote and that you discussed in San Diego is entitled Self-Blame and Suicidal Ideation Among Combat Veterans. Can you talk a little bit about what's happening with the suicide rate with the veterans? Well, basically, it's going up, up, up. We don't have real solid statistics going back 100 years or anything. But from 1980 to 1992, it was in between 11 and 14 per 100,000 soldiers per year would kill themselves, which is about the same as the rate in the general population, basically. And then from 2003 to 2010, it just about doubled to 21 per 100,000 per year. And I'm not sure what the very latest stats are, but I think it's gone up more from there. So it's substantially more than the rate in the general population. And what is contributing to the suicidal rate going up? Well, it's not any one thing. It's a whole bunch of different things, all to different degrees and different people. So and some of it's kind of common sense. So obviously, combat trauma is one thing that contributes. But also having a lot of childhood trauma in the form of abuse and neglect, just trauma all across your lifespan. Yes. So the more stress, the more trauma, the more at risk you are. Also, a bunch of emotional distress, conflict and stresses just in the 24 hours before the suicide attempt contributes. So there's immediate stress, problems in marriage or intimate relationships, job stress, depression and alcohol problems put the risk up. And it varies by type of military occupation. So if you're on the ground. In a combat role, your risk goes up. Physical pain, just in the general population of the world, chronic physical pain definitely increases your rate of attempted and completed suicide. And so it's the same with any kind of deployment or non-deployment rate or related injury. Chronic pain will contribute. Males are at higher risk for completed suicide in general in the world, also in the military. Right. Right. Right. Right. Right. Right. Right. Right. Right. Right. Right. Right. Right. Right. Right. Right. Right. Right. Right. Right. Right. Right. Right. Right. and then the thing that I'd like to focus on and this is the theme of this paper is guilt and shame. Right. So there's a whole bunch of things that kind of all contribute and interact with each other. The more of that you have, the higher your risk. So everything adds on to each other. In other words, it snowballs into getting to the point where they want to self-destruct. Right. It's kind of a perfect storm type thing. Yes. And the veterans that you have worked with were from the Iraqi War, the Afghanistan War, and the Vietnam War, correct? Right. I haven't actually worked with anybody from as far back as Korea. By this point, I would imagine that a lot of those vets have been in the military. They've passed on because that was what, the late 50s? Korea was 50 to 53. Okay. And my father's serving Korea. There's some vets alive, but we don't see them in the treatment situation. Mm-hmm. Now, do any one of those groups seem to have more PTSD symptoms than the other? I don't know. Statistically, I haven't noticed any particular pattern that any one war is worse than any other war. Mm-hmm. That could be the case, but I don't know about that. And could it also be the times of deployment? The more that they're deployed, the more likely they are to come back with PTSD symptoms. Yeah, that's definitely the case. Multiple deployments increase your risk. There's all kinds of things. There's a really good movie that wasn't very widely distributed called Stop Loss. Mm-hmm. It was set in Texas. It really portrayed that very vividly. And how long ago was that out? Six years or so, somewhere in that ballpark. Okay. Now, to get into the more psychological depths of what happens to a soldier, when he or she is deployed, what can, when they're out in the field, what really contributes to one soldier coming back maybe a little bit affected by the combat, the bombing, the killing that they've witnessed versus another vet coming back and being... Sorry, go ahead. Go ahead. Go ahead. I think everybody's minimum of a little bit affected. That would be the bare minimum. But in terms of having really serious mental health problems, full PTSD, suicide, there's a couple things that I see over and over and over and over. And also, I just want to point out that there's a very serious suicide rate in the military among people who have not been deployed. So it's not like it's only in the deployed people. Okay. But the people who've seen combat, it's this theme of self-blame over and over and over and over, which is at the core of a lot of things we deal with. So if I'm working with civilians who have childhood sexual abuse histories, they frequently, frequently blame themselves. And part of my treatment model is based on this idea that I call the locus of control shift. And there's a bunch of theory behind that. But basically, it's the self-blame that arises normally, naturally in a child's mind, because children see themselves as being at the center of the world. Everything revolves around them. They cause everything that happens in their world. And they have this kind of magical power to make things happen. That's just how kids' minds process things. So when you're a little kid and you're being abused and neglected, you just come to the conclusion that it's your fault. It's because you're unlovable, you don't deserve anything better, you're causing it. And then there is adults in your life, not to mention yourself, your peers who are bullying you over and over and over and over and over and grain that belief and grain that belief, reinforce it. And so when you come out of that childhood and you come into a combat situation and something goes wrong, then you're just primed to blame yourself in a very deep, very intense kind of fashion. Whereas if you come from a reasonably regular, healthy, normal, everyday family, where you don't have this underlying self-blame, self-hatred, hostility, towards yourself, it's a lot harder for a combat event to really take a deep hold in your psyche and really reinforce that deep, deep self-blame, which then becomes self-punishment, which then becomes suicide. So it sounds like the veteran that is more likely to have suicidal ideation had the household of neglect and abuse, thereby changing the way they think about themselves. Yeah, you... Yeah, you... Yeah, you... Yeah, you... Yeah, you... Yeah, you... Yeah, you... Yeah, you... Yeah, you... Yeah, you... Yeah, you... Yeah, you... Yeah, you... and shut down. But now it's been expanded to include negative thinking, negative beliefs, shame, guilt, gloom and doom about the future of yourself, the world, and anger and irritability. So PTSD isn't just a typical flashback fear or self-blame and shame are really a core element of it. And this is also what people mean when they talk about moral injury. There's a lot of talk about moral injury in combat troops, which is really tightly tied into this focus and control shift idea of mine, which is the self-blame and the shame. Right. And then when soldiers go out together, I mean, starting from boot camp, it's almost like a secondary family for a lot of these soldiers, correct? Yeah, just like gangs in East L.A. A lot of the power of the gangs. It's the substitute secondary family. And it provides the structure that they may not have had growing up at home or in their community. Exactly. Which is a good thing. It is a good thing, yes. The vets that I've worked with have stated that over and over again that they really liked the structure of being in the military because they knew when they were supposed to do certain things. Everything was pretty much laid out for them Monday through Friday a lot of times. And then they had their open time on the weekends. And then when they got back out to civilian life, they did not have that structure and were lost. Right. Yeah, that's a big problem just by itself. With or without combat and with or without PTSD. So within the self-blame spectrum, how far-reaching is that? Or is it more of a sense of kind of the world coming in to... To the victim and they're just taking everything on? Well, one of the things I talk about in the paper, which you said the roundabout answer to your question, is suicide as murder of the self. This paper was published in the American Journal of Psychotherapy in late 2013. People can find it if they want. So I talk about this in the groups I do quite often. Suicide as murder of the self. And what I say is... I think there's kind of two ideas that are intertwined. One is that any suicide is like a murder mystery. And there's three possible murders. So the first murder is the self killed the self, which is just what happened. So that's always true. And this is either completed suicide, attempted, or just thinking about it. The second murder is the other killed the self, by which I mean the person has all this hostility, abuse, neglect, verbal abuse. And the other person has all this hostility, abuse, neglect, verbal abuse, put-downs, and they internalize that, they identify with it, and they start drifting the other person's anger at themselves. So that is the self is killed by the other, because you've taken on the hostility and anger and verbal abuse of the perpetrator. And then the third murder is the self killed the other, and that's a kind of revenge motive. You'll be sorry, you'll see what you did to me, you'll pay, I'll get even with you because I'll kill your son or your daughter or your loved one or your buddy. And so the reason I talk about that is to try and get the person in touch with, it's not just I can't take the pain anymore, I'm too tired, I want out of here. It's an angry, violent, hostile attack on the self. And there's often anger behind it. And to explain that idea, then I talk about the coin of what I call the coin of suicide. And I've talked about this with hundreds and hundreds of people, and they pretty well all say, yeah, that makes sense. I see what you're saying. That's the way it works with me. So when I say suicide, it's like a coin with two sides. One side I call the euthanasia side. And that's just like when you've got the much beloved dog who's 15 years old and has got a horse. He has cerebral arthritis, cataracts, in pain, and now has cancer, now loses control of the bowel and bladder. So you take the dog to the vet to have him put to sleep. Not because you're angry at the dog, but because you love him. You want to ease him out of the pain. And that's how most people describe their suicidal thinking and their suicidal planning. It's just too much, too much pain. I can't take it anymore. I just want it to end. And it's like this act of kindness. And I'll just kind of... I'll just pressure myself over the world. That's the euthanasia side of the coin. The other side of the coin is it's a violent, hostile, angry murderer to a human being. And so then what I'm trying to do is get the person to start looking at it from this self-blame perspective. That it's anger directed at the self. It's punishment. And wherever there's punishment, there's something you're being punished for. Wherever there's guilt, there's something you're guilty of. So guilt I see is more about... The feeling of guilt is more about what you've done. The feeling of shame is more about who you are. But they're all intertwined with each other and very close neighbors of each other. Yeah, and I can imagine that it's hard to differentiate and pull those two apart sometimes. I don't really see a big need to try and do that too much. There are just... So intertwined with each other. They're just variations on the same thing. Now, with the guilt, you had gone through survivor guilt. That's very huge on the self-blame. Right. Well, survival guilt is something I heard about when I was in my training back in the 80s. Usually it had to do with Auschwitz survivors and so on. That's what I heard about it. It was mentioned. It's just one of those things that gets mentioned very briefly. Nobody really treats it or has therapy for it or otherwise writes about it. So I kind of thought to myself, survivor guilt. Well, why would they be guilty about surviving? I can kind of see it because their loved ones died and that wasn't fair. Why did they get to be the one that made it through the experience? And that's kind of the sum of my thinking. And until I got into this... what I call locus of control shift, which is shifting the control from inside the grown-ups, where it really is in a childhood abuse situation, to inside yourself. And then I started to think, oh yeah, now I'm starting to understand the depth of survivor guilt. And in the combat veterans, it pretty well always comes down to my buddy or my buddies died and I should have died and they should have lived and it's my fault. And that's the crime I'm guilty of. Whether it's an actual legal crime, usually not. It's a moral, spiritual, emotional kind of crime that you've committed. Sort of like a negligent homicide. And so then I asked the person to tell me, okay, so what is it that happened? You said you feel very, very guilty. So to have the feeling of guilt, there must be something you're guilty of. What is it you're guilty of? What happened over there? And I try to get them to give me the most intense or the core example. And so it varies from person to person to person to person. But a typical scenario would be, and I have the person walk through it in a fair bit of detail. So one guy from Vietnam was telling me about, he was one of those tunnel rats where you have to go down in the Viet Cong tunnels. And clear them out. So sometimes you go down in there, which is a very claustrophobic environment. And there's nothing, nobody there. Everything's fine. Sometimes you go in there, people are shooting at you, throwing grenades at you, flamethrowers. So it's incredibly overwhelming and scary. I could die any second kind of environment. And he was rotated through that function. And one day he went down into the tunnel. And a woman was holding a baby down. And he was sitting there and pointed a gun at him. He drew his gun. And they basically fired simultaneously. The woman was killed. He was shot. He passed out. His fellow soldiers came down, got him, brought him up to the surface. And just as he came back into consciousness, somebody yells, fire in the hole. Throws the grenades in there. And he comes to and says, well, where's the baby? And they go, well, what baby? And so 40 years later, he's blaming, blaming, blaming, blaming, blaming himself, punishing himself emotionally because that baby's death is his fault. And so then what I do, and another scenario might be in Afghanistan, we were in a firefight. I told my buddy to change positions with me. 30 seconds later, the sniper's bullet took my buddy out. It's my fault because if I hadn't changed positions, or it could be... You're in a convoy and there's an IED that goes off. It's my fault because I should have been in the vehicle or I should have spotted the IED. So there's always... I should have done something. I should have known. I should have taken preventive action. It's my fault. And therefore, I'm basically guilty of murder. And the punishment I'm inflicting on myself is death threats relentlessly, mental torture with self-blame, negative self-talk. And then the PTSD. Self can become part of the torture of the self. I don't deserve peace. I don't deserve any kind of calm or quiet or happiness or people to love me. And I deserve flashbacks, nightmares, constantly being scared. So the guilt and the belief that you need punishment can actually fuel and drive the other symptoms of the PTSD. And then the idea is if we can reverse that self-blame, we can sort of take the window, go to the sails of the PTSD. Yes, which definitely needs to happen. You need to help them change cognitively and change their perception of something that they've guilted. They've probably been carrying around for quite some time. Yes, with Vietnam guys, literally for 40 years. Yeah. And so what I do is I walk through the sky. I go step by step by step. And you go, okay, so... And I do the same thing with, you know, a 30-year-old. I'm a woman who's been raped, who's blaming herself. I shouldn't have worn the lipstick. I shouldn't have gone to the bar. I shouldn't have given them my phone number. I shouldn't have made out with them. Therefore, it's my fault. And I always want to take two perspectives. Hindsight is perfect. Okay, so it's just a fact. If you hadn't gone to the bar or if you hadn't changed positions with your buddy, then the event would not have happened. That's just a fact. But let's go back in time to before. Before the event took place. So in a civilian situation, that'd be a date rape. Here it's a combat situation where you change positions and your buddy got hit by the sniper. So first of all, do people die in war? Is it completely impossible to have serious warfare going on with no death? Right. So people die, and it doesn't mean somebody's made a mistake. It doesn't mean somebody's incompetent. It just happens. Yeah, it's just part of... It's part of warfare. There's a civilian psychiatrist who's never been in combat pointing this out to the guy because he's not thinking with his grown-up adult mind. He's thinking with his self-blamed, emotional child's mind about it. So it's not that I'm smarter than him or I know because I'm a civilian psychiatrist. I'm just trying to bump him out of his more magical child, it's my fault thinking, into his own rational adult mind, which I'm already in because I never went through the experience. Right. Yeah. And so when I walked through the whole scenario in quite a bit of detail, okay, how could you have known at the time what red flags were there? There weren't any. So the basic, basic problem is not that it's your fault. It's that it wasn't your fault. And the reason that's the basic problem is it's that underlying powerlessness and helplessness that's so hard to take. Yes, and it... No matter what, I could not save my... I just didn't have the power. I was helpless, vulnerable, scared. But if you stay in self-blame, then you're going, oh, well, wait a minute. I don't have to feel all that powerlessness and helplessness because, in fact, I had the power to control. I just messed up. So you stay out of the powerlessness and helplessness at the cost of self-blame and self-punishment. Yeah, and trying to get them back into a mode of self-control, correct? Right. Yeah. Dr. Ross, we are going to take a short commercial break and we will be back in a little bit, okay? Okay. Are you searching for answers and insight to life issues? Is the behavior of family or friends questionable or concerning? Find tips and possible solutions from the convenience of your own PC, cell phone, or tablet at therapycable.com. Therapy Cable has the most comprehensive library of contemporary therapy videos online. Help me. Be as easy as a few clicks away. Therapy Cable offers comprehensive therapy videos ranging from addiction to self-care and contact information for qualified providers. Find the answers to your life challenges at therapycable.com. And welcome back to Psych 101 with Julianne Good and Dr. Colin Ross. We are talking about suicide ideation and combat veterans. Dr. Ross, can you tell us a little bit about the brain biology and circuitry within therapy? And can you tell us a little bit about the brain biology and circuitry and PTSD? Sure, a little bit. I'm not an expert expert on that, but I do know a reasonable amount about it. And in a way, I think it doesn't matter what's going on with the brain. It sort of matters from a research perspective and in theory and proving that it's real and it's not just you imagining, it's really your brain. But really, what we know about the brain doesn't really tell us much about what to do in therapy. So, it's not much. It's not really my core interest, but basically we've got several layers to our brain. We've got the cerebral cortex, which is the top outer layer. And the frontal cortex, which is near your forehead, the top of your forehead. That's kind of the thinking part of your brain. And then we've got what's called the limbic system, which is the emotional part of the brain that's deeper in. And then way down deep in the brain and then the sort of brain stem, which is kind of where the brain meets the spinal cord. That's where the brain meets the spinal cord. That's a lot of the deep control centers for just breathing, basic digestion, things like that. And so, we know that trauma reaches at least down into the brain stem because there's fight flight adrenaline type centers down in there that get activated by trauma and become very hyper aroused. We know that part of the limbic system called the hippocampus, which is the kind of memory part of the brain, that brings us here, just walking around the world. You see something, you hear something, you smell something. You have the physical sensation, you have emotional sensation, you've got a thought. All of that has to get blended together into a uniform sort of integrated experience. Otherwise, you'd be like looking through the 400 lenses of the fly's eyes sort of thing. So the hippocampus does that blending together of memory. And we know that hippocampus can get, you know, damaged by trauma and stress. When you have a whole bunch of stress and trauma, your adrenaline goes way up and the adrenaline affects the nerve cells in the hippocampus. And through a series of steps, you end up with damage to those cells. And so we know from more than 10 or 15 studies now that if you take somebody with any form of PTSD and trauma, but including military and combat trauma, their PTSD is going to show up on brain scan often, not all the time, but often, as some shrinkage in hippocampus. And so that sounds horrible, but physical trauma, we know can cause brain damage. But emotional, psychological trauma also causes brain damage. But the good news is we've also learned in the last 20 years, especially the last 10 years, the brain, especially the hippocampus, actually has the ability to repair itself. So now the research is getting into trying to figure out if when you've got some damage to your hippocampus, so you can't integrate your memories properly, and your memory's not working as well as it should. If you go through a therapy healing process, does the hippocampus grow back to normal size? So that's, you know, remains to be seen, but pretty good chance that'll turn out to be the case. That'll be fascinating to see. Other parts, sorry, what? That will be fascinating to see, but pretty good chance that'll turn out to be the case. Other parts, sorry, what? That will be fascinating to see, because I know I've done a lot of brain research and research on PTSD, and you're right, it's the shrinkage of the hippocampus and amygdala, and the neurocircuitry is rewired in a way that, you know, has to be repaired if it can be. Now, what techniques do you use to do the repair work? Well, my treatment model and my treatment programs, which are inpatient and, you know, I'm not a doctor, but I'm a doctor, so I'm a doctor. I grew up doing day program treatment, but it's the same treatment model in outpatient therapists' office. Basically, there's a lot of cognitive behavioral, which is changing your thinking, changing your beliefs, changing perception of things so that you reassess the situation and go wait a minute, it's not reasonable to blame myself, it's not my fault. Certainly my dead buddy wouldn't be blaming me, and so I just need to let go of that and come to terms with, with the underlying sad reality, which is I couldn't save them. And it's not my fault. It just wasn't doable. So that's the kind of thinking, cognitive part of it. And then there's learning new life skills and how to cope better. So if you're drinking a lot to suppress your PTSD, you want to, just like going to school, learn more skill for how to modulate your feelings, deal with them, ground yourself, distract yourself. So there's a bunch of skill building like that. And then there's a lot of relationship rebuilding, like family members and loved ones. And then there's sort of a desensitization part of it, which is practicing and learning how to tolerate those feelings instead of running away from an anger, rage attack, or getting drunk, or beating up your wife, sex addiction, internet addiction, pornography addiction, all these things that people do to run away from their feelings. So how long of a program is it for inpatients? Well, where I work, it depends on which facility you're at, what kind of insurance you've got, and so on. So it's half Medicare, half managed care, just in my programs in general, and then the soldiers of TRICARE and so on. But basically, we're talking for civilians an average length of stay is a little under two weeks inpatient, a couple of weeks day program. Sometimes some programs can stretch that out more towards a month. And then there's a level of care called residential treatment center, which is more of a step down, not quite as intense, where insurance companies sometimes will pay for a month or two or three. And then there's different levels of programming within the program. And within the military and within the VA as well. So the inpatient part is relatively short and intense. The whole recovery process from, if you've got serious childhood trauma, serious combat trauma, full PTSD, depression, suicidal, maybe substance abuse, anger problems, this is not a couple of weeks or couple of months project. This is a couple of years. At least. It's better than years. Yeah. Yeah, that sounds like that would be really intensive work to be doing with a vet. It's complicated for the person. Yeah. It's intellectually complicated. It's exhausting. It's very, very painful. And you really got to roll your shoes up and get to work. But it's doable. Yeah, that's the great thing is it is doable. Now, what do you do to deal with the resistance? The first thing I do is applaud it. So I always say resistance sounds like you're not cooperating. You're being bad. You're not committed to recovery. We don't like you. Go away. We want to deal with somebody who's committed to recovery. That's kind of the bad press that resistance gets. But actually, if you went to the other extreme where you had no resistance whatsoever, you'd be totally overwhelmed and fluttered with all these feelings. You'd be completely meltdowned. You'd be completely out. So resistance is actually a good thing unless it's too much, too rigid, too inflexible. But also, many people come into the hospital, the majority actually, who come into the hospital, in a sense, they don't have enough resistance. They're too opened up, too overwhelmed, too fluttered with feelings and trauma. And then they're drinking and acting out to try and squash it back down. So we actually, in a sense, want to have a little more resistance, get the lid back. Get the person grounded and stabilized. And then work on it in a much more step-by-step-by-step kind of systematic fashion. So rebuilding the person from inward out, correct? And I view resistance almost as a self-protective measure. Absolutely, yeah. But like any self-protective measure, you can become too rigid, too overbored, too extreme with it. And then it becomes a problem. It becomes a problem just by itself. Mm-hmm. Yeah, and then they get the reputation as being rebellious and uncooperative, correct? Well, if we step outside the military context to kids, so kids are prone to getting in trouble, and then they get to see psychiatrists. And then psychiatrists put labels on them, like conduct disorder and oppositional defiant disorder. Mm-hmm. Well, I'd say, good job, kid. I'm glad to see that you got some spunk. You're not just buying into everything these abusive adults in your life are telling you and saying to you. So being oppositionally defiant when you've got abusive, out-of-control parents, to me, it's just good spunk and lack of spirit. Mm-hmm. But then if you become like an out-of-control little criminal in a 10-year-old body who's beating up kids on a school ground, that's not good. That's going too far. That's just not going to go well with it. Right. So what is the difference about working with a younger vet versus an older vet? Because it was interesting, I talked to a vet yesterday that had been in for 11 years, and he said that he and some of his fellow soldiers had to protect this 17-year-old female that came into their troop. Mm-hmm. And he said, she didn't have an infirm, so… Mm-hmm. she was just a baby and, you know, she was just wide open to whatever experiences they were going through. And, you know, I would imagine that being younger is going to have more of an impact versus somebody that's a little bit older as for coming back with symptoms. Well, it all depends. This is why there's very few like hard and fast rules. There's, you know, principles and general patterns. But so the younger person could have more problems, more PTSD because they were younger when they went over. They weren't as resilient. They didn't have much other life experience, et cetera. But on the other hand, the older person, maybe who's been in longer, has had more combat exposure and has even worse PTSD because they've had four deployments. So it could go either way. But the older guy who's been in for a while, he's had more combat exposure. He's had more combat exposure. He's had more 10 plus years. And you've got the young female who just comes in. When something happens to her, then it's, that's just going to, it's all your fatherly instincts and your protective instincts and you're like the male who's protecting the cave sort of instincts are going to get ramped up. And then when the woman that you're supposed to be protecting gets hurt, then the self-blame could even be greater. Especially if they're close to their mothers or their sisters at home. Exactly. But on the other hand, combat is actually not the most frequent cause of PTSD and deployed female U.S. military members. And this is according to the VA. This is not according to me. According to the VA, the most common cause of PTSD in female returning deployed personnel is rape by U.S. male military members. That's horrible. And so then, that's just horrible, period. And it's horrible in a civilian situation. You get that self-blame. It's my fault. I shouldn't have gone there. I shouldn't have this. I shouldn't have that. But then in the military situation, you've got several other layers added on. You've got not just betrayal by the individual person, but then you've often got the don't ask, don't tell sort of culture. And then you've got betrayal by the institution. And then you've got the military. It's supposed to be a protective family. And you're supposed to be honored for your service. But instead, you're not getting promoted. You're getting excluded. You're getting blamed. You're getting not believed. And you're getting thrown back in the line again. And that's this whole culture of the military that's extremely hard to change, which is not really much different from the culture of fraternities at college. You know, rape on colleges is a rampant out-of-control problem. And underreported. Undereported. Look the other way. There's hundreds of survivors. They deny it, deny it, deny it, until it just becomes undeniable like the Joe Paterno scandal. But the same thing happens commonly in the military. And so people just feel more powerless, more betrayed. And they're paying a price emotionally. Emotionally. Personally. And career-wise. It's a horrible, horrible problem. It is. Well, especially for the females who come in and they have been traumatized during their childhood. They may be escaping an abusive household by going into the military, thinking that they're going to be protected on a different level. And then they get assaulted in the military and come back. And then they come back with complex trauma. Yeah, very complex. Very complex. Which is a problem. Exactly the same as the civilian situation, except instead of going into abusive military, they go into an abusive marriage, and then another abusive marriage, and then another. You see that commonly. So having an abusive childhood doesn't doom you to an abusive adulthood, but it certainly much increases your risk. Yes. Because all these negative self-beliefs kick in. You have less self-protection, poorer boundaries, you feel like you don't deserve anything any better. So you don't say no as effectively. You make poorer choices in relationships. And then you just get stuck and trapped. Until you reach out and get some help and start breaking that cycle. Right. That's the key. Or sometimes you fail yourself. Yes, hopefully not. Dr. Ross, we're going to take another break. And when we come back, let's wrap up. And any last thoughts you have on this subject would be great. Sure. Thank you. Thank you. ¶¶ ¶¶ ¶¶ ¶¶ ¶¶ ¶¶ ¶ You're on your own ¶¶ In a world you've grown, few more years to go Don't let the hurdle fall, so be the girl you loved Be the girl you loved I'll wait, so show me why you're strong Ignore everybody else, we're alone now I'll wait, so show me why you're strong Ignore everybody else, we're alone now Suddenly I'm hit, it's the start of the storm And your friends are gone And your friends are gone And your friends won't come So show me where you've been So show me where you've been I wait, so show me why you're strong Ignore everybody else, we're alone now I wait, so show me why you grew grew grew I'll wait out Suddenly I'm hit It's the start and so I go And your friends are gone And your friends won't come So show me where you've been So show me where you've been So show me where you've been So show me where you've been So show me where you've been So show me where you've been So show me where you've been So show me where you've been So show me where you've been So show me where you've been So show me where you've been So show me where you've been So show me where you've been So show me where you've been So show me where you've been So show me where you've been So show me where you've been So show me where you've been So show me where you've been they're actively abusing you, then they're okay, and then they're absent. So you end up with this I hate you, don't leave me approach, avoid, love-hate relationship pattern with other people and with yourself. Yeah, definitely. And Dr. Ross, we have about a minute left, and can you instill a little bit of words of hope and how people can get you or find information off your website? Well, the website's rossinst.com, R-O-S-S-I-N-S-T, and all my books are available in the bookstore there or from Amazon. And my main message is not like a condescending pat on the head at all. My main message is if you roll up your sleeves, you get to work, you stick with it, there's no guarantee in the model field, but it's realistically possible you can make pretty and perfect decisions. I've seen a lot of people do it. That's great. Thank you so much for being my guest, Dr. Colin Ross. Thanks for having me. And thank you for listening to Psych One-on-One. I am now on Tuesday nights until the end of the year from my normal Monday night slot. So join us every Tuesday between 7 and 8 p.m. Pacific Standard Time. If you would like to contact me, my email address is jgoode8 at verizon.net. My office number is 562-234-7290. And you can contact me anytime. Please, if you have any suggestions or need some contact, need some help, please give me a call. Please contact me. And thank you so much, Jenny Guzman, for being on the board. And thank you for listening. Take care of yourself. Take care of each other now. Take care. Thank you.