B0038M1ADS EBOK

B0038M1ADS EBOK by Charles W. Hoge M.D. Page A

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Authors: Charles W. Hoge M.D.
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made his jumpiness worse. He had trouble sleeping, would wake after a couple of hours, and be unable to fall back asleep.
He also experienced nightmares, and would sometimes try not to fall
asleep to avoid them. Whenever he went places where there were crowds,
he felt tense, edgy, and his heart pounded. As a result, he stopped going
out much, which affected his relationships. He started drinking more alcohol to calm down and help with sleep.
    SSgt L (Staff Sergeant), back from his second tour in Iraq, found himself becoming furious every time things didn't go the way he expected.
If his fiancee, Sally, moved any of his things, he would become enraged.
During one incident, while running an errand, he came storming into her
house angry that he had been unable to reach her by cell phone. He had
mixed up the directions she gave him and had taken a wrong turn. When
she failed to pick up his calls, he lost his temper. Sally's sister, who was
visiting, was stunned by the intensity of his rage, and Sally's five- and sevenyear-old nieces cowered at the edge of the room. Sally felt humiliated at
being yelled at in front of her relatives. She also felt helpless, confused,
and angry. Finally, her sister stepped in and told SSgt L to take his anger
outside, which to his credit, he did. Sally's sister then turned to Sally and
told her that she was making a big mistake being involved with this guy.
It took about an hour for SSgt L to calm down, after which he was apologetic; however, Sally's family continued to feel uncomfortable around him.
    If either of these stories sounds familiar, then this chapter will provide
context and offer some useful advice. Both of these warriors were continuing to feel physically revved up and hyperalert after returning home. They
were reacting to situations back home as if in the war zone, and these reactions had become reflexes that they were unable to control. Both of these
men were experiencing high levels of anger-for HM3 J, toward himself;
and for SSgt L, toward his fiancee. Both were having problems with con trol. HM3 J was angry at being unable to control his own reactions; SSgt
L was angry at his fiancee if she moved his things or if she wasn't available for him when he thought she should be. The reactions for both of
these warriors were affecting their relationships. In SSgt L's case, his anger
didn't make a good impression on his fiancee's family. It embarrassed his
fiancee, scared her nieces, and resulted in her sister advising her to call off
the engagement.

    To understand the experience of these warriors, the most important
thing to realize is that their reactions were products of their combat survival skills-protective reflexes that were not well controlled after coming
home. For HM3 J, the speed with which he reacted to dangerous situations during deployment saved him many times and was ingrained in his
reflexes. After returning home his body remained on high alert to threats
and reacted instantly to loud noises. It sent him danger signals, such as his
heart pounding, whenever he entered a crowded mall. He found it difficult to relax and sleep. His sleep pattern was similar to what it had been
in Afghanistan, where he would catch two to three hours of sleep before
going out on a night patrol. Nightmares, often involving combat, also kept
him revved up. He was frustrated because his conscious mind could do
nothing to control his reactions. He expected to have better control over
himself since he had performed extremely well under fire. His anger at
himself made everything worse. He also didn't realize that his increased
use of alcohol was contributing to the heightened reactivity of his reflexes.
    For SSgt L, getting angry at his fiancee was also a result of his combat
survival skills. If she moved any of his things, he reacted in almost the same
way he would if he couldn't find an important piece of gear before going
on patrol. Not answering her cell phone

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