Operator Syndrome w/ Dr. Chris Frueh

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There are few things that make people successful.

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Taking a step forward to change their lives is one successful trait, but it takes some

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time to get there.

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How do you move forward to greet the success that awaits you?

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Welcome to Next Steps Forward with host Chris Meek.

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Each week, Chris brings on another guest who has successfully taken the next steps forward.

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Now here is Chris Meek.

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Hello.

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You've tuned in this week's episode of Next Steps Forward, and I'm your host, Chris Meek,

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and welcome to the new year.

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As always, it's a pleasure and an honor to have you with us.

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Our focus is on personal empowerment, a commitment to wellbeing, and the motivation to achieve

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more than you ever thought possible.

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We start 2025 with an outstanding guest.

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Dr. B. Christopher Free is a clinical psychologist by training and professor of psychology at

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the University of Hawaii, Hilo.

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His development of something called the Operator Syndrome is helping to change the way we understand

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and treat the complex set of interrelated health, psychological, and interpersonal difficulties

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experienced by military special operations personnel.

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Dr. Chris, as he's known, is also very actively involved in the SEAL Future Foundation, Boulder

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Crest Foundation, Military Special Operations Family Collaborative, The Mission Within,

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VetSync, The Quick Reaction Foundation, and the Military Special Operations Community

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in general.

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You're a busy guy, doctor.

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Dr. Free has testified before Congress and served as a paid contractor for the Department

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of Defense, Veterans Affairs, US State Department, and the National Board of Medical Examiners.

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Dr. Bartley Christopher Free, welcome to Next Steps Forward.

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Right on.

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Thank you.

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Thank you, Chris.

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I'm excited to be here.

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And again, we talked pre-show, but I'm a little jealous.

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I'm here in blustery Connecticut where it's 20 degrees with 40 mile gusts and you're in

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sunny Hawaii looking at the ocean.

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So if I'm a little green with envy here, that's why.

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So Chris, what I didn't mention in the introduction is that your dad is a US Air Force veteran

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who served in Vietnam.

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Is it fair to say that his experiences and yours growing up as the son of a military

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veteran who served in combat shaped your decision to pursue the career that you did?

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Yeah, definitely.

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Now, I do want to clarify.

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My father was a physician.

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He was not a combatant, but I was about six years old when he deployed to Vietnam.

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And then in subsequent years throughout my teenage, into my teenage years, had quite

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an awareness of the war, what it meant for the soldiers, even for the people of Vietnam.

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My father became very involved in the expat community at the University of Missouri of

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Vietnamese students in the early seventies.

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So we had a lot of, we had a lot of uncles and aunts from that community.

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But I also want to mention my great grandfather was a veteran of the Spanish American war

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and he served and fought at the Battle of San Juan Hill in the Michigan militia.

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And he was one of my childhood heroes.

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He lived to be almost a hundred.

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So I think I was 14, 13 or 14 when he died.

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So I knew him quite well.

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I went to graduate school with the idea of I wanted to work with veterans.

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It's amazing family history there.

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Now that's great.

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And thank you for your family service.

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So the first chapter of your career from 1991 to 2006 was with the Veterans Administration

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Healthcare System.

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Would you share your journey to becoming a psychologist and then what you learned during

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your 15 years serving at the VA?

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Sure, right on.

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So graduate school at the University of South Florida.

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My dissertation was with veterans with PTSD.

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That was the group I wanted to study for my dissertation.

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And I was able to get a position at the VA in Charleston, South Carolina for my final

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year of training.

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And that's part of the progression for a PhD in clinical psychology.

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So I went there for one year to complete that year of training.

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And that was the VA and the Medical University of South Carolina.

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And when that year ended, the gentleman who'd been my supervisor for the first part of the

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year had left.

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So I stepped right into that job.

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And I was there for another 15, 14, 15 years after that.

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I loved working at the VA.

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I really enjoyed the patients that I worked with.

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I really enjoyed my colleagues.

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Had a really good, solid, amazing team of colleagues while I was there.

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And I was a full-time clinician for the first seven years.

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But had these questions about our patients, the people we were seeing.

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And it just so happened we had a file cabinet of data, of patient folders going back probably

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a decade.

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And it was just all the psychological data in there.

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So we started putting that into statistical programs, entering a lot of that data by hand.

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And we wrote some papers.

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And that led to kind of the next phase of my career, which was I applied for several

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federal research grants from the NIH.

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Received those grants.

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And then the next eight years that I was there in Charleston were kind of divided between

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my work in the clinic at the VA and my research programs, which were at the VA and the Community

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Mental Health Center.

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I left the VA in 2006.

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And really, I would say the reason I left was I just was very frustrated with VA policies

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at the central office level.

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Not locally.

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I was not upset with anything locally.

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And it wasn't that I felt like I had to get out.

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But some opportunities came up.

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And I was kind of ready to go and move on.

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Obviously, you worked with a cross-section of veterans in the VA.

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But what drew you to work specifically with military special forces warriors?

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So that happened about 10 years ago.

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It started about 10 years ago.

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And it was not a plan that I set out to go, OK, I'm going to do these things with this

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community.

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It was more organic and kind of random in the way it started.

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I was at the University of Hawaii.

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But I also had a position at Baylor College of Medicine in the Baylor College of Medicine.

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And in Houston, Texas, where I was the director of research at the Menninger Clinic, they're

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affiliated with Baylor College of Medicine.

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And my friends, my circle of guys that I knew and hung out with, most of them came from

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the special operations community.

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And pretty early on, it was suggested to me by somebody who was not directly, he was not

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an operator, but he had served with operators in Afghanistan.

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And he said, you know, some of these guys are really struggling.

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Maybe you could talk to them and help see what you could help them figure out.

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And I started with the idea of, well, it's probably PTSD, you know, and I'm going to

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just put a pin in that because we'll come back to that probably.

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But I had an assumption that it was PTSD.

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And my assumption proved to be mostly wrong and certainly massively insufficient to understand

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the difficulties that they were.

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These guys, my friends were experiencing.

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And essentially, you know, you go, well, what's the, in medicine, we talk about what's the

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primary complaint or what's the starting point?

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And the primary complaint was this, something's wrong with me and I don't know what it is.

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And I essentially, I've heard that over and over again in the past decade.

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And starting with the assumption, well, what's wrong with you is probably PTSD.

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And then come to find out it really wasn't.

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And yeah, some depression, some anxiety, a lot of anger issues.

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But underlying that, and it took some trial and error to get there, was massive sleep

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dysregulation, not just insomnia, but sleep apnea.

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And that surprised me.

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I was not, 10 years ago, I was not prepared to find that these relatively young, healthy,

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fit men would have sleep apnea.

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That didn't, that didn't compute.

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The other thing that didn't make sense to me initially was we discovered they all had

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super low testosterone.

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Testosterone of, you know, of an 80 year old man.

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And so when a man has low testosterone at that young of an age, he's going to look, he's

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going to look like he's depressed.

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He's got, he's not going to be sleeping.

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Concentration is impaired.

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Irritability, anger, mood is going to be low.

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Motivation and energy are going to be very low.

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Just loss of interest in kind of everything, including working out, including work, including

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sex.

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And so a lot changed when we started to address the sleep apnea and the hormonal dysregulation

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that these guys had.

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And then that kind of opened the door to look at some other things.

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And wow, they've got, they've all got chronic pain.

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They've all got, you know, came to realize they all had traumatic brain injuries from,

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and I didn't understand this, but from blast exposures.

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And so now I have to learn about blast exposures.

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And in 2014, there wasn't much research out there.

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So that that's become something that today, I think we now have a much better lock on,

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but still, we're still far from, from really fully understanding this.

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And it has not, that knowledge, the scientific knowledge of blast exposures has not really

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leaked out into the broader community of clinicians.

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And so that's one of the things we face right now for all veterans, I believe.

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And how are military personnel different from those of us who aren't serving or haven't

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served in the military?

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And then how are special forces personnel different from other military personnel?

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Okay.

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So, right.

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Good question.

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Because we're talking about operator syndrome, I want to, I want to, I want to say a few

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words about what is an operator and how do we define them?

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And how do I think about this?

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So, first of all, I've worked with primarily, mostly a lot of operators, hundreds of operators

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over the last decade.

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An operator is, is somebody who's in one of the special forces units who goes through

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special assessment and selection process.

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For example, maybe Naval Special Warfare, they go through BUDS school and they can become

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a SEAL if they, if they complete it.

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So SEALs, Green Berets, MARSOC, you've got the, in the Air Force, you have the pararescuemen

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and, and combat controllers.

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I've worked with operators from Canada and many other countries as well.

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It's a, it's an extraordinarily rigorous selection process.

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Somewhere between, you know, maybe five and 8% of everybody who starts the training, it

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completes it and is selected into those units.

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And then for the people that, that make that for a career as an operator, those, those

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careers involve several things, but one is an incredibly high intensity level of training

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on a constant basis.

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And the level of training between an operator and, and pretty much any other, you know,

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soldier, for operators, the, let's, let me use the word dose, the dose of, of physicality,

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the dose of blast exposures, the dose of, of all of what, what we'll call allostatic

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load.

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And we can come back to that, is, is magnitudes of order more than it is for most soldiers.

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But I want to say this very clearly, operators are not the only ones that have aversion to

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aversion of operator syndrome.

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I've certainly seen it in, in, you know, any soldier doing urban combat, you know,

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Marine, Marines, they may have less, they may have shorter careers than the typical

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20 year career.

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But the intensity of that combat is, is, is profound.

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Artillerymen, combat engineers, infantry, pilots who are experiencing, you know, the

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G-forces, SWCC boat op, fast boat operators, and, and many of the support folks and intelligence

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roles that are embedded in work directly with operators.

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And then the other group that we see these, these issues in is law enforcement and first,

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first all first responders, law enforcement and firefighters have their own versions,

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some differences, but similarities.

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And 25% of the first responders are veterans themselves.

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That's right.

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That's, and my viewers and listeners know, I just finished my doctorate earlier this

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year and I was focused on first responder and police mental health.

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And so probably cited, probably cited a few of your papers in there.

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Yeah.

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So, so the same stuff that I do with operators is now, we're now applying that in a variety

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of contexts for first responders.

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And that's, that's, that's been, that's been really rewarding for me.

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And, and the one thing I've highlighted, I'll say the one positive thing of COVID is,

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it has put a big, huge spotlight on mental health and has significantly reduced the stigma,

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you know, with the phrase, it's okay to not be okay.

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And so that's the one positive thing that the negative, one of the many negatives though,

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is that we're now seeing that tsunami of that mental health crisis across the board come

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crashing down.

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And so I appreciate folks like yourself that are sort of in the fight, if you will,

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for treating those folks.

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And maybe as a follow up to that, building trust is always critical for psychologists,

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no matter who the patient may be.

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As you look at the differences between special forces personnel, other military personnel,

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and then the rest of us, what sort of professional challenges does working with special forces

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create for you and your peers?

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Well, good question.

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A very common story, a very common experience I hear from operators is that they have a

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good experience with mental health clinicians.

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Part of the challenge in the military is there's a dual role.

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So a psychologist, a social worker, other therapists in the military are both trying

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to treat, screen and treat soldiers.

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They're also part of the command structure.

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So the fitness for duty is a mandate that they have to report on and document.

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So if you're an operator, and I mean, you're going to know, depending on what you say to

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the psychologist, you might get pulled out of your unit.

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You might miss a deployment.

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You might get pulled off a training evolution.

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So there is a, I would say, I'll say this diplomatically, I would say operators are

237
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very guarded in what they share with mental health teams in the DoD.

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On the civilian side, so operators that go to, and this is true of many veterans that

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00:14:51,440 --> 00:14:58,960
go to the VA or go to civilian care providers, one experience, and I hear this all the time

240
00:14:58,960 --> 00:15:04,240
with operators, is they go, they have that first meeting with the therapist and they

241
00:15:04,240 --> 00:15:08,320
start just tipping their toe into the water and talking about a little bit of the things

242
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they've seen and done.

243
00:15:10,240 --> 00:15:11,920
And it upsets them.

244
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The therapist starts to have an emotional reaction, is crying or emoting.

245
00:15:17,600 --> 00:15:22,960
And frequently the soldier or the veteran just gets up and says, I'm sorry, and I'm

246
00:15:22,960 --> 00:15:23,280
sorry.

247
00:15:23,280 --> 00:15:23,680
I upset you.

248
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And they leave.

249
00:15:25,600 --> 00:15:31,600
Related to that I think is the bigger issue, which is most mental health professionals

250
00:15:31,600 --> 00:15:32,640
are not educated.

251
00:15:34,320 --> 00:15:37,760
They don't have an awareness of what operators are doing.

252
00:15:38,240 --> 00:15:42,880
They don't have an awareness of what operators do.

253
00:15:42,880 --> 00:15:47,760
They don't know, they don't have a sense of the culture, a sense of the experiences.

254
00:15:48,720 --> 00:15:52,400
And that's not even their fault per se.

255
00:15:52,400 --> 00:15:56,880
When I worked at the VA, I never had a patient who'd been a Navy SEAL or a Green Beret.

256
00:15:58,000 --> 00:15:58,560
Never.

257
00:15:58,560 --> 00:16:03,840
The closest I think I ever came to anything we would consider to be special operations

258
00:16:03,840 --> 00:16:10,320
was a couple of force recon veterans who were force recon in Vietnam.

259
00:16:10,320 --> 00:16:16,240
And that was, so there's not, I mean, operators are a small percentage of the military to

260
00:16:16,240 --> 00:16:17,280
begin with.

261
00:16:17,280 --> 00:16:19,120
And many of them just don't use the VA.

262
00:16:19,120 --> 00:16:25,440
So it's probably a group of patients that most therapists don't have experience with.

263
00:16:26,080 --> 00:16:32,400
Now, I tell you all of that to say this, there is a nonprofit organization now, it's about

264
00:16:32,400 --> 00:16:34,240
two years old called the Soft Network.

265
00:16:36,000 --> 00:16:39,840
And so if you're listening and you hear this, the Soft Network, you can look them up on

266
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the internet.

267
00:16:40,960 --> 00:16:47,360
And what they have is essentially a registry, state by state registry of therapists who

268
00:16:47,360 --> 00:16:53,680
have been kind of identified as being culturally competent to work with soldiers, combatants,

269
00:16:53,680 --> 00:16:55,200
and especially soft.

270
00:16:55,200 --> 00:16:59,040
They're not going to just, they're not going to, they don't have a, they don't have specific

271
00:16:59,040 --> 00:17:00,960
cutoffs for who they work with.

272
00:17:00,960 --> 00:17:06,320
All of the therapists are individual private practitioners who have this foundation.

273
00:17:06,320 --> 00:17:07,680
So it's just a way to find them.

274
00:17:07,680 --> 00:17:09,840
It's a, it's essentially a referral source.

275
00:17:09,840 --> 00:17:14,400
It's not, they don't, they don't pay for the care or provide or are either former soft

276
00:17:14,400 --> 00:17:20,400
themselves, former, there's a lot of operators who got degrees and are now therapists.

277
00:17:20,400 --> 00:17:23,920
There's a lot of spouses in there of operators.

278
00:17:23,920 --> 00:17:28,320
And then there's a, you know, there's a number of people who were clinicians in the, in the

279
00:17:28,320 --> 00:17:32,080
special operations community when they were active duty and are now out.

280
00:17:32,080 --> 00:17:34,400
So there, there are resources out there.

281
00:17:34,400 --> 00:17:35,520
We're starting to find them.

282
00:17:35,520 --> 00:17:38,160
They're starting to be developed kind of at the foundation level.

283
00:17:39,440 --> 00:17:42,880
And by soft network, you mean special operations forces network, correct?

284
00:17:42,880 --> 00:17:45,280
Just for clarity, just for our listeners, they know how to look it up.

285
00:17:45,840 --> 00:17:46,080
Yes.

286
00:17:46,080 --> 00:17:46,480
Thank you.

287
00:17:46,480 --> 00:17:49,680
So it's SOF, soft network.

288
00:17:49,680 --> 00:17:50,080
Thank you.

289
00:17:50,960 --> 00:17:54,960
And I want to go back to a comment you made about, you know, a clinician talking to an

290
00:17:54,960 --> 00:17:59,360
operator and then just not being able to handle those scenarios that the operators have gone

291
00:17:59,360 --> 00:18:00,240
through and are talking about.

292
00:18:01,120 --> 00:18:05,040
How do you handle your mental health and your wellbeing as you're treating these, these

293
00:18:05,040 --> 00:18:05,520
warriors?

294
00:18:07,440 --> 00:18:12,960
Oh, I don't, I don't have any, I don't think I have any special challenge with that.

295
00:18:12,960 --> 00:18:21,360
I mean, I think it's very common for therapists early in a career to working with veterans to

296
00:18:21,360 --> 00:18:23,520
have some of their own emotional reactions.

297
00:18:23,600 --> 00:18:26,880
And I certainly did in the first few months that I worked at the VA.

298
00:18:26,880 --> 00:18:28,400
I, I definitely remember.

299
00:18:28,400 --> 00:18:33,600
And that was, that was part of what the supervisors worked on with all of us was acknowledging

300
00:18:33,600 --> 00:18:38,000
that, yeah, as we're going to have some, some reactions to hearing the kinds of things that

301
00:18:38,000 --> 00:18:40,640
we, that we're not familiar with, that we haven't heard before.

302
00:18:41,520 --> 00:18:45,440
But I don't, I don't really feel that any, I don't, I mean, that went away quickly.

303
00:18:45,440 --> 00:18:51,440
And then as I started working with the special operators, yes, there's far more combat over

304
00:18:51,600 --> 00:18:54,640
course of many more years than there is for typical soldiers.

305
00:18:55,360 --> 00:19:00,480
A lot of the loss, a lot of the death that operators see, see and experience in their

306
00:19:00,480 --> 00:19:02,640
community actually comes from training as well.

307
00:19:03,360 --> 00:19:08,000
So, you know, static line jumps that didn't go well.

308
00:19:08,000 --> 00:19:08,800
Things like that.

309
00:19:11,760 --> 00:19:16,000
I don't really, you know, I get asked this question about vicarious trauma.

310
00:19:16,000 --> 00:19:18,480
No, I don't, I don't really feel anything for that.

311
00:19:19,440 --> 00:19:22,800
Do you ever work with the spouses of active duty personnel and private contractors?

312
00:19:23,440 --> 00:19:24,000
I do.

313
00:19:24,000 --> 00:19:25,040
Yeah, I have.

314
00:19:25,040 --> 00:19:25,600
Yep.

315
00:19:25,600 --> 00:19:28,800
And sometimes that's individually from their husbands.

316
00:19:28,800 --> 00:19:32,960
Sometimes it's with, you know, with the husband, with the, with, as a couple.

317
00:19:33,600 --> 00:19:35,520
And sometimes it's with the, at the family level.

318
00:19:35,520 --> 00:19:41,840
I know I've, I've had the, the, the pleasure to get to know many adolescent children who

319
00:19:41,840 --> 00:19:46,560
are learning and grappling with their, their parents' experiences.

320
00:19:46,640 --> 00:19:49,760
And I understand that you've also worked with Canadian special forces operators.

321
00:19:50,400 --> 00:19:53,840
Can you compare and contrast how they're the same as American special forces personnel

322
00:19:53,840 --> 00:19:54,880
and how they're different?

323
00:19:54,880 --> 00:19:56,000
If there are any differences?

324
00:19:56,640 --> 00:19:58,160
The only differences is the accent.

325
00:20:00,160 --> 00:20:01,440
A and cheese curd?

326
00:20:01,440 --> 00:20:04,640
And the, and the, yeah, and the cheese curd and the tolerance for cold weather.

327
00:20:05,520 --> 00:20:06,240
Fair enough.

328
00:20:06,240 --> 00:20:08,320
They're more hockey fans than baseball fans, probably.

329
00:20:09,120 --> 00:20:10,160
They're exactly the same.

330
00:20:10,800 --> 00:20:11,840
They're exactly the same.

331
00:20:12,480 --> 00:20:20,080
And I've, I've worked with operators in Australia, Israel, Britain, Netherlands,

332
00:20:20,080 --> 00:20:27,040
Scandinavia, Poland, probably a few other places, but well, Afghanistan and Iraq as well.

333
00:20:27,040 --> 00:20:31,680
I've worked with them, done work with some of the interpreters, actually quite a few

334
00:20:31,680 --> 00:20:34,400
interpreters who functioned as special operators.

335
00:20:34,400 --> 00:20:39,920
So it's, you know, it's the same, you know, the TBI, the hormone disruption,

336
00:20:39,920 --> 00:20:45,120
the sleep disruption, the chronic pain, the psychological features, the headaches, the

337
00:20:46,400 --> 00:20:49,760
cognitive problems, cognitive impairments.

338
00:20:49,760 --> 00:20:52,240
It's, it's, it's, it's universal.

339
00:20:53,520 --> 00:20:55,920
Earlier in the show, you mentioned the phrase operator syndrome.

340
00:20:56,880 --> 00:20:59,760
How long did it take you to recognize the concept of the operator syndrome?

341
00:20:59,760 --> 00:21:02,000
And how much longer did it take you to fully flesh it out?

342
00:21:02,000 --> 00:21:03,520
You know, was there a particular aha moment?

343
00:21:05,120 --> 00:21:09,520
Yeah, well, I don't know that there was an aha moment.

344
00:21:10,160 --> 00:21:12,640
I think there were multiple aha moments early on.

345
00:21:13,600 --> 00:21:19,120
And, you know, as I talked with dozens, and then eventually hundreds of operators over the,

346
00:21:19,120 --> 00:21:23,360
over the years, it became a pattern recognition thing.

347
00:21:23,360 --> 00:21:26,320
It's like, I've seen this, I know what questions to ask.

348
00:21:27,120 --> 00:21:31,520
Early on, I started keeping a, just kind of a log of things that I was learning.

349
00:21:32,320 --> 00:21:36,720
And, and as that log got longer, it was a living document.

350
00:21:36,720 --> 00:21:41,840
And I started sharing it with operators at some point after probably three or four years,

351
00:21:41,840 --> 00:21:42,720
like, Hey, read this.

352
00:21:42,720 --> 00:21:44,240
This is just kind of a white paper.

353
00:21:44,880 --> 00:21:47,120
This is kind of what I'm, I'm understanding.

354
00:21:47,120 --> 00:21:50,080
And initially I called it the operator sleep manual.

355
00:21:50,880 --> 00:21:54,480
Didn't put mental health in there, but, but everything it takes to sleep better

356
00:21:54,480 --> 00:21:56,400
covers everything that we're talking about here.

357
00:21:57,200 --> 00:21:59,280
And that was well-received.

358
00:21:59,280 --> 00:22:01,360
And I had guys saying, well, you should publish this.

359
00:22:02,080 --> 00:22:06,400
And eventually we were, I worked with a team of my colleagues and we did publish it in a

360
00:22:06,400 --> 00:22:10,320
medical journal, 2020, a paper called operator syndrome.

361
00:22:10,320 --> 00:22:11,600
Anybody can find it.

362
00:22:11,600 --> 00:22:12,320
Just Google it.

363
00:22:12,320 --> 00:22:13,360
It's on the internet.

364
00:22:13,360 --> 00:22:14,320
Very easy to find.

365
00:22:14,320 --> 00:22:19,600
It's easy to read because it came from this document that was partially written for operators,

366
00:22:19,600 --> 00:22:20,640
for their spouses.

367
00:22:21,360 --> 00:22:25,520
And so it's a descriptive paper and you can find the PDF of it.

368
00:22:26,480 --> 00:22:27,440
It's public access.

369
00:22:27,440 --> 00:22:28,640
So anybody can find it.

370
00:22:29,440 --> 00:22:31,280
We published that in 2020.

371
00:22:31,280 --> 00:22:34,720
And then folks kept telling me, you should write a book and say more about this.

372
00:22:34,720 --> 00:22:37,120
So that I eventually did that.

373
00:22:37,120 --> 00:22:38,560
And we published that this year.

374
00:22:38,560 --> 00:22:40,080
That was published earlier this year.

375
00:22:40,080 --> 00:22:40,560
Nope.

376
00:22:40,560 --> 00:22:41,040
Sorry.

377
00:22:41,040 --> 00:22:42,000
We're now in a new year.

378
00:22:43,840 --> 00:22:45,840
It was published in March of 2024.

379
00:22:46,400 --> 00:22:49,840
I think I've written up about four checks because I've written 2024 on them already

380
00:22:49,840 --> 00:22:50,400
so far.

381
00:22:50,400 --> 00:22:51,680
We're slowly getting into that.

382
00:22:51,680 --> 00:22:52,000
Yeah.

383
00:22:52,000 --> 00:22:53,920
Of course, I'm that until about March.

384
00:22:53,920 --> 00:22:54,480
Exactly.

385
00:22:54,480 --> 00:22:55,120
And I'm old enough.

386
00:22:55,120 --> 00:22:55,920
I still write checks.

387
00:22:55,920 --> 00:22:58,640
So that's kind of, I guess the backstory there.

388
00:22:59,440 --> 00:23:03,280
Your research and work with special forces suggests that the injuries are special forces

389
00:23:04,000 --> 00:23:08,080
while serving our country are extraordinarily complex and require complex solutions.

390
00:23:08,880 --> 00:23:10,400
Take us through their injuries first.

391
00:23:10,400 --> 00:23:12,560
And then we'll talk about the type of treatment they need.

392
00:23:12,560 --> 00:23:13,360
Okay.

393
00:23:13,360 --> 00:23:15,440
Well, let's start with a couple of concepts here.

394
00:23:15,440 --> 00:23:22,000
So one concept that I want to put out there is allostatic load and it's cumulative.

395
00:23:22,000 --> 00:23:28,320
So allostatic load is a hypothetical concept that's been defined as, and I'll paraphrase

396
00:23:28,320 --> 00:23:34,880
this, but it's essentially the stress, the strain, the challenge that gets put on all

397
00:23:34,880 --> 00:23:37,360
of the physiological systems in the body.

398
00:23:37,360 --> 00:23:39,360
So it's a physiological concept.

399
00:23:39,920 --> 00:23:44,240
So when we say physiological systems, we're talking about the nervous system, the neuro

400
00:23:44,240 --> 00:23:49,600
endocrine system, the immune metabolic, musculoskeletal, respiratory, perceptual systems.

401
00:23:50,400 --> 00:23:53,680
And of course the cardiovascular system and others.

402
00:23:53,680 --> 00:23:57,520
So all of our systems are interconnected, right?

403
00:23:57,520 --> 00:24:00,720
Our brain is connected to our gut, is connected to our hormones.

404
00:24:00,720 --> 00:24:06,480
So the concept of allostatic load is that the blast exposures, the running, the rocking,

405
00:24:06,480 --> 00:24:12,080
the physicality, the sleep deprivation, the chronic high stress and high op tempo.

406
00:24:13,520 --> 00:24:19,760
All of this has a profound physiological burden on the human body that in operators is cumulative

407
00:24:19,760 --> 00:24:21,040
because there's not a lot of rest.

408
00:24:21,680 --> 00:24:23,680
There's not a lot of pauses taken.

409
00:24:23,680 --> 00:24:29,200
So over the course of 10 years, 15, 20 or more, this accumulates.

410
00:24:29,760 --> 00:24:34,000
And we know that something, um, I'll keep it, I'll focus here.

411
00:24:34,000 --> 00:24:38,880
We know that a concussion, if somebody gets multiple concussions over the course of their

412
00:24:38,880 --> 00:24:45,120
life and the closer those concussions are together, they are more likely to have, uh,

413
00:24:45,120 --> 00:24:49,120
you know, some profound injuries and impairments that come from that, that can be permanent

414
00:24:49,120 --> 00:24:49,760
and lasting.

415
00:24:50,640 --> 00:24:56,080
So the concept of allostatic load is that operators and first responders and other soldiers

416
00:24:56,080 --> 00:25:00,640
just have this massive dose of allostatic load that accumulates over time.

417
00:25:01,600 --> 00:25:06,880
So operator syndrome is a, is a framework to take, to take that concept and say, how

418
00:25:06,880 --> 00:25:07,840
does this apply?

419
00:25:07,840 --> 00:25:12,160
How does this, how is the human body affected by the type of activities?

420
00:25:12,160 --> 00:25:17,120
So, you know, jumping out of perfectly good airplanes, combat, diving, running, rocking,

421
00:25:17,120 --> 00:25:20,080
combat is repelling all of that physicality.

422
00:25:20,080 --> 00:25:25,840
Then you add on all the massive amounts of blast exposures from demolitions, breaching,

423
00:25:25,840 --> 00:25:31,760
shoulder fired rockets, even, you know, sniper rifles, and even handguns involve a micro

424
00:25:31,760 --> 00:25:32,400
explosion.

425
00:25:33,120 --> 00:25:35,920
And that causes an invisible form of damage.

426
00:25:35,920 --> 00:25:40,160
We're only really kind of tuning into the last, probably the last 10 years or so.

427
00:25:41,120 --> 00:25:48,160
So what I'm talking about here, what makes this complex is that, you know, I'll get to

428
00:25:48,160 --> 00:25:51,840
the injuries in just a moment, but they're all interrelated.

429
00:25:51,840 --> 00:25:58,080
And that's part of, partly what, why we want to talk about this as a syndrome is it's not

430
00:25:58,080 --> 00:25:59,680
just a traumatic brain injury.

431
00:26:00,240 --> 00:26:04,400
It's a traumatic brain injury that connects to your sleep and affects your sleep.

432
00:26:05,040 --> 00:26:09,440
And together those affect your hormones and all combined.

433
00:26:10,080 --> 00:26:15,360
All of these things have effects on each other, which can lead to a vicious cycle.

434
00:26:16,160 --> 00:26:20,160
You know, one problem causes cascade of problems everywhere else.

435
00:26:21,200 --> 00:26:25,760
But to turn that around, this is the message of hope here is there's, there is good hope

436
00:26:25,760 --> 00:26:26,880
for recovery.

437
00:26:26,880 --> 00:26:32,960
You treat one issue and that can have a ripple effect on positive ripple effect on the other

438
00:26:32,960 --> 00:26:34,720
physiological systems.

439
00:26:34,720 --> 00:26:38,880
And if you start doing multiple treatments for multiple systems, then you're really going

440
00:26:38,880 --> 00:26:44,000
to see some, some, you know, really great benefits.

441
00:26:44,000 --> 00:26:48,560
So the recovery and healing is, is, is very possible, but let's talk about what, what

442
00:26:48,560 --> 00:26:50,160
the syndrome itself is.

443
00:26:50,160 --> 00:26:54,240
So operator syndrome really starts with traumatic brain injury.

444
00:26:55,440 --> 00:27:01,520
And I'll just go down the list, sleep disturbance with sleep apnea, hormonal dysregulation,

445
00:27:01,520 --> 00:27:07,600
primarily test, low testosterone in men, but that's not the only domain that gets

446
00:27:07,600 --> 00:27:08,080
affected.

447
00:27:09,520 --> 00:27:11,840
The perceptual systems have impairments.

448
00:27:11,840 --> 00:27:18,800
So hearing, vision, balance, chronic pain, headaches, a lot of guys have chronic migraines,

449
00:27:19,520 --> 00:27:24,480
the cognitive impairments to concentration, to short-term memory, even just to staying

450
00:27:25,120 --> 00:27:25,760
organized.

451
00:27:25,760 --> 00:27:30,640
And of course, learning new material is much harder after you've had a traumatic brain

452
00:27:30,640 --> 00:27:31,040
injury.

453
00:27:32,320 --> 00:27:37,040
And then we have the psychological, which I would say kind of in, in, in no particular

454
00:27:37,040 --> 00:27:41,920
order, but, but the anxiety, depression, and anger kind of are at the forefront.

455
00:27:42,800 --> 00:27:46,640
Some of the PTSD symptoms and also high potential for addiction.

456
00:27:46,640 --> 00:27:51,360
So heavy drinking is, is very common and as well as some of the other, using some of the

457
00:27:51,360 --> 00:27:53,040
other drugs that are out there.

458
00:27:54,000 --> 00:28:00,560
And then all of that, apologize for talking for, for so long without taking a breath,

459
00:28:00,560 --> 00:28:04,160
but then all of that cascades into the social systems.

460
00:28:04,160 --> 00:28:10,320
So we start with the physiological systems, but then our social systems, marriage, parenting,

461
00:28:12,160 --> 00:28:17,680
fitting into a civilian society, the intimacy challenges emotion.

462
00:28:17,680 --> 00:28:23,680
I mean, yes, sexual intimacy is very, is a, is a problem for many operators after a certain

463
00:28:23,680 --> 00:28:26,800
point, but the emotional intimacy is a struggle too.

464
00:28:26,800 --> 00:28:28,960
A lot of guys will talk about losing their empathy.

465
00:28:31,520 --> 00:28:37,120
Also toxic exposures, the radiological, the biological, all the, you know, the bad water,

466
00:28:37,120 --> 00:28:41,840
the not so clean air and whatnot that are, that are in many austere environments.

467
00:28:42,720 --> 00:28:46,080
Those are having effects, respiratory illnesses, cancers, other things.

468
00:28:46,960 --> 00:28:52,560
And then the last is the existential concerns, which we could spend a whole hour talking

469
00:28:52,560 --> 00:28:58,080
about right there, but this would include things like the horror of killing the thrill

470
00:28:58,160 --> 00:29:00,320
of killing a very common statement.

471
00:29:00,320 --> 00:29:05,680
A common perspective I hear is that the soldiers actually who do enough of it, who do a lot of it

472
00:29:06,240 --> 00:29:09,760
come to enjoy it, come to find it thrilling and then miss it later.

473
00:29:10,400 --> 00:29:17,040
And then also feel very guilty about those perspectives of having enjoyed it and missing

474
00:29:17,040 --> 00:29:17,280
it.

475
00:29:17,280 --> 00:29:23,440
And of course, we also have all the loss and the grief, you know, sometimes guilt, survivors,

476
00:29:23,440 --> 00:29:26,080
guilt, we might call it moral injury or shame.

477
00:29:26,080 --> 00:29:34,720
Sometimes at the end of a career, we often are faced with things like that sense of that

478
00:29:34,720 --> 00:29:37,040
loss of identity, loss of purpose.

479
00:29:37,040 --> 00:29:37,840
Who am I now?

480
00:29:38,800 --> 00:29:39,600
Loss of tribe.

481
00:29:39,600 --> 00:29:42,000
I'm no longer with the people I serve with.

482
00:29:42,000 --> 00:29:43,520
And that's a challenge.

483
00:29:44,080 --> 00:29:49,920
And then last, a lot of guys will talk about feeling betrayed by their nation, by society.

484
00:29:50,640 --> 00:29:55,200
Many will talk about, soldiers will talk about loss of faith in humanity or God.

485
00:29:56,080 --> 00:30:02,240
So there are these profound existential issues that I don't really think of as being psychiatric

486
00:30:02,240 --> 00:30:02,800
illnesses.

487
00:30:02,800 --> 00:30:08,800
I think of them as just, you know, humans struggling with being humans and the things

488
00:30:08,800 --> 00:30:10,640
that they've experienced and seen and done.

489
00:30:11,760 --> 00:30:13,040
Can you go into a little bit more detail?

490
00:30:13,040 --> 00:30:16,880
I haven't heard anything or much, I guess, about veterans feeling betrayed.

491
00:30:18,000 --> 00:30:20,240
Can you just give a little more color on that, please?

492
00:30:20,240 --> 00:30:20,880
Well, yeah.

493
00:30:20,880 --> 00:30:23,520
So two points, several points.

494
00:30:23,520 --> 00:30:25,680
It's not two, it's probably several.

495
00:30:25,680 --> 00:30:32,960
One is in special operations, very few people, very few operators go out on a high note at

496
00:30:32,960 --> 00:30:33,840
the end of their career.

497
00:30:34,560 --> 00:30:36,320
Many are med boarded out.

498
00:30:37,120 --> 00:30:42,560
Many have, you know, experiences towards the end of their careers that aren't so positive

499
00:30:42,560 --> 00:30:48,080
and maybe they are kind of separated from their team.

500
00:30:48,080 --> 00:30:56,000
Maybe they go and do some kind of last year or two of terminal duty somewhere where they're

501
00:30:56,000 --> 00:30:58,720
not really part of the unit that they've been with.

502
00:30:58,720 --> 00:31:03,840
And so oftentimes there's just kind of some bad feeling that's there.

503
00:31:05,040 --> 00:31:09,120
I think there have been some other things in recent years, you know, the manner in which

504
00:31:09,120 --> 00:31:13,920
the war has been prosecuted, the rules of engagement, which have changed multiple times

505
00:31:14,560 --> 00:31:16,240
over the last several decades.

506
00:31:16,960 --> 00:31:23,840
The pullout from Afghanistan, that has been a profound demoralizer for many in the SOF

507
00:31:23,840 --> 00:31:30,480
community, in part because they had, you know, so much blood and treasure was spent there,

508
00:31:31,040 --> 00:31:38,400
but also in part because they work so closely with Afghani interpreters and soldiers, most

509
00:31:38,400 --> 00:31:39,760
of whom were left behind.

510
00:31:39,840 --> 00:31:47,120
And so that has left a very, very, that's had a very demoralizing effect.

511
00:31:48,320 --> 00:31:54,320
A lot of folks have been upset by the way the military handled the vaccine mandates,

512
00:31:54,320 --> 00:32:00,800
by the way, diversity, equity, inclusion has been sort of manifested throughout the

513
00:32:00,800 --> 00:32:01,920
Department of Defense.

514
00:32:02,560 --> 00:32:06,880
So there's, and it's no one thing, it's often a lot of things.

515
00:32:06,880 --> 00:32:10,480
And then you, of course, you combine that with all the other stuff we just talked about,

516
00:32:10,480 --> 00:32:14,640
you know, the injuries and the impairments and it's a lot, it's just a lot.

517
00:32:15,280 --> 00:32:18,240
You know, I didn't think about the withdrawal from Afghanistan.

518
00:32:18,240 --> 00:32:22,960
I have three classmates that were special operators and had the three of them on the

519
00:32:22,960 --> 00:32:28,080
week after the withdrawal and they expressed a lot of what you just highlighted.

520
00:32:28,080 --> 00:32:30,160
And so, so thanks for flagging that for me.

521
00:32:31,040 --> 00:32:34,480
A few moments ago, when you're talking about the different injuries, you mentioned physiological

522
00:32:34,480 --> 00:32:36,480
systems probably a dozen times.

523
00:32:37,440 --> 00:32:41,360
You've noted that although you're a psychologist, you take a very physiological perspective

524
00:32:41,360 --> 00:32:42,720
on helping the people you work with.

525
00:32:43,360 --> 00:32:46,160
Would you explain how that's different from, you know, for lack of a better phrase, the

526
00:32:46,160 --> 00:32:48,240
average psychologist who cares for similar patients?

527
00:32:48,240 --> 00:32:49,040
Yeah, sure.

528
00:32:49,760 --> 00:32:51,840
Well, I start, I start now.

529
00:32:51,840 --> 00:32:56,480
I mean, this is, this has been an evolution for me over probably the last 10, maybe 15,

530
00:32:56,480 --> 00:33:02,400
20 years, but we're animals, we are biological animals.

531
00:33:02,400 --> 00:33:06,720
And when we injure any part of our body that, that can have an effect.

532
00:33:08,080 --> 00:33:11,280
We often think of things like, let's just take depression.

533
00:33:11,280 --> 00:33:14,960
For example, depression is a, is a psychological issue.

534
00:33:16,160 --> 00:33:20,320
And, you know, we have Freudian psychoanalytic theories, we have behavioral theories, we

535
00:33:20,320 --> 00:33:25,120
have cognitive theories that explain it and not to take anything away from those theories

536
00:33:25,120 --> 00:33:29,600
that it's not to say that they're wrong, but what we have not really paid attention

537
00:33:29,600 --> 00:33:31,520
to is for example, genetics.

538
00:33:32,480 --> 00:33:36,400
We know that depression has a genetic component to it.

539
00:33:36,400 --> 00:33:40,640
If your parents had depression, you're more likely to have depression.

540
00:33:40,640 --> 00:33:45,360
And now we're starting to identify some of the specific candidate genes that may contribute

541
00:33:45,360 --> 00:33:45,920
to that.

542
00:33:45,920 --> 00:33:48,320
So that's an example of a physiological thing.

543
00:33:49,600 --> 00:33:54,880
Another understanding that I think is really developed in the last, in recent years is

544
00:33:55,440 --> 00:34:03,920
the idea that chronic systemic inflammation in the body is a causative factor of depression.

545
00:34:05,120 --> 00:34:11,200
So if we don't eat well, if we don't move our bodies, if we are not living an anti-inflammatory

546
00:34:11,200 --> 00:34:15,520
lifestyle, which almost none of us are, we're more prone for depression.

547
00:34:16,800 --> 00:34:23,280
And that implies one of the, that gives you a clue to one of the interventions, which

548
00:34:23,280 --> 00:34:26,720
is to live an anti-inflammatory lifestyle.

549
00:34:26,720 --> 00:34:27,840
What does that mean?

550
00:34:27,840 --> 00:34:31,920
That means cutting out anything that's going to increase inflammation in the body.

551
00:34:32,640 --> 00:34:33,200
What is that?

552
00:34:33,200 --> 00:34:40,800
That's sugar, alcohol, processed foods, not getting enough sleep, not getting enough exercise

553
00:34:41,680 --> 00:34:42,640
and many other things.

554
00:34:43,760 --> 00:34:48,240
One of the, one of the thing, one of the treatments that's been identified as a, as a

555
00:34:48,240 --> 00:34:57,440
powerful antidepressant treatment is, is hot sauna taking three 20 minute hot sauna baths a

556
00:34:57,440 --> 00:35:03,920
week in randomized controlled medical trials has been shown to lower inflammation and reduce

557
00:35:03,920 --> 00:35:05,600
depression significantly.

558
00:35:06,560 --> 00:35:11,920
So there's a, there's a whole body of work out there now focusing on more physiological

559
00:35:11,920 --> 00:35:14,640
treatments than what, what therapists typically do.

560
00:35:15,440 --> 00:35:16,800
So let's start with that.

561
00:35:16,800 --> 00:35:21,680
Traditional mental health care in the West right now is a combination typically of psychiatric

562
00:35:21,680 --> 00:35:24,560
medications and, and psychotherapy.

563
00:35:25,200 --> 00:35:28,960
And I'm not criticizing, you know, there's a lot of value in both of those treatments.

564
00:35:28,960 --> 00:35:31,600
So don't, don't, I'm not dismissing them at all.

565
00:35:32,560 --> 00:35:34,080
Don't, don't hear me say that.

566
00:35:34,080 --> 00:35:35,840
I do worry about over medication.

567
00:35:35,840 --> 00:35:37,600
That's a, that's a very common problem.

568
00:35:39,600 --> 00:35:41,840
But we have so many other treatments as well.

569
00:35:41,840 --> 00:35:44,560
And I can go through some of those if, if, if we have time.

570
00:35:44,800 --> 00:35:48,560
I'm okay for me to just kind of rattle off.

571
00:35:48,560 --> 00:35:49,040
Absolutely.

572
00:35:49,040 --> 00:35:57,520
So one treatment I think is, well, so with, with probably most psychiatric patients today,

573
00:35:57,520 --> 00:35:59,920
we should be getting a sleep study and a hormone panel.

574
00:36:01,200 --> 00:36:06,960
Both of those measure very important physiological aspects of the human body that will have a,

575
00:36:06,960 --> 00:36:12,080
you know, very negative, can have very negative effects on, on psychological functioning,

576
00:36:12,720 --> 00:36:13,600
cognitive functioning.

577
00:36:13,600 --> 00:36:16,480
So I always say we need to do a TBI assessment.

578
00:36:16,480 --> 00:36:20,800
We need to do a sleep study and we need to get a hormone panel and probably also a metabolic

579
00:36:20,800 --> 00:36:27,280
panel and then follow whatever treatment recommendations come out of that, out of those

580
00:36:27,280 --> 00:36:29,040
tests, out of those evaluations.

581
00:36:29,600 --> 00:36:34,560
One of my go-to treatments that I recommend for pretty much everybody is a stellate ganglion

582
00:36:34,560 --> 00:36:34,880
block.

583
00:36:36,480 --> 00:36:39,680
Stellate ganglion block is a physiological intervention.

584
00:36:39,680 --> 00:36:43,600
It involves injecting a little medicine into the sympathetic nervous system.

585
00:36:44,800 --> 00:36:50,800
And it, what it does is it lowers the physiological arousal in the body.

586
00:36:50,800 --> 00:36:55,360
And it, and it has a lasting effect for months, maybe even a year or more.

587
00:36:56,320 --> 00:36:58,320
One injection into the side of the neck.

588
00:36:59,200 --> 00:37:01,280
It does not, it does not dope you up.

589
00:37:01,280 --> 00:37:03,680
It does not impair your cognitive functioning at all.

590
00:37:03,680 --> 00:37:07,760
It has almost no side effects or lasting, you know, any kind of long-term risks.

591
00:37:08,560 --> 00:37:11,760
Um, the worst thing that can happen typically is it might not work.

592
00:37:11,760 --> 00:37:17,440
So about 90% of the people I recommend for this, uh, describe it as being profoundly

593
00:37:17,440 --> 00:37:18,000
beneficial.

594
00:37:18,880 --> 00:37:23,680
Um, what it does is it takes that baseline level of anxiety, which might be at like a

595
00:37:23,680 --> 00:37:27,840
seven, eight, most of the time, and it can bring it down to like a two or a three.

596
00:37:28,800 --> 00:37:36,080
So for general anxiety, for PTSD anxiety, for people who do a lot of worrying, uh, and

597
00:37:36,080 --> 00:37:40,720
maybe can't sleep at night because they're so the ruminating and they're obsessing over

598
00:37:40,720 --> 00:37:46,240
things for people with, who have what we sometimes refer to as low stress tolerance.

599
00:37:46,240 --> 00:37:49,520
In other words, people who are impatient and easily angered.

600
00:37:49,520 --> 00:37:55,280
A lot of that is because the anxiety is so high to begin with that when there's a small

601
00:37:55,280 --> 00:38:00,560
frustration that bumps them above the threshold for losing, you know, losing their, their,

602
00:38:00,560 --> 00:38:01,120
their temper.

603
00:38:01,760 --> 00:38:07,840
When we bring it down with this injection, what we see, and it works almost immediately,

604
00:38:07,840 --> 00:38:13,200
like literally within a few hours, people describe feeling more relaxed, calm.

605
00:38:14,240 --> 00:38:17,760
They're more focused, more present, uh, with their family.

606
00:38:18,480 --> 00:38:20,000
They can enjoy things differently.

607
00:38:20,640 --> 00:38:22,400
Their mind is, is more clear.

608
00:38:22,400 --> 00:38:23,360
They can think better.

609
00:38:23,360 --> 00:38:27,600
They can concentrate better because all that anxiety noise is cleared out.

610
00:38:28,480 --> 00:38:32,880
Um, they, they become less angry, less irritable, and they start sleeping better.

611
00:38:33,840 --> 00:38:35,600
It helps with the insomnia.

612
00:38:35,600 --> 00:38:36,560
And so guess what?

613
00:38:36,560 --> 00:38:37,840
You get one of those shots.

614
00:38:38,960 --> 00:38:44,560
And for the next two to three weeks, months, at least most people feel really, really good.

615
00:38:45,520 --> 00:38:49,520
And you know, the medicine will wear off and some of that anxiety may come back.

616
00:38:50,400 --> 00:38:52,960
You can have the, you can repeat this treatment.

617
00:38:52,960 --> 00:38:56,480
You can have it done multiple times over the course of, you know, you can get it done once

618
00:38:56,480 --> 00:39:02,640
or twice a year, but more than that, what it does is it opens that it opens a window

619
00:39:02,640 --> 00:39:03,520
of opportunity.

620
00:39:03,520 --> 00:39:08,000
I think I've seen this many times, get the guys, get the Stella ganglion.

621
00:39:08,000 --> 00:39:09,680
Sometimes their spouses get it too.

622
00:39:09,680 --> 00:39:16,400
I often like to see a couple's intervention with that and it, and it gives them kind of

623
00:39:16,400 --> 00:39:18,640
a holy moly experience.

624
00:39:19,440 --> 00:39:23,920
I got a phone call a couple of weeks ago from a, from one of my younger guys who's currently

625
00:39:23,920 --> 00:39:25,680
active duty at a tier one unit.

626
00:39:26,560 --> 00:39:31,520
And he, he got his first LA ganglion block and he called me that night and he, and he

627
00:39:31,520 --> 00:39:33,520
says, you've been telling me about this for months.

628
00:39:34,080 --> 00:39:35,280
I finally got it.

629
00:39:35,280 --> 00:39:36,160
Holy cow.

630
00:39:36,160 --> 00:39:37,120
I feel so different.

631
00:39:37,120 --> 00:39:38,800
I've never felt this way before.

632
00:39:39,360 --> 00:39:41,200
I mean, he wasn't high.

633
00:39:41,200 --> 00:39:46,640
He was just excited about this new feeling of relaxation that he had never, he had never

634
00:39:46,640 --> 00:39:46,880
felt.

635
00:39:46,880 --> 00:39:49,440
He had a rough childhood as many have.

636
00:39:49,440 --> 00:39:53,600
And so he didn't even have the, he didn't even have relaxation in his childhood.

637
00:39:53,680 --> 00:39:56,160
But now it's easier to talk to a therapist.

638
00:39:56,720 --> 00:40:00,720
Now it's easier to engage in other lifestyle changes.

639
00:40:00,720 --> 00:40:06,480
Now it's easier to re-engage or engage with family members, especially spouses in a different

640
00:40:06,480 --> 00:40:06,720
way.

641
00:40:06,720 --> 00:40:13,440
So it really kind of opens the door to, you know, to, to more healing, more recovery in

642
00:40:13,440 --> 00:40:14,000
other ways.

643
00:40:14,880 --> 00:40:18,960
So huge fan of Stella ganglion block treatments.

644
00:40:18,960 --> 00:40:22,800
We've been talking a lot about military personnel and earlier in the show, we briefly

645
00:40:22,800 --> 00:40:24,000
touched on first responders.

646
00:40:24,960 --> 00:40:27,520
Then they experienced many of the same emotional and physical traumas.

647
00:40:28,080 --> 00:40:31,760
You've written about what you call firefighter syndrome because they also face a high risk

648
00:40:31,760 --> 00:40:35,440
of traumatic brain injuries, including impact force injuries and toxic exposures.

649
00:40:36,080 --> 00:40:38,880
Can you describe firefighter syndrome and the treatment approaches it requires?

650
00:40:40,480 --> 00:40:41,280
The same.

651
00:40:41,280 --> 00:40:42,000
It's the same.

652
00:40:42,640 --> 00:40:47,200
The brain injury is a little different and the toxic exposures are a little different.

653
00:40:48,160 --> 00:40:53,280
Firefighters aren't working with demolitions in intentionally trying to blow things up,

654
00:40:53,280 --> 00:40:55,520
but they do go into structure fires.

655
00:40:55,520 --> 00:40:59,600
They do go into environments where it's not known what they're going to be breathing.

656
00:40:59,600 --> 00:41:04,480
And sometimes they're in environments that change rapidly while they're in a structure.

657
00:41:05,680 --> 00:41:11,520
So that's, that's, that's part of what they, what they have to deal with.

658
00:41:12,000 --> 00:41:16,480
Now, um, there's another piece to this and I didn't even mention this with, with, with

659
00:41:16,480 --> 00:41:21,920
soldiers and veterans, but the transition points are a challenge for soldiers.

660
00:41:21,920 --> 00:41:27,680
There's a difficult transition coming home from a deployment or a, or a lengthy training

661
00:41:27,680 --> 00:41:28,240
evolution.

662
00:41:29,040 --> 00:41:31,600
There's the transition at the end of the career.

663
00:41:31,600 --> 00:41:32,960
That's a huge challenge.

664
00:41:32,960 --> 00:41:36,880
And we know this, you know, you, whether it's, whether you've been in the military for two

665
00:41:37,040 --> 00:41:42,800
years, four years, 24 years, when you leave the service, you're stepping into a whole

666
00:41:42,800 --> 00:41:43,360
different world.

667
00:41:43,360 --> 00:41:45,040
And that's a, that's a, that's a challenge.

668
00:41:45,040 --> 00:41:48,560
It's a significant challenge for first responders.

669
00:41:48,560 --> 00:41:52,640
However, let's, let's give them, let's give them their due here.

670
00:41:52,640 --> 00:41:55,440
And this is something that a lot of soldiers have pointed out to me.

671
00:41:56,080 --> 00:42:04,880
First responders are putting on the uniform every day or every shift, and they're not

672
00:42:05,440 --> 00:42:06,800
fighting overseas.

673
00:42:06,800 --> 00:42:11,520
They're not going over to another faraway country for their war.

674
00:42:12,560 --> 00:42:15,440
First responders are doing it on the streets of their hometown.

675
00:42:16,240 --> 00:42:17,920
It's their neighbors they're protecting.

676
00:42:17,920 --> 00:42:19,760
It's their community that they're protecting.

677
00:42:19,760 --> 00:42:20,720
It's their own family.

678
00:42:21,440 --> 00:42:28,640
So, um, for responders, you have that experience at the end of every shift, taking the uniform

679
00:42:28,640 --> 00:42:29,600
off and going home.

680
00:42:30,560 --> 00:42:31,920
How do you walk in the door?

681
00:42:32,400 --> 00:42:38,560
You know, an hour ago you were dealing with maybe the death of a child or, you know, the

682
00:42:38,560 --> 00:42:44,160
injury, severe injuries in a, in a, in a motor vehicle accident, or, you know, dealing with

683
00:42:44,160 --> 00:42:46,880
people who've been horribly victimized by crimes.

684
00:42:47,440 --> 00:42:52,720
And then 10 minutes later, half an hour later, you're at home in your living room with your

685
00:42:52,720 --> 00:42:53,200
family.

686
00:42:54,000 --> 00:42:56,640
How, you know, how, how do you, how do you manage that?

687
00:42:56,640 --> 00:43:01,040
That's, that's, that's, that's quite a, quite a powerful thing.

688
00:43:01,920 --> 00:43:06,240
And then you have also, you're out in your, your community.

689
00:43:06,240 --> 00:43:10,240
You take your family out to dinner or to a movie or shopping.

690
00:43:10,960 --> 00:43:12,240
How do you let down your guard?

691
00:43:13,040 --> 00:43:18,320
How are you not looking around to see who's around you, who the bad guys might be?

692
00:43:19,040 --> 00:43:22,640
How, what might you need to do to, to intervene, to protect people?

693
00:43:22,640 --> 00:43:27,440
So it's a whole different, uh, psychological challenge for first responders than it is

694
00:43:27,440 --> 00:43:28,160
for soldiers.

695
00:43:28,160 --> 00:43:33,040
And a lot of soldiers have said to me, what we had to deal with was, was, was hard, but,

696
00:43:33,040 --> 00:43:33,920
but not that hard.

697
00:43:35,120 --> 00:43:39,840
They take, they tip their hats to what first responders do, you know, on a regular basis

698
00:43:39,840 --> 00:43:45,040
at the end, you know, every shift, um, on the streets of America.

699
00:43:45,760 --> 00:43:46,000
Yeah.

700
00:43:46,000 --> 00:43:50,640
As part of my research, I found that the younger generation of first responders, you know,

701
00:43:50,640 --> 00:43:55,680
kind of five to seven years on the job, they're much more engaged from a mental health, uh,

702
00:43:56,240 --> 00:44:00,720
perspective in terms of being open to it versus sort of the older regime of 25 years in the

703
00:44:00,720 --> 00:44:01,600
force.

704
00:44:01,600 --> 00:44:04,160
You know, and I remember a couple of guys saying like, you know, something would happen,

705
00:44:04,160 --> 00:44:05,600
you know, something bad would happen.

706
00:44:05,600 --> 00:44:08,720
They'd go to the bar that night, you know, have a beer and a shot and then walk out and

707
00:44:08,720 --> 00:44:09,280
that was it.

708
00:44:09,280 --> 00:44:10,080
And you buried it.

709
00:44:10,960 --> 00:44:11,200
Right.

710
00:44:11,200 --> 00:44:13,280
And so the good news is it's becoming right.

711
00:44:13,840 --> 00:44:16,880
Probably more than one beer and one more than one shot.

712
00:44:16,880 --> 00:44:18,240
Probably, probably.

713
00:44:19,600 --> 00:44:23,440
You co-authored a study about the efficacy of using ketamine infusion in combination

714
00:44:23,440 --> 00:44:27,440
with other procedures to treat post-traumatic stress and a traumatic brain injury and special

715
00:44:27,440 --> 00:44:27,920
forces.

716
00:44:28,640 --> 00:44:32,400
And that caught my eye because like most people, if they've heard of ketamine at all, we've

717
00:44:32,400 --> 00:44:35,600
only heard about it in the context of the death of the friend's actor, Matthew Perry.

718
00:44:36,400 --> 00:44:39,280
Talk to us about ketamine and its potential benefits and dangers.

719
00:44:39,280 --> 00:44:39,520
Right.

720
00:44:40,960 --> 00:44:48,080
Ketamine is a, is a hallucinogenic compound and it's been long used in, in medicine for

721
00:44:48,080 --> 00:44:58,640
decades as one of several anti, um, um, uh, not anti as several, um, struggling with finding

722
00:44:58,640 --> 00:45:01,600
the word here, uh, and anesthesia.

723
00:45:01,600 --> 00:45:03,360
So it's often used.

724
00:45:03,360 --> 00:45:08,080
It's certainly used in battlefield, uh, pain management, but it's also used in like trauma

725
00:45:08,080 --> 00:45:08,720
surgery.

726
00:45:08,720 --> 00:45:11,920
Usually there'll be two or three different anesthesias that are used.

727
00:45:12,000 --> 00:45:17,840
And ketamine has been one of the, you know, is in combination with others is, is, is not,

728
00:45:17,840 --> 00:45:18,800
is not as common.

729
00:45:19,760 --> 00:45:24,560
Um, it's also, we discovered that ketamine also is a, is a treatment for depression.

730
00:45:24,560 --> 00:45:28,560
And so ketamine is FDA approved as a treatment for depression.

731
00:45:28,560 --> 00:45:30,480
It's a legitimate treatment for depression.

732
00:45:30,480 --> 00:45:35,760
And a lot of us think that it also treats anxiety and PTSD and some of the existential,

733
00:45:36,560 --> 00:45:42,160
uh, it helps people frame the existential, you know, issues and concerns in ways that

734
00:45:42,160 --> 00:45:43,440
make it easier to manage.

735
00:45:44,320 --> 00:45:45,280
Let me say this though.

736
00:45:45,280 --> 00:45:47,280
There's different ways of delivering ketamine.

737
00:45:48,240 --> 00:45:55,680
The only way I ever ask or recommend anybody to use it is to have it, um, infused intravenously

738
00:45:55,680 --> 00:46:01,120
into, into your bloodstream in a clinic under full medical supervision.

739
00:46:01,920 --> 00:46:06,160
And so that treatment, and there's many clinics around the country now that will provide this,

740
00:46:06,160 --> 00:46:08,640
it's usually four to four to eight sessions.

741
00:46:09,600 --> 00:46:11,600
Six is a pretty common number of sessions.

742
00:46:12,320 --> 00:46:18,000
Each session involves going into the clinic, sitting in a very comfortable chair, receiving

743
00:46:18,000 --> 00:46:22,240
them at, you know, receiving the medication, having them run it into your veins for about

744
00:46:22,240 --> 00:46:24,720
an hour, hour and a half, maybe less.

745
00:46:25,520 --> 00:46:29,600
And then they disconnect, they, they take, they remove the needle and you sit there for

746
00:46:29,600 --> 00:46:31,360
another hour or so until your head clears.

747
00:46:31,360 --> 00:46:33,360
And then you go home and that's one session.

748
00:46:35,200 --> 00:46:39,520
What we have found, what we have seen in our, in our really now starting to look at more

749
00:46:39,520 --> 00:46:46,560
carefully is ketamine and stellate ganglion block therapy combined into one, um, into

750
00:46:46,560 --> 00:46:52,640
one treatment or done at about the same time has that there's synergistic effects with

751
00:46:52,640 --> 00:46:53,440
the two treatments.

752
00:46:54,160 --> 00:46:56,800
And so, um, like there's programs, Dr.

753
00:46:56,800 --> 00:47:00,400
Lipoff's programs, you can get this through the, through some of the Stella centers and

754
00:47:00,400 --> 00:47:01,920
many other clinics around the country.

755
00:47:02,560 --> 00:47:08,160
Go in for a week, get, get a ketamine treatment for maybe four of them throughout the week,

756
00:47:08,800 --> 00:47:15,040
get the stellate ganglion block treatments done and that they are symbiotic with each

757
00:47:15,040 --> 00:47:15,280
other.

758
00:47:15,280 --> 00:47:16,400
They enhance each other.

759
00:47:17,440 --> 00:47:24,560
We also are now thinking that both stellate ganglion and ketamine separately, but especially

760
00:47:24,560 --> 00:47:30,960
in combination, um, help stimulate neuro generativity, help stimulate the brain to

761
00:47:30,960 --> 00:47:33,120
repair and start to heal itself.

762
00:47:33,120 --> 00:47:38,800
So these are treatments that work profoundly on many of the things we've just talked about,

763
00:47:39,360 --> 00:47:45,120
but including depression, anxiety, existential concerns, and brain health.

764
00:47:46,480 --> 00:47:50,160
And there's other things that we think have similar, I don't want to say similar, but

765
00:47:50,160 --> 00:47:53,600
also are excellent treatments for these issues.

766
00:47:53,680 --> 00:47:58,160
So, um, I think in five years, we'll see not five years.

767
00:47:58,160 --> 00:48:02,560
I think we're already kind of getting there, but psychedelic medications, ibogaine, five

768
00:48:02,560 --> 00:48:05,760
MEO DMT, psilocybin, ayahuasca.

769
00:48:05,760 --> 00:48:12,080
These are shown, we're seeing really good effects for, um, operator syndrome for brain

770
00:48:12,080 --> 00:48:17,120
health, for psychological health with these, with these treatments, the research is developing.

771
00:48:17,120 --> 00:48:21,120
I think they will be made more at some of these compounds will be more mainstream treatment

772
00:48:21,760 --> 00:48:22,640
in the near future.

773
00:48:23,600 --> 00:48:24,720
Other treatments.

774
00:48:24,720 --> 00:48:29,440
One of my, one of the things we just, I just, today I got a paper published on the use of,

775
00:48:30,080 --> 00:48:32,320
of transcranial magnetic stimulation.

776
00:48:33,040 --> 00:48:34,720
It's a form of neuromodulation.

777
00:48:35,760 --> 00:48:40,480
We can individualize it using what's known as magnetic electronic resonance therapy.

778
00:48:41,280 --> 00:48:47,840
It's essentially sitting in a chair for 30 or 40 sessions while a magnet pulses a little

779
00:48:47,840 --> 00:48:53,920
bit of electrical energy, magnetic stimulation into one side of your, of your, your brain.

780
00:48:53,920 --> 00:48:56,320
And it goes back and forth within the brain.

781
00:48:57,280 --> 00:48:58,560
It's not shock therapy.

782
00:48:59,280 --> 00:49:00,720
It's a mild stimulation.

783
00:49:01,360 --> 00:49:02,080
It doesn't hurt.

784
00:49:02,080 --> 00:49:05,280
It doesn't have any dramatic side effects.

785
00:49:05,280 --> 00:49:10,880
It, most people don't even really notice its benefits in a, in a, in a, in an abrupt way

786
00:49:10,880 --> 00:49:16,400
cause it, cause it's gradual and gentle over the course of multiple sessions.

787
00:49:16,400 --> 00:49:18,400
But we're seeing really good benefits from that.

788
00:49:19,680 --> 00:49:26,800
Vestibular therapies, speech pathology therapies, hyperbaric oxygen therapy.

789
00:49:26,800 --> 00:49:31,680
We're finding so many different things that we have out there with some of the foundations

790
00:49:31,680 --> 00:49:32,400
that I work with.

791
00:49:32,400 --> 00:49:37,360
We're now sending guys to functional medicine clinics where they're using things like stem

792
00:49:37,360 --> 00:49:43,600
cells and NAD plus infusions to help with brain healing, help with chronic pain in the joints.

793
00:49:44,560 --> 00:49:48,960
So there's just, there's many treatments that we have out there that we're not

794
00:49:48,960 --> 00:49:53,040
widely using with veterans or service members or first responders.

795
00:49:54,640 --> 00:49:56,240
We have just about two minutes left.

796
00:49:56,240 --> 00:49:59,440
Would you please take us to the end of our conversation with advice or a story that helps

797
00:49:59,440 --> 00:50:03,040
our audience feel more resilient, empowered, and able to succeed in the face of adversity?

798
00:50:04,560 --> 00:50:11,120
Well, that's a hard, hard thing to summarize in two minutes, but I'll say this for everybody

799
00:50:11,600 --> 00:50:19,840
who I've been talking about, soldiers, veterans, operators, other combat, combatants or combat

800
00:50:19,840 --> 00:50:21,600
support and first responders.

801
00:50:22,720 --> 00:50:24,400
There is hope for healing.

802
00:50:24,400 --> 00:50:25,760
We have good treatments.

803
00:50:26,320 --> 00:50:30,560
We have the ability to do good diagnostics and good treatments.

804
00:50:31,440 --> 00:50:37,200
Right now, it's hard to find those treatments cause they're not widely offered by VA or

805
00:50:37,200 --> 00:50:38,160
DOD medicine.

806
00:50:38,800 --> 00:50:43,360
What a lot of people have found success with is finding the operator syndrome paper,

807
00:50:44,160 --> 00:50:49,040
downloading it, going through it with a highlighter in their hand, maybe discussing it with their

808
00:50:49,040 --> 00:50:55,120
spouse, and then taking that paper with all the markups on it to their primary care provider,

809
00:50:55,120 --> 00:51:00,640
educate that primary care provider a little bit and present them with a, with a, you know,

810
00:51:00,640 --> 00:51:02,800
sort of a list of things that you need help with.

811
00:51:02,960 --> 00:51:07,840
My book has some, some very specific plans and strategies and even, you know, treatment

812
00:51:07,840 --> 00:51:09,600
guidance issues in there.

813
00:51:09,600 --> 00:51:12,080
The book, the book is really a book I wrote.

814
00:51:12,080 --> 00:51:13,200
It's not an academic book.

815
00:51:13,200 --> 00:51:17,440
It's for operators, responders, soldiers, and for their spouses.

816
00:51:17,440 --> 00:51:20,960
So it's really intended to be kind of a self-help, a very practical guide.

817
00:51:21,680 --> 00:51:23,680
And where can our listeners and viewers find your book?

818
00:51:23,680 --> 00:51:24,240
Amazon.

819
00:51:25,440 --> 00:51:26,400
And we'll keep it simple, right?

820
00:51:26,400 --> 00:51:30,560
Dr. Chris Frege, clinical psychologist and author of the fascinating, insightful book,

821
00:51:30,560 --> 00:51:31,840
Operator Syndrome.

822
00:51:31,840 --> 00:51:33,120
Thank you for being with us today.

823
00:51:33,120 --> 00:51:34,160
Thank you for having me.

824
00:51:34,160 --> 00:51:35,440
No, absolute honor.

825
00:51:35,440 --> 00:51:38,880
And thank you to our audience, which now includes people in over 50 countries for joining us

826
00:51:38,880 --> 00:51:41,360
for another episode of Next Steps Forward.

827
00:51:41,360 --> 00:51:42,160
I'm Chris Meek.

828
00:51:42,160 --> 00:51:47,040
For more details and upcoming shows and guests, please follow me on Facebook at facebook.com

829
00:51:47,040 --> 00:51:51,680
forward slash ChrisMeekPublicFigure and an X at ChrisMeek underscore USA.

830
00:51:51,680 --> 00:51:52,640
We'll be back next week.

831
00:51:52,800 --> 00:51:55,760
And an X at ChrisMeek underscore USA.

832
00:51:55,760 --> 00:51:59,760
We'll be back next Tuesday, same time, same place with another leader from the world of

833
00:51:59,760 --> 00:52:04,080
business, health, public policy, politics, sports, entertainment.

834
00:52:04,080 --> 00:52:07,280
Until then, stay safe and keep taking your next steps forward.

835
00:52:12,000 --> 00:52:14,960
Thanks for tuning in to Next Steps Forward.

836
00:52:14,960 --> 00:52:19,280
Be sure to join Chris Meek for another great show next Tuesday at 10 a.m.

837
00:52:19,280 --> 00:52:21,120
Pacific time and 1 p.m.

838
00:52:21,120 --> 00:52:22,080
Eastern time.

839
00:52:22,080 --> 00:52:24,960
On the Voice America Empowerment Channel.

840
00:52:24,960 --> 00:52:28,480
This week, make things happen in your life.