I couldn't have asked for a better time to have all of the counseling that I have had in the past day and a half.  Group CPT ended up being one on one because none of the other members of the group were able to make it.  I individual therapy we discussed why the intensity of the anger, nightmares, and hypervigilance have been increasing recently.

Group CPT:
When I got there and realized that no one else was coming, I almost left disappointed.  I really needed to talk out what transpired over the past week.  When the doc expressed a desire to talk with me relieved, I was really relieved.  So I went over everything that happened.  He grew very serious and we discussed two topics.

• Blaming myself for what happened:  Doc took an interesting approach on this one but it was effective.  He asked me if I was a paraplegic in a wheelchair out walking with my two year old and the got loose and ran out into the street, would it be my fault?  NO.  Would you have been able to do anything to prevent it?  NO.  Would you and your wife acknowledge that limitation and modify how you do things until your daughter is old enough not to run out in the street?  YES.  Do you understand that your PTSD is a disability?  YES, but I don't want to accept it.  Do you understand that there is no reason to blame yourself for what happened.  NO.  Think of the paraplegic - would he blame himself or would he change his environment to ensure the incident never repeated?  NO to the first part and YES to the second.  Treat your PTSD the same way.  No one is at fault for what happened.  You just need to change your environment to accommodate for this aspect of your disability and move forward.  Easier said than done doc.  Why?  Because I still blame myself for not thinking it could happen in the first place.  Are you omniscient?  NO.  So why do you think you have the right to anticipate everything before it happens?  I don't but...OK doc, I see your point.
• Deconstructing my script:  Doc and I sat down and looked at the behavior that was resulting from what happened - withdrawal.  Starting there, worked backwards.  He asked me what emotions I felt as a result of what happened.  Horror, guilt.  What thoughts or beliefs did you have that made you feel those emotions?  I don't know doc.  I don't recall thinking much of anything.  Take your time and think about it.  Oh my God.  I hurt my daughter.  I failed her and my wife.  My wife is never going to be able to forgive me.  I'm going to lose my family.  Let's look at those thoughts logically.  On a scale of 0% to 100%, how realistic are those thoughts?  Realistic?  I don't know.  OK, start with the first thought.  How realistic is it to believe that a 270 pound man could have hurt a 35 pound two year old?  100%.  It sure is realistic.  How realistic is the thought that you failed your family?  100%.  Wrong.  Would you, not the PTSD, ever intentionally hurt your daughter?  No.  So what's the reality here?  30%.  It may not have been intentional but it still happened, doc.  Fair enough.  How realistic is it that your wife won't forgive you?  If I would have actually hurt my daughter, 100%.  Did you?  No.  So how realistic is it?  20%, I guess.  How long have you been married?  A little over six years.  Is this the first major issue you two have experienced in that time.  No.  Has she forgiven you for your past behavior?  Yes.  Would she ever take your daughter away from you?  Only if I hurt her intentionally.  That's not what I asked.  You stated that you would never intentionally hurt your daughter so that thought is illogical.  Does it stand to reason that since your wife has stood by you through all the ups and downs for six years that she's not going anywhere and that she's not going to take her away from you?  Yes.  I get what you're saying.  Realistically, doc, 0%.  Max, this is your script you came home from Iraq with.  Every time something happens, you read this script and the end result is withdrawal from your family.  THIS is what we are going to work on changing.  You need to learn to write a script for every situation.

Needless to day, it was a productive session.  It has helped me to put what happened into proper perspective and helped me identify an underlying issue that causes my PTSD to have such a deleterious effect on my health and life.

Individual Therapy:
My therapist's major concern is the increasing intensity of my nightmares, my inability to fall asleep easily, and  my hair-trigger temper at work.  She asked me how much physical activity I am getting outside of work.  I told her that I don't really get much.  She said that I needed to find a way to work exercise into my week.  She said that I didn't need to go all out every day of the week.  She said to start small - one or two times per week.  Her concern is that only talking and thinking about things doesn't help to drain off the energy I build up over the course of a day.  When the physical doesn't have an adequate outlet, it can have a very detrimental effect on the mind.  So I promised her that I would talk to my wife about making sure that I have the time to exercise at least twice a week without distractions.


So there you have it.  I have a few new things to consider and act on.  It gives me a sense of direction, of purpose.  I don't feel like I am just reacting to my PTSD right now, which is a pleasant change.  We'll see how it goes over the coming weeks and months as I work on these new tasks.

I experienced a new level of nightmare on the night before Thanksgiving.  The smells and sounds were always there, but these new recollections/flashbacks now include the fear, anger, horror, and disbelief that I experienced in the moment.  The end result:  I fell asleep on the couch at the in-laws and had nightmares.  My daughter was the one who startled me awake.  I became aware of what I had done when I looked over and saw her kneeling on the floor in the middle of the room and the looks or horror on everyone's faces.  My startle reflexes had caused me to scare the bejesus out of my daughter.

Needless to say, for my sanity and safety and that of my daughter's, my wife and daughter have been sleeping at her parents' house so that, God Forbid, I don't actually hurt her.  She was scared by my startle response, but unhurt.  She's over it but I can't forgive myself.  It is my worst fear - hurting my daughter.

I was at work yesterday and had a breakdown.  I effectively hadn't slept since Friday night.  My father took me to the VA and they are putting me back on Trazadone.  The doc said that it would keep me from being physically able to act on any startle response.

I needed someone to talk to about what had happened that wasn't emotionally invested in a positive outcome.  So, naturally, I talked to Rod Deaton.  Rod may be a doctor at the VA and I may be a veteran with PTSD, but we are friends and do not share a doctor patient relationship.  What is great about having someone so knowledgeable to turn to in situations like these is that he can stay calm and talk me down from my figurative ledge.

Talking to him last night definitely did that. He made me remember that I am a good and honorable man.  That, in and of itself, would ensure that there wasn't a repeat of what happened on Thanksgiving.  Additionally, he made me realize that my I was allowing me fears to blow what had happened out of proportion.  I am, and always have been, my own worst critic.  When I get into situations like this past week, I verbalize my irrational fears to those I love, causing them to worry excessively.  I force them to think the worst.

It's form of self-flagellation.  On some level I have been punishing myself continually since my daughter was born.  I think about all of the worst-case outcomes to my behavior and believe myself capable of making those outcomes a reality.  It's self-fulfilling prophecy.  I have been hamstringing myself like this ever since my daughter was born.  It all stems from irrational fears of losing my family, my daughter.

I won't go into all of the details but my conversation with Rod last night led me to make some incredibly substantial realizations about myself:

• When I think about the consequences of my actions I have believed myself capable of the worst possible behavior in any given situation.
• I have been irrationally afraid of my wife and daughter being taken from my life permanently.
• My irrational fear of my inability to control my behavior has led me to take on my PTSD on my own, shutting out the love, support, and advice of the person I value the most in life - my amazing wife.

So what's the end-result of the mess of a week?  Blessings dressed in wolf's clothing...

• I now understand that, even when I have really bad days and weeks, that my wife and daughter will always be there for the long haul.  My irrational fear of losing them permanently has finally been put into proper perspective.
• I am now aware of the consequences of my actions but now understand that the worst possible response in a given situation is not the most likely (or even remotely probable) outcome.  I have proven over the last three years since I have been at my current employer that I have better self-control than that except when I let the fears control me.
• I am no longer afraid to be me.  I have learned from all of this that I am (despite my best efforts to convince myself otherwise) a good man, an honorable man.  I still need to work on accepting that even good and honorable men aren't perfect -  that they aren't perfect.  It is not rational to hold myself to that standard.  What does that mean for me?  I am no longer afraid to be the man hiding behind the fear - I can let him out to shine, warts and all.

So it has been a traumatizing and productive week all at the same time.  I am still exhausted and have to work at not being too hard on myself, but my wife and daughter deserve to enjoy the man I am - not the man I was afraid I could become.

Today, I woke up groggy and out of sorts.  I had intense nightmares last night for the first time in a while.  They were particularly intense and I am not sure as to why.  I have had the nightmares about once a week pretty consistently for the past few months, but they haven't been very intense and they haven't had that HD replay reel feel or the scent memory of blood for a while.  I have actually been looking forward to the holiday this year and what happens?  Yeah, nightmares...

It was an amazing and fulfilling experience this past Wednesday at group.  We had known ahead of time that one of the guys in group was going to share his experiences in full. And boy did he.  For the sake of privacy, let's just say it was pretty emotional and very heartfelt on his part.

What really touched me in a way that I didn't expect:  How honored I felt that he trusted me and the other guys in group with his story.  It takes a lot of courage for someone to come forward like that and lay it all out, raw and unfiltered in a group setting.  So I wanted to congratulate him on taking the leap.  For the other guys who still haven't shared their trauma, I think this was an encouraging moment.  A watershed moment.

The other thing that our doc talked about was the fact that so many current conflict veterans seem to have a cavalier attitude about death - an ambivalence about their own survival.  It's something that has been seen in veterans of other conflicts, just not in numbers of this magnitude.  Doc thinks it may partially contribute to the high suicide rate and wonders how energy drinks (available by the case when I was over there) could affect the way that emotional and psychological trauma is received by the brain.  Interesting thoughts, but I disagree.  I think that it is a generational thing.  It's not that a lot of veterans are cavalier about it.  I think it's because they are desperate to appear as normal as possible.  The faking disregard for suicide ideation comes across as disingenuos, cavalier.  I would love to hear others thoughts on this.

I have written and erased this post more times than I can count in the past week.  It was a tumultuous week for me.  I was talking with my therapist about the timing of when I felt I started losing control over my anger and about the thought pattern - I don't know what's coming next, but whatever it is can't be good.  After thinking about it, I started to lose control and emotionally withdraw right after my daughter was born.  I said it so nonchalantly. We concluded our session and my therapist left.

About ten minutes after she left, it hit my like a ton of bricks.  Holy shit, my daughter's birth is the root of all of this.  As I thought about it more, I realized that this was the first time in my experience that intense POSITIVE EMOTION triggered my PTSD.  That realization turned everything on it's head.  So let's explore what I mean in more depth:

• The moment I held my daughter for the first time, I was filled with unbridled joy, love and devotion - my daughter was everything I ever dreamed she would be.  Beautiful, healthy...I sat there staring at her in wonder.
• Then an insidious thought sneaked in:  If Anything Ever Happened To Her...
• Raising a child is an exercise in uncertainty.  Every devoted parent I have ever known has had that thought cross their mind and they expressed a healthy fear of anything happening to their child.  With the PTSD in the mix, I went down a different road.
• I obsessed.  I was certain that something horrible was going to happen to my perfect little bundle of everything good in life.  So I obsessed and brooded over every possible scenario:  Not being able to afford a stable income led to workaholism.  Fear of my PTSD being triggered and lashing out at my daughter led to withdrawing emotionally from interaction with her and my wife.
• Everything started to unravel at the seams.  All because of the intensity of the positive emotions I feel for my daughter.

Finally realizing this has given me some element of power over it and control over my fears.  It has been and exhausting journey, but I am hopeful that things will improve as I move forward.  It's hard to cope with fears when you aren't aware of what they are.  For the first time, I feel like I have a little better control over my anger again.  Here's to hoping that things continue to get better.

To My Wonderful Daughter Caley:  When you are older and you discover this blog, I want you to know I love you more than words could ever hope to express.  Don't ever, even for a second, think that this was your fault.  Know that it is the intensity of my feelings for you that make this healing possible.  I love you widget, don't ever forget it.

I had a really productive session Friday Morning.  We continued talking about the anger issues that I have been dealing with lately and everything kept on coming back to having more and more difficult not lashing out at work.  My clinician asked me last week if my wife and I have a safety plan and we do, but it's not comprehensive.  We have a safety plan if I become unstable at home.  What happens if that happens at work?  That was my homework assignment for this coming week.  I need to think about how I can exit a volatile situation when I am working.

That being said, my clinician was concerned.  She is concerned that I don't understand why and how my anger is being triggered at work and why it is getting progressively harder and more exhausting to control.  In the past the pattern has been that I work somewhere for six to eight months.  Then I get so fed up with something, anything, that I quit.  I know I can't do that now.  In a way that makes it harder to cope with, knowing I have to stick this out.

I need to make this clear, I enjoy my work.  It's not the work that I hate - it's that my ethics and morality are black and white.  I have no room for shades of grey.  The rest of the world operates in gray areas, making life even more difficult for me to manage my anger.

So that's what I am doing this week -thinking about how to create a safety plan that could help to reduce my stress and potential for angry outbursts at work.  Unfortunately, I am at an impasse on this.  Maybe I should sleep on it and see what comes up tomorrow.