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Throughout my research, I have notice a common theme in successful treatment: forgiving one's self. Many of the veterans who deal with PTSD have survivor's remorse and feel responsibility for the traumatic event which cause their PTSD. In most cases, it was not their fault, but they still cannot face that notion. Forgiving themselves seems to take the weight off their shoulders and relieve them of this remorse. The only problem is trying to find a way to get to that point where they are willing to forgive themselves.

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Have you ever noticed how you can hold on to past mistakes long after they occurred? Some of us hold on to things for years!

Forgiveness is a process. It does not happen over night and the process will be different for everyone. But no matter how long it takes, there's hope! Here are some steps you can take toward that journey:
1. Become clear on your morals and values as they are right now.
The reason most of us feel guilt or shame for actions done in the past is because those actions are not in line with our current morals and values. Our past wrongs can actually clue us in to what we hold important. By identifying our morals and values, we start to get a clearer picture as to "why" we're hurting over what we've done, or what others did to us.
2. Realize that the past is the past.
This seems fairly straightforward, but when we can really wrap our head around the fact that we can't undo the past, the past is done, those things happened, we open ourselves up to more acceptance. Increased acceptance can lead to the emotional healing we are all looking for.
3. Create a "re-do."
Never underestimate the power of a "re-do". Write down how you would have done things differently if you could go back and do it again. In doing so, we affirm that we not only learned from our past mistake, but that if we had the skills we have now, back then, we would have done things differently.
4. Realize you did the best you could at the time.
The way we respond depends on the skills we have, the frame of mind we're in, and how we perceive the situation at that moment. Maybe we didn't have as much objectivity, or acted out of survival or protection mode. Maybe we'd let stress build up, which put us at a higher risk of responding poorly. Whatever the factors, cut yourself a break. If you learn from it, it was never in vain.
5. Start acting in accordance with your morals and values.
The best thing you can do for yourself in order to forgive is start replacing the negative behavior and thoughts with more appropriate ones that are congruous with your morals and values. By so doing, you reaffirm to yourself that you can handle situations in the way you want to. This can lead to a sense of pride, which is a huge part of building self-esteem.
6. Identify your biggest regrets.
When I work with clients on moving on from their past, it can be very overwhelming for them because they see so many regrets. It's often helpful to categorize these things because people often only hold on to a handful of big categories/patterns. Working on patterns of behavior is often more helpful than working on individual regrets.
7. Tackle the big ones.
There may be some regrets that don't seem to improve, and they're going to require some extra work. I call it "clearing your conscience." This means it might take bringing this regret into the room and apologizing for your past mistake.
8. Turn the page.
At some point, you have to accept that the past has happened and you've done everything in your power to amend past mistakes. It's now time to turn the page and accept those events as part of your story. They've all contributed to making you who you are. Being grateful for those experiences allows you to move on and truly forgive yourself.
9. Cut yourself some slack.
When we learned how to ride a bike, most of us realized it would probably take a few tries before achieving perfection. New behavior and thinking patterns are no different. They're both skills. Cut yourself some slack while you're on a new learning curve. Realize that you're going to make mistakes. We all do.
10. Move toward self-love.
The last step in building self-esteem is moving toward loving yourself. Think kind thoughts toward yourself and show yourself some compassion. If we can learn to think of ourselves as our best friend, to speak to ourselves with love and kindness, and put ourselves as a priority, it reaffirms that we believe we are worth it. Engage in psychotherapy or coaching if you need some outside perspective in this area. Seek books on this subject. Surround yourself with supportive people.

You are more than your past mistakes, and I promise you, you are so worth it!!

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10 Ways To Forgive Yourself & Let Go Of The Past

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Have you ever noticed how you can hold on to past mistakes long after they occurred? Some of us hold on to things for years! Forgiveness is a process. It does not happen over night and the process will be different for everyone. But no matter how long it takes, there's hope!

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My research will now focus more on reviewing novels, short stories, films, and whatever other works I can find that deal with PTSD in military veterans. Although I am not a fan of romance novels, I will have to read one since they have a large role in this genre. I will also continue performing more background research on what it is like living with PTSD and treatments for the disorder. I am still searching for more fictional stories which deal with the actual treatment for PTSD, since many of the pieces I have reviewed end once treatment begins.

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To write a believable story, the author needs to ensure the details are correct. For the most part of the films and novels I have read, the writers have portrayed veterans with PTSD fairly accurate. Most veterans I know are knit-picky when it comes to military details. Writers must also realize one of their readers might be someone struggling with PTSD and their story might encourage them to seek the treatment they need. The more precise is, that veteran will be more inclined to believe they can recover from PTSD.

Below is my buddy Oscar and I in northern Iraq in 2003.

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I found it surprising when searching for novels about PTSD, romance novels with characters with PTSD are in abundance. In my mind, there is nothing romantic about PTSD, but it must sell since so many authors use it in their narratives.

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Sep 21, 2017 ... These 5 must-read novels explore PTSD through fiction. The Impossible Knife of Memory by Laurie Halse Anderson. via pinterest.com. In An Empty Room: A Novel by Stephen Spotte. via open-bks.com. In the Weeds by Mark Ozeroff. via open-bks.com. Slaughterhouse-Five by Kurt Vonnegut. The Hummingbird by Stephen P.

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The Rehabilitation of Rambo: Trauma, Victimization, and the Vietnam Veteran

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The Rehabilitation of Rambo: Trauma, Victimization, and the Vietnam Veteran

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An interesting article about First Blood, the first Rambo film. Kathleen McClancy examines how the movie is more than just blood and guts, but rather an in-depth portrayal of the struggles Vietnam veterans faced when they returned home.

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A radio broadcast and article dealing with how Ecstasy can help individuals with PTSD

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MDMA, often known as Ecstasy or Molly, has for decades been used as a party drug - consumed in clubs, fuel for all-night raves. But lately, the substance is also being used in very different settings, for a very different purpose: to treat post-traumatic stress disorder.

The Food and Drug Administration has approved phase two clinical studies of the treatment, and they're now underway in four locations. Results so far have been promising, according to reporter Kelley McMillan, who has been investigating this new use of MDMA and has written about it in the current issue of Marie Claire.

"The findings from these most recent studies are supporting the earlier phase two findings, which found that 83 percent of participants were cured of their PTSD - compared to 25 percent who were cured from talk therapy alone," she tells NPR's Rachel Martin.

These conclusions remain preliminary, however, and phase two trials often fail by the time they reach phase three. And McMillan offers a word of caution of her own.

"People should not be going out and taking MDMA recreationally and thinking that they're going to have these healing experiences," she says.

Still, some therapists are hopeful about the ways they've seen the substance help patients who are grappling with PTSD. "One of the psychiatrists I spoke to likened it to mental anesthesia, and she said that ... it allows a person to kind of get right in and get to the malignant thing that needs to be examined."

She talks to Martin about MDMA's physical effects and its spotty history - and they're both joined in the conversation by Brenda, one of the patients profiled in McMillan's story. Only Brenda's first name has been used, for privacy reasons.
Listen to the full conversation at the audio link above.
Interview Highlights
On the effect MDMA can have on the brain
McMillan: Basically, MDMA unleashes a massive release of serotonin, dopamine and oxytocin. And this creates a state in which participants are very calm, and there's a deep feeling of trust with their therapist. So they're able to explore their trauma and process it.
On how this drug came to be used to treat PTSD in the first place
McMillan: Well, this is what I found so fascinating. Really in fact, MDMA was first used in the '70s and early '80s in therapy, in an underground network of therapists - but it wasn't illegal yet.

And then it got coopted by clubbers in the '80s, so consequently MDMA has gotten a really bad rap and has been sort of the subject of a really unfair publicity campaign.
Brenda, on how MDMA has affected her therapy

Brenda: As a child, I was abused and tortured by my father from the time I was 3 until I was 12. And as an adult, I saw a therapist every single week for 15 years - and I still wanted to die. You know, I was suicidal since I was 5 because that was the only way that I thought I could find [a] solution.

Two years ago, I had a colleague who said, "Hey, I've got my wife who has been struggling with PTSD as well. She's seeing this great therapist that's doing a little bit different kind of therapy, trying to process trauma through the body. You might try that" So I went, very skeptically.

And about six months into therapy, I take the medicine from my doctor, and within about an hour, I had a lot of imagery come up for me - some people do. And the first place I saw was this maze. It looked like a maze that I had been to as a kid, and I remember thinking very clearly, "All right, here we go" - and went in. And, yes, there was so much trauma. I had never remembered these terrible, terrible things.

And before MDMA, I really did think it was my fault. I mean, I felt it in my bones that something was so wrong with me, that I deserved those things. And being on the MDMA was the first time I'd ever felt compassion for myself, realizing that I was a child, I had no choice. I had no choice.
On what life is like for Brenda now

Brenda: It's like I've been living life with the mute button on. You know, before the MDMA study, I could see what was happening in the world, and I could kind of make my own conclusions, based on the fact that I couldn't really hear what was happening. And that was because the noise in my head was too loud.

But now, life is good. Spending 35-plus years suicidal was something I don't wish on anyone, and after six months in that study, I am not suicidal. I want to live.

My dad died in 1995, and it really wasn't until session three of the MDMA trial where I really believed he was dead. So I don't live in fear anymore.

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From Club To Clinic: How MDMA Could Help Some Cope With Trauma

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MDMA, often known as Ecstasy or Molly, has for decades been used as a party drug - consumed in clubs, fuel for all-night raves. But lately, the substance is also being used in very different settings, for a very different purpose: to treat post-traumatic stress disorder.

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Eye Movement Desensitization and Reprocessing

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Eye Movement Desensitization and Reprocessing

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An article and video about using EMDP to treat PTSD.

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Francine Shapiro, PhD, an American psychologist, developed Eye Movement Desensitization and Reprocessing (EMDR) Therapy as a breakthrough therapy with special capacity to overcome the often devastating effects of psychological trauma in the late 1980s. An ever-growing community of therapists soon saw directly its power to transform lives. At the same time, controlled research studies consistently demonstrated its efficacy and effectiveness. For many therapists who took up this therapy, EMDR felt like a "gift" to themselves and their clients, and they were eager to "pay it forward" by spreading the word to colleagues.

Initially, EMDR was utilized and studied as a therapy for PTSD (post-traumatic stress disorder) which was itself a relatively new diagnosis for an age-old human affliction. More than 20 controlled clinical trials of EMDR therapy have now been completed and reported, attesting to its value and demonstrating its usefulness across all ages, genders, and cultures for post-traumatic stress disorders. Tens of thousands of clinicians have been trained in EMDR therapy and have applied the defining protocols of this psychotherapy to many other conditions, including: Personality disorders, eating disorders, panic attacks, performance anxiety, complicated grief, stress reduction, dissociative disorders, disturbing memories, addictions, phobias, pain disorders, sexual and/or physical abuse and body dismorphic disorders.

EMDR therapy is a cost-effective, non-invasive, evidence-based method of psychotherapy that facilitates adaptive information processing. EMDR therapy is an eight-phase treatment which comprehensively identifies and addresses experiences that have overwhelmed the brain's natural resilience or coping capacity, and have thereby generated traumatic symptoms and/or harmful coping strategies. Through EMDR therapy, patients are able to reprocess traumatic information until it is no longer psychologically disruptive.

During this procedure, patients tend to "process" the memory in a way that leads to a peaceful resolution. This often results in increased insight regarding both previously disturbing events and long held negative thoughts about the self. For example, an assault victim may come to realize that he was not to blame for what happened, that the event is really over, and, as a result he can regain a general sense of safety in his world.

Since the development of EMDR therapy, many adaptations of the therapy have been established to address particular types of psychological problems, but all specialized applications rest on EMDR's basic protocols and concept of adaptive information processing.

Adaptive Information Processing - the Guiding Principle of EMDR Theory

The Adaptive Information Processing (AIP) Model has been constructed from observations of many people in states of psychological health and dysfunction. The model reveals that health is supported by positive and successful experiences that increasingly prepare a person to handle new challenges and that the brain is equipped to manage and process adversity.

Yet, there are negative life experiences that can elude a person's natural processing abilities. Another way to look at this is to consider a splinter lodged in one's hand. This foreign object can cause pain and infection. Once removed, the body naturally knows how to heal. Depending on the nature of the trauma, the strengths and developmental stages of the person impacted, and the support available at the time of the traumatic event, some experiences cannot be easily moved or recovered from. This can go on to drive psychological symptoms. Once processed or removed like the splinter, the natural process of healing from adversity can take place. The AIP model guides a clinician's use of EMDR procedures so that the person's own brain can complete the processing of difficult memories. This results in the reduction of suffering and symptoms and the development of new coping skills that can support psychological health.

Description of an EMDR Therapy Session

Eye Movement Desensitization and Reprocessing (EMDR) is an approach to psychotherapy that has been practiced in the U.S. and around the world for the past 25 years. It integrates many of the successful elements of a range of therapeutic approaches, yet there are aspects of EMDR that are unique. In particular, the therapist leads a patient in a series of lateral eye movements while the patient simultaneously focuses on various aspects of a disturbing memory. The left - right eye movements in EMDR therapy are a form of "bilateral stimulation". Other forms of bilateral stimulation used by EMDR therapists include alternating bilateral sound using headphones and alternating tactile simulation using a handheld device that vibrates or taps to the back of the patient's hands.

EMDR therapy is applicable for a wide range of psychological problems that result from overwhelming life experiences. During the processing of difficult memories, a person who has been abandoned by a spouse may come to realize that she is loveable and is no longer overwhelmed by negative feelings about herself or participate in unproductive behaviors stemming from those feelings. A person fearful of driving due to a terrible car accident in the past may end the session feeling safe to drive again.

The therapeutic effects of bilateral stimulation were discovered by Francine Shapiro, Ph.D., who grasped their power in psychotherapy. Dr. Shapiro found-quite by accident-that emotional and behavioral symptoms resulting from disturbing experiences tend to resolve naturally when a person allows him/herself to recall various elements of a memory while engaging in bilateral stimulation such as lateral eye movements. Dr. Shapiro and her associates developed a number of procedures for coordinating this "dual awareness". The procedures have been refined and validated through controlled research at several centers around the world. Precise and careful use of these procedures can lead to a safe processing of memories, such that the negative thoughts and emotions disappear.

More than a set of "techniques", the EMDR approach provides a model for understanding human potential, including how positive experiences support adaptive living, or psychological health, and how upsetting experiences can sometimes lead to psychological problems that interfere with a person's ability to meet life challenges. The EMDR protocol guides clinicians in careful assessment and preparation work, particularly for persons with histories of multiple traumas. EMDR procedures should only be used by a fully trained EMDR clinician, who holds licensure in the mental health field.
"EMDR is one of the most powerful tools I've encountered for treating posttraumatic stress. In the hands of a competent and compassionate therapist, it gives people the means to heal themselves."
Steven Silver, Ph.D.
Former director of the PTSD Unit,
Veterans Administration Medical Center,
Coatesville, Pennsylvania

How does EMDR work?

While research is actively taking place, the precise mechanism by which EMDR works to resolve traumatic stress is unclear, in part because we are just beginning to understand exactly how the brain processes intense memories and emotions. However, a number of neuropsychologists believe EMDR enables the person undergoing treatment to rapidly access traumatic memories and process them emotionally and cognitively, which facilitates their resolution.

"We believe that EMDR induces a fundamental change in brain circuitry similar to what happens in REM sleep - that allows the person undergoing treatment to more effectively process and incorporate traumatic memories into general association networks in the brain. This helps the individual integrate and understand the memories within the larger context of his or her life experience."
Robert Stickgold, Ph.D., Harvard Medical School
By accessing these memories in the context of a safe environment, the hypothesis is that information processing is enhanced, with new associations forged between the traumatic memory and more adaptive memories or information. These new associations result in complete information processing, new learning, elimination of emotional distress, and the development of cognitive insights about the memories.

"EMDR quickly opens new windows on reality, allowing people to see solutions within themselves that they never knew were there. And it's a therapy where the client is very much in charge, which can be particularly meaningful when people are recovering from having their power taken away by abuse and violation."
Laura S. Brown, Ph.D.
Past Recipient of the American Psychological Association Award for Distinguished Professional Contributions to Public Service
After successful treatment with EMDR, affective distress is relieved, negative beliefs are reformulated, and physiological arousal associated with stress is reduced.

Finding an EMDR Clinician

Trauma Recovery/HAP does not make referrals for psychotherapy, but individuals seeking an EMDR therapist can consult the following websites to locate a therapist by location, specialty area or level of training: EMDR International Association: www.emdria.org, or the EMDR Institute, www.emdr.com

Research Findings

Research on EMDR is ongoing. Trauma Recovery/HAP provides a periodically updated bibliography of Research Findings. Additional information on trauma, EMDR practice and history can be found in numerous books and monographs. A growing collection of these and other materials can be found at the Francine Shapiro Library.

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What is EMDR? Learn More About EMDR Description of an EMDR Session How Does EMDR Work? Finding an EMDR Clinician EMDR Resources Research Findings Francine Shapiro, PhD, an American psychologist, developed Eye Movement Desensitization and Reprocessing (EMDR) Therapy as a breakthrough therapy with special capacity to overcome the

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Veterans find peace through whitewater rafting.

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"Forward! Forward!! FORWARD!!!" shout the river guides.

Eighteen US military veterans plunge their paddles into foaming waves.

"Get DOWN!" comes the next command.

The vets tilt forward.

Several of them scream.

Four gray rubber rafts pitch over the eight-foot drop at Clavey Falls.

The veterans and their support staff of six guides and two mindfulness instructors are traveling 18 miles on a three-day journey through a wild, deep river canyon west of Yosemite National Park.

They're here thanks to a San Francisco-based program, Honoring the Path of the Warrior, which provides an unusual, highly skillful mix of free-of-charge, adrenaline-junkie fun with secular training in mindful breathing, acceptance, and compassion.

This is HPW's sixth whitewater trip. It has also sponsored rock-climbing and hiking events, so far serving more than 400 veterans. Several recent clinical studies suggest that training in mindfulness-nonjudgmental, accepting awareness-can help alleviate some of the symptoms of post-traumatic stress disorder (PTSD), which has grown to epidemic proportions among veterans of the Iraq and Afghanistan wars.

Each week, roughly 1,000 veterans receive new diagnoses of PTSD, according to recent estimates from the Department of Veterans Affairs. Classic symptoms include depression, anxiety, irritability, and panic. The disorder is also a frequently cited factor in the alarming and increasing rate of suicides among US troops and veterans. Some 8,030 veterans committed suicide in 2010, the VA has reported- averaging out to 22 each day, and more in just one year than the total estimated number of US military deaths since the beginning of the Iraq and Afghanistan wars.

Even so, however useful mindfulness may be as a tool for relief of psychic suffering, it's the rare former military member who is eager to sit still. "Most vets like adventure," says Lee Klinger Lesser, HPW's tan, silver-haired cofounder and executive director, one of the two women leading the trip. "And the power of the river is immediate. You have to show up."

It's early July, and the banks of the Tuolumne are patched with charred remnants of buckeye, oak, and pine trees burned in last year's devastating fire. The water is shallower than in past years, in the wake of a record-setting drought, although periodic releases from upstream reservoirs keep it flowing.

Wearing bright orange plastic helmets and life vests, the vets stand out against the brown and gray of burnt grass and granite boulders. They listen for orders, poised to react, as if they were once again in training or combat.

"BACK, now, BACK!" shout the guides, and the rafters furiously back-paddle to clear a jagged rock known as the Rooster Tail. Whitewater rafting is considered an "extreme sport." The professional guides make it safer, but the dangers are real-particularly if participants aren't paying close attention. Rafters can get thrown into the waves and sucked into the eddies that swirl around rocks, which the guides call being "worked in the hole."

Many of the vets haven't met each other before this week. Nor at first do they seem to have much in common. Five women and 13 men, they range in age from late 20s to early 50s. One is a university professor; another owns a small mechanics company.

Some are back in school. Two are still employed in the armed forces. Several are out of work.

They've served in the army, air force, navy, coast guard, and National Guard-in Iraq and Afghanistan, most recently, but also in Bosnia, Haiti, post-Katrina New Orleans, and as part of multinational forces in Israel. What brings them here and binds them together is soon obvious. All have been suffering-mostly alone-from a range of troubles including depression, anxiety, night terrors, and the aftermath of sexual assault. Many of these injuries date back to long before they signed up to serve, the military often seeming a safe haven from abusive families. It's soon clear that they also miss the camaraderie and sense of purpose they had for a time and have since lost, but find again each time they reunite with other vets.

The two HPW instructors, Lesser and cofounder Chris Fortin, a Zen teacher and psychotherapist with a contagious high-pitched laugh, help the group work toward recovery with a daily routine that includes training in mindful breathing and instructions on nurturing compassion for themselves and each other. The vets, in turn, help each other, as they dare to be increasingly honest about their struggles and triumphs.

The river journey reinforces everything they're learning, meanwhile, with vivid sensory experience. The vets come to appreciate, for instance, that they can't navigate whitewater while distracted by painful memories. While at first it may feel counterintuitive to lean forward into the waves, they find that, as in life, it helps them avoid getting thrown overboard.

* * *

Aftershocks

Boarding the raft Tuesday morning, the first day on the river, Danny Martinez, 28, mumbles that he's sorry for the way his gym shorts keep slipping down his back. "They took away the string when I was in the psych ward," he explains.

Martinez enlisted in the army at 19, after dropping out of vocational school. He trained as a parachute rigger at Fort Bragg for three years, and then re-enlisted, after which he was deployed to Afghanistan. He lasted just one month there, however, before suffering a nervous breakdown. He missed home and dreaded getting caught in combat.

This is Martinez's second trip with HPW. His face is a mask of sorrow and he speaks only rarely, between heavy sighs. He says he has few friends and is battling drug addiction-both of which turn out to be common complaints among the rafters. Another veteran struggling with PTSD and haunting memories from Iraq says that on returning home, he drank a fifth of whiskey every night to numb his pain, until the morning he awoke to find three burns on his arm that he'd made with a fireplace poker. There was a rifle lying by his side. He believes he would have killed himself had the rifle not jammed.

Several of the former soldiers are still coping with feelings of betrayal by partners in arms. Three of the five women rafters speak of being sexually assaulted by fellow soldiers and even designated superiors, crimes none of them ever reported.

"I wanted to be that strong, no-one-can-mess-with-me kind of girl," says Dawn Marie, 40, who served in the navy from 1997-2004. "But that's when I first lost trust. Not just in other people, but in myself. That I could handle things."
For Jose Arana, who joined the army at 17, fleeing an alcoholic stepfather who beat him, starting at age six, with "TV antennas, belts, boots, and baseball bats," the hardest part about being in the military was coming back home.

"While I wasn't addicted to alcohol or drugs, I was addicted to control, and to anger," says Arana, who spent 28 years in the armed forces, including four years of active service and a stint as a military advisor in Iraq. "I'd bark and yell and argue with my wife. I couldn't stand to be calm, because that was when I felt worthless."

Last year, Arana abruptly took a leave from his US Postal Service job after arguing with his boss. His VA counselor recommended that he join an HPW river trip leaving two weeks later. "That was the start of my recovery," Arana says.

In Soul Repair: Recovery from Moral Injury After War, the author, Rev. Dr. Rita Nakashima Brock, describes the variety of psychic injuries lying behind the PTSD label, from having witnessed shocking suffering and death to feeling betrayed by colleagues and commanders to regret over having violated one's own moral beliefs. Such wounds have been hard enough to bear in the wake of popular wars. But soldiers who've served in Iraq and Afghanistan-among the most controversial US conflicts in history-often come home to find themselves isolated from family and former friends who may neither understand nor care what they've endured.

For them, the standard VA treatments-clinic visits and prescription drugs-may feel like flimsy Band-Aids. Many of them shun the VA altogether, for reasons some reveal on the river trip.

Dawn Marie, the navy veteran, says at one point she was taking four different antidepressants every day, despite feeling "numb" and gaining 30 pounds. Given the alternative, who wouldn't rather raft down a river? The physical exercise is invigorating, as is the companionship, while the stigma of needing help is at a minimum.

The whitewater adventure also bridges what might otherwise be an insurmountable cultural divide between the gentle, politically liberal San Francisco Bay Area mindfulness teachers and the macho, mostly politically conservative men and women they're trying to help.

Forty-some years ago, Lesser, the HPW director, joined street protests against the Vietnam War. Back then, she says, she found it easy to vilify Americans who fought there, categorizing them as "a separate species" and judging their behavior "in the ridiculous hubris of thinking I'd never do such things." Today, however, as a mother of young adults who under other circumstances might have wound up in Iraq or Afghanistan, it's much easier for her to imagine and empathize with what the vets have endured. "The truth is I lose my temper with my kids, and if someone I loved were shot in front of me, I don't know what I'd do-and I have a mindfulness practice of 40 years," she says.

Fortin, HPW's cofounder, recalls how the idea of working with returning vets seemed at first both "impossible, because we had no connection with or understanding of military culture...and imperative-because whether I agreed with the war or not, young men and women the same age as my son were being put in harm's way in a war that felt like part of our collective karma. I couldn't turn away."

Only later, says Fortin, did she come to appreciate the connection with her own family history. She believes her father, a World War II combat veteran who earned a Bronze Star, suffered from PTSD, although he never spoke of his experiences.

The cultural divide has two sides, to be sure. National Guard Major Cheryl Wachenheim, who teaches agribusiness at North Dakota State University, was so worried that the fare on the river would be vegetarian (it wasn't) that she ate 18 link sausages for breakfast at her hotel on the morning before joining the trip. After nervously driving on highways alongside Priuses with Obama bumper stickers, Wachenheim was relieved to meet other vets-some arriving in trucks and jeeps-who, as she describes it, became a safe haven from her fearful stereotype of California.

After a couple hours on the river, just past a Class IV rapids called Gray's Grindstone, Noah Nash, a guide from the All-Outdoors rafting company leading the trip, offers Danny Martinez a turn at the helm of the "oar raft," where the helmsman is responsible for most of the navigation.

Martinez moves to the back of the boat. He looks briefly alarmed as Nash hands over the heavy oars, with one nearly slipping from his grip. But he's muscular and learns quickly, and is soon confidently steering the boat through small waves.

The vets on the other boats watch and cheer him on. Martinez's sad face is transformed by a grin.

The Toolbox

Matt Huffman, whose burly right arm is tattooed with a bracelet of skulls and the motto, "GOD HATES A COWARD," is leading a meditation exercise. It's Wednesday morning, the second day on the river. The group is camped out on the shore for the day, awaiting the next scheduled release of water that will once again make the Tuolumne navigable.

"Picture you're sitting on the boat," Huffman instructs his fellow rafters, as they sit in a circle of camp chairs under pine trees. "There's smooth water, and then there are the rapids. Notice the thoughts that come, but don't grab onto them. Think of each thought like a stick floating down the river. Just observe it. There's that stick! There it goes! Keep breathing.... See if you can increase the end of the exhale."

Huffman, 39, grew up in Clear Lake, California. His mother died of a heroin overdose after spending most of his childhood in prison. Beginning at age 17, Huffman spent three years in the infantry. He began to drink heavily while stationed at Fort Ord and Fort Irwin in California. Returning home, he started using methamphetamine, at first as a way to hold more liquor, and then, as he describes it, as a way "to celebrate, to mourn, and to live." He got high smoking meth every day for five years straight, beginning in 2005, he says, although he adds, with a soft chuckle, "I wasn't your typical meth addict." True, he lost his home, driver's license, and fiancée, and stole from friends to support his habit. Yet, as he explains: "I always took care to hydrate, and I brushed my teeth, so I only lost four of them."

That core of resilience may help explain how Huffman managed to go straight after hitting a low in 2010. Arrested for stealing a car, he wound up in county jail, where, after fighting and telling off the guards, he was placed in solitary confinement for two weeks.

There, he says: "I came to some realizations. This is not everybody else's fault. I started praying. It was the first time I'd asked for help."

Huffman attended an HPW rock-climbing event on the advice of his VA counselor. He thought the mindfulness part was silly at first. But as he continued to practice, he realized he'd discovered a balance he'd sought for years as he'd tried, and failed, to mediate between the high of meth and the low of alcohol. Lesser and Fortin noticed his increasing dedication and eloquence, and persuaded him to enroll in HPW's eight-month veteran leadership program. Subsequently, they chose him to be one of three vet leaders for the river retreat, where he skillfully encourages his fellow travelers to open up with the example of his own rigorous honesty.

"Reach for some water," he says now, raising his hands and grasping at the air. "Take two handfuls. Slowly pour it over your body. Notice the sounds of the river, always flowing, and the sounds of breath coming in and going out of our lungs. Here we are. We're all alive right here."

A pair of yellow-and-black swallowtail butterflies flit past, but most of the vets don't see them. Eyes shut, they're dutifully following Huffman's directions, splashing the imaginary water over their chests.

"I love you, man!" Jose Arana shouts when he finishes.

"Where'd you learn that, Dude?" calls out Aaron Tozier, who served in Iraq from 2005-6.

Mindfulness masters and philosophers have relied on flowing-water metaphors for millennia. Both the Buddha and Heraclitus compared life to an ever-changing river, both vexing and lovely in its impermanence. Throughout the three days of the river journey, Lesser and Fortin and their vet leaders draw frequent parallels between the rafters' experience on the water and the challenges they face in their lives, encouraging them to face both experiences with the tools of drawing their awareness to their physical sensations, and taking that extra breath.

Dawn Marie, also a vet leader, like Huffman, tells how the mindfulness skills the vets call their "toolbox" helped her the day she arrived at the campsite. She survived colon cancer a few years ago, requiring a colostomy. She also has a weak knee from a snowboarding accident that was compounded by the wear and tear of climbing stairs on her navy ship. Despite the big blue disabled-parking sticker on her dashboard, a man outside the restaurant in a nearby town where she'd stopped to buy a cup of coffee told her to park in a lot from which she would have to walk upstairs.

"A year ago, I would have gotten mad at him and argued," she says. "Instead, I took a breath and told myself I'm about to be on a wonderful trip. I'll focus on that instead."

Mindfulness on the Rocks

Just a few days before the vets began their river trip, University of Virginia and Harvard researchers reported a new study suggesting that many people would prefer to administer painful electric shocks to themselves rather than spend time alone with their thoughts.

This group wouldn't seem to be an exception. The Tuolumne journey features several Class IV rapids in addition to the Class V rapids at Clavey Falls. (The International Scale of River Difficulty lists only six classes of rapids, with Class VI "rarely attempted.") But the veterans on this trip are apparently not satisfied with this degree of risk. At one point, several of them, including Dawn Marie, with her colostomy bag and weak knee, head ashore to climb a 20-foot rock ledge from which they leap into the water. At another, they turn their rafts straight back into a rapid called Surf City, in a maneuver known as "surfing." They appear undeterred by the guides' warnings of the risks of falling out.

And sure enough, as the tip of one boat flies up against a wave, Aaron Tozier topples into the water. All you see for one alarming instant is his bare foot in the air. All four rafts speed toward him at once, but it's Danny Martinez who gets there first, throwing himself across his boat to grab Tozier and pull him up by his vest. Tozier is 6-foot-4; Martinez 5-foot-7. Martinez seems galvanized.

Tozier's leg is bleeding, and he has lost both of his shoes, but is otherwise unharmed. "I owe you one, man!" he shouts to Martinez, who grins his new grin once again.

Scenes like this reveal the skillfulness of the adventure-and-emotional therapy formula offered by Lesser and Fortin, a combination that in past years, in different incarnations, has been used with troubled teenagers, and now is becoming increasingly popular for vets.

It's striking how the rafters snap back so quickly into working as a team, responding to orders and looking out for each other. Their bravery on the rafts also carries over to their group conversations, as, revealing their struggles, they repeatedly discover that they're not alone.

"It's really exactly like the military," says Arana, Wednesday evening, as the vets sit in their circle of camp chairs in the sand, and a nearly full moon rises over the canyon. "In the military, we learned to trust in the equipment. Here, you may get anxious but you have that trust factor of the equipment and the guide. So you get into that mode and you hear the commands and trust it'll come out okay."

Arana tells the group: "I took a chance this year, taking what I've learned and saying I needed help. Even though I came with a smiley face, it was hard. But you know what?" He raises his hand in the air. "I'm weak. And once you can say that, the healing begins."

Wachenheim, the army reserve major from North Dakota, whom everyone, by now, is calling "Fargo," speaks haltingly at first as she tells the group that the pine trees on the riverbank remind her of the beauty of Afghanistan. Baring her heart doesn't come naturally; throughout the trip, she has preferred to crack jokes and splash other rafters with her paddle.

"I'm ashamed of what we did do and I'm ashamed of what we didn't do," she says of her war experience, holding her knee to try to stop its jiggling. "But this is the first time since I've gotten back that I remember something good about Afghanistan. This trip, and all of you, provide me with hope."

Norma Martinez, another active major, in the US Army Reserve (and no relation to Danny) smiles at Wachenheim and tells the group: "Cheryl told me this morning, 'I don't want everybody to know I'm crazy.' I told her, 'Don't worry. Everybody already knows you're crazy. And we're all crazy.'"

At moments like these, the word "disorder" seems particularly wrong to describe what these veterans are experiencing. Their responses to what they have experienced instead appear abundantly human, which helps explain why many military leaders have recently begun to drop the "D" from PTSD.

On Thursday, the group has to wait until after noon for the water release from upriver. There are nine more miles to go, including four more Class IV rapids, with names like Thread the Needle, Hell's Kitchen, and Pinball. But in the last few miles of the journey, before the river widens at the opening to the Don Pedro Reservoir, the landscape looks a lot less charred. Drought-hardy chaparral shrubs and vines-manzanita and toyon, as well as poison oak and blackberry-make patches of green on the riverside. Dragonflies gleam above the water, and Nash, the guide, points out a bald eagle, sitting in a brand-new nest in a pine tree.

Band of Brothers and Sisters

The rafters spend the last night of their trip at a campsite near the tiny town of Groveland. Before getting into their cars to return home Friday morning, they stand, joined by Lesser and Fortin, in two lines that face each other. Many have tears in their eyes.

The lines twist around so that each person gets a moment to look each other in the eyes. The vets take turns telling each other, "Thank you," and "You're welcome." After just a few minutes, many dispense with the ritual and simply embrace.

These past few days spent beyond the reach of cell phones, TV, and computers, have helped them listen to each other with rare attention.

Lesser and Fortin take precautions so that after all this intense closeness, the vets aren't left completely alone. They name pairs to be buddies to check in with each other, and remind them to keep appointments with psychotherapists. They announce a barbeque in San Francisco the following week, and more events, including veteran-leadership training, through the fall, seeking to build a community of war veterans supporting each other in their recovery.

At the campsite, Lesser and Fortin also offer tips for re-entering daily life.

"How many people here are feeling anxious?" Lesser asks them.

More than a dozen hands are raised.

"It's really important to notice where you feel anxiety in your body," she reminds them. "That can become your ally. Think of it as your mindfulness bell."

Fortin, the other leader, tells them: "We're talking about a practice of kindness. Not oohey-gooey kindness, but deep, courageous kindness. If I take a breath before answering the phone, I'm being kind not just to myself but also the whole world. Just stop whenever you're feeling edgy or sad or alone. Put your hands on your heart. You're right here."

Danny Martinez, who rescued Aaron Tozier from being "worked in the hole," thanks everyone "for being so friendly." He adds, "I'm such a loner. I'll sit at home all day and not do anything. I know it will be tough, readjusting, transitioning. I'll take some time. I'll practice my breathing."

Nearby, cars are revving their engines in the campground lots, reminding the vets of passing time, their own looming separation, and all the obligations, relationships, and emails awaiting them back home. Change is inevitable. Good times and bad times alike routinely transform into something else. And, just as on the river, the safest path forward is straight into the waves. ●

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War veterans-who've seen more pain and devastation than most will see in a lifetime-struggle to find peace, and ways to fit back in and contribute all they have to offer. Three days on a roiling river bring them a step closer to feeling good in their own skin again. #mindfulmagazinefeb15

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Other Interesting Resources and Treatment Methods

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Other Interesting Resources and Treatment Methods

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1LT Buck Compton is sent to the rear after witnessing two of closest friends get hit with artillery, each losing a leg. Although he returns to battle, the viewer can see a change in him.

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Blow: A Short Story of the Military Misadventures of Having PTSD

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Blow: A Short Story of the Military Misadventures of Having PTSD

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A not well-written short story about a female service member who has an extreme case of PTSD.  Rowan seems to go over the top with the main character, which is nameless.  Rowan seems to over exemplify the characteristics of PTSD to get her point across.

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Although slightly inaccurate when dealing with actual military details, the portrayal of Boaz, a Marine returning from Iraq, it is fairly correct.

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A novel about a WWI English captain who has shell shock and partial memory loss. Published in 1918, the West did her research on what was known about PTSD at the time.

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Although based on the book of the same name, an extremely accurate view of a Vietnam veteran and his struggle with PTSD

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Have these books and films portrayed the characters with PTSD accurately?

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From Shell Shock and War Neurosis to posttraumatic Stress Disorder: A History of Psychotraumatolog

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From Shell Shock and War Neurosis to posttraumatic Stress Disorder: A History of Psychotraumatolog

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A French study researching the ever changing diagnosis's of PTSD.

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An article from the Veterans Affairs website on the history of PTSD

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An article from the Veterans Affairs website on the history of PTSD

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Page Not Found - 404 Error - PTSD: National Center for PTSD

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The Relationship Between Course of PTSD Symptoms in Deployed U.S. Marines and Degree of Combat Exposure

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The Relationship Between Course of PTSD Symptoms in Deployed U.S. Marines and Degree of Combat Exposure

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A study of Marines and how the amount of actual combat they have seen can lead to severity of PTSD.

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A look into using meditation to treat PTSD.

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A film about two Iraqi War vets who walk from Milwaukee to Los Angeles in attempt to battle their PTSD.

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Moral injury is a relatively new concept and "involves psychological and spiritual wounds that result from experiences that conflict with one's deeply held beliefs of right and wrong. This is not a mental disorder", says Katinka Hooyer, PhD, also a character in Almost Sunrise.

Dr. Brett Litz, a pioneer in the study of moral injury, points out that, "The key precondition for moral injury is an act of transgression, which shatters moral and ethical expectations that are rooted in religious or spiritual beliefs, or culture-based, organizational, and group-based rules about fairness, the value of life..." The injury can arise in a variety of forms ranging from "....perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations."

Recently, researchers and therapists on the frontlines of veterans' care have started to identify what may be a critical factor in the overall suicide crisis - a sort of "missing link" - a condition called "moral injury".

I would bet anything, that if we had the wherewithal to do this kind of research we'd find that moral injury underlies veteran homelessness and suicide.

- Dr. William Nash, Director of Psychological Health for the United States Marine Corps

"Moral Injury Panel at AFI Docs"
AFI panel discussion on Moral Injury
Moral injury in the context of war

The actions that war requires, whether committed or witnessed, often violate the core cultural beliefs Veterans learned from their families and communities.

Moral injuries surface when a Veteran begins to reflect on the memories of war, judging their own behavior or that of their friends or leaders. The memories that define a moral injury are about sorrow, shame, and deception, not so much fear or anger. Fear and anger are more representative of PTSD.

The consequences of violating one's moral code, even if the act was necessary and unavoidable in that moment, can be very destructive. In these instances, self-judgment is at the core of moral injury. The killing of children and women, not being there for a battle buddy who lost their life or the incapacity to help injured civilians are common sources of moral pain that Veterans talk about.

Witnessing leaders and respected peers violate core values is a different form of moral conflict. Feelings of betrayal are at the root of these types of moral injury. Examples include being raped by fellow service members or witnessing the inhumane treatment of prisoners.

The stories that may provide a clue to moral injury are linked more to what service members have done or failed to do, not what was done to them. Feelings of guilt and shame, related to not living up to their military charge or failing to fulfill their own standards of right and wrong, are a strong sign of moral injury.

The emergence of moral injury has no particular timeline. There are life experiences that may trigger awareness of moral injuries. These experiences include changes in life stages, marriage, the birth of a child, and the loss of a relationship, the empathy of a stranger, the death of a loved one or even experiencing unconditional love.

"The diagnosis of PTSD has been defined and officially endorsed since 1980 by the mental health community, and those suffering from it have earned broad public sympathy and understanding. Moral injury is not officially recognized by the Defense Department. But it is moral injury, not PTSD, that is increasingly acknowledged as the signature wound of this generation of veterans: a bruise on the soul, akin to grief or sorrow, with lasting impact on the individuals and on their families."
- David Wood, A Warrior's Moral Dilemma, Huffington Post ( http://projects.huffingtonpost.com/projects/moral-injury )

Moral injury can be expressed through

* Overwhelming depression

* Guilt or shame

* Loss of meaning in life

* Feelings of worthlessness, despair and remorse

* Feeling like "I've lost a part of myself"

* Feeling like "I do not know who I am anymore"

* Feeling intense distrust

* Difficulty connecting emotionally to others

* Abandonment of core values

What to do with Moral Injury?

Veterans carry moral injuries with them because often they are too ashamed to tell anyone. One of the most healing things Veterans can do is share these experiences with other Veterans that have similar stories. Receiving acknowledgement from other Veterans is important to know they are not alone in their moral conflicts. Sharing with a trusted loved one can also be comforting and relieve some of the burden.

Sometimes, connections to religious communities can offer some grace and assist Veterans in coming to terms with their internal moral conflicts. For others, serving humanity in a manner that can help them "right the wrongs" they believe they committed, is also healing.

Civilians and veteran families:

It is VERY important not to pass judgment, good or bad, and just LISTEN and say, "I hear you." The Veteran is already judging themself in a very damaging way. They may have had other people make excuses for them and say, "You did what you had to" or "It was either them or you." It can be hard to hear Vets describe their pain and it is crucial to remember that your role is not to "fix" the pain. Just listen in a way that shows respect, acceptance and continuing support. That is a huge gift to someone - it lets the person know, without words, that they are worthy.

ALMOST SUNRISE is the first feature documentary film to identify Moral Injury and explore the veterans experience through the lens of this timely condition.

"Almost Sunrise is a timely and groundbreaking look at what could be a missing piece of the puzzle-the true nature of the psychological wounds of returning soldiers known as 'moral injury,' and the undeniable potential power of meditation and nature therapy in helping veterans to reclaim their lives." - Hollywood Glee

Warrior's Return: Restoring the Soul After War, by Edward Tick

Tribe: On Homecoming and Belonging by Sebastian Junger

For Families and Healthcare providers:

Thank You for Your Service by David Finkel

Soul Repair: Recovering from Moral Injury after War by Rita Nakashima Brock and Gabriella Lettini

Adaptive Disclosure: A New Treatment for Military Trauma, Loss, and Moral Injury by by Brett T. Litz PhD, Leslie Lebowitz PhD, Matt J. Gray PhD, William P. Nash M.D.

What Have We Done: The Moral Injury of Our Longest Wars by David Wood

Afterwar: Healing the Moral Wounds of Our Soldiers by Nancy Sherman

The Things They Cannot Say: Stories Soldiers Won't Tell You About What They've Seen, Done or Failed to Do in War by Kevin Sites

Partner Organizations:

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Almost Sunrise Documentary | Hope Is On The Horizon

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Moral injury is a relatively new concept and "involves psychological and spiritual wounds that result from experiences that conflict with one's deeply held beliefs of right and wrong. This is not a mental disorder", says Katinka Hooyer, PhD, also a character in Almost Sunrise.

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Below are sources I have used as a basis to compare works of fiction.

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ACRONYM: The Cross Generational Battle with PTSD

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ACRONYM: The Cross Generational Battle with PTSD

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A look at veterans from WWII to the present wars and how they struggle with PTSD.

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Teach Toddlers Colors Numbers Preschool Race Cars & Magnet Truck

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22/75. Twenty two U.S. veterans takes their lives EVERY DAY. Seventy five veterans attempt suicide EVERY DAY. One, is too many! From the beginning of war, those thrust onto the field of battle have gone through their own levels of mental trauma.