Overview of Triage Therapeutic Approach
The Triage Method of Emotional Therapy (TMET) is supported by clinical experiences during a 24-month pilot program titled, Operation Recovery. The method is influenced by empirical findings from recent neuroscientific research and considered an on-the-ground application of the Hakomi Method of Body/Centered Psychotherapy.
In a pilot program titled Operation Recovery, TMET proved effective when applied in a contained, open-air garden/woodshop environment. While engaged in physical activities and social interactions, participants were able to:
(a) develop the trust required for an effective therapeutic alliance
(b) experience a sense of self-control by initiating their own therapeutic process
(c) learn to self-regulate physical and psychological function through education and experiential training
(d) gain trust in their capacity to acknowledge and tolerate their own feelings,
emotions and thoughts
(e) learn to engage and control their own physical and mental defensive systems
in real time.
With survival as the genetic dictate, organic systems of the body regulate energy and effort in relation to efficiency and effectiveness. Affective Neuroscience, a book authored by Jaak Panksepp, describes how threats to survival, labeled traumatic experiences, activate survival mechanisms in the primitive brain, which increase affect, a pre-emotion neuroprocess, for the primary purpose of stimulating physical movement.
As threats to survival increase, the Primitive Base Brain becomes the Supreme Command Center (SCC) and instinctually elevates the production of motivational affect to influence other neuro-centers. Greatly increased affect results in an overload for the Central Nervous System (CNS) and a decreased capacity in higher brain function – emotion, cognition, language, attention and memory.
All three of these neuro-centers are systematically integrated during:
(a) the integration of sensory input with motor output
(b) the regulation of physiological arousal
(c) the capacity to communicate experience in words.
However, only the SCC has the capacity to selectively control the process. Its supreme control is dictated by genetic survival structures.
Continuing SCC arousal with a decrease in CNS function – combined with limitations in memory and attention, produces a virtual experience of being lost in space and time. This produces the out of body experience during moments of trauma and may explain the Marine feeling like they are still in Iraq, when they are with family at home.
Until the SCC is convinced the threat is over it will continue its potential to control with or without reminders or triggers of the original threat. Variations in reactions to trauma and in the persistence of control by the SCC are related to the particular structure of each individual’s genetic coding for survival – suggesting relationship to resiliency.
Additional research published by Rauch/Van Der Kolk, Hull, and Lindauer supports Panksepp’s work on how threats of survival motivate increased affect in the SCC as a means of generating physical action, while decreasing the higher brain’s capacity to regulate affect – to slow or stop action in threat’s presence.
These researchers have all pointed out that popular therapies, which seek to medicate or modulate the higher brain functions of emotion, cognition and language, may find their methods inefficient and/or ineffective in treating trauma. As Van Der Kolk points out, higher brain chemistry and emotions are activated in order to bring about action. They are not what “is” motivating the activation. In addition, experience in Triage suggests that some of the actions being motivated may be designed to hide and protect the motivator!
The SCC is not easily convinced that threat is over. When missing the experience of a return to safety or through physical damage, the SCC appears to be mandated to continue generating affect, which stimulates the chaotic thoughts, intense emotions and irrelevant behavior of PTSD. The SCC is not designed to simply trust the CNS and higher brain functions to make decisions on issues of survival. It is designed to resist and distract any deviation from its dictate to survive. Only by the experience of knowing the threat is over will this system lower its guard and allow the other neuro-centers the opportunity to regulate peace of mind.
Continuing symptoms are evidence that the SCC is actively sorting for safety and not finding it. During psychotherapy treatments where the focus of support was on SCC processes, a decrease in affective tones has been documented using Quantitative Electroencephalography (QEEG). Certain popular treatments may prove more than ineffective if studies were to find a rise in affect during symptom treatment.
Van Der Kolk concludes, that effective trauma treatment needs to involve (a) creating a safe, controlled environment where trust and the therapeutic alliance can develop organically, (b) learning to tolerate feelings and sensations by increasing the capacity to mindfully observe and track one’s own inner experience, (c) learning to regulate one’s own affect and the resulting emotions, thoughts and actions, (d) learning to re-engage physical defenses and re-build collapsed or overwhelmed systems.
The Triage Method
The Triage Method (TMET) is an on the ground adaptation of methods and principals of the Hakomi Method of Body/Centered Psychotherapy and neurologic system concepts supported by empirical findings of recent neuroscientific research. The Method has been refined over the last 15 years working with individuals exposed to mild to severe violence, who have lost trust and remain hyper vigilant to mental and physical invasion.
During the last 24 months, working with Marines and their families the method did show very positive outcomes. A garden provided the safe environment to initiate therapeutic relationship in a non-clinical, non-diagnostic way. It provided a space where Marines and families could rest, turn their attention inward and notice their unique organic process.
Triage principals honor the fact that living organisms were created to ensure selfish longevity and purpose. The best hope for both is that the organism’s design includes a systematic electrical/chemical system at its core – one, which can self-direct communication between all possible participants in its survival, from its simplest gene to its complex social environment. The supreme goal of this selfish system is to maintain an efficient and effective balance – of all things relevant to self-survival, within limits defined by a Window of Tolerance.
The practice of Triage in the garden involves noticing any activity threatening to take a participant outside their Window-of-Tolerance. This means noticing any subtle thing that disrupts the participant’s present state of balance and theoretically becomes a threat to their survival. Once noticed, choices are made about what to do about the perceived threat.
For example: In broad strokes, too long under water, not enough oxygen tips the balance and causes survival systems to ratchet down efficiency (stop thinking and emoting and swim like a fish to the surface), regain balance and survive. Here, noticing someone is drowning – we take action and throw out a preserver. We don’t shout to them the fact that they are drowning.
Prolonged exposure to threat of immediate death and constant surveillance with sleep deprivation provides information that the Supreme Command Center (SCC) must take over and dictate the survival effort. Thinking stops. Emotions cease. Information from the SCC is standard operational procedure and the first line of motivation for muscle and body organs. Here, noticing someone is sleepless – we help them notice the process they may be using to block sleep. We don’t throw them a pillow and turn down the lights.
As long as the affective signals of communication from the SCC continue to prevail other neuro-centers generating emotions, thoughts and ideas will struggle to compete, to regain their stature. This struggle heightens the potential for an individual to feel disordered and malfunctioned. The choice here is, do we join in the struggle or do we support the SCC until it can self-integrate into present real time?
In a more specific example: An active duty Marine with two tours of Iraq returned to a church group for Marines struggling with PTSD and TBI. He hadn’t looked at me or said anything to me, the visitor, until he suddenly turned and started telling me his traumatic story of war. He persisted, deepening as he went. The church counselor attempted to interrupt by commenting, “Gosh, you haven’t told me any of this stuff before.” He never took his eyes off mine. Never blinked.
When he was done I simply said, “Damn, I wish that hadn’t happened to you. Seems like you had a lot of responsibility” (the story was laced with gestures of responsibility and distrust for superiors). I used the word responsibility because it seemed to be a core theme in “Who” this Marine was. In theory, to be responsible was a core process of his SCC. As we begin to explore the possibilities of the theory, our connection abruptly ended. He pulled back saying, “I had chores like everyone else when I was a kid.”
That was it. He turned back to the group. To check, I asked if he wanted to continue. Without looking at me and with assurance he said, “No!” We had arrived at a Window of Tolerance, too close to a vulnerable operating system the base brain SCC utilized to define his World. Responsibleness defined him. It was a core filter he automatically used to efficiently regulate his World. He was using it before the war. He used it during the war. And, he was now using it to define how he carried the war experience. Responsibleness was both motivating his PTSD associated rage (They weren’t/aren’t responsible and I am) and limiting his resolve (It’s all mine to bear).
At the end of the meeting, he again turned and said in a voice of authority, “I want to come visit you at the garden on Friday. I need to build a bed frame.” Two days later he visited the garden/woodshop and built a bed frame. We didn’t return to the earlier conversation about his combat experience. We stayed in the present moment. He let me assume and direct some of the responsibility for making the bed frame sturdy. I applied my idea of Gorilla Glue and dowels, while he sanded and stained.
His agreeing to let me assume some responsibility may have been a test. However, it felt like a shift in his perception of threat, where he was assessing threat to Who he was with present time experience. In theory, his SCC experienced safety, turned down affect allowing trust to develop, when responsibleness was recognized, supported and given time to rest.
The example demonstrates an aspect of the therapeutic process involved in the resolution of Operational Stress, PTSD and other general distractions from efficient and effective regulation of the life experience. The SCC, especially when activated for frequent and prolonged durations, remains hyper-vigilant and active dictating when and how other neuro-centers get to contribute.
Intellectually, the Marine in the last example may or may not have understood what had been revealed, but somehow he deduced when it was time to stop and how to allow himself to reorient. Research from Damasio, Ledox, Panksepp, Porges, Llinas and Davidson has shown that the internal process he may have used is automatic and systematic. Its function is to stabilize the life-experience by maintaining a predictable environment within a Window of Tolerance.
For this Marine, exploring the intimate structure of responsibility in his life-experience was unfamiliar and thus unpredictable territory, posing too much risk. Staying with what I had noticed about the motivating core structure was the quickest way to demonstrate predictability. It by-passed all the negotiating involved in the emotional and cognitive neurostructures.
A Marine puffed-up with power cannot risk knowing or exposing a vulnerability his SCC is mandated to protect through puffing. John Wayne and General Patton are historic examples.
Read Montague, director of the Human Neuroimaging Lab at Baylor College of Medicine in Houston, recently published studies on how the brain codes for predictability as a vital resource and generates social interaction based on rewarding predictable experience. The more predictable life-experiences are, the less effort required to maintain the Window of Tolerance and the less risk to survival.
Fortunately, as the intimate processes of the SCC, which frame the life-experience, become more familiar they become more predictable, making them the most efficient systems to engage for the reduction and resolution of stress and disorder. Triage encourages participants to become familiar with their own inner, neuroprocesses. Once core impulses are experienced as predictable they become tolerable and manageable. Talking, planning and medicating can be supportive to this process. However, The Triage Method guides participants to self-discover their own intimate core processes, which support self-directed integration of their life-experience, as a means of empowering self-discipline and control.
A Marine who struggles to make sense of two extreme feeling states, the serene, calm feeling he has outside the wire in Iraq and the irrational, chaotic thoughts and emotions he has at home with his wife and children, may be experiencing distortions in space and time and the effects of his brain sorting for predictability. Outside the wire surprise and uncertainty are predictable and expected. At home nothing feels predictable. Over time a Marine and family can sort out who makes breakfast and when, and who will drive. They may even quickly reconnect intimacy, but the overriding question of who will live to return can’t be predicted. The impermanence of life affects predictability.
That question looms as unanswerable, yet the answer is vital to calm the impulse to predict. Without the answer nothing is predictable in the family structure because all things depend on continuance. For civilians the question rarely impedes on their life-experience, rarely leads to hanging themselves out of hopelessness. PTSD and Operational Stress make it a real and threatening situation for Marines, as with the late Marine Sgt. Boyd “Chip” Wicks, 2004.
The Triage Method offers the potential to overcome and decompress these systematic, base brain operational procedures. By directing attention to where, when and which system is activated and or overwhelmed in any particular moment participants begin the process of turning their attention inward. This is the mindfulness of Triage, noticing and tracking inner neuro-processes in action. This is the primary and most critical job for achieving self-directed self-discipline and self-regulation.
Once operational procedures are noticed they become known and are the general framework for behavioral development and change. Without appreciation for the potential of systems – especially core mechanisms related to survival, a change in life-experience is inefficient and takes great effort.
The result of inefficient effort is usually circular violence within these systems and throughout the individual’s family and social system. Response to this violence is often labeled denial, resistance, bone headedness and/or just Who they are, creating stigma for the individual and hazard for the culture and it’s ethos.
In the previous example, the church counselor seemed to feel left out regarding information pertaining to the Marine’s traumatic war experience. Her not noticing the system motivating the experience represents violence. The interaction could have been experienced as threatening to the SCC if her desire to connect appeared self-focused. By not noticing the motivator in the war story, driven by emotions and thought, she was not truly supporting the Marine’s supreme dictate to stay within a Window-of-Tolerance.
The expressions of the SCC, those systematic or instinctual base brain directives, can be noticed in physical structure as well as behavior. Core systems that hold the behavioral codes for survival appear to utilize those codes as blueprints to mobilize a body in support. Ron Kurtz and his associates at the Hakomi Institute have spent 30 years utilizing reference to eight generalized physical or character expressions they contend develop in relation to nurtured experiences.
These postures illustrate the core neuro-blueprints expressing physical tendencies to Withdraw – Collapse – Rely on Self – Charm, Manipulate – Expand Power – Take on Burden – Distract by Doing and Up the Struggle.
In developing The Triage Method, correlations have been researched showing relationships between Kurtz’s eight physical character expressions and behaviors described by Panksepp’s core neuromechanisms, Keirsey’s innate temperament types and Bowlby’s attachment styles.
This is an area offering significant potential for understanding Marine behavior in relation to Marine ethos, the codes of war and expression of behavior associated with stress, especially PTSD. Behaviorist may have been duped by the self-fulfilling prophesy of the SCC. Based on the theory utilized in Triage, the parent/caregiver didn’t just reject the baby causing it to develop a tendency to withdraw. The baby came organized, at least in part, to reject the caregiver.
Research coming from the field of Genetic Biology is clearly showing that at least 50% of human behavior is genetically directed. If we accept this data, then we must begin to consider the possibility those same genetic codes have influence on the physical structure expected to back up the behavior. A baby born with a frail, alien body may be predisposed to support its own SCC directives to withdraw and carefully regulate energy before any possibility to feel rejected. Genetic directive to express a power attitude, born into a frail body, would be ill matched to survive the generations.
Triage treats these character types as physical expressions of neuro-blueprints organized by the same SCC codes that dictate behavior. While aspects of these characters appear to be evident in everyone and usually remain relatively fluid, they do deepen and become more pronounced in relation to increased stress load.
Functionally, Marines can learn to utilize Hakomi’s eight character types to predict generalized behavior for themselves, their fellow Marines and their adversaries. An individual who has a tendency to stay withdrawn from the social environment usually has an underlying and continuous sense of feeling not welcome. They will also have a supportive body structure, one that is thin, unstructured and undefined – unnoticeable.
An individual with a tendency to withdraw may become a Marine but leave duty disappointed in not getting what they were hoping for from Marine ethos. The tendency to withdraw or be responsible plays a vital role in the experience of trauma and expression of PTSD. The Marine expressing responsibleness had unique physical resemblance to the illustrated Take-on-Burden character.
Triage maintains its potential when both physical and behavioral expressions are noticed at the point of initial contact. It builds trust and produces a great amount of efficiency. Trust and respect happens at a feeling level and it is allowed to deepen in an organic way without effort, reducing tension, stress and ultimately risk.
Marines who learn to utilize The Triage Method have tremendous potential to mentor fellow Marines at home and during deployment – increasing Marine ethos, reducing Operational Stress and Risk, reducing dependence on medication and supporting intelligent career choices rather than automatic or emotional ones.
It makes no sense that a Marine can return from Iraq, after a rocket slammed into his armored vehicle, killing three of his team members and burning him, has to spend five years struggling to make sense of and control the persistent impulse to kill/destroy himself and others. In a particular situation, who was in imminent danger was depending on his level of hopelessness and rage.
The most difficult aspect of this Marines struggle was that because of his injuries, he had spent most of his post-traumatic days in therapy of one form or another. When we met he seemed relatively relaxed – for what appeared to be a Marine coping with a heightened use of the “Withdrawn” neurological character style. However, once he began to trust me – after an all day fishing trip off the coast of San Diego, we explored what he called his consistent “just under the surface” suicidal / homicidal rage.
The alarming aspect was that – in all the years of therapy, he had never been asked to notice his own inner experience of rage, notice the layers of how he organized the associated emotions or that, indeed his rage had complex associations to memory, meaning, and automatic impulses. This is simply wrong and beyond comprehension!
The Triage Perspective
New information offers the potential to adapt our ways of viewing,
managing and treating Operational Stress and PTSD.
The garden environment and its many activities are unquestionably grounding and therapeutic. However, the proposed Common Ground therapeutic garden’s potential and effectiveness is enhanced with therapeutic principals and methods currently successful in Operation Recovery’s Garden Program in Oceanside, CA. The Triage Method of Emotional Therapy (TMET) frames the relational principals and methods utilized. TMET is an adaptation of The Hakomi Method of Body-Centered Psychotherapy, where awareness is always related to and from a loving, heart-centered perspective – one of acceptance and respect.
The Triage Method is a relational method, which utilizes an attunement to existing temperament, attachment and intrapersonal neuro-radiance theories, and empiric neurological findings.
Key mentors include:
Dr. Jaak Panksepp
Distinguished Research Professor Emeritus of Psychobiology at Bowling Green State University (Primal Neuro-Mechanisms motivating behavior).
Dr. Stephen W. Porges
Professor of Psychiatry and Co-director of the Brain Body Center at the University of Illinois at Chicago (The Polyvagal Neuro-system Theory).
Dr. Bessel A. Van Der Kolk
Clinical Implications of Neuroscience Research in PTSD, New York Academy of Sciences, 1071: 277-293 (2006). Boston University School of Medicine, The Trauma Center, Brookline, MA.
Dr. Marco Iacoboni
Neuroscientist at David Geffen School of Medicine, UCLA, Los Angeles.
Pioneer in brain imaging studies of the human mirror neuron system.
Of primary importance in Triage is Dr. Jaak Panksepp’s Affective Neuroscience. His research is deeply rooted in psychophysiology and behavioral biology – including behavioral genetics. His work offers the conclusion that survival mechanisms or core neuroprocesses, based in the primitive neuro-structures of the human body, generate affective expression or primitive affect from the Basal Ganglia, the reptilian “old school” area of the brain.
Dr. Panksepp’s research suggests these mechanisms have ultimate control over the body’s physical affective expression because they potentially frame all behavior with genetic dictation. And that stress, especially extreme stress of combat and long-deployment, activates these survival mechanisms in extreme ways.
Fear, anger, panic, and to seek have been empirically identified as the primary core processes by Dr. Panksepp’s research and that of others. It appears that the symptoms of PTSD are motivated by at least one of these four core neuroprocesses. Triage often reveals PTSD symptoms to be a complicated blend of two or more.
The supreme dictate of survival is the incentive for these core processes to be inherently continuous, systematic and efficient. They represent the body’s core organizational structure, which Panksepp suggests, provides the information motivating other brain activity and ultimately behavior.
This is one foundation for the relational and information gathering aspects of The Triage Method. By noticing which mechanism or combination of them a Marine is utilizing to manage experience in the moment, choices can be made to deconstruct the automatic structure of affect – offering the potential to experience a change in the behavioral outcome.
With respect due Dr. Panksepp, it may be valuable to add Justice as a 5th mechanism. Justice, or “making things right” seems to innately permeate all cultures and is an especially obvious concern in trauma. Genetic neuroscientists may add a whole range of other innate mechanisms. However, these are the mechanisms supported with the greatest amount of research.
My experience working with OIF/OEF veterans suggests that they (as we all do to different degrees and intensity) – in trying to regulate to their post-war environment, migrate between and within these five with greater intensity and with out much relief. Unfortunately, relief is the antidote! And, successful relief comes – in part, by experientially understanding these mechanisms.
In a very short mater of time, this Marine had – through his developing trust, began to notice and differentiate when he migrated through the various innate mechanisms described by Panksepp. He did however, continue to struggle with the underlying tension of not understanding “Why!” – still not able to make sense of it. Until, I wrote the word justice on an old fishing lure carton and slipped it to him. He immediately said, “That’s it, that’s freeking it!” I quietly, made an observation, “Pisses you off”, without emphasis or elicitation – as in a question. Triage is not about questioning. Instead it is about guiding awareness.
He got quite and began to reflect on a lifetime of struggling with justice. It was his dominate drive. It was what drove him to be a Marine. And, it was what was driving his rage.
How was he going to make sense of how his team died and he was air lifted from duty moments before they were to roll towards Fallujah in 04’. Or, that an immediate family member had become seriously ill while he was in recovery. Or that his girlfriend left him after repeated warnings about his abuse on her. Where was the justice in all that had happened?
It appeared that this decent – although shy (withdrawn), kid from middle America had had his natural bias (sensitivity) to justice amplified – not only by his experience in war, but by his post-war experiences. And, as research suggests, once these impulsive mechanisms or neuro-systems are amplified during traumatic experience they remain amplified. Having an opportunity to learn and experience his inner processes in relation to these systems offers an opening to regain control of their intensity and persistence.
This Marine, in his final days of assignment to the Wounded Warrior Battalion West, finally found relief and an understanding. Word has it he is now a Marine veteran and ready to go fishing again – only this time in a different state of mind.
In general, Panksepp concludes the core affect originating in the raw nerve structure of the body and brain-stem are used to stimulate the limbic area or mid-brain to regulate, regulate and adapt that affect as a means of surviving in a social context without neurologic overwhelm. This regulation process produces the felt sense of experience known as emotion. The more evolved outer layer of the brain, the neo-cortex, utilizes core affect and mid-brain emotion to generate cognitive function, declarative knowledge, reasoning and logical thought, which are advanced coping, managing and surviving processes utilized when risk is low.
All parts of the brain initiate muscle action. However, the instinctual part has supreme control because it has genetic dictate with the ability to shut off or restrict higher brain function under extreme stress. Also, because it is integrated with all areas of the brain and environment the base brain’s creation of affective information is paramount in the creation of moment-by-moment behavior. It is always on-line.
When the underlying processes influencing felt emotion and cognition are intensively activated, especially by extreme psychophysiological stress, their structure of influence may become disorganized demanding them to remain persistently on or off. This persistent override thwarts thoughtful emotional action and appears to be related to some of the disorders referred to in PTSD. Rage or panic affect, override emotional action. Freezing or taking flight limits the ability to seek. Understanding this process with the experience of self-regulating affect reduces the possibility of system overwhelm and allows emotions and thoughts to regain their status of control.
Attention to the possibility that these systems may be exerting inappropriate influence is the primary focus for change provided by TMET. As the affective signal from these mechanisms increases the body and brain experience increased stress, the more stress the closer to the Window of Tolerance the more survival impulses ignite.
For example: A Marine with two Iraq tours was diagnosed with PTSD at discharge. His horrendous stories of combat were punctuated with hopelessness for a marriage and a desire to live. He had come to the garden seeking something. Turning attention to the seeking allowed its affect to settle (be regulated) and his whole coping system was discovered.
In theory, separation from the Marines had created increased panic (Who am I now?), to cope with the intense panic affect his SCC directed an increase in rage affect (I’ll control this), which was mistakenly directed at a mush safer object, his wife. The shame of beating her (Who am I, a monster?) and her leaving him reignited the panic affect. To cope the SCC shut those affect motivators down and collapsed him with flight motivating affect. Here, without available rational thought or emotion, it manifested into a flight to suicide ideation.
Once he had the opportunity to notice and feel this unique process loop in real time the overwhelming affect gave way to increased emotions and rational thought. He found a balance when risk declined and more systems were allowed to participate in his life-experience.
Survival is assured by nerve circuits systematically informed, organized and motivated by 3-levels of brain function in direct relation to perceived degrees of risk.
Base-Brain The Supreme Command Center, (SCC). The instinctual blueprint part uses a core neuro-blueprint to automatically seek/find, panic/connect, flight/freeze, fight/rage or be just/make sense as survival risk escalates. This area of the brain receives and regulates continuous affective information from the sensory systems of the body and filters them to the Mid-Brain and through some systems, directly to the Executive-Brain.
Mid-Brain The regulating Mid-Brain defines and sets the stage for memory by utilizing Base-Brain’s affect to generate emotion as a means to communicate and cope in relationship – to self and social environment, in relation to associated risk.
Executive The thinking, planning, learning (memory) and explaining part of the brain. Constructs concepts of reality from base affect and emotions utilizing thoughts and words to communicate, manipulate, cope and survive within an ultra low risk, stable environment.
Affective, Biological and Anthropological Neuroscience all offer new understandings of how our nervous systems organize, express and resolve experience. They also honor that individual nervous systems and family and group relational systems organize in much the same way.
Within these developments there is evidence supporting methods of prevention, mitigation and resolution of Operational Stress and PTSD. The Triage Method, as an on the ground application of the Hakomi Method, utilizes these developments with respect for the participant’s potential to heal themselves. Yoga, Meditation, EMDR, and Virtual Iraq seem to be affecting core neuroprocesses, only in a more externally directed way.
Perhaps the most important finding relevant to the Marine is how the base brain’s neuro-mechanisms produce mental chaos through instinctual processes when internal impulses deviate from the code of a warrior. The dissonance between the way a Marine expects to respond and the actual real time reaction produces stress. This stress represents the emotional/mental disorder in the brain’s function and validates the SCC function.
For example: A Marine, who initially knows he is a kind person and a Marine trained to act with morals and integrity in the act of war, may experience something in the line of duty that cannot be reconciled. Perhaps he turns toward incoming fire, trained to make fast decisions to reduce the threat, but momentarily freezes, not able to pull the trigger until it is too late. Or, he snipes a 12-year old at 300 yards. How does his brain make sense of the experience and the difference between instinct and training? Any lasting incongruence holds potential for stress and increased Operational Risk.
Science seems to have the mechanism of this process in PTSD understood. It is a disorder in the primitive brain. When the Basel Ganglia’s generation of affective signals to higher brain function is startled into activation or activated for extended periods of time its instinctual structure is reorganized and remains vigilant though not necessarily ordered in its capacity. The Department of Defense’s funding to research experimental drugs this summer, designed to alter the chemical function of the base brain’s genetic dictate to freeze or flight, is based on these findings. It is an attempt to cure or limit the structure of PTSD development.
An artificial adjustment to this process may have interesting ramifications because these neuro-mechanisms are motivated by genetic dictate for a reason. Survival. Seeking shelter, panicking during separation, raging at intrusion and freezing or flight from threat may serve Marines in combat even when they are trained to act otherwise.
In another example: A pattern of SCC directed action was discovered when a Marine’s curiosity was aroused during a garden experience. He made the statement, “This is weird. I was just remembering a situation I don’t understand. I don’t think I was ever afraid, while it was happening, but I was doing some odd things.”
As a Warrant Officer he was leading a crew outside the wire to gather concrete barriers to cover their new base camp’s flank. Standing in open field, under threat of snipers, he calmly directed the loading and transfer of the first barrier with heavy equipment. As his crew moved into the distance, toward base camp, he found himself standing alone next to a pile of barriers. He said he wasn’t afraid. He knew with his training and physical resources he could handle what might come at him. But, he still found himself diving and freezing behind a barrier until his crew returned.
In theory, his panic mechanism motivated the anxiety of separation. It increased to a point where his SCC coped with it by directing the activation of muscles to seek shelter, then freeze behind a remaining barrier. Once the crew and heavy equipment returned he was suddenly out from cover and calmly directing the next load. He felt safe and calm again.
When the last barrier began to move off with his crew, he surprisingly found himself running and zigzagging to keep up and behind the last barrier as it dangled from the equipment. He described this as odd because his training and beliefs were telling him he wasn’t afraid and that he should stand and be alert to threat. His SCC was overriding his training and the result was disconcerting.
If the natural instincts directing his actions were to have been medically altered, could the outcome have changed? Would he have scurried behind the barriers when alone or stood in the open waiting? Would he have run behind the last barrier or walked along side? Did he experience himself as scared and weak or as a warrior?
More importantly, would the difference between his experience and mental expectations have created Operational Risk?
An article in Semper Fidelis: A Psychological Study of Heroic Bravery, describes research conducted by Terence W. Barrett, PhD, Department of Psychology, North Dakota State University. Dr. Barrett found that 292 U.S. Marines who acted heroically brave and earned the nation’s Medal of Honor shared forty-one behavioral tendencies or characteristics.
Each of these characteristics of bravery appears to be motivated by the instinct to seek. Seek challenge, adventure, risk, social unity, approval and more. It is possible that the instinctual mechanism to seek was genetically dominant for these Marines. There may have been a predisposition to shut down fear and seek. Had they understood this, those that subsequently died in combat may have survived longer by augmenting their heroic impulse.
The capacity to distinguish honorable acts from those that may lead to unnecessary death or be felt as shameful and lead to serious psychological damage is important. Understanding the neuro-mechanisms motivating these seemingly automatic actions may be vital to a Marine’s capacity to optimize self-regulation and change results – of actions and stress.
The officer in the example found considerable relief as he came to understand how these instinctual processes work. It allowed him to resolve and integrate an experience where previously he had been bothered by irrational and conflicting thoughts. Had his tendency to seek overridden his other impulses would he have stood in the open and unknowingly risk unnecessary death?
By understanding and experiencing these neuro-mechanisms in action, in the garden, the Marine learned techniques of how to participate in his own neurological processes, to make sense of both honorable and potentially shameful action, and minimize the potential for any resulting mental chaos. This training could be paramount to the mitigation of the long-term effects from stress, which can fester into PTSD.
Other Marines have successfully embodied the art of self-attunement and emotional regulation through participation in an educational training process in Operation Recovery’s garden. It is expected that this training will enhance their capacity to maintain situational awareness under extreme conditions and ensure the Marine makes appropriate decisions with awareness rather than instinctual inclination or habit.
