➣ Re-owning & Re-homing Scattered Pieces of Lost Self

by Deborah Grassman


PTSD is not limited to those who’ve been traumatized by combat. Victims of crime, abuse, natural disasters, serious motor vehicle accidents, marital affairs, life-threatening illnesses, etc. might suffer PTSD; policeman, firefighters, emergency room responders, and other people who witness trauma are also vulnerable for experiencing PTSD symptoms. These traumatic experiences are sometimes not integrated into a person’s consciousness. Instead, the trauma is left compartmentalized, stored in unconscious experience, sabotaging personal peace.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the fundamental reference for defining mental health. It identifies a constellation of symptoms that must be present for the diagnosis of Post-traumatic Stress Disorder. These include: exposure to a traumatic event experienced with fear, helplessness, or horror; after the original trauma is over, the trauma is re-experienced through recollections, dreams, flashbacks, hallucinations, illusions, distress at cues that symbolize the trauma, or physiologic responses when confronted with cues reminiscent of the trauma. The distress of the re-experienced trauma causes people to exhibit avoidance behaviors and utilize emotional numbing in order to block out the trauma. But in spite of their best efforts, there are times when the trauma is re-experienced anyway and the person exhibits symptoms of arousal such as: difficult sleep patterns, irritability or outbursts of anger, difficulty concentrating, hypervigilance (staying on guard and unable to calm down or relax), exaggerated startle response to noises, being touched, etc. When this constellation of symptoms lasts for at least a month and causes significant impairment, a diagnosis of PTSD is made.

Many people with PTSD have successfully suffered their traumatic experiences by learning lessons that help them live their lives, deal with trauma, and reckon with PTSD. If they have received PTSD treatment, they can often say what helps them feel better. They might already have a PTSD network of friends who can provide support. Family members usually know how to respond to breakthrough episodes of PTSD because it’s familiar territory.

Other people with PTSD have not had this experience. They’ve compartmentalized the trauma, banishing it into unconsciousness. They might have increased difficulty as death approaches – haunted by residual memories or corroding guilts. Others seem less affected.

When patients with PTSD are admitted to a Hospice unit, they are sometimes anxious, suspicious, or angry. Leaving their home to enter an unknown hospital environment is threatening, increasing their feelings of danger. The hospital environment itself can act as a trigger with its militarized processes. Their own anticipated death can act as a PTSD trigger. PTSD, especially when combined with alcohol abuse, has often taken its toll on their relationships, leaving much unfinished business to be resolved so a peaceful death can ensue. Sometimes they arrive at the end of their lives broken, bitterness poisoning their souls. However, it is never too late. Opportunities for growth abound when death approaches and many people – even those who are bitter – avail themselves of the lessons.

Raymond was a veteran in a local hospital with end-stage liver disease, the result of excessive alcohol usage used to self-medicate his PTSD he sustained with the Vietnam War. His doctor phoned me, requesting admission for the patient to our Hospice and Palliative Care unit.

I had a mental image of what Raymond probably looked like based on his diagnosis: swollen abdomen due to accumulated fluid, mentally dull from built-up toxins, and the ruddy, disheveled appearance of a man who no longer took pride in himself.

That night, I dreamed I went to meet Raymond, and he arose from his hospital bed, tall, handsome and well-groomed, in a three-piece business suit. Then I awoke, puzzled by my dream. Raymond arrived later that day; he looked sick and ungroomed like I had expected.

The Hospice team held a meeting at his bedside to learn more about Raymond. He told us he had PTSD and had been a drifter since Vietnam, finding it difficult to establish relationships or maintain a job for long periods. “I don’t know what got into me. I wasn’t raised like that. I should have done something with my life,” he told us. I asked him if there was anything from the war that might still be troubling him.

“I try not to think about it,” he said. “But what keeps coming back is the eyes of my comrades. I saw peace in the eyes of the dead; I saw fear in the eyes of the living.” Our team sat in stunned silence as we let ourselves experience war vicariously.

Later in my office, I kept reflecting on the profundity of this casual comment and the detachedness with which it was said. I let its chilling truth penetrate my illusory, warless world. Now I understood the meaning of my dream. It was not this Raymond I had seen, but the Raymond he might have been. I had met the Raymond who had not gone to Vietnam. That’s when I realized that war robs people of many things; but possibly the most significant is a young person’s hope and dreams.


If you would like to help heal our nation of the aftermath of war, please consider sponsoring a Soul Injury Ceremonial Workshop community event that invites combat veterans to come mourn their fallen brethren. Contact us and we will come help you. Don’t miss this opportunity to heal the aftermath of war in your community. E-mail for more information. We will help you!


Peace at Last

While caring for thousands of veterans over a 25-year career in a hospice setting at a VA hospital, Deborah Grassman gathered stories of pain,redemption, personal awakening and peace. She’s built these stories into an unforgettable book, taking the reader on a journey of understanding and growth. Her pioneering work in identifying the unique needs of veterans has changed how this nation honors, respects, and treats veterans at the end of life. Already, her book has become a classic on the topic.

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