Bill Maier MSW

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03/22/2016

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The Science of PTSD and IntimacyPutting things in neat categories does a real number on intimacy.  A PTSD sufferer feels...
02/20/2016

The Science of PTSD and Intimacy
Putting things in neat categories does a real number on intimacy. A PTSD sufferer feels safer when things are in tidy, defined boxes. Retreating into less attached states-of-being allows for less complex responses; therefore, more rapid reactions. Primary affects, such as; fear, rage, despair, shame and disgust can be habituated to wall off our later developing, slower emotions, such as; love, sadness, happiness and feelings of belonging. In a sense you could say people with an exaggerated sense of endangerment (PTSD) get scared when they feel an emotion. They rapidly, 40-60 milliseconds, utilize more primitive, less socialized strategies to determine their thoughts and behaviors which can facilitate quick action. Rather than an emotionally informed decision, a survival based choice dominates.
Following 9/11, all of the 5000 First Responders were provide mental health screenings. In follow-up, a few years later, it became clear what helped people relax with their horrific memories. It did not make a difference if they got psychological treatment for their anger, fear, sleep problems, depression or flashbacks. What mattered is if they got connected with people they respected and trusted. Good psychotherapy for these folks was designed help them isolate less and to feel more comfortable in social situations. Friends, family, church, civic organizations, teams, hiking clubs, music groups, dancing and etc…are the necessary types of activities for letting the internalized story of yourself, which includes your memories of trauma, sit calmly within you.
It often seems safest to wall-off from any feelings that might be related to those trauma memories. This is a short-term solution which only feels like a safe haven. In reality avoid feelings create a barrier between you and other people. Committed intimacy is the greatest threat to this armor. However there are disastrous long term consequences to feeling walled off from everyone.
Human wiring is relational. Allan Schore in 2012 states “attachment can be fundamentally defined as the dyadic (two person) regulation of emotion” The frontal lobe works by being reflective about our insides and those around us. Our limbic system, or mid-brain, is coordinated around empathy and our feeling states in different situations. The brainstem processes instinctively seek out interactions with our environment. Allowing these systems to operate smoothly and harmoniously requires openness. You must love yourself and believe someone else can love you. This is Attachment Theory 101. To be close to someone means they know deep inside you. The direction of good psychotherapy therapy is toward an ability to feel safe as a person gets to know you better. You also have to learn you can share the confusing parts of yourself with someone, go your separate ways, and then reunite with a new shared knowledge.

This is where therapy comes in handy. If you feel too ashamed to let your support system known the difficult things you have lived through, talk to a knowledgeable professional. Then you will know what to tell your love ones. You are actually inviting a person into the sense of being you developed in order to function in the trauma environment you survived.
Rapid categorization is a survival strategy to keeps us out situations that remind us of dangerous present or past events. If we learn to live alone with these self-protective feelings it seems impossible to allow someone into their most basic influences.
Especially with a person who was exposed to repeated traumatic events, this rapid categorization is necessary to not waste the time necessary to process complex social/emotional cues. In its most devastating form this form of ignoring feelings is; dissociation. The more garden variety is an inability to recognize and express feelings. Feelings of inadequacy, failure and being flawed (shame) are the most common and intensely painful defenses against getting close to people.
Shame feelings are among the easiest to clarify in psychotherapy. You can use most therapists to help you explain your earliest feelings of shame or embarrassment. Then notice situations in your life where you have similar feelings. These are defensive processes. Although they feel very important, they are not, and they create habits of thoughts and behaviors that keep you at a distance from others.
Recover includes embracing all your feelings. If those feelings are unimportant they will travel through you. If the feelings need to be processed they will keep coming up. Relax with them, they are part of you. Your close support system needs to know your most difficult feelings.
Remember, PTSD is always either getting worse or it is getting better.

Bill Maier is a psychotherapist in private practice in Portland, OR. Chapters of his forthcoming book on therapy for illuminating your shame and utilizing your Shadow are currently appearing on his website: https://sites.google.com/site/billmaiermswpdx/home
He can be reached for further information by email or telephone.

02/08/2016

References:
Winnicott, D. (1982) The Maturational Processes and the Facilitating Environment.
London: The Hogarth Press.
Morrison, A. (1997) Shame: The Underside of Narcissism.
New York, NY: W.W. Norton
Panksepp, J. (2012) The Archaeology of Mind.
New York, NY: W.W. Norton

Winnicott, D. (1963) Fear of Breakdown.
London: The Hogarth Press.
Schore, A. (2012) The Science in the Art of Psychotherapy.
New York, NY: W.W. Norton
Schore, A. (2003) Affect Regulation and the Repair of the Self.
New York, NY: W.W. Norton
Schore, A. (2003) Affect Dysregulation and the Disorders of the Self.
New York, NY: W.W. Norton
Benjamin, J (1995) Like Subjects, Love Objects.
New York, NY: W.W. Norton
McWilliams, N. (2011) Psychoanalytic Diagnosis.
New York, NY: The Guilford Press
American Psychoanalytic Assoc. (2006) Psychodynamic Diagnostic Manual.
Silver Spring, MD: Alliance of Psychoanalytic Organizations
Hirsch, I. (2008) Coasting in the Countertransference.
New York, NY: The Analytic Press
Brizendine, L. 2006 The Female Brain.
New York, NY: Morgan Road Books

Schore, A. (1994) Affect Regulation and the Origin of the Self.
Hillsdale, NJ: Lawrence Erlbaum Publishers

Non-formulaic, Intersubjective Process---The insufficiency of Technique—
“From the intersubjective point of view, there is no ‘right answer’ to the questions about self-disclosure or other matters of what many call ‘technique.’ There are two people together, an analyst and a patient, trying to find understanding that will permit a reorganization of experience or perhaps a developmental second chance.´ Orange, D. (2001) Working Intersubjectively p. 34

12/28/2015

A Tenth of A Second in Vietnam,

December 27, 1967, Cpl. Maier, 60mm mortar squad, Lima Company, 1st Battalion, 1st Marine Regiment, 1st Division

As I am diving toward a hillock near the “Street Without Joy”, thousands of thoughts were etched into my mind. We had seen many North Vietnamese Army soldiers (NVA) disappearing into holes as we swept through this village just before dark last night. We were in assault formation with dawn still a half hour away. The day was overcast with no rain. The night times had been cooling to a chilling 80°. The official Marine Corp report says, “The infantrymen found no evidence of the presence of Communist formations.” The night before at 7:30 as we swept through this same village, I listened to the radio I was carrying as the Weapons Platoon radio operator. I heard half of our company’s radiomen reporting as many as 12 NVA going underground. “There’s ten of them running into a hole to my right”. “I see two disappearing in front of me”, and so on for six other radios. Clearly no one recorded what our highly concerned radio operators reported. There was a party going on every night at D**g Ha Base five kilometers away, where all of our career military were hanging out.

In front of me, as I dove, were three areas of muzzle flashes, with ten or more flashes per area. The hillock I dove toward was about three feet high and eight feet at the base. If I completed my dive I would be completely shielded from the small arms fire. Scenarios began playing through my mind. Laying low with minimal, short bursts from my M-16 was the automatic image. This patterned reaction always happens while heading to the dirt. No one survived in my unit unless their body learned its fastest possible movement toward the ground. Imagining firing wastes no milliseconds. In fact, the firing would not delay the impact with the ground where I would become the smallest possible target where ever I was. My next image followed shortly on its heels, of me not firing at all. This well-practiced maneuver provided a far better chance of my survival by not drawing fire into my direction. In June 1967 I had determined it was my patriotic duty to keep in-tacked my government’s equipment, me, to fight another day. By June, during our almost daily movement, we had been ambushed, sniped at, or engaged with rifle fire,40 times. Prior to June there had been an ambivalence between providing firepower and not becoming a target, which was slowing my reactions and needed to be resolved. Again it was my patriotic duty to dissolve this ambivalence. I solved it by deciding to keep myself alive.

It is important to realize it is quicker to raise your rifle while getting off a burst than it is to eat the dirt. If the survival demands had been obvious to fire, I would have fired before my feet had a chance to move me. You could tell a seasoned Marine because he shot a diagonal burst of three to five rounds that would disperse diagonally to about four feet at the distance of his target’s chest, before anything else happened. Many of the hundreds of firefights I had prior to December 27 flashed through my mind as comparisons. My toenails knew the data was overwhelming to not be able to suppress the enemy’s fire. Most firefights had required instantaneous return fire. When an explosion or mortar round started a firefight, the last guys to get to the ground were much more likely to be hit by the accompanying small arms fire. Many attacks required ‘eating the dirt’; a movement far faster and more violent than training had taught me.

The decision made to access cover after consulting my whole being’s desire for survival, a third alternative appeared that often provided the best of both worlds. By accessing cover first and then returning fire I had several advantages. I would provide almost no target at all for the enemy. I can stabilize my weapon and put my bursts with the rounds almost on top of each other, because my rifle would be stabilized on the ground. I carried seven 20 round clips. That is a lot of firepower, if it is focused from a protected position. I could piece together the images I had witnessed in that fraction of a second while diving and raise up enough to effectively do my part of the suppressing fire.

This third alternative had made several varying outcomes play through my mind as I flew through the air. If I could have been clairvoyant the need to scrap all these ideas would have been obvious. I had seen Second Platoon, about 30 guys who had crossed the creek about 50 meters in front of me, mowed down. It looked like a giant invisible scythe cutting down wheat. First Platoon was off to my right and Third Platoon was online sweeping from the beach up to my left. I knew the machine-gunner in the Third Platoon would more than cover his fields of fire. He always wore a red and white bandanna around his neck and we called him ‘Cowboy’. I found out that he had jumped up on a rice paddy d**e to get a better angle to shoot over the berm at the incoming fire. I knew heroics from him, and others like him, were our only chance. After this thought a new possibility began to form in my mind/body. Three other dependable guys were spread out in his platoon. There were another 5-10 of the new guys, who I assumed from our recent 20 firefights, might put down some effective fire. First Platoon had similar numbers without the known quality of the machine-gunner. Second Platoon was silent between me and the enemy fire. Cowboy’s heroics cost him several fatal hits from small arms fire. My mind was still mostly focused on three main alternatives and how they fit with everything I knew. Clairvoyance would have had me running for the mortar, rather than diving.

Now I am halfway through the dive, and I have come to a crossroads. My three main alternatives had my pack and radio on my back while meeting the ground. Now my strategic position needed to be added to the equation. I am 10 meters to the right of center of the Command Post group (CP) at the rear of our back-up part of the online sweep with Third and First Platoons. That is 120 guys, each far enough apart that a hand gr***de would only get one guy, stretched out with Second Platoon 25 meters in front of the flanking platoons and the Command Post group 50 meters behind Second Platoon. As I imagine the covering fire options, I realize that many of my scenarios end with the enemy able to pin down or kill the two rifle platoons. None of the CP group had reached the creek which had a four foot berm on the enemy’s south side of it for protection. We, the CP group, contained my two mortar carriers with pistols, seven ammunition carriers and me with M-16s, two company radiomen, an Aerial Observer (AO), a Forward Observer (FO), the company Corpsmen, the Executive Officer (EO), and the Company Commander (CO); all carrying pistols. The odds that that many NVA would be unwilling to charge us with our limited fire power seemed remote. The beginning awareness of the likely outcome, including an attack on us out in the open rice paddy, added to the need for life-threaten actions as the best chance for survival.

There were hundreds of possible other forms of actions presenting themselves to my awareness. However, the collective awareness that some of us needed to add to our personal risk for any chance of the rest of us to survive, may have clarified my need for the emergence of a new type of behavior. Something inside me told me about 10 members of my company knew this as well as I did. I got my arm out of the right side of my pack straps, to allow me to turn my body toward the center of the CP group. I could then see Al, with the closest mortar to me. He was just getting the two inch wide web strap, which supported the mortar, off his shoulder. He had not touched the half inch strap holding the bipod legs against the 60mm tube of eighth inch steel. This strap can be difficult to get open. You must back up the webbed section enough to pull the tip back through the clip, then you can free the whole strap from the bottom of the buckle. I would have been completing this process while the gun was moving off my shoulder under its own wait. I used the spreading of the bipod legs to release the bottom part of the strap. This process requires no concern with the possibility it might not work. In many life-and-death situations I had learned I was still faster if something hung up, if I barged through the process, even if I needed to redo some part. My usual time from shoulder to ground and round fired was seven seconds. Things don’t go wrong when you are aggressive and sure of yourself. I knew from our practicing, Al's fastest time to getting a round off had been 19 seconds. I was never slower than nine seconds, and I hit my targets. He would not yet be setting the base plate on the ground until after I hit the hillock. He was then going to tackle the strap until it was undone before spreading the bipod legs. The slide that holds the legs to the barrel still needs to be unloosened and moved to the correct position. For Al the correct angle of the gun would have been a trial and error, then readjustment until he could get the gun level on the bubble setting his mate would tell him. I knew exactly were the slide needed to be to have the least need adjust by raising the leg length to get the proper angle.

I also had the experience, before Al got to Vietnam four months ago, of being on a Listening Post with ten guys when a double column of enemy soldiers were moving down a draw that would have them walking right into us. When we opened fire with a mortar, machine gun, rocket and seven rifles, the enemy fired a burst from 75 guys and ran away. As I dove into the mortar we had the gun set up in during this June firefight, the foot tall grass was moving around me, as if the wind was blowing. It had been a still night. Those had been bullets moving the grass. Little did those NVA know we weren’t at least 30 guys? Now six months later I knew these NVA might think twice each time they stuck their heads up or considered advancing on a group of Marines including mortars that were landing on them. A third of our small arms were already silenced. Most of my Company, Lima, Third Battalion, First Marine Regiment had arrived in Vietnam in the last two months. The guys who arrived two months ago had been involved in the six biggest battles I had faced in my 10 months. We had been resupplied with 20 replacement troops four weeks ago and again two weeks ago to cover for the people we lost in those firefights.

This dive was taking place just before the sun came up. Now I was exquisitely aware the rest of the Command Post group, except me, was exposed in an open dry rice paddy. Knowing I could easily be the last surviving person in my company. I saw the image of being found and killed, and the much worse image of being captured, or taking my own life as the NVA approached me. At dusk last night we had set up our perimeter about a kilometer north of here, after walking through this village knowing a large number North Vietnamese Army soldiers were hiding just out of rifle range. We set up for the night jst north of a 50 foot tall hill between us and this village, so we were safe for the night from small arms fire. We had no idea we would be assaulting back into the village. We knew that Kilo and Mike Companies were somewhere in our area. Your battalion had done three weeks of training during November in the Philippines to teach us varying types of amphibious assaults. Lima Company's troop strength had never been higher than 88 men until that training, when we were bought up to full troop strength of 120 guys. That meant we had at least 40 new guys because people with less than three months to go were transferred to other units. It was easy for me to imagine the three companies being arranged in a manner to have some overlapping protection of each other. It was a comforting thought that was completely untrue. Mike Company came running through our position in the creek by the village just before sunrise December 28th. They, and Kilo Company, had been nowhere near our position. As First Platoon began to stretch out to the right of our position they were heading up into slightly raising ground where more bushes grew. Third Platoon stretched toward the ocean that we could not see 500 meters away. As usual, the Mortar Squads, with your rifles, were the rear guard of this 120 man on-line movement.

My first day in the ‘field’ (in the countryside with no protection) on February 23, 1967, we had done this same maneuver. Llewellyn, about my height, had walked up to the company area with me three days before. That day, as the Mortar Platoon moved out, Butch Ashman, our Squad Leader, had Llewellyn and me move out as the furthest back people. The instant the company’s last men walked over a rise and began to disappear, a sniper started shooting at us from behind the two of us. We looked at each other, having no idea what to do. Do we return fire, from a completely exposed position? Do we look for cover, as the rest of the company gets out of there? Or do you do, as we did? We took off, waddling under the unfamiliar weight of seven mortar rounds, two days’ worth of food, carrying two canteens full of water, an M-14 rifle with seven magazine, a rubber poncho, shovel, knife and various toilet and cooking items, after the company. By December 27, 1967 I had been in this position many times. Sometimes the fear of the type of territory we were going through would start to grip me. This day the feeling was much different. As the reality of what we were doing got clearer, the impossibility of the task got more obvious. No wonder the official record needed to say we had sighted ‘no enemy’ in the village. Someone would have been responsible for not getting the information radioed into the Communication Center to the Commander of this operation. I have since found out that officers in D**g Ha, the closest base, had parties many evenings, with the officers out in the field coming in boats on the river near us to party with them.

On "The Wall" there is a block of 32 names in a row. Killed-In-Action people were listed by order of the report of their death. Those 32 men died December 27, 1967, while with Lima Company.

Then the decision solidified. If I flew another foot I could not remove the back pack before I hit the ground. There was steady incoming fire. 60 mm mortar rounds must hit those areas of fire fast! I have no etched patterns of thoughts or images from the middle of my dive to arriving at Al’s mortar two seconds later, except the ones I explain below. Decision made, a new process took me over. This was a deeply internal, procedural process. Each movement wasted no milliseconds. The two seconds to get to the gun were dramatically different than the clearly recognizable, seemingly infinite, things in my mind/body in the previous tenth of a second. I managed to remove the radio and backpack before I hit the ground and kept ahold of my rifle. I was up, hardly having touched the ground, and was running toward Al. He had just set the base plate of the mortar on the ground as I completed the ten meter run to the exposed, dead center of our assault.

About an hour later it will be evident that I didn’t record these images with any use of the big parts of my brain. I knew exactly where the enemy were firing from in that moment, and an hour later when my survival again depended on knowing where the enemy was, I thought they were 50 meters further away than they actually were. I grabbed the bipod legs unbuckling the canvas belt, expanding them to the paddy hardpan, slid the collar to almost vertical, yelled for no increments (the small plastic warped explosives clipped between each fin around the shotgun shell in the tail section of the High Explosive (HE) 60mm round. I looked through the sight as I traversed to the middle area I had envisioned fire coming from. Adjusted after the round hit, and ‘fired for effect’ three rounds, traversed to the left and dropped the barrel enough to reach the area I wanted to hit, dropped four rounds, traversed back to the center position fire two more rounds, traversed to the right dropping our last three rounds of HE. I then fired a White Phosphorus (WP) round at each position. When this firefight ended the next morning, we found a tail section of the WP inside the doorway of the central bunker. Al would have gotten off his first round shortly before I had used up our ammunition.

We, mortarmen, then scrambled up to the creek with the rest of the CP group. The Captain, CO, told us, mortar platoon, to string out along the creek to connect up with Third Platoon. That took all his rifles from what was left of his CP. He left the Corpsman and the Executive Officer at the creek and charged over the berm of the creek. None of them got more than ten feet. Later we had to crawl over the berm with heavy protecting fire to retrieve the two survivors. One was a fellow I ridden with in the troop truck (Six-by) to the First Marine Regiment five kilometers southwest from Danang when we first arrived in Vietnam. He was from Bremerton, WA. He died about 20 years later of complications of his wound. He was shot through the right shoulder. His fellow radio operator, who had also walked up to the Lima Company office with us on February 20, 1967, was shot through the center of his neck. My life had been saved by the fact that I was a half a foot taller than these two, and was therefore assigned to mortars, instead of an infantry platoon because I could carry more ammunition for the mortar. Thus began the longest 24 hours of my life.

The aura of walking in the northern part of South Vietnam.

Every wisp of social thinking needs to be replaced by thoughts and feelings of viciousness. I think this was more noticeable to me than most of my comrades because of the high profile nature of my young life.

Your mind must be constantly focused on doing the most vicious, violent thing imaginable in every second. It is much quicker to divert the most vicious act toward a lesser degree of harm, than to increase the deadliness of an action. Think of a martial art expert stopping a punch an inch from the throat of his opponent. As your attention is wandering changing violent possibilities in each new scenario there are internal challenges appearing. Your mind always wanders to things such as, making meaning, thinking of consequences and daydreams. The most deadly diversion is exploring fear-based scenarios. "Will my weapon jam? Will I react and shoot a friendly or an innocent? For four months thinking like this seemed important to categorize the sudden settings I would find myself in. Seemingly from one day to the next I realized there were almost infinite variables, and all though I was getting quicker, nothing happened instantly. I quickly began to nurture the feeling I will shoot first and suffer the consequences of inappropriate action later.

Poised in a moment of life and death, it was clear that if my mind wandered into a daydream and I relaxed I would snap back to reality by thinking about my next possible action. Thinking about an action prior to engaging the Basal Ganglia takes a minimum of a quarter of a second. Catching the day dream and a vicious grimace on my face solved two purposes. One, I am already forming internal images of acting with decisive violence; and two, my body language is exuding a desire to inflict destruction. I want 20 enemy to think hard before deciding I would be an easy target. They could wait and hope the next guy didn't look so mean. I survived long enough to have gotten over any body language showing I might have to decide before I reacted. Deciding before reacting is ultimately a moral decision. I learned to pre-decide morality. Exuding viciousness kept my attention focused.

I didn't know that grimace was such an important part of my presentation as a predatory until 30 years later when I saw a black and white 8 X 10 photo of the face of my neighbor. He was a grade school teacher. His big masculine face in 1997 always looked warm, caring and lively. The 8 X 10 prominently in his living room was almost unrecognizable. The anger, viciousness, coldness and age of the face was hard imagine as belonging to him. I could feel it as the face I walked around with the last nine months in Vietnam. The face that preceded the instant diagonal burst toward the incoming fire. I fired my rifle reactively while walking about 100 times in those nine months. Every time it was in the direction of the threat, never once at the actual person who was firing at me. The readiness to fire with almost no knowledge of the consequences of my firing, allowed me to be an effective part of a wall of lead moving toward the threat.

12/19/2015

Awakening Your “Midi-Chlorians".

Our Mitochondria (Midi-Chlorians) operate deep within each of our cells. We actually know very little about how, or if, mitochondria influence multi-cellular systems. They direct many of the systems inside the cells. “Stars Wars” tells us we can work hard at relaxing and focusing to learn to let them add power to our brain/body.

Let’s you and I suppose for a few minutes that we can get better at using their direction. From studies in Attachment Theory we know that many magical things happen when two people resonate. Many of the body and brain rhythmic processes mimic from one person to the other. This is true when a Mom has an awareness of her last trimester fetus. The empathy part of both brains (the right side of the amygdala) will light up in the same pattern. These patterns continue to build and becoming massively complex as baby and mother get to "know" each other.

Hippocrates and the early Greek ideas of medicine in 400 B.C. understood medicine through the use of "Vital Force" and would embrace Lucas’ idea of restoring balance to provide healing and empowerment. The Midi-Chlorians would be closely related to what C. Jung called "the fire of our beings". The passion to seek out from our center is our deepest directive.

May the Force Be With You!!!

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