“I LOVE this no-contact, stay-at-home situation!” How many of our Veterans with PTSD thought that in the first week of the current pandemic? From what I’ve heard around the clinic, quite a few but definitely not all. Some seem to be doing better and others far worse. My guess is this is true for many of us, not just Veterans. After all, when is the last time any of us couldn’t choose from multiple social situations to distract ourselves from our own doubts and demons? One thing we truly know from the current situation is that when the outside noise and distractions quiet down, we are faced with more time listening to ourselves.
Considering the different reactions from patients and people in general, I think that problems now and in the future when restrictions end could be around the whole concept of reintegration. Merriam-Webster’s Dictionary defines this term as “to integrate again into an entity: restore to unity.” I find this definition insightful. It speaks to two or more things that were once joined, became separate parts, and are now once again face-to-face, without any ‘social distancing.’ All of us have aspects of ourselves we aren’t proud of, wish were different, and try not to think about. Now consider having something in your past causing moral distress, intense pain, and that you literally don’t think you can live with. Avoidance and distraction isn’t all bad – it can help us not dwell on things we can’t escape. It can be an adaptive coping mechanism when it isn’t running your life. I, for example, wish I were more active at home. I have always had a lazy and procrastinating side and admit I don’t like this about myself. I’ve always wanted to be the type who is constantly working on things instead of vegetating on the couch. But I have a laid back personality. So when the “you should’s” come up, I acknowledge them, use them to motivate me for the moment, or simply change the topic in my thoughts. How? I call someone, go out and engage with others, interact with family, etc. However, those options are now limited.
People living with trauma and other behavioral health difficulties have a wide range of painful triggers and ways they cope. For many, they cope with distressing memories and thoughts by pouring themselves into the external world. They may also find that the external world triggers them so they isolate. Many do both. In a time of social restrictions, initially the thought of not having to engage with others sounds great. However, this leaves more time to spend with our own thoughts. We are faced with avoided aspects of ourselves without our usual escapes. The longer this lasts, the more we are faced with the decision to either do the work of reintegrating these parts of ourselves we don’t like or alternately finding different and potentially more destructive ways to keep those parts of ourselves completely separate.
In the most difficult times, family can be our rock we lean on. Yet how many of us are experiencing a sense of suffocation constantly being with our family without a substantial break in sight? No matter how much we love our family, there are limits to how much continual face-time we have with anyone. But I should WANT to be with them, right? What does it mean that I have a shortened fuse with them, or they are triggering my trauma symptoms and/or depression?! When we have urges to escape from our loved ones, it can make us feel even worse about ourselves. It is helpful to remember that time apart is just as important as time together when it comes to lasting relationships. Everyone does things that annoy and irritate other people. We often deal with these by temporarily escaping the person. If we do this too much, we may have never learned how to tolerate annoying habits. Forced extended togetherness can also bring to light aspects of a person that we might not have noticed before. With family, the idea of reintegration is coming together to truly get to know each other, annoying habits and all, and figuring out how to accept these in loved ones without denying they exist. No one if perfect, after all. We may learn that those irritating habits we thought would drive us crazy are actually tolerable. We might also learn what we really can’t live with and come to a family understanding of when space is truly needed. Humorously, this even extends to pets sometimes. I, for one, keep getting stink-eye from my cat who wants me out of her territory during the day! It is her house, after all, isn’t it?
There are also people doing very well away from the world. A common theme for them is the outside world was somehow exacerbating their distress. There was too much going on and it is great to just have all of that stress turned off. Examples of this include individuals struggling with medical issues and the patient role. It can be a relief to be away from all of the appointments and not have to think of yourself as damaged. Talking to colleagues about these individuals has me wondering what happens when restrictions lift and they once again have to step into the roles that are causing them distress. What happens when they reintegrate all aspects of their current selves, both the relaxed person at home and the person navigating a frustrating medical system who is constantly reminded of their limitations? It is a marvelous opportunity for these people to see there is more to them than suffering! Can they hold on to this once the reminders start up again?
In my lifetime I have seen and experienced deployment reintegration, so much so that I have a playbook for the different ways this manifests and how to work with it. But this? Most of us have never lived through a situation where we are more isolated from others for such a prolonged time. We have never had such an en masse situation where we face such extreme barriers to escaping our internal worlds and at the same time distancing from stressful external situations. For both ourselves and others, we need to consider how we can reintegrate with the different parts of ourselves in a healthy way, find new healthy distractions as needed to cope, and eventually reenter roles in ways that they don’t consume the other parts of who we are.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Debra Nofziger, Psy.D., is a Senior Military Internship Behavioral Health Psychologist with the Center for Deployment Psychology at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. Dr. Nofziger is currently located at the Brooke Army Medical Center, TX.