January 7, 2025 • 52 mins
Dr. Chris Frueh, PHD has over thirty years of professional experience working with military veterans and active duty personnel as a clinical psychologist. In this edition of Next Steps Forward, he joins Dr. Chris Meek to discuss his work to uncover a pattern of interrelated afflictions, including traumatic brain injury, hormonal dysregulation, sleep apnea, chronic pain, and more, which he has labeled “Operator Syndrome.” Throughout the hour he will guide the audience through the harrowing terrain of Operator Syndrome, providing a roadmap to understand its multifaceted origins and complex effects on every biological system in the body - as well as the social systems of family, work, and the indifferent society warriors return to. In addition, he explains how modern healthcare systems have failed a generation of service members by all too often relying on the PTSD “easy button” and provides real solutions, lifestyle adaptations and treatment strategies that truly work.
About Chris Frueh: Dr. Chris Frueh, PHD has over thirty years of professional experience working with military veterans and active-duty personnel, and has conducted clinical trials, epidemiology, historical and neuroscience research. He has co-authored over 300 scientific publications, including a graduate textbook on adult psychopathology. His work on “Operator Syndrome” is helping change the way we understand and treat the complex set of interrelated health, psychological, and interpersonal difficulties that are common downstream outcomes of a career in military special operations. He devotes effort to the SEAL Future Foundation (chair, medical advisory board), Boulder Crest Foundation (scientific advisory panel), Military Special Operations Family Collaborative, The Mission Within, VETS, Inc., Quick Reaction Foundation (Houston) and to the military special operations community in general.
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Episode Transcript
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(00:00):
There are few things that make people successful.
(00:08):
Taking a step forward to change their lives is one successful trait, but it takes some
time to get there.
How do you move forward to greet the success that awaits you?
Welcome to Next Steps Forward with host Chris Meek.
Each week, Chris brings on another guest who has successfully taken the next steps forward.
(00:30):
Now here is Chris Meek.
Hello.
You've tuned in this week's episode of Next Steps Forward, and I'm your host, Chris Meek,
and welcome to the new year.
As always, it's a pleasure and an honor to have you with us.
Our focus is on personal empowerment, a commitment to wellbeing, and the motivation to achieve
more than you ever thought possible.
We start 2025 with an outstanding guest.
Dr. B. Christopher Free is a clinical psychologist by training and professor of psychology at
(00:54):
the University of Hawaii, Hilo.
His development of something called the Operator Syndrome is helping to change the way we understand
and treat the complex set of interrelated health, psychological, and interpersonal difficulties
experienced by military special operations personnel.
Dr. Chris, as he's known, is also very actively involved in the SEAL Future Foundation, Boulder
Crest Foundation, Military Special Operations Family Collaborative, The Mission Within,
(01:19):
VetSync, The Quick Reaction Foundation, and the Military Special Operations Community
in general.
You're a busy guy, doctor.
Dr. Free has testified before Congress and served as a paid contractor for the Department
of Defense, Veterans Affairs, US State Department, and the National Board of Medical Examiners.
Dr. Bartley Christopher Free, welcome to Next Steps Forward.
Right on.
Thank you.
(01:39):
Thank you, Chris.
I'm excited to be here.
And again, we talked pre-show, but I'm a little jealous.
I'm here in blustery Connecticut where it's 20 degrees with 40 mile gusts and you're in
sunny Hawaii looking at the ocean.
So if I'm a little green with envy here, that's why.
So Chris, what I didn't mention in the introduction is that your dad is a US Air Force veteran
who served in Vietnam.
(01:59):
Is it fair to say that his experiences and yours growing up as the son of a military
veteran who served in combat shaped your decision to pursue the career that you did?
Yeah, definitely.
Now, I do want to clarify.
My father was a physician.
He was not a combatant, but I was about six years old when he deployed to Vietnam.
And then in subsequent years throughout my teenage, into my teenage years, had quite
(02:25):
an awareness of the war, what it meant for the soldiers, even for the people of Vietnam.
My father became very involved in the expat community at the University of Missouri of
Vietnamese students in the early seventies.
So we had a lot of, we had a lot of uncles and aunts from that community.
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But I also want to mention my great grandfather was a veteran of the Spanish American war
and he served and fought at the Battle of San Juan Hill in the Michigan militia.
And he was one of my childhood heroes.
He lived to be almost a hundred.
So I think I was 14, 13 or 14 when he died.
So I knew him quite well.
I went to graduate school with the idea of I wanted to work with veterans.
(03:12):
It's amazing family history there.
Now that's great.
And thank you for your family service.
So the first chapter of your career from 1991 to 2006 was with the Veterans Administration
Healthcare System.
Would you share your journey to becoming a psychologist and then what you learned during
your 15 years serving at the VA?
Sure, right on.
So graduate school at the University of South Florida.
(03:35):
My dissertation was with veterans with PTSD.
That was the group I wanted to study for my dissertation.
And I was able to get a position at the VA in Charleston, South Carolina for my final
year of training.
And that's part of the progression for a PhD in clinical psychology.
(03:56):
So I went there for one year to complete that year of training.
And that was the VA and the Medical University of South Carolina.
And when that year ended, the gentleman who'd been my supervisor for the first part of the
year had left.
So I stepped right into that job.
And I was there for another 15, 14, 15 years after that.
(04:17):
I loved working at the VA.
I really enjoyed the patients that I worked with.
I really enjoyed my colleagues.
Had a really good, solid, amazing team of colleagues while I was there.
And I was a full-time clinician for the first seven years.
But had these questions about our patients, the people we were seeing.
(04:38):
And it just so happened we had a file cabinet of data, of patient folders going back probably
a decade.
And it was just all the psychological data in there.
So we started putting that into statistical programs, entering a lot of that data by hand.
And we wrote some papers.
And that led to kind of the next phase of my career, which was I applied for several
(05:05):
federal research grants from the NIH.
Received those grants.
And then the next eight years that I was there in Charleston were kind of divided between
my work in the clinic at the VA and my research programs, which were at the VA and the Community
Mental Health Center.
I left the VA in 2006.
And really, I would say the reason I left was I just was very frustrated with VA policies
(05:32):
at the central office level.
Not locally.
I was not upset with anything locally.
And it wasn't that I felt like I had to get out.
But some opportunities came up.
And I was kind of ready to go and move on.
Obviously, you worked with a cross-section of veterans in the VA.
But what drew you to work specifically with military special forces warriors?
So that happened about 10 years ago.
(05:52):
It started about 10 years ago.
And it was not a plan that I set out to go, OK, I'm going to do these things with this
community.
It was more organic and kind of random in the way it started.
I was at the University of Hawaii.
But I also had a position at Baylor College of Medicine in the Baylor College of Medicine.
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And in Houston, Texas, where I was the director of research at the Menninger Clinic, they're
affiliated with Baylor College of Medicine.
And my friends, my circle of guys that I knew and hung out with, most of them came from
the special operations community.
And pretty early on, it was suggested to me by somebody who was not directly, he was not
(06:38):
an operator, but he had served with operators in Afghanistan.
And he said, you know, some of these guys are really struggling.
Maybe you could talk to them and help see what you could help them figure out.
And I started with the idea of, well, it's probably PTSD, you know, and I'm going to
just put a pin in that because we'll come back to that probably.
(06:58):
But I had an assumption that it was PTSD.
And my assumption proved to be mostly wrong and certainly massively insufficient to understand
the difficulties that they were.
These guys, my friends were experiencing.
And essentially, you know, you go, well, what's the, in medicine, we talk about what's the
(07:19):
primary complaint or what's the starting point?
And the primary complaint was this, something's wrong with me and I don't know what it is.
And I essentially, I've heard that over and over again in the past decade.
And starting with the assumption, well, what's wrong with you is probably PTSD.
And then come to find out it really wasn't.
(07:40):
And yeah, some depression, some anxiety, a lot of anger issues.
But underlying that, and it took some trial and error to get there, was massive sleep
dysregulation, not just insomnia, but sleep apnea.
And that surprised me.
I was not, 10 years ago, I was not prepared to find that these relatively young, healthy,
(08:01):
fit men would have sleep apnea.
That didn't, that didn't compute.
The other thing that didn't make sense to me initially was we discovered they all had
super low testosterone.
Testosterone of, you know, of an 80 year old man.
And so when a man has low testosterone at that young of an age, he's going to look, he's
(08:24):
going to look like he's depressed.
He's got, he's not going to be sleeping.
Concentration is impaired.
Irritability, anger, mood is going to be low.
Motivation and energy are going to be very low.
Just loss of interest in kind of everything, including working out, including work, including
sex.
And so a lot changed when we started to address the sleep apnea and the hormonal dysregulation
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that these guys had.
And then that kind of opened the door to look at some other things.
And wow, they've got, they've all got chronic pain.
They've all got, you know, came to realize they all had traumatic brain injuries from,
and I didn't understand this, but from blast exposures.
And so now I have to learn about blast exposures.
And in 2014, there wasn't much research out there.
(09:13):
So that that's become something that today, I think we now have a much better lock on,
but still, we're still far from, from really fully understanding this.
And it has not, that knowledge, the scientific knowledge of blast exposures has not really
leaked out into the broader community of clinicians.
And so that's one of the things we face right now for all veterans, I believe.
(09:37):
And how are military personnel different from those of us who aren't serving or haven't
served in the military?
And then how are special forces personnel different from other military personnel?
Okay.
So, right.
Good question.
Because we're talking about operator syndrome, I want to, I want to, I want to say a few
words about what is an operator and how do we define them?
And how do I think about this?
So, first of all, I've worked with primarily, mostly a lot of operators, hundreds of operators
(10:02):
over the last decade.
An operator is, is somebody who's in one of the special forces units who goes through
special assessment and selection process.
For example, maybe Naval Special Warfare, they go through BUDS school and they can become
a SEAL if they, if they complete it.
So SEALs, Green Berets, MARSOC, you've got the, in the Air Force, you have the pararescuemen
(10:26):
and, and combat controllers.
I've worked with operators from Canada and many other countries as well.
It's a, it's an extraordinarily rigorous selection process.
Somewhere between, you know, maybe five and 8% of everybody who starts the training, it
completes it and is selected into those units.
(10:48):
And then for the people that, that make that for a career as an operator, those, those
careers involve several things, but one is an incredibly high intensity level of training
on a constant basis.
And the level of training between an operator and, and pretty much any other, you know,
(11:08):
soldier, for operators, the, let's, let me use the word dose, the dose of, of physicality,
the dose of blast exposures, the dose of, of all of what, what we'll call allostatic
load.
And we can come back to that, is, is magnitudes of order more than it is for most soldiers.
(11:29):
But I want to say this very clearly, operators are not the only ones that have aversion to
aversion of operator syndrome.
I've certainly seen it in, in, you know, any soldier doing urban combat, you know,
Marine, Marines, they may have less, they may have shorter careers than the typical
20 year career.
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But the intensity of that combat is, is, is profound.
Artillerymen, combat engineers, infantry, pilots who are experiencing, you know, the
G-forces, SWCC boat op, fast boat operators, and, and many of the support folks and intelligence
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roles that are embedded in work directly with operators.
And then the other group that we see these, these issues in is law enforcement and first,
first all first responders, law enforcement and firefighters have their own versions,
some differences, but similarities.
And 25% of the first responders are veterans themselves.
(12:34):
That's right.
That's, and my viewers and listeners know, I just finished my doctorate earlier this
year and I was focused on first responder and police mental health.
And so probably cited, probably cited a few of your papers in there.
Yeah.
So, so the same stuff that I do with operators is now, we're now applying that in a variety
of contexts for first responders.
And that's, that's, that's been, that's been really rewarding for me.
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And, and the one thing I've highlighted, I'll say the one positive thing of COVID is,
it has put a big, huge spotlight on mental health and has significantly reduced the stigma,
you know, with the phrase, it's okay to not be okay.
And so that's the one positive thing that the negative, one of the many negatives though,
is that we're now seeing that tsunami of that mental health crisis across the board come
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crashing down.
And so I appreciate folks like yourself that are sort of in the fight, if you will,
for treating those folks.
And maybe as a follow up to that, building trust is always critical for psychologists,
no matter who the patient may be.
As you look at the differences between special forces personnel, other military personnel,
and then the rest of us, what sort of professional challenges does working with special forces
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create for you and your peers?
Well, good question.
A very common story, a very common experience I hear from operators is that they have a
good experience with mental health clinicians.
Part of the challenge in the military is there's a dual role.
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So a psychologist, a social worker, other therapists in the military are both trying
to treat, screen and treat soldiers.
They're also part of the command structure.
So the fitness for duty is a mandate that they have to report on and document.
So if you're an operator, and I mean, you're going to know, depending on what you say to
(14:27):
the psychologist, you might get pulled out of your unit.
You might miss a deployment.
You might get pulled off a training evolution.
So there is a, I would say, I'll say this diplomatically, I would say operators are
very guarded in what they share with mental health teams in the DoD.
On the civilian side, so operators that go to, and this is true of many veterans that
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go to the VA or go to civilian care providers, one experience, and I hear this all the time
with operators, is they go, they have that first meeting with the therapist and they
start just tipping their toe into the water and talking about a little bit of the things
they've seen and done.
And it upsets them.
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The therapist starts to have an emotional reaction, is crying or emoting.
And frequently the soldier or the veteran just gets up and says, I'm sorry, and I'm
sorry.
I upset you.
And they leave.
Related to that I think is the bigger issue, which is most mental health professionals
are not educated.
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They don't have an awareness of what operators are doing.
They don't have an awareness of what operators do.
They don't know, they don't have a sense of the culture, a sense of the experiences.
And that's not even their fault per se.
When I worked at the VA, I never had a patient who'd been a Navy SEAL or a Green Beret.
(15:58):
Never.
The closest I think I ever came to anything we would consider to be special operations
was a couple of force recon veterans who were force recon in Vietnam.
And that was, so there's not, I mean, operators are a small percentage of the military to
begin with.
And many of them just don't use the VA.
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So it's probably a group of patients that most therapists don't have experience with.
Now, I tell you all of that to say this, there is a nonprofit organization now, it's about
two years old called the Soft Network.
And so if you're listening and you hear this, the Soft Network, you can look them up on
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the internet.
And what they have is essentially a registry, state by state registry of therapists who
have been kind of identified as being culturally competent to work with soldiers, combatants,
and especially soft.
They're not going to just, they're not going to, they don't have a, they don't have specific
cutoffs for who they work with.
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All of the therapists are individual private practitioners who have this foundation.
So it's just a way to find them.
It's a, it's essentially a referral source.
It's not, they don't, they don't pay for the care or provide or are either former soft
themselves, former, there's a lot of operators who got degrees and are now therapists.
There's a lot of spouses in there of operators.
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And then there's a, you know, there's a number of people who were clinicians in the, in the
special operations community when they were active duty and are now out.
So there, there are resources out there.
We're starting to find them.
They're starting to be developed kind of at the foundation level.
And by soft network, you mean special operations forces network, correct?
Just for clarity, just for our listeners, they know how to look it up.
(17:45):
Yes.
Thank you.
So it's SOF, soft network.
Thank you.
And I want to go back to a comment you made about, you know, a clinician talking to an
operator and then just not being able to handle those scenarios that the operators have gone
through and are talking about.
How do you handle your mental health and your wellbeing as you're treating these, these
warriors?
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Oh, I don't, I don't have any, I don't think I have any special challenge with that.
I mean, I think it's very common for therapists early in a career to working with veterans to
have some of their own emotional reactions.
And I certainly did in the first few months that I worked at the VA.
I, I definitely remember.
(18:28):
And that was, that was part of what the supervisors worked on with all of us was acknowledging
that, yeah, as we're going to have some, some reactions to hearing the kinds of things that
we, that we're not familiar with, that we haven't heard before.
But I don't, I don't really feel that any, I don't, I mean, that went away quickly.
And then as I started working with the special operators, yes, there's far more combat over
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course of many more years than there is for typical soldiers.
A lot of the loss, a lot of the death that operators see, see and experience in their
community actually comes from training as well.
So, you know, static line jumps that didn't go well.
Things like that.
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I don't really, you know, I get asked this question about vicarious trauma.
No, I don't, I don't really feel anything for that.
Do you ever work with the spouses of active duty personnel and private contractors?
I do.
Yeah, I have.
Yep.
And sometimes that's individually from their husbands.
Sometimes it's with, you know, with the husband, with the, with, as a couple.
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And sometimes it's with the, at the family level.
I know I've, I've had the, the, the pleasure to get to know many adolescent children who
are learning and grappling with their, their parents' experiences.
And I understand that you've also worked with Canadian special forces operators.
Can you compare and contrast how they're the same as American special forces personnel
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and how they're different?
If there are any differences?
The only differences is the accent.
A and cheese curd?
And the, and the, yeah, and the cheese curd and the tolerance for cold weather.
Fair enough.
They're more hockey fans than baseball fans, probably.
They're exactly the same.
They're exactly the same.
And I've, I've worked with operators in Australia, Israel, Britain, Netherlands,
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Scandinavia, Poland, probably a few other places, but well, Afghanistan and Iraq as well.
I've worked with them, done work with some of the interpreters, actually quite a few
interpreters who functioned as special operators.
So it's, you know, it's the same, you know, the TBI, the hormone disruption,
the sleep disruption, the chronic pain, the psychological features, the headaches, the
(20:46):
cognitive problems, cognitive impairments.
It's, it's, it's, it's universal.
Earlier in the show, you mentioned the phrase operator syndrome.
How long did it take you to recognize the concept of the operator syndrome?
And how much longer did it take you to fully flesh it out?
You know, was there a particular aha moment?
Yeah, well, I don't know that there was an aha moment.
(21:10):
I think there were multiple aha moments early on.
And, you know, as I talked with dozens, and then eventually hundreds of operators over the,
over the years, it became a pattern recognition thing.
It's like, I've seen this, I know what questions to ask.
Early on, I started keeping a, just kind of a log of things that I was learning.
(21:32):
And, and as that log got longer, it was a living document.
And I started sharing it with operators at some point after probably three or four years,
like, Hey, read this.
This is just kind of a white paper.
This is kind of what I'm, I'm understanding.
And initially I called it the operator sleep manual.
Didn't put mental health in there, but, but everything it takes to sleep better
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covers everything that we're talking about here.
And that was well-received.
And I had guys saying, well, you should publish this.
And eventually we were, I worked with a team of my colleagues and we did publish it in a
medical journal, 2020, a paper called operator syndrome.
Anybody can find it.
Just Google it.
It's on the internet.
Very easy to find.
It's easy to read because it came from this document that was partially written for operators,
(22:19):
for their spouses.
And so it's a descriptive paper and you can find the PDF of it.
It's public access.
So anybody can find it.
We published that in 2020.
And then folks kept telling me, you should write a book and say more about this.
So that I eventually did that.
And we published that this year.
That was published earlier this year.
(22:40):
Nope.
Sorry.
We're now in a new year.
It was published in March of 2024.
I think I've written up about four checks because I've written 2024 on them already
so far.
We're slowly getting into that.
Yeah.
Of course, I'm that until about March.
Exactly.
And I'm old enough.
I still write checks.
So that's kind of, I guess the backstory there.
Your research and work with special forces suggests that the injuries are special forces
(23:04):
while serving our country are extraordinarily complex and require complex solutions.
Take us through their injuries first.
And then we'll talk about the type of treatment they need.
Okay.
Well, let's start with a couple of concepts here.
So one concept that I want to put out there is allostatic load and it's cumulative.
So allostatic load is a hypothetical concept that's been defined as, and I'll paraphrase
(23:28):
this, but it's essentially the stress, the strain, the challenge that gets put on all
of the physiological systems in the body.
So it's a physiological concept.
So when we say physiological systems, we're talking about the nervous system, the neuro
endocrine system, the immune metabolic, musculoskeletal, respiratory, perceptual systems.
(23:50):
And of course the cardiovascular system and others.
So all of our systems are interconnected, right?
Our brain is connected to our gut, is connected to our hormones.
So the concept of allostatic load is that the blast exposures, the running, the rocking,
the physicality, the sleep deprivation, the chronic high stress and high op tempo.
(24:13):
All of this has a profound physiological burden on the human body that in operators is cumulative
because there's not a lot of rest.
There's not a lot of pauses taken.
So over the course of 10 years, 15, 20 or more, this accumulates.
And we know that something, um, I'll keep it, I'll focus here.
(24:34):
We know that a concussion, if somebody gets multiple concussions over the course of their
life and the closer those concussions are together, they are more likely to have, uh,
you know, some profound injuries and impairments that come from that, that can be permanent
and lasting.
So the concept of allostatic load is that operators and first responders and other soldiers
(24:56):
just have this massive dose of allostatic load that accumulates over time.
So operator syndrome is a, is a framework to take, to take that concept and say, how
does this apply?
How does this, how is the human body affected by the type of activities?
So, you know, jumping out of perfectly good airplanes, combat, diving, running, rocking,
(25:17):
combat is repelling all of that physicality.
Then you add on all the massive amounts of blast exposures from demolitions, breaching,
shoulder fired rockets, even, you know, sniper rifles, and even handguns involve a micro
explosion.
And that causes an invisible form of damage.
We're only really kind of tuning into the last, probably the last 10 years or so.
(25:41):
So what I'm talking about here, what makes this complex is that, you know, I'll get to
the injuries in just a moment, but they're all interrelated.
And that's part of, partly what, why we want to talk about this as a syndrome is it's not
just a traumatic brain injury.
It's a traumatic brain injury that connects to your sleep and affects your sleep.
(26:05):
And together those affect your hormones and all combined.
All of these things have effects on each other, which can lead to a vicious cycle.
You know, one problem causes cascade of problems everywhere else.
But to turn that around, this is the message of hope here is there's, there is good hope
(26:25):
for recovery.
You treat one issue and that can have a ripple effect on positive ripple effect on the other
physiological systems.
And if you start doing multiple treatments for multiple systems, then you're really going
to see some, some, you know, really great benefits.
So the recovery and healing is, is, is very possible, but let's talk about what, what
(26:48):
the syndrome itself is.
So operator syndrome really starts with traumatic brain injury.
And I'll just go down the list, sleep disturbance with sleep apnea, hormonal dysregulation,
primarily test, low testosterone in men, but that's not the only domain that gets
affected.
(27:09):
The perceptual systems have impairments.
So hearing, vision, balance, chronic pain, headaches, a lot of guys have chronic migraines,
the cognitive impairments to concentration, to short-term memory, even just to staying
organized.
And of course, learning new material is much harder after you've had a traumatic brain
(27:30):
injury.
And then we have the psychological, which I would say kind of in, in, in no particular
order, but, but the anxiety, depression, and anger kind of are at the forefront.
Some of the PTSD symptoms and also high potential for addiction.
So heavy drinking is, is very common and as well as some of the other, using some of the
(27:51):
other drugs that are out there.
And then all of that, apologize for talking for, for so long without taking a breath,
but then all of that cascades into the social systems.
So we start with the physiological systems, but then our social systems, marriage, parenting,
(28:12):
fitting into a civilian society, the intimacy challenges emotion.
I mean, yes, sexual intimacy is very, is a, is a problem for many operators after a certain
point, but the emotional intimacy is a struggle too.
A lot of guys will talk about losing their empathy.
Also toxic exposures, the radiological, the biological, all the, you know, the bad water,
(28:37):
the not so clean air and whatnot that are, that are in many austere environments.
Those are having effects, respiratory illnesses, cancers, other things.
And then the last is the existential concerns, which we could spend a whole hour talking
about right there, but this would include things like the horror of killing the thrill
(28:58):
of killing a very common statement.
A common perspective I hear is that the soldiers actually who do enough of it, who do a lot of it
come to enjoy it, come to find it thrilling and then miss it later.
And then also feel very guilty about those perspectives of having enjoyed it and missing
it.
And of course, we also have all the loss and the grief, you know, sometimes guilt, survivors,
(29:23):
guilt, we might call it moral injury or shame.
Sometimes at the end of a career, we often are faced with things like that sense of that
loss of identity, loss of purpose.
Who am I now?
Loss of tribe.
I'm no longer with the people I serve with.
And that's a challenge.
(29:44):
And then last, a lot of guys will talk about feeling betrayed by their nation, by society.
Many will talk about, soldiers will talk about loss of faith in humanity or God.
So there are these profound existential issues that I don't really think of as being psychiatric
illnesses.
I think of them as just, you know, humans struggling with being humans and the things
(30:08):
that they've experienced and seen and done.
Can you go into a little bit more detail?
I haven't heard anything or much, I guess, about veterans feeling betrayed.
Can you just give a little more color on that, please?
Well, yeah.
So two points, several points.
It's not two, it's probably several.
One is in special operations, very few people, very few operators go out on a high note at
(30:32):
the end of their career.
Many are med boarded out.
Many have, you know, experiences towards the end of their careers that aren't so positive
and maybe they are kind of separated from their team.
Maybe they go and do some kind of last year or two of terminal duty somewhere where they're
(30:56):
not really part of the unit that they've been with.
And so oftentimes there's just kind of some bad feeling that's there.
I think there have been some other things in recent years, you know, the manner in which
the war has been prosecuted, the rules of engagement, which have changed multiple times
over the last several decades.
(31:16):
The pullout from Afghanistan, that has been a profound demoralizer for many in the SOF
community, in part because they had, you know, so much blood and treasure was spent there,
but also in part because they work so closely with Afghani interpreters and soldiers, most
(31:38):
of whom were left behind.
And so that has left a very, very, that's had a very demoralizing effect.
A lot of folks have been upset by the way the military handled the vaccine mandates,
by the way, diversity, equity, inclusion has been sort of manifested throughout the
(32:00):
Department of Defense.
So there's, and it's no one thing, it's often a lot of things.
And then you, of course, you combine that with all the other stuff we just talked about,
you know, the injuries and the impairments and it's a lot, it's just a lot.
You know, I didn't think about the withdrawal from Afghanistan.
I have three classmates that were special operators and had the three of them on the
(32:22):
week after the withdrawal and they expressed a lot of what you just highlighted.
And so, so thanks for flagging that for me.
A few moments ago, when you're talking about the different injuries, you mentioned physiological
systems probably a dozen times.
You've noted that although you're a psychologist, you take a very physiological perspective
on helping the people you work with.
(32:43):
Would you explain how that's different from, you know, for lack of a better phrase, the
average psychologist who cares for similar patients?
Yeah, sure.
Well, I start, I start now.
I mean, this is, this has been an evolution for me over probably the last 10, maybe 15,
20 years, but we're animals, we are biological animals.
And when we injure any part of our body that, that can have an effect.
(33:08):
We often think of things like, let's just take depression.
For example, depression is a, is a psychological issue.
And, you know, we have Freudian psychoanalytic theories, we have behavioral theories, we
have cognitive theories that explain it and not to take anything away from those theories
that it's not to say that they're wrong, but what we have not really paid attention
(33:29):
to is for example, genetics.
We know that depression has a genetic component to it.
If your parents had depression, you're more likely to have depression.
And now we're starting to identify some of the specific candidate genes that may contribute
to that.
So that's an example of a physiological thing.
Another understanding that I think is really developed in the last, in recent years is
(33:55):
the idea that chronic systemic inflammation in the body is a causative factor of depression.
So if we don't eat well, if we don't move our bodies, if we are not living an anti-inflammatory
lifestyle, which almost none of us are, we're more prone for depression.
(34:16):
And that implies one of the, that gives you a clue to one of the interventions, which
is to live an anti-inflammatory lifestyle.
What does that mean?
That means cutting out anything that's going to increase inflammation in the body.
What is that?
That's sugar, alcohol, processed foods, not getting enough sleep, not getting enough exercise
(34:41):
and many other things.
One of the, one of the thing, one of the treatments that's been identified as a, as a
powerful antidepressant treatment is, is hot sauna taking three 20 minute hot sauna baths a
week in randomized controlled medical trials has been shown to lower inflammation and reduce
(35:03):
depression significantly.
So there's a, there's a whole body of work out there now focusing on more physiological
treatments than what, what therapists typically do.
So let's start with that.
Traditional mental health care in the West right now is a combination typically of psychiatric
medications and, and psychotherapy.
(35:25):
And I'm not criticizing, you know, there's a lot of value in both of those treatments.
So don't, don't, I'm not dismissing them at all.
Don't, don't hear me say that.
I do worry about over medication.
That's a, that's a very common problem.
But we have so many other treatments as well.
And I can go through some of those if, if, if we have time.
I'm okay for me to just kind of rattle off.
(35:48):
Absolutely.
So one treatment I think is, well, so with, with probably most psychiatric patients today,
we should be getting a sleep study and a hormone panel.
Both of those measure very important physiological aspects of the human body that will have a,
you know, very negative, can have very negative effects on, on psychological functioning,
(36:12):
cognitive functioning.
So I always say we need to do a TBI assessment.
We need to do a sleep study and we need to get a hormone panel and probably also a metabolic
panel and then follow whatever treatment recommendations come out of that, out of those
tests, out of those evaluations.
One of my go-to treatments that I recommend for pretty much everybody is a stellate ganglion
(36:34):
block.
Stellate ganglion block is a physiological intervention.
It involves injecting a little medicine into the sympathetic nervous system.
And it, what it does is it lowers the physiological arousal in the body.
And it, and it has a lasting effect for months, maybe even a year or more.
(36:56):
One injection into the side of the neck.
It does not, it does not dope you up.
It does not impair your cognitive functioning at all.
It has almost no side effects or lasting, you know, any kind of long-term risks.
Um, the worst thing that can happen typically is it might not work.
So about 90% of the people I recommend for this, uh, describe it as being profoundly
(37:17):
beneficial.
Um, what it does is it takes that baseline level of anxiety, which might be at like a
seven, eight, most of the time, and it can bring it down to like a two or a three.
So for general anxiety, for PTSD anxiety, for people who do a lot of worrying, uh, and
maybe can't sleep at night because they're so the ruminating and they're obsessing over
(37:40):
things for people with, who have what we sometimes refer to as low stress tolerance.
In other words, people who are impatient and easily angered.
A lot of that is because the anxiety is so high to begin with that when there's a small
frustration that bumps them above the threshold for losing, you know, losing their, their,
their temper.
(38:01):
When we bring it down with this injection, what we see, and it works almost immediately,
like literally within a few hours, people describe feeling more relaxed, calm.
They're more focused, more present, uh, with their family.
They can enjoy things differently.
Their mind is, is more clear.
(38:22):
They can think better.
They can concentrate better because all that anxiety noise is cleared out.
Um, they, they become less angry, less irritable, and they start sleeping better.
It helps with the insomnia.
And so guess what?
You get one of those shots.
And for the next two to three weeks, months, at least most people feel really, really good.
(38:45):
And you know, the medicine will wear off and some of that anxiety may come back.
You can have the, you can repeat this treatment.
You can have it done multiple times over the course of, you know, you can get it done once
or twice a year, but more than that, what it does is it opens that it opens a window
of opportunity.
I think I've seen this many times, get the guys, get the Stella ganglion.
(39:08):
Sometimes their spouses get it too.
I often like to see a couple's intervention with that and it, and it gives them kind of
a holy moly experience.
I got a phone call a couple of weeks ago from a, from one of my younger guys who's currently
active duty at a tier one unit.
And he, he got his first LA ganglion block and he called me that night and he, and he
(39:31):
says, you've been telling me about this for months.
I finally got it.
Holy cow.
I feel so different.
I've never felt this way before.
I mean, he wasn't high.
He was just excited about this new feeling of relaxation that he had never, he had never
felt.
He had a rough childhood as many have.
And so he didn't even have the, he didn't even have relaxation in his childhood.
(39:53):
But now it's easier to talk to a therapist.
Now it's easier to engage in other lifestyle changes.
Now it's easier to re-engage or engage with family members, especially spouses in a different
way.
So it really kind of opens the door to, you know, to, to more healing, more recovery in
other ways.
(40:14):
So huge fan of Stella ganglion block treatments.
We've been talking a lot about military personnel and earlier in the show, we briefly
touched on first responders.
Then they experienced many of the same emotional and physical traumas.
You've written about what you call firefighter syndrome because they also face a high risk
of traumatic brain injuries, including impact force injuries and toxic exposures.
(40:36):
Can you describe firefighter syndrome and the treatment approaches it requires?
The same.
It's the same.
The brain injury is a little different and the toxic exposures are a little different.
Firefighters aren't working with demolitions in intentionally trying to blow things up,
but they do go into structure fires.
They do go into environments where it's not known what they're going to be breathing.
(40:59):
And sometimes they're in environments that change rapidly while they're in a structure.
So that's, that's, that's part of what they, what they have to deal with.
Now, um, there's another piece to this and I didn't even mention this with, with, with
soldiers and veterans, but the transition points are a challenge for soldiers.
(41:21):
There's a difficult transition coming home from a deployment or a, or a lengthy training
evolution.
There's the transition at the end of the career.
That's a huge challenge.
And we know this, you know, you, whether it's, whether you've been in the military for two
years, four years, 24 years, when you leave the service, you're stepping into a whole
(41:42):
different world.
And that's a, that's a, that's a challenge.
It's a significant challenge for first responders.
However, let's, let's give them, let's give them their due here.
And this is something that a lot of soldiers have pointed out to me.
First responders are putting on the uniform every day or every shift, and they're not
(42:05):
fighting overseas.
They're not going over to another faraway country for their war.
First responders are doing it on the streets of their hometown.
It's their neighbors they're protecting.
It's their community that they're protecting.
It's their own family.
So, um, for responders, you have that experience at the end of every shift, taking the uniform
(42:28):
off and going home.
How do you walk in the door?
You know, an hour ago you were dealing with maybe the death of a child or, you know, the
injury, severe injuries in a, in a, in a motor vehicle accident, or, you know, dealing with
people who've been horribly victimized by crimes.
And then 10 minutes later, half an hour later, you're at home in your living room with your
(42:52):
family.
How, you know, how, how do you, how do you manage that?
That's, that's, that's, that's quite a, quite a powerful thing.
And then you have also, you're out in your, your community.
You take your family out to dinner or to a movie or shopping.
How do you let down your guard?
(43:13):
How are you not looking around to see who's around you, who the bad guys might be?
How, what might you need to do to, to intervene, to protect people?
So it's a whole different, uh, psychological challenge for first responders than it is
for soldiers.
And a lot of soldiers have said to me, what we had to deal with was, was, was hard, but,
but not that hard.
(43:35):
They take, they tip their hats to what first responders do, you know, on a regular basis
at the end, you know, every shift, um, on the streets of America.
Yeah.
As part of my research, I found that the younger generation of first responders, you know,
kind of five to seven years on the job, they're much more engaged from a mental health, uh,
(43:56):
perspective in terms of being open to it versus sort of the older regime of 25 years in the
force.
You know, and I remember a couple of guys saying like, you know, something would happen,
you know, something bad would happen.
They'd go to the bar that night, you know, have a beer and a shot and then walk out and
that was it.
And you buried it.
Right.
And so the good news is it's becoming right.
Probably more than one beer and one more than one shot.
(44:16):
Probably, probably.
You co-authored a study about the efficacy of using ketamine infusion in combination
with other procedures to treat post-traumatic stress and a traumatic brain injury and special
forces.
And that caught my eye because like most people, if they've heard of ketamine at all, we've
only heard about it in the context of the death of the friend's actor, Matthew Perry.
Talk to us about ketamine and its potential benefits and dangers.
(44:39):
Right.
Ketamine is a, is a hallucinogenic compound and it's been long used in, in medicine for
decades as one of several anti, um, um, uh, not anti as several, um, struggling with finding
the word here, uh, and anesthesia.
(45:01):
So it's often used.
It's certainly used in battlefield, uh, pain management, but it's also used in like trauma
surgery.
Usually there'll be two or three different anesthesias that are used.
And ketamine has been one of the, you know, is in combination with others is, is, is not,
is not as common.
Um, it's also, we discovered that ketamine also is a, is a treatment for depression.
(45:24):
And so ketamine is FDA approved as a treatment for depression.
It's a legitimate treatment for depression.
And a lot of us think that it also treats anxiety and PTSD and some of the existential,
uh, it helps people frame the existential, you know, issues and concerns in ways that
make it easier to manage.
Let me say this though.
(45:45):
There's different ways of delivering ketamine.
The only way I ever ask or recommend anybody to use it is to have it, um, infused intravenously
into, into your bloodstream in a clinic under full medical supervision.
And so that treatment, and there's many clinics around the country now that will provide this,
(46:06):
it's usually four to four to eight sessions.
Six is a pretty common number of sessions.
Each session involves going into the clinic, sitting in a very comfortable chair, receiving
them at, you know, receiving the medication, having them run it into your veins for about
an hour, hour and a half, maybe less.
And then they disconnect, they, they take, they remove the needle and you sit there for
(46:29):
another hour or so until your head clears.
And then you go home and that's one session.
What we have found, what we have seen in our, in our really now starting to look at more
carefully is ketamine and stellate ganglion block therapy combined into one, um, into
one treatment or done at about the same time has that there's synergistic effects with
(46:52):
the two treatments.
And so, um, like there's programs, Dr.
Lipoff's programs, you can get this through the, through some of the Stella centers and
many other clinics around the country.
Go in for a week, get, get a ketamine treatment for maybe four of them throughout the week,
get the stellate ganglion block treatments done and that they are symbiotic with each
(47:15):
other.
They enhance each other.
We also are now thinking that both stellate ganglion and ketamine separately, but especially
in combination, um, help stimulate neuro generativity, help stimulate the brain to
repair and start to heal itself.
So these are treatments that work profoundly on many of the things we've just talked about,
(47:39):
but including depression, anxiety, existential concerns, and brain health.
And there's other things that we think have similar, I don't want to say similar, but
also are excellent treatments for these issues.
So, um, I think in five years, we'll see not five years.
I think we're already kind of getting there, but psychedelic medications, ibogaine, five
(48:02):
MEO DMT, psilocybin, ayahuasca.
These are shown, we're seeing really good effects for, um, operator syndrome for brain
health, for psychological health with these, with these treatments, the research is developing.
I think they will be made more at some of these compounds will be more mainstream treatment
in the near future.
(48:23):
Other treatments.
One of my, one of the things we just, I just, today I got a paper published on the use of,
of transcranial magnetic stimulation.
It's a form of neuromodulation.
We can individualize it using what's known as magnetic electronic resonance therapy.
It's essentially sitting in a chair for 30 or 40 sessions while a magnet pulses a little
(48:47):
bit of electrical energy, magnetic stimulation into one side of your, of your, your brain.
And it goes back and forth within the brain.
It's not shock therapy.
It's a mild stimulation.
It doesn't hurt.
It doesn't have any dramatic side effects.
It, most people don't even really notice its benefits in a, in a, in a, in an abrupt way
(49:10):
cause it, cause it's gradual and gentle over the course of multiple sessions.
But we're seeing really good benefits from that.
Vestibular therapies, speech pathology therapies, hyperbaric oxygen therapy.
We're finding so many different things that we have out there with some of the foundations
(49:31):
that I work with.
We're now sending guys to functional medicine clinics where they're using things like stem
cells and NAD plus infusions to help with brain healing, help with chronic pain in the joints.
So there's just, there's many treatments that we have out there that we're not
widely using with veterans or service members or first responders.
(49:54):
We have just about two minutes left.
Would you please take us to the end of our conversation with advice or a story that helps
our audience feel more resilient, empowered, and able to succeed in the face of adversity?
Well, that's a hard, hard thing to summarize in two minutes, but I'll say this for everybody
who I've been talking about, soldiers, veterans, operators, other combat, combatants or combat
(50:19):
support and first responders.
There is hope for healing.
We have good treatments.
We have the ability to do good diagnostics and good treatments.
Right now, it's hard to find those treatments cause they're not widely offered by VA or
DOD medicine.
What a lot of people have found success with is finding the operator syndrome paper,
(50:44):
downloading it, going through it with a highlighter in their hand, maybe discussing it with their
spouse, and then taking that paper with all the markups on it to their primary care provider,
educate that primary care provider a little bit and present them with a, with a, you know,
sort of a list of things that you need help with.
My book has some, some very specific plans and strategies and even, you know, treatment
(51:07):
guidance issues in there.
The book, the book is really a book I wrote.
It's not an academic book.
It's for operators, responders, soldiers, and for their spouses.
So it's really intended to be kind of a self-help, a very practical guide.
And where can our listeners and viewers find your book?
Amazon.
And we'll keep it simple, right?
Dr. Chris Frege, clinical psychologist and author of the fascinating, insightful book,
(51:30):
Operator Syndrome.
Thank you for being with us today.
Thank you for having me.
No, absolute honor.
And thank you to our audience, which now includes people in over 50 countries for joining us
for another episode of Next Steps Forward.
I'm Chris Meek.
For more details and upcoming shows and guests, please follow me on Facebook at facebook.com
forward slash ChrisMeekPublicFigure and an X at ChrisMeek underscore USA.
(51:51):
We'll be back next week.
And an X at ChrisMeek underscore USA.
We'll be back next Tuesday, same time, same place with another leader from the world of
business, health, public policy, politics, sports, entertainment.
Until then, stay safe and keep taking your next steps forward.
(52:12):
Thanks for tuning in to Next Steps Forward.
Be sure to join Chris Meek for another great show next Tuesday at 10 a.m.
Pacific time and 1 p.m.
Eastern time.
On the Voice America Empowerment Channel.
This week, make things happen in your life.
There are few things that make people successful.
(00:08):
Taking a step forward to change their lives is one successful trait, but it takes some
time to get there.
How do you move forward to greet the success that awaits you?
Welcome to Next Steps Forward with host Chris Meek.
Each week, Chris brings on another guest who has successfully taken the next steps forward.
(00:30):
Now here is Chris Meek.
Hello.
You've tuned in this week's episode of Next Steps Forward, and I'm your host, Chris Meek,
and welcome to the new year.
As always, it's a pleasure and an honor to have you with us.
Our focus is on personal empowerment, a commitment to wellbeing, and the motivation to achieve
more than you ever thought possible.
We start 2025 with an outstanding guest.
Dr. B. Christopher Free is a clinical psychologist by training and professor of psychology at
(00:54):
the University of Hawaii, Hilo.
His development of something called the Operator Syndrome is helping to change the way we understand
and treat the complex set of interrelated health, psychological, and interpersonal difficulties
experienced by military special operations personnel.
Dr. Chris, as he's known, is also very actively involved in the SEAL Future Foundation, Boulder
Crest Foundation, Military Special Operations Family Collaborative, The Mission Within,
(01:19):
VetSync, The Quick Reaction Foundation, and the Military Special Operations Community
in general.
You're a busy guy, doctor.
Dr. Free has testified before Congress and served as a paid contractor for the Department
of Defense, Veterans Affairs, US State Department, and the National Board of Medical Examiners.
Dr. Bartley Christopher Free, welcome to Next Steps Forward.
Right on.
Thank you.
(01:39):
Thank you, Chris.
I'm excited to be here.
And again, we talked pre-show, but I'm a little jealous.
I'm here in blustery Connecticut where it's 20 degrees with 40 mile gusts and you're in
sunny Hawaii looking at the ocean.
So if I'm a little green with envy here, that's why.
So Chris, what I didn't mention in the introduction is that your dad is a US Air Force veteran
who served in Vietnam.
(01:59):
Is it fair to say that his experiences and yours growing up as the son of a military
veteran who served in combat shaped your decision to pursue the career that you did?
Yeah, definitely.
Now, I do want to clarify.
My father was a physician.
He was not a combatant, but I was about six years old when he deployed to Vietnam.
And then in subsequent years throughout my teenage, into my teenage years, had quite
(02:25):
an awareness of the war, what it meant for the soldiers, even for the people of Vietnam.
My father became very involved in the expat community at the University of Missouri of
Vietnamese students in the early seventies.
So we had a lot of, we had a lot of uncles and aunts from that community.
(02:47):
But I also want to mention my great grandfather was a veteran of the Spanish American war
and he served and fought at the Battle of San Juan Hill in the Michigan militia.
And he was one of my childhood heroes.
He lived to be almost a hundred.
So I think I was 14, 13 or 14 when he died.
So I knew him quite well.
I went to graduate school with the idea of I wanted to work with veterans.
(03:12):
It's amazing family history there.
Now that's great.
And thank you for your family service.
So the first chapter of your career from 1991 to 2006 was with the Veterans Administration
Healthcare System.
Would you share your journey to becoming a psychologist and then what you learned during
your 15 years serving at the VA?
Sure, right on.
So graduate school at the University of South Florida.
(03:35):
My dissertation was with veterans with PTSD.
That was the group I wanted to study for my dissertation.
And I was able to get a position at the VA in Charleston, South Carolina for my final
year of training.
And that's part of the progression for a PhD in clinical psychology.
(03:56):
So I went there for one year to complete that year of training.
And that was the VA and the Medical University of South Carolina.
And when that year ended, the gentleman who'd been my supervisor for the first part of the
year had left.
So I stepped right into that job.
And I was there for another 15, 14, 15 years after that.
(04:17):
I loved working at the VA.
I really enjoyed the patients that I worked with.
I really enjoyed my colleagues.
Had a really good, solid, amazing team of colleagues while I was there.
And I was a full-time clinician for the first seven years.
But had these questions about our patients, the people we were seeing.
(04:38):
And it just so happened we had a file cabinet of data, of patient folders going back probably
a decade.
And it was just all the psychological data in there.
So we started putting that into statistical programs, entering a lot of that data by hand.
And we wrote some papers.
And that led to kind of the next phase of my career, which was I applied for several
(05:05):
federal research grants from the NIH.
Received those grants.
And then the next eight years that I was there in Charleston were kind of divided between
my work in the clinic at the VA and my research programs, which were at the VA and the Community
Mental Health Center.
I left the VA in 2006.
And really, I would say the reason I left was I just was very frustrated with VA policies
(05:32):
at the central office level.
Not locally.
I was not upset with anything locally.
And it wasn't that I felt like I had to get out.
But some opportunities came up.
And I was kind of ready to go and move on.
Obviously, you worked with a cross-section of veterans in the VA.
But what drew you to work specifically with military special forces warriors?
So that happened about 10 years ago.
(05:52):
It started about 10 years ago.
And it was not a plan that I set out to go, OK, I'm going to do these things with this
community.
It was more organic and kind of random in the way it started.
I was at the University of Hawaii.
But I also had a position at Baylor College of Medicine in the Baylor College of Medicine.
(06:14):
And in Houston, Texas, where I was the director of research at the Menninger Clinic, they're
affiliated with Baylor College of Medicine.
And my friends, my circle of guys that I knew and hung out with, most of them came from
the special operations community.
And pretty early on, it was suggested to me by somebody who was not directly, he was not
(06:38):
an operator, but he had served with operators in Afghanistan.
And he said, you know, some of these guys are really struggling.
Maybe you could talk to them and help see what you could help them figure out.
And I started with the idea of, well, it's probably PTSD, you know, and I'm going to
just put a pin in that because we'll come back to that probably.
(06:58):
But I had an assumption that it was PTSD.
And my assumption proved to be mostly wrong and certainly massively insufficient to understand
the difficulties that they were.
These guys, my friends were experiencing.
And essentially, you know, you go, well, what's the, in medicine, we talk about what's the
(07:19):
primary complaint or what's the starting point?
And the primary complaint was this, something's wrong with me and I don't know what it is.
And I essentially, I've heard that over and over again in the past decade.
And starting with the assumption, well, what's wrong with you is probably PTSD.
And then come to find out it really wasn't.
(07:40):
And yeah, some depression, some anxiety, a lot of anger issues.
But underlying that, and it took some trial and error to get there, was massive sleep
dysregulation, not just insomnia, but sleep apnea.
And that surprised me.
I was not, 10 years ago, I was not prepared to find that these relatively young, healthy,
(08:01):
fit men would have sleep apnea.
That didn't, that didn't compute.
The other thing that didn't make sense to me initially was we discovered they all had
super low testosterone.
Testosterone of, you know, of an 80 year old man.
And so when a man has low testosterone at that young of an age, he's going to look, he's
(08:24):
going to look like he's depressed.
He's got, he's not going to be sleeping.
Concentration is impaired.
Irritability, anger, mood is going to be low.
Motivation and energy are going to be very low.
Just loss of interest in kind of everything, including working out, including work, including
sex.
And so a lot changed when we started to address the sleep apnea and the hormonal dysregulation
(08:50):
that these guys had.
And then that kind of opened the door to look at some other things.
And wow, they've got, they've all got chronic pain.
They've all got, you know, came to realize they all had traumatic brain injuries from,
and I didn't understand this, but from blast exposures.
And so now I have to learn about blast exposures.
And in 2014, there wasn't much research out there.
(09:13):
So that that's become something that today, I think we now have a much better lock on,
but still, we're still far from, from really fully understanding this.
And it has not, that knowledge, the scientific knowledge of blast exposures has not really
leaked out into the broader community of clinicians.
And so that's one of the things we face right now for all veterans, I believe.
(09:37):
And how are military personnel different from those of us who aren't serving or haven't
served in the military?
And then how are special forces personnel different from other military personnel?
Okay.
So, right.
Good question.
Because we're talking about operator syndrome, I want to, I want to, I want to say a few
words about what is an operator and how do we define them?
And how do I think about this?
So, first of all, I've worked with primarily, mostly a lot of operators, hundreds of operators
(10:02):
over the last decade.
An operator is, is somebody who's in one of the special forces units who goes through
special assessment and selection process.
For example, maybe Naval Special Warfare, they go through BUDS school and they can become
a SEAL if they, if they complete it.
So SEALs, Green Berets, MARSOC, you've got the, in the Air Force, you have the pararescuemen
(10:26):
and, and combat controllers.
I've worked with operators from Canada and many other countries as well.
It's a, it's an extraordinarily rigorous selection process.
Somewhere between, you know, maybe five and 8% of everybody who starts the training, it
completes it and is selected into those units.
(10:48):
And then for the people that, that make that for a career as an operator, those, those
careers involve several things, but one is an incredibly high intensity level of training
on a constant basis.
And the level of training between an operator and, and pretty much any other, you know,
(11:08):
soldier, for operators, the, let's, let me use the word dose, the dose of, of physicality,
the dose of blast exposures, the dose of, of all of what, what we'll call allostatic
load.
And we can come back to that, is, is magnitudes of order more than it is for most soldiers.
(11:29):
But I want to say this very clearly, operators are not the only ones that have aversion to
aversion of operator syndrome.
I've certainly seen it in, in, you know, any soldier doing urban combat, you know,
Marine, Marines, they may have less, they may have shorter careers than the typical
20 year career.
(11:51):
But the intensity of that combat is, is, is profound.
Artillerymen, combat engineers, infantry, pilots who are experiencing, you know, the
G-forces, SWCC boat op, fast boat operators, and, and many of the support folks and intelligence
(12:13):
roles that are embedded in work directly with operators.
And then the other group that we see these, these issues in is law enforcement and first,
first all first responders, law enforcement and firefighters have their own versions,
some differences, but similarities.
And 25% of the first responders are veterans themselves.
(12:34):
That's right.
That's, and my viewers and listeners know, I just finished my doctorate earlier this
year and I was focused on first responder and police mental health.
And so probably cited, probably cited a few of your papers in there.
Yeah.
So, so the same stuff that I do with operators is now, we're now applying that in a variety
of contexts for first responders.
And that's, that's, that's been, that's been really rewarding for me.
(12:58):
And, and the one thing I've highlighted, I'll say the one positive thing of COVID is,
it has put a big, huge spotlight on mental health and has significantly reduced the stigma,
you know, with the phrase, it's okay to not be okay.
And so that's the one positive thing that the negative, one of the many negatives though,
is that we're now seeing that tsunami of that mental health crisis across the board come
(13:21):
crashing down.
And so I appreciate folks like yourself that are sort of in the fight, if you will,
for treating those folks.
And maybe as a follow up to that, building trust is always critical for psychologists,
no matter who the patient may be.
As you look at the differences between special forces personnel, other military personnel,
and then the rest of us, what sort of professional challenges does working with special forces
(13:41):
create for you and your peers?
Well, good question.
A very common story, a very common experience I hear from operators is that they have a
good experience with mental health clinicians.
Part of the challenge in the military is there's a dual role.
(14:04):
So a psychologist, a social worker, other therapists in the military are both trying
to treat, screen and treat soldiers.
They're also part of the command structure.
So the fitness for duty is a mandate that they have to report on and document.
So if you're an operator, and I mean, you're going to know, depending on what you say to
(14:27):
the psychologist, you might get pulled out of your unit.
You might miss a deployment.
You might get pulled off a training evolution.
So there is a, I would say, I'll say this diplomatically, I would say operators are
very guarded in what they share with mental health teams in the DoD.
On the civilian side, so operators that go to, and this is true of many veterans that
(14:51):
go to the VA or go to civilian care providers, one experience, and I hear this all the time
with operators, is they go, they have that first meeting with the therapist and they
start just tipping their toe into the water and talking about a little bit of the things
they've seen and done.
And it upsets them.
(15:12):
The therapist starts to have an emotional reaction, is crying or emoting.
And frequently the soldier or the veteran just gets up and says, I'm sorry, and I'm
sorry.
I upset you.
And they leave.
Related to that I think is the bigger issue, which is most mental health professionals
are not educated.
(15:34):
They don't have an awareness of what operators are doing.
They don't have an awareness of what operators do.
They don't know, they don't have a sense of the culture, a sense of the experiences.
And that's not even their fault per se.
When I worked at the VA, I never had a patient who'd been a Navy SEAL or a Green Beret.
(15:58):
Never.
The closest I think I ever came to anything we would consider to be special operations
was a couple of force recon veterans who were force recon in Vietnam.
And that was, so there's not, I mean, operators are a small percentage of the military to
begin with.
And many of them just don't use the VA.
(16:19):
So it's probably a group of patients that most therapists don't have experience with.
Now, I tell you all of that to say this, there is a nonprofit organization now, it's about
two years old called the Soft Network.
And so if you're listening and you hear this, the Soft Network, you can look them up on
(16:39):
the internet.
And what they have is essentially a registry, state by state registry of therapists who
have been kind of identified as being culturally competent to work with soldiers, combatants,
and especially soft.
They're not going to just, they're not going to, they don't have a, they don't have specific
cutoffs for who they work with.
(17:00):
All of the therapists are individual private practitioners who have this foundation.
So it's just a way to find them.
It's a, it's essentially a referral source.
It's not, they don't, they don't pay for the care or provide or are either former soft
themselves, former, there's a lot of operators who got degrees and are now therapists.
There's a lot of spouses in there of operators.
(17:23):
And then there's a, you know, there's a number of people who were clinicians in the, in the
special operations community when they were active duty and are now out.
So there, there are resources out there.
We're starting to find them.
They're starting to be developed kind of at the foundation level.
And by soft network, you mean special operations forces network, correct?
Just for clarity, just for our listeners, they know how to look it up.
(17:45):
Yes.
Thank you.
So it's SOF, soft network.
Thank you.
And I want to go back to a comment you made about, you know, a clinician talking to an
operator and then just not being able to handle those scenarios that the operators have gone
through and are talking about.
How do you handle your mental health and your wellbeing as you're treating these, these
warriors?
(18:07):
Oh, I don't, I don't have any, I don't think I have any special challenge with that.
I mean, I think it's very common for therapists early in a career to working with veterans to
have some of their own emotional reactions.
And I certainly did in the first few months that I worked at the VA.
I, I definitely remember.
(18:28):
And that was, that was part of what the supervisors worked on with all of us was acknowledging
that, yeah, as we're going to have some, some reactions to hearing the kinds of things that
we, that we're not familiar with, that we haven't heard before.
But I don't, I don't really feel that any, I don't, I mean, that went away quickly.
And then as I started working with the special operators, yes, there's far more combat over
(18:51):
course of many more years than there is for typical soldiers.
A lot of the loss, a lot of the death that operators see, see and experience in their
community actually comes from training as well.
So, you know, static line jumps that didn't go well.
Things like that.
(19:11):
I don't really, you know, I get asked this question about vicarious trauma.
No, I don't, I don't really feel anything for that.
Do you ever work with the spouses of active duty personnel and private contractors?
I do.
Yeah, I have.
Yep.
And sometimes that's individually from their husbands.
Sometimes it's with, you know, with the husband, with the, with, as a couple.
(19:33):
And sometimes it's with the, at the family level.
I know I've, I've had the, the, the pleasure to get to know many adolescent children who
are learning and grappling with their, their parents' experiences.
And I understand that you've also worked with Canadian special forces operators.
Can you compare and contrast how they're the same as American special forces personnel
(19:53):
and how they're different?
If there are any differences?
The only differences is the accent.
A and cheese curd?
And the, and the, yeah, and the cheese curd and the tolerance for cold weather.
Fair enough.
They're more hockey fans than baseball fans, probably.
They're exactly the same.
They're exactly the same.
And I've, I've worked with operators in Australia, Israel, Britain, Netherlands,
(20:20):
Scandinavia, Poland, probably a few other places, but well, Afghanistan and Iraq as well.
I've worked with them, done work with some of the interpreters, actually quite a few
interpreters who functioned as special operators.
So it's, you know, it's the same, you know, the TBI, the hormone disruption,
the sleep disruption, the chronic pain, the psychological features, the headaches, the
(20:46):
cognitive problems, cognitive impairments.
It's, it's, it's, it's universal.
Earlier in the show, you mentioned the phrase operator syndrome.
How long did it take you to recognize the concept of the operator syndrome?
And how much longer did it take you to fully flesh it out?
You know, was there a particular aha moment?
Yeah, well, I don't know that there was an aha moment.
(21:10):
I think there were multiple aha moments early on.
And, you know, as I talked with dozens, and then eventually hundreds of operators over the,
over the years, it became a pattern recognition thing.
It's like, I've seen this, I know what questions to ask.
Early on, I started keeping a, just kind of a log of things that I was learning.
(21:32):
And, and as that log got longer, it was a living document.
And I started sharing it with operators at some point after probably three or four years,
like, Hey, read this.
This is just kind of a white paper.
This is kind of what I'm, I'm understanding.
And initially I called it the operator sleep manual.
Didn't put mental health in there, but, but everything it takes to sleep better
(21:54):
covers everything that we're talking about here.
And that was well-received.
And I had guys saying, well, you should publish this.
And eventually we were, I worked with a team of my colleagues and we did publish it in a
medical journal, 2020, a paper called operator syndrome.
Anybody can find it.
Just Google it.
It's on the internet.
Very easy to find.
It's easy to read because it came from this document that was partially written for operators,
(22:19):
for their spouses.
And so it's a descriptive paper and you can find the PDF of it.
It's public access.
So anybody can find it.
We published that in 2020.
And then folks kept telling me, you should write a book and say more about this.
So that I eventually did that.
And we published that this year.
That was published earlier this year.
(22:40):
Nope.
Sorry.
We're now in a new year.
It was published in March of 2024.
I think I've written up about four checks because I've written 2024 on them already
so far.
We're slowly getting into that.
Yeah.
Of course, I'm that until about March.
Exactly.
And I'm old enough.
I still write checks.
So that's kind of, I guess the backstory there.
Your research and work with special forces suggests that the injuries are special forces
(23:04):
while serving our country are extraordinarily complex and require complex solutions.
Take us through their injuries first.
And then we'll talk about the type of treatment they need.
Okay.
Well, let's start with a couple of concepts here.
So one concept that I want to put out there is allostatic load and it's cumulative.
So allostatic load is a hypothetical concept that's been defined as, and I'll paraphrase
(23:28):
this, but it's essentially the stress, the strain, the challenge that gets put on all
of the physiological systems in the body.
So it's a physiological concept.
So when we say physiological systems, we're talking about the nervous system, the neuro
endocrine system, the immune metabolic, musculoskeletal, respiratory, perceptual systems.
(23:50):
And of course the cardiovascular system and others.
So all of our systems are interconnected, right?
Our brain is connected to our gut, is connected to our hormones.
So the concept of allostatic load is that the blast exposures, the running, the rocking,
the physicality, the sleep deprivation, the chronic high stress and high op tempo.
(24:13):
All of this has a profound physiological burden on the human body that in operators is cumulative
because there's not a lot of rest.
There's not a lot of pauses taken.
So over the course of 10 years, 15, 20 or more, this accumulates.
And we know that something, um, I'll keep it, I'll focus here.
(24:34):
We know that a concussion, if somebody gets multiple concussions over the course of their
life and the closer those concussions are together, they are more likely to have, uh,
you know, some profound injuries and impairments that come from that, that can be permanent
and lasting.
So the concept of allostatic load is that operators and first responders and other soldiers
(24:56):
just have this massive dose of allostatic load that accumulates over time.
So operator syndrome is a, is a framework to take, to take that concept and say, how
does this apply?
How does this, how is the human body affected by the type of activities?
So, you know, jumping out of perfectly good airplanes, combat, diving, running, rocking,
(25:17):
combat is repelling all of that physicality.
Then you add on all the massive amounts of blast exposures from demolitions, breaching,
shoulder fired rockets, even, you know, sniper rifles, and even handguns involve a micro
explosion.
And that causes an invisible form of damage.
We're only really kind of tuning into the last, probably the last 10 years or so.
(25:41):
So what I'm talking about here, what makes this complex is that, you know, I'll get to
the injuries in just a moment, but they're all interrelated.
And that's part of, partly what, why we want to talk about this as a syndrome is it's not
just a traumatic brain injury.
It's a traumatic brain injury that connects to your sleep and affects your sleep.
(26:05):
And together those affect your hormones and all combined.
All of these things have effects on each other, which can lead to a vicious cycle.
You know, one problem causes cascade of problems everywhere else.
But to turn that around, this is the message of hope here is there's, there is good hope
(26:25):
for recovery.
You treat one issue and that can have a ripple effect on positive ripple effect on the other
physiological systems.
And if you start doing multiple treatments for multiple systems, then you're really going
to see some, some, you know, really great benefits.
So the recovery and healing is, is, is very possible, but let's talk about what, what
(26:48):
the syndrome itself is.
So operator syndrome really starts with traumatic brain injury.
And I'll just go down the list, sleep disturbance with sleep apnea, hormonal dysregulation,
primarily test, low testosterone in men, but that's not the only domain that gets
affected.
(27:09):
The perceptual systems have impairments.
So hearing, vision, balance, chronic pain, headaches, a lot of guys have chronic migraines,
the cognitive impairments to concentration, to short-term memory, even just to staying
organized.
And of course, learning new material is much harder after you've had a traumatic brain
(27:30):
injury.
And then we have the psychological, which I would say kind of in, in, in no particular
order, but, but the anxiety, depression, and anger kind of are at the forefront.
Some of the PTSD symptoms and also high potential for addiction.
So heavy drinking is, is very common and as well as some of the other, using some of the
(27:51):
other drugs that are out there.
And then all of that, apologize for talking for, for so long without taking a breath,
but then all of that cascades into the social systems.
So we start with the physiological systems, but then our social systems, marriage, parenting,
(28:12):
fitting into a civilian society, the intimacy challenges emotion.
I mean, yes, sexual intimacy is very, is a, is a problem for many operators after a certain
point, but the emotional intimacy is a struggle too.
A lot of guys will talk about losing their empathy.
Also toxic exposures, the radiological, the biological, all the, you know, the bad water,
(28:37):
the not so clean air and whatnot that are, that are in many austere environments.
Those are having effects, respiratory illnesses, cancers, other things.
And then the last is the existential concerns, which we could spend a whole hour talking
about right there, but this would include things like the horror of killing the thrill
(28:58):
of killing a very common statement.
A common perspective I hear is that the soldiers actually who do enough of it, who do a lot of it
come to enjoy it, come to find it thrilling and then miss it later.
And then also feel very guilty about those perspectives of having enjoyed it and missing
it.
And of course, we also have all the loss and the grief, you know, sometimes guilt, survivors,
(29:23):
guilt, we might call it moral injury or shame.
Sometimes at the end of a career, we often are faced with things like that sense of that
loss of identity, loss of purpose.
Who am I now?
Loss of tribe.
I'm no longer with the people I serve with.
And that's a challenge.
(29:44):
And then last, a lot of guys will talk about feeling betrayed by their nation, by society.
Many will talk about, soldiers will talk about loss of faith in humanity or God.
So there are these profound existential issues that I don't really think of as being psychiatric
illnesses.
I think of them as just, you know, humans struggling with being humans and the things
(30:08):
that they've experienced and seen and done.
Can you go into a little bit more detail?
I haven't heard anything or much, I guess, about veterans feeling betrayed.
Can you just give a little more color on that, please?
Well, yeah.
So two points, several points.
It's not two, it's probably several.
One is in special operations, very few people, very few operators go out on a high note at
(30:32):
the end of their career.
Many are med boarded out.
Many have, you know, experiences towards the end of their careers that aren't so positive
and maybe they are kind of separated from their team.
Maybe they go and do some kind of last year or two of terminal duty somewhere where they're
(30:56):
not really part of the unit that they've been with.
And so oftentimes there's just kind of some bad feeling that's there.
I think there have been some other things in recent years, you know, the manner in which
the war has been prosecuted, the rules of engagement, which have changed multiple times
over the last several decades.
(31:16):
The pullout from Afghanistan, that has been a profound demoralizer for many in the SOF
community, in part because they had, you know, so much blood and treasure was spent there,
but also in part because they work so closely with Afghani interpreters and soldiers, most
(31:38):
of whom were left behind.
And so that has left a very, very, that's had a very demoralizing effect.
A lot of folks have been upset by the way the military handled the vaccine mandates,
by the way, diversity, equity, inclusion has been sort of manifested throughout the
(32:00):
Department of Defense.
So there's, and it's no one thing, it's often a lot of things.
And then you, of course, you combine that with all the other stuff we just talked about,
you know, the injuries and the impairments and it's a lot, it's just a lot.
You know, I didn't think about the withdrawal from Afghanistan.
I have three classmates that were special operators and had the three of them on the
(32:22):
week after the withdrawal and they expressed a lot of what you just highlighted.
And so, so thanks for flagging that for me.
A few moments ago, when you're talking about the different injuries, you mentioned physiological
systems probably a dozen times.
You've noted that although you're a psychologist, you take a very physiological perspective
on helping the people you work with.
(32:43):
Would you explain how that's different from, you know, for lack of a better phrase, the
average psychologist who cares for similar patients?
Yeah, sure.
Well, I start, I start now.
I mean, this is, this has been an evolution for me over probably the last 10, maybe 15,
20 years, but we're animals, we are biological animals.
And when we injure any part of our body that, that can have an effect.
(33:08):
We often think of things like, let's just take depression.
For example, depression is a, is a psychological issue.
And, you know, we have Freudian psychoanalytic theories, we have behavioral theories, we
have cognitive theories that explain it and not to take anything away from those theories
that it's not to say that they're wrong, but what we have not really paid attention
(33:29):
to is for example, genetics.
We know that depression has a genetic component to it.
If your parents had depression, you're more likely to have depression.
And now we're starting to identify some of the specific candidate genes that may contribute
to that.
So that's an example of a physiological thing.
Another understanding that I think is really developed in the last, in recent years is
(33:55):
the idea that chronic systemic inflammation in the body is a causative factor of depression.
So if we don't eat well, if we don't move our bodies, if we are not living an anti-inflammatory
lifestyle, which almost none of us are, we're more prone for depression.
(34:16):
And that implies one of the, that gives you a clue to one of the interventions, which
is to live an anti-inflammatory lifestyle.
What does that mean?
That means cutting out anything that's going to increase inflammation in the body.
What is that?
That's sugar, alcohol, processed foods, not getting enough sleep, not getting enough exercise
(34:41):
and many other things.
One of the, one of the thing, one of the treatments that's been identified as a, as a
powerful antidepressant treatment is, is hot sauna taking three 20 minute hot sauna baths a
week in randomized controlled medical trials has been shown to lower inflammation and reduce
(35:03):
depression significantly.
So there's a, there's a whole body of work out there now focusing on more physiological
treatments than what, what therapists typically do.
So let's start with that.
Traditional mental health care in the West right now is a combination typically of psychiatric
medications and, and psychotherapy.
(35:25):
And I'm not criticizing, you know, there's a lot of value in both of those treatments.
So don't, don't, I'm not dismissing them at all.
Don't, don't hear me say that.
I do worry about over medication.
That's a, that's a very common problem.
But we have so many other treatments as well.
And I can go through some of those if, if, if we have time.
I'm okay for me to just kind of rattle off.
(35:48):
Absolutely.
So one treatment I think is, well, so with, with probably most psychiatric patients today,
we should be getting a sleep study and a hormone panel.
Both of those measure very important physiological aspects of the human body that will have a,
you know, very negative, can have very negative effects on, on psychological functioning,
(36:12):
cognitive functioning.
So I always say we need to do a TBI assessment.
We need to do a sleep study and we need to get a hormone panel and probably also a metabolic
panel and then follow whatever treatment recommendations come out of that, out of those
tests, out of those evaluations.
One of my go-to treatments that I recommend for pretty much everybody is a stellate ganglion
(36:34):
block.
Stellate ganglion block is a physiological intervention.
It involves injecting a little medicine into the sympathetic nervous system.
And it, what it does is it lowers the physiological arousal in the body.
And it, and it has a lasting effect for months, maybe even a year or more.
(36:56):
One injection into the side of the neck.
It does not, it does not dope you up.
It does not impair your cognitive functioning at all.
It has almost no side effects or lasting, you know, any kind of long-term risks.
Um, the worst thing that can happen typically is it might not work.
So about 90% of the people I recommend for this, uh, describe it as being profoundly
(37:17):
beneficial.
Um, what it does is it takes that baseline level of anxiety, which might be at like a
seven, eight, most of the time, and it can bring it down to like a two or a three.
So for general anxiety, for PTSD anxiety, for people who do a lot of worrying, uh, and
maybe can't sleep at night because they're so the ruminating and they're obsessing over
(37:40):
things for people with, who have what we sometimes refer to as low stress tolerance.
In other words, people who are impatient and easily angered.
A lot of that is because the anxiety is so high to begin with that when there's a small
frustration that bumps them above the threshold for losing, you know, losing their, their,
their temper.
(38:01):
When we bring it down with this injection, what we see, and it works almost immediately,
like literally within a few hours, people describe feeling more relaxed, calm.
They're more focused, more present, uh, with their family.
They can enjoy things differently.
Their mind is, is more clear.
(38:22):
They can think better.
They can concentrate better because all that anxiety noise is cleared out.
Um, they, they become less angry, less irritable, and they start sleeping better.
It helps with the insomnia.
And so guess what?
You get one of those shots.
And for the next two to three weeks, months, at least most people feel really, really good.
(38:45):
And you know, the medicine will wear off and some of that anxiety may come back.
You can have the, you can repeat this treatment.
You can have it done multiple times over the course of, you know, you can get it done once
or twice a year, but more than that, what it does is it opens that it opens a window
of opportunity.
I think I've seen this many times, get the guys, get the Stella ganglion.
(39:08):
Sometimes their spouses get it too.
I often like to see a couple's intervention with that and it, and it gives them kind of
a holy moly experience.
I got a phone call a couple of weeks ago from a, from one of my younger guys who's currently
active duty at a tier one unit.
And he, he got his first LA ganglion block and he called me that night and he, and he
(39:31):
says, you've been telling me about this for months.
I finally got it.
Holy cow.
I feel so different.
I've never felt this way before.
I mean, he wasn't high.
He was just excited about this new feeling of relaxation that he had never, he had never
felt.
He had a rough childhood as many have.
And so he didn't even have the, he didn't even have relaxation in his childhood.
(39:53):
But now it's easier to talk to a therapist.
Now it's easier to engage in other lifestyle changes.
Now it's easier to re-engage or engage with family members, especially spouses in a different
way.
So it really kind of opens the door to, you know, to, to more healing, more recovery in
other ways.
(40:14):
So huge fan of Stella ganglion block treatments.
We've been talking a lot about military personnel and earlier in the show, we briefly
touched on first responders.
Then they experienced many of the same emotional and physical traumas.
You've written about what you call firefighter syndrome because they also face a high risk
of traumatic brain injuries, including impact force injuries and toxic exposures.
(40:36):
Can you describe firefighter syndrome and the treatment approaches it requires?
The same.
It's the same.
The brain injury is a little different and the toxic exposures are a little different.
Firefighters aren't working with demolitions in intentionally trying to blow things up,
but they do go into structure fires.
They do go into environments where it's not known what they're going to be breathing.
(40:59):
And sometimes they're in environments that change rapidly while they're in a structure.
So that's, that's, that's part of what they, what they have to deal with.
Now, um, there's another piece to this and I didn't even mention this with, with, with
soldiers and veterans, but the transition points are a challenge for soldiers.
(41:21):
There's a difficult transition coming home from a deployment or a, or a lengthy training
evolution.
There's the transition at the end of the career.
That's a huge challenge.
And we know this, you know, you, whether it's, whether you've been in the military for two
years, four years, 24 years, when you leave the service, you're stepping into a whole
(41:42):
different world.
And that's a, that's a, that's a challenge.
It's a significant challenge for first responders.
However, let's, let's give them, let's give them their due here.
And this is something that a lot of soldiers have pointed out to me.
First responders are putting on the uniform every day or every shift, and they're not
(42:05):
fighting overseas.
They're not going over to another faraway country for their war.
First responders are doing it on the streets of their hometown.
It's their neighbors they're protecting.
It's their community that they're protecting.
It's their own family.
So, um, for responders, you have that experience at the end of every shift, taking the uniform
(42:28):
off and going home.
How do you walk in the door?
You know, an hour ago you were dealing with maybe the death of a child or, you know, the
injury, severe injuries in a, in a, in a motor vehicle accident, or, you know, dealing with
people who've been horribly victimized by crimes.
And then 10 minutes later, half an hour later, you're at home in your living room with your
(42:52):
family.
How, you know, how, how do you, how do you manage that?
That's, that's, that's, that's quite a, quite a powerful thing.
And then you have also, you're out in your, your community.
You take your family out to dinner or to a movie or shopping.
How do you let down your guard?
(43:13):
How are you not looking around to see who's around you, who the bad guys might be?
How, what might you need to do to, to intervene, to protect people?
So it's a whole different, uh, psychological challenge for first responders than it is
for soldiers.
And a lot of soldiers have said to me, what we had to deal with was, was, was hard, but,
but not that hard.
(43:35):
They take, they tip their hats to what first responders do, you know, on a regular basis
at the end, you know, every shift, um, on the streets of America.
Yeah.
As part of my research, I found that the younger generation of first responders, you know,
kind of five to seven years on the job, they're much more engaged from a mental health, uh,
(43:56):
perspective in terms of being open to it versus sort of the older regime of 25 years in the
force.
You know, and I remember a couple of guys saying like, you know, something would happen,
you know, something bad would happen.
They'd go to the bar that night, you know, have a beer and a shot and then walk out and
that was it.
And you buried it.
Right.
And so the good news is it's becoming right.
Probably more than one beer and one more than one shot.
(44:16):
Probably, probably.
You co-authored a study about the efficacy of using ketamine infusion in combination
with other procedures to treat post-traumatic stress and a traumatic brain injury and special
forces.
And that caught my eye because like most people, if they've heard of ketamine at all, we've
only heard about it in the context of the death of the friend's actor, Matthew Perry.
Talk to us about ketamine and its potential benefits and dangers.
(44:39):
Right.
Ketamine is a, is a hallucinogenic compound and it's been long used in, in medicine for
decades as one of several anti, um, um, uh, not anti as several, um, struggling with finding
the word here, uh, and anesthesia.
(45:01):
So it's often used.
It's certainly used in battlefield, uh, pain management, but it's also used in like trauma
surgery.
Usually there'll be two or three different anesthesias that are used.
And ketamine has been one of the, you know, is in combination with others is, is, is not,
is not as common.
Um, it's also, we discovered that ketamine also is a, is a treatment for depression.
(45:24):
And so ketamine is FDA approved as a treatment for depression.
It's a legitimate treatment for depression.
And a lot of us think that it also treats anxiety and PTSD and some of the existential,
uh, it helps people frame the existential, you know, issues and concerns in ways that
make it easier to manage.
Let me say this though.
(45:45):
There's different ways of delivering ketamine.
The only way I ever ask or recommend anybody to use it is to have it, um, infused intravenously
into, into your bloodstream in a clinic under full medical supervision.
And so that treatment, and there's many clinics around the country now that will provide this,
(46:06):
it's usually four to four to eight sessions.
Six is a pretty common number of sessions.
Each session involves going into the clinic, sitting in a very comfortable chair, receiving
them at, you know, receiving the medication, having them run it into your veins for about
an hour, hour and a half, maybe less.
And then they disconnect, they, they take, they remove the needle and you sit there for
(46:29):
another hour or so until your head clears.
And then you go home and that's one session.
What we have found, what we have seen in our, in our really now starting to look at more
carefully is ketamine and stellate ganglion block therapy combined into one, um, into
one treatment or done at about the same time has that there's synergistic effects with
(46:52):
the two treatments.
And so, um, like there's programs, Dr.
Lipoff's programs, you can get this through the, through some of the Stella centers and
many other clinics around the country.
Go in for a week, get, get a ketamine treatment for maybe four of them throughout the week,
get the stellate ganglion block treatments done and that they are symbiotic with each
(47:15):
other.
They enhance each other.
We also are now thinking that both stellate ganglion and ketamine separately, but especially
in combination, um, help stimulate neuro generativity, help stimulate the brain to
repair and start to heal itself.
So these are treatments that work profoundly on many of the things we've just talked about,
(47:39):
but including depression, anxiety, existential concerns, and brain health.
And there's other things that we think have similar, I don't want to say similar, but
also are excellent treatments for these issues.
So, um, I think in five years, we'll see not five years.
I think we're already kind of getting there, but psychedelic medications, ibogaine, five
(48:02):
MEO DMT, psilocybin, ayahuasca.
These are shown, we're seeing really good effects for, um, operator syndrome for brain
health, for psychological health with these, with these treatments, the research is developing.
I think they will be made more at some of these compounds will be more mainstream treatment
in the near future.
(48:23):
Other treatments.
One of my, one of the things we just, I just, today I got a paper published on the use of,
of transcranial magnetic stimulation.
It's a form of neuromodulation.
We can individualize it using what's known as magnetic electronic resonance therapy.
It's essentially sitting in a chair for 30 or 40 sessions while a magnet pulses a little
(48:47):
bit of electrical energy, magnetic stimulation into one side of your, of your, your brain.
And it goes back and forth within the brain.
It's not shock therapy.
It's a mild stimulation.
It doesn't hurt.
It doesn't have any dramatic side effects.
It, most people don't even really notice its benefits in a, in a, in a, in an abrupt way
(49:10):
cause it, cause it's gradual and gentle over the course of multiple sessions.
But we're seeing really good benefits from that.
Vestibular therapies, speech pathology therapies, hyperbaric oxygen therapy.
We're finding so many different things that we have out there with some of the foundations
(49:31):
that I work with.
We're now sending guys to functional medicine clinics where they're using things like stem
cells and NAD plus infusions to help with brain healing, help with chronic pain in the joints.
So there's just, there's many treatments that we have out there that we're not
widely using with veterans or service members or first responders.
(49:54):
We have just about two minutes left.
Would you please take us to the end of our conversation with advice or a story that helps
our audience feel more resilient, empowered, and able to succeed in the face of adversity?
Well, that's a hard, hard thing to summarize in two minutes, but I'll say this for everybody
who I've been talking about, soldiers, veterans, operators, other combat, combatants or combat
(50:19):
support and first responders.
There is hope for healing.
We have good treatments.
We have the ability to do good diagnostics and good treatments.
Right now, it's hard to find those treatments cause they're not widely offered by VA or
DOD medicine.
What a lot of people have found success with is finding the operator syndrome paper,
(50:44):
downloading it, going through it with a highlighter in their hand, maybe discussing it with their
spouse, and then taking that paper with all the markups on it to their primary care provider,
educate that primary care provider a little bit and present them with a, with a, you know,
sort of a list of things that you need help with.
My book has some, some very specific plans and strategies and even, you know, treatment
(51:07):
guidance issues in there.
The book, the book is really a book I wrote.
It's not an academic book.
It's for operators, responders, soldiers, and for their spouses.
So it's really intended to be kind of a self-help, a very practical guide.
And where can our listeners and viewers find your book?
Amazon.
And we'll keep it simple, right?
Dr. Chris Frege, clinical psychologist and author of the fascinating, insightful book,
(51:30):
Operator Syndrome.
Thank you for being with us today.
Thank you for having me.
No, absolute honor.
And thank you to our audience, which now includes people in over 50 countries for joining us
for another episode of Next Steps Forward.
I'm Chris Meek.
For more details and upcoming shows and guests, please follow me on Facebook at facebook.com
forward slash ChrisMeekPublicFigure and an X at ChrisMeek underscore USA.
(51:51):
We'll be back next week.
And an X at ChrisMeek underscore USA.
We'll be back next Tuesday, same time, same place with another leader from the world of
business, health, public policy, politics, sports, entertainment.
Until then, stay safe and keep taking your next steps forward.
(52:12):
Thanks for tuning in to Next Steps Forward.
Be sure to join Chris Meek for another great show next Tuesday at 10 a.m.
Pacific time and 1 p.m.
Eastern time.
On the Voice America Empowerment Channel.
This week, make things happen in your life.
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