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Authors: Charles W. Hoge M.D.

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Personal Changes Resulting from Deployment

Examples that might be written down in the negative changes/losses
column include physical impairment from being wounded or from an
injury; the breakup of an intimate relationship; divorce; loss of custody
or separation from children; feeling distant and cut off from family and
friends; your child not recognizing or connecting with you in the same
way; difficulty relating to people you used to enjoy being with; losing a job
or promotion opportunity; loss of interests that used to be enjoyable; not
being able to complete major educational goals; financial problems; loss
of years and feeling old; not being able to attend important events, such
as the marriage of a sibling or the funeral of a close relative; missing time
with children as they grow up; and difficulty coping with experiences that
occurred downrange. All of these represent losses of one kind or another,
and are accompanied by substantial feelings.

If you experienced a major loss, like losing a buddy in combat or your
marriage, it may be hard to focus on other losses that also occurred. However, try to write down all the major ways things have changed in your life
since before deployment.

The next step in this exercise is to select the most difficult or painful
loss from the list you made and write it down in the left column of the
next worksheet, under the heading, "Most Difficult Change/Loss Resulting from Deployment." This could include the breakup of an important
relationship, separation from children, physical injury, the loss of a buddy
in combat, or something else.

Identify which emotions are connected with the loss and circle them.
Add any other emotions that you're experiencing if they aren't on the list.
Also, are you blaming yourself in some way by asking "why" questions or
using "should" statements (per chapter 5, skill 4)? For now, justwrite "yes"
or "no" if you are, and then later on in this chapter (skill 3), we'll look at
this in more detail. If you experienced more than one major loss, photocopy or scan this worksheet and repeat it as necessary.

The key to this exercise is to fully acknowledge the feelings/emotions
associated with the most difficult losses. Experiencing loss hurts, and it's
supposed to hurt; however, acknowledging and expressing how you feel helps the feelings to shift and change (see also chapter 5, skill 2). The key
skill is to acknowledge any important losses, notice and accept all of your
feelings, and understand the nature of your feelings.

Primary Emotions

There are two categories of emotions of loss: primary and complex. Primary
emotions are relatively pure, single feelings that are right here, right now, as
a direct result of the loss. They may be high- or low-intensity, but don't have
any specific direction. When we hurt, we hurt; when we're sad, we're sad;
when we're afraid, we feel fear; when we're grieving, we're bereaved and
mourning; when we're angry, we're angry. When we're helpless or powerless, we feel that we're unable to respond in any way. These emotions are
not made up of other emotions. They are directly related to the particular
loss, are immediately present to us, and are untainted by thought processes.

Loss Worksheet

Primary emotions are also raw and more primitive, less connected with
thoughts, processed more in the limbic system, and extremely unpleasant;
you want them to stop, they exist outside of time (which is why they can be
so unbearable and feel like they'll go on forever), and you can feel them
in your gut (for example, you feel nauseous or you feel discomfort in the
pit of your stomach). Emotional pain can hurt just as much and be just as
physical as physical pain.

Complex Emotions

Complex emotions are very different. They reflect mixtures of several emotions, involve detailed thought processes that extend in time, are often
directed at others or ourselves in self-deprecating or judgmental ways,
and are there to protect us or motivate actions. These emotions are often
closely linked, although each has its own unique quality. Being despondent is a state of being extremely disheartened or dejected over a specific
loss. Demoralization carries more of a feeling of powerlessness, injustice,
or lack of fairness also related to a specific situation or loss. An example
would be a severely hostile work environment (e.g., abusive or sexually
inappropriate behavior by a supervisor) but not being able to leave the
position or get anyone in higher authority to believe that this is happening. Being in despair-which carries a sense of futility, defeat, and utter
hopelessness-spreads the hurt over various emotions that may include
elements of sadness, helplessness, hopelessness, powerlessness, grief,
despondency, demoralization, and sometimes the desire to die. Depression, which is a medical diagnosis, a physiological process, and an emotional state, has various definitions and manifestations involving different
mixtures of primary and complex emotions, often including fear.

Complex emotions involve ruminative thought processes where the
person goes over and over events and situations in their mind in an effort
to figure out, make sense of, or assign some meaning or reason to what happened. Often these processes include "should" statements and "why" questions (e.g., "Why is this happening to me?", "Why am I being punished?",
"What did I do wrong to deserve this?"). Complex emotions may involve
feelings of betrayal, anger at self or others for failing to respond in some way, repeatedly going over scenarios or conversations in the mind, hopelessness
that anything can ever change, feeling morose, and isolating oneself from
others. Complex emotions often involve thoughts of blame or judgment as
to the value of oneself or another. Examples include feeling worthless or
being racked with guilt or shame. In keeping with the discussion in chapter
7 (skill 4), anger is considered a primary emotion, and rage and hate are
complex emotions; hate moves in the direction of judgment. We can get
stuck in complex emotions for extended periods of time. Complex emotions are private caves where we can reside and remain indefinitely.

One state that can be associated with both primary and complex loss
emotions is dissociation-feeling as if things are unreal, or feeling separate from one's body. Dissociation is essentially what people do when
they freeze in a situation where they can't fight or flee. If we are hurt to
such an extent that we can't bear the pain, there are chemicals in our
nervous system that cause us to feel dissociated from our body and numb
to the primary pain. After the trauma or loss has passed, dissociation can
become a defense that helps to numb us to the emotional pain and is
closely associated with complex emotions.

How Complex Emotions Protect Us

How do complex emotions protect us or motivate actions? Here's an example to help address this. Severe neglect or abuse of a child by a parent who
the child depends on for safety, security, and love is probably one of the
greatest and longest-lasting hurts that a person can ever endure. There are
several reasons why it can have such a lasting effect, including the direct
physical or emotional pain and hurt caused by the parent (which may
induce dissociation); fear associated with the shock and confusion of the
irrational nature of what is happening; sadness and grief resulting from
the difference between when the parent is loving and when they are cruel;
powerlessness and helplessness resulting from the inability to escape or
change the situation, and an inability to express emotions; and the lack
of understanding of what is happening or what is being felt to buffer the
impact and help the child to understand that it's not their "fault" they're
being abused, despite what the parent wants them to believe.

Perhaps most important, the child is not in any position to understand
their primary emotions. They might not have the vocabulary to understand what they're feeling, and because they don't feel safe, are unlikely
to verbally express their primary emotions. They certainly feel hurt, fear,
sadness, grief, anger, helplessness, or powerlessness, but they may not consciously understand what they're feeling and may not be allowed to fully
express their feelings.

What happens to a child in this situation, particularly if the abuse
continues, is that they can't remain or live with the primary emotions of
hurt, fear, sadness, grief, anger, helplessness, or powerlessness forever.
These emotions can't be endured forever without being understood or
expressed. If the child continued to live with the intensity and weight of
these primary emotions, powerless and helpless to express them or understand them, the child would become unable to move, function, or cope,
and might stay dissociated or become psychotic.

The complex emotions are key coping mechanisms involving various thought processes that help the child separate from or suppress the
primary emotions. The complex emotions are part of the brain's attempt
to "figure out" something that is totally irrational and incomprehensible.
These emotions provide a way for primary emotions, which are not permitted to be expressed openly, to be processed and felt in solitude. Depression, demoralization, despondency, hopelessness, worthlessness, despair,
guilt, and shame all provide a way to privately feel and try to make sense of
what's happening. They allow the child to cope with deep feelings involving
the primary emotions that they can't otherwise express, understand, and
endure. All of this happens automatically, and subconsciously.

One feature of these complex emotions is the feeling that no one else
in the world can possibly understand or relate to them; these emotions
feel unique. Everyone can relate to primary emotions. Complex emotions provide a unique identity that fosters a feeling of self-preservation
for the individual separate from others. These emotions offer a way to
cope through engaging the mind in figuring out why something is happening, creating distance from the environment, and minimizing the hurt
through shutting down and altering certain physiological functions (e.g., energy level, sleep, appetite, interest in activities, personal hygiene); they
allow the child to remove and protect him- or herself in an act of selfpreservation. Feeling worthless, guilty, ashamed, or filled with self-blame
provides meaning for what's happening and reduces the fear, confusion,
and hurt associated with something that's utterly irrational and incomprehensible. There's a repetitive and ruminative quality to the expression of
these emotions, and no one can do anything to change them.

One of the benefits of complex emotions to the individual is that
they can actually motivate others around them to step in and intervene in an attempt to alleviate the suffering or take over the duties and
responsibilities of the individual. Underlying feelings of helplessness
may be transferred to family members and friends, and become a shared
experience. The emotion of rage, when it gets expressed, can drive the
individual toward action. Although it may seem counterproductive and
detrimental to live with depression, rage, guilt, shame, low self-worth,
despair, etc., these are far preferable for the individual than remaining
in a powerless state, unable to express (or comprehend) the underlying
primary emotions.

It's important to know that some children who grow up in circumstances involving severe neglect or abuse are able to demonstrate extraordinary resilience and not end up with lifelong depression, rage, shame, or
other complex emotions. Often the children who are able to rise above
their situation and escape the "ghetto" (literally or figuratively) are ones
who had someone in their life who loved them and provided a buffer to
protect them, or at least to let them know that they were not the ones who
were crazy-that they actually had value in the meaningless and nonsensical universe into which they were born.

This is a very important concept that many mental health professionals don't understand. When a person like this requests help later
in life for their depression, rage, shame, despair, and other symptoms,
what they need most is someone who is kind, compassionate, and who
will love them. They need someone to ask, "What's bothering you?" rather
than "What's wrongwith you?" They need someone who has the ability to
tell them that they're not crazy for wanting to kill their mother or father, not crazy for feeling rage and anguish on a daily basis, not crazy for being
perpetually depressed and suicidal, not broken for feeling worthless and
filled with shame, not wrong for being hostile and self-destructive; someone who is willing to spend the time necessary for them to fully express
their emotions, whatever it takes and however long it takes, and who
won't judge them or make them feel like they're a living example of
every major mental disorder in the psychiatric Diagnostic and Statistical
Manual of Mental Disorders (DSM). This is hard to find during most fiftyminute psychotherapy sessions.

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