Overcoming Mental Health Hurdles After Combat

Scott DeLuzio:    00:00    Hey everybody, this is the Drive On Podcast where we talk about issues affecting veterans after they get out of the military. I'm your host, Scott DeLuzio, and now let's get on with the show.

Scott DeLuzio:  Hey everyone, thanks for tuning in to the Drive On Podcast. Before we get started, I wanted to take a minute to ask a quick favor from the listeners. So, the point of this show is to help veterans through sharing stories like the one we're about to hear but it can't really help if no one hears the story. So, if you wouldn't mind, hit pause for a second and head on over to DriveOnPodcast.com/subscribe where you can find links to subscribe to and review the show on all of your favorite podcasting apps. And if you wouldn't mind taking a second to share the podcasts on social media or email or whatever or even directly to a friend who you think might benefit by listening to the podcast, I'd really appreciate it. Today my guest is Dave Pecirep. Dave deployed to Afghanistan in 2006 and was wounded by an IED. After the deployment, he graduated college and went on to research PTSD and traumatic brain injuries with the Department of Veteran Affairs. Dave, welcome to the show. Why don't you tell us a little bit about yourself, a little bit about your background and everything like that.

Dave Pecirep:    01:17    Thanks for having me first off.  I guess to put this within the confines of our conversation, I think we should probably start where I was originally wounded and then sort of work our way from there. So, it was 2006 and a little back story to that, I was in my senior year of college at <inaudible> University and the apex of both a social experience and the academic experience and the best of the four years.  I had been giving a great deal of thought too things. I'd already been on one deployment and it wasn't what I had hoped it would be. I'd given a lot of thought, a lot of thought, walking around thinking, my God, I can't believe I really haven’t gone yet.

Dave Pecirep:    02:08    And then people would find out you were in the service and they'd say, “Where have you been?” And my heart would just sink. So, finally towards the end of my senior year, stick it out through the senior year, graduate or my unit was going to get deployed. And if I went and signed a waiver, it was a done deal. You're going to Afghanistan. So, I didn't consult my parents. I knew that there'd be a big “no” from them.  I think everybody's parents probably say a hard, no.  I signed, came home, told them and that was that.  Six months later or so, we're in Afghanistan, I was infantry 11 Bravo, with the 110 2nd light infantry. And we went in with a 10th mountain and then we actually ended up getting attached to special forces group at this forward operation base in the <inaudible> Province

Dave Pecirep:    02:58    Afghanistan, right near a little town called <inaudible>. So, I've been there for some time. We went on a mission; I was in the turret of the third vehicle leaving this town and we got hit and I got hit. So, the whole thing was what you would imagine, pretty terrible. The people that were with the guys that were like the mid-range at NCO’s real cool heads and they didn't make it seem half as bad.  I mean, their reactions were pretty cool. And even in the position that I was in looking at it, I was like, okay, this isn't as bad as I thought. They're not freaking out; if the pilot's not freaking out, we shouldn't.

Dave Pecirep:    03:45    The extent of my injuries, the deeper details of all that, I ended up getting sent home and that was tough.  So, then begins like chapter two. So, all your friends and all the guys that you were close with, you love them, but you hate them, but you love them. They're your unit. They're gone. And I was at Brooks Army Medical Center in San Antonio, Texas. It's a burn unit. The bigger portions of the things that I got hurt with were burns. So, I ended up there. Then the whole thing sort of becomes trying to reconcile what just happened.  Some confusion initially about how extensive my back injuries would be with regards to severity and length of it being a problem as will it be a lifelong thing here.

Dave Pecirep:    04:46    So, the girl that I was engaged to at the time, she left me at that point.  I was getting ready to write a Blues album. This was just going from bad to worse. After that they got me to a program which allowed me to come home a little bit faster than I think other people did. Other guys were there sitting in units, getting medical treatment, just going to appointments for like a year plus. I don't know if they do that anymore like that but the worst thing you can do for mental health is just have somebody sit there and do nothing. That seems like a key ingredient is someone not feeling well. They're already replaying things in their head more often than not.

Scott DeLuzio:    05:39    And just actually through the conversations that I've had on this podcast with other people who have broken through that funk that they were in, that’s clearly not a technical term but they came to the realization that just

Scott DeLuzio:    05:58    sitting there and dwelling on things is not going to help them and they need to do something and move on. So, that's probably very similar to what you're talking about.

Dave Pecirep:  Yeah, absolutely. And eventually there'll be libraries of research, like research they can fill libraries on that one topic about how ineffective that is. So, I ended up getting out. I finished up college and then got my first “life out of the military job” at the West Haven, Connecticut, VA with a research group called and the acronym is prime P. R. I. M. E. and it's complicated. It stands for Pain Research Informatics Medical Comorbidities Education Center.  So, I was involved as an administrative officer, organizing and helping set up studies and not one of the scientists though. That's an important distinction.

Dave Pecirep:    07:07    The first move you got to make if I think I want to go in this direction. I come from a family of clinicians. My mother's a clinician, my father is a surgeon. My sister's a nurse, my other sister's a therapist. So, medicine is big in the family and I grew up around it. So, that's the first move you have to, get your foot in the door if you want to work somewhere that's credible.  I went ahead and applied to grad school. So, from that sort of springboard and I went to CCSU and I think grad school in total was like just about five years. And I got a master's of science in counselor education, which allows you to then become a psychotherapist, which is what I do now.

Dave Pecirep:    08:01    I'm in private practice and I've been in private practice for three years. So, the trajectory of being a patient and then going to the other side of the coin and taking care of the patient, I am constantly reminded of how impressively similar you are, even if you're better now, like you can be like, “Oh yeah, yeah, yeah, I remember what that looked like. No, not all of it but yeah. I think it really does allow you to better serve those that you're working with because you can, if not recognize, understand where they're coming from when it comes to the major mental health stuff like major depression, post-traumatic stress disorder and just dealing with all of the comorbidities that come with trauma and comorbidities, I guess could more easily be said

Dave Pecirep:    09:13    it's like all of the different issues that can come out than just the ones you think would be obvious. So, as a therapist, the therapy that I do, the one that I hang my hat on is cognitive behavioral therapy, which is linear and logical. And what's great about it is if you really do have something to worry about, it'll say you should start working. Whereas if you have nothing, you come up with nothing. It's an excellent way of cross examine, very chaotic or catastrophic thoughts. And then people, especially guys, they like that. And I tell people in session, if you got something to worry about, I'll tell you, I'll tell you right now.  If you don’t; you don’t.

Dave Pecirep:    10:07    One other side piece of this and then I'll kind of slow down.  Another really important contextual factor is when I came home my parents, being clinicians, took one look at me and they say, physically, you're getting there but we're worried about you. So, here's the deal. You have to go see somebody.  I started seeing somebody in New Haven and I had gone through a bunch of different mental health professionals and I thought people are just fabricating in their mind a feel-good moment. But when they leave, there's really no practical application, those sorts of things, right. Where you're just like, “come on, this just is not for me.” I don't want to sit in here and bang and drop in light some incense and not feeling like either way it's either we fix the problem where we go.

Dave Pecirep:    11:01    And I ran into this guy who was ferociously intelligent and had a background in philosophy in undergrad. And the guy was just an all-star. And he happened to be like a pretty alpha guy, which was not what I had encountered yet. I thought everything this guy is saying is making sense. And he was a cognitive behavioral therapist and that's really, I would say that was the one thing I could say takes the lion's share for me being where I am today is to be able to go to that therapy and walk away and say not only does it work, I'm going to go do it.

Scott DeLuzio: That seems to make a ton of sense, too. You've seen it work firsthand; you've experienced the benefits of

Scott DeLuzio:    11:54    it and why not make that available to more people through the work that you do now.  That just makes a ton of sense.  Someone who does yoga or something and they lose a bunch of weight and they're like this is amazing. Let's go learn how to be a yoga instructor and teach more people or something like that.  It seems to make sense that you would follow along in a path like that to get to where you are today. Now the people that you work with, are they vets or is it more generalized or a mix of people that you work with now?

Dave Pecirep:    12:41    So, the private practice that I work with is general practice. I would say a third of my patients are adolescents and two thirds are adults. What would be the presentation of like a smattering of the public? So, nothing too exotic as far as mental health issues but certainly not veterans’ issues. It's not something that I'm not going to eventually move closer to, but this is where I am right now.

Scott DeLuzio:    13:10    I think it's important too. Some of the people have issues that might mirror some of the traumas that come through war.  Some of the traumas that you experienced in that many other soldiers that have experienced through war, whether it's, car crashes or some other abuses or things like that. Some of those traumas could probably mirror some of the things that soldiers have experienced, as well.  So, it's important to help everybody in a practice like yours and that makes a ton of sense to be able to help out the general population, too and not just focus on any one subset of the population.

Scott DeLuzio:    14:04    So, you talked about your experience going through, therapy and going to a couple people who just didn't seem to quite get it. What was that experience like?  I know I've talked to a few people before who said that they went to a counselor and they didn't seem like they were a good fit and they felt like they just wanted to throw their hands up in the air and quit on the therapy that they were doing. It just didn't seem like it was working. What was your experience like with that?

Dave Pecirep:    14:41    Sounds similar to what you just described?

Dave Pecirep:    14:50    It'd be one of a couple of factors. One, you'd sit down, you'd look at this person, you go, “no, this isn’t somebody I'd share 10 minutes with outside, smoking a cigarette, let alone anything deep. And I guess that's sort of judging a book by its cover but this isn't going to happen. And then there'll be another one that, well their approach would be like abrasive or like it just wasn't right. I guess this is really simplifying this and I don't know if it should be simplified at this point but it's like Goldilocks and the food, this one's too cold, this one's too one of these things but more serious. It's got to be the right fit. And then there were a few of them that almost seemed like they were upset or they got some sort of shift they weren't pumped about and you're like, “I'm not that pumped to be here either.”

Dave Pecirep:    15:51    I think the VA is a big organization and they're trying to get this stuff right. But this is back in 2006-2007.  I wasn't impressed and thank God I come from a background where my parents could say, look, you have to go, we'll help, let's go. I guess I'm not giving you as many details as you'd like as to particulars. Why or why not? It's been a little bit of time but you know that expression, you don't remember what they said to you, you remember how they made you feel?  And I don't remember the particulars but I remember walking out of there and being like, “what world is this? What's going on?”

Scott DeLuzio:    16:37    Okay. Well that does make sense.  I know from my own personal experience, I happened to get lucky on the first go. The first person I went to and talked to, we hit it off and he was able to help me out and work through some issues after I came back.  I'm eternally grateful for all this stuff.  I think just because I happen to have that good experience where I found somebody right away that was able to help me and that now, not only were they able to help me, they cared enough to be able to help and not to say that the other people don't care, but you know, there's varying degrees of  the level of service that you're going to get in any kind of industry that you're talking about.

Scott DeLuzio:    17:39    The same thing in the mental health industry. You're going to have some people who are rock stars and some people who are just barely scraping by and you're going to get the whole range there. So, you have to keep an open mind and not just give up on it because that first person you went to didn't work out, like what happened with you and you went to somebody else and somebody else and eventually you found that person who resonated with you and you really clicked. I think that's important for people to take away and understand that if you need to talk to somebody regardless of whether the fact that the first person that you've talked to was the right person, you're still going to need to talk to somebody the next day or the next week or whatever. So, you can't just give up, maybe that person's not right but try somebody else, move on from that one person.

Dave Pecirep:    18:36    When I do my intakes, this is such a thing that I mentioned it in my intake. I say right around the middle, “by the way, this is an interview for you to check me out. If you walk out of here and you think, “no shot.” “Don't worry about it. My feelings aren't hurt. In fact, let me know. I'll help you find someone else. So, don't worry about me, this is all about you. And if this isn't right, maybe I'll remind you of someone that you hate. Don't worry about it. I'll help you find someone else, just let me know.”

Scott DeLuzio:    19:10    I'm glad that you do things like that and I'm sure there's others out there who do similar things too but that's really important to make sure that they feel comfortable talking to you because if they don't feel comfortable, they're not going to talk about it. They're not going to give you that deep dive into their background and the issues that they're experiencing. Those are deeply personal things that they're going to be talking about, most likely. If they are not feeling comfortable that they're just not going to open up the way you're going to need them to.  The other thing that you mentioned and I thought it was really interesting was how your parents observed some issues that were going on with you and said, physically seems like you're headed in the right direction.

Scott DeLuzio:    20:00    You're getting back to where you need to be. But maybe mentally you need a little bit of help.  I think that is a huge thing to have that support of family or some sort of support network, whether it's family, not everybody has family around that's going to be able to point that stuff out, but friends, family, neighbors, coworkers, things like that. People who are able to point those things out and feel comfortable enough bringing them up to you. Is that something that you see with your patients, the people who come to you is like, “My wife told me that I haven't been acting right or whatever and that's why I'm here.”  Is that something that you typically see or is it more self-diagnosis, like, “Hey, I'm just not feeling right.”

Dave Pecirep:    21:02    I do see quite a few people who come in with reports from like their close family saying, something is different. So, could you be specific and here is X, Y and Z?  Anybody who sort of closely orbits that person is like a real asset and trying to understand the behavior of that person. So, there you've been with him for his whole life. What's going on? Well, now he's this, that and the other. And you would know it in such a way that someone who potentially orbit isn’t the right word, but someone who's slightly, one or two more rungs removed may not be close enough to see. They're truly an asset to lean on and to talk to as much as possible if the patient lets you.

Scott DeLuzio:    21:50    That's really good. And do you incorporate those other people into your sessions when you talk to people or do you just rely on the fact that they gave them that nudge to start seeing you?

Dave Pecirep:    22:06    It's case specific and when it’s determined that it would be beneficial, absolutely.  Sometimes for the kids, for adolescents, you don't want to set up a scenario where you look like an additional parent.  You have the parent there, the kid's there, I'm there and now we're talking about the window got broken and we're looking into it. What's up? I might look like the other parents. So, I don't like to bring in parents for that stuff. Because you want to be sure to remain clinical neutrality. You're there for them and that's it. You advocate for them. So, for adults, you can bring the family in sometimes, especially around substance abuse. I want to have some confrontation around that. You’re misremembering maybe but mom's here, she's saying that there's a lot around that's going to disappear around the house. And you were saying you don't know what I'm talking about. So, how do we reconcile the two? And for something like that, you certainly need both parties in the room and it wouldn't be like a cross examination. This is simply a case of who done it.

Scott DeLuzio:    23:22    In a lot of cases, you know but sometimes they need to hear that from multiple angles to come to be able to admit it on their own.  So, that's probably good to have that outside force. But I know, through talking to other people that the family and those other relationships, those people, like you said, who are kind of like in that inner circle, the people who are closest to the individual are extremely beneficial to being able to point out when things seem like they're not going right. I think from a mental health perspective and I'm not a therapist or counselor, I'm not trained in any of this at all but

Scott DeLuzio:    24:12    I would think having those relationships, any close relationships, maybe you don't have a great family relationship with your parents or your siblings or whatever. But if you have close relationships with somebody who is going to be willing to call you out when it seems like there's an issue and help you get the help that you need, I think ultimately has been beneficial. And I know the reason why I'm bringing this up is because I know that there are some people who push other people away when they start to question about how are you feeling? How are you doing all that? All those types of questions, they start to push those people away because they don't really want to face those issues.

Scott DeLuzio:    25:03    But by facing them, they are ultimately going to get better. Hopefully going to get better. And I don't see there being any downside to facing these issues, necessarily. I could be wrong with some of that. But I think my point is having those close relationships is a good thing. And if you're listening to this and you're one of those people who feel like you need to push people away because they are questioning how you're doing and everything, I think you'd need to reevaluate that a bit and embrace some of those relationships. I don't know, hopefully I'm not leading people in the wrong direction. I will let the person who's a little more qualified to talk about that confirm or talk a little bit more about that.

Dave Pecirep:    26:00    I applaud you for pointing this out and I would highlight it. Look, if you're already starting to be in isolationist behavior. It's like boom, the first light goes off. It's like, all right, fine, something's up. And as a friend, I think because we love the person and because there's an intimacy between friends and certainly you also want to know what's up and how can you help. And I think as beautiful as a sentiment that is, I would caution and probably just say as the friend, I’m not the counselor. Let's not, you and I hash it all out. What I will do as the friend is get you to go to somebody; don't be the therapist.

Dave Pecirep:    26:54    Clearly you don't feel well; you don't have to say anything to me, let's just go though, I'll take you or whatever. Or like, let's keep talking about this is a possibility. That's like shots of B-12. Because that can make things tough for someone who's trying to play a role there and I think appropriately, it's the friend trying to get you help, not the friend trying to be the help. And I think there's a major distinction and one is very unqualified. And even if you are qualified, it's still sometimes like, “Whoa, I'm not sure here. Like the right answer is not readily available. What is this?”

Scott DeLuzio:    27:32     And you might be too close to the situation, too. And you might have some blinders on and especially if like you're saying, if you are qualified, you may not be the best person to talk to this person. So, that does make sense. I'm glad you confirmed that and not that I need the ego boost that I was right or anything like that to mention that but I'm glad that it made sense to somebody who does know what they're talking about and not just some guy who runs podcasts.

Dave Pecirep:    28:17    You are right on the money.

Scott DeLuzio:    28:18    So, what other kind of advice would you give to let's just say a vet, somebody comes back from Afghanistan or Iraq, wherever they're at and they come back and they're having some issues, whether it's at home or with drinking or drugs or whatever.

Scott DeLuzio:    28:45    What kind of advice, outside of just go talk to somebody, what kind of advice would you have to give to them about that?

Dave Pecirep:    28:57    So, first what I would say is, of course, you have to start seeing somebody but that's not enough. There has to be a few other things here. And one thing that I was always impressed by when I worked at a rehab facility for my clinicals for two years and I did a lot of group work and you'd get guys in for individual one on one therapy and you may have a great 55 minutes and sometimes you didn't, you put 15 guys in the room with the same issue and then you run the group and then you of back off. They became eight out of 10 times a stronger change agent for each other than I did standing there and talking to them with a whiteboard. So, when I think of guys coming home, I'd say, look, go get into group. Even if there's some old timer Vietnam and stuff like that, they're still going to be some parallels. You want to be around guys that are similar So that you're not walking around thinking I'm going crazy. I'm the only guy out here because you're not. And those guys are such a strong change agent for each other. Much more effective than one on one therapy and augment it with one on one therapy if you can and you should.

Dave Pecirep:    30:19    In addition to that, I mean if it's something more serious, if there's lethality involved in it, then I'd say you want to go inpatient and you want to have friends and family push you to that. But that's where it goes to. And if it goes there, by the way, it's not good. It's not bad. No, it's not ethical. It's not unethical. It's just the appropriate treatment for the problem. Just like a big wound requires stitches or diabetics have to take a med. There's so much stigma wrapped around these, “Oh, well, I don't want to get help like that because don't worry about it.” It's just the right, it's what the doctor ordered for that. That's it.  I wouldn't spin your wheels thinking about what this mean about me? Nothing. It just means like the appropriate dosage for the appropriate issue.

Scott DeLuzio:    31:03    Yeah, no, that makes a lot of sense. I think that group settings that you were talking about earlier is really good too and I think for partially for the same reasons that we were talking about not to push people away and things like that is you have a group of people that perhaps are likeminded or at least going through the same issues or similar issues I should say and that helps people know that they're not alone in whatever issues they're struggling with. What would you say about, not necessarily from a therapy standpoint, but you get out of the military, you're used to the last five, 10, 15, 20 years or whatever you were in the military and used to spending time with a bunch of other grunts in the military, and then you all of a sudden get out and now you're living a civilian life, you're working a civilian job, you're going to civilian stores, you're not going to the PX or whatever on base or whatever.

Scott DeLuzio:    32:11    You're in civilian life. What would you think in terms of joining a veteran organization, like the VFW or American Legion or things like that in terms of the comradery that you have? Do you think that that might help boost or at least make it a little bit easier to transition into civilian life being a part of a group of other like-minded kind of individuals?

Dave Pecirep:    32:49    Unequivocally, yes.

Scott DeLuzio:  Yeah. Awesome.  I think so.  Echoing a lot of the reasons for what we were just saying about a group as well. We actually had someone from the VFW on the show a couple of weeks ago and we're talking a little bit about people getting out and having that struggle of just jumping right into civilian life, even though we all were civilians at one point; we get rewired a little bit in the military and we don't think like civilians anymore.  So, getting back into a group of people who are likeminded in one of those veteran type organizations makes sense

Scott DeLuzio:    33:44    to feel like you still have that connection with people who are likeminded.   We're coming up on time here as far as the length of the episode but I have one last question that I like to ask everybody before wrapping up. The question is, “before you joined the military, is there anything that you wish someone would have told you, either about what the experience would have been like or what to expect in a combat environment and you can answer this seriously or with a joke combination of the two; it doesn't matter. There's no wrong answer. We've had all sorts of answers to this question. Is there anything that you wished someone would have told you before you joined?

Dave Pecirep:    34:42    That's a good question. I have nothing clever here to state. I mean, other than, my estimation of how difficult it would be; I didn't realize it could be as tough as it was but I'm here. Here's what I wish someone had told me. You're about to get an education for which there's no tuition.

Scott DeLuzio:  Yeah, that is very true. As a matter of fact, you get paid to go get this education for college tuition.  And I actually remember in basic training, sitting there on the 50 Cal range, letting it rip and thinking to myself, they're actually paying me to do this. This is amazing.

Dave Pecirep:    35:35    Exactly.

Scott DeLuzio:  So, all right. Any last things that you want to add that maybe we didn't talk about or any way that people might be able to get in touch with you if they want more information or anything like that?

Dave Pecirep:  No, that is pretty much it on my end.  Thanks a million for having me on; it was a lot of fun. I was a little nervous and I wasn’t sure how this was going to go.

Scott DeLuzio:  I’m glad you did it.

Dave Pecirep:  Thank you. Absolutely.

Scott DeLuzio:  All right. Thank you.

Scott DeLuzio:    36:11    Thanks for listening to the Drive On Podcast. If you want to check out more episodes or learn more about the show, you can visit our website, DriveOnPodcast.com we're on Facebook, Twitter, and Instagram @DriveOnPodcast.