The Soldier’s Guide to PTSD

Drive On Podcast
The Soldier’s Guide to PTSD

Virginia Cruse is a soldier-turned-therapist who struggled through her own debilitating PTSD. She wrote The Soldier's Guide To PTSD offering those who read it facts about what PTSD is (and is not). It provides the reader with empathy and direction while urging the service members to get the help they need. It also does a great job of helping family members understand the battlefield we served on, and connects the civilians who read it with the warrior culture.

Virginia is a Licensed Professional Counselor and National Certified Counselor specializing in Military Issues and Combat-Related Trauma. She provides crisis intervention and evidence-based treatments for Post-Traumatic Stress Disorder, Moral Injury, Depression, Combat Operational Stress, and other diagnoses. Virginia is a certified clinician in Cognitive Processing Therapy and Prolonged Exposure Therapy and has 20+ years' experience serving Active Duty Military, Veterans, Military retirees, and family members. She is a Certified Group Psychotherapist (CGP) and an active American Group Psychotherapy Association member. Virginia is an Army Reserve Officer, Combat Veteran, and published re-searcher.

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Scott DeLuzio:    00:00:00    Thanks for tuning into the Drive On Podcast, where we're focused on giving hope and strength to the entire military community, whether you're a veteran, active duty, guard, reserve, or family member, on this podcast we'll share inspirational stories and resources that are useful to you. I'm your host, Scott DeLuzio. And now let's get on with the show. Welcome back to the drive on podcast, everyone. Today, my guest is Virginia Cruse; Virginia served in the army and is currently serving as a Navy reserve officer. And she's also the author of the book. The Soldier's Guide to PTSD, A No Shit Guide to Reclaiming Your Life to PTSD a No Shit Guide to Reclaiming Your Life. And we're here to talk today about her book and her experiences that led her to write this book and get it straight from the source. So welcome to the show, Virginia, why don't you tell us a little bit more about yourself and your background.  

Virginia Cruse:    00:00:52    Scott, thank you so much for having me on. It's really nice to connect with your viewers and your listeners. Thank you. I don't have a really cool origin story. I didn't do, full disclosure, I am not a cool origin story. I didn't intend on growing up and becoming a trauma therapist and I would hope that nobody does. So I enlisted in the army in 1997 and I'm an Arabic speaker. So I, as you can imagine, right at the kickoff of the worst cycle spent a lot of time in Iraq and it was after my third deployment in 2008 that I was not okay. And got into some trouble at work and I was commanded to go to see a psychiatrist. So I was living in Germany at the time and I went to a major military treatment facility and I knew that I wasn't okay.  

Virginia Cruse:    00:01:42    I didn't know what was wrong, but I knew something was wrong. I was having hallucinations. That's when you see or hear or smell or taste, or feel things that we ostensibly know weren't there. I was drinking like a fish, which even Europeans were kind of like, Hmm, I don't know. That's a lot of wine, lady.  I was drinking constantly. I was not sleeping. I was blowing up all of my relationships to include my marriage.  I was just not okay. I was just going off like that and I knew something was wrong. And so when I went to go see this psychiatrist, I was really happy to find that they were active duty military service members.  What we call a slick sleep, somebody who had never been deployed before. This was an 06 male Colonel who was working in this military treatment facility. And I poured my heart out to him. I told him everything that had been going on and I knew I needed help. And when I was done with that interview, he looked at me. He said Virginia, I can tell you're really struggling, but I can't help you if you don't choose to be honest with me. And I was super confused by that. And he clarified for me, saying we all know that women don't serve in combat.  

Virginia Cruse:    00:02:59    I wish I were making that up. That's just not a thing. And you know, I wasn't an infantry like you, or a special warfare like your brother, but that was a real kick in the teeth. And it really kicked me while I was down. I found it to be belittling and really dismissive. And it made me even more hopeless than I was before. Full disclosure, I was pretty suicidal before I went and saw him. I was thinking about suicide pretty much every day and using it as a coping mechanism just thinking about it made me feel better. And after that, yeah, it got worse. It actually got worse. And it was at that point though, Scott, that I decided if I don't figure this out, if I don't reclaim my life, if I don't get my stuff together, I'm going to die.  

Virginia Cruse:    00:04:00    I'm either going to kill myself or whatever this is that's going on in my head is going to kill me. And so I did the only thing I knew how to do. I went to grad school and here we are 13 years later and here I am talking to you. And one of the first gigs that I got after I was newly licensed as I started working in an inpatient treatment facility. So that means that's an inpatient hospital.  Inpatient is just a clinical term. That means you don't go home at night. You actually stay at the hospital. So it's kind of being locked up. But this particular inpatient treatment program was for military service members, active duty, who were dealing with what we call co-occurring disorders. So that's a fancy ass term. That means that two things are happening at the same time.  

Virginia Cruse:    00:04:51    So for the most part, it was PTSD and alcohol abuse as we all know, that's usually the couple that comes into the party together, but also folks who are dealing with depression or anxiety or OCD or eating disorders. And my job was to teach them about PTSD. And so they gave me this really smart curriculum that was written by PhDs. And it was very clinically skewed. I mean, it was good stuff. Told me all about my amygdala and the frontal lobes and the brain mechanism. And all my students went to sleep. And I was teaching this curriculum which was correct. And I thought, man, I had an NCO on my first tour who used to always say, Hey, are you picking up what I'm putting down? And I love that expression. And I realized that I need to create a class where somebody is going to be picking up what I'm putting down.  

Virginia Cruse:    00:05:48    So I thought to myself, what is it that I needed to know when I was at my lowest point? And what I really needed to know back then was what exactly is this? What exactly is PTSD? Don't sugarcoat it. Don't give me a bunch of psychobabble nonsense. Tell me word for word. I'm not stupid. Tell me exactly what this is. Give me some courses of action. What do I do about it then? How do I execute? I needed some good aura. I just needed to figure out what this is? Am I crazy? Am I crazy? Or is there an explanation to this? What do I do about it? And then moreover, how do I get the buy-in? How can I repair my relationships with my family? How can I talk to my chain of command or my HR department or other people who may not necessarily care what I'm going through, but I need their buy-in because you know, eventually once I've recovered from PTSD or alcohol or drug abuse, I have to go back to work unless I'm independently wealthy.  

Virginia Cruse:    00:06:51    And then how do I maintain these gains? How do I keep from relapsing? So we think about relapsing a lot in terms of drugs and alcohol, but we can relax in anything. This just means going back to an earlier point, so we can relapse with PTSD or depression. So I needed to know the steps about how to get social support, which sounds really simple. But in the military you got your fire team, you've got built-in friends, you have brothers. It is what it is, like it or not, they are your siblings, right? When we leave the military, how do we make friends? Not intuitive, not easy. And especially if you're male, because it's weird. It is weird as a female, I can go up to you and I can be like, I love your hair and boom, we're friends and we're going to go and hang out next week, guys, not so much. So we talk about that in the book and really about boundaries. How do I make healthy boundaries? How do I protect my gains? Even if I'm in the military, how do I deal with the toxic leader? It used to be a big topic in the war college back in like 2010, 2011, I guess it's not anymore. So I guess we don't have them anymore in the military. 

Scott DeLuzio:    00:08:19    Maybe the problems are magically gone. Right. I mean, it has to be if they just sprinkled some magic dust on it and it's gone.  

Virginia Cruse:    00:08:28    Legit. So how do we maintain boundaries? And how can we protect ourselves so that we are not feeling suicidal so that we're not feeling homicidal. We don't want to show it to anyone else either. That's jail time. Right. And so I wrote this curriculum. I rewrote the curriculum and I've taught it to literally over a thousand service members at this point. And I've been working with military service members with PTSD and moral injury for a while. And then my students stayed on me. They stayed in touch and they stayed with me. And they said you got to get this out in a book. And so finally I was like, I know. And Scott Mendoza, I know if I heard you and wrote the book and really it's my love letter. It is my love letter to soldiers. You know. I got a commission in the Naval reserve, but you know, in my heart, I'm still a soldier and I'm actually taking time off from all reserve duty right now, just full disclosure because I'm finishing up my PhD because apparently I just have too much time.  

Scott DeLuzio:    00:09:48    Too much time, that's the thing that you said you knew how to do. You just went back to school.  

Virginia Cruse:    00:09:53    Too much time, too much money. How can I waste all that I know, I'll go back and finish that up. Right.  This book really is my love letter to all of you. And because I was really looking for it; this is what the book that I was looking for when I was at my sickest, because I remember I went to Dr. Google and I when I didn't get a diagnosis of PTSD, by the way, I should be very Pacific as opposed to being Atlantic. After I saw that psychiatrist, I was labeled as having a personality disorder, which is really insulting and pretty hard to shake. As I've talked to service members and veterans over the years, unfortunately, I found that my experience isn't very unique and that's especially true for women, people of color and people who identify as queer unfortunately that happens.  There can be gaslighting within the mental health community. It's easy for folks who are door knockers, bell ringers, infantry members but sometimes unfortunately other people's experiences are dismissed and there is an attitude of, well, you don't deserve to have PTSD because fill in the blank. And so go ahead. I didn't mean to cut you off.  

Scott DeLuzio:    00:11:26   No, that's fine. And I want to really dive into this book, but at the same time you know, when I read this book I was taking a lot of good stuff out of it. So I want to go into every single detail, but at the same time, I don't want to give the whole book away. And I want people to go out and get it, and read your book. So, there's kind of a fine balance here. So I don't want to get too far into it.  

Virginia Cruse:    00:12:01    We are giving all your listeners and all your viewers the first two chapters for free, they can go to and give us your email. We're going to put you on our newsletter list. Don't worry you can unsubscribe later.  But we'll give you the first two chapters, which cover the diagnostic criteria of PTSD because Lottie Dottie, everybody deserves to understand what PTSD isn't, what it is and how we can recover from it. So we really wanted to give that away to everyone who will take it.  

Scott DeLuzio:    00:12:34    And that's great. And when I was reading this book, the thing that I enjoyed the most about it was that it wasn't written in this super technical jargon, mumbo jumbo and all that kind of stuff going into it. It was explained in an easy to understand way for someone who isn't trained as a mental health professional. I was able to walk away with a whole bunch of information that was easy to understand just by going through your book.  I think the same thing for anyone who picks up this book, they're going to be able to take away some actionable advice. And actually even just in the first couple of chapters, they'll be able to get that diagnosis, understand what the criteria are anyways for that type of diagnosis.  

Scott DeLuzio:    00:13:29    And so I think that giving that little teaser that the first couple chapters is going to be a really good way to get people to understand, okay, is this the book for me? You know, once when we figure out the diagnosis criteria that goes into it, then we can understand, do I need to keep reading, if this isn't applied to me. Okay. But if it does, then maybe we need to keep reading. And some of the stuff that you talk about really, like you started to mention before some of the rumors that float around about PTSD, is it curable or, a lot of people don't think it can be, but you say otherwise in the book, and there's a whole bunch of other rumors that are out there that you dispel a lot of the myths in there.  I think that that's a good place to start.  

Virginia Cruse:    00:14:31    I really appreciate that feedback, Scott, thank you so much. You know, I didn't start out as a trauma therapist. I started out as a linguist. And so I'm always thinking in terms of language, because language really, it matters what we say, how we communicate matters. Are you picking up what I'm putting down? If not, there's no sense in me putting it down, I'm wasting my time. And you know, that was why one of the first things we did is we made this into an audio book and Kelly Taker did the recording. So you won't have to listen to me drone on, we found a fantastic narrator, but only because I mean, I'll speak personally, I'm reading your book right now, Scott, and phew...tough. It is a tough read. I love it. And I would recommend Surviving Son to anyone who is listening, really fantastic work.  

Virginia Cruse:    00:15:24     But the first thing we did was make it into an audio book because I very rarely read books and it's not that I'm not an anti-intellectual, who's got time for reading. One thing I do have, and that's a commute and that's why I love podcasts like yours.  Because I can go, I may not have an hour to read something, but I do have 30 minutes while waiting in traffic or going to work. And so we went ahead and put it on an audio book, but you know, language matters. So it's really important to me that this was very plainly spoken, but not pedantic, not stupid. I mean, I don't have to talk down to anyone at the end of day. Service members are incredibly smart. I mean, we train 18 year olds how to fix nuclear reactors and jet planes.  

Virginia Cruse:    00:16:20    We can explain PTSD. And if we're being honest and for real, you don't need a PhD for this. This is not rocket surgery. This is not, this is not high math. This PTSD is unbelievably straightforward and simple, especially in terms of a mental health diagnosis. It's a really straightforward disorder and that word disorder I want to hit the pause button, taking me from it because a lot of people take exception to the word disorder. And I want to tell everyone to just calm down from it. So that's a clinical word. That means that you're walking, talking everyday. Life is being affected by your symptoms. Your life is out of order because of what you're going through. So that word disorder doesn't have judgment behind it, and it's not intended to, but I recognize that it can feel like it, but that's not the intent behind that anyway, to make a long story longer, PTSD is a very normal, very, very normal reaction to a very abnormal set of circumstances.  

Virginia Cruse:    00:17:28    It is completely logical. It is our brains' way. Our brain has two main jobs. Number one, to keep us alive, keep us breathing, keep us moving. Number two, to make meaning whether we have all the information or not. I say again, whether we have all the information or not, and because I'm talking to you and you're listening, or watching this podcast, your brain is doing its job. Now. I refer to my brain as a he.  I love my brain and he, but I think it's easier within the context of PTSD to think of your brain as a separate person. I think about it as that one team member, that one younger sibling who is always trying to help, but just can't seem to get it right. It's like if your child comes into the garage and like, dad, can I help you clean?  

Virginia Cruse:    00:18:20    And you're like, oh, sure, you don't want to say no, but at the same time you're going to have to clean everything again. It's sort of the same thing. Your brain really is going through flips and this really Herculean task to keep you alive, to keep you safe. So that whole idea of stay alert, stay alive. So if we can see PTSD in that context, all the symptoms, all the criteria are very, very logical. So we think about those intrusion symptoms, criteria and Bravo, those intrusion symptoms think about an intruder coming into your home. Trust, take all your shit when you're not paying attention, that sustains things that intrusion symptoms to try to knock into your brain, shake you up when you're not ready. Now, within the context of PTSD, you think about your baby brother, brain trauma, brain stay alert, stay alive.  

Virginia Cruse:    00:19:19    So those are things like flashbacks. And that's when, and you talk about that in Surviving Son also. So flashbacks, a lot of times we see that in the movies and if it were like that would still suck, but it wouldn't suck as much as a real flashback. So in the movie we see it as kind of a little movie, a little montage with some music over it in slow motion roll, and we jump on whatever flashbacks, and in real life though can be a lot more uniquely terrifying because we literally feel as if we are back in that event. So, it comes with full sets. It tasted like Moondust, you're smelling burnt hair, it's full sets and there's no layover music and it doesn't slow down. Bummer.  So those intrusion symptoms, your brain is trying to keep you alert because if you're relaxing, you're in danger.  

Virginia Cruse:    00:20:24    And so think about when you go outside the wire, I think about your brain in terms of your brain is always getting ready for fight, flight, freeze. Freeze is kind of the redheaded stepchild of trauma, which clearly I take very personally, but you know, we don't talk about it a lot, but here's the thing. The Army does a really good job trying to train the freeze out of us. So we do live fire exercises. That's why as an infantryman, you know all of those, just by all of your formations by row, you could call in a nine line today just as well as you could from the field. I mean, your body, the army is trying to freeze the train out of you. And I mean, we've all been through basic training and the hand grenade range, and you see that pucker factor.  

Virginia Cruse:    00:21:16    It's like, Ooh, shit. Like what's about to go down. 

Scott DeLuzio:  Do you really want me to pull the pin? 

Virginia Cruse: Like, are you for real, are you sure? But you know, every time you are in danger, whether it is going on a convoy, it is real or threatened. So every time you leave the wire you potentially could get wacked. We could get hit. Let's say you never do get hit. Thankfully you're a smart cookie. You listen to your S2, hopefully, or at least you watch the news. You know, that convoys do get schwacked.  You know the routes that get hit the most. And so every time you leave the wire, your body and your brain gear up for that, it's freaking miraculous, to be honest with you, unless you're living it, then it's not so much.  

Virginia Cruse:    00:22:12    But if you know, 20/20 hindsight, so a lot of things start happening. Your heart starts beating. The reason for that is to get all the blood to your muscles. So you can start preparing for fight, flight, freeze, hopefully fight. You know, if you're in a convoy or a flight, if you have to. Your eyes start to dilate, you start to shake, where you start to sweat the part of your brain, your frontal lobes that are really responsible for memory think about them as kind of shutting down. This ain't Disney. You're not here to take pictures and wear mouse ears. That goes out to lunch because you're not taking pictures. This is not the time for snapshots.  Everything is going into that survival mode. So that's why we tend to forget that a lot of people, and I won't say we at large because you know, there's always exceptions, but a lot of folks, myself included, don't remember big chunks of our deployments.  

Virginia Cruse:    00:23:15    We don't remember big chunks of our trauma, and it's not because there's something wrong with us. It's because your brain is trying to keep you alive. There's a purpose. There's a purpose here. So you're leaving the wire and whether you get hit or not, your body is gearing up for that fight, flight, freeze.  Outside of the context of PTSD, we can really look back on that and say, I don't remember that. What could be wrong with me? You know, or I'm having hallucinations; I'm legit seeing, hearing, smelling, feeling things that I know aren't there. I hear people screaming my name in the middle of the night. I live with my dog on a mountain. I'm a Unabomber.  Let's talk about the why by that.  

Virginia Cruse:    00:24:13    Now I'll speak as a therapist on this. So I personally have never seen a case of PTSD without hallucinations. I want to say that one more time for the folks in the back. I have never personally seen a case of PTSD without hallucinations. Here's why hallucinations within the context of PTSD make a ton of sense. If we are trying to relax, sleep, meditate, pray, our trauma brain. Remember our baby brother brain is freaking the F out. He's like, Hey, yeah, hold on. What, Scott don't you remember that the world is a dangerous place where he gets whacked at any minute. Hey, I know it'll help you to remember. Let me give you some of these intrusion symptoms. Let me go ahead and manufacture a gunshot sound. Let me give you the smell of something burning.  

Virginia Cruse:    00:25:13    Let me give you the taste of moon dust. She's talking to a client the other day who smells prayer oil from a certain mission that they were on and just smells it all the time in the most random places.  Let me go ahead and manufacture these voices, calling out your name. Now we're smart. You know, maybe we watch those true crime podcasts or we're really into murder porn that not real murder porn calmed down like that whole truth thing.  God, I don't want you to start getting strongly worded emails, Scott, you gotta correct my freckles. All right. So don't write letters to Scott. That one's my fault. Anyway, if we are even watching Law and Order, we know that hearing it, seeing it, smelling things that aren't there, we are a hop, skip, and a jump away from the tin foil hat.  

Virginia Cruse:    00:26:14    And you know, we really feel like we're losing it. And sometimes we'll leave and go to a therapist who doesn't specialize in trauma. And we'll say, you know what? I could have sworn that I heard people calling my voice. They're like, oh, psychotic, let me put you on some antipsychotic medication. Not a thing. Again, I say again, PTSD, very normal reaction to a very abnormal set of circumstances, nightmares.  When we're sleeping, we're very vulnerable, obviously we're sleeping. And so our brain will do all sorts of things to try to wake us up, to try to get us back into the here and now where we can stay safe. PTSD makes a ton of sense and we can explain it to anybody or rather we could explain it to anybody. And language is really important to me. And so I really take exception.  

Virginia Cruse:    00:27:17     I'm about to piss off some of your listeners, probably Scott, but I do. I really take exception to therapists and mental health professionals who pretend that this is high math because mental health isn't, we all have mental health. Everybody deals with some sort of depression. We all feel anxious. This is not rocket surgery. This is our lived experience. And NCO does a lot of great hip pocket training. We can do the exact same thing with PTSD, with drug and alcohol abuse, with depression, with OCD, with eating disorders. This is not high math and PTSD, especially is incredibly logical. Doesn't make you comfortable,  

Scott DeLuzio:    00:28:06    Right? And it's not comfortable. And a lot of times the conversations around it are very uncomfortable. You know, when you start talking about it to a therapist or whoever a spouse or something like that, it's an uncomfortable situation because in my opinion, anyways, we have this stigma about mental health. And when you start talking about these things, talking about seeing things or hearing things, or smelling things, people just sorta like, well, man, that guy's nuts. You know, he's gotta be crazy, you know? And so you don't really want to admit these things publicly or to anybody really, sometimes it's unfortunate that it's like that, but we sometimes don't want to have these conversations, but I think it is important to have the conversations as uncomfortable as they may be.  

Virginia Cruse:    00:29:05    I appreciate you saying that, Scott. And I think my dream fantasy when I was going through this and I hear this a lot in session is, you know what, Virginia, I just really want to do this on my own. I just want to read the book. I don't want to hear, do this on my own shit. If you could do it on your own, you already would have, brother. You would have already figured this out. We don't heal in isolation. We heal in community. You don't go out on a convoy. You don't Bergdahl it. You don't freaking go out without your fire team. Because that doesn't end well. And so I implore your brothers and sisters in arms here. If you could do this on your own, you already would have, you already would have.  

Virginia Cruse:    00:29:59    But here's the fact and you talked right at the top about facts and rumors about PTSD. There are a lot of rumors about PTSD that are 100% not true, but absolutely will fuck with your head and the number one and your belief system. Moreover, number one, rumor I hear and you touched on this. I want to go back, if that's all right.  Is this idea that PTSD has no cure? I'll always have PTSD. I'm so glad that Scott and Virginia could come back from their PTSD, yeah for them, but that's not my thing. You know, I'll always have PTSD. It'll never go away and I'm just subscribed to that belief system; it is so widely held and so widely propagated within the active duty environment within the veteran environment and even within the therapeutic environment, all the facts of rumors that I have in my book are actually things that I've heard from other masters and PhD level clinicians.  

Virginia Cruse:    00:31:07    I mean, this isn't just from Joe on the street it isn't just Private Snuffy. This is Dr. Empty Chuck as well. And so this is just not true. Now, there are three evidence-based treatments that are approved by the department of veteran affairs for treatment of PTSD. Now these aren't the only treatments, but first I want to say, well, first let me tell you about cognitive processing therapy, CPT, then we've got prolonged exposure therapy, and then we have EMDR eye movement, desensitization and reprocessing. That is a mouthful. Well, if it doesn't have an acronym, it's not real, EMDR. So those are the three evidence-based treatments that are approved by the VA, which is significant because the VA is a bureaucratic beast for them to approve something is oh, hallelujah, amen brother.  

Virginia Cruse:    00:32:14    But that means that they're pretty ubiquitous. Well, today we can find them in pretty much any military treatment facility.  You can go online and do a “psychology today,” search and put in EMDR therapist, Macallen Texas 7 8 501 and poof, you're going to come up with folks who specialize in that form of trauma therapy. Those are available and evidence based treatments are important, Scott, because they've been scientifically proven to help most people most of the time. So think of this in terms like the Pareto rule. Okay. So if we do 80/20 this stuff, and we've got a course of action, a cognitive processing therapy, it's gonna help 80% of people, outliers going to be 20%. Let's say you're an outlier.  

Virginia Cruse:    00:33:15    If I had a 20% chance of winning the lottery, I'd play. All right, I got it. We know that a certain number of folks who engage in any of the treatments are going to be outliers and it won't work because that's math and that's how numbers work. Got it. Then you go to Cobra Brava. Then you go to Charlie, let's say that you do all three of these VA approved evidence-based treatments for PTSD. Does that mean you're fucked? No, it means one of two things, either we have the diagnosis wrong, which happens a lot, it is what it is, where no one's perfect. It could mean that you have something called a co-occurring disorder. So that's a fancy ass term. That means coming with. So PTSD is one of those disorders that always comes to the party with friends, super joiner, woop party on. So, in my practice, I see five different disorders that always come to the party with PTSD. So depression, anxiety, drug, or alcohol misuse, obsessive compulsive disorder, OCD, and eating disorders. I say again, eating disorders, and I'm talking to my men out there and I'm especially talking to you, special work for community infantry folks.  

Virginia Cruse:    00:34:50    You know, I'm talking about you. We don't talk about it a lot. Eating disorders are very prevalent within the community.  There also could be moral injury and I devoted an entire chapter of the book to it; moral injury, something that we don't talk a lot about.  and you know, I had already been licensed for several years before I started reading research on it. And we'll maybe come back to that. But if you are an outlier, you might have that co-occurring disorder. We might have a bad diagnosis, or you might've won the PTSD lottery and have what we call treatment resistant PTSD. But guess what folks, we have treatment for treatment resistant PTSD. It's like having a bad rash.  

Virginia Cruse:    00:35:40    I don't know what would be worse. Another story for another day. Anyway, we have so much money.  Thank God and so many freaking brilliant researchers who are really working on treatment resistant PTSD. And I think especially of the folks at the department of defense, if I can brag on some colleagues for a bit, the department of defense center of excellence for PTSD is in San Antonio, Texas. And it's the project strongest That is a ridiculously long acronym, south Texas research PTSD, something anyway, strong And they're doing all of this amazing research for pre-treatment resistant PTSD. They're doing things like ketamine, the God shot, the stellate ganglion block. We call it the God shot sometimes and DMA what we call transdiagnostic therapies, meaning that it takes care of a lot of shit all at once.  

Virginia Cruse:    00:36:44     We're doing all sorts of faith based therapies that are really working. And so if a lot of folks who are listening to this are probably thinking like, oh, so that's nice for Scott and Virginia. But what I would want you to know is that this is for you. This is where treatment is for you. Also evidence-based treatments are important. And why did you take a minute to talk about why they're based in science? And I know a lot of people don't like science these days, I get it. But you know, you don't have to believe in gravity either, but this shit is for real. And if you try to sit down and the chair's not there, your ass will hit the floor. These evidence-based treatments work for most people most of the time. And that's science friends, but hear this here, no thing, and no one can change your strongly held belief if you don't want it to. And that's science too. So it is what it is.  

Scott DeLuzio:    00:37:48    So if you feel like there's no hope for you, you can't change. You're just going to be stuck with this forever. If that's your belief, then that's what it is. I mean, it's like a self-fulfilling prophecy. It's like, that's just gonna be what you end up with. Is that kinda what you're saying?  

Virginia Cruse:    00:38:10    Yeah. You know, and I would want to start by saying feelings aren't facts. I'm not going to say, fuck your feelings. Because feelings matter, feelings keep us alive. They were a very fundamental part of evolution. You know, feelings keep us alive, feelings, every good thing that's ever happened in the U S story, because somebody was pissed off and that's not a bad thing. You know, you don't have your feelings and we have to get real that there are a lot of people who are listening to this who believe that treatment, just it's just not for me that all right, there is really no nice way to say it. So just put your seatbelt on and send your strongly worded emails, letters later.  There are a lot of us who are on the fence and we're not really sure whether we believe treatment is possible, whether we believe change is possible or whether we can actually do that.   

Scott DeLuzio:    00:39:24    And I think that that's a point I was trying to get to. I like the way you said it much better than I did, but I think that the key there is that the key to being successful in getting treatment is to change that mindset. And that's something that only the person can do. You know, that individual can do if I don't think that treatment's right for me, well, it's not going to be right for me until I decide that it is right for me. And so I need to come to that realization.  

Virginia Cruse:    00:39:59    And I'm not going to bullshit you and pretend it's easy.  Because you know, if I had one super power, Scott, I wouldn't want to fly or be invisible. I would want to be able to believe both, make people believe that change is possible and make them want to change as a therapist. That would be amazing. There's nothing I can say. There's no book I can write. There's no study I can give you to make you believe that you can do this. And that's okay. It's okay to be on the fence. And what I would want to ask you if I were your therapist and I were eyeballing you in my office or in my zoom room, I would want to ask you, is it possible that you're wrong?  

Virginia Cruse:    00:40:49    Is it possible that you are just dead ass wrong? And at the risk of being offensive, fuck you. Is it possible that you are wrong? Have you ever been really challenged by something before and overcome it? Have you ever been in a situation that you thought was insurmountable and you survived it? Is it possible that you're wrong? I'm not asking if you are. I don't need a yes, no, I don't need a definite. I just want to know if it's possible, because if it's possible that you're wrong and I don't know about you, but I'm wrong every single day, several times a day. If it is possible that you're wrong, then it's possible that killing yourself might not be the right answer.  

Virginia Cruse:    00:41:45    It's possible. It's possible that you could come back from this and remind me what the fuck you have to lose, by the way, by engaging in treatment with PTSD or moral injury or depression, or an eating disorder, what do you have to lose? And then there's kind of that bigger elephant in the room. And this especially comes with moral injury. There are a lot of us who are listening to this podcast who don't believe that we deserve to recover, that somehow if I reclaim my life, that it dishonors my brother, my battle buddy, that somehow it makes what I did in combat Okay. That somehow it erases the value judgment that comes with what I did. And it's possible. You're wrong about that too, you know?  

Scott DeLuzio:    00:42:55    And the moral injury is an interesting thing. That phrase is relatively new to me. It's something that I only just within the last maybe year or two, I actually first heard that phrase. And it is interesting because you may have done nothing wrong, but you may have seen something that gets done. And it's an injury, it hurts, it injures you just like other injuries could and it is an incredibly strong thing to deal with those moral injuries. I wrote about those in my book. I still sometimes have trouble dealing with those types of injuries. Just the things that occurred, it just was a difficult thing.  I wonder how many people are out there who are struggling with a moral injury and don't even realize it because maybe they don't meet the criteria of all of the PTSD symptoms and all of that type of stuff. And they just don't know what is going on with them. And you know, I think that's an interesting one.  The moral injuries,  

Virginia Cruse:    00:44:27    I appreciate that Scott. And with your permission, I'd like to just kind of get down to brass tacks, because there might be a lot of people who are listening to this podcast who've never heard that term, moral injury. So PTSD is pretty well known. So that is a trauma reaction. It's our brain and body's very natural reaction to threat, to trauma. So our brain will go through incredible acrobatics in order to keep us safe. And those are those PTSD symptoms. So moral injury really has to do more with the should.  It's really rooted in shame. So it stems from what we believe. I say again, what we believe we should have done, what we should have known, how things should have been in war, in life, in combat.  There are a lot of things that happen.  There are a lot of things that happen downrange, and the further you are away from the flagpole, the more likely it happens.  

Virginia Cruse:    00:45:33    It's just, it is what it is. And research on moral injury puts these in three. And this is not my research, by the way, I want to give mad props to Brett Litz and his team out of Boston university, brilliant guy, great researcher.  I remember the first time that I read his book called Adaptive Disclosure.  I remember thinking that it felt like he was sitting around a campfire, getting piss drunk with a bunch of us and just taking really excellent notes. And I thought to myself, how is it that no one's talking about this and listen, his team put this into three categories. So combat loss, perpetration, and leadership betrayal. And I want to flesh those out just a little bit. So combat loss and I don't ever want to feel like I'm lecturing you on this because your book really covers this in a heart breaking, very poignant way.  

Virginia Cruse:    00:46:45    So in war, we lose people downrange and we lose people to suicide after. And at this point, unfortunately, I don't know many of us who have lost more people to combat than we have to suicide. You know, we've all lost a lot of battle buddies by suicide at this point.  When combat loss happens, it's especially hurtful because as the mission goes on, not all of us have an experience like you're saying, God, where we find out about combat loss. We find out about the death of someone we love so much. And then we're taking enemy fire, like literally in the next beat. But there is something very, very hard about that. And we use these words like sacrifice and hero and it can feel very empty and I especially think, I mean, I joined in 97.  

Virginia Cruse:    00:47:45    I'm a lot older than you, but I think about those post 9/11 enlistees; there was something really pure and honorable we all wanted, to bring the fight there and to bring a battle buddy, bring our buddies home and uphold the Geneva conventions, the rule of law. And things happen in war that are just not simple or pure and combat loss is especially hard because it's incongruous, this idea of losing somebody so dear to us, and then the aftermath and then perpetration get your emails out. So this is what this is, war crimes. But not just war crimes. In my private practice, I work with people for the most part who have either witnessed or committed war crimes and that's a really big umbrella and we need to stop pretending that that's not a thing it's a really big umbrella.  

Virginia Cruse:    00:48:58    It happens across gender and gender identity services. There's even that word fragging that we all giggle at in the field. That's perpetration that would fall under this, but yeah, a lot of things happen downrange that are not okay.  And then we have leadership betrayal and this is a special type of fuckery because everybody makes mistakes. Okay. I'm shit. I make mistakes every day and leaders make mistakes every day. But leadership betrayal is a special class of fuckery because this is betrayal that is especially capricious and intentional and it always seems to be a major, It's that Major who wants to keep going outside the wire to meet with the local so they can get their combat action badge or their CIB, right.  

Virginia Cruse:    00:50:10    Or it's somebody who is bullying someone until they commit suicide and this happens, or rape, sexual assault.  These are things that are happening down rage, a male sexual assault happens a lot. We don't talk about it a lot, but it happens a lot. And oftentimes leaders know about it, really excessive hazing getting swept under the rug. Dr. Jennifer Frayed is out of the University of Oregon and she writes about a similar topic, similar nuts, same oh gosh, am I going to blank on her stuff right now, Institutional Betrayal that was actually covered on South Park. She's South Park, famous bad-ass, she's such a good researcher and just an advocate and awesome human being. And you know, she talks about the Darville model with sexual assault.  

Virginia Cruse:    00:51:15    So this is the idea especially with university programs where someone will be sexually assaulted and then it gets kind of swept under the rug because there was a lot of really healthy discussion about that in the Me Too movement. But anyway, her work on institutional betrayal is sort of analogous to this leadership betrayal, but those are three kinds of broader categories of moral injury. And they're heavy and a lot of times in therapy and I'm a therapist, so I will totally bad mouth all of us, but I'll just speak for myself. We're not chaplains. And we were talking about deep soul wounding. If we're being real, if the idea of a soul, a wounded soul is a little too touchy feely for you, I think it might help to think about this as an all-out existential crisis.  

Virginia Cruse:    00:52:19    I know, come to Jesus. What the fuck happened moment that alters our belief system about ourselves, especially about ourselves, about other people in the world, but really about ourselves. And we see a lot of really self-destructive behavior that comes with moral injury. When I'm talking about self destruction, I'm not talking about drinking too much. I'm talking about riding your motorcycle without a helmet while high on Coke to go get your daughter from daycare type risk behavior. The story, I can't make this shit up.  This is the type of high-risk behavior that we engage in that self punishing behavior, because with moral injury, we can't just process the trauma so you and I in the pre-show we were talking about cognitive processing therapy, what an amazing tool for people who are analytic to take something as nebulous and ugly, and just hard to wrap your head around as a feeling and to put it into the emotional equivalent of an Excel spreadsheet, to be able to right size and make things hit autosome and make it make sense.  

Virginia Cruse:    00:53:44    But when it comes to that, and that's perfect for PTSD, but when it comes to moral injury, we have to process the trauma and its meaning. I say again, we need to process the trauma and its meaning because we start asking ourselves these questions: what type of person would let this happen? What type of person would allow this? I was in this interrogation mission or there's a lot that falls under this umbrella.  

Scott DeLuzio:    00:54:22    And then I talk about a situation in my book where I'm faced with the decision, whether or not I should kill a child, that wooden gun that kid was holding. And from a distance, it looked like he was holding an AK 47. And so I raised my rifle to shoot him and the kid was 10 or 11 years old, however old he was. And I was just a trigger pull away. The safety was off. I was aiming at him. It was close enough. It was an easy shot. I probably would've killed him that day. And had I not realized that he was just holding a wooden gun and prior to that moment and all of that happened in a blink of an eye it was just as quick as raising your rifle and getting ready to shoot.  

Scott DeLuzio:    00:55:10    I mean, it's really that quick.  But prior to that moment, I thought of myself as the type of person who would literally do anything to protect a child. And then here I am standing with a rifle pointed at a kid ready to blow his brains out. And in a blink of an eye I saw myself as completely changed. And you know, talking about being injured with a moral injury, like in this it was kind of self blaming, blaming myself for different things and everything like it hit me hard and it still is something that I struggle with from time to time. It's just a difficult situation.  

Virginia Cruse:    00:55:58    And we do have ways to right-size that. And when I say right size, I need to process it and to understand it, we don't talk a lot about this sort of stuff. And I think that we're failing troops that we are not talking about unintentional or intentional killing of non-combatants. We don't talk about torture or sadistic acts or aggression or sexual assaults.  We don't talk about it and it's not because it doesn't happen. I get it and talking about that, it might not be smart a lot of the time, especially if we can still be prosecuted for it.  I talk about a lot about this in the book because if we're still on active duty and we need to process this, but we signed a non-disclosure agreement, or we made a pact with our team, which happens a lot.  

Virginia Cruse:    00:57:03    There still are ways that we can process this. And you know, in my practice I use adaptive disclosure.  That's by Brett Litz, who I talked about earlier.  It's a one session add-on to prolonged exposure therapy.  It's super, but it works, it works.  I described it at length in the book, so you can get wooed out there.  I don't need to sound crazy on your show, Scott. We do use, oh goodness, what is the name of that, trans diagnostic? It'll come to me later.  I should probably have it right here, but what the hell is it, at my age it happens, watch out it'll happen to you too.  There are ways that we can with evidence-based treatments, evidence-based treatments meaning that we have tested them using a scientific method.  

Virginia Cruse:    00:58:17    We've tested them over the course of years on literally thousands of participants; think about how the FDA tests drugs, double-blind studies over the course of, in some cases, decades. So we know that these evidence-based treatments work and the idea of processing moral injury and especially when it comes to something we've done personally, that we're not so proud of, the point is not to make it okay. Like, oh yeah, I processed dead. Yeah. I'm forgiven. I'm okay.  It's to look at it from a more objective third person perspective. And I know that that might sound really like we're kind of fucked up, like for real, but when it comes to moral injury, when it comes to our own heads and when it comes to PTSD, we were literally not in our right minds a lot of the time.  

Virginia Cruse:    00:59:19    And it's quite possible that we are not seeing ourselves objectively; you know, one thing I often say to clients and even to friends, I hear folks beating up on themselves. I say, shit, what would you do if somebody came up and said that to your kid, what you're saying to yourself? Oh, I get so mad. What if somebody else comes and says that to you? I get so mad. So why are you saying it to yourself? Knock it off, right? Like that is not okay. I mean, we can beat ourselves up better than anyone, but it's not necessarily true. Maybe you're not a war criminal. Maybe you're just an asshole.  

Scott DeLuzio:    01:00:10    That's a possibility and there's a lot of them out there.  

Virginia Cruse:    01:00:16    I've reached that conclusion many times with clients and that's not to be mean.  It is what it is. There's a lot of things that we do, Lieutenant Colonel, David Grossman wrote on killing, which is a classic for a reason.  There is a light that probably wouldn't surprise you to know that somebody like me designed army training, not an NCO, we have been training soldiers the same way for millennia. You know, the idea of we're going to break you down to build you up the idea of group punishment. You know, if we're in formation together and my boots are untied and I wasn't going to come up to me like, Hey, for Jenny your boots untied, how does that make you feel? No, we're all going to be doing pushups together because what have we learned from this situation? We all have to look out for each other's training. So we want to train, we want to instill that idea of good order and discipline into soldiers, into Marines, into even Coasties and Airmen.  

Virginia Cruse:    01:01:29    No, I'm done fucking with you. Don't write me an email, but we want to instill that good order. Discipline. The reason is super simple. If I'm your commander and I say, Scott, I need you to take that hill. Here's a spoon. Here's your weapon. I don't need you to look at me and say, I don't know if you were aware that this is a spoon. I need you to go, oh shit, whoa. I need you to charge with that spoon. I need you to go all Braveheart for me because that's what I need. And so we learn that that's part of our training. It's just so; it's beautiful. But then outside of that environment, let's say that there is somebody who 's having problems with DUI.  

Virginia Cruse:    01:02:19    You know, he gets a DUI because they're having problems with their PTSD and alcohol abuse, like fucked up peas and carrots. They come together all the time. And so maybe they get a DUI and the fish rots from the head. We'll see folks out on base you know, we punish them, we give them extra duty. We remind them to barracks. And then all of a sudden you've got maybe any five or any six and they're getting shit on by a PFC. And you're like, really? But remember, it's that group punishment. It's how we're trained. It's how we're trained. There's no ill intent behind it. It just is what it is. And so you know, there's a lot that goes into the making of a soldier, the making of a Marine. It does a really good job explaining that. And I would really recommend a lot for my folks who are dealing with moral injury. I would certainly recommend it to your listeners.  

Scott DeLuzio:    01:03:27    Excellent. Yeah. And that's a good way to kind of kind of wrap up the moral injury piece of that. I think we've done that a lot of justice, but I think you go into some stuff with moral injury in the book and it makes a lot of sense the way you outline it and put it out there. So for anyone who any of this stuff has resonated with, I really encourage you to go get the book and take a look at it because there's more information in the book and it's laid out in a really clear manner. And it really does make sense.  You described something else in the book that I wanted to touch on a little bit too about how people who are dealing with PTSD can cope by tuning out those negative emotions that they're feeling.  

Scott DeLuzio:    01:04:26    And you talk about it like your emotions, if you were to draw out like a timeline almost where you have the negative stuff on one side and you have the positive stuff on the other side, so you have the sadness and depression and all this stuff over on one side, and then you have happiness and joy and all that stuff on the other side.  But you talk about how when people are suffering from PTSD, they sort of learn to block off some of the negative things, but it's not a good thing because it has the equal or opposite effect of also blocking out the positive emotions and so it kind of shrinks that timeline in. And so all that the person is feeling is just in the middle, the kind of myth, like blah feelings.  

Scott DeLuzio:    01:05:21    And it was very interesting for me to see that in here, like why that happens and how that's just a thing that does happen, because I noticed that in myself where I was trying to just suppress some of the negative, the bad things that were going on in my head, but then at the same time, I wasn't feeling joy or happiness either in my own life. And with things that I ordinarily would have been extremely happy about, or extremely positive emotions, it would have been flowing during some of these things. I just couldn't find it in me to be happy about certain things when you go to a sporting event and the home team, like a baseball game and the home team hits a home run everyone stands up and they're cheering.  

Scott DeLuzio:    01:06:22    And I was the type of person who would just be kinda like sitting there, like, well, good for him. I recognize it as a good thing, but it just didn't really turn me on. It didn't really do much for me. And it was very interesting how you describe how by bringing in the negatives closer to the middle, it also is bringing in the positives closer to the middle, and then all that you feel is just that middle ground. And that was very interesting to me. Would you be able to kind of dig into that just a little bit?  

Virginia Cruse:    01:06:55    Yeah, for sure. I had a friend who used to always say if you're already in over your head, does it really matter how much deeper you go in the ocean? And so I say that as a trigger warning, because this is super uncomfortable, super uncomfortable. But if we can't talk about it here, what are we doing? So this has to do with criteria, Charlie of PTSD, it's avoidance and avoidance within the context of PTSD. It's so logical. It is so logical, the most logical illness there is. So that avoidance, we will go way, way, way out of our way to avoid anything that reminds us of our trauma. So we will avoid people, places, things, conversation, social media, you name it, we will avoid it. And since we're already talking about an uncomfortable subject, let's just go there when we have PTSD, we know we're not okay. We may not know what's going on, but we know we're not okay, our family knows that we're not okay. And we know they know we're not okay. And they know, we know, they know we're not okay. And so we start to avoid our family members because we don't want to worry them.  

Virginia Cruse:    01:08:24    They're worried and they don't want to talk about it because maybe they've gone to Dr. Google and they're like, holy shit well, I don't want Scott to schwack himself, so I'm not going to ask it. It becomes this big festering elephant in the room. Now that's a metaphor, no actual meat, no real elephant, but it becomes as big and nasty and festering as an elephant in the room. It's there, everyone knows it's there and no one talks about it. And so when it comes to avoidance, we start pushing away. I say again, pushing away the people who can support us the most, we show up piss drunk to our family reunion. We blow up our perfectly good marriage. We stop hanging out with our friends. We pick fights on Facebook or whatever social media is cool. These days we will start just blowing shit up. And a big part of that is avoidance. We will start to avoid. And avoidance makes a lot of sense within the context of PTSD because who wants to feel shitty.  

Scott DeLuzio:    01:09:32    Right? It does. It makes a lot of sense because you said, who does want to feel bad? And if you don't have any of these good meaningful relationships, then you can't be hurt either. You know, you can't screw it up and ruin it. So just avoid them. You know, it does make sense. I'm not saying it's the right thing to do for the listeners. I'm just saying it does make sense.  

Virginia Cruse:    01:09:58    Makes sense. It's very, very logical. And by the way, in the book, we do talk about how to reclaim our relationships. You absolutely can unfuck your relationships.  We go through how I promise if I can do it, anybody can. But when we think about feelings, we think about them on a continuum. So that's that timeline that you were talking about. So this continuous feeling is this and this is just my example. I think it's probably the easiest way I can explain neuroscience in a snap. So think about feelings on a continuum on this side of the continuum of all the shitty feelings I don't want to feel. So I don't want to feel sad. I don't want to feel angry. I don't want to feel upset.  

Virginia Cruse:    01:10:49    And then we go through and you've got those middle feelings. I feel ambivalent. I feel okay, then over here, I've got those feelings. I want to feel happy and joy and sprinkles, rainbows and shit. And so the idea is that I want to avoid all the bad feelings on this side of the kitchen. I just want middle feelings and good feelings. And if that were a thing, it would be awesome, but that's not how the brain works. So there are these unintended second and third order effects that happened. So when we start trying to avoid the feelings on this side, what happens is things on a continuum on both ends in equal measure. So they give it like an accordion. So if I start to avoid these feelings on this side, all the bad feelings, what happens is this comes in the same amount. All of a sudden, I can't feel, I say again, I can't feel all of the feelings on the right side. So I'm not able to feel joy and laughter and happiness and sprinkles. And I get into this middle space called numb. I just don't feel anything.  

Virginia Cruse:    01:12:07    And if we're being for real, that is fucking terrifying because we know cognitively in our minds, we know I should feel something. My spouse comes up to me. My kid comes up to me and they always listen, she’s upset. And I know that they should be upset. They have every right to be. I don't feel anything, even worse. Maybe I feel annoyed. Maybe I say to myself, just quit your crying, you fucking baby. And then I think to myself, what did I say that to my kid for, did I really just think and say that? That only and then feeds into this idea because only a monster would do that. I don't feel anything. Maybe I will start Googling it. And I start wondering if I'm a psychopath or sociopath and newsflash, if you're asking, you're not. So that's a good thing. If you're not asking, go see a therapist.  

Virginia Cruse:    01:13:01    But if you're asking, you're definitely not, definitely not. But this numb feeling is really terrifying. And then a lot of times what will happen when we're in this numb place, we don't feel anything, is we get an idea and I think fuck it. I'll just commit suicide. Then I feel something. I feel something, I don't feel good. I don't feel bad, but I feel something. And if you've been going through a period of numbness for a very long time, that's new, surprising and good. Does it matter that most suicide attempts don't end? Well, just talk to an EMT, go have a deep conversation with an EMT, that does not end well, that does not end well, but we feel something. And we tell ourselves it has got to be good if I feel something because that's better than feeling nothing that makes me more normal.  

Virginia Cruse:    01:14:01    So I feel something. So then maybe I start thinking about, I start ruminating about suicides. You start thinking about it because I tell myself, well, I'm not going to do it, but it makes me feel better. And I also tell myself, I'm just thinking about just thinking about it. And here's the thing about coping mechanisms. They work until they don't, we need to get very real about that. Drinking and drugs are awesome because they work until they don't. If I can get rid of all of it, if my solution is a swallow away, that's a lot easier than eight to 12 weeks of therapy. I got it. It's why we see that together so much. So I tell myself that I'm just thinking, I'm just thinking about it. Maybe I'm thinking about who I think is going to show up to my funeral, to my Memorial service.  

Virginia Cruse:    01:14:56     How am I going to do it?  What am I going to write as my last fuck you post on the Facebook?  Which was my personal favorite thing to ruminate about. So I'm not throwing anything out there.  When you start thinking about it and it feels good, it feels good because I have a coping mechanism. I have something else to think about. So here's the problem with coping mechanisms. They work until they don't and like it or not friends, we all get to a point where our ability to cope is overwhelmed by our circumstances. I say, again, our ability to cope is overwhelmed by our circumstances, that is called life, and that's going to happen. And when we are ruminating, when we're thinking about suicide as a solution, that's our go-to, it happens so fast. It happens so fast.  

Virginia Cruse:    01:15:53    In the last years I have had a lot of really cool jobs and a lot of not really cool jobs. And one of the jobs that taught me the most is I worked on a military base where I responded to units, where there was maybe a murder, suicide, or suicide within the ranks. And I've also worked in the jail system where folks who try to commit suicide, it doesn't work and so I want to kind of start there because I wanna walk the dog so this is kind of what happens. So when I am visiting folks in jail, first of all, you're wearing, I don't know if you've ever been to jail, but they're cold. Jail is cold. Well, not if you're in south Texas like me, but in most places, jail is really cold.  

Virginia Cruse:    01:16:53    I mean, they keep it very, very cold and you end up in something called a turtle suit and I don't know the real name for it. And I'm not trying to be pejorative and no offense to turtles out there. But you know, it's a one piece green smock that has so much stitching in it that it's not able to be pulled. So there's no suicide risk. So all of your clothes are removed. You know, all of your items are removed. You're put in a turtle suit and you're in a really cold cell. And then you got to talk to somebody like me; shitty day. And if I've heard it once, I've heard it a hundred times and it's almost the same. Every single time, Virginia, it happened so fast. Before I knew it “fill in the blank,” the bottle of pills was gone.  

Virginia Cruse:    01:17:50    And so it was half of this before I knew it. I had the gun in my mouth before I knew it. My child walked in on me while I was tying the noose before I knew it. The SWAT team showed up and I had red dots on my chest before I knew it. This shit happens fast. This should happen fast. And so real talk here. I need you and your listeners, your viewers to know that when we are thinking about suicide as a coping mechanism, we are on a razor's edge. We're a lot closer than we think. And it is time to get help. It's time to get help. Let's flip to the other end on visiting these units and sometimes family members, but mostly for me, the experience has been with military units.  

Virginia Cruse:    01:18:46    The one thing I hear almost every single time is that I knew Scott had gone through some shit. I knew things were bad, but it seemed like he was getting better. You know, he came to the office, Christmas party. I saw him smiling. You know, he was looking good, I thought he had turned things around. And then when we go back to that suicide as a coping mechanism, it makes a lot of sense because we're thinking we have a solution now, where we didn't have one before. And so we do kind of externalize that we do start giving our things away and being nicer to people because we have a solution in our mind, it's a forever solution.  That is the thing that I hear over and over and over again is I thought everything was turning around as suicide happens really quickly.  

Virginia Cruse:    01:19:48    And it almost always happens when we're under the influence of drugs or alcohol, almost always.  When we are feeling suicidal, we have to be real. We are literally, literally not in our right minds. And I mean, I'll just speak for myself when I was suicidal. You know, I was thinking about suicide all the time and it made me feel better, you know? And I was asking myself things like, oh, will my life insurance payout, if I commit suicide, I even told myself that it would be better. Now this goes to the heart of selfless service. This goes right into Army values, that my unit would be better off if I were gone, that my husband would be better off, if I were gone, maybe he could find a really nice lady and dad babies or something.  I really told myself that it would be better for my family, for my loved ones, if I was out of the picture.  

Virginia Cruse:    01:20:48    And that's some truth there, but here's the thing, love is stubborn. Fuck love is unbelievably stubborn. Even if you've already signed the divorce papers, even if you've already shown up piss drunk at your family reunion, even if you've already told off your ex and your kids aren't talking to you there, that might not be the end. You might be wrong. You could be wrong. When we're in that really numb phase, it's absolutely terrifying. And what I need your listeners to understand is that, and this is going to hurt to hear this even feels gross to say it's normal. And when I say that something's normal within the context of PTSD, that doesn't mean it feel good as it feels like dog shit. And it's really frightening, but it is a very normal trauma reaction.  

Virginia Cruse:    01:21:53    It is normal. It doesn't mean you're going crazy. It doesn't mean you're hopeless. It doesn't mean suicide's the right answer. It means that you have a problem and there is a solution. We have those evidence-based treatments. You can ask for them by name. You know, there is a way back in evidence-based treatments. I didn't mention this before, and I'm remiss eight to 12 sessions, 15 on a high. So that means if you're meeting with, let's say, you've been dealing with your PTSD symptoms for five months, 50 fucking years. You're still seeing Charlie in the foxhole from Nam. And a lot of people are, especially with the fall of Afghanistan. You know, we're getting a lot of folks coming into therapy, whether it's been five months or 50 years. What we know about evidence-based treatments is that they literally take eight on the low end of 15 sessions on the high end to see a significant change; it's statistically significant reduction in symptoms.  

Virginia Cruse:    01:23:00    If you're going to intensive therapy three days a week, literally in three to four weeks, you will never be the same in a good way, in a good way. And I get that. Before I became a therapist I was very Freudian and it was the idea of lying on the couch and talking about my mother. And if you want to talk about your daddy issues, I mean, do it, do it, do it. I'm not going to hate all of my psychoanalytic friends there. But what I would want you to know about those evidence-based treatments is they're very specific. They're very direct there. The only way out of that valley is through therapy and their APIs are trained. A trained trauma therapist can walk with you. And there are a lot of ways that you can find those three evidence-based treatments that you can get that help you need and ask for them by name, they work and they work quickly. Now they don't tickle. I want to be honest. And for real, and you can speak to this because you did call cognitive processing therapy and that's a bucket of suck, but it's not forever. Here's your straw. Suck it up. It is not forever. And it's not harder. I say, again, it is not harder than what you've already been through.  

Virginia Cruse:    01:24:29    I'm reading your book right now, Surviving Son and there is nothing harder. There's nothing harder than what you have personally already been through. And the same goes with your listeners. There is nothing harder than that. These evidence-based treatments, they don't tickle, but they're not forever. You absolutely can do this. You need support. And you know, in the book, we go to a great length to talk about how we get support? How do we make friends? 

Scott DeLuzio:    01:25:11    And you talked about this earlier in the episode where for women, it's easier, they go up and they can just oh, I like your hair. I like your whatever. And now all of a sudden they're chatting. They're best friends. And they go on and whatever, but guys don't do that. Like, we just don't talk to each other that way. And it's really hard to do that. The other day I was thinking about that because I had just finished listening to your book. And I was thinking about the difference between men and women. My wife goes out to a park with the kids and she comes home with three new friends.  

Scott DeLuzio:    01:25:56    And it's like, where the hell did this come from? And it's just bizarre. And you know, so I was thinking about this and I was out on a run one morning this last week actually. And I stopped. There's this little, like an exercise station. They have like a pull-up bar and all that kind of stuff. And so I stopped there and I was doing the pull-ups and everything else. And a couple of guys, like they stopped and they were on a run together and they stopped to exercise at the same place. And they're like, do you want to join us on our run? We're training for a Spartan race or whatever. And you want to join us on the run. And I thought about what you had written about. And I was like, I was trying to figure out where these places are?  

Scott DeLuzio:    01:26:42    Where do you go? And then these people just showed up. And it was like, where the hell did this come from? You know, but I was like, yeah, sure, I'll join you on the run. And then we ran around for a little bit and we got to know each other and it was a good way to get to know some new people who lived in the neighborhood. I just never crossed paths with them before, but now we exchanged numbers and now we're kind of hanging out every once in a while. And so that's cool to get in touch with new people but it's a hard thing to do. Like that just happened to happen to me.  

Scott DeLuzio:    01:27:21    And it wasn't like a planned thing. It wasn't like I had an event I was going to like, okay, I'm going to go here and I'm going to go meet new people or whatever. And so it was a much different experience for me. My wife comes home with friends all the time and I can't keep track of them all, but for me, it was just like this out of the blue situation. And so for guys that is a lot harder.  

Virginia Cruse:    01:27:46    Yeah. We talk about that a lot in the book. And because you know, we think about friends in terms of, these are my ride or die friends or their acquaintances, and there's really nothing in between and what we need for social support. We need those in between friends. And that's a term I stole from my cousin, Mark Jackson. I just lifted it off of him because it's brilliant. This idea of in-between friends. Like they're not my ride or die, but they're also not just a guy and the way that we find in between friends. I mean, you lucked out legit. That was pretty good. But for those of us who are not as charismatic as you, the way that we find in between friends is we have to go to places where other people are also looking for in between friends.  

Virginia Cruse:    01:28:47    And thankfully, there are a lot of them, there are a lot of places. So we're looking for activities or events where people go by themselves. In other words, it's not a group or a couple or anything like that. You're specifically going to an event where other people are looking to have in between friends.  There's inactivity involved because there's nothing worse than being, tell me about your smell. It's like, oh boy, you got an activity we're running, we're doing a Spartan race. Do you want to run, cuts out all the small talk because you're trying to breathe or at least  

Scott DeLuzio:    01:29:26    Yeah. Yeah. And you're breathing heavily. You're not in it for this deep conversation with anybody because everyone is sucking wind and they're having a hard time breathing while they're talking at the same time. So it's a quick two sentence or two word sentence. And that's all you're going to get out of someone  

Virginia Cruse:    01:29:48    And everyone's sucking wind.  And yeah, there's an activity. And if you keep going to it, you build community. The idea is to build community. So if you don't go, someone will call and check in on you. And that's what we call social support. That's big psychobabble talk for friends and social support is if we have meetup groups. Now you can go to the meetup once the pandemic's over, we'll all be meeting up again.  Church groups if you're not sure, you can go to meetup groups are agnostic or atheist, book clubs, Spartan, running, race groups, running groups, meetups at museums, 12 step support groups AA, Alanon for family members, ACOA adult children of alcoholics, Coda, co-dependence anonymous solos, survivors of loved ones suicide.  

Virginia Cruse:    01:31:02    There are incredibly powerful support groups out there that really provide a lot of support and a lot of help. And the idea is you're going to make a lot of in-between friends. Listen, we have a whole chapter about it in the book. So we got ideas for days because I've had to go through this myself. My husband's still active duty and we move every 10 minutes. So like it or not, it is what it is. And so we have to get in where you fit in. And so the idea is we're going to make a lot of in-between friends, and then we're going to have that accountability. If you don't show up for your Bunco group, ladies Bunco group Mabel's gonna call me, Virginia, where are you?  

Virginia Cruse:    01:31:51    And we need people to check on us, especially when we're struggling. And if you don't show up to a meeting, your sponsors can be like, oh girl, get your ass to a meeting. At least my sponsor does. And you know, it's important. It is important to have that accountability. And for every 10 in-between friends you make, you might make one ride or die friend. That's awesome. We deserve people who are in our lives, who are all in, who really care about us and guess what? They deserve us too. They're there because they need us as much as we need them. It's not a one-way street. The end. And this goes back to that criteria in Charlie avoidance. I know that if I could do this on my own, I would.  

Virginia Cruse:    01:32:43    So rather I know the idea of making friends is like, really like, no, I just want to be left alone. I I just want to Unabomber it. I want to be on my mountain. I want to do my thing. But guess what? The data are overwhelmingly clear. The key to lasting recovery is social support. I say again, the key to lasting recovery, social support. So if you're serious about staying recovered from your PTSD, you don't get a choice, right? You need to start making friends. If we don't, we don't recover in isolation, we recover in community.  

Scott DeLuzio:    01:33:28    And I think that is incredibly important and you're right. It is incredibly difficult to do, but it's incredibly important to do at the same time, they have no choice.  

Virginia Cruse:    01:33:42    Exactly.  

Scott DeLuzio:    01:33:44    Right. And who wants to go back to that? You know, once you've gone through all of that hard work to get out of that space for the eight to 15 weeks after you went through all that, why would you want to go back and have to go through all of that again? You know, so if the worst thing that comes out of this is you make some new friends, like it isn't really that bad, you know? So well with that, I think we have definitely given the listeners a lot to consider and we've covered a lot about this book on the show.  More than I thought we would actually, but I'm glad that we got into all of that, but there is so much more in the book.  

Scott DeLuzio:    01:34:39    And so if any piece of this has resonated with any of the listeners I really do encourage you to go out and get a copy of this book.  It's available on Amazon and Kindle paperback in an audio format. So you know, however you like to consume your books, you can get whatever way you prefer.  Is there anywhere else that people can go to follow what you do to get more information and you mentioned earlier about the first two chapters that you were going to be giving away to the listeners, could you say again where they can go to find that?  

Virginia Cruse:    01:35:27    Pleasure, you can go to the  You give us your email, we'll sign you up for our newsletter and we'll send you a free preview copy for the book. It's got the first two chapters. So we go line by line through the criteria.  Also once you sign up with our newsletter, you can get a free copy of our workbook, that's really great for your CMP exam. So for your compensation and pension exam I recommend having the workbook and filling that out to really, I think it's really imperative that we understand our symptoms better than anyone else. And unfortunately, this includes therapists. This includes our doctors, our chain of command. We have to know this disorder. We have to know it inside out so we do have that workbook available.  

Virginia Cruse:    01:36:23    We're available pretty much anywhere books are sold online. We've got the audio book and Kelly Taker is fantastic. You can get a hold of us.  We have a Twitter, we have a Facebook page and we've got a really cool interactive group. And I want to give a mad shout out to my team. So we've got this team of true believers who are just so flipping awesome. Katie Salinas, Nicole Tribbett and Barbie McGray, who are just absolutely amazing and are thankfully much younger than me and know how technology works and are just really awesome women. Anyway, also in 2022, we're going to be putting the book out in Spanish.  That's really important to us because access matters.  Unfortunately, there is a dearth of information. There's just nothing out there in Spanish for mental health and that's not okay.  

Virginia Cruse:    01:37:25    That is not okay because a lot of service members and veterans speak Spanish and so do their family members and they deserve to recover from PTSD too. We're also putting out Katie Saliva is coauthor of the Woman's Guide to PTSD, and that will be much more civilian focused and that'll be coming out in 2022 as well. So sign up for the newsletter, hang out with us on Facebook and Twitter. A No Shit Guide to Reclaiming Your and get your free review copy. We really love hearing from readers and listeners. So we'd love to hear from you. Oh, I forgot to mention I'm remiss, also in 2022, we are putting out a a Guy Soldiers Guide to PTSD specifically for Vietnam veterans.  You know, that was a real blind spot of mine  

Virginia Cruse:    01:38:23     that's on me. It was 100% on me.  I had a lot of readers get back to me and they said I'm a Vietnam era vet, and I'm picking up what you're putting down, but it's not in the language I need. And so I've been working with a couple of peer support groups out in Michigan of all places I've never even visited, just sounds really cold. And they are helping them to just make it pan our Vietnam vets just really had it different. It was a very different war and they made it, so that when we came home, when we redeployed, we were really supported. It's unimaginable to me, the idea of having protesters at the airport and being spit on or called a baby killer.  It really is our Vietnam vets who made sure that that didn't happen to us. And that's deeply moving to me and we all owe them a debt of gratitude.  My dad was a Vietnam vet. He died in 2019 and he never talked about his experience ever. And you know what, if I have an opportunity to pay that forward, I want to, and so that'll be coming out in the new year.  

Scott DeLuzio:    01:39:58    Well, that's excellent. And it seems like you have a lot of great resources that are available. So anyone who is listening to this and who has struggled with PTSD, if any of this stuff has resonated with you, reach out, go to the get the soldiers guide to PTSD.  It's like Virginia said it's available anywhere, and don't do it alone. You know, go and find someone who can help you work through this. If the VA is not the right fit for you, for whatever reason, there are other organizations, there are other people out there who are providing this type of service. And like Virginia said earlier, type in the type of treatment option that you think would work for you and your zip code. And Google will tell you where to go and figure out what the best course of action is. There's so many people out there, don't go it alone.  It's much easier when you're not carrying this burden by yourself.  

Virginia Cruse:    01:41:15    Thank you so much, Scott, it's been a real privilege to talk to you.  I love your book. I'm a big fan girl. Thank you for sharing your story and for inspiring other people to do the same. It's bad-ass . 

Scott DeLuzio:    01:41:30    Well, thank you very much. And I appreciate you taking the time to come on the show and share your work and everything that you're doing. I really do appreciate it.  

Virginia Cruse:    01:41:41    Thank you for this and thank you for caring.  

Scott DeLuzio:    01:41:44    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 We're also on Instagram, Facebook, Twitter, LinkedIn, and YouTube at driveonpodcast. 


  1. John Strickland on 30 November 2021 at 15:46

    Great Podcast. Thank you Scott and Virginia. I have ordered Virginia’s book on Amazon.

    • Scott DeLuzio on 30 November 2021 at 15:51

      I’m glad you liked it, John. Her book was very insightful. I hope you enjoy it as much as I did!

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