The Team House - WTF is Operator Syndrome? | Dr. Chris Frueh | Ep. 357

Episode Date: July 3, 2025

The conversation with Dr. Chris Frueh delves into "Operator Syndrome," a framework for understanding the complex, interrelated health issues faced by high-risk professionals beyond just PTSD. He discusses its physiological and psychological components, challenges within the VA and military in recognizing it, and emerging treatments for these often-misdiagnosed conditions.Operator Syndrome:https://www.amazon.com/Operator-Syndrome-PhD-Chris-Frueh/dp/1962202070Dr. Frueh's website:https://chrisfrueh.com/Today's Sponsors:GhostBed⬇️https://www.ghostbed.com/houseFOR 10% off! Mando ⬇️https://shopmando.comPromo code "TEAMHOUSE" for 40% off your starter pack.For ad free video and audio and access to live streams and Eyes On Geopolitics...JOIN OUR PATREON! https://www.patreon.com/c/TheTeamHouseTo help support the show and for all bonus content including:-live shows and asking guest questions -ad free audio and video-early access to shows-Access to ALL bonus segments with our guestsSubscribe to our Patreon! ⬇️https://www.patreon.com/TheTeamHouseNew merch, patches, and stickers! ⬇️https://theteamhouse-shop.fourthwall.comSupport the show here:⬇️https://www.patreon.com/TheTeamHouse___________________________________________________Subscribe to the new EYES ON podcast here:⬇️https://www.youtube.com/@EyesOnGeopoliticsPod/featured__________________________________Jack Murphy's new book "We Defy: The Lost Chapters of Special Forces History" ⬇️https://www.amazon.com/We-Defy-Chapters-Special-History-ebook/dp/B0DCGC1N1N/——————————————————————Or make a one time donation at: ⬇️https://ko-fi.com/theteamhouseSocial Media: ⬇️The Team House Instagram:https://instagram.com/the.team.house?utm_medium=copy_linkThe Team House Twitter:https://twitter.com/TheTeamHousePodJack’s Instagram:https://instagram.com/jackmcmurph?utm_medium=copy_linkJack’s Twitter: https://twitter.com/jackmurphyrgr?s=21Dave’s Twitter: https://twitter.com/dave_parke?s=21Team House Discord: ⬇️https://discord.gg/wHFHYM6SubReddit: ⬇️https://www.reddit.com/r/TheTeamHouse/Jack Murphy's memoir "Murphy's Law" can be found here:⬇️ https://www.amazon.com/Murphys-Law-Journey-Investigative-Journalist/dp/1501191241The Team Room Reading Room (Amazon Affiliate links):⬇️ https://jackmurphywrites.com/the-team-room-reading-room/Intro music by https://www.youtube.com/user/RemixSample"Karl Casey @ White Bat Audio"00:00 - Start 00:49 - Introducing Operator Syndrome03:45 - Dr. Frueh's Background & PTSD History24:17 - Debunking PTSD Myths37:40 - Developing Operator Syndrome Framework50:40 - Resistance to Operator Syndrome1:04:15 - Key Treatments for Operator Syndrome1:33:43 - Emerging TreatmentsBecome a supporter of this podcast: https://www.spreaker.com/podcast/the-team-house--5960890/support.

Special Operations. Covert Ops. Espionage. The Team House. With your hopes, Jack Murphy and David Park. Hey, everybody. Welcome to Episode 356 of the Team House. I'm Dave.

This is Jack. Our guest tonight is Dr. Chris Free, the author of the Operator Syndrome, which is, I feel like a seminal book. Like, it pulls in so much. many things that people are ignoring now or that are getting misdiagnosed or just kind of lumped all together. Thank you so much for joining us. It's really great to have you. Oh, well, thanks for having me. I'm excited to be here. So real quick, before we go into your origin story and your,

can you just give us a real quick teaser on what operator syndrome is? Yeah, sure. So operator syndrome is not a diagnosis per se, but think of it as a framework for understanding the very complicated and interrelated injuries and impairments that develop over time during the career for many high-risk professionals. So obviously operators from military special operations are an extreme end of that. The framework is relevant for first responders, firefighters, law enforcement for soldiers from other parts of the combat arms. Quite a bit of my work has been with paramilitary intelligence adjacent operators. And so the concept is that these professions involve an enormous amount of physiological

strain on the human body. And we call that allostatic load. So that allostatic or physiological strain affects all of the physiological systems in the human body. Nervous system, endocrine system, respiratory system, metabolic system, musculoskeletal, etc. And we have failed, in my opinion, we have failed, you know, generations of soldiers and first responders now by overrelying on the diagnosis of post-traumatic stress disorder. So we've used for decades now, we've used PTSD as the easy button. And when we do that to a hyper-risk professional, we're saying, oh, all of your problems that you think

you have all fit into one bucket. We call it PTSD. And we only treat that with two issues, two treatments, psychotherapy and a bucket full of psychiatric medications. And so the concept of operator syndrome is that that's a fail and that we need to be looking at brain health, so traumatic brain injuries, hormonal dysregulation, sleep dysregulation, sleep apnea, chronic joint pain, chronic headaches, cognitive problems that develop over time. And yes, some psychological issues, anger, depression, general anxiety, addiction, and even a little

PTSD, although let me say this, what I don't see in the guys I work with and the gals I work with, I don't see the fury activity or the avoidance of triggers that are associated with PTSD. So for myself, I don't really, although I'm a so-called PTSD expert, according to some people, I don't see it. That's not the problem. It's interesting. Yeah, I don't want to derail, but about the post-motic stress stuff. I'll talk about that later.

But first off, please tell us your origin story. Where did you grow up? How did you get into medicine? Oh, okay. Well, so I grew up in a lot of different places. My dad was a physician. He commissioned in the Air Force in the early 60s. So he was a Vietnam. He became a veteran of the Vietnam War a few years later as a physician. We lived all over. I think of the Midwest is primarily my home, although I was born in New York. city. I went to high school in Missouri, Wisconsin, Michigan. I did my graduate training in Ohio. And then I got a PhD in clinical psychology in South Florida, Tampa, Florida. And that was

the kind of the beginning of my journey of my career working with veterans and service members. So can, like around what year, is that? And then like what was your initial impressions of veterans at that time? And then how, if that changed over the years, how did it change? Yeah. Yeah. Okay. Well, let me go back to my childhood. Sure. I was, I was probably about five years old when my father was served in Vietnam. And I think that was 68, 67, 68. My great-grandfather, who lived until, who died when I was 14, So I knew him very well. My great-grandfather was a veteran of the Spanish-American War.

Wow. And he'd fought at the Battle of San Juan Hill. So from both my father and my great-grandfather, I developed a sense of, you know, what it meant to serve, what it meant to be a soldier, as well as that there is a cost associated with that that endures for years after the war and for many people, many soldiers. And that was kind of my wife.

for why I wanted to be a psychologist. So I went to graduate school, started in 1987, graduated in 1992, and to put a little that into a little bit of context, the diagnosis of PTSD was added in 1980, was added to the psychiatric nomenclature in 1980. So when I started graduate school and was already thinking about my dissertation with PTSD, it was a new diagnosis. It only been officially books for about seven years. years.

Prior to PTSD, was shell shock, like, was it a diagnosable thing, or was it just like parlance? Battle fatigue. Yeah, I think it was parlance. And I don't, you know, I wasn't practicing prior to 1980. So I don't really know how it was handled in terms of like VA coding or insurance billing and those sorts of things. But we can trace it all the way back to the Civil War.

and in the years after the Civil War, there was a syndrome that was described by a doctor named De Costa. It became known as either soldier's heart or DeCosta's syndrome, kind of interchangeably. The idea, the concept of it was, were Civil War soldiers were going into see doctors post-war, and they were describing cardiac problems for which there was no pathophysiological basis. that could be identified. And the guys weren't dropping dead of cardiac problems. They were just describing shortness of breath, tightening chests. Guess what?

That's probably panic, panic disorders. And so that was the very beginning of really modern medicine going, wait a minute, there might be something going on here with regard to post-war experiences. In World War I, a different term, kind of came out of that, shell shock. The concept of shell shock at the time was very neurological. And it was the idea that soldiers on the front lines

were exposed to these bombardments of artillery. So flashing, blinding lights, loud booms, vibrations of the earth. And they were needing to be pulled off the line. And then actually they were generally sending them back to Britain, at least the Western allies were sending them back to Britain, arrest homes and it became known as shell shock and it was thought of at the time as being a neurological condition and then it was promptly forgotten when the war was over there's some really classic writings of some of the neurologists at the time who laid out a research agenda for how we

could understand this better but with the war over nobody followed up on it until we got to world war two in world war two we came up with a different conceptualization of it. So in World War II, we called it combat fatigue. And the concept was soldiers, over time, would just get fatigued. And in a sense, they normalized it as a normal reaction, not an extreme reaction. It's just, you know, you can only spend so many days at the front line in combat, and then we've got to pull you off. Now, what they didn't do, they didn't send people to far away rest homes for six months or a year. They pulled soldiers back from the front lines, just a few miles, where they would be in a camp, in a tent with a cot, warm, dry, reasonably good food, and just

three to five days with nothing to do other than to rest and sleep. But then they would be sent back to their units. And the concept of that was actually turned out to be very effective from the, from the perspective of war fighting. We had very few psychiatric casualties during World War II using this concept of giving soldiers rest periodically. Now, if we carry that forward to the combat fatigue concept to Vietnam, that had implications for how we fought that war. So we created, the U.S. military created the Deroz system,

Deros is an acronym for date of expected return from overseas. So it was a one-year tour of duty. If you were in the Army, well, Marines are tougher, so they had to do 13 months. But if you were Army, it was 12 months, Marines 13 months. But you knew when you were coming home if you lived, if you survived, and if you weren't injured to the point of needing to be medevac to out of country. The idea was any soldier could go and fight for a year, knowing that on the this date, they were going to be, they were done.

And so that was, that was a strategy that the military used to mitigate psychiatric casualties. And they included R&R for some, some many soldiers got R&R midway or partway through their year, like a Hawaiian vacation or a trip to Japan or the Philippines. It's fascinating. And then, you know, because shell shock almost, did you read the story about the Marine Unit, the artillery unit in Syria that fired off so many rounds that guys when they came home were seeing ghosts thinking demons were after them like it was yeah yeah yes and so I think where you're going with that is they got it right yeah in World War one they actually got it

more right than not and we have spent now 100 years where we went off in a different direction really a very Freudian direction. The concept of trauma is very Freudian. And I'm not a Freudian. It doesn't mean that trauma doesn't have a conditioning effect or a conditioned reaction to traumatic experiences. I do believe that. But we really pulled way back and we went very psychological

with our concepts here. And we left neurology out of the picture. We left brain health out of the picture, and we turned it all into the psychological thing. And all of our treatments focus on the psychology of responding to trauma experience. And part of the problem there is everybody responds differently. There's genetic differences, there's upbringing differences,

there's training differences. We know that soldiers who are really well trained and are surrounded by tight, you know, spree to core within their units, within their units, that that right there is a huge protective factor for any kind of psychological or psychiatric reaction during a war, during a deployment, as well as after words. So we've actually lost a lot of the good common sense that we used to have in medicine a hundred years ago. And hopefully we're bringing our way back around to getting to picking up where we left off in 27. Yeah, when you mentioned PTSD, it reminded me of an article I had read before the Global War on Terror.

And it was a medical study that they had checked the brains of people who had made it through SFA, Special Force Assessment Selection. They had a higher or lower amount of some neuropeptide. I don't remember the specifics now. But they said that basically it created sort of this like this. Teflon layer where they didn't like revivify memories. They didn't, you know, when something happened, it just kind of was gone. And so there was this idea that these guys would have a lower incidence of post-traumatic stress. But then after the GWAT, it left me wondering, you know, what's all this post-traumatic stress?

But, you know, you're saying that it's not just that. You know, that it's a combination of all these things. It's not. It's not just that. I mean, let's go to the extreme nature of what it means to train to be an operator or anything adjacent to that. It involves an enormous amount of physicality, rucking, lifting, running, combatives, jumping out of airplanes, repelling, maybe diving, tactical driving. So these are all things that are not easy on the body. Then you add on top of that the sleep deprivation, which is both necessary for training and combat. I mean, it's an inherent part of it, but it's also part of the selection and assessment strategies of, you know, you've got to go, you've got to stay awake for five days. And we're going to see if you can do that and keep functioning as part of the selection. Then you have the blast exposures. And I think blast exposures are the signature injury of global war on terror.

We haven't admitted that, but I think we are, if we get right, we're going to come around to that understanding. Training with demolitions, with shoulder-fired rockets, breaching, sniper rifles, even handguns involved microblasts. And now we know that for about eight years now, nine years now, we've, we've, we have some inkling of what blasts, due to the brain, which is very different from anything we've ever understood before, and it's a different type of injury than an impact force is. So blasts have a shearing effect through the body, and what was revealed in a study published in 2016, is that the shearing effects leave the glial cells in the nervous system scarred.

So each neuron in our system, those are the messenger cells, has about 10 glial cells as its support network. They hold the neurons in place. They protect them. They insulate them. They take out the toxins. And they get damaged from blast exposures. So you get this scarring pattern in the brains.

It's very different from the amyloid plaques, the tau proteins that can develop and build up after an accumulation of, of impact force blows to the head. Hey guys, it's Jack. I want to tell you guys about the sponsor for today's show. It's Mando. Mando makes a whole series of male grooming products. They are unique in that there are a deodorant

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or at least understand the effect that they've had. That's very new. And, like, has the VA or a lot of other organizations, caught up with that, or is everything still just post-traumatic stress? Well, so I'm not in the VA. Right, right. I don't know exactly what happens in the VA, but I talked to a lot of people who either work there or veterans like yourself who may have tried to use the VA.

The VA has for, since the 1980s, has invested heavily in PTSD treatment programs. There are, there's a network called the National Centers for PTSD and there's seven or eight of them around the country in the VA. They're funded by Congress. So they have separate funding. And so we've built a huge industry in the VA around PTSD. And the people that run these centers that run these networks, many of them are scientists, clinical scientists. And so when you look at even NIH funding, NIH grant panels often have many VA investigators on there. When you look at the journals, the medical journals, the psychology journals related to trauma, many of them are led by VA employees.

And so the VA is a very, very powerful force for supporting the construct of PTSD. and the treatment for it. And they've been very influential on DOD and every other part of our Western mental health systems. Law enforcement, firefighters, when they have trouble, if they're having difficulties, they often are almost immediately diagnosed with PTSD. And so maybe rephrase your question again.

So we've kind of gotten away far away from, where we were in 1917. We know TBI is a problem for soldiers. We know it, know it, but we don't really act on that knowledge very efficiently. You go ahead and hear TBI and PBST clumped together as if they're the same thing.

Right. If they're similar, we can't tell them apart. Do you think, do you think that one of the reasons that like TBI isn't, and blast exposure isn't as recognized because they don't really know what to do about it right now? Maybe in part. We don't understand it very well. It's hard to evaluate

in a truly objective fashion. I mean, I can talk to you in half an hour. I can figure out if you probably have TBI, but I would be asking questions that other doctors might not ask. And in terms of like doing an MRI and cognitive performance testing and getting that kind of data, that's both expensive and complicated and highly imperfect because an MRI doesn't necessarily show us brain damage, especially at the cellular level. So when we talk about the tau proteins or the glial cell scarring associated with chronic traumatic encephalopathy or what's now been called interface astroglyle scarring, the only way to really know that and look at that is post-mortem. So we have to wait until somebody's dead before we can actually go into their brain at the level that pathologists do.

So we are hampered by ignorance. We are hampered by a lack of really good technology to really explain things. We're also hampered by what I'll refer to as a little bit of a deep state in the VA system. So when the global war on terror started, almost 20, years ago. The VA system was what it was, and hasn't really evolved much since. Everybody who had the power, who had the empires, who had the clinics and the centers and the research funding, they weren't immediately, they weren't changing directions or switching lanes very, very rapidly, if at all. And so I think the problem we have today

is, and PTSD is the number one injury that you see, me be careful about it. It's one of the top injuries that you see in VA disability claims. So it's been so deeply ingrained and codified in the VA's policies, in the clinicians, and even in the veterans and the patients. It's a term that gets, you know, that gets thrown about and used widely. Could we do better? Absolutely. We absolutely can do better. And where is the VA changing? I'm not sure, but I do know they have five polytrauma centers, what they call polytrauma centers. And one of those centers, I think, is soon going to incorporate the word or the phrase operator syndrome into the name of their program.

And they're certainly using the concept, the construct, and the framework in what they're doing now. That's fantastic. Yeah. When we get further on, I want you to kind of give us more on the VA, because you mentioned some really interesting things in your book. So you start out, your focus on post-traumatic stress when it's relatively new. And really, what did people know about post-traumatic stress from the movies in the 70s and 80s?

And even up until today is that somebody has flashbacks, they think that, you know, Charlie's in the wire. And they kill everybody in the office, right? Yeah, yeah, yeah. And really interesting question that we can wonder about here. did Hollywood create the PTSD that we have today? Did all those movies in the 70s that used flashbacks as a plot device, did that create what we now have as a symptom of PTSD? I have never had a patient, even in my years at the PTSD clinics,

who really had what you often saw in the movies. where they grew flashback that involved them acting as if they were back in that scenario. And an interesting study that was done probably 15 or 20 years ago by the Brits. We've got some of the great research happening with veterans as comes out of Britain. And what these guys did was they got all of the, they got the medical records from the Boer War fought at the very, end of the 19th century, early 20th century. So they got the military records of British soldiers who fought in South Africa. And they went through them, just qualitatively reading through them,

looking for symptoms of PTSD. And they found a lot of symptoms of PTSD, but notably there was one thing they didn't find any reports of in the medical records, and that was flashbacks. They didn't find any evidence of people describing these dissociative episodes, where they thought they were reliving or re-back in a moment of combat and acting accordingly. They didn't find it.

That may just be a modern invention. Yeah. Thank you, Hall. Yeah. And it's interesting because, like, people, they're still very influenced by that idea today. I remember when the whole, I don't know, maybe during Trump's first term, maybe it was Obama. But, you know, there was a school shooting and there was the argument about, like, arming veterans, you know, to guard schools.

And, you know, a couple of people that I knew in New York were like, no, they can't do that because the veterans might have post-traumatic stress and they'll shoot all the kids. It's like, that's not how it works at all. No. That's a, yeah, that's a sad. Well, that's a sad outcome of the fact that half of all veterans of the G-W, it's probably more than half now, are rated. disabled by the VA for PTSD.

If anybody who served in a war zone, that's the diagnosis that they can very easily get. And it does, it is compensable. The problem there is, what kind of message does that send us? Mm-hmm. Society. We have a whole society who's now walking around with this wrongful notion in their heads that soldiers, that soldiers who, who, who deployed to war are broken, damaged,

likely to snap, risky, dangerous. And we don't think of them as likely to be good fathers, good husbands, good members of a community, good workers, good spouses. And nothing can be further from the truth if we look at the data, but most people just go with the stereotypes. One thing that really disturbs me, and I see this a lot nowadays, is divorces, a mother going through a divorce with somebody who's formerly, you know, an operator or another high-risk professional, often will report to the court, to the judge, that their husband is a risk, is dangerous, and they're afraid of them because of PTSD.

and judges seem to look at that and go, okay, yep, that makes sense. So maybe there's a restraining order. Maybe visits with children only happen on a very limited basis with supervision. And I just can't even begin to extol the tragedy of veteran and responder fathers who are losing enormously in their divorce. divorce settlements and custody settlements because of some wrongful myths or beliefs about PTSD

and how their service, how their work may have affected them. Yeah. And, you know, we're trying to normalize the idea of post-traumatic stress, operative syndrome, you know, blast exposure, things like that. But what veteran is going to come forward,

what male veteran is going to come forward, when that's a looming possibility. It's like red flag laws. You know, it's like red flag laws. And what veteran is going to, like, say they have post-traumatic stress or anything else going on if they might not ever be able to own a weapon again? That's right. That's right.

I have a good friend who is a DEA agent, and he's in his early 50s. He actually spent five years as a DEA agent in Afghanistan, running and gunning with drug interdictions, functioning very much like an operator, never mind, not to mention what he does in the U.S. And part of his story is a few years ago, he raised his hand and said, I'm not doing well, and I need help.

And he was one of the senior, he wasn't the sack, but he was one of the senior agents in his regional office. And leadership there took his gun away from him. They put him on a desk. And he was told almost right off the bat by somebody in HR, that he certainly probably almost certainly had PTSD,

and they were going to refer him for PTSD treatment, which they did. And he went along with it. He was trying to be a good team player. He went along with it for several months. And what he found was the diagnosis didn't make sense to him. The treatment didn't make any sense to him. And he just stuck it out. He went through the motions.

And about a year ago, you read the Operator's Syndrome book. and I actually met him at an event and we became friends since then. And that's part of his story is he modeled for the younger guys in his region in his office that, hey, it's, you know, it's okay to say you need some help. And then he was punished for it. Right. And so, you know, he got slapped pretty significantly for about two years. Now, he used the operator syndrome framework and he got some of the right treatments for himself. and he's now back functioning, operating again.

He's back at the full duty that he wants. But that is such a common experience. And I'll even give you another example. Probably about 10 years ago, yeah, about 10 years ago, there were some of the psychologists who were with Naval Special Warfare out on the East Coast. One was the lead, you know, they were leaders at some of the teams out there, including development group. and they had operators, they had SEALs and EOD technicians who they realized weren't going to talk to them

because they didn't want to get pulled off of potential deployments. And so for a while there, they were referring them my way. And, you know, I'm not in the military. I'm not in the VA. I'm not in any of the command structures. So that was their thinking, hey, talk to this guy. he might be able to help and he's not going to nothing is going to be put into your official records. So, you know, if I, so to this point today, I've probably worked individually with 600, 650.

Wow. Operators over the last 12 years or so. Most, more than half of that has been entirely pro bono. The other half of it or less than half of it has been through work I've done for some some attorneys working with private defense contractors who needed to be evaluated for for treatments and for insurance claims. So I was able to take advantage of that to do full evaluations using the operator's syndrome framework. So let's, so you start out your, do you say your graduate thesis was on post-traumatic stress?

Yes. Okay. Yeah, my dissertation. Your dissertation, all right. So, you have to forget the, I'm. uneducated amongst us who don't know the difference. But so your dissertation is on post-traumatic stress. And so what was post-traumatic stress at that time?

What did you learn? What did you discover? Well, I don't want to bore the world with my dissertation because that was not a terribly important study. But maybe the question you're asking is, from today was, PTSD different at that time in the 1980s, early 90s. And the answer is it was different.

We change the DSM every 10 to 15 years. We are currently using the fifth edition of the DSM. And I'm sorry, I should say what the DSM is. DSM is the diagnostic and statistical manual for psychiatric illnesses. So it's put out, it's a book that is created and put out by the American Psychiatric Association. and it's a catalog of all the psychiatric diagnoses that we recognize. And it says what their symptoms are and some other information about it. So PTSD was added to the DSM in 1980 for the third edition.

The fourth edition came out in 94 and the fifth edition came out in 2013. And each of those two times, there's been significant additions or changes to the definition. And I think this is actually an important question that you've asked. The original definition of PTSD was fairly simple and straightforward. It involved a trauma that was considered to be, quote, outside the range of normal, usual human experience, such as combat, such as being sexually assaulted. And it was primarily the whole, all the symptoms were around the concept of fear. fear reactivity and avoidance of things that might stimulate or trigger that fear. It got watered down a little bit in 1994.

They took out some of the wording about outside the range of human experience. So now it's just a traumatic experience that involved the sense of fear, helplessness or horror at the time. In 2013, they took even that out. out. So our current definition, while it involves, you know, you have to have trauma to have post trauma stress, the definition of trauma is very nebulous. It's really left open to the interpretation of the individual. VA took it one step forward in 2010. They actually passed a lot in the federal registry that a veteran meets the criteria for PTSD for the trauma.

part of PTSD if the veteran ever set foot in a war zone during their military career. Doesn't say anything about what they do, what they did, what they saw, what they experienced, just merely being there for a day or maybe even less than a day, just merely having been there counts as the criterion A trauma for the diagnosis. Wow. We could go off, you guys know this, we could go off on a whole, conversation about society and how everything now has become defined as stressful or traumatic. I mean, I imagine some of that is also a reaction to the huge number of veteran suicides that VA was getting a lot of bad press for at the time.

And hiding for a while. Yeah. And by the way, they still are. They've not brought those numbers down at all. Yeah. Those numbers have stayed the same no matter what they've done. And, I mean, we are in a society now where trauma seems to be political currency or social currency. Students, college students will proudly tell you they have PTSD and a childhood of trauma.

Now, sometimes I don't, you know, I don't go digging or exploring, but I have certainly found many examples where somebody has described trauma. and when they describe it, you have a little bit of a, hmm, sounds stressful. It doesn't sound traumatic, though. So I think we've changed the threshold of what trauma is. That's one thing. The other thing we did in 2013 with the revised diagnosis of PTSD is we added a lot of symptoms in there related to general anxiety and depression. And if you take the questionnaire that's most commonly used, it's called, the PTSD checklist. Everybody uses it. It's a one-page, simple checklist form. You can give that to

anybody who does not have a traumatic history at all, but if they have depression or anxiety, they're going to score as if they have high levels of PTSD. So we've turned it into a diagnosis that really doesn't have any sensitivity to separate one patient from another. Hey, guys, our show is sponsored by GhostBad. Check them out. Please. that make awesome mattresses, awesome pillows, awesome bedding. Ghostbred provides high quality and super comfortable award-winning mattresses crafted in the U.S. and Canada. Did you know that 60% of U.S. adults report being too hot when they're trying to sleep? That's me.

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But I think it's like you say, it's sort of this opening up of society so that everybody's lived experience is as equal to the next person's lived experience. And, you know, if somebody yelling at me in the street is traumatic, then who's to say it's not if I say it is, right? So as you were like, you know, as the GWAT was progressing and you were in this field, what were some of the things that you were seeing that would eventually lead you to the operator, the operator syndrome? Well, so the story is pretty organic. I left VA in 2006. So that was just as we were starting to get.

the veterans from the GWAT, the first sort of wave of them coming into the VA. So I left just as we were starting to get GWAT veterans coming in. So clinically I didn't have a whole lot of experience with them. In about six years later, I was working in Houston, Texas. Actually, I had my job here at the University of Hawaii, and I had a job at Baylor College of Medicine. So I was commuting every month, spending a week in Houston. And there's a small foundation that had just started up there.

They had been started by a former naval officer and a recently separated Navy SEAL who had been together. And they had been kind of there the night that extortion 17 went down. And they were helping identify bodies and things like that. I think they kind of had a bond. So they started this small foundation that in Houston, Houston, which was at the time initially it was really just, it was like a happy hour thing. You know, every two weeks, all of the soft community in the city of Houston were invited to come together for this. And it was, it wasn't just Navy. It was Army, Marines, Air Force. They had a lot of

guys from the intelligence world, including at least one guy who'd been on the bin Laden task force for many years. And it was really just intention. to be a chance to get guys together just to kind of hang out and connect with each other and maybe make some job connections, employment connections and that kind of thing. And early on, when they invited me to start attending their meetings, what happened was a lot of guys would come up to me, you know, kind of one-on-one privately, ask if they could talk. And then we'd set that up and I would do that, you know, separately. And the typical complaint that I would hear would be go something like this.

Doc, I don't know what's wrong with me, but I don't feel like I used to feel. I don't function or perform like I used to. I'm tired. I'm apathetic. I don't want to work out. I don't really have much interest in sex. My girlfriend's beautiful,

but just not that interested. Trouble concentrating, trouble motivating, not sleeping. And I assumed, I did what psychologists did then and do still today, I assumed it was PTSD initially until I started talking with these guys

and getting to know them. And at some level, you know, within probably the first month or two, a couple of months, really realized this isn't PTSD. This is something different here. So traumatic brain injury and depression were kind of the two next big hypotheses. But did some stuff, some trial and error stuff

that kind of shocked me. including we were getting blood panels and the testosterone levels that came back were really low. I hadn't seen, did not expect that at all. Why does this 37 year old former Navy SEAL who looks healthy, who looks well, who looks big and muscular, why does he have the same testosterone level of an 80 year old man? Sleep studies, they kept coming back with sleep apnea, which didn't make any sense to me either. Why do these late 30s, early 40 guys, why are they having sleep apnea? That didn't compute for me.

Also, through my research program, we had a ticket and all you could scan at the Baylor College of Medicine brain neuroimaging center. So I was taking all of my research subjects from the hospital, we're getting their brain scan. So let's try this with some of these operators. We put them through the same protocol. and working with the neurologist friend of mine looking at them, what his reaction was was, well, these, and all I told him, these are men. He didn't know what he was looking at, not really. So these are men, and he looked at him and he's just like,

so these look like relatively healthy brains, no lesions, no tumors, no great big white matter spots, relatively healthy brains for an 80-year-old man. he thought he was looking at elderly braids because of the ventricle atrophy. So now it's like, holy shit. And I wasn't, you know, these guys were not describing these index events of head injuries. They weren't, none of them were diagnosed with traumatic brain injury. None of them had any history of being blown up, like in an IED explosion. So they didn't, none of them were even had even been evaluated for a TBI.

And so that became part of what we were doing. And then the more we, the more, you know, the more I talked with these guys and then their friends and then their friends, it was a snowball thing that happened. All just had the same pattern over and over again. Every single guy had evidence of TBI, evidence of low testosterone and other hormonal dysregulation, insomnia, sleep. apnea, chronic pain, chronic headaches, cognitive impairments. Then of course, social impairments, that all bleeds out into your family life, your marital life, your work, other aspects of your world. And that's when I started in my own thoughts thinking, this is a syndrome. This is not a simple one diagnosis. These all go together. And when we go, well, why does somebody how, why would a man

and 37-year-old seal have low testosterone. And then you go through, well, why wouldn't he have low testosterone? And it's probably multiple factors, the brain injury. So the pituitary is the master gland that's in the brain. The high-op tempo of never taking a knee, of going, going, going, never quit. You come back from deployment, you start training. you go through intense training evolutions.

So there isn't a time. There just isn't time for the cortisol and other stress hormones to normalize. Hasn't it also been linked to like sleep deprivation and poor diet, stress, like burns out the endocrine system? So TBI, sleep deprivation, sleep problems, that high op tempo, poor diet, alcohol abuse, chronic pain.

Yeah. So all these things go together. and teasing them out, well, what percentage is related to blasts versus a high op tempo? I don't know. I don't know that we're ever going to know that. And at least for right now, it doesn't matter. We got to jump on this body, this body of injuries and impairments and treat it now because guys are, you know, they're hurting. They're losing the good things in their life, their marriages, their jobs.

and we do have a very serious suicide rate in all of the high profession, high-risk professionals. Chris, where does the sleep apnea come from? Because that's not something you think of a relatively fit guy having. Totally. And I don't know. I don't know the answer to that. Is it come from some aspect of the TBI? does it come from some aspect of neck and head, you know, muscular injuries in this area?

Is it something that builds up over time when you're just not sleeping and not getting enough quality sleep? So I'm going to just, like, I'm ignorant. I don't know the answer to your question. I don't know that anybody does. So how were you putting together this framework as you were capturing it? because in your book, like there are, I don't remember how many chapters, but there were like 12, 15 chapters of like different things. How were you compiling that?

Yeah. You know, early on, I wrote up a document for myself, which was just kind of notes. And then I thought, you know what, I need something to educate and share information with the guys I'm talking to and their spouses. So I took that document and I gave it a title, a title that the operator's sleep manual. No operator wants to talk about mental health.

I don't blame them. So let's talk about sleep. And when you put everything it takes to sleep better, you're really taking care of everything. So that was the hook that was sleep. The way the army gets them is they call it like, what is it like performance enhancement or something like that that, like evaluating you and to,

improve your performance and they can get guys into the clinic for that? Yeah, that's exactly right. You want to perform better in sleep. You got to do these things. Yeah, yeah. And as I was learning, I just, that document was a living document. So it kept getting longer. It kept getting, having things added to it.

And at some point in 2018 or 19 with some colleagues, we took that document and we turned it into a paper that we submitted to medical journal and it was published. And so that's the 2020 medical paper titled Operator Syndrome. And just for your readers, anybody can find that online. If you just Google or do a search for Operator Syndrome medical paper, it should come right up. It'll be a PDF. You can print it off. It's actually pretty easy to understand because it was written initially as a document to help educate operators and their spouses.

Now, Chris, you start running in. First off, you talked about the VA earlier. And one thing you mentioned in your book was, you know, is like I didn't know that the VA research in order to be a researcher, you had to be a VA employee. Like they don't take research from anyplace else. But you also ran into people who were like, no, like soft guys. Like we don't like don't make them pre-badonna's like social justice demands that they don't get any special attention. Like people were trying to shut you down, right? Yeah, well, maybe some people trying to shut me down.

I certainly have been on the receiving end of some, you know, some arrows here and there. The VA does not, I mean, some of the people from the VA PTSD world, I would say, really don't want to hear this. One of the leaders in the VA said to me in a meeting, she said, well, this is all kind of silly because their problems are really PTSD. And I will, I said, well, what do you base that on? She goes, well, they all have very high scores on the PCL checklist. Okay, so now we go down to this, we go down this little rabbit hole of PTSD checklist, measures a lot of things, it's not very specific to PTSD. I also asked her about her, about her data.

Where do you get these 150 operators you say you have? Well, they come to our clinic. Okay. How do you know their operators? Oh, well, they self-identify. Do you know what branches? No, we don't have that. Do you know what kind of units?

No, we don't have that. Do you have anything on their deployments? No, we don't have it. So all she had is people saying that they had been an operator without any other details. And she didn't seem to understand why that might be a problem or a concern. And I said, well, you know, most of the guys I talk to in interview and talk to you very deeply at length, don't report these symptoms of these very specific symptoms of PTSD. And her response to that was she just kind of smile and goes, yeah, that's denial.

They're all in denial. Wow. And so it's a no-win situation with somebody like that. You either endorse all the symptoms and you have PTSD or you don't endorse the symptoms and then you're in denial and you have PTSD. Right. So no matter what, you're going to have it. So there's a little bit of that.

We were trying to get a program funded at Houston Methodist Hospital. some years ago. And a large site visitor team came out and met with us. There were, I think, six or seven of them. This was the Marcus Brain Health folks. And in working with the Green Beret, who was the veteran's point person for this group, I'd been in comms with him for probably about six months by this time. And I thought we were going to be funded. I thought that, This was almost more of a formality. And it came out, and the guy, the neurologist, a neurosist named Jim Kelly, who was the leader of the team in the first five minutes,

literally the very beginning of the day. We had a whole day and an evening blocked out to spend with them. And as we were going through our sort of our opening introductions, when he realized that we were only proposing to treat operators in our program, he said, nope, I won't approve that. And he didn't stand up and leave at that point, but mentally he did. He didn't participate in the discussions or the meetings the rest of the time. In fact, when we met with the hospital, the CEO of the hospital later that day,

he sat in this nice mahogany walled office and pretended to fall asleep during that meeting. What he said was, we're not going to do this, we're not going to fund this, it's not right, it's not fair. operators have already been treated special. They're all careers, and we're going to treat everybody. We have it's socially just to give the same treatment available to anybody. And his own point person, the Green Beret, sitting at the table, said to him, well, wait, hold on. We're talking here about a group of operators as a group of people who have unique injuries, unique experiences, unique exposures.

So the idea, I mean, he laid out what I had already given to him, which is it's not about doing something special for somebody, special, special. It's about giving every patient the treatment they need to be well and healthy. And for somebody whose job took them to very specific certain types of experiences that would produce injuries, we have a responsibility as a nation, as a society, to give those. individuals the treatments that they need. That did not fly. He was not persuaded by that. So that didn't.

So we didn't get the funding for that. It just died right there in that moment. And it's sad too because just like in the military, things that, you know, soft gets that the rest of the army does or the rest of the military doesn't eventually, you know, trickle down. You'd trickle down. That's true. That's right.

So. So had this gotten off the ground with, you know, with the operators, then it would have become a platform for, you know, those infantry units that we're out there hooking and jabbing all the time. And I see what you're saying, though, also that, you know, with operators, you know, or soft guys, you know what that group is, right? You know what they've been through. With everybody else in the military, there are infantry guys and Marines who were out there. like in it, right, slugging away. But with this really broad expanse of thing of post-traumatic stress, suddenly you guys get flooded with, you know,

people who spent their time, you know, behind the wire the whole time. Right. And so you're exactly right about that. And so that becomes, you know, that's also a real problem for the VA is most clinicians, most people in civilian society don't understand that when you think of the Department of Defense and the different branches, there are people, there are soldiers who are in the combat arms

and then there are soldiers who do all the other things, very important things, critical things. But that doesn't mean they're being shot at or shooting at enemy. And we really have, I mean, I don't know the exact proportion, but I think it's about a third of soldiers are in the combat arms and about two-thirds are in play these very important support roles for those in the combat arms. And we never talk about the difference there. Never even heard about it when I worked at the VA.

I came to realize it myself because I read a lot and I talk to a lot of people. But I don't think your average VA clinician really has that awareness. Right. And so when they get a patient who comes in and says, Doc, I have PTSD, and yeah, I served in Iraq for a year. There isn't an understanding. They can't even picture what was in Iraq. They don't know what the bases or the fobs

or the different regions were about. They don't know that if this person was a mechanic, they were likely to be doing certain things that would be very different from somebody who was infantry. And of course, even there, you know, we know that some of those mechanics did end up out at remote fobs. maybe stationed there or moving around and rotating.

So those mechanics also may have experienced quite a bit of indirect fire or whatever. And so they may themselves be different from others who are not in the combat arms. We're just not, we just haven't done a very sensible job of training medical clinicians, right, on these nuances. Well, and it's like you say, like with them opening up the definition of post-traumatic stress and what trauma is, I mean, I'm sure somebody who is in one firefight one time at their base or got rocketed and, you know, maybe somebody was heard or whatever, I'm sure that was traumatic for them, right? No question. But then to take that and then to try to compare that to, like you say, the allistatic load that people who were doing it,

over and over and over every night. You know, it's so, you know, where, like, you have to draw a line somewhere when you're starting out a pilot program like this. Yeah, yeah, yeah, that's right. Here's another experience that happened kind of along these lines. So it isn't just the VA, and it isn't just the PTSD industry folks. It's also, I think, officers in some corners of SOCOM. So I had heard for a number of years from people who, you know, were a little bit on the inside that the generals and admirals at Socom really didn't want to hear about operator syndrome.

They weren't curious. It wasn't something they wanted to know about. I presented last year to a civilian foundation and or to a foundation, not not active military. And in the room, in the audience was a recently retired admiral. I say recent, last five years, retired admiral who had more than one star. And he stood up after my short presentation and he said, I don't like this. I haven't read your book, but your ideas seem very dangerous. And he was in part talking about things he'd been thinking and hearing for several years

because he referenced the medical paper. But he essentially said, you know, shame on you. These ideas are dangerous. They're going to hurt recruitment. And it sends the wrong message about, you know, operators and who they are and what they are. The very next person to stand up in that room was,

I think she was a social worker from the Warrior Care Coalition. And she completely pushed back on him. She said, sir, you know, I got to disagree. We use this. It's relevant. It resonates. And it has been what we've used successfully to get so many guys to engage in various treatments that they need.

And so by labeling it as a dangerous idea or a dangerous concept and just saying we're going to ignore it and not even engage in the conversation is going to be really harmful to, you know, to so many people. I think the military has been very, let's just politely say they've been very slow to recognize traumatic brain injury. And, you know, this part is, I would speculate that it may be because they're concerned about personnel issues, that they'll have to take people off of their positions to be treated and may be discharged out of the military. Like I spoke to a senior, he was a senior leader in Delta Force where they started putting the sensors on their bodies to measure blast over pressure. And he wasn't in denial about it. He was like, yes, this is a real thing.

It's a real issue. But his point was, if we're going to avoid blast over pressure, it becomes that we can't do our job, from riding on helicopters, shooting guns, explosive breaches, all of these things. Well, we have to stipulate that, of course, that we are not going to stop training. We have to do those things. Those are, you can't, you can't, you don't have special operations. You don't have soldiers if you don't train.

So there's no part of me saying we need to stop training. And I'm not even saying we need to train less or differently. I don't know, that's not my area of expertise. There probably are ways in which we could train smarter. People will find, smart people will find. More people will find those. But I think what we can do to mitigate those injuries along the way. along during the career.

There's many things we can do that don't involve, you know, that aren't complicated, aren't expensive, aren't, getting the soldiers baseline. Yeah. That would be one.

Yeah. Getting baselines of cognitive functioning, hormone levels, probably a handful of other things. It's interesting, though, because that admiral was basically saying, fuck the guys who are suffering.

We need more guys. Like, let those guys. guys suffer. Like, we're done with them. We've used them. We're not worried about them. Thanks, bro. We don't want the bad PR. And it's very short-sighted anyway because, like, anybody who, like, saw Muhammad Ali when he was later on in life, that didn't stop the boxing injury or industry. Like, football, you know, never suffered from knowing all the things that those guys go through. When you're young, you think you're invulnerable. You don't think about the

future. You're not worried about it. You're like, I want to do this thing, I'm going to do this thing. Yeah. Yeah, and actually that you're absolutely right. I don't think the fear of death or injury keeps people from going into special operations. Because if it did, there wouldn't be anybody in special operations. So it's kind of a, it's almost a ridiculous argument to make. And we were a year ago, we did have a recruitment problem in the U.S. military.

And that has changed under the current presidential. administration. So maybe the problem wasn't so much operator syndrome as it was other things. I, you know, this, this resistance to anything new, certainly in medicine, but probably everywhere, is something that takes a little time to fade away. What I'm seeing now is more of the leaders, the one in the two-star office flag officers. Many of them are people that I'm I may have known five or 10 years ago before they got a star on their shoulder. So they've kind of almost like come through the ranks with some awareness and understanding. And their perceptions are going to be very different.

So I have some level of optimism that there's going to be more openness. I did the last year, last May I was invited to present at Soft Week in Tampa. So I did that. that was kind of a marker of maybe a little bit of a change. And then in January of this year, I recorded a podcast for, I did the Socom podcast with Matt Parrish. And it hasn't been published yet because something happened in the recording, so we got to re-record it. But my sense of even being asked to be on that is also a marker of there's more interest and there's more willingness to. engage this specific conversation.

Chris, I want to check how we're doing on time because, all right. Now we're in, I think. Yeah, okay. Because I actually want to ask you or just kind of go over a few of the things you mentioned, just for anybody who's watching, you know, maybe you know somebody, you are somebody or know somebody. So the syndrome, you start out with TBI's, sleep disturbance, a sleep disorder, How big is the sleep disturbance sleep disorder aspect of this? Massive. It's massive.

Sleep is so important for our health. We can't think of it as optional anymore. And what we know today, we didn't know 10 years ago. Sleep is critical for every body bodily function. So if you're not getting enough sleep, your body is not going to regulate its metabolism well. So you're going to gain weight. If you're not getting enough sleep, your hormones aren't going to get produced and managed and regulated. Everything in our body has some aspect where it needs sleep.

And when we talk about sleep, we need several things. One is we need enough of it. So seven and a half or eight hours for most of us. We need time, sufficient time in REM state and slow wave state sleep. each of those states has very specific purposes things that happen in those states and we really need to sleep most more or less through the night without a lot of interruptions and awakenings

so that we can go through our normal sleep cycles REM sleep is when our cognition is really being sharpened our experiences and things that we we learn during the day are being sorted through and made you know and we're making sense out of things. When we're in slow wave sleep, that's when our testosterone is being produced. That's when our body is healing.

If we're sick or fighting off an infection anywhere, that's very important time to have more time in slow wave sleep. We also know that during slow wave sleep, that's when our brain is cleaning itself. Those glial cells are taking out the toxins that build up in the neurons. So if we, if we, if we don't get enough of that good sleep,

all of our physiological systems are getting wrecked. And we're not recovering. And we're going to gain weight. And our hormones are going to be a mess. And our cognitive functioning is going to be very much suboptimal. And over time, we're aging ourselves and slowly killing ourselves if we're really, really not getting the sleep we need. And, you know, you mentioned, you know, people using penderdrill.

You brought up like ambient, the hypnotics and, you know, and things like bat, but none of those are good long-term solutions, right? Yeah, right. Your best bet, I mean, yeah, we have medications that will put you to sleep. The problem is they aren't going to give you the quality of sleep that you need, and it may not be sleep that's any good at all. So just because you're unconscious doesn't mean that you're getting good sleep. Well, I mean, yeah.

I was going to say the other problem with Ambien is you end up with an Amazon order of, like a whole bunch of D&D books or you know you find out that you tried to make candy by putting a whole bunch of honey. Well that happens if you're drinking too to get to sleep. Yeah. Yeah, I mean, the things I've done on Ambien, like, because

I didn't fall right asleep. Did you say D&D books, Dungeons and Dragons? Oh yeah. Yeah. Yeah, a whole like stack of fifth edition. Not a books. I bought it all. Yeah. Yeah. But like cooking while I'm on it like crazy

with no recollection I've known guys that have woken up in the morning and discovered they cooked and ate an entire meal yeah I've done that I've done that shave off their beard I have not done that walked into the bathroom in the morning

looked in the mirror and just about jumped out of their skin I know guys that have gone for a ride in the middle of the night they wake up why is my truck parked to the front yard and start realizing, oh, here's the receipt from 7-Eleven. Oh, I bought some cigarettes. I don't even smoke.

Why did I buy cigarettes and smoke two of them? Yeah. These are not meditations to take lightly. And there's the panic you check all your social media and make sure that you didn't like workposts. But generally, even if you do post, it's unintelligible. Like, nobody knows what it is. Yeah.

Did I mention monkeys with wings one time to you, Derek? I don't know. Anyway, hormonal dysfunction. That's a big one too, right? Huge, huge. For a man with low testosterone, it isn't just that that affects sex drive and sex performance. Low testosterone for a man is going to mimic depression.

That guy is going to feel tired no matter how much sleep he gets, although low testosterone also contributes to insomnia. It's going to affect his concentration, his muscle man. his energy, his motivation. He's going to be irritable and cranky. He's going to look in the mirror and his face isn't going to look the same. He's going to be like,

why do I have this extra flesh around my jaw and my neck? And maybe at the extreme end of it, gynecomastia man boobs can develop in some guys. Now that's usually when testosterone is down for a long time and estrogen is up for a significant period of time. But that's why I say get a full panel, not just testosterone,

because it might be thyroid, it could be human growth hormone, it could be estrogen, it could be all of them affected. Well, and like the next one is chronic pain and headaches. And like it's all, it almost seems like it's all this cascade and you don't know like which came first. Am I not sleeping because like lying on either shoulder hurts? and then I can't sleep so my testosterone goes down, which means that everything,

like it's just a nonstop loop, isn't it? Everything is interrelated. Yeah. And that's the bad news when you talk about an injury to one system, but it's also the good news when we talk about an intervention for one system. So if we can help you sleep better, there will be a ripple effect of benefits. If we treat your testosterone,

whether that's with testosterone, testosterone replacement therapy or something else. And there are other ways of treating it for many people. As the testosterone comes back up, we're going to start to see better sleep, which is going to need to better brain health, better cognitive clarity. And we have treatments now that we know are really effective, not just for treating the psychological aspect of things, but for example, stella ganglion block, ketamine infusions.

These are treatments that have pretty quick, and profound benefits to existential concerns, to depression, anxiety, but they also, we're pretty sure now stimulate neurogenerativity. Interesting. Meaning we're, now we're growing new neurons. We're growing new connections in the brain. And so we're not just, like the Stelli Ganglion Block

is a one, it's basically a one stop outpatient procedure, just takes a few minutes, inject the medicine into the nerve, the Steli-ganglian nerve, that's the sympathetic nervous system that brings that fight or flight arousal down. So a lot of guys and gals in the high-risk professions are just baseline day in, day out, somewhere at a seven, eight, nine

on that physiological arousal. With this shot, it drops that down to a two or a three. So there's a immediate sense of relaxing, of feeling calm, of actually thinking thinking being more sharp cognitively because all that noise isn't going on. But it also, now we also see that this is creating physiological benefits to the brain, to the neurons, the glial cells in the brain. So we're getting better brain health from these interventions as well.

That's fascinating. And then depression, anxiety, anger, hypervigilance, I think is a big one that, you know. And somebody explained it one time that I thought was really good. They said it's like having one foot on the gas and one foot on the break all the time. Yeah, yeah, yeah. Always in the red. Yeah, red line. Post-traumatic.

Oh, please. Yeah, I just, that's just agreeing. That's a good analogy. Yeah. Post-traumatic stress, substance abuse. This was an interesting one to me, was the perceptual system's impairment. Can you talk about that a little bit? Sure.

Well, so if you're playing with toys that go boom, that is going to affect hearing. Blast exposures in particular may affect the delicate muscles around the eyes. TBI in general can affect vision. So a lot of some people describe blurry vision, double vision. TBI also can cause disequilibrium. So some people have trouble with their balance. And that can be mild.

At the mild end, it looks like, well, I'm just a little clumsier than I used to. be or I don't have the same hand-eye coordination that I used to have. At a more extreme level, it can be, it can, it can manifest as vertigo. Dindiness combined with nauseousness or vomiting. And that can be really miserable. Yeah. And we have a treatment for that. It's called vestibular therapy.

And that seems to be really powerfully beneficial for a lot of people. No medications, no surgeries. It's literally, I don't want to say literally. It's physical therapy for the interior, basically. They did that too with the guys that have Havana syndrome. Whole other issue, but they did vestibular therapy, and it did show a lot of results for at least a good number of those people. Oh, okay, very interesting.

Yeah. I just learned something. Well, so again, this is a treatment that is not expensive. It's not invasive. It does not involve a lifetime of being on medications forever. Why are we not making it easy for individuals who need it to get this intervention? Now, would you consider both visual and auditory hallucinations as part of that, or is that something else? Something else.

Okay. Hallucinations, that's more psychosis. Okay. Okay. Cognitive impairments, definitely. Marital family concerns, intimacy concerns, military-divitian transition concerns. Can you talk about that a little bit?

Yeah. Well, let me go back to the emotional intimacy. Okay, please, yeah. There's something I want to say that touches on a few of these. physical intimacy sex is often a challenge a lot of guys will do have erectile dysfunction but also emotional intimacy is a challenge a lot of guys describe feeling numb or they describe not not being able to feel the feelings they know people expect them right to show in certain situations so for some guys that means they fake they show it they show fake

They smile when they know they're supposed to smile. They look sad when they know everybody else is looking sad, that kind of thing. A lot of guys get told by their intimate partners that they're just not very sensitive. Anybody ever told you you're not very sensitive or you're insensitive? I think there's an emotional intimacy piece around patience and sensitivity and empathy. and the empathy threshold gets reset for people who see death and destruction and the horrors that men do perpetrate on each other on a regular basis. And that can lead to, I mean, the way I look at it is just like with anything else in our life that involves a little bit of learning or conditioning. What one person, what a civilian views is traumatic or stressful, might be not.

that at all to somebody else. I'm not being very articulate here. If the three of us are sitting in a classroom with some of some undergraduate college students who are talking about the stress of being in college and having final exams and maybe having a sick grandparent at the same time. and they're stressing out and they might use the word traumatized. Of the three of us, and you guys, you know, seen and done and been a part of things I never have been, but I'll include myself on your side of the conversation here just because I've heard so much. Are we going to have much empathy or sympathy for these college students who are lamenting their stressful life with final exams?

Probably not. Probably not. Probably not. Yeah. Yeah. And I've learned to fake it with college, with my undergraduate students. I've learned to fake being a little bit sympathetic. But so much of what we lament are first world problems. Right.

And you guys have seen the third world problems and then some. So how do you connect emotionally with your wife or your girlfriend, with your children. How do you come into a space that's your home, your loved ones, and yet you know there's a, you've habituated to certain things. And so the things that cause other people to cry

may not affect you in the same way. Now let's take that and move that. You've gone from being a soldier to being a civilian, that transition. The way I've described this book, before is if somebody came to me and said, okay, Chris, you were taking away your PhD, you can still have it, frame it, keep it on the wall, whatever, but you're no longer, you can no longer practice as a psychologist. We're going to strip your license. Everything you've ever written

before, we're going to put that in a vault somewhere, so that's not really relevant anymore. And good luck to you. Go find something new to do. Oh, and by the way, everybody you're going to be with speaks the same language, but words don't mean the same things. Handshake doesn't mean the same thing. Trust and cooperation may be different. And a lot of the language, you're not even going to be sure of what they're saying, because the words are familiar, but they may have different meanings. Good luck.

See you. Oh, and try to do all this with the brain injury that makes it hard to learn new things. try to do all of that with a sense of cognitive impairments, try to do that with a lot of anger and feeling in a short temper or short fuse. It's hard. Transitioning from the military out into or to it from any of the high-risk professions to a civilian job or to a civilian life. Massive challenge.

massive stressor. I tell guys that have done, you know, 20 years in the military to think of the transition as probably being about a five-year experience and you're never going to truly not be a soldier. Right. And nor should you try to be. The way I try to, you know, impart some advice on guys is to tell them like, you know, how hard you had to fight to get into special operations and go through selection and all that. well you're going to have to work that hard to transition out of it. And, you know, when you throw like mission and sense of purpose in there, too, and that, you know, you were doing something that you, that was a dream for many of us, right?

Yeah. And you were doing it. And then you get out in the civilian world and it's like that I think that that's probably where like a lot of the Anadonia. Anadonia, am I saying that right, comes from. and everything that once you've like been where you wanted to be it's like you have to dig really deep to find a new place that you want to be that brings that same sense of purpose yeah yeah and let's add the tribe on there now you're now you're not now you're trying to do this but you're not part of a team of like-minded people that you're doing it with now you're separate from that yeah

you left the unit those guys are all still doing their thing they're not even thinking about you They're preoccupied. Now you're back to wherever your home is trying to go, okay, how do I make, how do I fit in here and make sense out of this? We've also seen that even for those marriages that endure to the point of retirement, that that first year after retirement is a stressor. It's a really challenging period for marriages. The wife is like, who's the stranger that's now in my house all the time?

It's her domain. runs the place. She knows how everything goes and where it goes and how it works and who to call. You don't know anything. Maybe. And so there's not just a whole new set of skills that have to be learned and developed and habits, but how do you do that? How do you fit that together at the family level? That's a real challenge. Yeah. Toxic exposure to illnesses and cancers. Existential concerns, suicide, and then we go into part three of the healing and recovery, which is phenomenal. Yeah, it's, look, I recommend this book to everybody. It puts so many things together that I thank you.

So thank you. And link is down in the description. I highly recommend it. It's, for me, it put a lot of stuff together that I've been trying to figure. out that I've been wrestling with. So, you know. Thank you for saying. Yeah, very valuable.

Can I have a favor to ask of you and your listeners? If you do look at the book, one thing that would be very much appreciated would be a review on Amazon. I've been a little concerned that some of my things have been kind of shadow banned. I know they have been on social media when I was on social media. And so getting through some of the Amazon algorithms, it helps if you have, have some of some reviews for the book. I'm going to do it right now just because I'll forget if I don't.

Thanks. But yeah, so what's next? Like, where can people find you? What's nuts for the operator syndrome? And also if, you know, obviously, one of the things you mentioned is, you know, taking the, you mentioned to me before the show, taking the document to the VA, to your primary care position. And just pointing out, like, these are all things that I'm suffering from.

they don't have to buy into the operator syndrome, but can I get these tests and things like that? This is a medical document. That strategy seems to work for a lot of people. I tell them, print the paper off, go through it with a highlighter, take it to your medical providers, educate them,

and use it as a conversation starter to ask for what you need. And, you know, more often than not, that seems to have a very positive effect. Yeah. I would also say, you know, it is a challenge.

to find the treatments that are helpful. For me, the three kind of low-hanging fruits are get a sleep study if you haven't had one. Get your hormones checked if you haven't already done that and addressed, if need be. And then the steli-ganglion block is a very low-invasiveness treatment. It's literally a one-time-only outpatient procedure. It takes just a few minutes. It's very similar treatment to when the dentist injects a little novacane into a tooth nerve before drilling on that tooth.

It's a different nerve. It's a different medication, but that's essentially what it is. It just kind of blocks that nerve for several months. Now, a lot of guys will get the benefit, and the benefits will endure for months and months, even years. Sometimes they never go back. Some people go and do it again a year later. but it also opens a window of opportunity because you're feeling relaxed,

you're feeling better, it makes it easier to start doing some of the other things to take good care of herself, which might even include psychotherapy or journaling. But that's one of the things I encourage people to look into. So can you say those three things one more time, please? Yeah, the three things that I would recommend right off the bat. Sleep study, hormone panel, and stella ganglion block therapy. And then go from there. Okay.

And then what, because I know you mentioned protein. You talked about, you know, that we don't, we aren't getting enough protein. And some people say up to one gram of protein per pound. Per pound of body weight, yeah. And I, it's probably slight correction there on myself. It should be one pound, one pound. gram of protein per pound of desired body weight. Okay.

So if you weigh 300 pounds, but you're trying to get down to 200 pounds, then you should have 200 grams of protein. And there's different ways of getting protein, obviously. Different foods have different types of protein or different levels of proteins. But one thing you can use to give yourself a jump start on the protein is essential amino acids, EAAs. which are the nine essential amino acids that our body cannot produce on its own. If you take about 10 grams of essential amino acids with a big 16 ounces of water in the morning,

you're giving your body, not only are you hydrating yourself, but you're giving your body the equivalent of about 50 grams of protein. So you can get, you know, 25 to 50% of your daily protein needs this way. It's cheap, it's easy. It's very effective. You get really good protein synthesis, and it doesn't break your fast. So if you're doing intermittent fasting, the EAAs only have like four calories. So it doesn't end your fast if you're doing intermittent fasting.

And then you also mentioned creatine, which, you know, like I used to use when I was lifting, but apparently it has more benefits than just for working out. I've come to believe we should all be taking creatine. At least five grams, I take 15 grams a day. And it is important for lifting and strength training, but it's also a really good brain health supplement. And that's recent news. That's recent data in the last three, four years.

A number of studies have come out showing how good creatine is for our brain. Creatine is like, I think it's considered the only supplement that really has like robust medical, you know, academic backing. Yeah, yeah. That plus mega B vitamins, but that's more complicated. Interesting. Yeah.

Oh, please go ahead. One thing, just to throw out there for you guys and your listeners, there is an online magazine called HV-E-O-K, HV-O-K, HV-Gourn, and they are, it's free, It's online and they're mostly targeted towards veteran soldiers first responders. I just published essentially a super abridged version of the Operator Syndrome book on Havoc Journal.

So it's in four parts. The fourth and final part just published today. And the other three parts published each of the last, the previous three Mondays. So if you go to Havoc Journal search operator syndrome, this four part, art series should show up. And it's essentially a condensed, you know, four magazine articles that condenses a lot of the book into one place. Yeah, great.

And where can people find you? What do you mean by that? I don't want to be. Okay. Well, what I meant is, I mean, I know you mentioned that you weren't really on social media. I know you had an unfortunate incident with LinkedIn and stuff like that. You know, are you anywhere where people can, like, follow your work? or I have a website.

It doesn't necessarily change very often. So it's not like there's a web news link or a newsletter there. Chrisfree.com is the website. But I'm trying more and more to just kind of keep a low profile. I live in rural Hawaii. I don't leave my house very often. Yeah. And what I do, it's not things I'm going to, I want to publish or put out there on social

media. So I may be intentionally a little bit hard to find at times. Yeah. And are there any follow-ups to, I mean, I'm sure you guys are constantly learning new things. I mean, it almost feels like it's going to be a living document, you know. Well, yeah. So I am working on a couple of papers right now. I know there will be scientific publications, I hope, at some point in the next couple of years.

And that will add a little bit. I think the transformative research going forward is not going to come from me. It's going to have to come from other people. I'm old. I'm not that invested in the academic world anymore. But there are people who are. There's a psychologist in the VA system who is essentially, I think, trying to make that his career goal to collect the law.

longitudinal, not just the cross-sectional, but the longitudinal data to begin to better understand operator syndrome. And he's at one of the polytrauma centers that may change their name to the something something operator syndrome program. At least that's their tentative plan. Do we have questions? Yep, we got one from M. Corbin. Could any treatments help address the negative cognitive effects linked to digital devices, addiction. If I had a simple answer for that question, I would probably become a very, very wealthy person.

I don't know specific treatments other than the kinds of things that work for addiction might be relevant. The cognitive therapies, there's probably one series of books that I kind of I like are the easy way books, the easy way to stop drinking, the easy way to stop smoking. I wonder if they have an easy way to reduce the digital. But when it comes to digital porn addiction, things like that, those are medically different, physiologically different from building up tolerance and then experiencing withdrawal from a substance like alcohol or opiates.

on the other hand they have a lot of similarities including how the brain the reward centers the brain fire so I'm sorry I don't have a really good answer for that other than what's out there for addictions are there any

emerging treatments that aren't really widely known yet that you're excited about or decide about the possibility of uh well I think a lot of the things that we're looking at right now with related to psychedelic medicines, transcranial magnetic stimulations, hyperbaric oxygen therapy. I think those are some of the things we're going to know a whole lot more about in a few years. And there's some really promising things that

we're learning in each of those areas. Hyperbaric oxygen therapy five years ago, I thought we kind of, you know, we kind of looked at it and then decided it wasn't worth it. It didn't produce enough benefits. We're going back to that now, in part because the Israeli research program, the Israelis have changed the protocol that they're using for hyperbarics and getting very, very different and very good results with it. So I think for all people who have heard, well, hyperbarics don't help with TBI or PTSD. Maybe they do. we just haven't been giving enough of a dose. So more sessions and at a higher level of pressure,

I think is what the Israelis are doing. Please go ahead. I was just going to offer one other thing. I mean, I'm sure there's many things I don't know of or understand. There are probably hardly a month goes by when I don't have somebody reach out to me with a new product or a new gizmo or gadget that purports to do this or that. some of those probably have you know value right now i think that part of the challenge is sifting

through all the noise to find the signal there is something i'm i'm intrigued by there's a there's a monot ketone ester called delta g and it was initially funded the research on this was initially funded 25 years ago by DARPA through their you know their super soldier program and then it got kind of shifted over and it was scientists at Oxford University in Britain and with the NIH funding. Anyway, this thing is on the market now. You can go look for Delta G and you can find this ketone ester. I took a ketone energy drink before we started. Delta G ketone ester. Delta G ketone ester. There's a number of them on the market and I'm not trying to be a salesperson for this, this product. other than it's different from the other products.

It will put, if you take about 30 grams of the stuff, it will put you into a very deep state of ketosis in about 15 to 20 minutes. So it's very, happens very fast. And it will last for four or five hours. So a deep state, almost immediate and lasting. And one of the thoughts, and I've dappled with the stuff. I've used the stuff. I gave it probably a pretty good two-month run

and found it to be very helpful in a variety of ways for myself, including cognitive sharpness. And part of what DARPA was looking for was to be able to take a soldier who sleep deprived and physically exhausted, give him a little shot of this stuff, and have him cognitively restored to be sharp again. There's another piece of this thing.

though, the deep ketosis seems to produce a very, an anti-inflammatory response in the body. And so one of the things that I've wondered about, and this is just me spitballing here, but as a use case, could you use this with some operators that are going to go on, let's say, a breaching or a shoulder fire rocket training day? Take a dose of this stuff before the training,

and then maybe four or five hours later or maybe at the end of the day, if you do that while you're training and really reduce the inflammation in the nervous system, could that be neuroprotective? And I don't know the answer. This is just me spitballing here. But there are things like that that I think we're going to be digging much more deeply into as the years go by. The Delta G, you can buy it.

You can purchase it. You can get their website and purchase it, but it's very expensive. So there aren't many of us that are going to use it on a regular basis unless we have the DoD or the Tour de France money supporting our habit. Yeah. And one last thing that you mentioned that caught my attention, because people have mentioned them before to me, but I don't quite understand them, is peptides. Can you tell us a little bit about that? Not very much, because I don't know very much. But what I will say is one of the places where a lot of guys are finding relief are at regenerative medicine clinics,

or sometimes referred to as functional medicine clinics, where they're using peptides, exomes, NAD plus infusions, stem cells to treat a variety of things related to brain health, joint health. A lot of these clinics also do the Stelic Anglian and the ketamine infusions. So they can be one-stop shops for a lot of the different kinds of interventions that might be useful. And they will do a deep dive on nutrition and they'll get a full panel of all kinds of things like your vitamin D levels. but with 50 other metabolic markers, and then they will tailor a treatment or a supplement regime for you, regimen for you based on your numbers. So I think regenerative medicine, functional medicine,

is going to be a place that we see much more important things happening for people with operator syndrome. Chris, it's been amazing. We really appreciate it. Thank you for having me. This has been good. Yeah, thank you for coming on. The book is amazing.

And links will all be down in the description for people who want to find the book or want to find Chris's website. Yeah. Yeah. Was there anything that we failed to ask you or anything that we left out that you wanted to talk about? Nothing comes to mind. We probably could sit here for another five hours, though, and find a steady stream of things to talk about. Oh, I could. So you'll just have to invite me back another time.

Absolutely. Thank you so much, Chris. We really appreciate it. You bet. Thanks for having me. Thank you. Thanks, everybody. Good night.

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