WTF is Operator Syndrome? | Dr. Chris Frueh | Ep. 357

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/1962202070 Dr. Frueh's website: https://chrisfrueh.com/ Today's Sponsors: GhostBed⬇️ https://www.ghostbed.com/house FOR 10% off! Mando ⬇️ https://shopmando.com Promo 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/TheTeamHouse To 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 guests Subscribe to our Patreon! ⬇️ https://www.patreon.com/TheTeamHouse New merch, patches, and stickers! ⬇️ https://theteamhouse-shop.fourthwall.com Support 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/theteamhouse Social Media: ⬇️ The Team House Instagram: https://instagram.com/the.team.house?utm_medium=copy_link The Team House Twitter: https://twitter.com/TheTeamHousePod Jack’s Instagram: https://instagram.com/jackmcmurph?utm_medium=copy_link Jack’s Twitter: https://twitter.com/jackmurphyrgr?s=21 Dave’s Twitter: https://twitter.com/dave_parke?s=21 Team House Discord: ⬇️ https://discord.gg/wHFHYM6 SubReddit: ⬇️ 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/1501191241 The 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 Syndrome 03:45 - Dr. Frueh's Background & PTSD History 24:17 - Debunking PTSD Myths 37:40 - Developing Operator Syndrome Framework 50:40 - Resistance to Operator Syndrome 1:04:15 - Key Treatments for Operator Syndrome 1:33:43 - Emerging Treatments Become a supporter of this podcast: https://www.spreaker.com/podcast/the-team-house--5960890/support https://www.spreaker.com/podcast/the-team-house--5960890/support?utm_source=rss&utm_medium=rss&utm_campaign=rss.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

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• 1:32Speaker 04

  Special Operations.

• 1:36Speaker 04

  Covert Ops. Espionage. The Team House. With your hosts, Jack Murphy and David Park.

• 1:52Speaker 05

  Everybody, welcome to episode 356 of The T-Mouse. I'm Dave, this is Jack. Our guest tonight is Dr. Chris Frueh, the author of The Operator Syndrome, which is, I feel like, a seminal book. Like, it pulls in so 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.

• 2:18Speaker 06

  Oh, well, thanks for having me. I'm excited to be here.

• 2:21Speaker 05

  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?

• 2:30Speaker 06

  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.

• 3:09Speaker 06

  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 of 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

• 3:53Speaker 06

  by overrelying on the diagnosis of post-traumatic stress disorder.

• 3:59Speaker 06

  So we've used for decades now, we've used PTSD as the easy button. And when we do that to a high-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 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.

• 4:43Speaker 06

  And yes, some psychological issues, anger, depression, general anxiety, addiction, and even a little PTSD. Although let me, 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 the, I don't see it. That's not the problem.

• 5:14Speaker 05

  Mm-hmm. It's interesting. Yeah, I don't want to derail, but about the post-traumatic 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?

• 5:27Speaker 06

  Oh, okay. Well, so I grew up in a lot of different places. My dad was a physician. He joined, he commissioned in the Air Force in the early 60s. So he was a Vietnam, he became a veteran in Vietnam, a veteran of the Vietnam War a few years later as a physician. We, we lived all over. I think of the Midwest as primarily my home, although I was born in New York City. I went to high school in Missouri, Wisconsin, Michigan.

• 6:02Speaker 05

  Wow.

• 6:03Speaker 06

  I did my graduate training in Ohio. Then I got a PhD in clinical psychology in South Florida, Tampa, Florida. And that was the, kind of the beginning of my, my journey, of my career, working with veterans and service members.

• 6:19Speaker 05

  So, so can, what?

• 6:24Speaker 05

  Like around what year was that? And then like, what was your initial impressions of veterans at that time? And then how, if that changed over years, how did it change?

• 6:33Speaker 06

  Yeah, yeah, okay. Well, let me go back to my childhood. So 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, died when I was 14. So I knew him very well. My great grandfather was a veteran of the Spanish American War. And he fought at the Battle of San Juan Hill. So from both my father and my great grandfather, I, I developed a sense of, you know, what it meant to serve, what it meant to be a soldier, and as well as that there is a cost associated

• 7:17Speaker 06

  with that, that endures for years after the war and for many people, many soldiers. And that was kind of my why, 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 was officially books for about seven years.

• 7:56Speaker 05

  Was, prior to PTSD, was shell shock, like, was it a diagnosable thing? Or was it just like parlance?

• 8:04Speaker 06

  Battle fatigue? Yeah, I think it was parlance. And, 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, described by a doctor named DeCosta. It, it became known as either Soldier's Heart or DeCosta's Syndrome, kind of interchangeably. The idea, the concept of it was, we're Civil War soldiers were going in to see doctors post-war and they were describing cardiac problems for which there was no pathophysiological

• 8:53Speaker 06

  You know, basis that could be identified. And these 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. Yeah. And then, and so that was the very beginning of, 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 freight, 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.

• 9:38Speaker 06

  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 to rest 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, there's some, 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. Mm hmm. And we got to World War II.

• 10:20Speaker 06

  In World War II, 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, and in a sense, they normalized it as a normal reaction, not an extreme reaction. It's just, you know, you could only spend so many days at the front line in combat, and then we got to pull you off. Now, what they didn't do, they didn't send people to faraway rest homes for six months or a year. They pulled, they pulled soldiers back from the front lines, just a few miles, where they would be in a, in a camp, in a tent with a cot, warm, dry.

• 11:05Speaker 06

  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 warfighting. We had very few, 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, we created, the US military created the DROSE system.

• 11:49Speaker 06

  DROSE is an acronym for Date of Expected Return from Overseas. So it was a one-year tour of duty. If you were, 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 medevaced out of country. The idea was any soldier could go and fight for a year, knowing that on this date, they were gonna be, they were done. And so that was, that was a strategy that they, that the military used to mitigate psychiatric casualties. And they included R and R for some, so, so many soldiers got R and R midway or partway

• 12:34Speaker 06

  through their year. Uh, like a Hawaiian vacation, or a trip to Japan or the Philippines.

• 12:40Speaker 05

  It's fascinating. And, and then, you know, cause shell shock almost, I, did you read the story about the marine unit, uh, the artillery unit in Syria? They fired off so many rounds that guys, when they came home, were seeing ghosts, thinking demons were after them, like it was...

• 12:58Speaker 06

  Yeah. Yep. Yes. And so I think where you're going with that is, they got it right.

• 13:05Speaker 05

  Yeah.

• 13:06Speaker 06

  World War I. 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.

• 13:22Speaker 06

  And I'm not a Freudian. It doesn't mean that 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.

• 14:07Speaker 06

  We know that soldiers who are really well trained and are surrounded by tight, you know, esprit de corps within their units, that that right there is a huge protective factor for any kind of psychological or psychiatric reaction during war, during a deployment, as well as afterwards. So we've actually lost a lot of the good common sense that we used to have in medicine 100 years ago. And hopefully, we're bringing our way back around to picking up where we left off in 27.

• 14:42Speaker 05

  Yeah. When you mentioned PTSD, it reminded me of an article I had read before the global war on terror. And it was, it was a medical study that they had checked the brains of people who had made it through SFA, Special Forces Assessment and Selection. That 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 revitalize memories. They didn't, you know, when something happened, it just kind of was gone. And so there was this idea that, that these guys would have a lower

• 15:24Speaker 05

  incidence of post-traumatic stress. But then after the GWOT, 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.

• 15:40Speaker 06

  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, rappelling, 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

• 16:22Speaker 06

  and assessment strategy. So you gotta go, you gotta stay awake for five days and we're gonna 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, I think we are, if we, if we get right, we're gonna, we're gonna come around to that understanding. Training with, with demolitions, with shoulder fired rockets, breaching, sniper rifles, even handguns involve micro blasts. And now we know for about eight years

• 17:02Speaker 06

  now, nine years now, we've, we've, we've, we have some inkling of what blasts do to the brain, which is very different from anything we've ever understood before. And it's a type, different type of injury than, than an impact, impact force is. So blasts have a shearing effect through the body. And what we, what was, what was revealed in a study published in twenty nine, twenty sixteen, is that the, the shearing effects leave, leave the glial cells in the nervous system scarred. So each neuron in our system, those are the messenger cells, has about ten glial cells as its support network. They hold the neurons in

• 17:45Speaker 06

  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, in the brains. It's very different from the amyloid plaques, the tau proteins that can develop and build up after, after, after an accumulation of, of impact force blows to the head. Hey guys, it's Jack. I want to tell you guys.

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• 21:07Speaker 05

  So, you know, and that's, like you said, we're just now starting to understand blast injuries, 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?

• 21:29Speaker 06

  Well, so I'm not in the VA.

• 21:31Speaker 05

  Right, right.

• 21:32Speaker 06

  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.

• 22:13Speaker 06

  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.

• 22:40Speaker 06

  And so the VA is a very, very powerful force for supporting the construct of PTSD and the treatment for it.

• 22:52Speaker 06

  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 get, if they're having difficulties, they often are almost immediately diagnosed with PTSD. And so

• 23:13Speaker 06

  maybe rephrase your question again. So we've kind of gotten away

• 23:17Speaker 05

  Yeah.

• 23:18Speaker 06

  far away from where we were in 1917.

• 23:24Speaker 06

  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 PTSD clumped together as if they're the same thing.

• 23:37Speaker 05

  Right.

• 23:37Speaker 06

  If they're similar, we can't tell them apart.

• 23:40Speaker 05

  Do you, do you think, do you think that one of the reasons that like TBI isn't and blast exposure isn't as recognized is because they don't really know what to do about it right now?

• 23:54Speaker 06

  Maybe in part. They don't, we don't understand it very well. It's hard to evaluate in a, in a, 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 in 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

• 24:39Speaker 06

  what's now been called interface astroglial scarring, the only way to really know that and look at that is postmortem. So we have to wait till 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 call, refer to as a little bit of a deep state in the VA system. So when the global war on terror started, 20, almost 25 years ago, the VA system was what it was.

• 25:22Speaker 06

  It 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, maybe careful of that. 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

• 26:07Speaker 06

  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.

• 26:39Speaker 05

  That's fantastic. Yeah, when we get further on, I want you to like, kind of give the, give us more on the VA, because you mentioned some really interesting things in your book. But so you start out, you, 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 till today, is that somebody has flashbacks, they think that, you know, Charlie's in The Wire, and Huey's over Saigon. And they kill everybody in the office, right?

• 27:07Speaker 06

  Yep, yep, yep. And really interesting question that we can wonder about here. Did Hollywood...

• 27:17Speaker 06

  Create the PTSD that we have today. Did all those movies in the seventies that 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 who really had what you what you often saw in the movies. Where they drew flashback that involved them acting as if they were back in that scenario. And an interesting study that was done probably fifteen or twenty years ago by the Brits.

• 28:01Speaker 06

  We've got some of the great research happening with veterans that 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 nineteenth century, early twentieth century. So they got the rec the military records of British soldiers who fought in South Africa. And they went through them, just, you know, 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

• 28:44Speaker 06

  where they thought they were reliving or re back in a in a in a in a moment of combat and acting accordingly. They didn't find it. That may just be a modern invention. Thank you, Hal.

• 28:58Speaker 05

  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, I don't remember, 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.

• 29:28Speaker 06

  No, that's a, yeah, that's a sad, well, that's a sad.

• 29:36Speaker 06

  Outcome of the of the fact that half of all veterans of the GWAT, it's probably more than half now, are rated disabled by the VA for PTSD. 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? Society? We have a whole society who's now walking around with this wrongful notion in their

• 30:14Speaker 06

  heads that soldiers, that soldiers 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, 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.

• 30:56Speaker 06

  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 him 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, I can't even begin to, to extol the tragedy of veteran and responder fathers

• 31:34Speaker 06

  who are losing enormously in their divorce settlements and custody settlements because of some wrong, wrongful.

• 31:47Speaker 06

  myths or beliefs about PTSD and how their service, how their work may have affected them.

• 31:53Speaker 05

  Yeah, and you know, and you like we're trying to normalize the idea of post-traumatic stress, operator 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 gonna like, say they have post-traumatic stress or anything else going on if they might not ever be able to own a weapon again?

• 32:24Speaker 06

  That's right. That's right. So 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 US. 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 SAC, 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

• 33:07Speaker 06

  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, you know, 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, he read the operator 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

• 33:51Speaker 06

  need some help. And then he was punished for it.

• 33:54Speaker 05

  Right.

• 33:55Speaker 06

  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, 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 of some of the teams out there, including Development Group.

• 34:35Speaker 06

  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

• 35:17Speaker 06

  with 600, 650 operatives 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 attorneys, working with private defense contractors who needed to be evaluated for treatments and for insurance claims. So I was able to take advantage of that to do full evaluations using the operator syndrome framework.

• 35:47Speaker 05

  So let's, so you start out, your, like, did you say your graduate thesis was on post-traumatic stress?

• 35:56Speaker 06

  Yes. Yeah, my dissertation.

• 35:59Speaker 05

  Your dissertation, all right. So, yeah, you have to forget the uneducated amongst us who don't know the difference. But so your dissertation is on post-traumatic stress. And so what was, what was post-traumatic stress at that time? What did you learn? What did you discover?

• 36:18Speaker 06

  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

• 37:02Speaker 06

  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 important, this is actually an important question that you've asked. The original definition of PTSD was fairly simple and straightforward.

• 37:45Speaker 06

  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.

• 38:10Speaker 06

  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 a sense of fear, helplessness, or horror at the time. In 2013, they took even that 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. Really left open to the interpretation of the individual.

• 38:55Speaker 06

  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. And we could go off, you guys know this, we could go off on a whole conversation about

• 39:40Speaker 06

  society and how everything now has become defined as stressful or traumatic.

• 39:47Jack Murphy?

  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.

• 39:56Speaker 05

  And hiding for a while, yeah.

• 39:58Speaker 06

  And by the way, they still are, they've not brought that, those numbers down at all. Those numbers, they 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.

• 40:26Speaker 06

  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.

• 40:41Speaker 06

  Sounds stressful, doesn't sound traumatic, though. Um, so I think we've, 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.

• 41:02Speaker 06

  And if you take the, the questionnaire that's most commonly used, it's called the PTSD checklist. Everybody uses it. It's a one-page, uh, simple checklist form. You could 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 turned it into a diagnosis that really doesn't have any sensitivity to separate one patient from another.

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• 45:19Speaker 05

  Yeah, it's interesting, 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 operated syndrome?

• 46:04Speaker 06

  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. And 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.

• 46:46Speaker 06

  So I was commuting every month, spending a week in Houston. And there's a small foundation that had just started up there. They'd 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, which was at the time, initially was really just, it was like a happy hour thing, you know, every two weeks, all of the SOF community in the city of Houston were invited to come together for this.

• 47:30Speaker 06

  And 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 intended 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.

• 48:13Speaker 06

  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.

• 48:56Speaker 06

  And at some level, you know, within probably the first month or two, 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?

• 49:43Speaker 06

  Sleep studies, they kept coming back with sleep apnea, which didn't make any sense to me either. Why do these, these thirty, late thirties, early forty guys, why are they, why are they having sleep apnea? That didn't compute for me. Also, through my research program, we had a, I 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 were getting their brain scanned. 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, what his reaction was, was, well, these, and all I told him, these are

• 50:28Speaker 06

  men. He didn't know what he was looking at, not really. So these are men. And he, 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 eighty year old man. He thought he was looking at elderly brains 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

• 51:07Speaker 06

  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 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

• 51:49Speaker 06

  course, social impairments that, you know, that all bleeds out into your, into your family life, your marital life, your work, other aspects of, of your world.

• 52:01Speaker 06

  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 have, why would a man, 37 year old SEAL, have low testosterone? 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. Uh, 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.

• 52:46Speaker 06

  So there isn't a time, there just isn't time for those, for the cortisol and other stress hormones to normalize.

• 52:52Speaker 05

  Hasn't it also been linked to like sleep deprivation and poor diet, stress, like burns out the endocrine system?

• 52:59Speaker 06

  Right, so TBI, sleep deprivation, sleep problems, that high op tempo, poor diet, alcohol abuse, chronic pain.

• 53:10Speaker 05

  Yeah.

• 53:11Speaker 06

  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 gotta, we gotta jump on this, 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, we, we, we do have a very serious suicide rate in all of the high profession, high risk professionals.

• 53:47Speaker 05

  Chris, where does the sleep apnea come from? Cause that's not something you think of a relatively fit guy having.

• 53:56Speaker 06

  Totally. Um, and I don't know. I don't know the answer to that. Is it, it is a come from, does 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?

• 54:12Speaker 06

  Um, is it something that builds up over time when you're just not sleeping? And not getting enough quality sleep? So I, I'm gonna just, like, I'm ignorant. I don't know the answer to your question. I don't know that anybody does.

• 54:25Speaker 05

  So how were you, how were you putting together this framework as you were capturing it? Um, because i- in your book, like, there are, I, I don't remember how many chapters, but there were like 12, 15 chapters of like different things. How were you compiling that? Yeah.

• 54:44Speaker 06

  You know, early on, I, I wrote up a document for myself. It was just kind of notes. And then I thought, you know what? I need to, something to educate and share information with the guys I'm talking to and their spouses. So I, 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, you're really taking care of everything. So that was the hook, was sleep.

• 55:23Jack Murphy?

  The way the army gets them is they call like, what, 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?

• 55:35Speaker 06

  Yeah, that's exactly right. You want to perform better in sleep, you gotta do these things.

• 55:40Jack Murphy?

  Yeah, yeah.

• 55:41Speaker 06

  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, a paper that we submitted to Medical Journal and it was published. And so that was, that's the 2020 medical paper titled Operator Syndrome. And just for your readers, anybody can find that online. If you just Google or search, 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, as a document to help educate operators and their spouses.

• 56:25Speaker 05

  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-Badonias, like, social justice demands that they don't get any special attention. Like, people were trying to shut you down, right?

• 57:00Speaker 06

  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, 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,

• 57:42Speaker 06

  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 they're 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..." So all she had is people saying that they had been an operator, without any other details. And she didn't soon understand why that might be a problem or a concern. And I said, "Well, you know, most of the guys I talk to and interview and talk to very

• 58:23Speaker 06

  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 smiled and goes, "Yeah, that's denial. They're all in denial."

• 58:34Speaker 05

  Wow.

• 58:34Speaker 06

  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.

• 58:46Speaker 05

  Right.

• 58:47Speaker 06

  So, no matter what, you're gonna 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, the Marcus Brain Health folks. And in working with the Green Beret, who was the Veterans 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

• 59:28Speaker 06

  thought this was almost more of a formality. And he came out and the guy, the neurologist, 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, in the discussions or the meetings the rest of the time. In fact, when

• 1:00:08Speaker 06

  we met with the hospital, the hospital, the CEO of the hospital later that day, he sat in this, this nice mahogany walled office and pretended to fall asleep during that meeting. What, 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 old 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, but, but, but wait, hold on. We're talking here about a group of operators as a group of people who have unique injuries, unique experiences,

• 1:00:53Speaker 06

  unique exposures. So the idea, I mean, he, he laid it, he laid out what I'd 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, of Of experiences that would reduce, produce injuries. We have a, 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. That it just, just died right there in that moment.

• 1:01:36Speaker 05

  And it, it's sad too, because just like in the military, things that, you know, soft gets that the rest of the army doesn't or the rest of the military doesn't, eventually, you know, trickle down.

• 1:01:50Speaker 06

  Who trickle down? That's true. That's right.

• 1:01:52Speaker 05

  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 were out there hooking and jabbing all the time.

• 1:02:05Speaker 06

  Yeah.

• 1:02:05Speaker 05

  And I, and I see what you're saying though, also that, you know, with, with operators, you know, or soft guys, you, you, you know what that group is, right? You know what they've been through. With everybody else in the military, there, there are infantry guys and Marines who were out there like in it, right? Slugging away. Um, but with this really broad expansive thing of, 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.

• 1:02:38Speaker 06

  Right. And so you're exactly right about that. And so that, that becomes, you know, that's, that's also a real problem for the VA is most clinicians, most people in, 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 are, who do all the other things, very important things, critical things.

• 1:03:08Speaker 06

  But that doesn't mean they're being shot at or shooting at enemy. And we, 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, for those in the combat arms. And we never talk about that, the, 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, oh, I have PTSD and yeah, I served in, in Iraq for a year.

• 1:03:51Speaker 06

  There isn't an understanding, they don't even, 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 is infantry.

• 1:04:10Speaker 06

  And of course, even there, you know, we know that some of those mechanics did end up at it 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.

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  Job of training medical clinicians on these nuances.

• 1:06:01Speaker 05

  Well, and you know, and it's like you say, like when 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 hurt or whatever, I'm sure that was traumatic for them. Right?

• 1:06:19Speaker 06

  No, no question.

• 1:06:21Speaker 05

  But then, but then to take that and then to try to compare that to, like you say, the allostatic load that people who are doing it over and over and over every night, you know, it's so, you know, where you like, you have to draw a line somewhere when you're starting out a pilot program like this.

• 1:06:40Speaker 06

  Yeah, yeah, yeah, that's right. Here's another, 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, in, in some corners of SOCOM. So I, I had heard for a number of years from people who, 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, I presented last year to civilian foundation and, or to a, to a foundation, not, not active military.

• 1:07:29Speaker 06

  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."

• 1:08:14Speaker 06

  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."

• 1:08:54Jack Murphy?

  I think the military has been very, I'll 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 maybe discharged out of the military. I spoke to a senior, he was a senior leader in Delta Force, where they started putting the sensors on their bodies, you know, 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,

• 1:09:37Jack Murphy?

  it becomes that we can't do our job." From riding on helicopters, shooting guns, explosive breaches, all of these things.

• 1:09:46Speaker 06

  Well, we have to stipulate that, of course, that we are not going to stop training.

• 1:09:52Jack Murphy?

  Yeah.

• 1:09:52Speaker 06

  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 and people will find, smart people will find.

• 1:10:14Jack Murphy?

  Yeah, yeah.

• 1:10:15Speaker 06

  Smart people will find those.

• 1:10:16Jack Murphy?

  But the thing.

• 1:10:17Speaker 06

  But I think there's a lot 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 don't, that aren't complicated, aren't expensive, aren't, aren't, you know.

• 1:10:31Jack Murphy?

  Getting the soldier's baseline?

• 1:10:33Speaker 06

  Yeah. Getting, that would be one.

• 1:10:35Jack Murphy?

  Yeah.

• 1:10:35Speaker 06

  Getting, getting baselines of cognitive functioning, hormone levels, probably a handful of other things. That would be one.

• 1:10:43Speaker 05

  It's interesting though, because that admiral was basically saying, fuck the guys who are suffering. We need more guys. Like, let those guys suffer. Like, we're done with them. We've used them. We're not worried about them.

• 1:10:56Speaker 06

  Thanks, bro.

• 1:10:57Speaker 05

  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, 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 gonna do this thing.

• 1:11:24Speaker 06

  Yeah. Yeah. And actually, you're absolutely right. I don't think, 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 US 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, I, you know, this, this resistance to anything new, certainly in medicine, but probably

• 1:12:05Speaker 06

  everywhere, i- is something that, that takes a little time to, to fade away. What I'm seeing now is more of the leaders, the one and the two-star office, flag officers. Many of them are people that I may have known, um, 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, their perceptions are, are going to be very different. Um, so I, I have some, some level of optimism that there's going to be more openness. Um, I did the, uh, last year, last May, I was invited to present at Soft Week in Tampa. So I did

• 1:12:49Speaker 06

  that. That, that was kind of a, a marker of, of maybe a little bit of a change. And then, uh, in January of this year, I recorded a podcast for, um, I did the SOCOM podcast, uh, 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, of even being asked to be on that is also a marker of there's, there's more interest and there's more willingness to engage in this specific conversation.

• 1:13:22Speaker 05

  Chris, I want to check how we're doing on time, cause, uh, all right. About an hour in, I think. Yeah, okay. Uh, cause I actually want to ask you, or just kind of, um, go over a, a few of the things you mentioned, just for anybody who's watching, um, you know, maybe you know somebody, you are somebody or know somebody. Um, so the syndrome, uh, you start out with TBIs, sleep disturbance, the sleep disorders. How, like, how big is the sleep disturbance, sleep disorder aspect of this?

• 1:13:57Speaker 06

  Massive. It's massive. Sleep is so important for our health. It's, we can't think of it as optional anymore. And what we know today, we didn't know 10 years ago.

• 1:14:09Speaker 06

  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 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

• 1:14:53Speaker 06

  that happen, 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 are 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 that's very important time to have more time in slow wave sleep. We also know that during slow wave sleep,

• 1:15:38Speaker 06

  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 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.

• 1:16:10Speaker 05

  And you know, you mentioned, you know, people using Benadryl, you brought up like Ambien, the hypnotics and, you know, and things like that. But none of those are good long-term solutions, right?

• 1:16:20Speaker 06

  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 they may not, 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.

• 1:16:39Speaker 05

  Well, I mean, yeah. I was gonna say, the other problem with Ambien is, you end up with an Amazon order of like, a whole bunch of D and D books, or, you know, you find out that you tried to make candy by putting a whole bunch of honey.

• 1:16:51Jack Murphy?

  That happens if you're drinking too, to get, get to sleep.

• 1:16:54Speaker 05

  Yeah, but, yeah, I mean, the things I've done on Ambien, like, because I didn't fall right asleep, uh...

• 1:17:01Speaker 06

  Did you say D and D books, Dungeons and Dragons?

• 1:17:05Speaker 05

  Oh, yeah. Yeah. Yeah, a whole, like, stack of fifth edition books.

• 1:17:10Speaker 06

  I bought it all.

• 1:17:11Speaker 05

  Yeah. Yeah. But like, cooking while I'm on it, like, crazy. With no recollection.

• 1:17:20Speaker 06

  I've known guys that have woken up in the morning and discovered they cooked and ate an entire meal.

• 1:17:25Speaker 05

  Yeah, I've done that. I've done that.

• 1:17:28Speaker 06

  Shaved off their beard.

• 1:17:29Speaker 05

  I have not done that.

• 1:17:30Speaker 06

  Walked into the bathroom in the morning, looked in the mirror, and just jumped out of their skin. I know guys that have, uh, gone for a ride in the middle of the night. They wake up, why is my truck parked in the front yard?

• 1:17:43Speaker 05

  Yeah.

• 1:17:44Speaker 06

  And start realizing, oh, here's a receipt from 7-Eleven. Oh, I bought cigarettes. I don't even smoke. Why did I buy cigarettes and smoke two of them? Yeah. These are not medications to take lightly.

• 1:17:56Speaker 05

  And there's the panic, you check all your social media to make sure that you didn't, like, or post. But generally, even if you do post, it's unintelligible. Like, nobody knows what it is. Yeah. Um, did I mention monkeys with wings one time, did you, Jack? I don't know. Anyway, hormonal dysfunction, that's a big one too, right?

• 1:18:16Speaker 06

  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 gonna mimic depression.

• 1:18:29Speaker 06

  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 mass, 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

• 1:19:12Speaker 06

  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 testosterone, it could be all of them affected.

• 1:19:26Speaker 05

  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 every, like it's just, it's just a nonstop loop, isn't it?

• 1:19:49Speaker 06

  Everything is interrelated.

• 1:19:51Speaker 05

  Yeah.

• 1:19:52Speaker 06

  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 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 lead to better brain health, better cognitive clarity. And we, we have treatments now that we know are really effective, not just for treating

• 1:20:31Speaker 06

  the psychological aspect of things, but for example, stellaganglion 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.

• 1:20:52Speaker 05

  Interesting.

• 1:20:53Speaker 06

  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 stellaganglion block is a, is a one, it's basically a one-stop outpatient procedure, just takes a few minutes, inject the medicine into the nerve, stellaganglion nerve, that's the sympathetic nervous system that brings that fight or flight arousal down. So a lot of guys and, and gals in the high-risk professions are, are just baseline, day in, day out, somewhere out of seven, eight, nine, on that physiological arousal. With this shot, it drops that down to a two or a three.

• 1:21:36Speaker 06

  So there's a sense of, of relaxing, of feeling calm, of actually thinking, being more sharp cognitively, because all that noise isn't going on. But it also, now, we also see that, 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.

• 1:21:59Speaker 05

  That's fascinating. And then depression, anxiety, anger, hypervigilance, I think is, 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 brake all the time."

• 1:22:15Speaker 06

  Yeah, yeah, yeah. Always in the red.

• 1:22:18Speaker 05

  Yeah.

• 1:22:19Speaker 06

  Red light.

• 1:22:20Speaker 05

  Yeah. Post-traumatic, oh, please.

• 1:22:22Speaker 06

  Yeah, I just, I'm just agreeing, that's a good analogy.

• 1:22:25Speaker 05

  Yeah. Post-traumatic stress, substance abuse. This was an interesting one to me, was the perceptual systems impairment. Can you talk about that a little bit?

• 1:22:35Speaker 06

  Sure. Well, so if you're, 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. 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.

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• 1:24:30Speaker 06

  At a more extreme level, it can be, it can, it can manifest as vertigo. Dizziness combined with nauseousness or vomiting. And that can be really miserable.

• 1:24:42Speaker 05

  Yeah.

• 1:24:42Speaker 06

  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 inner ear, basically.

• 1:24:58Speaker 05

  They did that too with the guys that have Havana syndrome. Whole, whole, 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, you know.

• 1:25:11Speaker 06

  Oh, okay. Very interesting.

• 1:25:14Speaker 05

  Yeah.

• 1:25:15Speaker 06

  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?

• 1:25:36Speaker 05

  It's a, now, would you consider both visual and auditory hallucinations as part of that? Or is that something else?

• 1:25:48Speaker 06

  Something else.

• 1:25:49Speaker 05

  Okay.

• 1:25:50Speaker 06

  Hallucinations, that's, that's more psychosis.

• 1:25:53Speaker 05

  Okay. Okay.

• 1:25:58Speaker 05

  Cognitive impairments, definitely. Marital family concerns, intimacy concerns, military civilian transition concerns. Can you talk about that a little bit?

• 1:26:11Speaker 06

  Yeah. Well, let me, let me go back to the emotional intimacy.

• 1:26:15Speaker 05

  Okay, please, yeah.

• 1:26:17Speaker 06

  Is it, there's, there's, 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.

• 1:26:45Speaker 05

  Right.

• 1:26:45Speaker 06

  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, by their intimate partners that they're just not very sensitive.

• 1:27:09Speaker 06

  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.

• 1:27:44Speaker 06

  What one person, what a civilian views as traumatic or stressful

• 1:27:50Speaker 06

  might be not that at all to somebody else.

• 1:27:56Speaker 06

  I'm not being very articulate here. If the three of us are sitting in a classroom with 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,

• 1:28:18Speaker 06

  and they're stressing out, and they might use the word traumatized. Of the three of us, and you guys, you know, have 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 gonna find these college, are we gonna have much empathy or sympathy for these college students who are lamenting their stressful life with final exams?

• 1:28:46Jack Murphy?

  Probably not.

• 1:28:48Speaker 06

  Probably not, or we might struggle to.

• 1:28:50Jack Murphy?

  Yeah.

• 1:28:51Speaker 06

  And I've learned to fake it with college, with my undergraduate students. I've learned to fake being a little bit sympathetic.

• 1:29:02Speaker 06

  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, how do you connect emotionally with your wife or your girlfriend? With your children? How do you, 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.

• 1:29:45Speaker 06

  The way I, the way I've described this 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 gonna strip your license. Everything you've ever written before, we're gonna put that in a vault somewhere. So that's, 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 gonna 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.

• 1:30:30Speaker 06

  And a lot of the language, you're not even gonna be sure of what they're saying, because the words are familiar, but they may have different meanings. Good luck. See ya. Oh, and try to do all this with a brain injury that makes it hard to learn new things. Try to do all of that with a, a sense of, of cognitive impairments. Try to do that with, with a lot of anger. And feeling in a, in a short, short temper or short fuse.

• 1:31:03Speaker 06

  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.

• 1:31:29Jack Murphy?

  Right.

• 1:31:30Speaker 06

  And you nor should you try to be.

• 1:31:34Jack Murphy?

  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 gonna have to work that hard to transition out of it.

• 1:31:48Speaker 05

  And, you know, and when you throw like mission and sense of purpose in there too. And that, you know, you were doing something that you that is a was a dream for many of us, right? 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 anhedonia, anhedonia, am I saying that right? Comes from and everything that 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.

• 1:32:25Speaker 06

  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.

• 1:32:37Speaker 06

  Now you're separate from that. 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?

• 1:32:54Speaker 06

  We've also seen that even for those marriages that are that endure to the point of retirement, that that first year after retirement is a stressor, is a really challenging period for marriages. The wife is like, who's this stranger that's now in my house all the time? It's her domain. She runs the place. She knows how everything goes, where it goes, and how it works, and who to call. You don't know anything. Uh, maybe. Um, and so there's not, 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.

• 1:33:38Speaker 05

  Uh, yeah. Toxic exposure to illnesses and cancers, existential concerns, um, suicide, and then we go into part three of the healing recovery, which is phenomenal. Um, yeah, it's, uh, look, I, I recommend this book to everybody. Um, I, it, it, it puts so many things together that, that I thank you so, thank you. Uh, and the link is down in the description. Um, I highly recommend it. It's, um, 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.

• 1:34:18Speaker 06

  Thank you for saying that.

• 1:34:19Speaker 05

  Yeah, very valuable.

• 1:34:20Speaker 06

  If, can I, a favor to ask of you and your listeners, if you do look at the book, uh, one thing that would be very much appreciated would be a review on Amazon. I've been a little concerned that, uh, some of my things have been kind of shadow banned. I know they have been on social media, um, when I was on social media, and, and so getting through some of the Amazon algorithms, it helps if you have, have some reviews for the book.

• 1:34:47Speaker 05

  I'm gonna do it right now, just because I'll forget if I don't.

• 1:34:49Speaker 06

  Thanks.

• 1:34:51Speaker 05

  But yeah, so what's, what's next? Like where can people find you? What's next for the operator syndrome like? Uh, and also if, if, you know, obviously you, 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 physician and just pointing out like, these are all things that I'm suffering from. Like 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.

• 1:35:21Speaker 06

  That, 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, 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.

• 1:35:41Speaker 05

  Yeah.

• 1:35:42Speaker 06

  I would also say, you know, it is a challenge to find the treatments that, that are, that are helpful. Um, the, 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. Um, and then the stellaganglion block is a very low invasiveness treatment. It's literally a one time only outpatient procedure, takes just a few minutes. It's, it's very similar treatment to when the dentist, um, injects a little Novocain into a nerve tooth nerve before drilling on that tooth. It's a different nerve, it's

• 1:36:25Speaker 06

  a different medication, but it's essentially, that's essentially what it is. Just, it just, 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. Um, sometimes they never go back. Some people go and do it again a year later. Um, 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. Um, which might even include psychotherapy or journaling. Um, but it's a, it's, that's one of the few, it's one of the things I encourage people to look into.

• 1:37:02Speaker 05

  So that, uh, can you say those three things one more time, please?

• 1:37:06Speaker 06

  Yeah, the three, the three things that I, I would recommend right off the bat, sleep study, hormone panel, and stellaganglion block therapy.

• 1:37:17Speaker 06

  And then go from there.

• 1:37:18Speaker 05

  Okay. And then what, uh, cause I know you mentioned protein. You talked about, uh, you know, that we don't, we aren't getting enough protein and some people say up to one gram of protein per pound.

• 1:37:32Speaker 06

  Per pound of body weight. Yep. And I, I, it's, it's probably slight correction there on myself. It should be one pound, one gram of protein per pound of desired body weight.

• 1:37:43Speaker 05

  Okay.

• 1:37:45Speaker 06

  So if you weigh 300 pounds, but you're trying to get down to 200 pounds, then you should have 200 milli- 200 grams of protein. And there is a, there is, there's different ways of getting protein. Obviously different foods have different, different types of protein or different levels of proteins. But one thing you can use, uh, to give yourself a jump start on the protein is essential amino acids, EAA's, 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, with a, a big 16 ounces of water in the morning, you're giving your, your body, not only are you hydrating yourself, but you're giving your body the equivalent of about 50 grams of protein.

• 1:38:30Speaker 06

  So you can, you can get, you know, 25 to 50% of your daily protein needs this way. It's cheap. It's easy. Um, 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 EAA's only have like four pro- four gram, four calories. So it's, it, it doesn't, it doesn't end your fast if you're doing intermittent fasting.

• 1:38:58Speaker 05

  And then you also mentioned creatine, which, you know, like I used to use when I was lifting, but apparently it, it has more benefits than just, uh, for working out.

• 1:39:08Speaker 06

  I've come to believe we should all be taking creatine.

• 1:39:12Speaker 06

  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.

• 1:39:32Jack Murphy?

  Creatine is like, I think it's considered the only supplement that really has like robust medical, you know, academic backing.

• 1:39:41Speaker 06

  Yeah, yeah. That plus, plus mega B vitamins, but that's more complicated.

• 1:39:47Jack Murphy?

  Interesting. Um, yeah.

• 1:39:52Speaker 06

  One thing, one thing just to throw out there for you guys and your listeners. There is an online magazine called Havok Journal, H A V O K, Havok Journal. And they, they are, it's free, it's online, and they're mostly targeted towards veterans, soldiers, first responders. I just published essentially a super abridged version of the operator syndrome book on Havok Journal. So it's in four parts. The, the fourth and final part just published today. And the other three parts published each of the last, the previous three Mondays.

• 1:40:33Speaker 06

  So if you go to Havok Journal, search operator syndrome, this four part 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.

• 1:40:45Speaker 00

  Migraine makes me miss out on the moments that matter. So I asked my doctor about saying yptivapet, eptinezumab, JJMR, an IV infusion given every three months that helps prevent migraine attacks in adults. Don't receive if allergic to vayepdi. Get help right away for allergic reactions like rash, swelling of face, lips, tongue or throat, trouble breathing, hives or facial redness. Tell your doctor if you have constipation that is severe or associated with severe or constant belly pain or swelling, vomiting or bloating. If you have increased blood pressure or color changes, pain or numbness.

• 1:41:16Speaker 02

  and fingers or toes. Common side effects are stuffy nose, scratchy throat, and allergic reactions. Tap the ad to see how many migraine-free days you might reclaim and see the full prescribing information at fyipt.com.

• 1:41:30Speaker 02

  Hey guys, Lady Luck here. I just love the fall season. Kris Mornings Pumpkin Spice Latte, and it's the best time to cozy up and play Spin Quest. They have over a thousand different slots in all my favorite casino-style games, and they're running a deal for all new players. A $30 coin package for just $10. So this fall, grab your favorite blanket, visit spinquest.com, and download the app today.

• 1:41:55Speaker 03

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• 1:42:01Speaker 05

  Yeah, great. And where can people find you?

• 1:42:05Speaker 06

  Uh, what do you mean by that?

• 1:42:07Speaker 05

  All right.

• 1:42:07Speaker 06

  I don't want to be...

• 1:42:08Speaker 05

  Okay, well, what I meant is, I mean, I know you mentioned that you weren't really on social media. I know you had a unfortunate incident with LinkedIn and stuff like that. You know, are you anywhere where people can like follow your work or?

• 1:42:24Speaker 06

  I have a, 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. chrisfrueh.com is the website, but

• 1:42:38Speaker 06

  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.

• 1:42:44Speaker 05

  Yeah.

• 1:42:44Speaker 06

  And what I do, and what I do is not things I'm gonna, I want to publish or put out there on social media. So I mean, I may be intentionally a little bit hard, hard to find at times.

• 1:42:56Speaker 05

  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 documented, you know?

• 1:43:06Speaker 06

  Well, yeah, so...

• 1:43:10Speaker 06

  I am working on a couple of papers right now. You know, there will be scientific publications, I hope, at some point in the next year, 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, I'm, I'm old. I'm not that invested in my, in the academic world anymore. And, but there are people who are. There's a psychologist in the VA system who is, who's essentially, you know, I think, trying to make that his career goal, to collect the longitudinal, not just the cross-sectional,

• 1:43:52Speaker 06

  but the longitudinal data to begin to better understand operator syndrome. And he's at one of the polytrauma centers that may, may change their name to the, to something, something operator syndrome program. At least that's, that's their tentative plan.

• 1:44:11Jack Murphy?

  Do we have questions?

• 1:44:12Speaker 04

  Yep, we got one from M. Corbin. Could any treatments help address the negative cognitive effects linked to digital device addiction?

• 1:44:22Speaker 06

  Hmm. If I had a simple answer for that question, I would be, probably become a very, very wealthy person. I, I don't know of specific treatments other than any, the kinds of things that work for addiction. Might be relevant. The cognitive therapies, the, there's probably, if you look, one, one series of books that I kind of 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, to, to reduce the digital. But when it comes to digital porn addiction, things like that, those are, those are.

• 1:45:08Speaker 06

  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 of 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.

• 1:45:37Speaker 05

  Are there any emerging treatments that aren't really widely known yet that you're excited about or excited about the possibility of?

• 1:45:47Speaker 06

  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

• 1:46:29Speaker 06

  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 the people who've 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.

• 1:46:56Speaker 05

  Please, go ahead.

• 1:47:00Speaker 06

  I was just gonna 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 intrigued by. There's a mono 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.

• 1:47:45Speaker 06

  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.

• 1:48:01Jack Murphy?

  I took a ketone energy drink before we started.

• 1:48:05Speaker 05

  Delta G ketone ester?

• 1:48:08Speaker 06

  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, 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, it 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 dabbled 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,

• 1:48:53Speaker 06

  including cognitive sharpness. And part of what DARPA was looking for was, was to be able to take a soldier who's 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, though. The deep ketosis seems to produce a very...

• 1:49:20Speaker 06

  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 gonna go on a, let's say, a breaching or a shoulder fire rocket training day? Take a dose of this stuff before the training, 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.

• 1:49:54Speaker 05

  Yeah.

• 1:49:55Speaker 06

  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 gonna 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.

• 1:50:16Speaker 05

  Oh, is it?

• 1:50:17Speaker 06

  So, there aren't many of us that are gonna use it on a regular basis unless we have the DOD or the Tour de France money supporting our habit.

• 1:50:25Speaker 05

  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?

• 1:50:39Speaker 06

  Not very much, because I don't know very much.

• 1:50:41Speaker 05

  Okay.

• 1:50:42Speaker 06

  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 stellate ganglion and the ketamine infusions. So, they can be one-stop shops for a lot of the different kinds of interventions that might be useful.

• 1:51:18Speaker 05

  Fascinating.

• 1:51:19Speaker 06

  And they will do a deep dive on nutrition and, you know, 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. Prejudice for you based on your your numbers. So I think I think regenerative medicine, functional medicine is going to be place that we we see much more important things happening for people with operator syndrome.

• 1:51:59Speaker 05

  Chris has been amazing. We really appreciate it.

• 1:52:03Speaker 06

  Thank you for having me. This has been good.

• 1:52:05Speaker 05

  Yeah, thank you for coming on. The book is amazing.

• 1:52:08Jack Murphy?

  And links will all be down in the description for people who want to find the book or want to find Chris's website.

• 1:52:13Speaker 05

  Yeah. Yeah. Was there anything that we failed to ask you or anything that we left out that you wanted to talk about?

• 1:52:25Speaker 06

  Nothing comes to mind. We probably could sit here for another five hours, though, and and and find a steady stream of things to talk about.

• 1:52:35Speaker 05

  Oh, I could.

• 1:52:37Speaker 06

  So you'll just have to invite me back another time.

• 1:52:39Speaker 05

  Absolutely. Thank you so much, Chris. We really appreciate it.

• 1:52:43Speaker 06

  You bet. Thanks for having me.

• 1:52:44Jack Murphy?

  Thank you.

• 1:52:44Speaker 05

  Thanks, everybody. Good night.

• 1:52:47Jack Murphy?

  Hey, guys, it's Jack. I just want to talk to you for a moment about how you can support the show. If you've been watching it, enjoying it, but you'd like to get a little bit more involved and help us continue to do this, you can check out our Patreon. It is patreon.com/the team house. And for $5 a month, you can get access to all of these episodes of the team house ad free. The same goes with our affiliated podcast, Eyes On, with Andy Milburn, Jason Lyons, McMulroy. That one, you will also get all of those episodes ad free. And you support the channel and the show, and we really appreciate it. The Patreon members are literally what has helped this company, this small business,

• 1:53:29Jack Murphy?

  survive, especially during our early years. And you are what continues to help this thing going, even as we navigate the turbulent world of YouTube advertising. So we really appreciate all of you guys. There's going to be a link down in the description to that Patreon page. And there is also going to be a link to our new merch shop. So if you guys want to go and get some Team House merchandise, we got stickers, and we also have patches. And I should mention, if you sign up for Patreon at $10 a month, we will mail you this patch as well.

• 1:54:04Jack Murphy?

  So we really appreciate that. But they're also for sale on the merch shop. And additionally, they got T-shirts up there, water bottles, a tote bag, coffee.

• 1:54:16Speaker 02

  Migraine makes me miss out on the moments that matter. So I asked my doctor about saying yep to VYAPT, eptinezumab J J M R, an IV infusion given every three months that helps prevent migraine attacks in adults.

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• 1:55:30Jack Murphy?

  Hugs, all that good stuff. So please go and check them out and support the show. We really appreciate it, guys. Thank you.

• 1:55:41Speaker 02

  Migraine makes me miss out on the moments that matter. So I asked my doctor about saying yep to VYAPT, eptinezumab J J M R, an IV infusion given every three months that helps prevent migraine attacks in adults.

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  Don't receive if allergic to VYAPT. Get help right away for allergic reactions like rash, swelling of face, lips, tongue, or throat, trouble breathing, hives, or facial redness. Tell your doctor if you have constipation that is severe or associated with severe or constant belly pain or swelling, vomiting, or bloating. If you have increased blood pressure or color changes, pain, or numbness in fingers or toes. Common side effects are stuffy nose, scratchy throat. and allergic reactions.

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  She's been thinking about this sleepover all week, but I think about her food allergies all the time. Fortunately, her doctor prescribed ZOLAR, omalizumab. It's proven to significantly reduce allergic reactions if a food allergy accident happens.

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