PTSD, Michael Fellner

Dr. Michael Fellner, a licensed and board certified psychologist, worked 29 years at the V.A. Black Hills Health Care System. He has worked with Post-Traumatic Stress Disorder programs and started the Vet Center in Rapid City.

Deb Holland, Journal staff

Avoid avoidance.

That's the advice of Dr. Michael Fellner, a licensed and board certified psychologist, who worked 29 years at the V.A. Black Hills Health Care System, gives those suffering from post-traumatic stress disorder.

Fellner recently presented "PTSD — Now & Then," as part of the Sturgis Big Read program.

"You must face up to the feelings of intense vulnerability," he said.

One of the hallmarks of PTSD is avoidance and making sure that nobody knows what the traumatic experience was like because no one "can" know.

"We avoid it. We hole ourselves up. We don't talk about it. And we all know that can make things worse," he said.

Minimizing avoidance and isolation are keys to treating PTSD, Fellner said.

"Stay active. Pursue enjoyable activities," he said.

Part of the problem with PTSD is that individuals are afraid to be vulnerable again.

"You can't love anyone without allowing yourself to be vulnerable," he said.

But when you are vulnerable, people get to poke and prod and find all your little pitfalls and stumbling blocks, Fellner said.

"None of us like that," he said. "If you can't be vulnerable with people, they can't get close to you which makes it easier to be isolated and avoidant which keeps perpetuating the problem."

Those suffering from PTSD need people around them who won't put up with their avoidance.

"We need those annyoing people who don't give up on us," Fellner said. "It takes courage to live well. It takes courage to love. It takes courage to allow others to love you. None of that comes easily."

Fellner, who has worked with PTSD programs and started the Vet Center in Rapid City, said a common trigger for those suffering PTSD are smells.

He said he has heard from a number of Vietnam veterans that they can't get the smell of Napalm out of their noses.

Napalm is a flammable liquid that was used in warfare. It is a mixture of a gelling agent and either gasoline (petrol) or a similar fuel. It was initially used as an incendiary device against buildings and later primarily as an anti-personnel weapon, as it sticks to skin and causes severe burns when on fire.

Fellner says smells are powerful triggers for intrusive events from trauma coming back.

In the U.S., the idea of PTSD has actually been around since the Civil War under different names. During the Civil War there was a condition called The Soldier's Heart, which referred to a combat soldier who couldn't take it anymore and couldn't deal with the violence.

"They were so deeply emotionally tied into the death and the violence of war that they couldn't function anymore," he said.

In World War I, there was a new name for PTSD — shell-shock — but the symptoms were the same. During World War II, PTSD became know as combat fatigue. And during the Korean Conflict, it took on the title of combat neurosis.

"It was in Vietnam that we first came up with the term post-traumatic stress disorder in the psychiatric diagnosis," Fellner said.

Prior to and during World War II there was not a cohesive set of symptoms to describe PTSD or any of its other names.

"Each of the military branches had their own description of it, as did the VA," Fellner said.

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Different eras of the military dealt with their PTSD in different ways, Fellner said.

"Many of them came back from World War II, raised their families and typically never talked about their war experiences. You weren't expected to talk about it," he said.

That changed with those returning from Vietnam. One of the reasons was because of the demand for services by veterans.

"Vietnam is what started the Vet Center movement," Fellner said.

There also was a change in philosophy, with people believing veterans needed to talk about their experiences because it was not good to avoid it.

"Nightmares, flashbacks and all of that gets worse when we avoid it," he said.

Today there is a treatment called acceptance commitment therapy, which focuses on moving past avoidance.

"The first thing is to accept things as they are before moving on to do anything about it. That's hard," he said.

It takes a lot of courage to face PTSD, Fellner said.

"I think back to some of the clients I've had, and they have been unbelieveably courageous. I don't know that I could get through that, day after day, session after session," he said.

He said the VA runs many groups for veterans with PTSD.

"They can help each other like nobody else can," he said.

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