Geriatric Mental Health Disaster and Emergency Preparedness

334 Geriatric Mental Health Disaster and Emergency Preparedness
veterans’ psychic attention and energy. Avoidant behaviors may range from
avoiding anxiety-provoking situations—such as not answering the telephone
because there is a strong belief that it will be bad news—to avoiding
abandonment by not telling or showing a spouse or partner your love
because if you do you will be hurt when they die or leave. These behaviors
also encompass not taking an active role in raising children—because it is
your fault if something bad happens because you failed to protect them—
to seeking anonymity in the workplace.
Withdrawal From Relationships and Intimacy
To a large degree, the veteran does not develop the usual network of interpersonal
relationships. The veteran keeps social and family contacts to
a superficial minimum. Perceptions of being an outsider or being different
than others because of one’s combat experience play a significant role.
Particular core beliefs about veteran versus civilian and beliefs about self
as unworthy and others as unsafe or untrustworthy underlie this behavior.
Protection
Veterans feel a need for power and control based on a belief that the more
control they exercise the safer their world will be. Veterans with PTSD often
invest time and energy into creating a secure home environment to
ensure their spouses and children are protected. The more the veteran
can demonstrate to his own satisfaction that he has created a safe environment
the more in control and therefore less anxious the veteran feels in
this regard.
Reaction
The veteran maintains a posture of hypervigilance in order to feel safe and
in control. The veteran fears losing control over his environment by becoming
complacent. The reactive mode, particularly in crisis, allows the
veteran to feel superior and in control of a potentially threatening or dangerous
situation. This behavior operates at a more primitive or pre-rational
functioning level within the brain that is connected to the basic instinct of
survival. It is associated with the fight, flight, or freeze reaction characteristic
of the limbic system and the amygdala. This is the area of the brain
stimulated during boot camp and matches perfectly to the primitive circumstances
of combat. A combat veteran’s belief about losing one’s edge