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San Diego VA Studies The Role Of Guilt In PTSD Treatment

Jesus Seineke takes a break in Iraq in 2004.
Jesus Seineke
Jesus Seineke takes a break in Iraq in 2004.

The San Diego Veterans Affairs Hospital is looking at the role guilt and shame play in the treatment of Post Traumatic Stress Disorder.

Researchers want to find the best way to treat people who may not think they deserve to get better.

Jesus Seineke dismissed his own injuries when he talked about the time his Stryker vehicle was hit by a rocket-propelled grenade during an ambush outside of Mosul in August 2004.

No, he said, it was his buddy who was hurt.

“We’re shoulder to shoulder and he takes a round," Seineke said. "Shrapnel or whatever to the face. So like, I injured my back ... but he took a round to the face.”

Skip forward 11 hours that day, and they are still in the firefight. Seineke’s weapon is a .50-caliber machine gun. It can tear through a vehicle. At this point, he is running out of ammunition. Suddenly, a car was barreling toward their position, and he was faced with a choice.

“I opened fire on the vehicle. Took out the engine block and the wheels. Then proceeded to lay waste to the inside of the cab,” he said.

Later he found out who was inside.

"An old man, a young woman and two young children in the back seat," Seineke said. He took a long pause.

You can tell Seineke he was under fire. Or that he didn’t know who was in that car.

“You can hear that from everyone else like I’m hearing that from you. But it’s like deaf. It just doesn’t process the same,” he said.

Years later, all those memories came rushing back, when the county threatened to take custody of his young son. Seineke attempted suicide.

"Those are the types of stories we hear from our patients, in our research, every day," said San Diego VA researcher Sonya Norman.

San Diego VA Studies the Role of Guilt in Treatment of PTSD

Norman is the lead researcher for a nationwide study on the treatment of PTSD for veterans of the wars in Iraq and Afghanistan. They want to know the role guilt and shame play in seeking PTSD treatment. It is something Norman has seen since she began treating these vets starting in 2008. Split second decisions can haunt these veterans.

"It can complicate treatment a lot. Partly because sometimes the next thing people tell themselves is 'I did something so bad, and it means I am bad. And it means I don’t deserve to feel better,'" she said.

RELATED: More Vets Who Are Coping With PTSD From Sexual Assaults Get Honorable Discharges

The study will look at the range of treatments offered by the VA to see which ones work best, as well as which treatments the VA may consider rolling out nationwide. San Diego veterans of the wars in Iraq and Afghanistan are encouraged to join the study.

Over time, Seineke said, he’s been able to get his own guilt under control. He was able to win back custody of his son, who is going into middle school. And Seineke now has a daughter. He now counsels other veterans who are struggling to deal with that one terrible moment that changed their lives forever.

San Diego VA Studies The Role Of Guilt In PTSD Treatment
San Diego VA Studies The Role Of Guilt In PTSD Treatment GUEST: Steve Walsh, military reporter, KPBS News

>> Thousands of veterans living in San Diego dealing with the aftermath of combat including PTSD. We are beginning to understand more about PTSD, how it affects us and how to heal us. June is awareness month and it is a good time to profile some of what we are learning. The VA is leading a study about the role of guilt and shame and how that complicates the treatment of PTSD. Joining us to talk about this is Steve Walsh. Thanks for joining us. You have done a story about a local veteran who has PTSD from his time in the service. Tell us, where did he serve and what did he tell you about the traumatic event that he had such a hard time getting beyond? >> He was outside of muzzle in 2004 when his unit, they were part of an 11 hour firefight. His leader had been hit early on. He was running out of ammunition. He was in something called a saw gunner, which is a machine gun. We don't know much about them, but they can tear a vehicle in half. It is a very powerful weapon. 11 hours into this fight, a car came barreling toward him and he asked for permission to fire and he was told yes, go ahead. Later he found out that inside of that vehicle, there was a woman, a man and a couple kids in the backseat. It was a very hard story for him to relate even years later. He did not know those kids were in the car. He was following his commanders lead and he just turned to me and said that was not enough. >> You can hear that from anyone else, but I am hearing that from you, but it is like death. It does not process the same. >> In the end, he just cannot hear it or it has taken years of treatment for him to finally hear that most likely, as horrifying as this image is, it probably was not his fault. >> Did he seek treatment when he first got home? >> He did not seek treatment for years. He tried to keep coping on his own and use the strategy that a lot of vets do who suffer from this. They put it out of their minds and put it in a shoebox and do not think about it. Then in 2010, he had an incident where he got into a scuffle over a parking ticket. He said it was a minor thing and he does not know why he blew up, but in the end, the state threatened to take away his son and at that point, all of these images from Iraq came flooding back to him. He attempted suicide. He said the Guild was a major reason why he did not try to confront these images sooner. >> The reason he kept it inside and presumably, that is something that many returning veterans experience with guilt, talk a bit more about why he felt guilty. >> He felt guilty because it was such a horrible image, the notion of -- he had young children himself at that time and imagine finding out that you have shot a vehicle filled with a mom and kids and an elderly man. It is something that you are never just going to forget. I ended up speaking with Sonya Norman, she is with the VA and she is a researcher and she was looking specifically at the role that guilt played in PTSD treatments. >> It can complicate treatment a lot. Partly because sometimes, the next thing people tell themselves is I did something so bad and it means I am bad and it means I do not deserve to feel better. >> That in fact means that they might not seek treatment because they really do not feel like they deserve to be healed? >> Think about that. If you are the person whose job it is to treat someone and they do not think they should get better, guilt can become the cornerstone of their personality. They can take this for years. They assume that what they did was horrible and then eventually it starts moving into the area where they start healing that they are terrible people and that they do not deserve to get better. So you have to somehow, as a physician, you have to find a way to bring them back into the fold and get them to deal with these images that they have been keeping out of their mind for so many years. >> Guilt is such a hard thing to treat, what is the VA coming up with in terms of treatments that might touch that? >> Studies are looking at a range of treatments offered by the VA, looking at the ones that might work best and there is something called prolonged exposure therapy, which basically forces you to look at these traumatic experiences. They will get you to face up to what has happened. I have talked to a couple of vets who do not like that approach. They do not feel that is effective for them. So what the VA is doing is researching all of the options that they have on the table to get a better sense of what might work. There is something called trauma informed guilt reduction in therapy. All these things are being tried a different VA's around the country. The idea here is to figure out which ones work best and which ones might roll out to VA's nationwide? >> Is the VA still recruiting people to be subjects? >> Date are looking for -- this is for vets, so Newark crops of veterans. One of the reasons San Diego is the lead researcher for this is this says we have a lot of veterans here at San Diego was a leader early on in looking at treatment. We have things like the aspire center here and they are working specifically with the VA in Rhode Island and there will be case studies around the country so they can get a better sense of which treatments are most effective in which treatments should be ruled out the VA's nationwide. >> Thank you so much.