22
July / 2021

#018: Operator Syndrome – Dr. Chris Frueh

What happens when we push ourselves too hard – over too long a period of time? What happens to our mental, physical and emotional states? Even the most elite performers reach a point when they can’t go any further. We are not talking about a single event, or a single day. We are talking about years, or decades, of driving to the limit, pushing through, and winning; only to wake up one day with nothing left in the tank.

This is called Operator Syndrome – and it affects the most successful champions in the world, first responders, doctors, lawyers, restaurateurs, and the rest of us driving to make it in the world. Dr. Chris Frueh is a Professor of Psychology at the University of Hawaii and a leader in the research and clinical evaluation of Operator Syndrome.

He joins host Fran Racioppi on this episode to show us that even as we push ourselves to the limit every day, we must be conscious of the cumulative effect of stress over long periods of time; and how sleep, nutrition and mindfulness are the “survival skills” we need to combat Operator Syndrome and its negative effects on our performance.

Listen to the podcast here:

What happens when we pushed ourselves too hard over too long a period of time? What happens to our mental, physical and emotional states? Even the most elite performers reach a point where they can’t go any further. We’re not talking about a single event or a single day. We’re talking about years or decades of driving to the limit pushing through in winning, only to wake up one day with nothing left in the tank. This is called Operator Syndrome and it affects the most successful champions in the world, first responders, doctors, lawyers, restauranteurs and the rest of us thriving to make in the world every day.

Dr. Chris Frueh, a Professor of Psychology at the University of Hawaii and the leader in the research and Clinical Evaluation of Operator Syndrome. Chris works in private sector executives as well as military leadership of special operations to evaluate, diagnose and treat Operator Syndrome. He joins me in this episode to show us that even as we push ourselves to the limit every day, we must be conscious of the effects. We break down the symptoms, the key that will affect stress for a long period of time and how to sleep, nutrition and mindfulness are the survival skills we need to combat Operator Syndrome in this negative effect on our performance. Chris also highlights how we can raise awareness and support each other to become the best versions of our ourselves.

Chris, welcome to the show.

Thank you, Fran. It’s a real honor to be here.

Chris, we spent seventeen episodes telling the stories of elite performance. We talked about the endless unrelenting drive for success and winning. We spoke about conquering fear, never quitting, finding the limits of performance and busting through them. We’ve even qualified this in the phrase, “No matter the challenge.” It’s there on our tagline. No matter what, you have to get out there, when and there’s no second place. It reminds me of, “If you’re not first, you’re last,” and that’s been so much of the premise of what we’ve talked about.

I asked you here because I’m interested in what happens when we push too far for too long in too many volatile, uncertain, complex and ambiguous environments. What happens when our drive and our push to win at all costs, costs us our mental, physical and emotional well-being at best. Maybe at worse. It causes stress, poor health disease or maybe even our life by suicide or disease and we die because of it. This happens. This is the second episode that we’ve had on the show where I’ve brought in a psychologist to give us the how-to. How do you define one specific thing in your world, combat it and get better because of it?

We’ve talked about identifying and changing behaviors empowering leaders to make changes in themselves in their organizations. You run one of the only programs in the country specifically designed to identify research and help those who’ve pushed too far for too long. That’s a factor you’ve called Operator Syndrome. I want to define Operator Syndrome, as you have as, “The natural consequences of an extraordinarily high allostatic load. The accumulation of physiological, neural and neuroendocrine responses resulting from prolonged chronic stress and physical demands. As the allostatic load builds, both mind and body begin to wear down and manifest notably in a wide range of impairments during the later stages of a career.” Can you define Operator Syndrome? Who’s affected by it? What is it? Why did you jump into this field of research?

If you're not getting that slow-wave sleep, you've got the proteins and toxins building up in your brain. Click To Tweet

For me, Operator Syndrome is a framework for understanding a complex set of interrelated medical and psychological, behavioral and social difficulties that many military special operators begin to experience towards the middle to later stages of their careers and certainly post-military careers. People often ask me, “Is that a medical diagnosis?” “Is it in the ICD or the DSM?” The answer is no. It’s a framework to begin to understand this complex ball of wax that a lot of guys are struggling with and these things are all connected and causative.

We can have vicious cycles and virtuous cycles. This can become a vicious cycle if we lead off with traumatic brain injury and let’s be clear of what we’re talking about here. There are several different avenues for traumatic brain injury that many military service members and veterans have encountered with one being concussive forces, impact forces and blast wave exposures. One of the things that I was truly shocked to learn about early on, probably more than a decade ago, was the Special Operations community spends months, years training and fighting with demolitions and explosions. Achieving this training alone, even for guys that have never deployed, the dose of blast wave exposure is massive.

What we’re talking about is an invisible wave. You can feel it but it has a shearing force to all the soft tissue in your body, your brain, your lungs, everything and it affects all of that. If that’s not enough, let’s also be mindful of the massive amount of toxic exposures that military special operators and other service members experience when they’re overseas in war zone deployments. Bad air, bad quality water, poor food and you’ve got all the heavy metals, chemicals, the gases, the air pollution and the burn pits on and on. All of that affects the brain.

The brain, the TBI, has a cascade effect so it interrupts cognitive functioning like memories, concentration, attention, executive planning and organizational skills. It also affects the endocrine system so many guys start to have lower testosterone, dysregulated thyroid, human growth hormone or even estrogen. We have guys from the community who are developing large breasts as a result of these hormonal changes.

We also know that TBI disrupts sleep as well as so many other things in the lifestyle. Chronic stress, shift work, night work and hypervigilance all affect sleep. If you’re not sleeping, it’s hard to heal your brain and it’s not about getting enough sleep, it’s about getting the right sleep. We’re seeing massively high rates of sleep apnea, periodic limb movement disorder, we see folks who are sleeping for 5 or 6 hours a night and we looked at their sleep architecture and they’re not getting hardly any REM sleep, slow-wave sleep or either of those. We need these different types of sleep. Slow-wave sleep is when our brain is cleaning itself. We have a lymphatic system that only kicks on when we’re in slow-wave sleep. If you’re not getting that slow-wave sleep, you’ve got the proteins building up and the toxins building up in your brain.

If that happens over time, years and decades, there’s a cascading effect of these things.

That makes your endocrine and brain functioning worse. What happens to your emotional state? What happens to your relationships with other people? Are you able to control your anger? Are you able to relax and rest when you want to? The answer for many people is that things and functioning become difficult. We use the word impairments. That was the thing we focused everything on are impairments.

That’s a long list of them here in addition to traumatic brain injury effects, endocrine dysfunction, sleep disturbance, sleep apnea, chronic joint back pain, substance abuse, depression, suicide, anger, worry, rumination, marital family, community dysfunction, problems with sexual health and intimacy. This hyper-vigilance on guard, memory problems, concentration, cognitive impairments, vision impairments and challenges transitioning from your work into normal life.

TJP 18 Dr. Christopher Frueh | Operator Syndrome

Operator Syndrome: Operator syndrome is a framework for understanding a complex set of interrelated medical, psychological, behavioral, and social difficulties that many military special operators begin to experience towards the middle to later stages of their careers.

Whether that’s in the military, civilian or private sector, that’s a big issue for a lot of high performers. How do I shut it off? How do I stop being on whether I’m a doctor, a lawyer, I run my small business or I am in special operations in the military? How do I shut it off, go home and operate with my family if you want to use the term operate and be part of my family and interact? This creates these existential issues that then draw someone to this hyper-alert state all the time that over prolonged periods of time wears them down.

We haven’t even talked about the memories, the experiences that have come before that the guys and gals have never had a chance to stop, process, think about to grieve, mourn and talk about with other people in a way that might be a little bit vulnerable. You end up with a list of people that you’ve lost. How many names do you still have in your phone of people who are gone now? How many funerals have you been to? How many Memorial Days have you sat out in the backyard by yourself and balled privately without anybody else seeing or knowing about that?

You brought up transition and that’s a complicated topic because there are different kinds of transitions. There’s the transition into a military, a unit, a service, a branch of the service, out of the service, leaving the military and going into civilian society. We forget this to our detriment to our peril. There are also the transitions from coming home from a deployment or going on to a deployment after being at home or being in the training environment for a period of time.

Let’s take this to other levels of our society, high performers in business, athletics, academia and most importantly, our first responders. They have a transition every day. How do you turn it on in the morning? How do you put that uniform on in the morning at the beginning of your shift and transition to that? At the end of the day, how do you come home and try to transition back to your home life, family and to your children? I know we started off talking about Operator Syndrome and I’m probably jumping out ahead of where we are. I want to plant that seed for the responders.

That’s an important point because if you look at somebody who operates in Special Operations in the military, they deploy forward. When you’re at home, you go through training and it’s a relatively calm period of time. You’re at home every day and you go forward, you deploy how for however long that may be a week, a month, a year when we were going to Iraq and Afghanistan. By and large, those experiences lie on what we call over there, overseas or in the box was a term that used to get used a lot if you’re a first responder, doctor, surgeon, lawyer or investment banker who deals with a firefight who deals with a high level of stress and risk in your daily work like a police officer.

Every day when you leave your house, that’s your deployment. Until you come home, you’re in effect in the box. You were there. You have to be on but yet you’re doing this day in and day out while trying to balance what is your normal life, your real life at home. Many times, these first responders, these folks who work in hospitals have seen things that are equally, if not sometimes, worse than what our military has seen and yet they’re seeing it every single day and expected to go home. How do you deal with that?

To even maybe put an exclamation point on that, I’ve been visiting with a longtime friend of mine, who retired a few years ago after twenty-plus years in the Navy and the Navy SEALs and he was at the most elite unit in Naval Special Warfare. I start talking with him about what were the toughest things you saw and did? This is common. It’s almost always about, “I was holding a child who died in my arms. I felt their last breath as they slipped away.” Maybe they died of an illness like malaria. Maybe they died in a fire, in combat, a blast of some sort but firefighters and police officers experience these kinds of same experiences on perhaps even more regular basis.

Think about the COVID workers in the hospitals who dealt with massive amounts of loss.

The American medical system, which is pretty much the same system used around the world, is very fragmented. Click To Tweet

To add to that, the pain of that is always a sense of helplessness. When you feel helpless, you are helpless. If it’s happening and you’re there, the best thing you can do is hold somebody’s hand and watch them go.

When you think about these symptoms or what you call these impairments, if you’re on the other side, you’re the person who is in this role, there’s a sense of self-assessment that probably occurs. Can you talk about what is that self-evaluation? How do you internalize it? Is that a daily thing or a weekly thing? How do you look at this list of impairments and start to think, “Maybe I suffer from one of these or several of them? Where am I on this spectrum?” Is there any test? Is there anything that somebody can take a step back and say, “I’m suffering from this Operator Syndrome and I need to do something about it.”

I have a lot of thoughts on that but let’s get real here for a moment. The American System Medicine, which is pretty much the same system that is used around the world, is fragmented. When you have an acute problem, you go to the specialist who is the guy or gal that does that and treats that specific problem. If you have chest pain, you’re going to end up seeing a cardiologist. When you have a foot problem, you’re going to see a podiatrist. If you have vision problems, you’re going to see an ophthalmologist or optometrist.

Do those people talk to each other? Those different specialists, when you go in, “Has your optometrist already spoken to your endocrinologist? Is your endocrinologist hearing from the sleep specialists that may be working with you?” The answer is, for the most part, no. We fragmented all of this stuff apart. I’m guilty of that too, myself so maybe I could go back and just give a little bit of a lead into how I came to this point in my own thoughts and in my own mind. I spent fifteen years in the VA system as a clinical psychologist working with veterans and this was in the ‘90s. I was there for fifteen years until 2006. I was in a PTSD clinic and we treated post-traumatic stress disorder in veterans.

Most of them in the ‘90s were Vietnam-era veterans, some more Korean and small numbers were World War II or Persian Gulf I. That’s what we did. We treated PTSD. You’ve got another problem? Go down the hall to this clinic or go downstairs into the left and that’s who you see. We were narrow in our focus and in fact, we were so narrow. We had a PTSD clinic right next to a general mental health clinic right next to a substance abuse clinic. Patients were getting shuffled back and forth between these three mental health clinics all the time. To go back to the early part of my career. How do I treat PTSD for somebody who has substance abuse? Do I send them down the hall and say, “Go get sober and come back?” That doesn’t work well.

Do I say, “If we’re going to treat your PTSD, we’re going to ignore your drug or alcohol problems.” That doesn’t work either. What I recommend is a framework that takes the whole person and all of the system into account as simultaneously as possible. The idea would be to go to a program and I’m describing the unicorn here now. The unicorn has a multidisciplinary team that involves a neurologist, neuroimaging, neuropsychologist to evaluate the TBI. A neurologist or an endocrinologist to look at the endocrine system. A sleep specialist involving interviews but also spending the night in a sleep lab, measuring all the things that we measure in a polysomnographic study.

A pain specialist, somebody who specializes in psychiatric disorders. You need orthopedic surgeons, orthopedic specialists, physical therapists, vision, hearing and vestibular specialists. You need to have more at the table at least once in a while to talk about each individual person and try to do that somewhat at the same time. You can’t do it at the same time but we could bring you into a program and have you visit us for 2 to 3 weeks. We could do all of that. We could pull it all together if you had about eight hours a day for 2 to 3 weeks.

At the end of that, we would have a whole lot of information for you. Everybody’s talked to everybody and now we’re targeting things in a way that will make more sense. For example, if you have low testosterone, I can tell you what that means. It means your concentration is low, you’re irritable, your mood is low so you appear depressed and grumpy. Your sleep is completely messed up. You can’t get enough sleep and you can’t get the deep sleep you need. You don’t have much energy and strength, the motivation or the drive that you used to have and you have a low sex drive. All that goes together. Imagine walking in and seeing a psychiatrist or your typical psychologist and social worker. They look at you and go, “That’s depression. Here’s your SSRI. Here’s your antidepressant medication.”

TJP 18 Dr. Christopher Frueh | Operator Syndrome

Operator Syndrome: Chronic systemic inflammation that runs through our whole body is one of the things that is driving cancer rates, diabetes, chronic illnesses, and probably depression and other psychiatric disorders straight up through the roof.

That’s not going to help your testosterone and almost nobody in the mental health field is looking at that. I’ve been in three different departments of psychiatry around the country, large, top and well-respected medical schools and large departments of psychiatry with 80 to 150 faculty. We didn’t have an endocrinologist in any one of those departments when I was there. If we did, I didn’t know about him.

We’re not connecting the dots effectively and everybody says, “It’s not my problem because I only treat the PTSD or the sleep problem.” Here’s the punchline for me. Do you know how many veterans you talk to who are on twenty different medications? I meet them quite frequently. I don’t want to say it all the time but every month I’m meeting these guys. It’s not uncommon and that’s because each different specialist goes, “Your problem is X and here’s the medicine for X.” Now, you go to somebody else with more symptoms. Guess what happens when you’re taking those medications? It’s not good. It’s not happy.

I imagine there’s a reaction to it that cut tail, essentially.

Who knows what’s working on what and you’re getting medications to counter the side effects of other medications. We can do better. I described it as a unicorn but as a unicorn, we could achieve if we put our shoulder to the wheel. You asked me about assessments and how to do this. The first question I’m going to ask anybody is, “Do you have a primary care doc? When was the last time you saw the primary care doc?”

That’s a simple question and hopefully, the answer is yes. Sometime within the last year, for special operators, what I’ll say is, “Take this paper that we’ve written and take it into your doc. Highlight the things that you think are relevant. Get yourself a purple highlighter and go through the paper. All the bolded words that stand out to you and sound possible, rip that thing through them, highlight them, take it in and have that conversation with your primary care doc.” That’s the easiest place to start.

It doesn’t hurt if you’ve got some priorities. Let’s say you’ve got to piecemeal of your own care together. Where would I start? I go get the blood lab test to see what the endocrine functioning looks like. That’s a simple blood test and you can have the results within a few days. I would ask for a sleep study. Ask your primary care doctor to go spend the night in a sleep lab. Let’s see what your sleep is like. If you’ve got sleep apnea, that simply means you’re not oxygenating your brain sufficiently. There’s a remedy for that that works for most people who have the need for it. Not everybody but for most people. Before you start looking at medications, go do those two things.

I want to ask about education. You brought up here the fact that primary care physicians are the first line or the first step in the process. What are we doing to educate the medical field, as well as people, first responders, military veterans and people who may suffer from this? I want to cite an Air Force article that spoke about this and highlighted some of your work where they said, “Education after the fact is critical to help operators not only to self-assess but also to assess others and urge them to seek assistance as operators typically are not aware when in a high-stress environment.”

That’s important because I know as an operator myself and even now in the business world, you operate in a high-stress environment. You’re trying to meet deadlines, do things and push things forward. There is this need to never quit, to always have improvement and never take a step back. You don’t look internally that often and say, “I may be suffering from these things.” You’ll say, “I only slept three hours last night but that was because I had to work late. I got up early this morning because I had more things to do but I’ve done that for the last 14 to 21 days.”

If we can control our inflammation, we're going to feel a whole lot better and be a whole lot healthier. Click To Tweet

That’s a reality of many jobs and many situations that we have those periods. I’m no different. I had an eight-year period of my life where I was working 100 hours a week. When I came out of it, here’s the story. I switched jobs and I moved somewhere where I had two weeks with nothing to do in between. To my surprise, after getting by 5 to 6 hours a night, I was naturally sleeping about twelve hours a night because I didn’t have a to-do list or morning deadline. I had nothing on my plate and my body said, “Great. Let’s get those twelve hours of sleep.” How do you create that space? It’s a challenge. It’s hard to do. When you go, you’re not going to have the insight. It’s hard to have the insight so you probably need a program, a spouse, a partner, a friend or people to remind you.

In terms of assessments, there’s no assessment for Operator Syndrome, specifically. You have to piecemeal it but you can use paper. We are developing three measures to assess it and probably will have those measures ready for us to start using and evaluating them in about a month. They’re almost ready. I just need to get a few days to sit down and work on them. One will be a clinician interview. It’s the clinician who’s talking to you running through those questions. The other is a patient rating scale. I could email it to you and say, “Fran, fill this out. Send it back to me and we’ll have a conversation.” The third is a parallel measure for somebody who knows you well, your spouse, your partner or a parent, perhaps who’s known you all your life. Ideally, getting multiple perspectives is ideal.

It’s like a 360 assessment.

If you call me and say, “I’m having some difficulties. Can you help me figure out what they are?” I would say, “Sure. Here’s a questionnaire for you to fill out. Here’s something for your wife. Send it back to me and I’ve got my own. I’m going to go through it and we’re going to put them all together and try to make sense of it all.” That’s not easy. Who’s doing that? At this point, almost no one. The SEAL Future Foundation is making a commitment to start doing this assessment with the SEALs that come to them for their health and wellness program and there are other programs around the country that are starting to do a little bit more of this. We have an assessment and treatment program in Houston and Methodist Hospital that we’re using this at. These are early days. Something that I should say is, our paper on Operator Syndrome came out in February of 2020.

It’s right at the start of one of the most, if not the most, stressful times as a society that we may have had especially if you work in some of these first responder-type roles.

It’s ironic, isn’t it?

You brought up sleep and a bit about mindfulness. I want to talk about sleep mindfulness but also the third part about nutrition. As a former Navy SEAL, Stew Smith is now a performance and fitness coach. He’s quoted your work and he said, “You’re not crazy because you have some of these symptoms but you can learn to deal with those systems with a multi-tiered approach.” He cites these three factors as survival skills. Sleep, nutrition and mindfulness. That’s to ensure that an operator or a high performer or someone who operates at an elevated stress level is recovering properly and maintaining his or her ability to perform day in and day out. You’ve also cited these articles and you brought up a couple of them here. Can you talk more about the positive aspects of sleep, nutrition, mindfulness and how we can use them in our daily lives to keep us grounded?

It’s for everybody, not just operators or first responders. I love Stew Smith. I was working out to his videos and his programs years ago and I’ve had the opportunity to get to know him a little bit. I love that tripod that he talks about. Let’s go into it a little bit, diet. What should your diet be? I don’t know exactly but it should involve sufficient proteins, fiber, clean and healthy fats and you need fats. We vilified fats for far too long in our society. Also, your fruits, vegetables and sufficient appropriate carbohydrates. The real problem is all the stuff we put into our bodies that we don’t need. What we don’t need in our diet is any sugar. Sugar is not a vitamin.

TJP 18 Dr. Christopher Frueh | Operator Syndrome

Operator Syndrome: Mindfulness is just being able to quiet things down, finding the ability to sit and be quiet and notice what’s going on in yourself.

We don’t need sugar, sodas, fast food, junk food or processed foods. I do the grocery shopping in my house for my family. When I go through the grocery store, there’s about 80% of the aisles I barely ever visit because everything on the aisle is processed junk food. A simple way to know what’s junk and what’s not is how many ingredients does it have. If it is more than 3 or 4 ingredients, you probably shouldn’t be putting it into your body. I’m not a dietitian, I don’t want to represent as one but there are some pretty simple rules that you can use.

You could take a step further. You could look into anti-inflammatory diets because if you put everything on sleep or put all your efforts into reducing inflammation, you’re going to end up with a lot of the same lifestyle changes. Chronic systemic inflammation that runs through our whole body is one of the things that’s driving cancer rates, diabetes and chronic illnesses and probably depression and other psychiatric disorders straight up through the roof in our society. If we can control our inflammation, we’re going to feel a whole lot better and be a whole lot healthier.

That’s the Tom Brady model. It’s the diet, eating right and anti-inflammation.

Sleep is a big part of that. Getting good quality sleep is getting enough of it. There’s sleep hygiene. Don’t put your focus on sleep in terms of sleep medications. Most sleep medications aren’t good for us in the long haul. Maybe for a few nights, a few months or under certain stress conditions but for the most part, we should be getting our sleep mostly naturally. If you need sleep PAP, figure out how to make it work for you.

Other than that, sleep hygiene. Unplugging from digital and not looking at screens for 1 to 2 hours before bedtime. Having a quiet, cool and dark bedroom. How many of us don’t even do those things? Have you got a TV running in your bedroom? I hear a lot of folks use a TV because they say it helps them quiet their mind and helps them sleep. Try a fan. Try something with a little white noise. That can have a better effect than running a TV.

I think about all the times I’ve fallen asleep with the TV on, the phone in my hand and the light on.

How’d you feel the next day?

I don’t think I ever went to bed.

Don't put your focus on sleep in terms of sleep medications. Most sleep medications aren't really good for us in the long haul. Click To Tweet

You were sleepwalking probably for a few minutes here and there that night.

What about mindfulness as the third leg of this tool? As I know from my own experiences, it’s hard for people to stand up and say, “I need to be aware of what I’m going through, be more mindful, either seek help, talk to someone or disconnect and step away.” We’ve had several conversations in previous episodes with different people who talk about meditation. Colin Beavan talked about Zen, the Zen philosophy and the ability to step away, internalize things and close your mind.

Mindfulness can mean a lot of different things and I’m not here to tell you what mindfulness is per se. Each of us has to figure it out a little bit for ourselves. One thing it means for me is being able to quiet things down, finding the ability to sit, be quiet and notice what’s going on in me, my thoughts, my body whether that’s meditation, going for a walk, sitting out in the woods, going for a swim, taking a shower, meditating or praying. There are a lot of ways to reach it. We don’t typically build that into our lives. Most of us don’t.

If you need help, there are apps, gadgets and different things that can help to evoke a cortical response that will help bring the brainwave activity to a slower, deeper level and that can be powerful. At the end of the day, the mindset is going to look a little bit different for each of us. Part of it isn’t about quieting the mind and being more aware of ourselves. Part of it also is about having an understanding that we have some agency and control of our lives.

I want to approach a situation with the mindset of, “I may not be great at this but I can try it. If I fail, that’s okay.” Depending on what it is but when you’re in the early stages of something, it’s okay to go, “I’m going to go play basketball and I’m not good at basketball. I’ll probably stink at it, other people will beat me and whatever we’re doing.” That’s okay because failure is how we learn. Failure in trying something, getting the feedback and being open to that feedback. It’s how we get better at things. For me, mindfulness means several different things.

You paired up with the Special Operations Association of America and I want to quote a couple of stats from a survey that you cited. Thirteen percent of families believed that there were enough resources to meet their needs when someone in their family may have suffered or encountered Operator Syndrome.

Fourteen percent of the special operations community.

Eighteen percent felt capable of pursuing their own goals. Special operators delay care for all non-catastrophic injuries at an average of 13 years in 3 months, which to me is mind-blowing, although I can understand because I suffered from two major back injuries and an eye injury while I was in service. I only received treatment for those when it was so debilitating that I could no longer function and had to be dragged in there to seek treatment. A twenty-year veteran of Special Operations Forces has 8 to 20 deployments.

TJP 18 Dr. Christopher Frueh | Operator Syndrome

Operator Syndrome: We need to be more mindful that law enforcement officers have some unique needs from, say, doctors, and doctors have some unique needs from special operations.

A Green Beret with a fifteen-year-old child has only been home for about five years of the child’s life. I remember the first four years of my daughter’s life, I was home for one. That’s about on. Divorce rates easily exceed 80%. I would imagine that these numbers and these statistics are fairly similar to other individuals who are in high stress, high-risk careers, first responders type things where they’re going through this every day.

You’ve said, “It’s necessary to invest in innovative longitudinal research for force and family and provide culturally competent and well-coordinated care. No studies have been funded to understand the challenges and needs of Special Operations families and the family plays a critical role in sustaining soft performance and well-being.” Can you talk a bit more about the Special Operations Association of America, the work that you’re doing and how we bring awareness to this and spread education not only to special operations forces but also to the private community who operate at this level all the time?

First, I want to acknowledge that my coauthor, who’s the lead author of this article, is a woman named Kaylie Lehman. She’s the wife of a special forces army officer who’s still active. She’s a powerhouse. We met and started talking. We wrote this article but we couldn’t get it published anywhere. We tried submitting it as an Op-Ed to most of the major newspapers in the United States and nobody took it up. This is the issue. Special Operations doesn’t have its own branch of medicine. If you’re in a Green Beret, you have Army medicine. If you’re a Navy SEAL, you have Navy medicine. If you’re a veteran from one of those units, you have VA medicine.

There’s nothing that’s oriented specifically to some of the unique issues you faced. I want to emphasize what those unique issues are. Special Operation personnel, the massive level of blast wave exposure and we’re talking about magnitudes. It’s not just double or triple. We’re talking about 10,000 times. Nobody’s quantified this but it’s magnitudes. The second difference is typically the number of years, 20 years, 15 years, a lot of years and the number of deployments, the operational tempo, the nature of the duties themselves like direct action or direct combat missions.

When you’re not deployed, what are you doing? You’re in training. You’re preparing for the next mission. You’re learning the next superpower skill. Now you’re learning how to jump from airplanes, combat diving or tactical combat driving. The training itself is not only rigorous but it’s damaging, dangerous and hazardous. Those three things, the nature of the tasks, the length of the tasks and the intensity and have off-tempo are what set the community apart from most other communities in those ways. Each community has its own unique challenges and issues. We need to be mindful of the difficulties for each community.

What we need to do as a nation is we need to be more mindful that law enforcement officers have some unique needs from say, doctors. Doctors have some unique needs. There are unique situations for the Special Operations community, the wives and the family’s needs and things. The operators and support personnel need some things. Drawing awareness is important. We don’t have uniques, programs or medicine specifically for them. We’ve tried to set up a program, specifically for the SOF operation that would be Operation Community that would take the holistic, comprehensive whole person and whole systems approach. What we came to find was even among the foundations and the organizations that want to be supportive of veterans and that fund programs for veterans.

Nobody wanted to fund this because what they want to say is we should treat all veterans the same. We should have quality for all veterans regardless of what they did, how long they did it and where they did it. They all should get exactly the same programs and programming of their services. We’re trying to say, “That’s not reasonable. We do need some special research and some specialized health care programming for the community.” Some of that is now starting. I’m not aware of published longitudinal studies but I’m pretty sure some of those studies are starting up within Naval Special Warfare and Special Forces.

I probably don’t have a full awareness of all of them. For a variety of reasons, it’s sensitive and challenging. We can’t say everything that’s going on in the community. Sometimes, we don’t even want to know what the data show. Many years ago, I had some funding from somebody who had a connection to an NFL football team and we were being funded to do brain research. We were doing an fMRI protocol that included multiple aspects with psychiatric patients and we said, “Your funding is to do this. It’s easy to do this with football players.” We were given a hard no. They didn’t want to go there.

How we learn from failure, trying something, getting the feedback, being open to that feedback is how we get better at things. Click To Tweet

Why do you think?

One is the perception that maybe it interferes with getting the job done. If you’re the head of an organization, you don’t want to know that the people who work for you for a 3 to 6-years stint are getting injured along the way because that impairs the business model or reduces the efficiency of your organization. I’m trying to be general here, not make it specific to one team, one sport, one unit or one branch. You could apply it to many places. As a problem in our lives, we have incentives that are right in front of us. How many of us are worried about what’s going to happen to other people in our organization, let alone ourselves, years from now?

The key to building resilient organizations is to identify these things. We talked about it in Special Operations Forces, which is so transferable to any organization. I talk about it all the time. Is the Special Operations Force the number one truth, our number one principle that people are more important than hardware? People are the basis of sustainable organizations and resilient organizations. They’re what you have to invest in. If you don’t look at your people, evaluate them and understand when they’ve been pushed too far for too long, too hard with no time to recover, step back, internalize what’s going on and seek this mindfulness, sleep, nutrition, are we preparing our organizations for success over the long term? I would argue not.

Therein lies a lot of the problem. We talked about it. We can move our mouths and we say those words but do we put our money and our efforts where it matters. Let me mention one thing that got my attention some years ago. It’s this idea of recovery. I use a whoop strap or whoop band but there are many other products out there that are a personal fitness tracker but the whoop and other things break it down specifically into you getting a report every day. Here’s how you strained or worked yesterday. There are a lot of different metrics in there, how long you worked out, how much you worked out, how many calories you burned.

There’s a sleep component of how long you slept and what the quality of your sleep was. There’s a recovery component. “Here’s how recovered you are.” Some of these devices now are making it so you wake up in the morning. One of the first things you get to see, “What is your recovery at? Where is it?” It gives you some guidance on tuning that day’s strain and effort to where the recovery is at so that you’re not overshooting your recovery on a constant chronic basis. That’s a good way for us to be aware of ourselves and that’s what I try to do with or without any fitness tracking.

“How is my strain now? Am I working out? Am I pushing myself? Am I getting my exercise? Am I getting the calories burned?” Not just stopping there. “What’s do the sleep and the recovery look like?” Sometimes you’ve got to take a day or a week off. You’ve got to switch up your daily strain. Let me maybe even conclude with this thought. When we start talking about Operator Syndrome, we’re talking about something that’s a downstream effect of years of allostatic load on the brain, the body and the psyche. That never quit, never take a knee, never give up or step out becomes that ethos that’s important. On the one hand, it also becomes part of what’s contributing to the problems that so many of us have.

We’ve got to be willing to take a step back. Thanks, Chris, for joining me in this discussion. This has been extremely enlightening. As elite performers and high achievers, we have this endless need to drive further and faster at all expense but what we forget is that we will still fail and we can still fail if we push too far, too fast for too long. I look forward to reading more about your research and speaking with you further as you take this to Congress in Capitol Hill. This is critical for any high achiever to understand and self-evaluate themselves, internalize it and become better every day because of it. Thank you.

Thank you, Fran. It’s been a pleasure.

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About Dr. Christopher Frueh

TJP 18 Dr. Christopher Frueh | Operator SyndromeChristopher Frueh, Ph.D. is a Professor of Psychology at the University of Hawaii, Hilo, HI; and Clinical Professor with the Trauma and Resilience Center, Department of Psychiatry, University of Texas Health Sciences Center, Houston, TX. He conducts clinical trials, epidemiology, historical and neuroscience research, primarily with combat veterans and military personnel.

He has co-authored over 300 scientific publications (h-Index = 84; total scientific citations > 20,000), including empirical studies of the U.S. Civil War and a current graduate textbook on psychopathology. He is also a Performance Specialist with Gray Ghost Solutions – a Houston-based group that provides private and government sector solutions to include medical and security concerns – and a speaker and contributor with the Talent War Group. Sometimes he considers himself a Salvage Consultant based on the types of projects he often works on.

Professionally, he has worked with combat veterans since 1991 – and his earliest interview was with a veteran of the Spanish American War and the Battle of San Juan Hill. More recently he has devoted much of his time to the Quick Reaction Foundation (QRF) in Houston and to the special operations community. He has consulted to US Congress, Department of Defense, Veterans Affairs, State Department, and for 17 years the National Board of Medical Examiners. He has also published commentaries in the National Review, Huffington Post, New York Times, Time, and Washington Post; and has been quoted in the Wall Street Journal, The Economist, Washington Post, Scientific American, Stars and Stripes, USA Today, Men’s Health, and Los Angeles Times, among others. He also has published 9 crime novels under the pen name “Christopher Bartley.” Just published in October 2019: A SEASON PAST – a collection of novellas about men with guns and their search for meaning and intimacy.

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