184: Beyond the Battlefield: Understanding PTSD in Everyday Life

Scot: Today we're talking about a topic that affects a lot of people, but it's misunderstood: post-traumatic stress disorder, also known as PTSD. And according to a joint study of the NIH and the U.S. Department of Veterans Affairs, as many as 4% of men in the U.S. will have PTSD at some point in their lives. And I know what you're thinking, probably. "Well, I'm not a returning combat veteran, so I'm sure this isn't something I have or will get, or will have to worry about." But is that really true? That's one of the many questions we hope to address today.

This is "Who Cares About Men's Health." Information, inspiration, and a different interpretation of men's health. My name is Scot. I bring the BS. Here with me, our resident health convert, Producer Mitch.

Mitch: Hey there.

Scot: And to help us with this conversation, we brought in an expert. And I can tell he's an expert because he's got a lot of letters after his name that seem really, really important. Psychiatrist Dr. Steven Sugden. He's an MD, an MPH, which is a Master of Public Health. And what's this MSS at Army War College? What is that? That sounds really impressive.

Dr. Sugden: So I've been an officer within the United States Army Reserves for about the past 22 years, and one of the opportunities I had to do was attend war college, which they have for their senior leaders. Upon the completion of the two-year program, then they offer a Master's of Strategic Science.

Scot: Wow.

Dr. Sugden: So an MSS is a Master of Strategic Science.

Scot: All right. I mean, PTSD, a lot of times people do associate that with individuals who have been in the military. So the fact that you've been in the military, you're a psychiatrist, I think we got the guy, Mitch. I think we got the right guy.

Mitch: I think so.

Scot: But I do want to, just right off the top here, make sure that the guys that are listening and continue listening know that they're going to get value out of this. So we have heard that it can impact veterans, right? That's pretty common knowledge. But can PTSD impact other men in other ways, like just a regular guy like me?

Dr. Sugden: Yeah. So I'm going to take a little bit of an issue with you where you mentioned that the Veterans Services said about 4% of men experience PTSD. In my experience, I think that that number is probably quite a bit higher.

Scot: Oh.

Dr. Sugden: I mean, I think it probably is about as common as one in five people.

Scot: So it's possible that that NIH/U.S. Department of Veterans Affairs study is just underreported. Guys are underreporting that they have it.

Dr. Sugden: Yes.

Scot: One in five? All right.

Mitch: Wow, that changes things.

Scot: Yeah, that does change things, right? I mean, think of you and four of your buddies going out to do something. One out of five of you might be struggling with PTSD.

Dr. Sugden: Exactly.

Scot: Do you have to be in the military? Do you have to be a returning veteran? I mean, what other ways could you find yourself suffering from PTSD?

Dr. Sugden: So I think that is the fallacy. I think the fallacy is that, "Oh, you have to have served in the military," or, "You had to have been a first responder." And many times, we just see it in the nature of growing up in households . . . Unfortunately, we see it a lot in poverty. We see it a lot in some ideas of neglect. And a lot of times those are environments where it's greatly underappreciated or underrepresented.

And then people just kind of grow up with that edge on their shoulders that they just are always trying to prove something or are always just on edge and are never really kind of happy or satisfied. If we look further, a lot of these individuals have post-traumatic stress disorder.

The other thing that I do is I'm an addiction psychiatrist. And when you look in the realms of people who have developed ongoing substance use disorders, I think the number is about 50% of the individuals with substance use disorders also have an underlying post-traumatic stress disorder. Many times, people feel that the substances . . . they use that to help manage their symptoms more effectively, or at least that's what they think.

Scot: So you mentioned individuals who may have grown up in poverty or . . .

Dr. Sugden: Bullying.

Scot: Bullying, yeah. Break it down. I don't think I had a bad childhood, but is it possible that something happened in my childhood that could cause some PTSD that you would never even think could potentially cause it? We do associate it with super traumatic first responder military events, right? Not just everyday life events.

Dr. Sugden: Correct. And the other population that we experience it a lot with is if somebody's been the victim of rape or some type of a sexual assault. We also think a lot of if somebody's been in a natural disaster, hurricane, fire, something like that, car accident. Those are the ones that usually get most of our attention.

Unfortunately, a lot of times, we see it in bullying or new kid on the block is from a different location, moves into a new school system, just never is accepted into that new school system, and has always felt on the edge or on the fringe of getting accepted into the mainstream.

And every time, efforts of trying to make the sports team or make this or make that, it's always, "Well, we have the preexisting sports team and you're just not good enough." And a lot of times it's just that you haven't been in the population long enough for people to give you a chance.

Mitch: I want to go back a little bit, just more basics for me. What is PTSD? I guess what is that basic "what is it"? Not just what causes it, but how can it kind of manifest itself?

Dr. Sugden: So that's a great question. I will try to do my best to answer that. I'm going to just talk a little bit about the physiology and kind of explain how we develop it. And I think once we understand how we develop it, then we start noticing it and start seeing how these symptoms become more manifested.

We have a part in our brain. It's called the amygdala. And the amygdala is really . . . its purpose is to keep us as human beings safe. And so it's always screening all of our interactions and saying, "Is this safe or is this something that's going to cause danger?"

And if danger is perceived or stress is perceived, it kicks in what's called our acute stress response. This activates what's known as our HP axis, or our hippocampal pituitary-adrenal axis, and we have the release of a stress hormone called cortisol.

And once this process is released, we get into this idea of fight or flight. We get this energy to be able to run fast, get out of there, or we're going to fight to the end.

If we've had enough of this activation or these triggers are significant enough, we then lose this perspective of just Thing A is causing fight or flight, which might be a significant thing, but little things then trigger that response. We then start developing a chronic stress response.

So not only are we getting this fight or flight response, which is driven by our sympathetic nervous system, but we also get in conjunction a parasympathetic response, which people then describe as a freeze or fawn response.

Then many times people are in this . . . they call this a window of tolerance where people try to be not in a sympathetic fight or flight response or a freeze or fawn response. And many times, just being in that window is very hard.

And sometimes to keep them on guard, it's not uncommon that you develop increased symptoms of hypervigilance. So you're always on guard kind of looking at, "What is that?"

I call it that saber-tooth tiger that's around the corner. It could be a real-life saber-tooth tiger. It could just be all a reflection of being shunned by our peers, because we have this long history of never being fully accepted by our peers. Maybe there's this neglect, and in times it just reinforces these things of neglect. But we're always on this hypervigilant response of feeling, anticipating, experiencing that.

Oftentimes, if these triggers have been significant enough, it affects our dreams to where we then would act out these responses. So nightmares become a very common response.

Mitch: So being someone who has struggled with anxiety disorder in the past, you just hit everything that . . . And I didn't realize it all kind of went back to this little, tiny, almond-shaped structure in the brain, the amygdala.

Dr. Sugden: Right. And there's the Valentine joke that the heart is the center that we love, that we have all the feeling in our heart. But really, we have all the feeling in our amygdala. It's that almond structure, and it just doesn't sell well at Valentine's Day if we just have these. "I love you with all my amygdala" just doesn't have the same ring to it.

Mitch: No, not at all.

Scot: Yeah, as he was describing that, Mitch, I totally was thinking about the anxiety disorder episode we did because it sounds very similar. How is it different from anxiety disorder, though?

Dr. Sugden: Initially, post-traumatic stress disorder was in the anxiety umbrella. However, I think anxiety, one tends to worry more where this, a lot of times, is more subconscious. They don't often perceive things as triggers, but they are reinforcing to that learned behavior that they had of that exposure that produced this result. And because of this result, anything that then reactivates that . . . They call it an unconditional learning experience. It reactivates that.

If I have generalized anxiety disorder, I'm often more aware of what my trigger is. I'm often aware if things are out of my control or I feel . . . Sometimes with the obsessive-compulsive disorder, people feel like they have to count, or they have to keep things organized. They're more aware of what those triggers might be. Whereas with the post-traumatic stress disorder, oftentimes they're not aware of what the triggering events are and how it's just returning them back to that sense of vulnerability that they had that kind of set up this unhealthy mindset.

Scot: So I'm trying to really wrap my brain around this. It sounds like this heightened sense of vigilance. Is that the ultimate end? And then you're just constantly in this heightened sense of vigilance? Is that the medical issue here?

Dr. Sugden: I mean, that's one of them, because one is kind of in that heightened sympathetic response. The other part of it is they can have an equal parasympathetic response. So then there's the avoidance, there's this depressed mood, there's this lack of enjoyment. Oftentimes we say a sense of feeling numb. It's almost by being numb, it's more of a way to escape all of the challenges that they're experiencing because it keeps them from . . . If they're not in the state of numb, then they go to the state of hypervigilance.

Scot: And just never living anywhere in between, which is kind of where we want to be.

Dr. Sugden: Right. That in-between stage is that window of tolerance. People really struggle to maintain that window of tolerance, just because for many people it's such a narrow safe space that they just bounce between this sense of hypervigilance or oftentimes this sense of numb.

Scot: Yeah. And what's the ultimate health implications of being in either one of those two states and not finding that nice middle state?

Dr. Sugden: Many times, when you're in that sense of hypervigilance, you're more aggressive, you're more angry, you're more irritable, you get into fights, you get into arguments, you're not trusting of others. For some people, they almost have this sense of they're paranoid because they're so suspicious of people around them. This oftentimes can then lead to violence, and it can lead to other non-healthy behaviors.

And in a sense of trying to then bring oneself down from that sense of hypervigilance, this is where there's such a high degree of substance use. They use the substances as a means to just kind of modulate their behaviors or bring them down to a healthier level, or what they perceive to be a healthier level.

Whereas if somebody's in that state of numb, they're not able to have healthy relationships, they're not enjoying life, they feel very depressed. And then, again, there's oftentimes this turning to substances because it helps them feel "normal" again, right?

That then becomes that vicious cycle that they use the substances either to tune down that hypervigilance or they try to tune up from that state of numb.

Scot: Yep. And both of those things impact your mental and emotional health, obviously.

Dr. Sugden: Exactly.

Scot: And they could also impact your physical health as well, I'd imagine, because if you are taking substances you shouldn't, we know that that's a cascading effect to certain health issues. What about just running at 110 all the time? Does that cause problems from a physical standpoint?

Dr. Sugden: It does. And so if you're running at 110, especially because if you struggle with nightmares at night, then you're not sleeping well at night. You're not getting the regular recharge, and then in the morning, because you're then also drowsy and you're feeling like you have to just run, run, run, what do people turn to, to keep running, running, running? It's sugar, it's caffeine, it's other substances. And that's where you can then see just that vicious cycle of eating patterns become off, what people choose to eat becomes off.

Scot: Unhealthy choices, potentially.

Dr. Sugden: Right.

Scot: And then the other thing is we've talked on this podcast a lot about the importance of sleep to our physical health. Not only our mental health, but our physical health. I mean, there's a lot of great research that shows if you're not getting sleep, you can gain weight. And of course, that could lead to metabolic issues. So it's kind of this cascade chain reaction.

Dr. Sugden: Right. And the other part, the catch-22 of it, is if you have poor sleep, you're more inclined to then use substances, or eat unhealthy, or be more impulsive as well.

Scot: Man, you feel just trapped, I bet. Do you have a lot of your patients that are like, "I just want to break this cycle, please"?

Dr. Sugden: They do. We've probably experienced a lot of these people. They just seem to be irritable. They seem to be angry. Nothing seems to bring them joy or contentness. Many times, we provide them what might be the standard psychiatric treatment, and it just doesn't work. And people are like, "Well, you're not following the textbook," and then you add some shame into that because they're not getting better.

People don't realize that there are just so many more of these underlying symptoms that are going on, that if we could help them learn how to just modulate some of their anger and their irritability, or this fight or flight or freeze response, then we can get a lot of significant improvement not just with the mental health part, but also all the health stuff that we've been talking about.

Scot: Dr. Sugden, when people come into your office, does it occur ever that after you've had some conversations and you suggest that maybe they have PTSD, they're like, "Wow. What? Really?" It surprises them. Or most of the time, if somebody comes in, do they have some sort of an idea?

Dr. Sugden: So I tend to see most of my patients . . . I work on the addiction medicine consult service in the University of Utah Hospital. And when we see patients, it's not hard when you start hearing their story. It's pretty easy to understand or to elicit the histories of trauma that people have and how their relationships have been.

And many times, people are looking for answers or looking for solutions, or looking for things. And when you explain it to them, they're like, "Oh, that makes sense."

Scot: Yeah. Are they a little shocked when they find out, like, "Wow, I guess I never considered it could have been PTSD"?

Dr. Sugden: Yeah. I think it's just more of like, "Oh, I wasn't aware. I didn't serve in the military. I didn't think I could have PTSD," or, "I didn't have any of those things that we talked about earlier of triggers."

Scot: Yeah. As you talked us through how this works, I could definitely see somebody coming to the realization very quickly, "Oh, this explains kind of what's happening to me."

Mitch: So I guess that's my next question then. What are the primary signs that someone should be on the lookout for both maybe in themselves or people around them to make sure that they are clued in that maybe something's going on like this?

Dr. Sugden: I think some of the big signs would be sudden bursts of anger. I mean, just overall difficulties that people have relating to others just because they feel that they don't understand. Or when they try to explain things, if people just don't seem to get what they're experiencing or saying, they get easily frustrated.

I think sometimes just the ongoing signs of difficulty sleeping. Many times, they'll also appear as just kind of being depressed from really no perceived triggers. And sometimes there are fluctuations within weather patterns that just remind them of these periods of their life.

It can just be as much of the weather, or it can be holidays, or it can be encounters with a disruptive coworker or an employer, or something like that. And it's just enough of a triggering event that then they . . . it subconsciously triggers events that they had from what may be some of these underlying triggers that they had earlier in their life.

Mitch: That's interesting because one of the . . . In my little bit of research I did before this, in that same vein, there was also this idea of avoiding reminders of events, even if you didn't realize it. Subconsciously avoiding and then even forgetting details. Your brain is trying to protect yourself from something, it seems like to me.

Dr. Sugden: Right. That's an interesting part that you mentioned, because when we think of our memory, we think of, "It's always sharp. It's always there. We'll always remember these details." But when you have these traumatic events, oftentimes our hippocampus, which is a region that is very close to the amygdala, fails to imprint that explicit memory, and instead it imprints it as an implicit memory. And so then that implicit memory is that it's doing everything it can to kind of forget the details of it. Whereas an explicit memory, you basically remember everything.

So it's like, "What did you do today, Mitch?" and you'd say, "Well, I ran errands, and I did a podcast." Whereas in the implicit memory, there might have been something, who knows what had happened, and we just can't remember those details. That's the brain protecting us. It's then when you have these other triggers that kind of go throughout the day, for whatever reason, it could be smells, it could be sounds, it could be feelings, that then triggers those implicit memories.

Scot: So, from the conversation, it feels like some of the major symptoms . . . it feels like a major one that you might look for is "Are there these vacillations between depressed and numb and really aggressive and angry?"

Dr. Sugden: Right. And again, from the realm within a substance use, then how are there substances being used?

Scot: Yeah. And then some of these are more subtle. I took them as subtle. Maybe they're not. So correct me. Some of the more subtle symptoms, for an individual, might be, "Huh, that's really weird that I never seem to remember anything associated with this particular event or when this happens."

Dr. Sugden: Or the more subtle would be like, "Why is it that my boss always pisses me off?"

Scot: And not really remembering details?

Dr. Sugden: Right. And it very well may be that growing up, there was a neighbor, a father, a coach, a somebody in their life that was just always yelling, always this, always that. Then when the boss comes into their office and is triggering or activating, it's a reminder of those childhood experiences growing up that then get projected onto the boss or the boss's behavior.

Scot: Got it. All right. So moving on, how effective is treatment? Is it pretty effective? Does it do a pretty good job of helping people? I'd imagine, again, you feel like you're in this spiral, like you just can't get out of this cycle, is what I was trying to say there.

Dr. Sugden: It is. And a lot of times, you have to start peeling back the layers. Again, for my realm, being in the worlds of addiction, the first thing we have to do is work on decreasing the substance use, because it's really hard to have any type of therapy when one is kind of caught up in this.

The next part is there may be a role for medications, especially depending upon what the substance is. Especially if there's increased mood irritability and some of those types of symptoms, there might be a role for medications.

In the process, really trying to work on improving one's sleep. And how do we improve one's sleep? Well, exercise can be a very potent way of not only helping one deal with anxiety, but it can also be if one is able to exercise, one oftentimes is able to have improved sleep.

We talk about changing one's diet, trying to avoid a lot of the foods that can trigger a lot of these types of symptoms. So that would be your caffeine, your ultra-processed sugars, those types of things, so that we're trying to eat healthier.

Another is trying to work on our relationships or that level of connectedness that we have. So not only are we trying to have increased social connections, but we're also trying to have an increased connection to a value or a purpose that's driving our lives. It's through that process or that connection to that value that also helps us have a better routine to where we know that our routines are then becoming very predictable and there's not chaos within those routines.

Oftentimes it's also then learning how to deal with stress better, and that can be just being aware of our symptoms and what seems to . . . when we get elevated or not.

For me, I know when I'm starting to have increased stress, I have every single muscle in the back of my back just tighten up. I call it my spider sense. I carry my stress in my shoulders. And oftentimes I can feel the tension even without acknowledging what the thought is. By being aware that the tension is beginning to build, I can use that to kind of try to deregulate or downregulate, or I try to say, "Hey, something is not right. Maybe I need to really exercise a little bit more or try to do some more yoga or try to do something or be aware that there's something that my body is aware of that I may not be aware of."

And then it comes down to oftentimes we have to do some therapy where we try to teach ourselves that we can be safe in the moment, that 53-year-old Steve is not 16-year-old Steve. What may have happened to me as a teenager or what may have happened to me if I was in a deployed situation or if I'm a first responder or I was in an accident or whatever that situation might be, I'm not there. And because I'm not there, I'm actually in a safe spot, and relying upon those tools of being able to help me bring back to places of safety.

Scot: The very first kind of stuff you talked about, getting more sleep, exercising, maybe cleaning up your diet a little bit, I think that those are all good. But I almost feel like therapy would be more of a part of this.

I understand getting off the substances, because if you're on substances, sometimes it's hard to then go through the process of really being honest and evaluating and seeing what's happening.

How much does therapy really play for most individuals? I would think a lot of guys would have to be trained to recognize when they're starting to go into these angered states or recognize when they're starting to go into these depressed states and then have some tools to be able to help slow that or reverse that.

Dr. Sugden: They do, but then the guys also have to be willing to go into the therapy part, and not all guys are willing to have those disclosures. And so sometimes if we're trying to work on improving health, that's where working on the lifestyle parts can at least be a first step that many times people are more of like, "Oh, you want me to kind of work on my lifestyle because it's going to help improve my overall health? Yeah, I can do that."

Scot: Oh, okay. I mean, that's a different perspective that I guess I don't have. I could see how there would be guys that would think that. For me, I would think, "I can't even change these other things because I'm so caught up in my mental stuff right now." I need to break that cycle before I can even find energy to exercise or be able to settle down enough to sleep.

Dr. Sugden: Right. And that's the great thing, is that there's not one right way for everybody. It's trying to be aware that there are multiple things that we can just try to find a pathway to where somebody feels that they're getting in progress.

For example, I would say after substances, the next most important thing is sleep. And then once one is able to sleep healthier, one might do four months, six months of therapy and then need a break from therapy. In the interim, what can they be working on? Well, they could be doing yoga, or they could be doing some of these other types of things to try to make some changes in their life. And maybe a year or two years later, they come back and they do another four or six months of therapy.

It's this process that as we learn to live and get in routine and have connection, our body starts healing, and then we become more aware. So then we're more aware when we go back into therapy. It gives us more insights. It's kind of this continuous process. It's not that I just do it once and then I'm one and done.

Scot: So it sounds like the priority, if you're on substances, is figure out how to get off substances, and whatever that takes. Maybe that takes medication, like you said. Maybe that does take a little therapy at that point. Maybe there are some individuals who can just stop.

Dr. Sugden: Right.

Scot: Then it sounds like, "All right. Now how do I get better sleep?" And for some individuals, it might be exercising more solves that problem, but maybe somebody else exercising more doesn't. Then they need to have a little bit more therapy time to talk through some issues that maybe are keeping them up at night or get some strategies to deal with whatever it is that's keeping them awake.

Dr. Sugden: Right. And sometimes it might be, again, medications to help sleep initially just to kind of get that pattern going, or maybe it's just medications that are . . . One works with their provider and they realize, "I don't need the medications every night, but if I have one really bad night, the likelihood is I'm going to have a second one. And so I'm going to be a little bit more aggressive for that just because we're trying not to have two bad nights in a row."

Scot: Got it. How can you break the cycle?

Mitch: And that's the stuff that I have dealt with before with my anxiety disorder treatment stuff. If I haven't slept well, I'm going to be grumpy. I'm going to make bad choices the next day. My ADHD is particularly bad usually the next day, etc.

When I first started getting treatment for a bunch of different mental health things, I was kind of repeatedly shocked that they started with, "Well, let's get you off nicotine and let's get you sleeping." And I'm just like, "What is that going to do?" But come to find out, it actually can do a lot.

Dr. Sugden: It's really the foundation of improved mental health, and it's probably even the foundation of improved physical health.

Scot: Yeah. And I think starting to recognize those patterns, Mitch, as you were talking about. I know if I have a bad night's sleep, I'm going to make not such great decisions maybe with my diet.

And if you know that, knowledge is power, right? So you're like, "Oh, now I understand why I want to eat all this junk food crap, because I didn't get a lot of great sleep last night. It's not a personal failing. You know what I'm going to do? I'm going to try to maybe have something healthy right now. And then if that works and fills me up, great. If not, then maybe I'll allow myself to make a poor choice."

Mitch: That is so much different than beforehand, where I would go get a taquito and a pack of Marlboros. I'm like, "Oh, it's just been a tough day." And that was kind of this weird not seeing those types of connections, both in my mental health and my physical health.

Dr. Sugden: And many times, why do we get the taquitos or whatever that was?

Mitch: Yeah, it was a taquito.

Scot: Don't act like you've never heard of those.

Mitch: What is this? Roller food?

Dr. Sugden: No, I understand. What I'm saying is why we go back to that. I mean, mine is bread. Why do I go back to bread? It's because it was my comfort food as a kid.

So many times, we're going back to our comfort food because, again, it ties back to some of those . . . We knew it was fast acting, and it brought us comfort, or there were good memories involved with it, or . . .

Scot: I just had maybe a little revelation, and maybe this is just complete crap. So I've been a fan of beer for a long time, and that's kind of my comfort food in a way. And it just dawned on me when I was younger and first in my professional life, I wanted to fit in. I wanted to be part of the crew, and a lot of that crew drank, so I kind of started drinking beer. I think I go back to it as comfort food, as a comforting thing. Is that possible?

Dr. Sugden: Absolutely. It reminds us of one fitting in. And especially if one is having anxiety or PTSD symptoms, one is definitely not fitting in at the moment. And so then it's these associations that we're trying to escape. We're trying to feel not numb or we're trying to feel not always on that guard or hyper-vigilant, and it becomes a learned, explicit behavior that's hiding an implicit behavior or memory.

Scot: As we wrap this up, it sounds like if somebody does have PTSD and they recognize it, or somebody that they know does and they recognize it, and they start taking the steps to try to live a life that's more fulfilling and healthier for them, it sounds like it's a bit of a process. It doesn't sound like it's just going to get better in a month or so. Is that accurate? I mean, does a guy need to kind of get ready for the long haul? Or what's your thought on that?

Dr. Sugden: I think people can get incrementally better. And so I think that when we are at the height of not feeling well, we forget what our best performance is, and maybe we're kind of getting used to our 85%.

And so we start sleeping better, and we start making some of these changes, and maybe we get to 90% of what is our 85%. And as we then start making more and more life changes, all of a sudden, what had been our 85%, we start realizing, "Well, we can actually get better than that."

We just weren't aware of that because of all the symptoms and all of the counter-behaviors were kind of locking us in at 85%. And then all of a sudden, we start hitting that 90%, 95%, and we're like, "Whoa, I never thought I could feel this good."

Scot: Yeah. I think it's like so many other things in our life, we want it so fast. I go to the gym, and I want to have the ripped physique just immediately not realizing that . . . Well, actually totally realizing that that's years and years of dedication and work and diet.

Dr. Sugden: Well, if you're up late at night, you can see those little new things that you can put on your abdomen and it will do all of those exercises for you in 15 minutes.

Scot: I'm skeptical. You're trying to talk me into it, but I'm not buying it.

Dr. Sugden: It was developed by Navy Seals.

Mitch: That's what I hear on the commercial.

Scot: I guess what I'm trying to say is that these changes do, like you said, kind of come incrementally. And another concept we've talked about on the show is showing gratitude and recognizing the positive. Sometimes it could be easy for us to recognize the negative. And that's how I've noticed positive changes in my life that I didn't otherwise necessarily see that were occurring. I mean, I guess the ultimate to that is, wow, there are a lot of skills and a lot of things that we need to do to get there, but you can get there.

Dr. Sugden: Right. And that was kind of one of the things that I mentioned in that part of connectedness. Part of connectedness is reconnecting to our purpose, reconnecting to these things that are really important to our life and we see the value of as we interact and we have improved health.

A key component of that is we develop or we become more of that with gratitude. And I can be grateful for today, but it's different than if I can have 10 years of a gratitude pattern or an attitude of gratitude over a 10-year process. It's going to help me develop and mature a lot more than just a 10-minute practice of gratitude.

Scot: Yeah. I think what I was just trying to say is sometimes it's hard for us to even recognize our progress. We've had a couple of gratitude shows where we talk about our health and we talk about, "Well, how are we better now than we were six months ago?" And sometimes it's small.

I think one time I confessed that I was able to hang from a chin-up bar for 30 seconds where before my arms and forearms and wrists couldn't even take it, right? That's better.

Dr. Sugden: That's amazing.

Scot: Yeah. I mean, that's better. So it's just a matter of when you're going through any sort of improvement process trying to improve or get better or get healthier, you kind of have to sometimes work to find, "All right. How am I better than I was a week ago, a month ago, six months ago?" And sometimes it might seem like silly little things, but really, if you're better, that's the point, right?

Dr. Sugden: Right. This is an example that I give. Years, years, years ago, I ran track collegiately, and my best mile was a 4:20 mile. What's the likelihood that 53-year-old Steve is going to run a 4:20 mile? Slim to nil to none, right?

Scot: Okay. You're not giving yourself good odds on this, huh?

Dr. Sugden: No, I'm not. And so if my definition of better is "I have to get back to what I was running in college," I'm setting myself up for failure. But if my definition of better can be "I can just be happy with the exercise and just be grateful that I can even exercise," then I'm living in a state of gratitude for being better with what I can do, not saying that I have to have this unmet or unreal expectation.

Scot: Right. What are you running nowadays, by the way?

Dr. Sugden: I'm biking more because the knees just aren't . . . I'm happy when I have to do my army running and I can get my two-mile run under 16 minutes. So I'm happy with that.

Scot: Yeah. And sometimes it's a different gauge. Maybe it's cycling. I don't know. And then six months later, did I get a little bit better? Well, yeah, I did. Maybe I gained 30 seconds on my best mile. Well, that's good.

Dr. Sugden: Right. And that's because that's monitoring where your fitness is and where your life is today.

Scot: Right. All right, Mitch. Well, this was really good. What did you get out of this today, Mitch?

Mitch: I was reintroduced to my amygdala, where it's something that I can . . .

Scot: How is your relationship with your amygdala?

Mitch: I mean, these days, I'm not having panic attacks when you end an email with a period. So I think we're okay. I think it's a major step in the right direction.

It is just that kind of reflective. There is a process that happens with anything that happens with mental health. And to understand that there are specialists out there that know a whole lot more than I do who can help guide me if I need them. And then there are also little things I can do every day and kind of appreciate the journey, I guess, and the little wins.

Scot: I really appreciate that we were able to establish that PTSD can happen to anybody. And I thought that Steven did a great job of explaining the process of what's going on so well that if somebody's listening, I think they could have an inkling of whether or not this is something that is impacting their life. And with that inkling, I hope that they will take the next step and go contact a professional.

And realize everybody's journey is a little bit different, but there is a journey to feeling better and feeling more fulfilled and having better relationships if PTSD is something that is impacting your life.

What final thought do you have for men listening, Steven?

Dr. Sugden: I think all of those were great insights. I think if you're in crisis, please call 988. Come to your local emergency department. Back from a veteran's perspective, we have far too many veterans that are committing suicide because they don't feel understood, they don't feel appreciated. We're never going to get this down to zero, but it would be nice if we could just get that down significantly.

There is hope out there. If you're feeling like nobody else understands you, I hope that with having this conversation, people would be willing just to give a health provider one more chance.

Scot: I do want to hit on that. If no one understands you, it sounds like that's just your brain playing tricks on you.

Dr. Sugden: Absolutely.

Scot: So don't fall victim to your brain playing those tricks on you. Let's figure out how to take control again.

Dr. Sugden: Right. Everybody has too much to give to this. I mean, we all have something to contribute to this planet humanity. And nobody's expecting us to be perfect robots. We're just wanting us to be perfect humans, 100% human. And being 100% human means I can have good days, I can have bad days, and I can have a lot of okay days.

Scot: That was awesome. Thank you very much.

If you have experienced PTSD or have comments or thoughts about today's show, feel free to reach out to us. You can always do so by emailing hello@thescoperadio.com.

Dr. Steven Sugden, thank you very much for being on the show. And thank you, listeners, for listening and caring about men's health.