Case 21: Infectious Suicidal Imagery in Combat PTSD
The SIS-II Video/DVD version may be used as a hypnotic-based memory stimulating interview aid for treating PTSD. This psychotherapeutic application differs from standardized psychodiagnostic testing, where traditionally the interviewer primarily acts like a ‘blank screen’ when enquiring about the psychometric properties of elicited responses introduced during inkblot viewing. In the much more active SIS approach, for aiding memory recall during the detailed enquiry, the psychotherapist may introduce outside relative clinical subjects from historical sources beyond the inkblots themselves.The result is an optimum therapeutic fusion of input from the pulling power of PT and that of clinical interviews. This multidimensional technique will be illustrated in reviewing a transcribed television teaching recording using the SIS-II Video. The case involves an American Vietnam veteran suffering from long-standing PTSD. Like many such military veterans, he had never sought treatment for his own mental symptoms. He had initiated treatment only after the recommendation of his stepson’s family therapist. The stepson had been deeply depressed and made a serious suicide attempt mimicking his biological father, who suffered from untreated combat PTSD and ultimately committed suicide. The youth had never been able to bond emotionally to his PTSD disturbed stepfather, who had superimposed onto him, a guilt-ridden mental picture of a boy he had blown apart in combat.
Dr B: I know you have been working in therapy and that’s good. If at this time, we could have you look at some images on the SIS that you have responded, and any emotions you would have, and anything that might remind you of even the real world or your past dreams or fantasies, okay?
J: Okay.
Dr B: At this point we’ll look at Image A1.
J: It looks like an x-ray of someone’s insides.
Dr B: Any special emotions or anything it recalls? (The interviewer attempts to elicit the cognitive symbolic content and affect linkage of the anatomical response. This hidden material surfaces in projective awareness later in the interview with A10).
J: No, not really. (Here the symbolic significance and affect linkage is either simply denied or repressed. Consequently, the interviewer elected to actively bring into the SIS detailed enquiry additional clinical information.)
Dr B: Did you see many people mutilated and cut up and all that stuff? (The family psychotherapist had previously indicated that he still had PTSD dreams related to combat experienced many years back in Vietnam.)
J: Yes, sir, I did.
Dr B: How’d you feel about that?
J: Sick. You… You want to do something, but there’s nothing you can do because it’s… it’s already… (combat situations often place the victim in life situations with little or no control on the traumatic outcome of stressful events.)
Dr B: Did you have any of that sick feeling while looking at Image A1? (The SIS interviewer asks a ‘leading question’ in order to bring into focus the affect linkage of his anatomical response, ‘someone’s insides’.
J: Some, yeah. (His affirmative answer suggests that previously there was dysphoria with the anatomical imagery but denied. This is consistent with the culturally based historical fallacy that soldiers are expected to ‘bite on the bullet’ and not experience either psyche or somatic pain. Of course, they do, making them vulnerable to mind anaesthetizing drugs and alcohol.)
Dr B: Okay. Maybe we’ll go to Image A2. What do you see there?
J: It looks like somebody’s trying to hold on to something.
Dr B: And how do you feel while looking at that?
J: It’s…
Dr B: Brings anything to your mind or anything or?
J: It looked like maybe a child is trying to hold on to something.
Dr B: Yeah. Okay. A child who is trying to hold on to something. (In this demonstration recording, the SIS-II Video was running at its usual rate. He had paused long before the image of the ‘child’ surfaced. Later responses clarify the symbolism.)
Dr B: How about this one, A3?
J: A lot of different colours… Nothing.
Dr B: Any feelings at all?
J: No. (His inability to conjure up a response related to the affect valence of the SIS stimulus bright colour and his mental defences inhibiting emotional expression. This is consistent with the ‘numbing’ experienced by victims following severe stressful events.)
Dr B: Where could that child be in Image A2 that was trying to hold on to something?
J: Oh, maybe a child in the womb.
Dr B: A child back in the womb?
J: Uhhum. (In the rapid-fire context of the recording studio, this response totally surprised and puzzled the interviewer. In later considering its symbolic significance after the interview, it seemed more likely theoretically, to have related to the dramatic mental age regression experienced transiently during the activation of stressful memories. There are many examples consistent with this theory: sometimes a soldier wounded and dying on the battlefield will cry out in an infantile voice for his mother or an adult person recalling early life traumatic events or may suddenly whisper inaudibly in a child-like voice.)
Dr B: The boy that you shot was 10 years old, any resemblances to him at all? (Here again, the interviewer introduces outside clinical information in actively pursuing PTSD memories. However, in this instance it likely was an erroneous question reflecting more what the interviewer mistakenly interpreted to be the PTSD memory source.)
J: There possibly could be, but it’s been 25 years… (since the Vietnam conflict).
Dr B: Right. Okay. How about image A4?
J: It looks like possibly the face of a person, abstract.
Dr B: Just relax and let your mind free itself and feel comfortable as much as you can. (Hypnotic suggestions to reduce test anxiety are repeated by the interviewer to heighten the trance-like state of SIS altered projective awareness). How about this one?
J: That reminds me of T. (His severely depressed stepson who recently had made an almost lethal aborted suicide attempt.)
Dr B: Makes you feel good then?
J: Yeah.
Dr B: Yeah, T. has a capacity for laughter and joy now that he’s in therapy, right? I like that unruly wild hair. (The interviewer actively brought forth his stepson’s appearance to make the recollection of positive feelings more vivid. This served the function of reducing test anxiety.)
J: Yeah. You can’t… miss him in a crowd, that’s for sure.
Dr B: Yeah. Thank goodness he’s getting some help. How about Image A6?
J: The teddy bear on the corner, security. A friend. The abstract on the side, I’m… I’m not too sure.
Dr B: That’s fine. It must have been very upsetting for you when T. was suicidal? (The time dimensions of the interview flip rapidly, moving from the distant past to the recent stressful situation of his stepson’s suicidal behaviour.)
J: Yes, it was. I’m just glad that there were people like you and Dr F. (family psychotherapist) who were there to piece him back together. That looks like somebody. It’s abstract of somebody dancing or…
Dr B: The sex of the person?
J: Female.
Dr B: How concerned were you about T.’s suicidal ideation?
J: Real concerned!
Dr B: Yeah. (The interviewer empathetically recognizes the intense level of the more immediate stress involving his stepson.)
J: Not only as his stepfather but as… as a friend of… of T. (Here he first reveals his confused perception of a dual role—that of stepfather and as well as friend of his stepson) it you know, it – you really don’t know when something like that happens where to turn or what to do. You want to – your – your instinct is to – to grab hold of the child and tell him everything’s okay.
Dr B: How about A9?
J: It looks like oriental writing.
Dr B: A10?
J: That looks like somebody’s face its parts aren’t there.
Dr B: What happened to it?
J: It looks like pieces of it have been blown away or removed. (Here long-standing PTSD memories are pulled into immediate dysphoric projective SIS consciousness by A10).
Dr B: Did you ever see that in Vietnam?
J: Yeah.
Dr B: Tell us about it.
J: I would see bodies floating down a river—bloated, disfigured. You come up alongside of it to see if it had dog tags. If it didn’t have dog tags, you shot it and let it sink. If it had dog tags, you retrieved the body.
Dr B: What would the faces look like?
J: Distorted, bloated, some of them were there; some of them weren’t… pieces of their bodies missing.
Dr B: Did you ever see images like that in your dreams? (The interview quickly moved from the real-world combat scenes to that of sleep disrupting PTSD dreams still tormenting the veteran.)
J: Yeah, I did. The rivers, the bodies floating in the rivers.
Dr B: Could you say something about that?
J: It… it wasn’t so much the… the body in the river. It was the smell.
Dr B: What was the smell like? (It is very important therapeutically to include a discussion of olfactory sensations, which frequently link emotions to PTSD imagery and dysphoric affect.)
J: Decayed flesh. Death!
Dr B: And what effect would that have on you, the smell?
J: Well, the first couple of times it happened, I went to the other side of the vessel and put my stomach in the river.
Dr B: You were nauseated?
J: Yes, sir. But then after a while it… it, I guess it calloused a person.
Dr B: You became numb? (The interviewer brings up again his mention of a classic mental symptom of PTSD.)
J: You got numb to the fact.
Dr B: Yeah.
J: And that happened about 90 days after you were there.
Dr B: Yeah. (This emotional blunting normally takes time to set in, depending upon the subject’s genetic vulnerability, past life experiences and the intensity of the stressors.)
J: You just went numb. The only thing you were worried about was your own survival.
Dr B: Did you ever get over that numbness? (The psychological defences blocking out the stressful memories through processes of neural inhibition, also inhibited the psychobiological processes underlying the PTSD imagery affect linkage.)
J: No.
Dr B: In what ways do you still carry that with you?
J: I find myself – I find it’s hard for me to get close to people. Relationships. I’ve had three different – three different relationships – or two different relationships that have gone completely to pieces. And I feel that a lot of that was of my close off or my numbness effect or the … (It is common for such veterans to have problems with marriage. Not only did his untreated PTSD numbing block emotional intimacy with women, it also impaired his capacity for a close relationship with his stepson).
Dr B: One of the problems we have in life J when we turn off, as you must do (in combat) are feelings and seeing something horrible then we turn off other feelings, love and intimacy and so we have some more work to do in your therapy. (The interviewer explains the nature of his symptom and emphasizes the positive value of treatment. It may be recalled, that despite the severity of his PTSD, that he had sought therapy only because of his stepson’s needs.) How about Image A11?
J: It’s a good abstract drawing of something, but I’m not exactly sure what. A nostril, maybe.
Dr B: The smell is strong at times? (The interviewer points out the association between his SIS heightened nasal awareness and the olfactory sensations in his PTSD dreams.)
J: The stra … yes, the smell of death and … and decay. The people in Vietnam were not exactly what the American people would classify as clean. They were by no means dirty, but their facilities, their living conditions weren’t what we know of them in the USA. Just the … I don’t know, the sewage systems, their … their way of throwing things away or their … their … their garbage or their waste, it’s just wherever it happened to fall. And, of course, in a hot, humid climate that all…
Dr B: Be with you 24 hours a day…
J: Was with you 24 hours a day basically.
Dr B: Yeah. And would have a demoralizing effect on you I would think. What about this Image A12?
J: I don’t see anything there.
Dr B: Do smells still get to you? (Even 25 plus years later).
J: Some, yes.
Dr B: Tell us about that.
J: Smells. Rotten eggs will usually do it, they will trigger old smells or old senses.
Dr B: What old smells come back from Vietnam when you smell rotten eggs?
J: The streets. They had a delicacy that they called Nukbaum that was basically a fertilized egg and they would bury it and that was one of the smells that … that kind of stuck with me and it … it seemed to be in the areas of the cities or the towns. I don’t know if it was so much that or if it was everything else combined, but it was not a very pleasant smell.
Dr B: Years ago, when I was in medical school, we had to do a great deal of dissecting. I remember the smell of the flesh and the formaldehyde and it’s very hard to get rid of it and it impacted you. Not in any way, the way your trauma impacted you. (Sharing related personal discomfort can enhance empathetic communication in SIS viewing). How about the next image, A13?
J: It looks like a hand reaching up or out of something.
Dr B: How do you feel looking at it and what does it remind you of?
J: It reminds me of one of the hands that I had grabbed when I was pulling bodies out of the river.
Dr B: Tell us about it.
J: I was on the same patrols. You had to verify the – the body that you see floating in the river. You had to make sure if it was of an American or of a V.C. (Viet Cong). When a body is – when rigor mortis sets in, you roll the body over and the hands and everything are stiff. And that image does…
Dr B: It was ghastly at times, wasn’t it? (The interviewer empathizes with his obvious dysphoria.)
J: Yes, sir, it was.
Dr B: How did you feel doing that?
J: Not good. I don’t know what the feeling was like … if you can put a name to it.
Dr B: Sometimes there aren’t words for those feelings, believe me! (The interviewer comments on the lack of descriptive language to describe such emotional discomfort). Did you have anyone to share, you know, at the end of a tough day of dealing with a body like that or bodies in the river, I mean, did you…
J: There were no medical people or anything like that. The only … you know, you didn’t talk too much about it between the other groups or people or the … your other men on the boat because they’re basically in the same boat that you were. They wanted to forget about it, too.
Dr B: So the strategy psychologically was to forget about it and at night might be to use drugs or alcoholor … (Previously he had indicated that he had used chemical substances extensively out of desperation to induce sleep.)
J: Drugs or alcohol.
Dr B: And what would you fantasize? To get away from there what sort of fantasies you’d think…
J: I would think of home.
Dr B: Yeah. Thank goodness you had fantasies then!
J: Yeah.
Dr B: How about A14? I’m getting sick just listening, I’ll tell you, this is … this is upsetting! (As was evident from his appearance and non-verbal presentation, the activation of his nauseating memories was causing him distress. Reflecting the interviewer’s empathetic feelings during the interview was supportive to him.)
J: That looks like a stomach.
Dr B: And how do you feel while looking at that?
J: Not good!
Dr B: Tell us about it.
J: Well, when you cut a 10-year-old kid in two with a 12-gauge shotgun there’s not much to put back together!
Dr B: What images of that come back as you look at that the image?
J: The kid laying there in two pieces.
Dr B: His guts were exposed?
J: Yes, sir.
Dr B: Tell us about it.
J: It’s … it’s not a pretty sight. It’s just…
Dr B: Blood was all over?
J: Yeah. He came around the corner with an AK47 in his hands and I had no other … I had no choice. And I didn’t realize it was a child until I’d shot. (In this instantaneous life-threatening stress, there was not enough time for his brain to cognitively process the reality-based visual sensory input. His perceptual defences immediately and out of his volitional control superimposed an image of an adult pointing a lethal AK-47 at him. His military-conditioned central nervous system responded in a reflex-like fashion sending rapid-fire neural impulses to his finger holding the trigger. Since then he had been plagued with guilt. He mistakenly believed that his action was preventable.)
Dr B: When you realized that, what did you feel?
J: I guess maybe I felt like committing suicide at that time. Maybe … maybe I was wrong in saying I’ve never felt like committing suicide or killing myself because I didn’t … I didn’t feel good about it. (Here, he recalls suicidal ideation that previously he had denied. It might be noted that he was a close military friend of his stepson’s father. After his buddy committed suicide, he married his widow. He was partially linked by similar PTSD imagery including the infectious suicidal ideation.)
Dr B: What did his face look like? What did his face look like?
J: I can’t remember.
Dr B: It’s hard to remember. But the guts and … J, what are you feeling now? ‘Because I can tell you’re on the verge of tears (identifying and accepting as a healthy normal grief concomitant of the SIS triggered traumatic memory). Can you share that, please, do you agree?
J: I thought I had this one put away, but I guess I don’t [crying].
Dr B: There’s still a lot of pain inside, isn’t there? What’s it like?
J: I wish that I could go back and change it.
Dr B: Are you feeling sad?
J: Guilty.
Dr B: And guilty. What’s the guilt like?
J: Taking a child’s life. There’s…
Dr B: It’s hard to live with, isn’t it?
J: There’s no reason for it.
Dr B: It was a reflex and you didn’t have a decision; it just happened. But over the years what ways has this guilt come back on you like now?
J: Every time that I… I’ve a 20-year-old son. And my hardest time with him is when he was 10 (here, he relates how he also transferred a superimposition of the Vietnam boy’s death scene not just on his stepson, but also his own biological son). And hoping that I could get through or get him through the ages of his being 10 and on up into… to manhood without him having to ever go through the military or to ever must put himself in that position. And I do the same thing with T (here, he reported apart from his generalized PTSD numbing of intimate interpersonal affect, the reason why he had trouble relating to T, beginning as the boy approached the 10-year age period…unresolved grief and guilt). According to the referring family psychotherapist, this distancing of his stepfather had played a major role in the stepson’s depression and serious suicide attempt. The long-term multiple psychological wounds and their effects on him and his relationships were more potentially impairing and destructive than if he had has suffered severe physical injuries.)
Dr B: Yes.
J: I don’t. I don’t want to ever have any of my children either foster or adopted or my own to ever must go through this. I’ve told myself, I’ve told Betty (his wife) that if the military was to go back to a draft, they would not have any of my children. I’d say just take me.
Dr B: You’d go and suffer again to save them from the pain. That’s how loving you are. It’s important that you forgive yourself. It’s a crazy world. How did you feel about the Vietnam conflict and then as the change in its complexion and all and hear what was happening, are you getting any of the news or…?
J: The news … the news we were getting in country was… was not anything like from what I understand and what I’ve been told by my father that, you know, at 6 o’clock, they sat down and ate dinner to war… (indiscernible) war. And the war that I was part of.
Dr B: It’s outrageous, isn’t it?
J: And the lying on our government’s part, you know, after I got back, I didn’t realize that what kind of nonsupport that the American people were giving to the Vietnam conflict. When I first came back, I had a friend of mine, her name was K. L., who picked me up at the airport. She worked at Berkeley College. And she picked me up during her lunch hour, so I had to go back to Berkeley College and sit and wait in her car until she got off work. Well, as I was waiting there, students on the campus spotted me in my camouflage greens as I was stretching out getting some leg exercise and just kind of stretching and whatnot on the side of her car, they called me everything from baby killer to, you name it, they called it (the verbal abuse by the students using the label of ‘baby killer’ added to his intense guilt). They damn nearly tipped her car over in the process of trying to get to me.
Dr B: You’re a brave man. You just (attempting to support and restore his self-esteem enjoyed prior to Vietnam conflict).
J: No, I jumped in the car and I was looking for a weapon, you know…
Dr B: You deserved better. You didn’t deserve that. You had enough guilt on your own without having that dumped on you.
J: This is true, but I didn’t… at that time I didn’t realize what was going on the American side of it.
Dr B: Let’s go on to the next image, A15. I appreciate your sharing J. What do you see here?
J: I … Reminds me of a river entrance on a map.
Dr B: Tell me more about it. A river entrance on a map?
J: Uhhum. We lost two boats while going up. I say a display of a river, but it… The river mouth was wide, and it narrowed down into nothing. And once you get a 50-foot boat up a river to where you can touch both banks and then you’ve got somebody behind you and they open fire and you’ve got yourself a…
Dr B: You’re trapped?
J: You’re trapped. You can’t back up because the boat behind is…
Dr B: Yeah.
J: Getting the holy hell stomped out of them so the only thing you can do is… is call in air and hope everybody comes out all right (indiscernible–simultaneous speech)….
Dr B: Do you remember that situation?
J: Oh, yes, I lost six men in that situation. (Here, he recalls a combat scene which also played an etiological role in his severe PTSD.)
Dr B: Tell us about it.
J: We ran up a… We were on normal patrol and we were supposed to… It was on night patrol and we were supposed to set up ambushes. And we saw this entrance and it was a pre-given location where we were all gone over prior to going out on patrol, that we would set up ambush on the mouth of this river, but we had to go back up in it, but nobody else had gone in there during the day to find out exactly how much room a person would have, because Charlie (nickname for Vietcong) was kind of funny. He liked to work at night and did most of his ambushing and whatnot at night. His staff, it was moving medical supplies, ammunitions along the Ho Chi Minh Trail at night. You get yourself into a situation you pulled up that river. And we pulled up and the boat behind me pulled in. They took a B40 HEAT round in the fuel tanks and we lost that entire boat. And then we ended up in the process of the fire fight and we called in air strikes, called in six Cobras and they came in and just basically cleaned house. We got the men back out. It was, all of them that weren’t there no more. And the funny thing about it is I can’t remember their names or their faces. I don’t know if I’ve mentally blocked it or what.
Dr B: We’ll go to the next image, A17.
J: It looks like a chest cavity.
Dr B: And how do you feel while looking at that?
J: It’s just a sick feeling.
Dr B: And what does it remind you of?
J: Just death and destruction itself.
Dr B: You saw too much of that. A18?
J: That looks like a heart of something and the drawing of a heart with something in the middle of it.
Dr B: Okay. How about A19?
J: That looks like an intestinal tract. Your lower intestines.
Dr B: Yeah. A20?
J: That looks like an abstract of Mickey Mouse, but…
Dr B: A22? What does it recall?
J: It looks like a drawing of something with a kind of a headdress on it or something to this effect.
Dr B: Okay. A23?
J: It looks like the spinal cord.
Dr B: Did you get any injuries during the war?
J: I came out of it without a scratch.
Dr B: Any close calls?
J: Oh, yeah. I had two boats blown out from under me in the process.
Dr B: You had which?
J: Two boats blown out from under me.
Dr B: How did that impact you?
J: I counted my lucky stars. I was stuck on the… on the beach for six days.
Dr B: The guy upstairs wanted you to get through. (The interviewer spoke using spiritual symbols that this veteran had previously reported to the family psychotherapist.)
J: He had something else in store for me that I am for sure.
Dr B: Okay. A25? How about that one?
J: That looks like a wound.
Dr B: And when you look at that wound how do you feel?
J: I don’t know about how I feel, but all wounds come in different sizes and shapes. It looked like a knife wound.
Dr B: Can you recall seeing a friend, a buddy with a knife wound and how you felt?
J: I don’t know if I can remember any incidents.
Dr B: Aside from the young man that you killed, how about hurting others? Do you… Did that happen much, do you recall the enemy?
J: Oh, yeah.
Dr B: Tell us about that and how you felt about it, wounding the enemy?
J: The enemy was the enemy. I mean they were it was… they would… before you went over there your… your mode of survival was anger. They pumped you up. Like when you went through survival school, they pumped you up the whole time. The only way you’re going to stay alive is stay mad.
Dr B: How did you keep that mad going?
J: It was just a drone more than anything. When you were on patrol, you were alert. As soon as you received fire from the beach, it was like triggering a mechanism within inside. It was instant anger.
Dr B: And when you wounded someone how did that anger get expressed?
J: It was joy. You’ve taken… you’ve taken the enemy out. And usually they don’t wound them. It was you killed them, period.
Dr B: Uhhum. How did you feel when you killed your first man?
J: Sick, but I felt and was trained that it was something that had to be done. It was either him or yourself.
Dr B: Do you ever wish you were back there, when the fighting was going on.
J: Back in Nam?
Dr B: In a regressive mode back in your childhood, happy years or whatever.
J: Yeah, there … there were times when … when I wished that I could stop the clock and turn the hands back, yeah, and start again.
Dr B: A27?
J: It looks like a breast.
Dr B: What sort of emotions?
J: Tender.
Dr B: Was it hard being away from women during the Vietnam conflict and all that?
J: Women yes, whore no.
Dr B: What role did the whores play?
J: They were … they were, you know, female companionship, but it was … the emotion wasn’t there. They were there for one thing, that was the money. There was…
Dr B: There wasn’t love of war for.
J: No. It was…
Dr B: You must have missed the love part, the intimacy?
J: Yes.
Dr B: Were you lonely at times?
J: Oh, yeah.
Dr B: Tell us about that?
J: Well, you think about home. I’d think about where I would have been if… if my life would have been different, if my mother hadn’t passed away, your mind does… you know, your mind wanders.
Dr B: I’m sure! Anything that gets you out of the horror of your immediate reality!
<Level A>Discussion
This educational video illustrates the use of the SIS-II Video as a psychotherapeutic aid in treating military combat induced PTSD. The SIS projective procedure serves as a modern day ‘time machine’ accessing traumatic memories laid down years back. Past stressful scenes were recalled for cognitive correcting and emotional reprocessing in the relative safety of the professional setting. Subsequently, the veteran’s individual psychotherapist then had the opportunity to undermine erroneous cognitions sustained originally, when the victim’s judgement was distorted by stress-related combat emotions. This therapeutic process can be amplified by follow-up group psychotherapy discussions. Empathetic veterans can emotionally support their buddies when sharing their corrective insights.
The video also illustrated the infectious nature of stressful PTSD death imagery, especially about suicidal ideation. Death seeking escapist impulses infected the minds of the veteran under review, his stepson, who made a serious suicide attempt, and the boy’s biological father, who after suffering from untreated PTSD, ultimately committed suicide. Not shown in the teaching tape was the extensive follow-up therapeutic work involving family psychotherapy, including this veteran’s wife. After her first husband killed himself, his military Vietnam veteran buddy eventually married her. Thus, although she never had been in combat, the Vietnam War had caused her great grief.
Many such veterans and their families are still suffering from the long-term psychological injuries of warfare. Majority of them are untreated. Most are reluctant to seek help from limited treatment resources. There are realistic restrictions concerning the cost-effectiveness of such intensive care that necessarily requires many providers involving multidisciplinary therapeutic strategies.
Since the Vietnam conflict, much has been learned about the nature of PTSD from the military’s traumatic experiences in Iraq and now Afghanistan. Although some recruits may be particularly susceptible, in general, the mental health of troops fluctuates with the severity and duration of exposure. For example, as the stressors in Iraq have recently fallen, the suicide rate has levelled off. Consistent with senior members of the military increased awareness, troops are being given more preventative information regarding self-destructive impulses. Also, access to video games or the Internet has been helpful, providing that these outlets do not exceed four hours daily. Moreover, troops who exercise or do other forms of physical activity have a greater resistance to stress.
The case study reveals therapeutic fusion of input from the pulling power of Somatic Inkblot Images (SIS-II Video) and clinical interviews.