Honoring our Veterans: A Conversation with Jessie Keller
Image Description: Words on a dark blue background: Women Who Serve, Gender and the US Armed Forces. 2M living veterans are women. Did you know that women make up roughly 10% of U.S. veterans?
Reference: “Demographics.” U.S. Department of Labor Seal, www.dol.gov/agencies/vets/womenveterans/womeneterans-demographics.
Conversations, Connections, and a Call to Action
In what some may recognize as true military fashion, we are prepared and pausing as many times as needed until proceeding makes sense.
We’ve been working on this post for some time and thought it only fitting to share on Veteran’s Day.
As we think about the lived experiences of United States Veterans, we are honored to share a conversation we had earlier this year, with occupational therapist and US Navy veteran, Jessie Keller.
You’ll find a transcript of the introduction and OT recap below, followed by a list of resources for a deeper dive. The link to the audio can be found below the Intro.
***NOTE***: Trigger warning— today’s post contains conversations around trauma and abuse during childhood and within military experiences.
Intro
(0.00) Jessie Keller is a woman who shares her story with so much grace and generosity of spirit. We don’t always know someone’s backstory but in this conversation, we have the privilege to hear some of the life experiences that have shaped Jessie. Today she is an occupational therapist (OT) who is dedicated and compassionate in her roles as a home health OT, fieldwork student educator, and a mental health advocate for civilians and veterans alike. Jessie is a go to resource to her colleagues and the academic community for working with complex situations.
Jessie is also a veteran of the US navy who lives with complex PTSD. This conversation does come with a trigger warning that we are talking about sensitive and complex topics, including abuse during childhood and within the military. We hear about her role in the military, her experiences with trauma,and how it affects her roles as a mother, friend, worker, and civilian.
On a personal note, I am blessed to call Jessie a friend since 2006. We met as classmates when we began occupational therapy graduate school. This conversation was a reminder that there are so many things that we may not know about one another that influence our day to day function and the gifts that come from noticing and staying curious about what may be going on for anyone at any point in time.
We are so grateful for Jessie’s willingness to share her experiences, and for the way she transforms her experiences as she offers a safe haven in her way of being-- especially to those who may feel most misunderstood.
As you listen-- here are a few key areas we all may benefit from listening to with greater focus in order to understand one another better.
(1:43) Complex Post Traumatic Stress Disorder (cPTSD) can happen as a result of a variety of experiences, we invite you to notice how complex PTSD affects Jessie’s daily living and experience with the environment around her, particularly how this impacts her senses.
Mental health and the need for avoiding making assumptions is a key topic of this interview. We invite you to pay particular attention to how Jessie’s experiences allow her to notice and act on cues in people that others may not notice.
We invite you to notice and listen to what is helpful as much as what is not helpful, recognizing what is beneficial to one person may be harmful to another.
And lastly-- we ask that we listen for what is possible, and wonder how each of us may work together toward the excellence Jessie invites us to consider.
With special thanks to all those who have served and continue to serve in the United States military and their families, we observe this Veteran’s Day by sharing Jessie’s story.
OT Recap
(1:10:11) This is another one of those conversations that could have a recap or reflections that go deeper in so many directions. For today, we will lift up a few of the key points for all of us humans and for health care and OT professionals in particular.
Often in health care, we are reminded that what is truly impacting someone’s day to day function or engagement in occupations is not as simple as it seems. Jessie’s story reminds us of that, not only for her clients, but also in her own experience living with complex post traumatic stress disorder (known as cPTSD). Bringing plenty of curiosity while checking our assumptions and judgment is key.
From an OT perspective, this is a great opportunity for us to reflect on the interaction between the person (Jessie) and the environment (both impacting each other) and resulting in how people engage in their day to day activities, or their occupational performance. In occupational therapy, one model of understanding occupation is called the PEOP model, which is basically proposing that the way someone engages in their daily activities, roles and routines (their participation and performance) is the result of the interaction between the person and the environment.
To understand how this model is helpful in understanding how, why, when, and what people choose to do or not do, we have included a link to seeing this model in practice at the end of this post.
In this conversation, we have the chance to understand the lived experience of someone who has complex PTSD. We hear the sensory changes that happen as a result of traumatic experiences and the chance to notice how this might show up in someone. In occupational therapy, we are trained to pay attention to not only the physical components of health, but also the mental, emotional, and spiritual components of health. Part of the core of understanding how we function in our environments is to recognize all humans have different sensory needs and thresholds. With cPTSD, certain visual, auditory, olfactory (smell), gustatory (taste), tactile (touch), proprioceptive (body awareness), and vestibular (balance system) stimuli may register differently or more intensely resulting in a change in how people experience and interact with the environments around them.
In Jessie’s story, we hear her experience of increased vigilance or level of alertness that she experiences in a variety of settings as she assesses for safety. One example of this was scanning the environment at the grocery store.
This increased level of alertness and sense of caution can take a significant amount of energy in performing daily activities and alter her habits, routines, and roles greatly. How the body registers different circumstances and communicates those back to us through internal sensations also can be referred to as interoceptive awareness. What is interoception? It is basically a big word to say the sense that allows us to understand what our body is telling us. For example, our stomachs growling means we are hungry, our palms sweat and we are nervous, etc.
Sometimes the messages the body sends can be experienced as far more intense, painful, or as a greater threat than the situation would typically be registered. Other times it is the opposite, where there is decreased awareness of the information the body is communicating. No matter where someone is on the continuum of interoceptive awareness, it is common to experience interoceptive disruption with cPTSD.
Vestibular and proprioceptive awareness are two other sensations occupational therapists consider that may impact daily functioning. They are lesser known than our 5 senses we have learned since childhood, yet make a big impact in how we function each day. The impact of our sensory systems on our daily routines and activities is one of those topics that deserves its own conversation and series of posts. For now, the goal is to be aware there are 8 sensory systems that can be impacted and occupational therapists are one of the professionals trained to understand the sensory system and its impact on functioning.
What does this mean for you as a listener?
(1:15:00) If you notice your sensory systems or others are affecting your day to day routine, an occupational therapist is a good place to start with asking for next steps in getting help navigating how to cope with the impact of sensory stimuli.
On a broader note, we talk about occupations that Jessie experiences as beneficial and transformative (such as reading) and that many of the activities people may recommend as therapeutic can be experienced as the opposite for her-- things like hugs (which may include tactile, proprioceptive, and olfactory input), time in nature (which also has many sensory components such as visual and auditory stimuli) and more. Sensory preferences vary by person and are influenced by our experiences and the way our body interprets sensory information.
We hear how Jessie’s experience in the military shape her interactions both as a woman in the military and outside of the military in her role as a civilian. We hear her talk openly about the challenges connecting with others who have not shared similar experiences can have on her relationships and how it continues to influence her life. As the Solidago team reflected on what we really wanted to recap in this interview, the words perception and connection were key.
Perception: Jessie talks about how your perspective of the world changes when you believe you may not come back (from serving) and notices that perception can differ as a member of the navy vs in the role as a mom of a military member. She also gives us the chance to notice how differences in perception based on our roles and life experiences can also have an impact on us. One example she shares is when an assessment (such as her assessment of disability) painted a different picture than the one she views of herself. Her observations about this invite us to notice what happens when those perspectives vastly differ? How do we navigate the space between our perceptions of how we are functioning and an assessment’s determination of function in a beneficial way?
Connection is another key theme that comes up. One of the key reflections being highlighting the difference between the therapeutic relationship and all other relationships. Therapeutic relationships (a one way relationship between a healthcare team member and a client, patient or family)-- expects nothing in return-- the relationship is focused on the needs of the client. As Jessie reflects on the difficulty connecting to civilians, and particularly women after her military experiences, we hear her talk about where it is easier to connect and her requests to those around her about how to respond to connection when it can feel like a one way street (though expected in a therapeutic client setting, may be more confusing to handle in other relationships where we may come to expect a two-way connection).
Jessie reminds us that if we know someone that has experienced or is currently experiencing trauma, the invitation to connect is still appreciated-- even if that person is not able to connect back-- continuing to reach out and not take it personally if they do not choose to engage is helpful.
(1:18:58) For health care professionals and occupational therapy professionals in particular, Jessie’s story illustrates how essential the understanding of mental health in impacting occupational performance is in our day to day activities. We are reminded that physical capabilities are just one part of what impacts function and wonder what else may be influencing someone’s participation in life beyond the obvious. If we are less comfortable or familiar with mental health, we offer resources at the bottom of today’s post to help you connect with resources that can enhance your skills.
When someone is behaving in a way that may not appear to match the current environment at first glance, Jessie shares tips on how to assess the situation--Scan, look, and listen.
How do we get more practice reading situations and trusting our intuition, particularly practice when the stakes aren’t so high? Resmaa Menakem is one author leading the way in somatic experiencing work-- he offers practical exercises, valuable information and insights into how the body responds to trauma and how we can practice getting comfortable being aware of what trauma looks and feels like through practical exercises in the book, My Grandmother’s Hands. which is also listed in the references of this post.
We’ve covered a lot so far.
So what can we do as everyday citizens or teams who may be working together and noticing the impact of trauma in our clients or colleagues?
Jessie reminds us how invaluable teamwork is and the lessons we might apply to civilian life from the military. The reality of everyone’s role impacting the whole cannot be ignored in military life and along with this, Jessie reminds us there are so many more opportunities to be more intentional about how different people can work together as a team to meet community needs. The recognition of every role being essential in the military reminds us of our many possibilities to take action to become a more multi-perspective and multi-disciplinary team.
Jessie’s observations remind us as occupational therapists, we have work to do to help the general community understand what our training and knowledge can bring to the function of a team and community members.
One of the military lessons applied to civilian life is what Jessie has to say about excellence. If you’re guided by excellence-- you’ll find the people who help you get to that. Take ownership of your community-- the untapped potential-- notice your untapped potential, who is needed to build those relationships and continue the path toward connection. Jessie reminds us to achieve excellence-- it naturally involves community and relationship building.
Thank you for listening today. Please check out the resources at the end of this blog post to learn more or access further help.
To the veterans past and present-- we thank you for your service and we’re with you on the journey
To a life well occupied
Resources
We recognize that you may have several questions after listening today. For further information and answers to questions you may have, please see the resources below.
Q. What is the difference between PTSD and cPTSD?
A.
PTSD (Post Traumatic Stress Disorder): A stress related disorder following exposure to a traumatic event or events
cPTSD (Complex Post Traumatic Stress Disorder: Trauma experienced over a significant amount of time without a chance of escape.
https://traumapractice.co.uk/what-is-the-difference-between-ptsd-complex-ptsd/
Q. What was the treatment mentioned that helped with anxiety due to cPTSD?
A.
Stellate Ganglion Block (SGB): Procedure that had been used for decades to relieve pain. Involves injecting a local anesthetic into the stellate ganglion. This group of nerve cells and nerves in the neck helps regulate the body’s “fight or flight” mechanism. https://www.rti.org/impact/stellate-ganglion-block-new-treatment-ptsd
Stellate Ganglion are a group of nerves in the cervical vertebrae C6 and C7/ Part of the sympathetic nervous system- a connection between the brain and the body
A few testimonies from the SGB study: https://www.rti.org/impact/study-indicates-stellate-ganglion-block-can-be-effective-treatment-ptsd
Q. What is the PEOP model?
A.
PEOP is a model of occupational therapy that is used to help understand what factors are influencing how we humans are engaging in our daily occupations and how the factors of ourselves and the environment influence each other resulting in occupational performance and participation (see model in link below for more specifics). This offers a better understanding of the types of things occupational therapists are considering in partnering with people to enhance their daily function and for occupational therapists it may serve as a refresher as to what this model looks like applied to practice.
https://seniorsflourish.com/peop-model/
Q. Where can we get help if we or someone we know are experiencing these symptoms?
A.
If you are someone you know is a veteran or an active military member and experiencing PTSD or other mental health issues, including suicide we want you to know you are not alone and help is available. Some of those resources include:
Invisible Wounds Project
This organization offers 100% confidential and free services to military members, first responders, and their families related to mental health, PTSD and suicide in Minnesota. They are on a mission to raise awareness of the needs of Minnesota’s military, first responders, front line medical staff, corrections, dispatch, and their families related to mental health, PTSD, and suicide.
Follow the link below to learn more or access help.
NAMI
If someone you love is needing greater attention to mental health, a nationally available resource is NAMI.
Did you know 1 in 5 people live with a mental health condition? Mental health is health. As occupational therapists, we recognize understanding people’s function includes understanding physical, mental, spiritual, and emotional health and are trained to pay attention to all of these areas. These four areas combine to equal health.
Whether you are certain you or others are experiencing difficulty with mental health or are wondering if this may be affecting your function, there are resources and teams of people who can help everyone get to the resources they need.
To connect with 24/7 crisis counseling or get more information on a variety of topics about mental health, check out the link below.
For more information on supporting someone with PTSD, please see the following resources:
https://www.ptsd.va.gov/publications/print/understandingptsd_family_booklet.pdf
https://www.helpguide.org/articles/ptsd-trauma/helping-someone-with-ptsd.htm
https://www.uofmhealth.org/health-library/af1005spec
Trauma and Somatic Awareness
Menakem, R. (2017). My grandmother’s hands. Central Recovery Press.
To enhance your mental health practice as an OT:
OT for Advancing MN Mental Health Services (OTAMMHS)
If you are an occupational therapy student or professional and want to connect with other like minded individuals who are passionate about the role occupations and OT plays in mental wellness, check out the group below. No matter what practice setting you work in, mental health is always part of our practice. This group is a chance to connect with others and enhance the mental health portion of your practice.
https://www.facebook.com/OTAMMHS
And in the words of Jessie, if you aren’t finding the help you need--- keep knocking on the next door.
