PTSD: A Case Study

The Time Cure, by Zimbardo, Sword, and Sword, is a manual describing “Time Focused Therapy,” an empirically validated treatment for post-traumatic stress disorder (PTSD). Here is a case study showing how it was used successfully.

Jamie, not his real name, joined the US Army after graduating from high school, where he had received excellent grades. Although Jamie wanted to continue his education and had received an academic scholarship from a nearby college, his parents could not afford the additional tuition and expenses. Jamie enlisted so he could attend university on the GI bill. Jamie once he had completed his service.

Four years later, after two years in Iraq and several close encounters with firefights in which some of his friends and colleagues were killed or maimed, he returned home and finally enrolled in college. Jamie had been a bright and enthusiastic student in high school, but now he had difficulty focusing. At the end of his first semester, he dropped out of school due to falling grades. Jamie knew that his time in the military had changed him, and not for the better. He recently realized that he had missed 2 vital elements in civilian life: the unique camaraderie that he had with his brothers in arms and the adrenaline rush of living amid danger. Jamie thought about civilian service-oriented organizations such as the fire or police departments; perhaps they might offer the camaraderie and excitement that he was missing. The local fire departments were not expecting recruits, but the Police Department had some openings. Well, at the police Academy, Marissa, a pseudonym and fellow candidate, was taken by James pensive mood and good looks, pursued him, and a romantic relationship commenced. Upon graduation they married and before long had a baby.

A triggering event.

One day, while Marissa was on leave, Jamie was called as a backup for a dangerous situation involving an active shooter in a low income neighborhood. During the incident Jamie underwent a, on the job, psychological breakdown. In his mind, the present had evaporated and had been replaced with a firefight that Jamie had experienced in Iran. His fellow law enforcement officers suddenly became his platoon buddies. The active shooter turned into an Iraqi insurgent. What the another police officer noted was, that while crouching behind a wall, Jamie was shaking uncontrollably and sweating profusely, he had been called by a different name. He told Jamie to stay put while he called headquarters. Jamie was admitted to the psychological psychiatric ward at the local hospital, and put on paid leave. Dturing his time he told the psychiatrist he was suffering from suicidal thoughts. After a few weeks of intensive therapy, he was released under the condition that he would continue seeing a psychiatrist for medication and psychological psychic psychiatric therapy. Jamie was to remain on leave until he had either been cleared by both practitioners, and was deemed fit to serve in the Police Department.

Jamie’s time perspective.

Richard Sword was convinced by the chief of police, and asked Jamie to be a client. While not knowing much about Jamie’s background as a veteran, they felt TPT might help the young officer. Rosemary Sword was the co-therapist for Jamie, and gave us permission to use his story.

Session 1. During his first session, Jamie mentioned that he had several tours in Iraq before becoming a police officer. The Swords suspected he had some form of post-traumatic stress syndrome and gave him psychological tests that diagnosed him with depression anxiety, and PTSD.

Session 2. The test results were explained. Jamie’s stress was so severe that he definitely had PTSD. The therapist told him that the recent incident as a police officer had triggered him. Jamie described the triggering incident and realized that he had been experiencing PTSD since he returned home. The symptoms had worsened since he joined the police force, married, and had a child.

Session 3. The third session was devoted to Jamie’s military service contact, especially the coma, the life threatening firefight, and past negative experiences. Jamie had an excellent memory and was prompted to relive these experiences in as much detail as he could manage. At the end of these exhausting sessions the therapist encouraged self-care, such as listening to soothing music, engaging in meditation, and recalling positive memories, such as experiences with family and friends, playing sports, riding horses in the countryside, hiking his favorite trails, and swimming in the ocean. When past negative thoughts arose, Jamie was told to immediately replace them with these past positive memories.

Session 4. During the fourth session, while sharing how he was doing at the present time, Jamie admitted to having suicidal thoughts. In TPT this is called extreme present fatalism. Jamie volunteered that he owned a gun and thought that if he were to kill himself, he would probably do it with the weapon. He was not sure that he really loved Marissa and felt she had pressured him into marriage and having a child. He did not know if he could keep up with their house payments. In addition to feeling overwhelmed with responsibility, he now realized that his time in Iraq had left him with extreme post-traumatic stress.

Deeply concerned with Jamie’s suicidal thoughts, and the handgun in his home, the therapist suggested he turn over the firearm to the Police Department. Jamie eventually agreed and muttered that although he had not thought about it, there were other ways he could take his life if he wanted to do so. The therapist called Jamie’s wife, and asked her to remove the gun from the premises before Jamie returned home. She took the gun directly to the police department.

The therapist then asked Jamie to focus once more on the past positives, including outdoor activities, surfing, diving, fishing, hunting, hiking, and farming. Jamie still enjoyed some of these activities, but was presently pessimistic, that with a wife on maternity leave, and a baby at the house that he helped care for, most of these activities were out of reach. The therapist suggested that he clear some time and plant his favorite vegetables. Jamie agreed to give it a try.

The therapist turned the conversation to Jamie asking him to consider all the alternatives in his life. Together they made a list: a loving partner, caring parents, and loyal friends, a roof over their head, and a baby he was getting to know and love. When Jamie found himself feeling depressed, he was to recount his many blessings and do some farm work on his land. The therapist also taught Jamie some self-soothing breathing techniques and simple guided meditations, which Jamie practiced between sessions, especially when he felt anxious and depressed.

Subsequent sessions.

Although Jamie’s suicidal thoughts had decreased, he continued to live with them on occasion. He frequently shared one of his main concerns about his future: that he would be unable to provide for his family if he lost his job on the police force. As a veteran, Jamie had taken advantage of the GI bill, but he had not considered other VA benefits. At the suggestion of the therapist, Jamie agreed that they would work together to apply to the VA for a disability claim for the service-connected PTSD, including their earlier sessions where they had reviewed his past negative experiences in the military. Getting additional details and formatting them for the VA would be fairly straightforward. The thought of receiving well-deserved compensation gave Jamie hope for a positive future.

As Jamie improved, his sessions were reduced to once a week. He had taken the therapist’s suggestions seriously and had cleared a portion of his land. The counseling session was conducted on Jamie’s property, and the therapist marveled at the large vegetable garden Jamie had planted. Jamie shared that he planned to clear another tract of land to plant fruit trees. Within four months of his first session, Jamie no longer suffered from suicidal thoughts. Within six months, he was cleared by both the psychiatrist and the psychologist to return to work. Simultaneously, he received a 100% service connected PTSD rating from the VA.

Jamie had also received a job offer from a former high school friend to work on a ranch a few 100 miles away. After discussions and the couple’s therapy sessions, Jamie and his wife decided they wanted to start over. The thought of working outdoors on a ranch excited Jamie, and while Melissa was reluctant to work, preferring to spend more time mothering their baby. They sold the house and purchased a modest house near their friend’s cattle ranch. At his last contact with the therapist, Jamie and Melissa were living “a brighter future” they had created together. Combining TFT with many of the other techniques mentioned in his book worked with Jamie.

Jamie’s story reminds us of a sobering statistic. While firearms are used in less than 6% of suicide attempts, over 50% of suicide deaths occur with firearms. In other words, guns are 8 times as lethal as other means and cause over half the suicide deaths. The most commonly used method of self-harm. Firearms are by far the most lethal, with a fatality rate of approximately 85%. Conversely, over 50% of people who attempt suicide using other methods will die, and the vast majority of all those who survive will not go on to die by suicide. This suggests that there is a real relationship between suicide attempts by firearms and an overall decline in the suicide rate.

While these statistics are alarming, they also highlight the importance of intervention and prevention. By promoting safe storage practices, increasing awareness, and ensuring access to mental health support, we can significantly reduce the risk of suicide and offer hope to those who are struggling. Jamie’s story, though tragic, inspires us to take action and reminds us that even small changes can save lives. Together, we can build a safer, more supportive community for everyone.