Speaker 1: You're listening to the Buck Sexton Show podcast, make sure
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Speaker 2: Hi, everybody, welcome to the Buck Brief. On this episode,
Speaker 2: our friend Chris Free joins us. Now he's got a
Speaker 2: book out, operator syndrome. He wants to talk to us
Speaker 2: about this very important phenomenon that faces our military veterans.
Speaker 2: And Chris, would you first just tell everybody about yourself
Speaker 2: and how you came to this point, just give some
Speaker 2: background before we dive into operator syndrome and the medical
Speaker 2: and behavioral components of it.
Speaker 1: Sure. So, first of all, thanks for having me Buck. So,
Speaker 1: my father was a Vietnam veteran growing up, he was
Speaker 1: not a combatant, he was an Air Force physician. And
Speaker 1: my great grandfather, who I knew very well, was a
Speaker 1: veteran of the Spanish American War. He fought at the
Speaker 1: Battle of San Juan Hill. So, as a young man,
Speaker 1: after college, I want to work with veterans. Went to school,
Speaker 1: got a PhD in clinical psychology in nineteen ninety two,
Speaker 1: and I worked in the VA system and the Medical
Speaker 1: University of South Carolina for fifteen years. Left there in
Speaker 1: two thousand and six, and I've been at the University
Speaker 1: of Hawaii ever since, and along the way about half
Speaker 1: you know, quite a bit of my time. For twelve years,
Speaker 1: I commuted to Houston every month for work, first at
Speaker 1: Baylor College Medicine and the University of Texas. So my
Speaker 1: career has been a mixture of clinical work, teaching, and
Speaker 1: quite a bit of research. So I have over three
Speaker 1: hundred scientific publications and all the grants and presentations and
Speaker 1: all that stuff. But my passion has been working with
Speaker 1: the special operations community over the last decade or so,
Speaker 1: and that includes operators from every branch of the US military,
Speaker 1: including probably maybe several hundred Tier one operators, maybe one
Speaker 1: hundred Tier one operators. I've worked with people that are
Speaker 1: still active duty, no longer active. A lot of the
Speaker 1: work has also been with private defense contractors, which is
Speaker 1: an invisible population to Americans because America doesn't know how
Speaker 1: many people who deployed to Iraq or Afghanistan during the
Speaker 1: last twenty plus years were not deployed as members of
Speaker 1: the armed forces but were private defense contractors.
Speaker 2: How do you first come upon your research on this
Speaker 2: specific constellation of medical and behavioral health care needs of
Speaker 2: military special operations forces. As I'm reading from your article
Speaker 2: here that toute operator syndrome. How do you find yourself
Speaker 2: first finding yourself drawn to the study of this and
Speaker 2: this challenge and this problem.
Speaker 1: Well, if we back up to nineteen ninety two in
Speaker 1: my career, when I started at the VA, and I
Speaker 1: really loved working at the VIA. I loved my patients.
Speaker 1: Most of the people I worked with were Vietnam era
Speaker 1: veterans I'm Korean, even some World War II veterans still
Speaker 1: coming into the VA at that time. What I didn't
Speaker 1: love about my job, and by two thousand and six
Speaker 1: I just couldn't take it anymore. What I didn't love
Speaker 1: was the bureaucracy of the VA and the politics and
Speaker 1: the policies, and the harm that I saw the VA
Speaker 1: was doing too many veterans via their policies, and the
Speaker 1: poor care and the lack of care that was pretty
Speaker 1: predominant in many ways. So that's why I left the VA,
Speaker 1: and a few years later, really just by fortune, good fortune,
Speaker 1: I made some friends in Houston who were former operators.
Speaker 1: One was a Tier one Navy seal who had been
Speaker 1: on a lot of the big time missions that movies
Speaker 1: have been made about. And I also met guys from
Speaker 1: Army and Marines and Air Force while I was there,
Speaker 1: and so just kind of had a friend circle of
Speaker 1: former operators. One of the things that was interesting and
Speaker 1: infusing was they did not seem to have PTSD. And
Speaker 1: a very common thing that I was hearing initially was, hey,
Speaker 1: can you help me. I don't know what's wrong. Something
Speaker 1: is off. I feel different, but I don't know what
Speaker 1: it is. And so with my background of PTSD, I
Speaker 1: thought I had this expertise blah blah blah. Turns out
Speaker 1: I did not have expertise. Turns out I did not
Speaker 1: know how to help these guys. So these are my friends,
Speaker 1: and we're just kind of playing trial and error. Let's
Speaker 1: get a sleep study, Well, let's get a blood test,
Speaker 1: and let's look at your hormones. Let's have a conversation.
Speaker 1: Can I talk to your spouse or your partner and
Speaker 1: get some information about how you behave, how you think,
Speaker 1: how you function, and how you sleep. And it was
Speaker 1: eye opening, and gradually, over time I kept seeing it
Speaker 1: was the same pattern of injuries and illnesses over and
Speaker 1: over and over again. Every guy I met had low testosterone. Hell,
Speaker 1: how is that possible? Why does a big, strong, thirty
Speaker 1: seven year old Navy seal who's just a year out,
Speaker 1: why does he have low testosterone? I didn't understand that.
Speaker 1: So over the course of time, we began I and
Speaker 1: some of my colleagues who kind of shared an interest.
Speaker 1: We talked with a lot of guys and a lot
Speaker 1: of listening and a lot of trial and error, but
Speaker 1: we began to figure some things out. We began to
Speaker 1: find that we could help guys, and from there it
Speaker 1: was just a matter of word of mouth, just hey,
Speaker 1: you help my friend, could you talk you helped me?
Speaker 1: Could you talk to my friend? Maybe you can help
Speaker 1: my friend, and then the friends of friends. So in
Speaker 1: the last decade, I would say I've come to just organically,
Speaker 1: I've probably talked to two hundred and fifty three hundred
Speaker 1: and fifty operators, and then I've also done some forensic
Speaker 1: work on the side of the defense private defense contractors,
Speaker 1: so I've worked with I think I've evaluated over two
Speaker 1: hundred and fifty private defense contractors putting in Defense Base
Speaker 1: Act insurance claims.
Speaker 2: So what what is operators syndrome and how is it
Speaker 2: different from PTSD Yeah.
Speaker 1: So well, let's start with how are operators different? And
Speaker 1: I'm gonna let's acknowledge there's a formal definition of operators.
Speaker 1: Somebody who's gone through selection and then training for a
Speaker 1: you know, for one of the special operations units. That's
Speaker 1: Navy Seals, that's Army Special Forces, that's and I include
Speaker 1: ranger rangers in there, that is Marine raiders, and Force
Speaker 1: recon that is Air Force pjs and combat controllers. And
Speaker 1: there's you know, paramilitary. You know from your your prior
Speaker 1: work that the the intelligence agencies have paramilitary and they
Speaker 1: employ private defense contractors global response, and so that's that's
Speaker 1: kind of the def I mean, that's kind of the
Speaker 1: people we're talking about. And then what makes them different
Speaker 1: from convention? This is something I think most people have
Speaker 1: no awareness of. Yeah, everybody knows that a Green Beret
Speaker 1: is cool, he's a badass dude, but nobody really understands
Speaker 1: the magnitude of the differences. So what we're talking about
Speaker 1: is just extensive experience, training and deployments with blasts. Last
Speaker 1: exposures cause a very unique type of damage to the brain.
Speaker 1: If you're standing within the radius that explosion is going
Speaker 1: to pass through the body. It's going to have a
Speaker 1: sharing effect through all of the soft tissue in the body.
Speaker 1: You have the incredibly high operational tempo going in and out.
Speaker 1: There's very little time off, so you do a six
Speaker 1: month deployment. On that deployment, you may be running missions
Speaker 1: twice a week, twice a night. Oftentimes it's nighttime work,
Speaker 1: not daytime work, so the sleep schedule is shifted and dysregulated.
Speaker 1: Come home from the employment, and then there's new training
Speaker 1: evolutions constantly, so there's really very very little downtime. That
Speaker 1: high operational tempo means our soldiers are living with chronically
Speaker 1: elevated cortisol and stress hormones flowing through their blood constantly.
Speaker 1: The sleep is always jacked up to some extent. Then
Speaker 1: you have the You have the massive amount of chronic
Speaker 1: pain on the joints, jumping out a helicopter, repelling out
Speaker 1: of helicopters, jumping out of perfectly good airplanes, rocking with
Speaker 1: heavy weight and body armor. Every guy I know who
Speaker 1: by the time he's thirty, has chronic pain and shoulders, neck, back, knees, elbows, ankles.
Speaker 1: That adds another burden. So part of how we describe
Speaker 1: this as allostatic load. Alostatic load is a is a hypothetical.
Speaker 1: It's not a specific it doesn't refer to anything specific,
Speaker 1: but it's a hypothetical construct that refers to the entire
Speaker 1: dose of everything that is on a soldier's back for
Speaker 1: the course of their career. And that's another thing that's different.
Speaker 1: Most operators have careers that are ten years long or
Speaker 1: fifteen or twenty. Very few of them are doing a
Speaker 1: four year enlistment and then being out. In fact, that's
Speaker 1: almost notheard of. So it's not just that they have
Speaker 1: maybe a magnitude of blast exposures that's ten thousand times
Speaker 1: more than a conventional soldier in one given year, but
Speaker 1: they're doing that for twenty years maybe, So you just
Speaker 1: have an incredible burden on the entire body. Then you
Speaker 1: talk about then you have the toxic exposures. Are soldiers
Speaker 1: in the Special Forces and we're seeing this now. It's
Speaker 1: just emerging the high rates of cancer and respiratory illnesses. Yes,
Speaker 1: we know burn pits are a thing, and those have
Speaker 1: affected soldiers from all branches who deployed, But it's not
Speaker 1: the burn pits that are really hammering the community of
Speaker 1: Special Operations it's the radiological materials, the biological materials. It's
Speaker 1: the the many doses of vaccines and shots that they've received,
Speaker 1: how much anthrax Us as a has a Navy seal
Speaker 1: received by the end of his career. Then you have
Speaker 1: the you just have the mystery things that are out
Speaker 1: there wandering around a field, wandering around an airfield in
Speaker 1: some other country. I won't say, I won't name countries,
Speaker 1: but countries around Afghanistan where old Soviet military bases were,
Speaker 1: and they're there for weeks months. I've talked to soldiers,
Speaker 1: contractors who spent year at these places. They're describing green
Speaker 1: ponds floating in the dirt. What's that? What's going on there?
Speaker 1: One of the gentlemen that I met, who that I know,
Speaker 1: who was one of these places, describes how he developed
Speaker 1: type one diabetes, Type one, type one diabetes.
Speaker 2: So you have to be born with that, right, is correct?
Speaker 1: Correct, But if you get your your you know, you
Speaker 1: get your pancreatic your pancreas smoked there, then you've got
Speaker 1: you know, you're gonna have some real issues. So there
Speaker 1: are there are maladies that we don't barely even understand.
Speaker 1: I got a text about fifteen minutes ago before we
Speaker 1: went on the air from a friend who spent twenty
Speaker 1: five years. At first it's SF and then Delta, who
Speaker 1: is in his mid forties and he just received a pacemaker,
Speaker 1: and it's not for the usual reasons that people receive
Speaker 1: a pacemaker for. And he, you know, he just can't
Speaker 1: get his blood pressure regulated. He's on he's been diagnosed
Speaker 1: with Parkinson's disease. He's concerned about, you know, sometimes several
Speaker 1: doctors have told him he has als. Doctors themselves can't
Speaker 1: figure out what's going on with a lot of our
Speaker 1: a lot of our guys. And then if you take
Speaker 1: that to the VA and kind of go back and
Speaker 1: think about what I said about leaving the VA, I
Speaker 1: think part of what I want to say to the
Speaker 1: folks and part of the message is the VA is
Speaker 1: completely missing the boat.
Speaker 2: Can we they have hold on that? Chris for one second,
Speaker 2: I want to go back to it, or just yep,
Speaker 2: just a word from our sponsor will address this. I
Speaker 2: want to know, Okay, Chris has these findings, has been
Speaker 2: working with these operators. One would think in the civilian
Speaker 2: world where I come from, that VADD would want to
Speaker 2: do everything they can to address these issues and to
Speaker 2: put resources behind it. I have a feeling Chris is
Speaker 2: going to tell me it has not been that smooth.
Speaker 2: So we'll get to that here in just a second.
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Speaker 2: slash free. Okay, Chris, so you've studied this, You've identified
Speaker 2: there's a problem. You try to bring the problem to
Speaker 2: the VA and to people in the government that should
Speaker 2: be helping our military and our warriors and what's been
Speaker 2: going on.
Speaker 1: Well, we'll talk about what the VA is for a moment.
Speaker 1: The VA is a large bureaucracy healthcare organization. They are
Speaker 1: set up to serve the vast majority of veterans, ninety
Speaker 1: five percent of whom, including those who deployed, were not
Speaker 1: necessarily combatants, and if they were combatants for the most part,
Speaker 1: they were not doing the same thing as the one
Speaker 1: to three percent of those who fought most of the
Speaker 1: war and saw the heaviest combat and saw the constant stressors,
Speaker 1: allostatic load, and the high operational tempo that they went through.
Speaker 1: What the VA does is the VA is very good
Speaker 1: at hitting the PTSD easy button. You served in a
Speaker 1: rock boomy PTSD, that's PTSD. We have so far over
Speaker 1: diagnosed PTSD. I mean, it's just it's a crime and
Speaker 1: shame to be honest. The problem that operators have is
Speaker 1: they don't really have PTSD. I mean, they may have
Speaker 1: some of the symptoms, but they don't have the fear reactivity.
Speaker 1: They don't have they don't show the same type of
Speaker 1: avoidance of triggers and cues that you see with you know,
Speaker 1: typical PTSD. What operators do have is massive traumatic brain injuries.
Speaker 1: They have low testosterone and other hormonal dysregulation. They have
Speaker 1: sleep dysregulation and insomnia. But they also many of them,
Speaker 1: maybe eighty ninety percent of the guys that I've worked with,
Speaker 1: have sleep apnea. Even when they're in their late thirties
Speaker 1: early forties, they're developing sleep apnea. So put that together
Speaker 1: with the chronic pain, the cognitive problems, and the headaches
Speaker 1: that go with TBI, many of them have the other
Speaker 1: some of the other classic symptoms of TBI, low poor balance,
Speaker 1: blurry vision, they all pretty much all have ringing in
Speaker 1: their ears and other perceptual system impairments vision, hearing, balance.
Speaker 1: Think about how that ripples out to their family, how
Speaker 1: that ripples out to their community, their work, and then
Speaker 1: there's nobody that understands them. They go to see a
Speaker 1: doctor and a doctor will say, oh, I've never seen
Speaker 1: anything like this. I don't know what to tell you.
Speaker 1: And in modern medicine, we have the problem of the
Speaker 1: fragmentation of care. So a veteran goes to the VA
Speaker 1: or any healthcare system, they're going to see one dock
Speaker 1: for their sleep, another doc for pain, another if they're lucky,
Speaker 1: another doc for urology if they're lucky. But these docks
Speaker 1: rarely talk to each other, so they're not They're just
Speaker 1: not getting what they need. My conversations with people who
Speaker 1: work for VA, work for SOCOM, work for DoD, and
Speaker 1: I want to be clear, I'm not affiliated with any
Speaker 1: of these organizations. I'm a complete outsider. There's no reason
Speaker 1: they should listen to me necessarily. But what I hear
Speaker 1: over and over again is well, we already got programs
Speaker 1: for everything. They will say, we can't build special programs
Speaker 1: for special operations because that's not social justice. And I've
Speaker 1: heard this argument over and over again, it's not socially
Speaker 1: just to build special programs for operators. In my response
Speaker 1: to that, and I'll I'll try not to drop any
Speaker 1: f bombs here is in medicine, we need to treat
Speaker 1: the injuries that people have. So if you have a
Speaker 1: group of people with unique injuries, they need unique care.
Speaker 1: They need care that is specifically contextually tailored for their needs.
Speaker 1: And just to give an example of one thing that
Speaker 1: I've heard over and over again, and this is a
Speaker 1: story that I've heard so many times that you know,
Speaker 1: I certainly believe it is. An operator goes into the VA,
Speaker 1: they're referred to mental health, They meet their social worker
Speaker 1: or their psychologist or what whoever their therapist is for
Speaker 1: the first time, and they start talking and their therapist
Speaker 1: has never heard the kinds of things that they're now
Speaker 1: hearing for the first time, and frequently they break out
Speaker 1: crying and sobbing. And so I've heard this many times,
Speaker 1: and operators tell me, Yeah, I had one appointment ten
Speaker 1: minutes in. My therap is just sobbing into her hands
Speaker 1: and into tissues, and I just like, I'm sorry, I
Speaker 1: get up and I walk out because what else am
Speaker 1: I going to do?
Speaker 2: Yeah? Wow? So, Chris, I want to get to what
Speaker 2: can be done to so you've identified this, people are
Speaker 2: pushing back on it. I want to get to the
Speaker 2: treatment here next. And also why you wrote the book
Speaker 2: Operator Syndrome, which for those who are watching and YouTube
Speaker 2: can see there's a copy of the book behind Chris's head.
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Speaker 2: costs and terms. Chris, how do we treat operator syndrome?
Speaker 1: Yes, that's the important question here, and the good news
Speaker 1: is we have treatments, we have ways to provide care.
Speaker 1: I would start with a general principles. You need to
Speaker 1: have some contextualization of the care. It's best if you
Speaker 1: have providers who have talked to operators and know a
Speaker 1: little bit about what an operator has been doing, what
Speaker 1: that means from a career perspective, but as well as
Speaker 1: also an injury perspective. I just go through some of
Speaker 1: the treatments and then I'll talk about kind of how
Speaker 1: we can put them together and some of the foundations
Speaker 1: that are just doing phenomenal work out there. First off,
Speaker 1: you know the basics. Yes, it's worth considering psychotherapy. Many
Speaker 1: guys might benefit from psychiatric medications such as anti depressants.
Speaker 1: What we don't want to do is load them up
Speaker 1: on three or four or five psychiatric medications. Which is
Speaker 1: what I commonly see, and that's a common complaint about
Speaker 1: when guys have tried the VA. But there's treatments that
Speaker 1: the VA doesn't typically provide, and but that they're out there.
Speaker 1: So say gang block therapy, that's one of the things
Speaker 1: I start with. Go get a steal gangly block therapy.
Speaker 1: It's a safe, one time medical procedure. We've been using
Speaker 1: it in medicine for over one hundred years. It's provided
Speaker 1: not by mental health professionals, but by psychiatry and neurology.
Speaker 1: It was a treatment for chronic headaches and certain types
Speaker 1: of headaches. But about ten fifteen years ago, a couple
Speaker 1: of neurologists at Fort Bragg working with soldiers noticed that
Speaker 1: when they treated a soldiers headache that their anxiety went
Speaker 1: down and they started to sleep better immediately, like that
Speaker 1: night or the next day. And so since then Sean
Speaker 1: mulvaney Jim Lynch have done some have done a number
Speaker 1: of randomized clinical control medical trials. Others have two and
Speaker 1: shown that it's a very effective treatment for reducing the
Speaker 1: anxiety and insomnia that goes along with PTSD, but general
Speaker 1: anxiety you know, as a rule, So this is a
Speaker 1: great place to start because it just brings the volume
Speaker 1: of that anxiety down. Now that isn't necessarily going to
Speaker 1: last forever. It's a treatment that involves injecting a little
Speaker 1: bit of lytocane or novacane into the stelic ganglian nerve.
Speaker 1: This can be accessed on the side of the neck.
Speaker 1: It goes down our central nervous system. It's the sympathetic
Speaker 1: nervous system, the fight or flight. So we're just we're
Speaker 1: just dialing it down. That's what the treatment does. This
Speaker 1: benefit lasts for anywhere from two months to over a year.
Speaker 1: Typically a lot of guys never even notice it when
Speaker 1: it wears off because they're doing other things that are
Speaker 1: really helpful. Ketamine infusion is a four to eight sessions
Speaker 1: of ketamine infusions are are very powerful treatment, and I
Speaker 1: and others have a hypothesis that combining the stelate and
Speaker 1: the ketamine in the same week or the same month,
Speaker 1: that they're symbiotic with each other. And we think they
Speaker 1: help not just with the anxiety and the depression and
Speaker 1: the know the mood and cognitive functioning, but that they
Speaker 1: help regenerate. They help stimulate nerve regeneration in the brain,
Speaker 1: so they're actually healing the brain. We are using very
Speaker 1: effectively a lot of regenerative medicine techniques. Now this is
Speaker 1: my thing, so I probably won't say too much about it,
Speaker 1: but the soldiers that we refer to some of these
Speaker 1: regenerative medicine clinics where they they use stem cells and
Speaker 1: exomes and peptides really reduce the chronic joint pain, which
Speaker 1: is a game changer. If you're living with chronic chronic
Speaker 1: joint pain all the time at a high level, to
Speaker 1: have that lifted off of you really profoundly changes your
Speaker 1: life for the better.
Speaker 2: And what are some have to sorry, because what are
Speaker 2: some of the entities that are working on this problem
Speaker 2: and that are trying to help operators who face the syndrome?
Speaker 1: Right? So I'm the one I work most closely with
Speaker 1: is the Seal Future Foundation. They have a program where
Speaker 1: any seal who's not no longer active duty can call
Speaker 1: and they're going to talk to another seal who's a
Speaker 1: former Corman medic combat metic and they'll have a long
Speaker 1: conversation and they'll talk with them about what's going on,
Speaker 1: what are your needs. They do use the Operator Syndrome framework.
Speaker 1: They one of the early things is hormones. So getting tested,
Speaker 1: getting a full panel of endocrine panel of to look
Speaker 1: at hormones, testosterone, estrogen, human growth hormone, thyroid and every
Speaker 1: single and the rest of them, and getting that treated
Speaker 1: early on is important. And that doesn't mean testosterone replacement
Speaker 1: therapy necessarily, but it does mean a number of things
Speaker 1: that can be targeted to improve the production of testosterone.
Speaker 1: And so seal future, we'll talk to the guy make
Speaker 1: the referrals and we've we've developed a large referral network
Speaker 1: and then they'll pay for it.
Speaker 2: And which is do you get into some more of
Speaker 2: this in the book Operator Syndrome.
Speaker 1: Oh yeah, oh yeah, yes, yeah, a little bit about that. Sure, yeah, yes, sure,
Speaker 1: thank you for asking. So the book has written for
Speaker 1: operators and for their spouses and their families. It's not
Speaker 1: an actdemic book. It's not a book I've written for
Speaker 1: other you know, desk jockeys like myself. It's written for
Speaker 1: the community. Each chapter in the book provides they're kind
Speaker 1: of like short magazine articles, so you can bounce around
Speaker 1: if depression is your primary issue, or addiction or existential issues, guilt, shame, loss,
Speaker 1: loss of tribe, Each chapter touches on one of the
Speaker 1: components of the syndrome, and there's there's treatment, there's then
Speaker 1: the third part of the book is about treatments and interventions,
Speaker 1: including lifestyle, because lifestyles are a big part of it. Well,
Speaker 1: you know, we need to change the way we eat
Speaker 1: and sleep, and health practices like cold plunge, hot sawna, bathing,
Speaker 1: those kinds of things can can make a profound difference.
Speaker 1: The other thing about my book, which I want to say,
Speaker 1: is I didn't write the whole book. I had a
Speaker 1: lot of help I was. I kind of went through
Speaker 1: it the other day. What I did is each chapter
Speaker 1: starts with two to five quotes from real people, operators
Speaker 1: and spouses. There are a handful of quotes from care
Speaker 1: providers or scientists who work with the community. So in
Speaker 1: the book are the voice of over forty operators are
Speaker 1: represented in there, and their names and their units, not
Speaker 1: their specific units, but the branches and the type of
Speaker 1: unit that they were in. So I wanted the book
Speaker 1: to be it's essentially an airport read for an operator
Speaker 1: can pick it up, read chapter one and be like, okay, wow,
Speaker 1: now I have a sense of some things, and I
Speaker 1: didn't know.
Speaker 2: Is it available on a specific website or just Amazon?
Speaker 2: And wherever books are sold? Where can people get it?
Speaker 1: Wherever books are sold? Amazon is it's on Amazon. The
Speaker 1: publisher's Ballast Books. You can go to their website. It's
Speaker 1: not released yet. It's coming out March twenty six. You
Speaker 1: can pre order it now, but it won't be released
Speaker 1: for another few weeks.
Speaker 2: Chris Free, thank you for your work, thanks for your
Speaker 2: time today, and for what you're doing for our warriors.
Speaker 2: We all appreciate what you're doing for them, and thank
Speaker 2: you very much, sir.
Speaker 1: Thank you Buck