From Trauma To Triumph: The Crucial Role of Psychology in Military Leadership and PTSD Recovery 

Dan Joseph: I know guys who were homicidal when they got back. From Iraq because they saw so many brains. They saw so many dead bodies that what’s another dead body to them? And so when they were pushed against a wall, they contemplated murdering someone. Thankfully he didn’t. Um, My friend didn’t do that, but he thought about it and he realized like, holy smokes, I didn’t realize war had that big of an impact on me because it was work.

Bruce Bassi: Welcome to the Future Psychiatry Podcast, where we explore novel technology and new innovations in mental health. I’m your host, Dr. Bassi, an addiction physician and biomedical engineer. Today we have Dan Joseph. He’s a former combat engineer in the Army. He just got out last September.

He has his master’s in industrial and organizational psychology. He’s also the author of Backpack to rucksack insight into Leadership and Resilience by the military experts where he explores P T S D and life in the military and leadership roles. Dan, welcome. Appreciate you. 

Dan Joseph: Good to be here.

Bruce Bassi: So give us a little background.

How do you get here and these interests in I n O is probably easier to say psychology and this topic and this book.

Dan Joseph: So I served in the military for three and a half years. I basically worked with a lot of combat veterans, guys who’ve been to war. And I noticed, man I just noticed a lot of. The dynamics that they were balancing internally within their own mindset, the stress levels that they’ve had what they’ve endured.

I really looked up to these guys as they mentored me in the military. During my time in the lockdowns occurred when, the pandemic hit. And so there’s a lot of downtime as we’re trying to figure out the safety procedures. So I decided to sign up for an online master’s in in psychology because I felt as a leader in the military, It would really allow me to shape myself as a leader, invest in myself as a leader, and then the people that I’m around would benefit from that.

The organization overall would benefit if I were able to, to, to better understand almost at a, at a very objective level, what is good leadership? What is, a healthy mindset. There’s so many buzzwords in, in the world on What mental health could be, a lot of social media type presence and conversations about this stuff, but I don’t find a lot of people really delve into the publications and the contemporary research that’s going on.

Peer-reviewed journals, journals out there and whatnot. And through. Getting a master’s degree, I was able to dig up research and come up with my own assessments of what’s out there and apply that in real time in the military as I was around folks who were struggling with what they have experienced in, in, in war.

Bruce Bassi: Can you give us a case example of why psychology is helpful in a leadership role in the military in particular or in an industry? 

Dan Joseph: Basically a lot of this stuff started in Juujitsu for me. I had some experiences in childhood that at 30 years old were coming out on the mats. I was going through essentially a C P T S type situation where I’d have a freeze response, a major overwhelm, just a huge amount of fear and anxiety and whatnot.

And I was having to manage that. I realized that a lot of my ego defensive behaviors in life, a lot of self-medication addictive processes that I was managing from younger in life stemmed from early childhood trauma and in Jiujitsu that came out I, and it was very experiential. It was phenomenological.

I was just feeling these things in my body, not knowing what they were. I didn’t have vocabulary for it. Then I discovered the world of psychology. What that meant, how the body keeps the score, as Dr. VanDerKolk says. And I just could not stop researching and reading about this stuff. And what I realized is Jiujitsu forced me to experience some pretty dark chapters in my life.

And when I talked to some combat veterans in the, in, in the Army about what I was experiencing on the mats in jujitsu, Man, my, my buddy just started tearing up and I asked him like, what the heck’s going on? He said, everything you described about your body, about what you’re feeling in Juujitsu. I feel that when I think about Iraq, I think about that.

When I think about my friends who died and hearing their voices on the radio and spraying the blood out of Humvees. Seeing people, some people rise up and fight the enemy. Other people literally fall down in the fetal position while they’re taking fire. He saw this stuff as a young soldier, and I realized throughout this journey that a lot of my personal struggle.

It stems from ego, defensive behavior, it stems from fear. There is an answer to this stuff in science. We can look at the brain, how it’s hardwired, how the mechanics work, how the el electrophysiology of the brain works, which you’re, a lot about. And by bettering myself psychologically, I’m gonna create better mental health for those around me.

Better emotional health. I’m not gonna stress people out like I would if I was projecting or acting passive aggressively, or coming up with some sort of emotional knee jerk reaction about the past to people in the present. That’s basically what a flashback is. And so I think every leader needs to it’s like an oil change or maintenance on a vehicle.

We maintain our vehicles and our weapons in the military like religiously. Why wouldn’t we do that with our brains?

Bruce Bassi: Yeah, totally. And you hit right upon the. The difficulty and the damage That’s done from P T S D where it, you have the initial impact of that episode, but then you have the reliving of that episode of what your brain thinks is going through the episode over and over again.

Like you’re right back there. And 

Dan Joseph: brilliantly said what the brain thinks, right? Because it’s. The time it’s asynchronous. It’s not happening right now, but your body physiologically swears it’s happening right now. Gnarliest experience ever. It’s crazy. It’s crazy making when you don’t have the words to explain that, it 

Bruce Bassi: Yeah, I want to get t-shirts that, that say the amygdala doesn’t care ’cause I say that all the time. The amygdala doesn’t really care about what you think, where you 

Dan Joseph: Yes.

Bruce Bassi: are. It just cares about its own protective mechanism, 

Dan Joseph: Yep.

Bruce Bassi: so it wants to protect you and It’s doing a bad job at that because you’re already fine and protected, but it doesn’t care.

Dan Joseph: It’s a five alarm fire when there’s no smoke, man.

Bruce Bassi: Exactly. You just gotta wait for the frontal cortex to come back online and start to suppress the amygdala response. 

Dan Joseph: Yes. But what happens is when people don’t have that awareness and the positive feedback loop of cortisol dump, cortisol, dump adrenaline, cortisol, adrenaline, whatever’s going on, then all of a sudden, the heart’s palpitating, sweating, all of that, and just this the powerful primal response of that survivalistic mechanism.

I know guys who were homicidal when they got back. From Iraq because they saw so many brains. They saw so many dead bodies that what’s another dead body to them? And so when they were pushed against a wall, they contemplated murdering someone. Thankfully he didn’t. My friend didn’t do that, but he thought about it and he realized like, holy smokes, I didn’t realize war had that big of an impact on me because it was work.

To him over there. That was his job to see these things. And then he gets back to the states, and like you said, the amygdala doesn’t know, it doesn’t know what the war zone is, it doesn’t know a geopolitical boundary. So he’d get back here and some leader who had no idea what this young soldier was carrying in his soul.

All of a sudden pushed him against a wall, emotionally psychologically, right? So what’s he gonna do? He is gonna, what did he do with the enemy in a war zone? He pulled out his weapon and he fired back when he’s under attack. And his amygdala was telling him do exactly that, and he could have been jailed the rest of his life for a, an emotional reaction.

Not that it would’ve been justified, but, talking to him, he’s a dear friend of mine and I love this man. And he to know that Just that trauma man, that he was carrying it and he didn’t have the words for it. He didn’t know how to tell a psychologist this stuff. He didn’t know who to speak up to in his chain of command.

And you notice I just took a big breath there because I just remember seeing the weight talking about this stuff. And that’s no small thing to, to have someone confess that to you. , I still check on him today. I still do my check-ins with him and several other guys because.

It’s amazing the what they carry and what they may not have the language to discuss until they find someone that they trust, 

Bruce Bassi: , I wanna get to what suggestions you have for clinicians for helping treat individuals like that. But first I wanted to make a clarifying point to our listener. When you mention p t s and C P T S and you leave off the deed there, is that intentional? And what is the reasoning behind that?

Dan Joseph: I was educated by someone very recently. She told me to drop the D because it’s, she experiences it. A lot of her colleagues she helps people through yoga and she said it’s a sign of respect to veterans to drop the D because don’t tell them it’s a disorder. It’s, yeah, it’s, and I know words mean things that we always say that in the military and.

It’s weird ’cause I don’t religiously try to tell people to, to correct that, but, and sometimes I, I will say P T S D instead, but I noticed something clicked in my brain when I spoke with her and she said, P t s I felt all the judgment, leave the room. I felt that there was no stigma with it. Post-traumatic stress, not a disorder.

It’s not a disorder. Yes. The brain is disordered. Yes. It’s a maladaptive modification to the mind, or there’s maladaptive behaviors associated with it. We do things to compensate for it, but what she was teaching me was, don’t make people identify with a disorder. And I don’t know, it’s just it struck a chord with me because I’ve worked with soldiers who told me That they don’t wanna talk about their issues.

They don’t wanna talk about their suicidality. They they don’t wanna be looked at a certain way. They don’t want to be damaged goods. They don’t want to be broken and looked at as you have a disorder, you are the disorder. ’cause they internalize that identity. And so the journey here is how do we work with clinicians on getting these service members to understand this is about the mechanics of the brain.

This is about biological materials, biological, tissues in your body. It’s not who you are. You don’t have to identify as a crazy person, someone who’s losing their mind, emotionally, erratic, whatever it is. Your brain is simply trying to recalibrate. It’s trying to recenter itself. And so it just really impacted me when she said that.

And I still carry that forward, 

Bruce Bassi: Yeah. Yeah. Everything you said speaks to me as well. I think it should be very individualized because we, A lot of people have different opinions about that, and I know that when I. The diagnosis came out in 1980 and DSM three with P T S D, I think it provided a lot of legitimacy to what people were going through.

Also, standard help to standardize research and treatment plans. I. To figure out what was the best option for them. And I feel like a lot of people, veterans coming back from Vietnam at the time felt that they’re finally heard and recognized as having an issue that the medical community is validating.

1. Their experience. But I know that the word disorder, and I’ve also talked in my group therapy that I run about the word victim versus survivor also carries different meaning to people depending on where they are in that process of self discovery. And which one they identify with more.

So it really does depend on the person and What that person thinks of those words in terms of what they’ve heard about them and the stigma associated with them. But you’re right there, people are so much more than a label or a word, or a diagnosis, and it is important to not over identify that as the explanation for everything they do.

And I see that happen too. And I think that that allows the P T S D to grow in their life. And their identity, because they’re using it to explain a lot of irritable impulsivity that they have. Maybe that’s not directly always associated with the P T S D, but

it’s important to not overgeneralize and when we’re speaking, such as in a podcast, we use shortcuts sometimes, but I thank you for teaching me about that.

Drop the d. 

Dan Joseph: Yeah. Thanks.

Bruce Bassi: So what would you say to clinicians who maybe haven’t worked at a VA before? I’ve spent a total of four or five years in VAs working there, so I have a pretty good sense of the comradery that is in the program there. How, basically you have to know, you have to know more the language, the how people speak in terms of.

Their experience in combat and afterwards and recognize that P T S D or P T Ss is a, is an issue that a lot of individuals struggle with going through the va. But what would you say? 

Dan Joseph: So I can speak more to the active duty side and you can take from it what you will and see the kind of congruency there. But from my soldiers and the soldiers I’ve been around who experienced medical care psychological services, behavioral health and whatnot there’s a lot of brilliant resources out there and a lot of providers who genuinely care, but there’s Sometimes a soldier will feel like a number not a name, not a person, as if there’s a one size fit all or psychiatric medication that they’re supposed to take.

And perhaps they feel it, it’s not working, or there’s another medication that they prefer that they’ve taken in the past. And I talked to one soldier where the psychiatrist just said, no, you’re gonna take what I’m giving you and you’re gonna do it until it works. So the soldier stopped taking it because he said, I don’t feel well on it.

And you’re not looking at me, you’re not seeing me. 

And he was told, and I asked him, why do you think that is he? And he said, it’s ’cause of my rank. Nobody cares about my rank. And I’m too low ranking. And I was so oof, man. I, because I looked at my soldiers like they’re my kids.

Like they’re my brothers. I love ’em. And I got really upset when I heard that. and anyway so we try to make some changes. I’ve heard from other people that they don’t want to disclose to a stranger what they’ve done in combat, what they’ve seen in combat because They’re not gonna open up to a c clinician like they would to appear like to somebody they were in combat with or just somebody who understands. So I was able to talk To an individual who disclosed some stuff to me about what happened in war. And he told me, this is stuff my wife doesn’t know.

This is stuff my I’ve never told a therapist, I’ve never told my chain of command, never told another human. And he said, I felt like telling you because I opened, I shared about my craziness, my emotionality, my vulnerability. I was vulnerable about what happened to me in Juujitsu and stuff like that.

And He felt compelled to share some similar level of vulnerability with what he experienced. So what he said to me was, because I felt this connection with you, I didn’t feel that there would be judgment or repercussions or any sort of stigma that could affect my career or my life or my marriage, right?

So it’s a stranger on the train phenomenon where I’ve heard people will. Find a stranger on an airplane that they’re sitting next to, or, back in the day, a train when people took ’em and they would just completely divulge like the most intimate stuff about their life because they knew they’d never see this person again.

And we all need that catharsis. All this stuff stays locked in our body. These memories stay locked in our body. And I’ve heard of people getting massages or physical therapy where. They’ll just start weeping, absolutely weeping, and they don’t know why. And it’s because a memory was trapped in a certain part of their body, a trauma they experienced, and all of a sudden that, physician or clinician, whoever it was, touched that part of their body and they boom, just had this emotional dump.

 I think a lot of people are unaware of what they keep housed inside their body. It’s hard for clinicians to validate every single human being that walks in their office as if they’re best buddies. ’cause it’s artificial. It’s, it wouldn’t be authentic. And they just, the infrastructure isn’t built like that.

They, they, and the providers don’t have that emotional bandwidth to bond that deeply. It took so much out of me to talk to this guy and have him share what happened to him in combat. It affected both of us deeply, and it still does, so the how do we personalize care and let these service members know that they’re protected and they’re safe, but that they can trust the provider?

A lot don’t, a lot don’t trust providers. They don’t trust a lot of people, and sometimes it’s because they’ve seen things with leadership or with authority figures in the past. I don’t know the answer and I don’t want to act like I know the answer. I just want more discussion about it, 

Bruce Bassi: yeah. Yeah I do notice that the longer I spend with the patient to try to build that relationship, to build that trust, It’s a powerful thing for both myself and the patient because you do get to know them so incredibly well. I actually was an ER doctor previously prior to psychiatry.

I did psych research. Then I went to er, decided it wasn’t exactly what I wanted as a career path and went into psychiatry. And since psychiatry, you get these longitudinal relationships where you can really build on. That trust in opening up with that individual. And I think that goes a long way for, to feel heard and to start to build new me or new experiences where there are good clinicians out there who I can trust and open up to, and they’re not all the same.

And I shouldn’t treat them all the same.

Dan Joseph: One thing that’s important too on the clinician side, and I want to validate you guys for what you do, there’s burnout from providers, right? Look at Covid. Look how many doctors and nurses committed suicide. Providers aren’t this genie in a lamp that you can just rub and get what you want out of it.

I understand that, and I’m not saying soldiers look at ’em like that necessarily, but it’s important to care for both sides of the house. And this is why I wrote a book on leadership. Leadership is so complex because you gotta care for the people you lead. You have to care for your subordinates.

You gotta show love. They’re not, they’re human beings. These are men and women who are husbands and wives and daughters and sons and brothers and sisters. It’s not just, go do this. ’cause I said, go walk into that meek grinder and war and get shot and do what I, I wrote this cute little picture on the board, and you’re gonna carry that battle plan, right?

You gotta also, You gotta care for them and treat them as human beings. But then the leader also needs self-care, needs to decompress themselves, needs to emotionally vent and get those feelings out. And leadership is super stressful. In the military. We make, every training situation is like insane levels of just things not working out.

And logistics last minute getting changed if anyone knows what up. Frago is we get Frago left and right. So you plan your mission set, you’re gonna go do this, and this. Last minute, boom, change, boom, change. Everything changes. Where you’re gonna fuel up, where you’re gonna grab your food, where you’re gonna take your weapon systems, what grid coordinates you’re going to.

It gets wild, right? And so you’re dealing with all the stress as a leader. The service, the soldiers are all dealing with the stress. ’cause they’re the ones actually doing all the hard work and hard labor. So everyone’s stressed out. And so what I wrote this book about, And what I still struggle with is how do you care for people?

You lead care for the leaders and push each other to the point where you’re revving, your pistons are red hot, they’re just revving your amygdala’s fired up. You’re on fight or flight mode. You’re in this, mission set or whatever it is, the training environment. But then you throttle back, calm everything down, take care of each other, the same way we do it in, a battle training situation.

Is the same thing with clinicians and on the medical side, it’s universal. So you know the clinician’s gonna get revved up because they’re hearing all these stories and they’re exposed to all the trauma like secondhand from someone they’re talking to. They’ve gotta go vent, they’ve gotta decompress.

And if you have providers that are stuck on remote bases or it uncomfortable environments as well. They need self-care just as much as the service members do. It’s a holistic approach and I’m not trying to be too utopian or too, I’m not trying to romanticize or make it something it isn’t.

But I don’t know. It’s just so important to, to figure out how we can operate optimally here.

Bruce Bassi: Yeah. What is your mission now? Why did you write this book and what, where is your career going now? 

Dan Joseph: I wrote this book to not lose my mind. I had to decompress when I got out. I just needed to catalog examples of healthy leadership in a way that would allow me to, again, study the objectivity of what a good leader is, to know what I made mistakes about and what I did well. And so in this book I cite and reference peer reviewed journal publications.

In each chapter that correlate with neurophysiology, interpersonal dynamics, human psychology on all fronts. Just to better understand some situations that I found myself in. One of my soldiers survived his suicide attempt. He wrote the intro to the book. He’s still alive today. I still check on him.

He’s a good guy. And my other friend wrote the foreword to the book, and 13 men from his unit committed suicide after Afghanistan. I still check in on him because there’s been moments where he could have been number 14 and those numbers could still be rising. It was 12 when I wrote the book after I published the book.

Number 13 killed himself. 

Bruce Bassi: These are people’s lives at stake right now. They were at stake during the military and they’re also very much still at stake. 

Dan Joseph: it’s a four to one ratio for every person that died in Iraq and Afghanistan for committed suicide. It’s like we couldn’t find enough bad guys. On our level, so we’re killing ourselves. It just doesn’t, it’s a rotten situation. And again, I’ve seen the faces of these soldiers, right?

I’ve been in intimate situations with them. We’re in the field together, we’re living together. And I’m, I, I’m hearing their stories. And yeah, it’s, I’m trying not to get emotional right now, but it, it’s These are people, man. These are people who are struggling and the stuff that they carry that they don’t tell other people about is astounding.

I shared, 1% of in my book about some of the stories that my friend told me. And I, there’s a lot I didn’t feel comfortable, letting the world know, ’cause these are private stories from his life. He gave me permission to put what was in the book. But there’s a lot I did not wanna share.

And To know that he goes to sleep at night and relives those images, those very visceral images for him to have a leader in his life who sucks, who’s rude, who’s condescending, who’s completely invalidating of his existence and what this man carried in his life that’s not a healthy situation for anybody.

And how do you tell somebody, Hey, if you’re treating me like this, I’m in the middle of. Remembering a, the anniversary date of a buddy who died, who got blown up, who, I saw bleed out. And today of all days, do not push my buttons. They don’t necessarily have the words to say this stuff ’cause they’re just feeling it, right?

Their heart rate’s through the roof. And so what do they do? They self-medicate, they drink they do a lot of stuff. But, how are you gonna go up to an unhealthy leader, a toxic leader? Tell them like, dude, if you don’t back off, like fists are gonna fly, if not another level of violence, right?

 The self-medication is what, what sucks So many people have to drink themselves to sleep. And I’ve seen it, six, seven drinks before bed and I used to drink quite a bit, man, I used to black out a lot before I joined the army because I was self-medicating. I was dabbling in drugs, I was doing things to just numb out.

A revving amygdala. And now I understand. I don’t fault myself for it. You know, I talked to a therapist who told me, Hey th thank your addictions. Your addictions kept you alive. They could have killed you. There are multiple times I should have died. 

Bruce Bassi: It’s a good way of reframing it. 

Dan Joseph: Huge reframe. Beautiful word, man. Reframe is such a cool word.

Bruce Bassi: You’ve mentioned the topic of suicide is there anybody or anything you would wanna say to somebody out there who is thinking of that as a solution? I. 

Dan Joseph: Yes. So it is a permanent solution to a temporary problem, is what we would brief our soldiers. And here’s the thing about suicide. It makes sense when you’re trying to reboot the amygdala. ’cause I think what suicide is a reboot. It’s like control, alt, delete. You want to force the system to restart. But it’s an end, right?

It’s a permanent end. Piece people are crying out to, to just stop the revving, right? The revving thoughts, the hypervigilance situational awareness the ruminations in their minds, they’re just looking for a frigging moment to just not be maxed out on being on the edge of their seat in life. And so suicidality logically.

It’s, they’re crying out for a hard reset. From what I’ve researched, the a c h, and you can talk to me about this, if you believe this is true, that there’s a, the anterior cingulate in the brain, along with other components of the brain, help us understand time. Meaning what is a minute, what is a second?

What is a week when people are suicidal? There’s no blood flow to that part of the brain. Apparently in functional MRIs that show, what happens is these weeks I’ve been in the dark place, we think like this moment is forever. So a solution that is forever is an equal variable. They cancel out.

Correct. That’s the logic of suicide, if you will, neurologically speaking. But if you’re able to ground these people and get them back into their body, as they say, to breathe them back in, turn down the amygdala, turn up the prefrontal cortex, blood flow will come back to the interior singlet and these other components, and then they suddenly realize transient of time.

They’re aware this doesn’t last forever. Things suck this month, this day, this minute, but I’m not gonna kill myself because at some point this event will pass. What are your thoughts on that specifically? Like time sequence?

Bruce Bassi: Everything you’re saying makes total sense to me. Anatomically I can’t speak to that very well. But I think when people’s are in, people are in the darkest throes of their depression. You don’t really, I. Have a good sense of time whatsoever. It’s hard to even think about tomorrow. It’s hard to think about later today.

It’s hard to even get outta bed today. Right now you’re really just trying to think about what’s in front of you. And everything seems so dark that it, it’s a very hopeless state to be in. And so you, the problems ev you know, the problem solving mechanism of your brain, I would say is also altered where You’ve, you feel like everything is insurmountable. 

But if it was somebody else’s issue, you would tell them, this is what you have to do, X, Y, and Z. But your brain will fight back and say, I can’t do that. I don’t want to do that. It’s not even a, there’s no point in doing that, so I’m not gonna do that. So it’s a very difficult thing.

We, I do like that you touched on mindful meditation. It could stay grounded. I think there’s a really good apps out there for that. I personally like the Waking Up app. I have a subscription to that. I use it all the time. It’s very cerebral. It makes you think of mindfulness in a different way.

There’s tons of other lessons as well that’s not just progressive body relaxation. It’s talking about happiness and. Your perspective and reframing and a lot of other good, really thought provoking topics. So it’s a cool one. I like that one. But Yeah going back to depression, I think what you said is spot on. 

Dan Joseph: Yeah. One thing I wanted to talk to you about is microdosing. So I have some friends, some of ’em are active duty, so they’re not allowed to be on a podcast like this to discuss it, but they’re taking L s d mushrooms. So psilocybin ayahuasca. And some of ’em, have told me they’ve gone to funerals of their buddies who died in Afghanistan and Iraq.

Completely numb, completely. There’s my buddy laying in a coffin. Not that I don’t care. Can’t feel it like he was here yesterday. I don’t know. I guess he’s just not here anymore. And Not until they were able to basically do hallucinogens, were they able to access like a tremendous amount of grief?

I’m not a big fan because I have come from a past where I’ve seen what drug dependency does. I’ve had friends who have overdosed, I’ve had on different drugs. I’ve had a lot of college peers. Several, like I think over six die from different drugs. Different situations. Aspirating, overdosing after sobriety.

’cause of the system shock from it. Just a lot. So I’m not the most I’m not the most unbiased when discussing this, so I would rather do meditation. ’cause to me that’s like a slower buildup of how to deconstruct ego defensive mechanisms and get in touch with our feelings and do a body scan.

But the hallucinogens are just this full brunt force of impact of you’re gonna experience this trip. But I’m hearing more from actually from active duty service members that they’re taking on the weekends that a lot of ’em, ’cause it’s not as easily detectable on a drug test, they’re able to take hallucinogens.

So my question to you is, when it comes to microdosing coupled with therapy, Is there truly an opening to get people to discuss their emotional state and access things, having neuroplasticity to reconstruct these thoughts in their brain, at a proteomic level? Or is it because, is it a crutch?

That’s a stigma with drug use of any sort. But, and I don’t mean to be disrespectful to people who do this and believe in it, but What are your thoughts on that? And I don’t think the military would ever allow somebody, to take a drug like that when they’re active duty. Maybe the VA is gonna look into it.

I have a friend who’s part of a study right now for that. But yeah, I don’t know. My mind’s not made up. I need more research on that.

Bruce Bassi: Sure, I’m happy to give my opinion on that. I think whenever we as a public have new access to a new treatment option, there’s an embrace of that option and enthusiasm about that option. And I think historically this repeats itself with Prozac when it came out in the late seventies and with cannabis maybe in the 2010 when legalization started happening, people say, wow, I can get cannabis for treating my issues. And now we’re seeing this with ketamine and now the psilocybin trials. And there’s this new enthusiasm about them. And I think it’s important to be cautious and judicious whenever starting a new treatment option.

I’m always hesitant to give any sort of blanket. Recommendations don’t do this even for cannabis. If somebody is. Feeling like it’s helpful and we keep reevaluating that it stays helpful for them over time, then I think there’s a place for it for certain individuals. And I’ve also treated individuals who have addiction to cannabis and quite a heavy addiction at that.

So it is possible that I can turn from being helpful to being unhelpful, and that’s where having somebody who you trust, like a therapist who’s following you longitudinally, who can give you feedback as to how you’re using these. Substances. Because it is maybe the embrace is out of a point of desperation.

I want help. I don’t know what else I’m gonna do. And they’re saying, I can’t do this, I can’t do this, I can’t do this because I might get discharged from my unit or I, it’s gonna come up on a drug screen, so maybe this is a possibility for. Some help for me.

So I get that, and I think we need more research and we need to be talking about it more with other people and get their experience.

And I have patients who use them and I’m probably asking them more questions so I can understand where are they coming from? How is it working for them? Do they ever have a bad trip? Do they feel enthusiastic about where the treatment is going, if they’re gonna continue using it from here on.

So it really is a quite nuanced conversation that I have with people about their experiences with these things. And even the word microdosing, I think there’s probably a range there. How often are you microdosing and what number of milligrams are you doing? How are you inputting it into your body?

Because there’s different bioavailability there. So I would say if we’re going to have somebody do it, let’s do it really smart. Let’s make sure it’s the right.

product that you want and it’s vetted and tested that’s the product you’re actually getting, that there’s supervision to how you’re using it, that you’re using consistently.

And we know what we’re actually using it for, to target and to treat. And when we’re gonna stop using it, when is it going to be? How are we gonna recognize when it’s now an issue for us? 

Dan Joseph: Yes. Yeah. These are all great questions. And I was talking to a buddy of mine today in preparation for this podcast, who let me know about one of the, a couple of the trips he’s had. And essentially what happens is he is able to challenge his ego and deconstruct it, and he has to face it head on, is what he said.

And then there’s a moment where he says, as he the upward part of the slope is the grieving process, he’ll access the grief. He’ll sometimes be stuck in a gnarly flashback. Involving warfare or whatever it is that tr, created that trauma in his life. And then he’ll process it.

And then afterwards there’s this amazing, almost euphoric feeling, this, and it’s very experiential. It’s abstract, but it’s this concept of acceptance and love and belonging and his identity just seems so much more solid and robust. And I talked to him about, Why he does that and why not just meditation.

And he says he’ll use meditation as a way to prepare. It’s if you look at the hallucinogen as Mount Everest, like in order to get to Everest, you gotta have Sherpa, right? You gotta have counselors, you gotta have preparation, the right gear, the right time, the right place, all of that. You don’t just take it recreationally if you want that much of a.

Self-awareness to come out. Yeah, you can have this moment of clarity. I guess some people get, but he said it is dangerous ’cause he’s had some bad trips where he feels completely stuck in that flashback. But he comes out of it and he processed a lot of the feelings. So my hypothesis was that certain individuals can be.

Either too prideful or to, have too much of a facade of strength on the outside in order to deconstruct their own ego willingly. And so meditation is like disassembling a wall, brick by brick, an ego defensive wall, brick by brick. The hallucinogen is more of the psychedelic, I guess is more of A wrecking ball that comes in or a sledgehammer and just breaks the wall down in one fell swoop, right immediately.

And then they’re able to access some things. The only issue I have with that is that when you deconstruct it brick by brick, you’re able to throttle how deeply you’re gonna walk past wall, what you’re gonna look at. Understand the context of certain emotions and certain traumas and certain experiences.

It’s not always clean. There’s been times in therapy where I was, weeping and my entire shirt is just soaked in tears which is crazy to me. It was wild I was able to access some deep stuff. I felt super embarrassed and exposed. But with psychedelics, it seems like they’re able to get that instantaneously.

They don’t have to put in as much time, as much effort. It’s more of, let me take this drug. They feel it in their body, and all of a sudden they come out on the other side with some sort of awareness. As to who they are. And he says that some guys he knows broke out of addictions, like longstanding addictions with one trip, with one use of it on a macro dose.

But I again, I come from a past where I’ve seen drugs kill people, so I don’t, I’m very cautious on yeah, man, go grab some shrooms that are growing on Ong and I hope that it helps you with what you experienced in war. The one thing I’ll say is I, when I talked to one of my buddies about his experience in Iraq, he told me that for three days he had vivid, lucid nightmares, just like absolute nightmares.

And it exhausted him. And you know this from therapy, I’m sure people get exhausted from bringing up a single memory. Full body, fatigued. It feels like influenza, right? He felt like he had the flu for three days. And it was scary to me because I didn’t realize what I caused him. To have come up.

He wasn’t aware of that, so I kept tabs on him and he was fine. But it’s scary what can come up if someone’s not prepared for what they just accessed about themselves. Self-disclosure is a scary thing.

Bruce Bassi: I think you were mentioning that anecdote about your friend beating addiction through these experiences, and I think the holy grail in our field is to figure out what were the characteristics of that individual that primed him for that benefit from that experience, so that we can better identify, hey, patient X, Y, or Z, we know you have these.

Issues and characteristics based on the data and testing that we’ve done with you, that we think that this is probably a good recommendation because it’s worked for these other individuals with similar characteristics. 

Dan Joseph: Q and ai, right? To dig up those biomarkers and associate those. Look up those data sets. Find some correlative biomarkers.

We could talk about VR if you’d like. I know that was something you brought up. My question for you is that is when it comes to vr, how do you not overstimulate the service member on something they’ve experienced and then allow them to have the toolkit to throttle them, their nervous system back down?

Because again, when I talked to one of my buddies about, His combat tours, it caused him to rev pretty, his amygdala was fired up for quite a while. Does VR, because it is so immersive, have that threat that danger side effect of overstimulating the amygdala and leaving it revving ’cause they couldn’t tell the difference between reality and what was virtual.

Bruce Bassi: Yeah, no, that’s a great question. I don’t think people should be scared of it for that reason. In fact, I think the fact that he had that experience is almost like a very powerful thing that he was able to immerse himself in that system and have that experience. I think it was just mis titrated.

One of the good advantages of using VR versus an in vivo exposure to treat O C D or P T S D is that you can adjust all of the elements. How close are you to the ledge? How loud is the gunfire? What, where where are these other elements in relation to you? 

Dan Joseph: So you’re saying you would bring a service member back to a combat environment? Let’s say my buddy almost lost his life to an i e D and had guys die in that i e d the VR experience would bring him back to a convoy movement where he’s driving on a road with a potential i e d that’s just, you wouldn’t expose him to that.

Bruce Bassi: You wouldn’t do that. It’s definitely not right away. And. If you do that eventually, it has to be very well thought out. I don’t think that’s the the norm. But essentially you’re reprocessing with L S D, with psilocybin, with E M D R, with brain spotting.

You’re reprocessing and reframing, 

Dan Joseph: Yes.

Bruce Bassi: VR is working appropriately, One could imagine you could be in the throes of some sort of environment similar to that and have it not be affecting you as much because you’ve already sequentially got there. That’s like how

Dan Joseph: Exposure therapy. 

Bruce Bassi: Exposure therapy.

works.

You don’t jump somebody right into the deep end. You go there so gradually and you try to get to a maybe 50 to 70% suds is the subjective units of distress. Per episode per exposure. And then you keep working through that. So if you’re at a 

Dan Joseph: do have a metric. 

Bruce Bassi: yeah you and the individual will come up with a stratum of what is on your extreme end and what is on your other extreme end. 

Dan Joseph: Yeah, the biggest thing I would say, I. Especially, and again, ’cause we’re talking VA versus active duty. On the active duty side, if a service member were to experience this and have to go back to work and have to go back to leading soldiers and have to get back in uniform, it’s like his mind’s gonna be revving about what you just experienced in that vr, right?

So that’s why I’m thinking give him time to decompress, give him the resources, that’s a 

Bruce Bassi: after maybe 15th session, 20th session. You would be doing all of the very safe environments to begin with. 

Dan Joseph: Cool. Yeah, that’s something I’ll look into. And yeah, I just, again, my, my, my mind was blown at how much people are carrying how many memories that they’re, and again, self-disclosure, they’re not fully aware of themselves. Because they don’t talk about it. So when it comes back up, it, it comes back associated with a lot of emotions that they may have forgotten about and stored really deeply down.

So that’s, I’m very sensitive to that because I’ve seen what happens when somebody’s just boom in the middle of a flashback and I gotta give this guy a minute. He’s in it right now. We’ll come back to what we were talking about later. 

Bruce Bassi: Then you can immediately switch the VR experience to something, their protective, safe space, get them to come back down, Anchor them. back down. Yep. Exactly. 

Dan Joseph: Cool.

Bruce Bassi: What challenges would you say lie ahead for you in your in your work?

Dan Joseph: Yeah right now I’m in the middle of. Actually reevaluating some military contracts. I do want to get back in some capacity. I don’t think I’ve I fully satisfied my itch to, to mentor and lead. Especially now that I wrote the book and process some stuff. I feel like there’s more I want to give back.

So yeah, so some training. I’m training for some stuff right now. But What’s ahead? I’d like to write another book on physical fitness and mental health. For those who, I’m 36 and I’m in the best shape of my life, thankfully, but I’ve served with a lot of people and know a lot of black belts and juujitsu just these amazing bad asses who have permanently broken bodies because they weren’t aware of their pain and their injuries, right?

Because they were so disconnected, so dissociated. That they worked through an injury or pain and now they permanently lost range of mobility. So I’d like to write a book on mindfulness and awareness of the body, but also I don’t wanna say elite fitness performance ’cause I’m not an elite athlete.

I’m just a dude, but I. To write about how do we push ourselves to way well past our normative, thresholds where our limits, but taking in consideration, longevity of our ligaments, cartilage, tendons. So I’m currently working on that. But I’m still dealing with the discomfort of talking about my book about sharing all this stuff because it’s, I’ve been told to like up my marketing game and get the word out.

But it’s hard when you’re marketing somebody’s trauma and people, things that have made people hurt. So I’m need to just get over whatever self-limiting capacity is stopping me from putting the word out. Reaching out to you is, it’s an amazing experience because, These service members that shared their stories with me, they want me to talk to folks like you about what they experienced.

So I want to carry that forward. The biggest challenge for me is how to do it in a way where it’s effective and it creates discussion and it doesn’t feel forced or, inauthentic. So that’s, I’m trying to work through that for 

Bruce Bassi: Yeah that’s interesting. Really cool. And congratulations on deciding to write another book. I think it, it’s it benefits an invisible number of people, and I think the same with this podcast. And it’s a little different from being a clinician where I see how people are affected by my words and whatnot right in front of me, and I can adapt to how they’re taking things.

But I, you gotta just keep going when you can’t really see the people who are out there benefiting. From this stuff, they may not reach out to you and say, Hey, your words really meant a lot to me because I felt so alone. And I thought that nobody else experienced what I was going through. But that book was really important to me at, et cetera, et cetera.

Dan Joseph: Yeah, it’s cool. I know I felt that when I read people’s books for sure. I, like I told you before we started recording, I’ve consumed, if you consider audio books, by the way, about 450 books. A lot of them on human psychology. And I know again when authors would give me the language to discuss a feeling state, I felt so grateful.

I’m like, that’s what it is. I’m not insane. I’m reacting biologically to an environmental stimuli. And this is the exact mechanism that the precision of that was so cool to know exact ’cause. Then I could predict my behavior, I could predict other people’s behaviors. And it normalized it, it made it feel human.

It’s part of the human experience. And yeah, it’s cool to help give that. I’ve received some positive comments about the book for sure. And that touches me. It’s really cool because that’s what I want people to. To reintegrate themselves, their ideas, their experiences, their thoughts, their identity.

’cause I was able to do that and I’m still working on it. I’m still a huge work in progress. It’s nice to give 

Bruce Bassi: trying your best. You’re trying your hardest. Do you have any advice for people who are thinking about innovating in this space, working with veterans on P T S D maybe to those engineers or clinicians other innovators who are thinking about launching a product or doing a startup, something like that.

Dan Joseph: Yeah, sure. Hire veterans, hire people. Get, have an intimate connection with service members. Intimate, be real with them. Have a liaison. Have someone in your company who has access. To these, their experiences and their thoughts on a very deeply personal level and harness that to market and to create a meaningful product.

But do it with transparency, do it respectfully, talking to a service member about them willing to lay down their lives in combat. Coming back to a life of disarray on the state side and dealing with divorce and dealing with domestic, disputes and violence and so much, self-medication.

That, it’s a messy process. And so to be respectful with that is, is hugely important. So when building a product it’s not like buying a phone or a clothing or something. These are people’s lives, right? To make sure it’s respectful, it’s personalized to them that they feel seen and heard and definitely differentiate the combat veterans, if you can, from other veterans.

I know that there’s, there is a hierarchy that, that is created. There are different levels of Experiences in the military that needs to be understood. And a lot of this stuff seems fairly esoteric if you’re outside of the community. And the biggest thing you could do for these folks, these men and women, is make sure they’re validated.

Make sure that they’re validated by whatever you’re creating and your mission and your message. That’s very important to veterans.

Bruce Bassi: Keeping in line with the theme of the podcast future of Psychiatry, do you have any thoughts on any new and novel treatments treatment ideas out there? That excite you, that you feel like personally have a lot of hope in using them to treat P T S D?

Dan Joseph: Honestly, I think the biggest treatment is. Proactive preventative measures and discussion. I think that’s the biggest thing is education on the subject matter. If we’re talking about what can be prescribed, I think microdosing is from what I understand, could have a lot of benefits.

I need to learn more about it, to trust it. But it’d be interesting to see what therapy does in conjunction with psychoactive drugs. Because my philosophy is give people the tools to help themselves, right? Don’t keep them stuck on something that they don’t need to be, they don’t need to be dependent on.

And I know that a lot of veterans and service members feel as if they are being over-prescribed medication. Others feel like they’re not being prescribed the right medication. So there’s multiple perspectives to balance out here. So if there’s, I guess the most exciting part would be personalization.

So medication, if that needs to be administered, but in a way where people can feel they can, they’re allowed to converse about their experiences on it, that they feel heard. Because oftentimes, like I said, they’ll take something, they won’t like it. But they’ll be told, just keep taking it until it works.

And this isn’t up for discussion, you’re just gonna take the medication. So if there’s a way. To give them a voice while they’re experiencing their medication is really important. ’cause again, the biggest thing to stop suicide is give people a voice like, As soon as possible, as proactively and preventatively as possible.

Not until it builds up, not until the amygdala is just stacked with this overload of data and information and experience, right to give them that release valve to let this stuff out. I know I’m rambling right now, but if there’s a way to combine that, so the talk therapy C B T, whatever it is, With psychoactive medication if that’s necessary, and that’s, if that’s appropriate.

But to make this about the service member, not about the standardization of what should work. I, it’s, more than I do about the ins and outs of that. But yeah, giving them a voice through their medical care.

Bruce Bassi: Yeah. Thank you. I appreciate that. I also wanted to, Let me ask a lead in question about the VR thing. I think we just jumped right into it, and I don’t know if it would come out smoothly in the podcast. And in terms of other future treatment ideas VR is a big opportunity for a lot of individuals.

Another, it’s probably another space and similar to psychedelics that really doesn’t have a whole lot of research on, and maybe people fear. Do you have any experience with using VR for P T S D or do you know of any areas or institutions or industries that, that use VR for treating the issues that you’re talking about? 

Dan Joseph: So I know that there’s a study here in San Diego for those with concussions to is it, I think it’s concussions as well as P T S D. There might be two different studies using vr to help them work through those issues. I. Yeah, I haven’t been, I haven’t participated in that study personally.

There’s been other studies I’ve participated in, but not that one. So I know it’s up and coming and it’d be interesting to see the results of that. But again I think it’s just really important to, to throttle it and understand. Yeah. How are you gonna program all these individual experiences?

That’s my question. 

It’s ’cause it’s not a one size fits all, but it’d be very intriguing to see how each person receives their own specific visualization technique in vr and also how that would compare to meditation and to visualization and say like a sensory deprivation tank. I’d wonder the diff the variances and that amount of stimulation on the brain and what’s the least stressful and what has the most beneficial impact.

Bruce Bassi: Interesting. I appreciate that. Dan Joseph, I appreciate you. You’re the author of Backpack to Rucksack 

Dan Joseph: Yeah, I do have a copy of it.

Bruce Bassi: Can you show the audience? Oh, beautiful. Nice backpack to rucksack insight into leadership and resilience by military experts and. It was really nice having you on the show and talking to you about all of these insights new treatment ideas and your thoughts on P t SS D and leadership.

And we mentioned some pretty intense topics on the topic of suicide. So if any anybody in the audience has has any thoughts like that or any of these topics had triggered you, please feel free to reach out to the suicide hotlines. Available in the description of the video and just remind yourself that suicide is never a solution to what you’re going through at that time. 

Dan Joseph: Thanks, doc. Appreciate it.

If anybody wants to check out some of the stuff I’m working on or see my podcast that I’ve been on like these, I’m cataloging them on my website, combatpsych.com. And I just appreciate all the service members and veterans who’ve allowed me to share their story. I. Who’ve mentored me, who’ve guided me.

This is for you, so feel free to coach me up on what I could do better, but just trying to create discussion. And I appreciate anybody who’s willing to be a part of it. And you, doc, thank you for being a part of it.

Bruce Bassi: I love that collaborative statement you made there about, saying, I’m trying to give everything I have to this, but also teach me, I, there’s always more to learn and that’s the same approach that I have too. So I appreciate our alignment and philosophy there. And thank you for being on the show. 

Dan Joseph: Thank you.