Where Everyone Knows Bear's Name

As my health improves and my legal cases wind down, I’ve begun applying for post-lawyer and law-adjacent jobs. Recently a friend suggested I reach out to a local bar leader to chat about his experiences. Although we have mutual friends, I wrote in my introductory email that we hadn’t met.

He graciously invited me to lunch next week. But he disagreed with me:

“By the way, we have already met in Fairhaven. Your dog Bear and my dog have met at least.”

Everyone knows Bear. And Bear knows everyone – especially everyone who’s ever offered him a treat.

Bear’s ideal walk is a six mile “Grand Slam,” which involves three treats in Fairhaven, two along the Boardwalk, and four downtown. The newest addition to our route is the bank. Recently their security guard saw us in the parking lot and asked where we were going. I told him I was using the ATM after going across the street to the post office to get my mail and Bear’s treat. The guard told us our longtime Chase branch also has treats. Now Bear is a regular customer.

 

When the tellers first met him last month, Bear was still wearing a tee shirt to protect his bite wound. I got to tell everyone the story of how an unleashed bulldog named “Bubbles” almost killed Bear at Christmas. On our next visit to the bank, the goofy bro teller was the one who brought out the dog treat. He asked if my wife had been in a couple of days ago with Bear. He remembered a lot of the details about Bear and Bubbles. But he didn’t remember me. 

Most days our first stop is at Village Books in Fairhaven. As Bear lunged toward the front door yesterday, I heard a gentleman on the sidewalk with his golden retriever marvel “They let dogs into the bookstore?” 

 

Not only are dogs welcome in Village Books, but there are treats waiting behind each counter. Bear knows our rule – only one treat per establishment per walk. But he’s allowed to say hi and get backrubs from his friends at any counter. So Bear will try to get me distracted enough for him to bum an extra biscuit off some weak-willed bookseller.  

 

I heard the internal Village Book staff newsletter announced Bear had a haircut this week. Everyone is startled by the contrast. Yesterday a clerk at one of the counters leaned down to ask my dog if he wanted a treat. Then she saw me and realized it was a shorn Bear. 

 

At least she recognized me. But she only knows Bear’s name.

The best treats are at Chrysalis Inn, the biggest treats are at Rumors, and the most treats are at Village Books. But Bear would say the best company is at Acme Ice Cream. 

A sign on the door identifies Acme as “dog friendly.” The photo montage of canine regulars on the wall prominently features Bear. In addition to sharing waffle cone fragments and gourmet treats from Mud Bay, the ice cream scooping baristas have taught Bear to shake. On busy days, Bear charms new customers while patiently waiting in line. On quiet days, the ice cream scoopers and I socialize while Bear enjoys getting scratched. 

 

When Bear and I started our long daily walks during covid, the manager Maddie asked me to introduce myself. Since then every Acme employee has always greeted both Bear and me by name.

When Eleanor and Lynn had frequent braces appointments on the other side of downtown, Bear and I would often go on waterfront walks through Squalicum Harbor. There used to be a coffee shop in the marina with homemade dog treats. Whenever we’re in the neighborhood years later, Bear will drag me across acres of parking lots to see if this particular coffee shop has reopened.

 

The former coffee shop’s owner recently opened a pastry place downtown. Yesterday I went in to check out the wares, tying up Bear outside. The cashier looked out the window and exclaimed “I love Bear’s haircut!” She told me she knows Bear because she’s friends with one of the ice cream scoopers at Acme. 

The bank, post office, and gay bar are all closed on Saturday mornings, so Bear’s only treat option downtown is Avelino Coffeehouse. I go to Avelino for the exceptional baked goods and to show off Bear’s manners.

 

Yesterday a man with two canes ahead of us in line was invited to give Bear his treat at the counter. The man walked out beaming, and said “That made my day!”

I never tasted coffee until I was twenty-five. Now I’m a terrible coffee snob. In fact, since the Terminal Building burnt down in December, there’s only one place in Bellingham where I’ll order coffee.   

 

A couple of years ago Facebook kept sending me links to articles with headlines like “Best Coffee Shops in America!” that highlighted Bellingham’s Camber café. Eventually Bear and I passed Camber on one of our walks downtown. Here’s the sign next to the door:

We love dogs, we love your dog, however:  for health and safety reasons we must ask that you do not bring your dog past the front counter. The only exception is if they are a registered service animal with a vest.

 

Please wait outside with them and we will bring your drink out to you.

Everyone is very welcoming to Bear as we wait to be served at the counter. Then Bear and I go outside on the patio where I give him water and a treat from my backpack. 

 

I’m sure their dog treats would be delicious, but Camber doesn’t serve pets. Instead, Camber has amazing coffee. The ambiance is elegant yet comfortable. And they remember my drink. Last month the barista came outside and said “the order said an Americano with walking room and three shots, but I assumed it was a mistake and you wanted four.” 

 

Although I only visit Camber a couple of times a month, I’m always greeted by name. The last time I stopped by alone, the woman at the counter called me “Roger” and asked how “your dog” was doing. I’m sure all the baristas at Camber know Bear’s name. But they know I don’t need to hear it with my coffee.

Hopefully

Last year my one of my children told me they identified as nonbinary. I’m that kind of a father.

 

They also said “Rosalind” felt like “too girly” a name. So at school this year they went by the nickname “Lynn.” In the meantime, because they still haven’t picked a new permanent name, I have a free pass using “Rosalind” at home. (They said old people can only handle so much change.)

When I was looking at baby names long ago, “Rosalind” seemed like a name that said “strong woman” – with shout outs to Shakespeare and Auntie Mame. But I remember how uncomfortable my child felt sitting in the audience at As You Like It five years ago when everyone kept referring to the main character with their name. Of course, Rosalind cross dresses for most of the play....

I have seen anti-trans headlines many times before. 

 

As Co-Chair of the Federation of statewide LGBT advocacy organizations during the 1990s, I was among the voices loudly insisting on full inclusion for trans voices and trans issues in our advocacy. There will aways be whispered (and often shouted) temptations to leave some folks behind. Instead, I’m proud to have been part of welcoming communities and organizations for the last thirty years. 

Trans journalist Evan Urquhart recently published a chilling essay in Slate under the headline “Many Queers Can’t Bring Themselves to Face the Emotion They’re Really Feeling Right Now. We Must.” According to Urquhart, “the word for what we’re feeling right now is ‘despair’: 

 

I first had the idea to write a piece about despair more than a year ago. Let me leave you with the knowledge that none of this was unexpected. For many in the queer community, we’ve moved well past the point of fearing something might happen, and on to figuring out how we’re going live through this. Our despair is grounded in grim acceptance and practicality. We are learning that life goes on after you accept the fact that no help is coming, and you’ve been left alone to defy or defend or escape, or just bear witness.

 

It is 2023, and I weep to see children used as punching bags by evil politicians and the Republican Party. But I refuse to despair.

Fathers and Brothers

My brother Doug Leishman died on April 25, 2023 after enduring spine cancer for the last six years. Doug asked that each of his brothers speak at his memorial. This is what I shared at the Mormon church in Bellingham on May 16, 2023.

I’m grateful for this opportunity to meet together as Doug’s family and friends. Gatherings of our extended family always have one very obvious impact on me and many other Leishmans, including Doug. After listening to everyone’s stories, I forget how to pronounce my own last name. It will take several days to switch back from Lishman to Leashman.

 

Leishman is an ancient Scottish surname. It’s been pronounced the same way for hundreds of years, since before Shakespeare and the King James Bible. But our branch of the family met the Mormon missionaries in Scotland during the 1850s. They sailed across the ocean and walked across the prairie. When they reached Utah, Brigham Young sent them north to settle Wellsville, in Cache Valley. They became a peculiar people, and developed a peculiar dialect. “Roof” became “ruff.” “Creek” became “crick.” And “Leishman” became “Lishman.” That’s how my brothers and I grew up pronouncing our last name.

 

When I began my professional career, I made a conscious choice to introduce myself as “Roger Leishman.” Just like I don’t say “crick.” But we don’t make a big deal about pronunciation, and respond politely to anyone regardless of how they say our name. Except for “Leischman,” of course.

 

Like Doug, on days like today we are all “Lishmans.”

When Kyla posted the announcement on Facebook letting folks know Doug had died, I was moved by the outpouring of comments. Three or four repeated words stood out:  “Nerd.” “Smart.” And “funny.” I realized that’s what the comments would say for all four Leishman brothers.

 

Folks often remark on how much we resemble each other and both our parents, but they struggle to put their finger on the specific similarity. Folks would say we are even more similar in our personalities. Especially my sisters-in-law, and our children.

There are differences. Yes, we’re all nerds, but Doug is the Dungeons & Dragons nerd. We’re all funny – but Doug is the master of sarcasm.

On the wall at my parent’s house there is a framed series of pictures of the four Leishman Brothers. The same series of photos hangs on the wall in my living room. They were taken a few years ago near Lake Whatcom. It was the only time when the brothers, parents, and grandchildren were all in the same place at the same time. So we hired a photographer. 

 

There are four pictures in this series. In the first picture Roger, Doug, Brian, and Warren are all smiling appropriately for the camera.

 

In the second picture, Doug has a quiet grin. He is sticking his finger into Warren’s ear.

In the third picture, Warren has his finger in my ear, and everyone is grinning.

 

In the fourth picture, the brothers have all burst into laughter. 

 

If you look close, you can see differences between the Leishman Brothers. Warren went bald early. I’ll always be the oldest, and the gay one. And as Brian is quick to point out, he is the tallest brother.

 

A couple of months ago, I had the opportunity to drive to Kamloops with my parents. Doug looked about the same as the last time I’d visited:  lying in a hospital bed on his stomach in the corner of the living room, surrounded by his children and grandchildren. Before we drove back to Bellingham, I reached in for a goodbye hug. I was struck by how thick and curly Doug’s hair had gotten. And still so dark. 

 

Technically, I am now the least bald Leishman brother, and Warren is the least grey. But I think we should retire the hair titles with Doug as champion.

Gatherings like this are important because we can help each other remember the real Doug.

I often find it a challenge to recall stories from the past without a picture or something to remind me. Faces are especially hard. Last month when my parents called to let me know Doug had died, I lay in bed weeping because I couldn’t remember what Doug looked like before cancer.

 

Doug spent the last few years of his life being seen from a strange angle. Spine cancer prevented him from walking or lying on his back, so we only saw him lying on his stomach. That’s how I noticed his dark curly hair.

 

I knew if I got out of bed and walk into the living room, the pictures on the wall would help me remember laughing together with Doug. But I wanted to conjure the memories on my own. Eventually I was blessed to remember two images of the real Doug.

The first memory was from the spine floor at Vancouver General Hospital. A year and a half ago, Doug was paralyzed by a new tumor in his neck. He was airlifted from Kamloops to Vancouver, where two separate teams of surgeons worked from both front and back, removing the cancer and reconstructing his vertebrae. Doug spent the next hundred days at VGH.

 

I sing in Vancouver Men’s Chorus, which rehearses on Wednesday evenings. Each week I would drive up early and spend time in Doug’s room. He was propped up on his back in a hospital bed. It’s the only time in the last few years when I got to look Doug in the face. It also gave me the opportunity to sit down and spend hours talking with my brother, sometimes with other family and sometimes just the two of us.

 

We discussed our challenges living with cancer and with PTSD. But mostly I remember sitting together face to face with Doug, and talking about what it means to be a father.

Spine cancer targets the parts of the body that signal pain. In addition to dealing with Doug’s underlying symptoms, his healthcare team always focused on making him comfortable. Greedy pharmaceutical companies and irresponsible doctors have created the terrible opioid epidemic that is ravaging our communities. But modern opioids are also miracle drugs that make it possible to endure to the end.

 

While Doug was at Vancouver General, three separate teams were responsible for the opioids in his IV drip, his pillbox, and the little pump installed in his chest. I happened to be visiting the hospital when the pain management teams realized not only were they not communicating clearly with each other, but they were using three incompatible measurements to track dosages. One team would give Doug enough medicine for him to sit up all the way for a meal. After a few minutes they would have to crank the bed back down for him to rest, which would react with the medicine from the other teams. Sometimes Doug would overdose. And then they would start over.

 

While visiting the hospital, I also observed the laborious process of putting Doug in a wheelchair. I listened to presentations about grueling rehabilitation programs at inconveniently located facilities. 

 

After more than three months at VGH, Doug was finally stable enough to leave the spine floor and return home. When I visited Kamloops with my parents a few months later, there was no sign of the elaborate rehabilitation programs we’d heard about at the hospital. Instead, Doug used every ounce of his energy to spend as much time as possible with his family. His world was tiny:  a bed in a corner of a living room. But Doug’s world was as large as eternity because he was at the center of his family.

As I lay in bed last month grieving, I remembered a second image of Doug, from a couple of summers ago. It was the height of the pandemic. Nothing was harder for our family than the Canadian border being closed for the first time since the War of 1812. Doug was stuck in a bed in Kamloops, and my parents and I were stuck in the States. 

 

Like everything else, the Mormon temples closed. But by a miraculous convergence of circumstances, Katie and Christian were able to get married in my parents’ backyard in the strangest Mormon wedding ever. I will always remember the last time I ever saw Doug walking:  he staggered down the aisle, holding on to his daughter, the happiest man and the proudest father in the world.

 

Besides “nerd,” “smart,” and “funny,” the other words Doug’s friends repeatedly used to describe him on Facebook were “family” and “father.” Fatherhood is at the center of all my brother’s lives. That is the great gift our parents and now Doug and Kyla have given to each of the “Lishmans.” 

Church policies and meeting schedules come and go, but the fundamentals are eternal, like the familiar slogan “Families are forever.” I recognize “forever” is way too long for some families. But not for us. 

 

When I was young, the president of the church was David O. McKay. He delivered a similar message, but with more words in it:  “No other success can compensate for failure in the home.” (It was the Mad Man era – our ad slogans were longer than my kids’ generation, just like our attention spans.)

 

My brother Doug lived a successful life when it comes to what really matters. I hope we can all remember and be inspired by Doug’s example.

Douglas Todd Leishman

1967-2023

 

Let the World be Kind

The annual Sehome High School yearbook displays free “advertisements” where parents salute their graduating seniors with embarrassing baby pictures and a short message. My daughter Eleanor is on the yearbook staff. She chose our photos, nagged me about submitting my advertisements before the deadline, and lent me a couple of old yearbooks to see examples of previous contributions from parents.

 

“We are so proud of you” and “We love you” were the most common messages. Quotations came from Maya Angelou, Shel Silverstein, Led Zeppelin, John Quincy Adams, and the Old Testament. Several parents loved their children to the moon and back, while others chose to signal their affection with a dense forest of exclamation marks.

 

As a parent and a writer, I had two favorites. The first example was exquisitely succinct:  “Well done – the whole world awaits!” 

 

The second parental advertisement sent a different message: 

 

You came into our lives, and you’ve almost been a son to us. While you may not be our number one child, you at least rate in the top three. When you return home from receiving your diploma, your stuff will be packed up for you to take away to be someone else’s problem. Please don’t try to find us. 

Love, Mom and Dad

 

Here’s what I wrote to Eleanor in the Sehome High School yearbook:

 

You are messy, passionate, determined, curious, sensitive, creative, and kind – all mixed up and baked in a beautiful pie. You’ll be gone, but you’ll always be mine.

Love Papa

 

And my message to Rosalind:

 

You are completely yourself:  brave, loyal, artistic, and kind, with a unique sense of style. Raising you has been the greatest accomplishment of my life. I will always be proud to be your father.

Love Papa

I wrote Eleanor’s yearbook message first. It’s a shout out to Waitress, her favorite musical. Before covid, I took Eleanor to a performance of Waitress at the Queen Elizabeth Theatre in Vancouver. In “She Used to Be Mine,” our inconveniently pregnant waitress lets go of the person she hoped she would become. Like many of the parental advertisements in the yearbook, the song involves a series of revealing adjectives baked together. In Waitress, the list opens with “She is messy” – which happens to fit my daughter.

 

Songwriter Sara Bareilles told the New York Times “the chasm between who we are, and who we thought we would be, is always something we’re negotiating.” New York Magazine offers its “definitive ranking” of YouTube versions of the song. (Bareilles herself only reached Number 6.) For her high school performance competitions, Eleanor chose the accompanying monologue the waitress speaks to her unborn baby. 

 

Other than my decision to describe Eleanor as “creative” and Rosalind as “artistic,” by the time I finished writing my message to Rosalind I’d forgotten which adjectives I used for Eleanor besides “messy” (which Rosalind emphatically is not). After forwarding my messages to the yearbook editors, I was struck to see the repeated adjective in both descriptions:  “kind.” 

 

When Bareilles composed “She Used to be Mine,” “kind” provided a convenient near-rhyme for “mine.” In my yearbook messages, the unconscious repetition is a reminder that my second greatest accomplishment may be raising children who aren’t lawyers.

First year law students are taught to “think like a lawyer.” Legal scholar Anne-Marie Slaughter provides an excellent summary of the concept in “On Thinking Like a Lawyer,” a short essay addressed to new law students. The phrase means, “in the first instance, thinking with care and precision.” But “thinking like a lawyer also means that you can make arguments on any side of any question”:  

 

Many of you resist that teaching, thinking that we are stripping you of your personal principles and convictions, transforming you into a hired gun. On the contrary, learning how to make arguments on different sides of a question is learning that there are arguments on both sides, and learning how to hear them. That is the core of the liberal value of tolerance, but also the precondition for order in a society that chooses to engage in conflict with words rather than guns. It is our best hope for rational deliberation, for solving problems together not based on eradicating conflict, but for channeling it productively and cooperating where possible. 

 

Professor Slaughter ends her essay with optimism about the contribution that lawyers and legal thinking can make to society: 

 

One of my colleagues at Chicago ends her first year civil procedure class by saying: “Sometimes in the first year of law school, people learn to think like lawyers, but to be a little less like people. You’ve learned the first of those things. You shouldn’t let us teach you the second.” I disagree. There is no dichotomy here. Thinking like a lawyer is thinking like a human being, a human being who is tolerant, sophisticated, pragmatic, critical, and engaged. It means combining passion and principle, reason and judgment. 

 

I absorbed a similar idealism about the legal profession when I was at Yale Law School. For me, thinking like a Lawyer or like a Writer means using words to explore and share ideas with other people, including your future self. It turns out that’s the only way I can think clearly. 

 

However, in the last few years I’ve discovered that “thinking like a lawyer” is corrosive when an attorney’s duty to vigorously advocate for the client becomes an excuse to selfishly twist the truth beyond recognition. Since my PTSD diagnosis, I’ve completed an extensive reading list in psychology and neuroscience. In the field of evolutionary biology, “thinking like a lawyer” has a much darker meaning than the ideal celebrated in Professor Slaughter’s essay. 

Humans are profoundly social animals. In particular, we’re deeply concerned about social status within our tribe. Evolutionary psychologist Robert Wright argues consciousness arose in human brains not to promote effective decision making but rather for “image management” – the “hoarding of credit and sharing of blame.” Like Trump University, evolution taught us “shady accounting,” resulting in “a deep sense of justice slightly slanted toward the self.” 

As Wright puts it, the “human brain is, in large part, a machine for winning arguments.” Evolution could have designed us to prioritize finding the right answer. Instead, “like a lawyer, the human brain wants victory, not truth.”

Is selfishness a bug or a feature of humanity? Is kindness?

 

Many atypical traits persist in the gene pool despite their lack of any obvious benefit to survival and reproduction, such as homosexuality, left-handedness, introversion, blue eyes, schizophrenia, and country music. In his recent book Good Reasons for Bad Feelings: Insights from the Frontier of Evolutionary Psychiatry, neuroscientist and clinician Randolph Nesse examines how evolutionary processes can explain various quirks of the human brain, including the persistence and power of altruism: 

 

For most species, close social partners other than relatives are either nonexistent or nearly interchangeable. That was probably the case for our human ancestors until some tipping point in the past hundred thousand years, when selecting especially capable, generous partners began to give advantages. The benefits of having relationships with the best possible partners shaped tendencies to generosity and loyalty.... The resulting prosocial traits are as expensive and dramatic as a peacock’s tail.

 

Common decency makes civilization possible. But no community can be healthy when it reaches the opposite tipping point, with too many individuals defaulting to lawyerly selfishness. 

David Browning, one of the second tenors in Vancouver Men’s Chorus, is a talented singer-songwriter. (In real life he’s just a doctor.) This year David set himself the personal challenge of writing a Christmas song. As any musician besides Mariah Carey will attest, composing a catchy holiday pop song presents a daunting assignment. 

 

David did an excellent job, and VMC was proud to premiere “Merry Christmas” at our recent concerts. The song’s bridge ends with the lyric “Let the anger and the tension unwind – let the world be kind.”

As Bear and I were walking through Boulevard Park last month, we met a young woman who was making a documentary for a college class. She asked if she could film me with Bear as I answered a few questions. After pointing her iPhone at us, the student asked “Are you happy?” 

 

Life has been extra frustrating lately. My family and I are beset with mounting health, personal, financial, and legal challenges. The road ahead is uncertain and confusing. Nevertheless, I am enjoying the best mental health of my life, and The Kids Are Alright. I found myself answering “yes.”

 

After I responded to a few more questions, the student filmmaker asked if I had any concluding message. I said “Be kind. And you’ll be happy.” 

Merry Christmas

Relabeling

I met my best friend Paul in 1970 on the first day of Grade 1. Like my best friends in high school, college, and law school, Paul turned out to be gay. (Apparently I’m contagious.) 

 

Paul also turned out to be mentally ill. After struggling with depression, anxiety, and other challenges, Paul killed himself twenty years ago.

I thought of my friend Paul while reading the first chapter of Stephanie Foo’s recent memoir. A few months before he died, Paul told me he felt betrayed by his healthcare providers. While peeking at his medical charts, he discovered he had Borderline Personality Disorder, a bleak diagnosis that was even bleaker two decades ago. No one bothered to tell Paul, which made it even worse.

 

In What My Bones Know: A Memoir of Healing from Complex Trauma, Foo writes about growing up in San Jose with dysfunctional immigrant parents who subjected her to relentless physical and emotional abuse before abandoning her as a teenager. Foo escaped to college, found an effective therapist, and went on to a successful career in Bay Area public radio. Eventually Foo moved to New York to work as a producer at This American Life, the granddaddy of podcasts. 

 

Nevertheless, Foo found herself increasingly frustrated with challenges at work and in her relationships. At age thirty she was still seeing the same therapist, now via Zoom. Eventually she asked “Do you think I’m bipolar?”

 

Samantha actually laughs. “You are not bipolar. I am sure of it.” she says. And that’s when she asks, “Do you want to know your diagnosis?”

I don’t yell, “Lady, I've been seeing you for a fucking decade, yes I want to know my goddamn diagnosis,” because Samantha taught me about appropriate communication. Thanks, Samantha. Instead, I say, “Yes. Of course.”

Something in her jaw becomes determined, and her gaze is direct. “You have complex PTSD from your childhood, and it manifests as persistent depression and anxiety. There’s no way someone with your background couldn’t have it,” she says.

“Oh. Yeah, PTSD.” Post-traumatic stress disorder. I had a crappy childhood, so I kinda figured that.

“Not just PTSD. Complex PTSD. The difference between regular PTSD and complex PTSD is that traditional PTSD is often associated with a moment of trauma. Sufferers of complex PTSD have undergone continual abuse-trauma that has occurred over a long period of time, over the course of years. Child abuse is a common cause of complex PTSD,” she says. Then her eyes drift to the corner of the screen. “Oh—we're out of time! Let’s continue this next week.”

We’ve recognized for millennia that wartime trauma causes a predictable constellation of physical and mental symptoms. In the 4000-year old Epic of Gilgamesh, the warrior-hero experiences intrusive memories and nightmares after witnessing the death of his best friend. Greek historian Herodotus described an Athenian soldier who was stricken with blindness in 490 B.C. when he observed the death of a comrade at the battle of Marathon. After the Civil War, veterans developed “soldier’s heart.” The term “shell shock” first appeared in The Lancet in February 1915, six months after World War I began. 

 

Seven years ago I moved to Bellingham to accept a position with the Washington Attorney General’s Office as general counsel to Western Washington University. My dream job became a nightmare when I began exhibiting strange new symptoms, including bizarre anxiety tics and skewed personal interactions. I was shocked when my new Bellingham physician, Dr. Heuristic, diagnosed me with PTSD and serious codependency. 

 

As I told a friend who developed PTSD after serving as an Army Ranger medic in Afghanistan, I was sheepish about sharing the same DSM-5 category with someone like him. He told me not to be concerned, and that soldiers feel lucky they get so many folks’ respect. They worry instead about the many women and children who are scarred by the impact of earlier domestic abuse and do not have access to the help they need.

 

Or as Stephanie Foo writes:

 

It is a great, sexist irony that in our society, PTSD is generally considered a male condition. It is the warrior's disease, a blight of the mind that must be earned by time in battle, in some dangerous overseas desert or jungle. But the real statistics suggest the opposite: Women are more than twice as likely to have PTSD than men. Ten percent of women are expected to suffer from PTSD in their lifetimes, as opposed to just 4 percent of men. But even after #Me Too, a global movement to recognize the legitimacy of women's trauma, treatment for this trauma remains a half-assed endeavor, an afterthought in the shadow of the glory of war. And it has always been this way.

Actually, it usually has been even worse. 

 

Bessel van der Kolk is one of the world’s leading experts in trauma and its treatment. In his classic book The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, Dr. van der Kolk describes how both sides in World War I mistreated their traumatized soldiers. Depending on the whims of individual doctors, British servicemen originally would either get a diagnosis of “shell shock,” which entitled them to treatment and a disability pension, or “neurasthenia,” which got them nothing. Then in June 1917, the British General Staff issued an order stating “In no circumstances whatever will the expression ‘shell shock’ be used verbally or recorded in any regimental or other casualty report, or any hospital or other medical document.” According to Dr. van der Kolk, “The Germans were even more punitive and treated shell shock as a character defect, which they managed with a variety of painful treatments, including electroshock.” 

 

During World War II, my grandfather’s generation benefited from more humane leadership and more effective psychiatric treatments. They also had the benefit of fighting and winning a “good war,” followed by the GI Bill and fifty years of peace and prosperity. Meanwhile, individuals and society mostly repressed the lingering impact of wartime trauma. 

 

In contrast, Vietnam was a “bad” war in every way, which likely amplified its traumatic impact on American veterans. When Dr. van der Kolk began his medical career with the Veterans Administration during the 1970s, he was struck by the fact that all his psychiatric patients were “young, recently discharged Vietnam veterans,” even though the VA hospital was filled with aging WWII vets who were all being treated for purely “medical” complaints:  “My sense was that neither the doctors nor their patients wanted to revisit the war.”

 

In a sign of the times, the term “Post-Traumatic Stress Disorder” was coined in 1978. The diagnosis was added to the DSM-III in 1980, with criteria that continue to reflect its status as an event-based disorder.

Dr. van der Kolk is the founder of the Trauma Research Foundation and the National Child Traumatic Stress Network. Although his work began with Vietnam veterans, he quickly recognized trauma also affects other vulnerable populations. In particular, “child abuse and neglect is the single most preventable cause of mental illness, the single most common cause of drug and alcohol abuse, and a significant contributor to leading causes of death such as diabetes, heart disease, cancer, stroke, and suicide.”

As the Department of Veteran’s Affairs recognizes, “Many traumatic events (e.g., car accidents, natural disasters, etc.) are of time-limited duration. However, in some cases people experience chronic trauma that continues or repeats for months or years at a time.” In 1988, Dr. Judith Herman proposed a new diagnosis of “complex PTSD.” In addition to the symptoms associated with classic PTSD, complex PTSD includes: 

• Behavioral difficulties (e.g. impulsivity, aggressiveness, sexual acting out, alcohol/drug misuse and self-destructive behavior) 
• Emotional difficulties (e.g. affect lability, rage, depression and panic) 
• Cognitive difficulties (e.g. dissociation and pathological changes in personal identity) 
• Interpersonal difficulties (e.g. chaotic personal relationships) 
• Somatization (resulting in many visits to medical practitioners) 

Rather than a single traumatic event, complex PTSD is a consequence of ongoing trauma that occurs over an extended period, such as childhood abuse and neglect, domestic violence, and religious trauma. Because these types of experiences tend to involve betrayals by an individual’s most trusted authority figures, the resulting symptoms focus on impaired interpersonal relationships. Although the DSM-5 does not include diagnoses for complex PTSD or codependency, complex PTSD is already recognized by the Department of Veterans’ Affairs, the World Health Organization, and the British National Health Service.

 

Here is Stephanie Foo's reaction when she ended the Zoom call with her therapist and found the VA webpage after googling “complex PTSD”:

 

It is not so much a medical document as it is a biography of my life: The difficulty regulating my emotions. The tendency to overshare and trust the wrong people. The dismal self-loathing. The trouble I have maintaining relationships. The unhealthy relationship with my abuser. The tendency to be aggressive but unable to tolerate aggression from others. It’s all true. It’s all me. The more I read, the more every aspect of my personhood is reduced to deep diagnostic flaws. I hadn’t understood how far the disease had spread. How complete its takeover of my identity was. The things I want. The things I love. The way I speak. My passions, my fears, my zits, my eating habits, the amount of whiskey I drink, the way I listen, and the things I see. Everything—everything, all of it—is infected. My trauma is literally pumping through my blood, driving every decision in my brain.

 

It is this totality that leaves me frantic with grief. For years I’ve labored to build myself a new life, something very different from how I was raised. But now, all of a sudden, every conflict I’ve encountered, every loss, every failure and foible in my life, can be traced back to its root: me. I am far from normal. I am the common denominator in the tragedies of my life. I am a textbook case of mental illness. Well, this explains it all, I think. Of course I’ve been having trouble concentrating on my work. Of course so many people I've loved have left. Of course I was wrong to think I could walk into fancy institutions full of well-bred, well-educated people and succeed. Because the person with C-PTSD, the person who is painted here on the internet, is broken.         

Stephanie Foo’s bleak epiphany comes near the beginning of her story, which is subtitled “A Memoir of Healing from Complex Trauma.” Eventually she recognized her disability had clouded her vision, and learned that healing is “the opposite of the ambiguous dread: fullness.”

 

I am full of anger, pain, peace, love, of horrible shards and exquisite beauty, and the lifelong challenge will be to balance all of those things, while keeping them in the circle. Healing is never final. It is never perfection. But along with the losses are the triumphs. I accept the lifelong battle and its limitations now. Even though I must always carry the weight of grief on my back, I have become strong.

 

Foo’s “inner narrative” finally changed “from a hateful whip-bearing tyrant to a chill(er) surfer dude. Like love and bankruptcy, it happened slowly, then all at once.”

 

In many ways my journey through complex trauma and PTSD parallels Foo’s. Both of us escaped from our abusive origins by joining demanding professions – journalism and law – that turned out to be toxic. Yet we both found healing through writing, with the support of true friends and expert healthcare providers. 

 

Nevertheless, my experience with complex PTSD differs from Foo’s in important respects. Like so many other trauma victims, Foo’s symptoms are rooted in the pattern of abuse she suffered at the hands of her own family. I am an outlier because I was betrayed by a different kind of trusted authority figure – the Mormon priesthood leaders who told me homosexuality was a spiritual disease that could be “cured,” and who continue to deny the humanity and existence of LGBT individuals today. Fortunately, in contrast with most people who struggle with complex PTSD symptoms, I had and have the support of the best family in the world. But I also had the traumatic overlay of coming out of the closet at the height of the AIDS epidemic, when silence and rage both equaled death.

 

In contrast with Stephanie Foo, no one ever told me “There's no way someone could come from your background and not have complex PTSD.” Who can predict something like that? As every personal or global disaster demonstrates, individual responses to trauma will vary. What I do know is there’s no way someone could come through all this and not be a trauma survivor. If they weren’t survivors, they wouldn't have made it through – as so many of my tribe can attest. Those of us who remain.

The panel that made me weep the first time I saw the AIDS Memorial Quilt

My friend Paul’s anger at his healthcare providers probably contributed to his suicidal distress. Stephanie Foo reacted to her belatedly revealed diagnosis not only with rage, but also with resolve:

 

After I started realizing the magnitude of what having C-PTSD meant, I was livid at Samantha for not telling me about it sooner. This should not have been a secret, I thought. My diagnosis should have been a critical part of the conversation about my mental health this entire time.

 

So Foo fired her longtime therapist and began treatment with a New York psychiatrist who is one of the world’s experts in complex PTSD.

 

Why don’t I complain about my doctor’s original label for my disability seven years ago? Because he got it right. As I’ve reported from the beginning, after hearing about my symptoms and my background, Dr. Heuristic diagnosed me with “PTSD and serious codependency.” In addition to referring me to a therapist who specialized in treating PTSD, he also directed me to read Facing Codependency by Pia Mellody, and to attend weekly meetings sponsored by Codependents Anonymous (“CODA”). Because of my doctor’s experience with the recovery community, he recognized I would benefit from CODA’s group therapy model.

 

As the term is used by CODA, “codependency” refers to a pattern of deeply rooted compulsive behaviors that interfere with individuals’ ability to sustain healthy relationships, maintain functional boundaries, and express their reality appropriately. These are the same symptoms that distinguish complex PTSD from the “classic” PTSD diagnosis in the DSM. At the beginning of each CODA meeting, everyone recites the words “Many of us were raised in families where addictions existed - some of us were not.” I’m one of the “some of us.” It turns out being gay among the Mormons can be more harmful than growing up in a saloon.

Paul and Roger in Grade 4

Labels are not the patient. 

 

This year I’ve been reading through all of Oliver Sacks’ books. Dr. Sacks, a distinguished neurologist who died in 2015, was an extraordinary observer of the great diversity in human thinking. Most recently I finished his classic The Man Who Mistook His Wife for a Hat, a fascinating collection of case studies. In the introduction, Dr. Sacks writes that when he was a young medical student 

 

it was the patients I saw, their predicaments and their stories, that gripped my imagination, and these experiences imprinted themselves upon me indelibly. Lectures and textbooks, abstracted from living experience, left almost no impression. I was, however, strongly drawn to the case histories that abounded in the nineteenth-century medical literature-rich, detailed descriptions of patients with neurological or psychiatric problems. It is only by accumulating case histories of people with similar syndromes, comparing and contrasting them, that one can more fully understand the mechanisms involved and their resonances for an individual life….  With the rise of neuroscience and all its wonders, it is even more important now to preserve the personal narrative, to see every patient as a unique being with his own history and strategies for adapting and surviving. 

 

Since moving to Bellingham, my family has been blessed with exceptional caregivers. In particular, my physician has guided my recovery with insight and compassion. He immediately figured out my weird symptoms added up to Post-Traumatic Stress Disorder and codependency. He correctly diagnosed my tennis elbow and plantar fasciitis. He’s much nicer than Dr. House, the abrasive but insightful head of TV’s fictional “Department of Diagnostic Medicine.” He doesn’t laugh at my jokes about suing people for malpractice, but doctors never do. 

 

I originally gave my doctor his nickname because a “heuristic” is a simple procedure that our brains use to find quick answers to difficult questions. An expert’s various heuristics add up to an effective algorithm. Eventually I figured out my doctor’s heuristic for me. Whenever I show up with some new complaint, he will generally select from a repertoire of three standard responses:

1. It's just another typical PTSD symptom.
2. It’s a common side effect of my medications.
3. It’s what happens when we get older. (He calls these “barnacles.”)

Nevertheless, Dr. Heuristic isn’t trapped by diagnostic categories. He sees each patient as an individual. He’s the opposite of the lawyers that surround me, who are blinded by confirmation bias, and so in love with the sound of their own voices that they cannot hear my scratchy lament. Because my doctor pays attention, he can help his patients find the answers they need. Rather than “Dr. Heuristic,” perhaps a better label for my insightful physician would be “Dr. Epiphany.”