It’s All In Your Head

| August 27, 2023

This is one in a series of short discussions of the myriad ways our society in general, and the mental health field in particular, fail to understand the veteran culture. That there is a such a thing as a “Veteran Culture” as something unique is itself a hotly contested when not summarily dismissed concept.

One of the most satisfying things I get to experience as a therapist is hearing, “this is not what I expected in therapy. If I had known…” In that vein, I want to break the fourth wall and explain what actually happens, or at least is supposed to happen in therapy. This is the way I operate but what I do, my orientation of cognitive-based modalities, is the most common therapeutic orientation of therapists. Because it works.

When meeting a new client, I have a spiel. My concentration is trauma, and much of my caseload is veterans and first responders, populations not known for having a positive opinion of therapy. I’ve learned this opening is necessary to level the playing field, so to speak. Many therapists, even those with a cognitive orientation, usually begin with, “What brought you in?”

If I went to someone and they started with that inane question I’d probably walk out. My spiel lets those who, with justification, have a strong reluctance to engage in therapy get the lay of the land. Often, the only reason they are sitting in my office is the wheels have, or are about to, come off. So, my little speech is an introduction to how I view therapy, mental health and, well, life.

Right off the bat, I explain I have little to no information about them beyond “seeking help with stress” or whatever they said when they called for an appointment. This is only fair as they really don’t know anything about me either, and that can be daunting. I explain what my license, education and orientation are: I’m a Licensed Professional Counselor, my degree is Clinical Psychology, and I work from a very science and evidence based, cognitive orientation. I don’t use words like “mindfulness”, though we will do what that term is supposed to accomplish.

Then, we’re going over the limits of confidentiality, meaning harm to yourself or others, or abuse, neglect or harm to a vulnerable person, i.e., a child, the elderly or the disabled. Other than that, confidentiality is sacrosanct. Of course, I have a supervisor and someone owns and therefore oversees, to some extent, the group practice but the conversations I have with them are about professional development for me, gathering resources, etc.

I happily report I have never been forced to break confidentiality. If I ever do, it won’t mean I’m automatically calling 911 or that men with one-size-fits-all white jackets are coming to take you away. Then there’s a bit of business, like the no-show fee that is pretty steep, but with the caveat that I can waive it under special circumstances. I make it clear it is not about the money, it is about despite being part of a decent-sized practice, most of us have full caseloads. That means if you’re not going to use this hour, someone else who wants our services can’t either.

Then, my personal statements come. Such as, I am very direct and will challenge you. It is akin to physical therapy in that it is hard work. If it is not hard work, there is no point to it. It is neither bragging nor a false, smarmy fishing for compliments to say I am very good at what I do. I openly admit I can be off base, so feel free to call me on it and I’ll humbly take your criticism.

I thoroughly enjoy the reactions I get to one of my favorite lines, “If you are looking for someone to hold your hand, to make you feel all warm and fuzzy, get a lap dog.” Then, they tell me why they are sitting in my office.

Every person has a right to know what they are paying for, and to whom they are divulging the things that go bump in their mind’s night. In the last few minutes, we wrap up with what they can expect to happen and how.

I get right down to it by addressing the elephant in the room, the thing most are thinking and fearing but don’t say, “It’s all in my head”. Um, duh? Our brains are in our heads. Except for those special souls whose brains reside where the good Lord split them. Or other areas in that general region. But I digress. And no, I have not said that to a client. Not explicitly.

Mental health is all in your head, which is attached to your body. It’s biology. More accurately stated, it is neurology. Different people experience mental health discomfort primarily in one part of the body, the so-called somatic symptoms. Paying attention to where in your body you feel it first is an important conversation. Think of it like an engine warning light. Ignore it long enough and the vehicle stops functioning.

Having a bad day and your chest tightens? It gets hard to breathe? Your neck muscles tense? You grind your teeth? Or your stomach feels like it’s in knots, and sometimes those knots suddenly loosen and you’re doing the butt squeeze trot to the nearest, hopefully private, toilet? People are astounded to learn that the gut – the enteric nervous system – contains five times more neurons than the brain.

That said, it is actually all in your brain. That’s where thoughts come from. Think of a thought as a noun, a thing. It is not the sum total of you but it is a significant part of how you experience life. Thoughts influence emotions, which impact our behavior, which affect how we feel in our bodies, which create thoughts, etc., etc., etc. Each of these four parts influence the others, so adjusting any one means a change in the others.

By the time someone is sitting on my couch, and yes, I have a couch (actually a sofa) but also a nice, comfy Barca as well as a desk chair – sit wherever –, there is something going on in you that is not comfortable. So, if you want to start with thoughts or emotions, or you’re here because the ER doctor told you to come after the EKG said it’s not, thankfully, a heart attack, it’s your choice.

Where ever someone starts, the most common complaint is anxiety, usually expressed as thoughts that won’t stop, in dreams or while awake. So, we talk about how it is logical and expected to get anxious about being anxious and about how long-term anxiety exhausts us. That exhaustion combined with the anxiety is depressing to live with which makes us depressed about how we don’t have the energy to do the things we used to and anxious about the things we need to do … and now we’re spiraling.

In the most general terms, I explain that our actions and reactions, particularly the less than healthy ones, served a function at some point. That function was survival.

We say humans are creatures of habit. It may be better envisioned as our brain being a creature of habit serving the primary goal of all organisms, survival. When faced with a discomfort, a challenge, a danger or threat, the brain takes special note of whatever we did in response. The next time there is a discomfort, challenge, danger or threat, the brain says, “I know! I know! This is what to do!” And the brain is right, at least from a strict survival perspective. The proof is we are alive to face this new discomfort, challenge, danger or threat.

Each thought both forms and follows a neural pathway. Each time that neural pathway is used, it is reinforced. Before we know it we have entrenched patterns, most of which are well outside our awareness. But that doesn’t mean outside of our control. Because we can talk about, challenge, and rewrite the script that are the thoughts that influence emotions, which impact our behavior, which affect how we feel in our bodies, which strengthen or weaken those neural pathways. Talk therapy is the process of how we can alter those thoughts, even when those thoughts are the result of memories we’d rather not have.

Neural connections that are weakened and eventually no longer used are flushed away by the cerebrospinal fluid. That is literally it’s function. Sometimes, however, the system stops working. We have so much wadded up, it backs up and overflows the rim. Piles of anxiety. Liquescent depression. The lingering scent of nightmares that cling as intrusive thoughts.

Therapy is neural Draino. Sometimes a plunger or auger is needed as well. So, that’s me. That’s my job. I’m a brain plumber. Everyone needs a plumber once in a while. You hate having to call the plumber, but if you don’t, you will be clogged with crap.

If you are struggling, reach out to a buddy or call 988 and press 1 if you want to identify as a veteran. If you are not struggling, reach out and be the buddy to someone else.

Category: Mental Health

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For the past few days, it’s been a struggle at work. The retailer I work for is not a gun store, but we sell guns, and as essentially the ATF Compliance guy for the store as well as a staunch 2A advocate, I have to remind myself of this. As a career NCO, I’m used to researching regulations, and as a Criminal Justice major, I like to be familiar with the law, especially those that keep me out of prison. In other words, I want to see it in writing. So, when I’m being told by management that something I know is legal is a violation of the law, I take it personal. The bottom line doesn’t care about individual rights, but I do. Got it, you’re management, I’m an employee, and corporate policy is something I can adhere to, or I vacate this position. Federal law is different, and talking to me like I’m an idiot doesn’t fly. I want to hear it’s policy–not law–and I’m fine. I’ve made it clear that I’m not worried about the retail side of things…if a mistake is made, I’ll pay for it, get written up, and/or get fired. Not the end of the world.

One thing that separates us from lifelong civilians is the sense of humor and potential darkness that comes with years or decades of service. What’s considered off-limits to the average civilian is funny to those of us who ventured forth knowing we may never come home. My unique service saw me run the entire life cycle of veterans, from recruiting young men and women, to training them, to serving and leading them in combat, and finally to laying them to rest in Arlington.


It can be hard to explain the challenge of being required to work under rules that fundamentally violate your beliefs and what you know to be right…and those in charge have no understanding of why your beliefs are what they are. If can feel like you have to bare your soul to justify what you know is right. Express any of that with frustration and you’re the problem.


I’ll admit, I’m irascible much of the time. Fortunately, I work behind the scenes and am generally even-tempered, but when I go to do a final check on a 4473 or put out display guns, it’s like I’m a magnet. Civilians seem not to understand that the “sweaty guy hustling an holding an ID and paper or with 30 unsecure guns” isn’t exactly front-line gun counter person. I always get the, “Excuse me, are you helping someone?” Worse, it messes up the queue out there when I go out not knodwing who’s next.

There right, and then there’s right. I spent 21 years not necessarily agreeing with everything but carrying out lawful orders and generally sucking a life at times due to toxic leadership. My job pays me a fair wage and as a private company they can establish policies, like not honoring the Brady Law. As a 2A advocate, I don’t agree with that, but as an American I respect their right to make such a decision. Customers can shop elsewhere; as I previously stated, we sell guns but are not a gun store.

My beef is when people don’t research and just assume. Earlier this year we had a kid from New York buy a shotgun for a hunting trip down this way. I had off the next two days and my counterpart couldn’t wait to tell me we’d made an illegal transfer. No over-the-counter sales to New York residents…except, no. The kid had already gone hunting, then brought the shotgun back for a full refund when he was told we should have transferred it to him, effectively giving us a used gun and him a free loaner. He was from Long Island, not the City, so the transfer was fully legal and lack of knowledge coupled with management’s tendency to be scared of the ATF lost the store hundreds of dollars in profit from a $1500+ return.


“It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so.”

During my short but interesting career as a security guard I had a supervisor, a lieutenant (naturally) who claimed to be a former police officer, who told us to shoot anyone we saw climbing the fence around our post(s). I discreetly informed him that he was in error, and I guess he actually checked. A few days later he corrected himself.


My concentration is trauma

Well, we’ve got that in common!

“If you are looking for someone to hold your hand, to make you feel all warm and fuzzy, get a lap dog.”


If anyone out there is hurting, stop it. Do something about it.

My ex said something once that stuck (one and only time?), ‘If you had a broken leg you wouldn’t feel embarrassed or delay treatment’.

Depends how the incident happened, but point was taken.

Now, (as applicable) go get your asses plungeréd!


Roh-Dog, you made me laugh out loud, “plungeréd!”


You mean like this:


OAM, thank you so much for what you do! Having dealt with therapists that were not like you, it’s awesome to hear there’s some out there that get it.
Not many things turn a person off to therapy quicker than making the therapist cry (don’t ask how I know, just trust me)..
Obviously getting “tough guys” to admit they need help is a major problem, but having competent therapists is another huge part of the equation. So glad that there’s at least one. Keep up the good work!


Fyrfighter- trust me, there’s a lot more than one, even in liberal bastions like my state. I wrote this, in part, to help those seeking help understand what to look for in a therapist. If they seem like they’re going to coddle you, that may not be the most effective use of your time.


I deal with mentally ill people every day and have a very small amount training in it. Some things I have noticed though that seem to be pretty consistent are:

People have to really, really want help for therapy to work for it to work. That said I don’t know anyone that is mentally ill that wants to be that way. Trying to legislate or court orders treatment is seldom successful.

Mental illness becomes a self feeding monster that left untreated can suddenly, wildly spiral out of control.

There is a very strong correlation between substance abuse and many kinds of mental illnesses. Unfortunately our society often sees these as two separate things. They may be, but I doubt it.


As a former health professional with experience in mental health I find it a bit odd that you don’t mention alcohol or other drug abuse and the effects that it has on the overall psyche, living conditions, interactions with significant others, kids, relatives, law enforcement and life in general.
A lot of the things you describe are real and have a huge impact on the minds of other Veterans and cannot be fixed unless that condition is either stopped entirely or at least cut down to a manageable level, which is rare in most cases.
All of these items have a direct connection to a healthy spiritual condition. I am not talking about religion, worship or anything else except the ability to keep your internal emotions in a balanced field inside your body.
In my own experience, and I’m only cleared to tell my side of the story, I had a huge hole in my soul that I kept shoving sex, drugs and Rock and Roll into.
There is no doubt in my mind that alcohol and drug abuse was but a symptom of a deeper troubled spirit.
There are no panacea’s in this life, no matter who tells you there are, they lie out of either ignorance or arrogance.
Alcohol is used to cover up the emotions and no matter how long you overused ETOH, those emotions have to come out. When they do, it will be in a tsunami and you will be lucky to survive. Others around you may also be lucky to survive. So this is important…
Go easy on yourself, stop and enjoy the beauty that surrounds us, find your inner soul and let it breathe without limits.


I pray the Rosary, It is a twenty minute conversation with my Higher Power and always helps soothe my soul. Others meditate, and some just sit and fume.
If you know someone that is having a hard time, try your best, gently, to get them to open up. I’ve done that a couple times in my life with other Veterans and the result was one of the most rewarding experiences of my life.
When I go into any Veterans facility I remind myself just how much of an honor it is to be part of this brother/sisterhood.
Everybody at any Veterans facility has worked for the right to be there. We were cut down into a number and rebuilt into something that is a thousand times better than any of us could ever be on our own.


“As a former health professional with experience in mental health I find it a bit odd that you don’t mention alcohol or other drug abuse and the effects that it has on the overall psyche, living conditions, interactions with significant others, kids, relatives, law enforcement and life in general.”

I drink a fair amount. I also do a lot of self-reflecting; verbalizing my thoughts and opinions to and from work daily, as well as any other time I’m alone in my vehicle. Hell, I should stop paying for SiriusXM at this rate. Therapy comes in many forms, and I know alcohol is destructive and, frankly, that I have no excuse to imbibe when I know from experience that getting more active prevents me from drinking much, if at all. “At least it’s legal… but that’s just an enabling thought pattern.”

My brother and my best friend have both struggled with much harder substances for years. As you stated, it affects the psyche, interpersonal relationships, life, and creates legal issues. My friend just got arrested (again) earlier this month. He was doing alright and was nearly 3 years out from his last nearly four-year stint in prison. I knew it was a matter of time, though. He picked up nicotine lozenges and beer on his way home and was abusing his suboxone. He finally quit that and talked his doctor into putting him back on Adderall. Needed money, started selling his pills, and wanted the high, so he started meth. Same old tired story, over and over. Multiple baby mommas, doesn’t know his children, and his former wife is the mother of his former girlfriend. I knew something was up with his addiction to sex and drugs when he (at 28) started cheating on the then-19-year-old, breaking up a 30-year marriage to mess around with a woman 20 years older than him.


On the other hand, insisting that the individual recognize that alcohol is a problem and then solve that problem before engaging in any therapy doesn’t seem to be a very helpful approach to this particular layman.


timactual – thanks for this comment.
this is the two sides of an onoing debate in the field. Which comes first, the chicken or the egg? Hence the term “Dual-Diagnosis”, or “Comorbid”.

Personally, I do not require abstinence as a precursor. Harm reduction coupled with sufficient sobriety to effectively engage in therapy seems to be the way of the future, at least outside the VA and many other large behavioral health and substance use programs.

To me, it just makes sense. Substance use is frequently a coping mechanism, albeit not a particularly healthy one. So, let’s find other, more healthy and sustainable ways to maintain mental health so that substance use has a better chance of being given up. But this all also depends on the substance being used…some are simply so destructive they must cease to be able to address the mental health component.


Substance use, or abuse, is not just a coping mechanism. In the case of alcohol, it can also be a cultural trait(?) (also not a particularly healthy one) having nothing to do with coping. In the military, for instance, consumption of copious quantities of alcohol is (or was) SOP.
Just as a probably irrelevant aside, if you watch old movies from the 1940s or 1950s, drinking and smoking was fashionable, if not mandatory. One movie I remember had the characters light up a cigarette and order a drink (three fingers of neat whiskey, no Mojitos, Martinis, or other crap) every time they stopped moving. Of course there was no sex in the movies back then, so they had to do something.

And if the morbidity is the cause of the substance abuse,….


Getting into the heads of us d’weeded, miscreanted deplorables is a true danger zone, OAM. Tho you’ve probably already done that thru our comments. Traumatic thought on it’s own merits. Our saving grace is we know that you won’t lose that lovin’ feelin’ for us, ‘specially those that build temples along your path so that we can worship the ground you walk on. The trauma that you have gone thru is way yonder much more worse than anything many have felt and you will always be FIRST (ht2 CW) in our hearts. Your saving grace is that you understand we use our dark humor as a coping mechanism for our life experiences. Another of our coping mechanisms is what many of us learned in our military experience…ie…Did you survive? Screw it! Don’t mean nothing! Drive on! We are all better off by having you as part of the family.

Back in ’06 I was required to see a nervous doctor due to being accused, charged, arrested, and jailed for Felony Domestic Violence. People that knew me knew that was the last thing I would do. Didn’t matter, no reason, Company Policy, go or no job, effective immediately. The Doc was much like you, a very well preserved, mature, ginger haired lovely that after the 1st session stated that in her professional opinion, there was no way I did, or could do what I was (falsely) accused of. Made a deposition to the Company, the court, and my attorney to that effect. Didn’t matter to the company. A mandated 12 months of weekly sessions (they paid for it) even tho the charges were found to be baseless and eventually dropped. We spent the next sessions talking in general, she picking my brain for things I did to cope to help our other folks that really needed help. Good Times!

“What brought you in?” What I tell every doctor…


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Skivvy Stacker

The biggest irony of this lack of understanding, or accepting that there is a “Veteran Culture” is that it happens the most at VA Hospitals all over this country.
I don’t see a VA Shrink anymore. I get my meds from there. I still get my physicals there. But I’ll be damned if I ever go there for mental health again.
VAs are danger zones for veterans with MH problems. Hell, they’re danger zones for veterans who have been waiting, and waiting, and waiting for help and just happen to RAISE THEIR VOICE on a bad day. The Patient Behavior Committee can then Red Flag your records, and you wind up being searched for weapons every time you come in for an appointment, and be listed in a NATIONAL data base to all other federal buildings to let them know that you’ve been flagged, and require searching. I was on such a list for SIX YEARS. I’m terrified when I’m there that I might say the wrong thing and wind up on that list again. Kind of like calling out; “Hi, Jack!” at an airport.
And God forbid I make any dark humor comments, or tell any jokes I heard in the Marines….they’d lock me up in 1K (the Minneapolis VA Psych Ward).
Does that sound like a good place to go for mental health help?

Mike B

Had another NCO i worked for, set me up with Mental Health, when I started having issues at work. I was a newly promoted E-4 “Buck” Sergeant, so around late 1990, placed in charge of the hardest and most screwed up section in the shop. I had made “Outstanding Life Support Airman of the Year” for 22nd Air Force, but lost at MAJCOM level just prior to my promotion. I was second guessing every decision I made, waking up at night and making To Do lists, going back in on weekends to double check stuff and do paperwork, etc. So I see the Therapist, after our chat he tells to me walk around the block and clear my mind of everything and only think of walking. I do and come back in and he asks what I learned. Told him it was a big block. Makes me do it again, asks again and say still big block. Tells me to do it over the weekend and we’ll talk about it Monday. Then that weekend I figured it out. The more I thought about walking, the harder it was to walk. You measure your steps and make your stride too short or too long, etc. Same thing with breathing, these things are natural and you don’t have to think about doing them, you just do them. Monday I tell him what I learned. He tells me good, now quit thinking about doing your job, just do it, because if you over think it you miss up. You know your job, the AF trained you, your superiors think you are highly capable, which you proved by your selection for an Airman of the Year award. Plus a fellow NCO sent you to me, because she felt you were worth the help. So, go to work, do your job, clean house in your section and get it running right. That is why they put in there and what they expect of you. I remembered what the Doc taught me and what my dad thought me too for the rest of my career. Dad… Read more »


“…Not explicitly.”


Bravo! Really enjoyed your spiel. Wish I had read/heard it a few decades ago. You also make psychology sound almost interesting. 🙂