Navigating Through Smoke, Confusion, Avoidance and Fear (Part 1 of 3)

By Capt. Richard Stoltz, commanding officer, Naval Hospital Guantanamo Bay and commander, Joint Medical Group. Stoltz is a clinical psychologist who began his Navy career in 1986.

Capt. Richard Stoltz, commanding officer, Naval Hospital Guantanamo Bay and commander, Joint Medical Group

An Example From The Past

Two decades ago a senior military service member asked if I could hypnotize him to stop smoking. His wife and children were adamant that he stop and were growing increasingly impatient with him. He also wanted to stop and had previously tried other treatment methods but could not understand why they all failed.   

I agreed to help him and asked how he preferred to relax. He told me that he had a favorite place on the outer banks of North Carolina where he spent a few days almost every year.  He found those days along the Atlantic Ocean to be among the most relaxing days in his life. I requested that he describe the scene in detail and then asked him to consider closing his eyes and imagining himself sitting along the shoreline. 

 “While you are doing that, I will repeat details of that scene to you and ask you to tell me whatever it is that you are imagining with your eyes closed. And, then, when you are very comfortable and peaceful seeing yourself peering out over that inspirational shoreline at the outer banks and watching those waves so beautifully roll in and out, I’ll ask you to start walking along the shoreline at your own pace. Eventually, you’ll see a bend in the shoreline. When you take a turn around that bend, you’ll encounter something that will help you better understand what you need to do to stop smoking. And, when you do, we’ll talk about it.”

 The service member closed his eyes and imagined sitting on the shore.  As I described the details of the outer banks to him, he told me what he was seeing. I asked him to touch the sand with his fingers and watched as he dropped his right hand down toward the floor of my office.  I asked if he could feel the sand. “Yes,” he said.   

“Whenever you’re ready you can begin to walk along the shore.”

“I just stood up and started walking.” Eventually, he mentioned seeing a bend in the distance. Seconds later, he added, “I’m making the turn now.”

Suddenly, his head dropped and his lips parted. It was clear that he was stupefied by whatever he was seeing. After he stewed in a state of bewilderment for nearly a minute, I whispered, “Whenever you’re ready, you can tell me what you’re seeing.”

“I’m seeing myself,” he said.  “I’m smoking a cigarette and looking like a truck-drivin’, horse-gallopin’ kinda guy! I’ve got that rough and gruff look: black and red checkered shirt, cowboy hat and worn blue jeans. I look like I can fix anything and prevail over everything. I’m enjoying my smoke and feeling good and strong. I can’t give up being this way.”

“What you don’t want to give up is ____?” 

He shook his head several times before replying, “I can’t give up my masculinity.”

“But, you can stop smoking without giving up your manhood.”

“How?” he asked.

“Talk to the man who is smoking that cigarette,” I suggested. “Let him know that it is time to say goodbye, that all that masculinity and virility remains with you whether you smoke or not. Tell him that your wife wants the man you are without the smoke, without the cigarettes, without the ashes. Tell him that your children want a healthier, smoke-free father.  They don’t want to see you dying of lung cancer. Your wife is convinced that you will actually be more masculine and virile without that smoke taxing your breathing, without that smoke bringing disease to your body, without you wheezing just trying to climb the stairs. You are a stronger man without smoking, a better husband without smoking and a better father without inhaling black poison. And, as you say all this to this dying image of yourself, you will be more and more ready to let that false image go. You are becoming increasingly aware of how much that image has harmed your health and kept you from being as strong as you can become.”

The service member squirmed.

I continued, “Are you ready to say goodbye to that smoker, knowing you’re healthier and more potent without him?”

“Yes,” he replied.

“I would like you to consider turning that smoking man into a statue. Just take as much time as you need to let him turn into stone.”

“Can you see him now as a stone statue?”

“Yes,” he nodded.

“And now are you ready to turn that stone into sand?”

“Yes,” he nodded.

“Let me know when you see him as a sand statue?”

“He’s turning to sand now.”

“Now, let the waves of the ocean come closer and closer into the shore, as if it is now high tide, and let those waves begin to touch that sand statue, and slowly wash that sand out to sea.”

The patient was deeply absorbed and didn’t move a muscle.

“Can you see this happening?”

“Yes, the statue is going away.”

“It’s going far, far away out to sea and it will never come back together again,” I affirmed.

As far as I know, this man never smoked again. He had desperately wanted to stop but could not do it without help. He was not aware of the internal fears that prevented him from achieving what he so desperately wanted to accomplish.

A Complex Challenge Today

Today there are hundreds of thousands of American service members who return from deployments with confusion and fear that they do not fully understand. While deployed they witnessed gruesome events, such as the aftermath of IED explosions and the smoke and commotion of battle.  Once returned to the United States, many of them desperately want to sleep better at night but can’t. They long to feel more peaceful inside. They yearn to be better spouses, better parents but aren’t sure how to make that happen. They may notice an increase use of alcohol but have trouble cutting down. However, no matter what they do, they experience intrusive turmoil inside of themselves.   

Some of these service members may keep trying to convince themselves that their problem is not that serious so they do not seek professional assistance. Some seek some form of help but do not feel fully understood and are disappointed with the results. Since their efforts to address their confusion and anxiety are not successful, they more desperately search for ways to block and avoid their inner malaise. Avoidance may temporarily appear to work, but that relief is usually short lived and runs the risk of becoming self destructive. 

Regardless of their personal motivation or the amount of support they receive from their family and friends, they continue to feel uneasy and may engage in behavior disturbing to those around them. Just like the man who tried to stop smoking, they do not realize how their inner dynamics prevent them from healing. Nonetheless, just like that smoker, they might try several treatment methods before finding one that works. When they do, some have problems so complex and severe that even the best and most experienced providers have difficulty achieving positive results in a short period of time.       

Monumental efforts have been made to increase resources to help these service members.  Research on optimum ways to assist has greatly intensified; however, as a growing number experience repeated deployments during our nation’s longest war, the demand to provide more effective clinical interventions is increasing at an alarming rate. Failure to meet these treatment challenges will likely result in long term mental disabilities for many thousands of our nation’s heroes.

(Part 2 will run on Wednesday, Feb 22)