Up Close With Dr. E

Hidden trauma resurfaces


Like his father, and his father’s father before him, he had joined the Army to defend his country and take vengeance upon an enemy who had committed the atrocity of 9/11. He had survived two wars, Iraq and Afghanistan, where his boots had tread upon the rubble of ancient palaces whose alabaster columns, glowing glass domes and rainbow-colored stone mosaics, had once been the pride of Persia.

At night, he had fought in dark valleys. By day, he trudged through endless fields of poppies, whose crimson color was indistinguishable from the drops of blood shed by a wounded soldier. He had been lucky; he was returning home without a single scratch. His mind? Yes, horrific images haunted him. But he knew the best medicine would be to hold her in his arms — Amy. Perfect smile, silky raven hair, piercing blue sapphire eyes. His name was Joseph J. Jackson, and he was coming home.

Back home: Joe and Amy had grilled steaks for Joe’s parents and “Gramps,” his paternal grandfather. They sat outside, on his parent’s deck, under a star-studded night sky. After eating, his parents and Amy went in to do the dishes, leaving Joe and Gramps on the deck.

As twilight descended, lime-green lights flickered on and off. Fireflies, hundreds of them. Joe traveled back in time, when he was five. Gramps had helped him catch and place fireflies inside a glass jar. “Gramps, where do all the stars come from?” “Well Joey, in the same way a caterpillar changes into a butterfly, so too does a star begin its life as a tiny firefly.”

“But a newborn firefly is too weak to cast a steady light, so it pulses on and off. As it grows up, it keeps its light on forever. That’s when it departs earth and flies up to take its place in the constellations of our galaxy.”

“Gramps, what about Tommy, is he up there?” Holding back tears, Gramps replies, “Sure. See that bright star? That’s the North Star. Now count over three more stars. Tommy is there, on the URSA Major, the Big Bear.” “Wow, Tommy’s star is a bear.”

Back to the future: Seven years had passed since Joe returned home. The sign on his new Chevy truck read, “Jackson Construction Company, Father and Son.” Business was good. Joe and Amy had a son, Stephen, 5. But then, it all came crashing down: Gramps was hospitalized for a heart attack, Joe’s dad fell and broke a hip, the economy tanked. When it rains, it pours.

As Joe worked longer hours, he became irritable and moody. He began having nightmares and woke up early, around 3 a.m., without being able to fall back to sleep. Then, he stepped over the line. He was catching fireflies with his son, Steven, and putting them into a glass jar, when he took a cell phone call from the bank. Joe erupted into a rage, picked up the jar and smashed it on the driveway.

First office visit: Joe had been given a clean bill of health, medically, so Dr. Edlund reviewed Joe’s psychological tests. “You’ve got two separate problems: chronic insomnia and emotional trauma.”

Joe was stumped. “PTSD? I have post-traumatic stress disorder from the war?” “No, Joe, it’s not PTSD from the war, it’s an older trauma.” Amy took Joe’s hand and said, “tell the story.”

“It was my fifth birthday. Tommy had just gotten his driver’s license and planned to take me to the premier of the movie, Superman. But he worried that all the tickets would be sold out, so he drove to town, got two tickets, and on the way home he hit a patch of black ice, spun out, and his car flipped.” Dr. Edlund jumped in, “What was your very first thought after hearing that Tommy had died?” Joe closed his eyes and answered, “I believed it was my fault, that I had killed him.”

Conclusion: Joe will receive two separate treatments:

1. Trauma treatment. Tommy died when Joe was five. This meant he lacked the cognitive skills to explain the death in an objective way. That is why Joe made it personal, “I killed him.” By correcting Joe’s false belief, he will be able to grieve.

2. Insomnia treatment. Joe will be taught skills to regulate his sleep.

Until a few years ago, Joe would not have received both treatments. Why? Sleep problems used to be viewed as symptoms of another disorder. Sleep is now recognized as a powerful healing agent. Sleep disorders, such as insomnia, need to be aggressively treated.

The content of this article is for educational purposes only, and should not be used as a substitute for treatment by a professional. The characters in this story are not real. Names and details have been changed to protect confidentiality.


References: Morin and Espie, “Insomnia”, 2004.

Perlis, “Why Treat Insomnia?”, 2012

Edlund, Matt, “The Power of Rest”, 2010.


Dr. Richard Elghammer contributes his column each week to the Journal Review.