Virginia Eubanks—Lessons on Love, Care, and Survival

And in fact, a 2015 study found that 60 days after a loved one enters the ICU, 23% of their um primary caregivers met the clinical criteria for post-traumatic stress disorder. Um and the researchers um finished talking about this work by saying that caring for a loved one in the ICU is the psychological equivalent of enduring and surviving an earthquake. Good evening and thank you for joining us tonight. My name is Henry Wheeler and on behalf of Harvard Bookstore, I'm thrilled to welcome you to tonight's event with Virginia Eubanks discussing her new book, A Guide to Open Water Life Saving. Virginia Eubanks is an investigative journalist whose work has appeared in the New York Times magazine, Harper's, The Guardian, Nature, and Scientific American. She is the author of Automating Inequality: How High-Tech Tools Profile Police and Punish the Poor. She is an associate professor of political science at the University at Albany State University of New York. Her new memoir is the story of her efforts to survive caregiving, trauma, love, and the systems seemingly set up to fail us. After her beloved partner is brutally beaten just steps from their house, they face a cascade of setbacks and Eubanks develops what is known as collateral PTSD. Common among caregivers, but rarely discussed. She turned to reliable sources to figure out how to heal. But it wasn't until she happened on an old life-saving manual that she found advice that actually helped. A guide to open water life-saving challenges readers to reconsider the networks of care that sustain our lives, reminding us that no one survives the wilderness alone. Please join me in welcoming Virginia Up you. So in 2015, my beloved partner of more than a decade, Jay, was the victim of two really violent um quite brutal attacks. The first one was in October, was just about a block and a half away from our home. And um that week in October, I was called in um literally from the woods um where I was at a writing residency working on what would become my last book, Automating Inequality, um into a new life as the primary member of a care team for someone who had quite severe and chronic post-traumatic stress disorder. And I just want to give you a sense of what that calling in felt like um and uh to me as a caregiver. So the first short scene that I'm going to read is um after Jay was attacked the first time we had to wait about two and a half weeks for the swelling to go down enough for him to get surgery um plastic surgery to um repair his his face and his skull. And this is me walking into the recovery room after that surgery. Also, you should know I don't been very careful around trauma responses in this book. I don't really um share a lot of gruesome details. This will be the toughest and then we're going to be through it. And it's not unless you have very specific mouth related medical trauma that you should be okay with this. Okay. So, this is me walking into the recovery room after this six and a half hour surgery. Head wrapped in gauze like a mummy, he was temporarily blinded by the procedure. His lower jaw, broken into four pieces, had been wired together, and then his top and bottom jaws were wired closed, leaving a narrow gap between his teeth so he could take in nutrition and medication. The staff seemed delighted by him, resting comforting hands on his shoulders, shooting me amused looks. The nurses handed me paperwork and gave me instructions. I took hurried scratch notes in a bright red notebook as they dictated his afterare. Put the eyes safe antibiotic gel in his eyes three times a day. Help him use the antiseptic mouthwash three times a day. Crush his antibiotics up with his oxycodone and put it in the smoothies you make for him. 5 to 10 milligrams of oxy every four to six hours for the first three days. Then crossfade the oxy with Tylenol up to four grams a day. ice his face for two or three days, then apply moist heat. Blood might come out of his eyes, they said. But they advised me not to worry about it. Except if the blood won't stop, they continued. Or if it's bright, bright red, then I should definitely call the doctor. It would be at least two months before he returned to normal. I didn't think to ask why they weren't keeping him overnight. An orderly pushed Jay's wheelchair to the hospital door as I dashed to the parking garage to fetch his car. Once on his feet, Jay moved like a blind bear, stumbling and clutching, arms waving, legs slowed by pain medication. I struggled alone to get him into the passenger seat. Left foot first, I must have said, holding his right arm as I carefully helped him inside. Left hand cradling his head like a newborn's. He was in in he was in pain and frustrated, less charming now, breath gasping and seething through metal and gauze. As we left the hospital, the nurses had given me a small set of wire cutters and told me that if the anesthesia or the pain made him sick, I should cut the wires holding his jaws together so that he wouldn't aspirate on his own vomit. At home, I curled myself into a tiny ball on the corner of our bed and watched him, terrified, holding the wire cutters. Near dawn, I fell into a restless sleep. I often find it really useful at this time to remind people that it's okay to laugh. Um, because there are parts of the book that are quite funny even though it's uh quite a serious um situation. And in fact, dark humor was one of the things that really got Jay and I through this period. So, if you feel like, "Oh my god, should I not laugh? I kind of thought that was funny. Is that wrong?" The book is supposed to be funny. It is quite funny. Um, so it's okay to laugh. I just want you to know that because sometimes people just get nervous and don't know what to do. So, this was really the beginning of what I think of as a cascade of systemic failures that we faced together after the attack. So, the six and a half hours of plastic surgery and not keeping him overnight. But then the next day, I went to the pharmacy to get his pain medication and was told that we no longer had health insurance. It had been suspended. Took us three weeks to get the health insurance back and that was after they had sent us a bill for $38,000 for the um for the surgery. Um we did eventually get it back. Um the uh police um I believe u miscatategorized the crime as assault in the third degree which is basically menacing. So like if I walked along behind you and yelled at you for blocks and blocks and blocks that would be menacing. Um it said at the bottom of a police report that they would have to revisit the charges based on the extent of Jay's injuries but that never happened. Partially because of that, when we applied for crime victim services, they sent us a check for $35 years after the attacks, a check that I promptly threw out because I was deeply insulted and then fished out of the trash because we needed $35. Um so um this was a sort of a a consistent um a consistent set of failures that made me as a caregiver feel like I had to live under sort of eternal vigilance that I was always watching out for my partner. I was always watching out for the next car wreck that was headed for us. And I was doing that in an atmosphere where my partner had post-traumatic stress disorder. So actually that kind of vigilance was a symptom of the disease and it became really quite cyclical and and um quite dangerous. Um and there were um by the way I was not alone in this. Um and I know I'm not alone in this now. Um there are 59 million kin caring for adult family and friends in the United States right now is about a quarter of the population. We provide $600 billion dollars in caring labor annually. We work an average of 27 hours a week at care. 30% of us spend five years or more providing care for our loved ones. 81% of us are completely unpaid and 70% of us have no paid help at all. Um so this has enormous emotional, physical, relational, financial impacts on caregivers. And in fact, a 2015 study found that 60 days after a loved one enters the ICU, 23% of their primary caregivers met the clinical criteria for post-traumatic stress disorder. Um, and the researchers um finished talking about this work by saying that caring for a loved one in the ICU is the psychological equivalent of enduring and surviving an earthquake. So I believe the reason that these um experiences of care which is I want to be really clear like the most fundamental human desire is to care for the people we love. What turns it into such a difficult situation is that um we are caregivers are are required or asked to um shoulder a responsibility as an individual that should be a collective and a social responsibility. And this is one of the reasons that after some time that old um hory cliche uh the oxygen mask um advice really started to get on my nerves. And so I just want to I just want to take a moment to destroy that advice and then we'll move on with the book. You have to put your own oxygen mask on first before you can help others. In the years that I served as the primary member of Jay's care team, friends and strangers constantly offered this commonplace airplane safety advice. At first, it seemed like a reasonable recommendation. Of course, if you're incapacitated, you're no good to anyone else. But the more I heard it, the more it graded. Jay and I weren't buckled up side by side, clutching hands, our eyes locked in a poignant gaze while we hurdled towards an entwined fate. No life-saving resources dropped from secret panels above our heads. No flight attendants offered instruction or assistance. Caring for a loved one through a serious illness or in the wake of violence is not like plummeting through the sky on a decompressing plane. Put your own mask on first. They say there were never any masks. So um we sort of continued in this way for about four years. These are I think of as the denial years or the acute emotions years. Um until in 2019, Jay's mental health took a really serious turn for the worst. And we tried to get him admitted to a behavioral health crisis unit um where we were turned away because he was not sufficiently homicidal or suicidal. Um and it was in that moment in 2019 that I really woke up to how much trouble we were really in. This was four years away from the attacks by this point. Um, and I responded as I respond to other things in my life. I responded as an organizer and I responded as a reporter and a journalist. So, the organizer in me after we got turned away by the mental health um crisis center um organized what amounted to an all volunteer um living room psych ward in my house um which lasted for several weeks and meant that there was one person coming in every day to help support Jay, make sure he was eating, make sure he was taking his meds. Um and then I also wrote um responded as a reporter and a journalist. And this is the moment that I really started to do research on what was happening to us. Up till then we kept sort of thinking, you know, in the beginning like it'll be six months and things will get back to normal. Okay, a year and then okay, two years then oh four maybe. And in 2019 it was really clear that there was no going back to normal and that I really needed to understand this place we were living in. So I started taking notes and eventually I gathered a thousand pages of single spaced um daily notes from 2019 to 2023. Um I started doing research on PTSD and on caregiving. Um and I started doing really um genuinely bananas stuff like um recording my therapy sessions, recording with with Jay's permission our coup's therapy sessions. We'll talk about that more in a minute. That's why you're going to hear some dialogue from a therapy session in a minute. And that's why is because I have all the tapes and I went back and coded the tapes like a good journalist. Um, I also during this time got some genuinely terrible advice. So I was desperate for any resource I could find. I was reading self-help. I was reading clinical work. I was reading the internet. And there was a lot of advice that said things to me like uh build a safe room in your house or love him the most when he deserves it the least. Um so a lot of advice that felt deeply sexist and quite toxic to me. Um it wasn't until 2021, two years later that I started realizing that the things I was reading about about post-traumatic stress disorder actually described me at this point. So, I was showing symptoms of intrusion, things like nightmares. I was showing symptoms of reactivity. So, I had a startle reflex that was so out of order that I remember driving um one day and a car came up on the left just a little too fast and I jumped so hard that I hit my head on the roof of the car and I was like, "Ah, this is dangerous. I need to address this." Um, negative cognition, constriction. These are all um symptoms that I knew about but had a lot of trouble admitting to myself that I was displaying. And so um in 2021, the good journalist that I am, I said, "I suspect this is going on with me, but I need secondary confirmation." So I called my beloved therapist at the time, Dr. John, and I asked him to give me what is known as the CAPS 5, which is the clinician administered. See if I can do this. PTSD. Clinicians administered survey for PTSD. Ah, what's it called? Let me find the right page. Ah, I was missing the S. Clinician administered PTSD scale for the DSM5. I'm not going to nerd out on PTSD and trauma and their definitions right now. I can happy to do that in the Q&A because I am very interested in these definitions. But there's one thing you should understand to understand the scene which is in 2013 there was a modification made to the um the diagnostic and statistical manual of diseases that's used by therapists and insurance companies to um classify um mental health um issues. And the modification was to the PTSD classification. And it said that um witnessing, learning about or hearing repeated and disturbing details of trauma counts as an exposure to trauma for a PTSD diagnosis. So this is the first time that it wasn't required to be direct, which is the thing that opened up this diagnos this diagnosis of collateral PTSD. Um that is now possible. I use collateral PTSD because people know what it is. I also really hate that language. And I think you'll discover why um as I read my um therapy um conversation with my with um Dr. John. Do you? So we doing okay with reading? We're still good. We want to hear from Dr. John. Great. Okay. So this is him giving me the caps 5. I've asked him to give me the caps five. Reading from the caps five. Dr. John began. I'll ask you to tell me a little bit about the event you say was worst for you, he said. Then I'll ask how that event may have affected you over the past month. What I'd like for you to do is briefly describe what happened. I had trouble identifying a single incontrovertible traumatic event. Were the attacks on Jay the worst? Receiving those wire clippers from the nurses? Getting thrown off our health insurance? being turned down by the behavioral health crisis unit or Jay turning on me during our worst fights. I replied, "This is the problem with having an academic as um a therapy client." I replied, "I have a whole critique of the idea that PTSD only comes from one terrible event. That's VA stuff. It doesn't really apply to me. But in responding to this clinically, I would say that I live with a person who has PTSD. His emotional volatility has been very hard for me to live around. And in addition, there have been a number of systemic failures that put it put us at risk for not surviving. I would say that's missing the point of this, Dr. John replied. I'm not supposed to prompt you, but Jay got beat up, right? I sighed. Yeah, Jay got beat up in October of 2015, and there was a second attack in December. The VA's diagnostic instrument recognized me as having experienced lifealtering existential harm, but only if I agreed that it was secondhand. Learning about the attacks on Jay qualified as a clinically significant trauma. But the harms I experienced directly, all the doors that shut in our faces, the doctors who disappeared or dissembled, the threat of debt, the impenetrable mazes of paperwork, the life-threatening rejections and cavalier erasers did not. This myopia impacted how I answered the other questions in the CAPS 5, minimizing or erasing many of my symptoms. Did I have unpleasant dreams about the event? I woke up drenched with sweat after horrifying nightmares about billing errors, losing my home, being abandoned without resources, and there were the dreams of drowning, of course. But if my index trauma was learning about the attacks on Jay, then no. Did I try to avoid people or places that reminded me of the event? I tried to avoid Jay when his dysregulation made my heart pound and my palm slick, but I was able to walk to the corner store where the first attack occurred without adverse physical or emotional impact. So again, no. In the past month, Dr. John asked, "Have you had strong negative beliefs about yourself, other people, or the world?" I laughed three short, dark, humming bursts of air from my nose. Other people? I replied. Sometimes I have strong negative beliefs about other people. Aggressive people? Dr. John asked. I don't love the people who did this to Jay, I admitted. Although, weirdly, I have more sympathy for aggressive people now because I see the trauma in them. H, he responded. But there's a whole category of people Jay and I don't talk to anymore. people who think the universe is gently holding them all the time. I've gotten much more short-tempered with people who I find naive. Jay and I call them nonRums. Dr. John laughed. Aggression I understand. I said, "It's not willful ignorance. It's just an unhealthy reaction to reality." Dr. John totaled up my responses at the end of our conversation. Despite the limitations of the instrument, I had a symptom severity score of 33 out of 80, placing me in the moderate category. The CAPS 5 made definitive what deep down I already knew. I had PTSD. So, um, the other thing that this US lifeguarding association manual of open water life-saving did for me is it sent me out on a pretty intuitive and scattershot series of wilderness survival classes that I still at the time I had no idea why I was doing it. I was grasping for resources. It had been six years since the attacks and I hadn't felt like anything had helped me until this lifeguarding manual. So, I was like, fine. Um, I'm just going to start taking these classes randomly and see if they have anything to offer this experience I have. Um, and the first I was so unaware of what I was doing that the very first class I took was kayak self-rescue. And I was so obsessively compulsively looking for this class that I drove 600 miles round trip for like six hours of instruction, right? Which is bananas. Um, and it wasn't until I was driving home after the class, sort of 80 miles into this 300 mile drive home that I was like, "Oh, it was a self-rescue class." Like, I get it now. I get what I'm doing. I understand. Um, and so when I got home, I um the next day I what I say in the book is I filled my calendar like a drunken prepper, right? So I had like $1,500 saved to do the research on this book, which I thought I would spend to like take the train to Boston to like talk to trauma researchers and interview neuroscientists. And instead, I took a class in kayak self-rescue. I took a class in winter survival. I got certified as a lifeguard. I got certified to provide wilderness first aid. I took a class in map and compass and a class in bushwhacking. I took a class in sea navigation. I spent a month in a monastery. Um, and a bunch of other things. So, amazing return, I think, on a $1,500 investment, right? Um, and particularly an amazing return because the lessons I learned were surprisingly portable and gerine to my experience as a caregiver. So, yeah, we're good on time. With the time we have, I want to offer two of those lessons and then I'll I'll wrap up. Um, so the first set of lessons that I learned was from wilderness first aid or from wilderness medicine. And this I don't know like now that I know of more about wilderness medicine maybe should have been um intuitive uh that it would be helpful, but it really wasn't until I got to the class. And this is what my um what my manual, my wilderness medicine manual um told me. It says um wilderness medicine assumes unstable situations, limited resources, and remote settings. It acknowledges that an oxygen mask won't do you much good when the plane is coming apart around you. Focus on serious problems, the manual advised. anything causing shock, respiratory failure, or brain failure. Everything else is just a logistical dilemma. Don't expect ideal conditions. Plan for the environment in which you're actually operating. Improvise, adapt, and keep an open mind, but don't take risks that are unlikely to pay off. So, my instructor for Wilderness First Aid was an extraordinary woman. Um, New York State Department of Environmental Conservation Forest Ranger Liz. Um, and she was such an extraordinary person that it became quickly clear to me that part of what I needed to do is interview all of the instructors from these um from these classes. And she was the first person that I interviewed. and she offered what I still think is maybe the single most important piece of advice that I give to caregivers all the time. Um, and she told me this uh incredible story about um right after she got out of the academy, she was called out on um a huge wildfire, the Overlook wildfire in Minowaska State Park in New York. Um, and she um arrived at this fire um with a more um senior uh forest ranger, a guy named Dave Meade. Um, and she is like as they're pulling up to the edge of the fire, she is like jumping out of the truck and putting her fire pack on and about to run into the flames when she turns around and looks and sees that Dave Me hasn't even gotten out of the truck yet. Right. So, he slowly gets out of the truck. He walks around to the back of the pickup. He reaches in the back of the bed. He pulls out this lawn chair and he unfolds it and he sits down. And she like loses her mind. She's like she's thinking to herself because she's like a baby ranger still. So she's not saying anything, but she's thinking to herself like there are pine trees torching right over there. There's a fire. We have to go fight it. And Dave Me kind of reads her mind. And he looks at the fire and he looks at her and he says, "What are you going to do about that?" you know that we need a dozer line. You know we need water drops. You know we need volunteers. You know we need an incident command center. Um there's another lawn chair in the back of the truck. So she stops and she like takes a breath and she grabs this lawn chair and she takes it out and she unfolds it. She sits down next to Dave and they spend the next day helping plan the response to this fire. And the fire ended up burning for 42 days. Um, it uh consumed about 3,000 acres. It took 250 people to control, but there were no injuries and no evacuations. And so when I asked Ranger Liz, "What is the best advice you can give people who are lost in the wilderness?" She said to me, "Sit down. If you no longer have clarity, stop doing everything and just sit down. Have a snack. Have some water. Force yourself to sit still. Unless you're about to get crushed by an avalanche, don't move again until you're thinking clearly. Sit down. Sit down and sit down. So, she said, "Rangers have a saying, rangers don't rush." Or they'll say, um, they'll say, "Slow is smooth and smooth is fast." And the thing that makes it possible, well, the thing that makes it necessary for them to move slowly is rangers don't rush because rangers stay, right? Unlike front country first responders like lifeguards or firefighters who turn vict like pull victims out of danger and then turn them over to EMTs that then turn them over to hospitals. Forest rangers are required to find victims, stabilize them and then walk them or carry them out of the woods. And that can take hours, it can even take days. Um, and the thing that makes it possible for them to do that is that rangers have extraordinary training tools and team. And so I think these are two things that caregivers tend to not be allowed. One is the lawn chair moment where we can take a second, let our cognition come back online and say, who do we want to be in this moment? Or like this relationship is that is going to be affected by this care. um what do I value about this relationship and how do I protect what I value about this relationship or who can I call on who can become part of my care team um who who who are the resources that I can share this work with um and we're certainly not given training tools or team either often most I'm going to ask my nomine people most often right um so in fact something like 30 million caregivers are currently doing technical technical nursing skilled activities like infusions, like injections, like wound care, like colostomy maintenance. And only 22% of them have been given any training at all. And that includes like a cousin showing up at your house and being like, "This is how you flush a line." For the purposes of the survey I'm talking about, that would count as training. So only 22% of people get even that, right? Um, so this is not something that caregivers are often offered is sufficient tools, training, and team to do the job they're being asked to do in a way that doesn't make them afraid that they're going to harm or even kill the person that they're caring for. There are solutions to this. I want to be really clear about that. I've done quite a lot of research since the book went into production, particularly on things like trauma recovery centers, which are these very cool organizations that are funded by violence uh um victims of crime act funding that do two really important things. They do what they call affirmative outreach, which means they'll show you don't have to find them. They'll show up bedside in the hospital and if you don't want them at bedside, they'll call you the next day. And if you don't want to talk to them that day, they'll text you two days later and they'll just keep touching until you accept help or tell them to go away. Um, and the other thing they do is what they talk about as wraparound services, which is you have a single case manager who helps you not only access psychological, psychiatric, and medical support, but also things like help with housing assistance because often you lose your housing or can't stay in the place where you were attacked. Um, they'll help you navigate the legal and criminal justice system. Um, they'll help you navigate crime victim services, which would certainly would have been helpful for us in our $35 sad $35 return from that process. Um, but you'll get one person. So, the caregiver, the the survivor of crime or the caregiver is not the person who has to be looking for all of those services. So, there are I also talk in the book about caring collectives and the disability community um and the VA's u program for comprehensive assistance of family caregivers. All I think good models for how to do this differently. Okay, running short on time. I can either tell you a story about bushwacking my own brain or I can do a sort of a longer inspirational summary. Which one would you like? Bushwhacking or inspirational summary? I mean, I'll hit the inspiration in the last two minutes. >> Bushwhacking. Okay. Yeah, Mary votes bushwhacking. Um, okay. So the things that I just talked about the sitdown moment and the tools training and team that would have helped us earlier in the process maybe all the way through the process but the time that I started doing these classes was 2021 2022 and by that time I was really thinking how do I heal from my case of collateral PTSD and one of the things again intuitively and with no logic behind it until later when I understood what I was doing I started camping alone in in the wilderness overnights. Um, and after an early experience with a very large eastern coyote in my camp, um, I still managed to keep going out, which is still surprising to me. So, again, I was obviously obsessive and compulsive about doing this thing, and I didn't really understand why. So, I want to read a very short bit and then explain what I think it was I was doing. So in July, I tried again, reserving the Crannle Leanto near Johnsbrook Lodge. Hikin only accommodations run by the Aderondac Mountain Club. With everything on my back that I'd need for two vigorous days, I launched myself up the rocky three and a half mile Phelps Trail, climbing through the valley between the Brothers and Big Slide Mountain to the north and Rooster Cone and Hedgehog to the south. Sweating on the deck of the lodge after my hike, I took in spectacular views of Mount Marcy, filled my dramadary bag at a water spigot, and crossed the brook. I set up my tent, paced off the distance from my bear canister, ate some gorp and corn chips. I bathed in John's brook, still icy from the snow melt, more brutal than bracing even in midsummer. I strung my hammock between two trees and settled in to read Kate Bollock's spinster, Making a Life of One's Own. until the mountains purpled and the shadows came down. I hoped physical exhaustion from the hike would help me settle that night. Oh, I was having trouble sleeping overnight. Yeah, I was scared. I was really frightened. But I wasn't taking any chances. After dinner, I took a sleeping pill and once I was in my tent, I played downloaded episodes of The Good Place on my tablet until I fell asleep. I wore headphones, turning the volume up high to drown out creepy nighttime forest sounds. Not a pure wilderness experience, but it did the job. For the first time, I slept through the night in the woods. So, I see now that I was trying to figure out fear. Um, I was really tired of being constantly keed up and jumpy and vigilant. And not every anxiety I had was unfounded. I lived I lived and live in a very unsettled neighborhood. I'm a person who keeps the lock zone by the front door, right? So, it wasn't entirely out of keeping that I should be vigilant in my home, but in the wilderness where my fears were less wellounded, I um did this experiment to try to come to Daytona with dread. Um and I didn't understand this until I reached out to um neuroscientist and psychologist Lisa Felman Barrett, who wrote a beautiful book, by the way, called Seven and a Half Lessons about the brain, which I cannot recommend enough. and she explained to me that humans gather data in stressful situations to better predict future dangers. So dealing with the unknown is really resource intensive. So the brain reduces uncertainty by making predictions about what might happen in the future, particularly things that might prove particularly metabolically costly. Like anything that involve fight or flight is metabolically costly. So we try to get really good at predicting those kinds of things. But in other words, the thing that's important here is that Barrett is arguing that our mind doesn't react to threats. It predicts them and then gathers data about them. So um when there's uh sort of abundant ambiguities that causes stress and that's the price that our brains pay to hone their prediction making um acuity for the future. And so I called Lisa Felman Barrett in 2025 and I asked her if neuroplasticity might allow us new ways to kind of navigate um the wilderness between our ears. And she said you can curate experiences for yourself now that will seed your brain to predict differently later. But she said the process is extremely costly for both mind and body. it does not feel good and not everybody has the same opportunities to do it. She said, "If you're already metabolically encumbered, you literally don't have the energetic resources to grow new receptors to push out dendritic branches." Um, but plasticity that allows us this extraordinary f flexibility as a species requires a lot of resources and effort. Um, but we can change the way our brains anticipate danger. um that is we can bushwack our own brains. Um and what I realized is I was going to the woods to reprogram my brain to and my body to react to danger in a different way. And as I encouraged my brain to make new predictions, that fear that I had been feeling began to um to to pass. Um, so, um, it's very similar actually to sensory motor therapy, which was a therapy I wanted to do, but couldn't find a therapist who would take my insurance within 300 miles of my house, so I just did it in the woods by myself. Um, um, but um, okay, so I've two minutes left. I want to make sure we have plenty of time for Q&A. One thing that I'm skipping right now is talking about sort of structure and process. So, if you have questions about that, I have all sorts of things I want to say about that. So feel free to ask. But I want to end with like why I wrote this book, which is I really wanted caregivers to feel less alone. Um that there were 59 million kin caring for adult friends and family and 13 million people with PTSD in this country um this year and that I felt like I needed to get help from a lifeguarding manual. It was ridiculous. Um and we need better resources. One of the things I ask readers to do in engaging with this book is to hold a a little bit more complexity about how we talk about trauma and PTSD and care because I feel like we're really stuck in these binary conversations. Um, on the PTSD and trauma side, we're either stuck in denial or an atrocity hierarchy that requires that it has to be the absolute worst thing ever to happen to any human being in order for it to be trauma. And on the other side, we're stuck. We're stuck in false equivalents. Everything is trauma. Um, everything is equal, which is not true. It's simply not true. Like a flooded basement is not a tsunami, right? We should be able to talk with more nuance um about trauma. And this is true on the caregiving side, too. I felt like there were really two stories I was being offered, none of which fit my situation. One was ride or die, martyr yourself to save someone you love. The other was save yourself, right? When things get tough, bail. I can't tell you how many people emailed me that Mary Oliver poem about so the only life you can save is your own. Like, which ask lifeguards. Not true. Just empirically untrue. Um, so I'm I'm really inviting a kind of specificity and a subtlety um in a time that I know it's really difficult to engage that subtlety and specificity, but I think it's absolutely crucial for people who are healing and for those of us who are caring um for people we love. Um, and the great joyful surprise of this book is that everywhere I looked when I was doing the research, new networks of care became visible to me that were invisible to me before. So, every time you sign into a trail register, it means that if someone reports that you have not made it back at the time you say you were likely to be back, rangers will come looking for you. Whether you want them to or not, whether you know about them or not, they will come looking for you. Um, I in my C navigation class, I had this amazing experience with the marine radio where we got a Mayday call as a in a kayak navigation class and had and luckily like because we were a sad little flotilla of of like very bad ducklings of kayaking. Luckily, there's someone closer to this person and they went out and we didn't have to go. But marine culture, boating culture is if you hear a Mayday, you have to go. Um, or like even now as a bushwhacker, I carry an extra map and compass in my pack and I carry a 2 and a half pound first aid kit every time I go hiking, even if it's just a mile, because I know that somebody might need me to show up for them. And this is really the take-home lesson of the book that I hope everybody under everybody gets from the reading, which is that really no one makes it out of the wilderness alone. I really appreciate your time and your attention tonight. We're Oh, almost is only a minute over. So, I'm feeling very proud of myself and we have plenty of time for questions and answers and I'd love um I'd love to engage the conversation with you. So, thank you so much. >> I have a question about bushwacking the brain. That section just really speaks to a struggle that I am having right now, which is that >> um I also n created these crazy systems whether it's like health care or insurance and learned kind of like the uh sort of like survival skills I guess. >> Yeah. >> And like uh you know just wretchedness that comes from that >> and >> I'm sorry. Well and >> I'm glad you have the skills but I'm sorry you had to find them. But like you're saying, it like it's made me like super vigilant, very kind of like who's gonna screw me over and when. >> And I guess my question for you is like >> I'm trying to change the brain patterns, but the problem is like my vigilance and paranoia keeps paying off. >> Yeah. Yeah. Yeah. Yeah. Yeah. So this is really important. I I don't want to interrupt you, but I do. Do you mind if I jump in? >> What the hell do I do? >> What the hell do you do? >> So, here's the tricky thing with bushwhacking your own brain with like pushing out these new connections, which is possible, but you have to have access to a place of genuine safety in order to do it. And that is unlikely to be the health care system that we're currently living under. Right? So, this is one of the things I do in the book, which is like we also tend to use PTSD as this really big catchall and there's actually several other things that have similar symptoms. So there's acute stress response, there's post-traumatic stress symptoms. The re and then there's PTSD, which is it's a it's about persistence about how long it lasts and how much it disorders your life. But the reason I make this distinction in the book is not to create a hierarchy. It's to say that like acute stress response and post-traumatic stress symptoms are totally normal, reasonable, evolutionarily positive responses to something like the health care system we now live live in. Um, and so it is like really there's there's two big pictures, right? there's the big picture of like what do we do together to create systems that serve um I mean in my case survivors of violence but it can be all kinds of different kinds of traumas um and caregivers better and that's a long-term goal that we need to work on together and then in the meantime it's like what do I do right now when I'm I'm in this situation um so I try to offer some resources in the book that um uh that address both of those things like from a policy but also just from like you picked up this book and you're in it like let me tell you what I what I know. So there's this series of lessons that are actually drawn out of the lifeguard manual that I've adapted to caregiving that are dropped in between the chapters and then the first appendix which very nicely a reviewer said should be an all bold and at the beginning of the book is like it's it's called in case of emergency and it's like the eight things I would now advise people do now that I've been through it. Um, you know, I wish I had like a silver bullet solution for you, but the reality is the system that we're operating under is deeply exploitative, particularly of caregivers. Um and it is you know the best it's depressing but the best advice I give to people who are um put in situations of sort of like um immediate or panicked caregiving um what I tell them is like the very first and most important thing you can do is forgive yourself now because it is not set up the system's not set up for you to succeed. You can't my press wants me to say you can't do it perfectly. The real advice I give my friends is you can't even do it well, right? Because it's a stitch up. Um, and so forgive yourself now, do your best, and know that like you're on the team now, and we've got you, right? This is the the good news about my experience in this is this was definitely like an aperture through which all parts of the past parts of my life did not fit, including friends and like other things that I've really valued in my life. But on the other side of that aperture, man, it's a good club. Like, it's a great club of people who don't want to be in the club, but it's there's really good people on the other side. Um, so >> talk to me when we're done. >> Yeah. Other questions? >> Yeah. Um I imagine that the types of people doing these sorts of um classes that you did are some of them doing them because they want to gain some self-sufficiency because they have some distrust in our institutions. they want to, you know, get I imagine like kind of like doomsday preppers, like people who want to be survivalists. And I wonder if you make that connection um with you doing these classes and also having to basically become like a doctor because the actual doctors weren't able to provide for your partner. Yeah. Yeah. So, I have such complicated I really love that question. Thank you so much. Um I have really complicated feelings about this, right? because on one level I believe that the state has a duty to care for its people and I really want to hold the state accountable for its duty to care for people and I'm fully aware of the moment we're living in and like it does not seem to be going in that direction any harder right um and so like when I I I one of the things I talk about in the book is care collectives right which are really common in disability communities where you are sort of inventing mutual aid alternatives um that are outside of the state and outside of the market and I am all for them and I also want to continue to hold the state accountable. Um so yeah, so I have like I think one of the things that was a big philosophical shift for me is like maybe before this experience I really admired people who um had like a lot of moral clarity. >> Not so much anymore, right? Like I I still really love people who are willing to give part of themselves away for other people. Like that is something I still really admire and I hope I still do that in my own life. And I am very impatient now with people who are like ideological purists. Um because I just think there's so this is such a fractured, broken, difficult system that impacts so many people so deeply like in terms of their very basic survival that like we should be trying everything we can try to to start fixing it. My experience with the classes was that it was mostly like um wilderness educators and like so fewer survivalists, but I definitely had a moment where when I was filling out my calendar with these classes, I was like, "Oh, Virginia, you're a prepper now." Um, and there's a whole scene about during co like I I talk about having a a depression era grandmother who's always lived in my head. Like I've always like made my own candles and like give you know like canned things and like I'm already a little bananas about that stuff. Um, but during COVID, I definitely like planted a medicinal section in my garden and like yeah, so there was like a part of me that I was just like, "Okay, depression or grandma." Like, "Let's see what you got." Like, I might really need you. Um, but but fundamentally, I do think it's about how we rely on each other. I think the most important thing about the survival classes is that um we have a lot we're talking a lot about self-care right now. And I think for some really, really good reasons. I think selfcare is deeply important, but it isn't what I mostly needed. What I mostly needed was a sense of competence, right? That was the scariest thing was not knowing what to do when was falling apart. And so it just felt better to me to have some of these skills. Um, and also I realize now from a psychological perspective that I was producing controlled crises >> in an atmosphere where I had support and training and a team and I was resolving those crises. And there was something that was just so deeply calming to me. I remember talking to Ranger Liz and being like, "Oh my god, a broken arm. Like I love a broken arm. Like it's so simple. Like it's so straightforward. We all know what the problem is. we know how to how to fix it for now, right? Like we know what to do. And she was like, "Oh yeah." She's like, "An emergency is such a joy because like in the rest of my life, I very rarely have any idea what to do." Like and in this crisis, you know exactly what to do because this person's life, you know, wise on you. So those felt like the important things. >> Oh. Oh, I think we're like I think we're now in Are you asking me or asking back row? >> No, I I >> because I love this. if it turns away from me, I'm I'm into it. >> I just want to share something. Um, so I have a son who has mental health condition and I have um I became like a psychiatrist. I've read so many books. I've watched so many shows, movies. I've read hundreds of books about mental illness and all that. I I got myself so educated and um I talked to therapists to nurses, doctors, no one helped me as much as I'm going to pitch now. >> I love the pitch >> the NAMI National Alliance for Mental Illness. Um, when I joined them, they gave me practical advice how to deal with my son. Even though I have this knowledge like I could probably get PhD, it doesn't work. None of that works. That knowledge helps me because I can identify, you know, he's in crisis. He's, you know, this is what I should do. Step up, you know, uh, sit down. >> Yeah, >> just sit down. >> But I can't help them. But when I joined NAMI and I had this community of people who were just like me, my peers, it really changed my life. And now I literally we you know I um become an advocate to mommy >> and it it's healing you know I can't help him but I can help others. >> Yeah. Thank you so much. I do think peer support is such a like absolutely crucial part of the puzzle. I will also say that I heard a lot from therapists and others who wanted to give me advice that I should seek more and more social connection. And as a caregiver, I found that I actually needed to spend a lot of time alone. Um, and that that was okay, too. Like, I'm not not to say that peer support isn't great. It's amazing and it can be life life-changing for a lot of people. But I also think that there are a lot of people who will give you advice about the one right way to do this, and there is no one right way to do any of this. Um, and so, you know, trust your gut as best as you can, educate yourself as best you can, find support. Um, but then in the end you have to do what works for you. Yeah. Yeah. So, I really appreciate that. Thank you. I think we have time for one more. >> Oh, over here. >> Wait, wait, wait. Get it on the tape. Get it on the tape. >> Thank you. No, no, no. Thank you. >> Thank you. Um, I was struggling to think of how exactly to ask this, but I guess it boils down to this, which is how should one give this book? And I mean that in the sense of it's I can think of two people in my life who I pointed uh your oped I pointed uh them towards your oped and I and I think this book does something but it's it's hard to what do people what's the wraparound what's the what's the message that you give with that you want to go with this book when you ask you know offer it as a source of help. >> Wow that's a great question and I should have an easy answer to this and I don't. So thank you for surprising me. We're 20 days in and this is like all the questions aren't always a surprise. So that's a great one. Um I think what I want people to take from the book is that um is a a really honest interrogation of you know the fractured and failing system we're living in. how that affects caregivers and people who have been um surv who are survivors of violence or whatever else is going on with folks. And also I want people to understand that there is all of this incredible help out there even though it feels often like there isn't and that sometimes you have to go sideways to find the way forward. Um, and also that you'll learn a lot about actual outdoor survival from this book. So like like how to deal with cold weather. There's a whole chapter called the umbles, right? Like I can tell you what to do if you fall through the ice and into cold water. Anyone turn around because the most stable ice is behind you is where you just fell in. If you can't you well the first most important thing is get yourself out. So, you should be carrying these little hooks that'll pull you out onto the ice. If you're not carrying those little hooks, you can't get and you can't get out of the ice. What you need to do is actually freeze yourself onto the edge of the ice if you can't get out because that will keep you from drowning. You will get very cold, but you might survive getting very cold and you won't survive drowning. So, there you go. Um, this kind of thing, um, surprisingly useful practical advice for how to survive the wilderness. And I often tell people like it's a it's a love story. It's my story. You know, it's a classic memoir in that way. And it's also a survival manual. Um, and it's surprisingly funny, right? So, yeah. Love story. Wait, the love story, my story, survival manual, surprisingly funny. Does that feel fair? >> Okay, that's a good elevator pitch for the book. I got it. Thank you for asking the question. >> Thank you so much, guys. Have a great night.