It was damp and cold on the morning of Thursday, November 2, 2016. That wet chill which permeates your clothes and skin into your core engulfed us. We walked through puddles from the car, shying away from the cold wet drops as we made our way to our destination. Once inside, a background staccato sound of the steady rain pelleting the structure’s metal roof greeted us. We were in the magnificent barn/indoor arena of Cricket Hill Farm outside Saratoga Springs, NY, owned by Martin Hellwig. The low pitched scraping crunch of horses chewing hay and the mild scent of manure greeted us as we viewed the stained wooden 10/12 stalls with metal vertical bars on the upper half and angle iron covering exposed wood to inhibit cribbing. There also were tack boxes, halters, lead lines, a tack room, a well drained horse bathing stall: a complete facility. A woman we had not yet met, Melody Squier, the Director of Equine Development and Lead Instructor stood to one side, somewhat distant from the barn doors and immediately began to evaluate us from that polite distance as we entered the facility. Brian Austin, the Veteran Liaison and a Marine Vietnam Veteran, and Janelle Schmidt, the Program Coordinator, both of whom we had met the evening before at dinner, greeted our veteran group. W Having served as a trauma surgeon at the 85th Evacuation Hospital, Phu Bai, Vietnam September ’70-’71, I had witnessed first hand war’s devastation of body, mind and soul. In my book Welcome Home From Vietnam, Finally, A Vietnam Trauma Surgeon's Memoir, through storytelling, I have related my experiences at the 85th Evacuation Hospital. I also addressed, in the book’s appendices, the travesty of one active duty personnel and twenty Veterans a day selecting suicide as the best choice to exorcise their demons. I suggested a preventive approach, prior to discharge, to reduce the incidence of PTS(D) and suicide. At a lecture I recently gave on this travesty in the Albany, NY area, I met Bob Nevins. He had read an informational post card for the book and solemnly advised me that he had been a Medivac (Dust Off) pilot who delivered the wounded to us at the 85th Evac. We instantly bonded. After a few shared stories, Bob informed me that he is the founder and director of Saratoga WarHorse, his labors now reborn in Alliance180, an organization that utilizes off the track racehorses to engage veterans with PTS(D). He and his group have offered this experience to over 500 clients with extremely positive outcomes. I was excited when Bob invited me to participate in as a client, along with other veterans from Iraq, Afghanistan and Vietnam, to experience first hand their reactions. My excitement was focused on what actually was happening neurologically during the process Bob describes as “switching off” the veteran’s encumberment of PTS(D) during their exercise with the horse. Unencumbered, the veterans weep, begin to trust themselves, open up about issues not previously shared, interact excitedly with the group and demonstrate a “relief” from tension, anxiety and fear. The military takes advantage of the fact that their inductees are functioning with an adolescent brain within which there exists a disparity in neurologic maturity wherein the reptilian/prehistoric limbic system (the “Beast” defined by Col. D. Grossman in “On Combat”) potentially may over ride the less developed pre-frontal lobe that functions in modulating the anxiety, fear, rage and adrenalin rush (fight or flight) produced by the “Beast.” In other words, maintaining “Harmony” with the environment. In addition, if one applies Porges’ Polyvagal Theory, the ventral vagal complex signals of wellbeing, safety and affiliation also become overwhelmed by sympathetic “fight or flight” output stimulated by Limbic System; creating “Disharmony.” Military training exaggerates this disparity, for their mission is to produce the most effective fighters not only to prevail in combat but also to bring as many home safely as possible. That end point is necessary. However, the military does not take effective steps to mollify the training process, military culture and combat zone experiences prior to discharge or separation. A veteran’s body returns home, but their brain is still in the war zone. They are not given time or direction to turn off the “Beast” and reengage the stabilizing ventral vagus complex to foster reintegration back into a peaceful society. There is a natural process utilizing a portion of what is called the autonomic nervous system, involving parts of the brain (the Limbic System) and the endocrine system (pituitary and adrenal glands), that releases adrenalin creating the “fight or flight” reaction: the sympathetic nervous system (SNS). Sensory input from the environment is directed into the middle of the brain (the Thalamus) by the cranial nerves (eyes, ears, nose, mouth and facial skin) and up the spinal cord from the remainder of the body. The Thalamus along with the Hippocampus, Amygdala and Hypothalamus are referred to as the Limbic System (Col. Grossman’s “Beast”) which is a primitive area that will respond in a subconscious fashion to environmental stimuli in an explosive manner. The Hypothalamus challenges the Pituitary Gland to induce the Adrenal Glands to produce Adrenaline leading to the “fight or flight” response. Note the location of the Pre-Frontal Lobe and the origin of Cranial Nerve X, the Vagus Nerve. Both these structures, as previously mentioned, are involved in influencing the effects of the Limbic System. A human will not survive if constantly in “fight or flight.” There must be a time to decompress, digest, rest and relax, i.e., rejuvenate. The portion of the autonomic nervous system that effects these restorative functions is the parasympathetic nervous system mediated by the Vagus Nerve. The chemical involved is acetylcholine. Moreover, according to the Porges Polyvagal Theory, the parasympathetic nervous system has dual but contrasting influences transmitted by this cranial nerve. The first is the primitive reptilian/prehistoric unmyelinated (not insulated by fat cells) dorsal vagal complex, targeting below the diaphragm initiating “rest and digest” thus, counteracting the metabolic depletions of sympathetic surge and potentially, with prolonged influence, may result in a “freeze” state or even unconsciousness, then death. The second is the more recently phylogenetically evolved myelinated (wrapped by fat cells) ventral vagal complex which targets above the diaphragm and coordinates the eyes, mouth, ears, facial muscles, expression, heart and lungs in creating: a) modulation of the SNS activity and b) a “release” of the sympathetic nervous system’s (SNS) un-discharged stored energy therefor, returning the brain’s chemistry to harmony and initiating affiliation, wellbeing and safety. I propose a “therapeutic time out” prior to discharge or separation in a safe place, out of the combat zone, not in the United States, where no stigmatizing records are kept, to allow the parasympathetic nervous system’s ventral vagal complex an interval to take charge in terminating the sympathetic adrenalin output and “releasing” the un-discharged stored sympathetic energy. The US Air Force, at their Deployment Transition Center in Ramstein, Germany is successfully applying this approach! Historically, most military personnel are discharged to “sink or swim.” They have not shed the “fight or flight” mantel; their sympathetic nervous system is still in charge. The ventral vagal complex has not been engaged therefor, resulting in the veteran’s inability to cope in a peaceful society and potentially disintegrating into PTS(D) and suicide. Here is where Alliance180 is a lifesaver! On that Thursday morning we were introduced to a horse’s hearing, sight, herd instincts, pecking order, senses, zones of comfort, anatomy, etc., by the very accomplished and experienced Melody Squier. That afternoon we were instructed in how to interact with a horse in the fifty-foot circular ring utilizing the information we were given that morning. Using a lunge line (a fifteen foot lead line) we lead an unfamiliar horse through the gate into the center of the ring. After establishing one’s presence, the horse is released and bolts (“fight or flight”) to the periphery of the ring and is prompted to canter along the rail by using motion of the lunge line while positioning one’s self slightly behind and inside the moving animal. After the horse begins to relax, one cuts across the ring at a diagonal, and forces the horse to change direction. Again he is prompted to continue moving, but begins to demonstrate signs of engagement by intermittently directing his inside ear and eye towards the veteran. After his direction of movement is changed back to the original, he slows to a trot, his head relaxes, and his inside eye and ear become fixed on the veteran. The horse stops. At that point the veteran’s gaze, which had been united with the horse, is averted and swept to the center of the ring. The veteran loudly exhales a deep breath. These activities stimulate the parasympathetic nervous system’s ventral vagal complex to create a mutual state of wellbeing (harmony). In the ensuing silence the relaxed horse submits and walks to the center of the ring and nuzzles the veteran’s shoulder. What a powerful moment! The horse and veteran are one! The horse invites contact! The veteran can’t help stroking and hugging the horse! Emotions are released and overflow! The “switch” has been thrown to initiate healing! An incremental release has been applied to the PTS, its un-discharged energy, traumatic stress and therefor, symptomatology. Watch this video produced by CBS Albany, NY to witness the release of the veteran’s tensions: https://youtu.be/CRN891Dk7Uc Now, what has been switched? I believe the restorative parasympathetic nervous system’s ventral vagal complex is switched on and acts to not only inhibit the sympathetic nervous system’s production of adrenalin but to also release the un-discharged (stored) sympathetic energy. When veteran and horse both enter the ring, each is in a “fight or flight” state: a) the veteran from his past military experience (Peter Levine’s un-discharged traumatic stress) in addition to the new horse exposure and b) the horse, since “fight or flight” is his natural default when thrust into unfamiliar situations. The horse’s brain lacks higher human neocortical function and controls, but it has the Cranial Nerve X (Vagus), memories and the ancient limbic system (Beast). While communicating in the ring, both veteran and horse gradually dispel the “fight or flight” sympathetic nervous system mode by engagement of their ventral vagal complex and embracing the restorative capabilities of the parasympathetic nervous system as it promotes the re-entering into a harmonious range of autonomic (sympathetic and parasympathetic) nervous system activity. Veteran and horse experience affiliation, wellbeing and safety. In my reading, the parasympathetic nervous system has only recently been considered important in PTS(D), addiction, and suicide. Perhaps its restorative powers are much more prominent and influential when harnessed than currently referenced. The positive results of the US Air Force Deployment Transition Center, a form of “therapeutic time out,” and Saratoga WarHorse certainly encourage the development of this hypothesis. Any effective prevention of, or intervention in, PTS(D) requires the restoration of ventral vagal complex physiologic authority. It appears the “Beast” should and can be harnessed to insure society a functionally reintegrated veteran. Not only the veteran but also our society will be the beneficiaries. Thank you, Bob, Melody, Brian, Janelle and all those who support Alliance180.