Operator Syndrome: Reclaiming the Warrior’s Path to Healing

Editor’s Note: This 4-part series was adapted by Chris Frueh, PhD, from his book titled Operator Syndrome (2024; Ballast Books). The pattern of injuries and impairments associated with the Operator Syndrome framework is often seen in soldiers from the combat arms, private defense contractors, intelligence agents, law enforcement officers, and firefighters. Read Parts 1: Operator Syndrome: When the War Comes Home in Silence; 2: Operator Syndrome: Unseen Scars of the Elite Warfighter and 3: Operator Syndrome: Why No One Is Coming to Save Our Warriors.

“I took the position as Chief of Health to help address the problems my community faced. I knew we had problems. However, the injuries and impairments are even more widespread and more severe than I had imagined. No one should have to live in pain or in mental strife after years of serving their country as my brothers have. Fortunately, there are treatments and solutions that can make a profound difference.”
—Joey Fio, former U.S. Navy SEAL, Chief of Health at the SEAL Future Foundation

By now, I’ve loaded you (perhaps overloaded you) with information about Operator Syndrome. I’ve described the complex and interrelated medical, psychological, existential, and interpersonal conditions and impairments that are common in the military special operations community.

It’s important to remember these are the result of an extremely high allostatic load—the accumulated weight of physiological, neurological, and neuroendocrine responses. In other words, these are quite literally physiological injuries, at the molecular and cellular level, sustained over the course of an operator’s military career.

We’ve finally arrived at the solutions and treatments that can transform health, wellness, functioning, and quality of life. This article outlines a general approach to identify and sequence the assessments and treatments that may be needed.

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Comprehensive and Contextualized Medical Care

Be mindful: the best treatment approach for you—the operator, soldier, or first responder—will involve a multidisciplinary medical panel. Fields might include neurology, psychology, psychiatry, social work, internal medicine, sleep medicine, physical therapy, endocrinology, pain management, orthopedics, and regenerative medicine.

Ideally, this team would function cohesively, communicating directly to address all your difficulties simultaneously. A care coordinator would manage your journey—“bouncing the ball” of your care—and the team would possess a nuanced, contextual understanding of what it means to be an operator or to be married to one.

Got that? Right.
Fat chance.

As you probably suspect, there simply aren’t many programs like this. This means, for now, you’ll need to coordinate most of your care on your own. But don’t be disheartened—it’s quite doable for most.

For a quick review of Operator Syndrome, read our original medical paper. Don’t be intimidated—it’s written at a level most can understand and can help educate your providers about the breadth of your injuries.

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The Strategy: Navigating the Healing Process

This article aims to provide insight into necessary approaches, the importance of having a partner in the process, the likely obstacles, and—most importantly—a general sequence of assessments and treatments to guide you.

First, you really need a primary care provider (PCP). If you don’t have one, find one now. A PCP is typically an MD or DO but can also be a PA or advanced practice nurse. They serve as the “quarterbacks” of modern healthcare—conducting exams, ordering labs, making referrals, and managing your ongoing care.

We recommend a whole systems approach—one that takes into account your biological systems (e.g., nervous, circulatory, gastrointestinal, endocrine, musculoskeletal), cognitive and psychological functioning, and family/social systems. Who you live with, work with, and engage with all matter.

Enlist a trusted partner throughout the process. A spouse or long-term partner is ideal. A “swim buddy,” “battle buddy,” or “fire team buddy” will help too. They’ll hold you accountable, help solve problems, and call you out when things get difficult.

Also, expect logistical and funding challenges. Be assertive. If VA or insurance doesn’t cover what you need, reach out to benevolent foundations. Many offer referrals and financial support for treatments like hyperbaric oxygen therapy.

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Common Challenges in the Path to Recovery

You must take a proactive stance. Expect these barriers:

• Civilian society doesn’t understand what you’ve experienced or sacrificed.
• Bureaucracies may prioritize social narratives over your individual care needs.
• The VA and modern healthcare systems often misdiagnose veterans with PTSD, ignoring other conditions.
• Medical science lacks effective treatment for TBI, hormone dysfunction, sleep issues, chronic pain, and addiction.
• Modern medicine is fragmented—your therapist won’t likely speak to your endocrinologist.
• Insurance rarely covers novel interventions (e.g., ketamine therapy, psychedelics, sauna therapy).
• Few providers understand operators’ unique context and exposures.

Recovery requires assertiveness, persistence, and trial-and-error. It may involve “alternative” treatments and must include lifestyle changes—sleep, diet, exercise, relationships, and finding meaning.

Approach recovery like you approached your career: never quit, never give up.

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Recommended Sequence for Assessments & Treatment

Step 1: Are you suicidal? If yes—or if someone you trust thinks so—seek immediate help.
Step 2: Have honest conversations with yourself and trusted allies. Review the Operator Syndrome Scale. Evaluate your lifestyle—sleep, diet, substance use, exercise, relationships, etc.
Step 3: Get a PCP and schedule an appointment.
Step 4: At your PCP appointment, bring the Operator Syndrome paper. Request a full evaluation including:

• Blood lab panels (metabolic and endocrine)
• Heavy metals and parasites testing (related to deployments)
• Sleep study (polysomnography)
• Psychiatric and psychological assessments
• Orthopedic/chiropractic/physical therapy evaluations
• Neurological testing for TBI, cognition, migraines

Step 5: Attend all follow-ups. Identify clinical targets. Ask: What’s urgent and needs attention now? Consider immersive treatment programs if possible.

Step 6: Begin treatments. Likely therapies include:

• Stellate ganglion block (preferably bilateral)
• Ketamine infusion therapy
• Cognitive behavioral therapy
• Couples counseling
• Physical therapy or pain management
• Migraine/headache treatment
• Psychiatric meds (optional)
• Sleep therapy (CBT or iCBT)
• Addiction treatment
• Vestibular therapy
• Speech therapy
• Transcranial magnetic stimulation (MeRT)
• Hyperbaric oxygen therapy
• Vision/hearing treatments
• Regenerative medicine
• Psychedelic plant therapy

Step 7: Support your brain and body through lifestyle:

• Sleep hygiene (dark, cool, quiet room)
• Whole food diet (Mediterranean or DASH)
• Avoid processed foods, added sugars
• Supplements (omega-3s, D, turmeric, B vitamins)
• Intermittent fasting
• Minimize alcohol and tobacco
• Moderate exercise (walks, resistance bands)
• Recovery practices (sauna, cold immersion, meditation, yoga, prayer, nature time, float therapy, hobbies)

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AAR: After Action Review

Adjust. Adapt. Continue.
Never quit.

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Christopher Frueh, Ph.D. is a novelist, clinical psychologist, and professor of psychology at the University of Hawaii. He has over 30 years of experience working with military and first responder communities, conducting clinical trials and neuroscience research, and has co-authored over 325 scientific publications. This 4-part series is adapted from his book Operator Syndrome (2024; Ballast Books).

As the Voice of the Veteran Community, The Havok Journal seeks to publish a variety of perspectives on a number of sensitive subjects. Unless specifically noted otherwise, nothing we publish is an official point of view of The Havok Journal or any part of the U.S. government.