My worst traumatic brain injuries came from training, not combat, and Dr. Chris Frueh has a name for what that kind of load does to a man.
I opened this one by asking Chris a strange question. Can a guy have a war injury without ever going to war?
Your body is one machine, and it’s keeping score
Chris spent more than 30 years in the room with combat veterans and special operators, and he coined operator syndrome in a 2020 medical paper after watching the same picture show up over and over in hundreds of guys. Mark Gordon, who you’ve heard on the show three times now, introduced us, so this is the next turn of the conversation we started with Mark.
Here’s the frame. Everything the job demands piles up into what Chris calls a high cumulative allostatic load. Blast waves, head impacts, years of elevated stress hormones, wrecked sleep, broken circadian rhythms, the sheer physicality, toxic exposures, and the psychological freight of loss and grief and rage and being gone while your kids grew up. That load doesn’t pick one target. It hits the whole machine at once.
So operator syndrome is a constellation, not a single diagnosis. Traumatic brain injury. Sleep apnea. Low testosterone and other hormone dysfunction. Cardiometabolic trouble and a beat-up gut. Attention and memory problems. Hearing, vision, balance. Chronic pain and migraines. Depression, anger, anxiety, PTSD, and the addictions that ride along. PTSD can be one piece of it, and the full picture is usually far bigger than that one label.
The part that reorganized how I think about my own health is that the body is one connected machine. Wreck the sleep and you wreck the hormones, which wrecks the brain, which wrecks the sleep, a vicious cycle feeding itself. Chris’s hope lives in the flip side. Fix one node and the benefit ripples. Help a man sleep and his brain, his hormones, and his heart all get a little better. You can turn a vicious cycle into a virtuous one. For years I got treated one symptom at a time, a pill for this, a referral for that, and nobody ever stepped back to look at the whole system. Chris says that fragmentation is the trap. Walk into a psychiatrist’s office with low mood, low energy, bad sleep, and no focus, and you’ll likely walk out with an antidepressant, when the same symptoms can be low testosterone, or a dozen things talking to each other at once.
The spectrum reaches a lot further than the teams
Here’s where it stopped being only a veterans’ story. Chris is careful that SEALs and Green Berets sit at one extreme end of a spectrum, and a lot of people live further along it than they’d guess. Cops. Firefighters. Infantry and artillery. First responders. Anyone running high tempo on bad sleep for years, carrying a load the body was never built to carry forever.
That’s the answer to my second question, the one I should have led with. Can you have operator syndrome without being the operator? Yes, you can.
It’s also why this landed in the headlines. Chris walked us through Secretary Hegseth’s July directive to screen service members 30 and older for testosterone, which set off a firestorm from people reacting to a headline. The one-page memo that followed put the screening inside a larger health and performance effort built on the operator syndrome framework, and Chris, who’s been close to the people behind it, says the real version is broader and more careful than the outrage suggested. Screening gets offered, treatment stays optional, it covers hormones well beyond testosterone, it includes women, and it leans hard on inflammation and lifestyle before any prescription. You can argue the policy. The framework underneath it is the same one Chris has been building for 15 years.
I’ll be honest about what the name did for me. For a long time I quietly figured I was just a guy who’d gotten weak, or soft, or broken in some way I couldn’t fix. Hearing the whole mess described as one connected injury with a cause and a map did more for me than any single treatment. It’s a lot easier to go to work on a problem than on a character flaw.
The window
When I pushed Chris for hope, he reframed it around a lifespan. A 20-year-old needs prevention. A 50-year-old who’s been out for 15 years and never got anything sorted needs repair. Different work at different stages, and almost all of it reachable.
Then he described the move that opens the door for a lot of guys, a stellate ganglion block. It’s an outpatient injection into the sympathetic nervous system, the fight-or-flight wiring, with very little risk, and it drops a man’s baseline arousal. Chris says operators, cops, and firefighters live chronically jacked up, and after the shot the common report is some version of “I haven’t felt this way since I was 18.” Sleep improves. The hypervigilance eases. He’s kinder to the people around him. It isn’t a cure and it doesn’t last forever, but 3 to 6 months of relief opens a window to do the real work, the diet, the breathing, the therapy that finally takes, and from there the hyperbaric oxygen, the ketamine, the rest of it.
I told him I’ve done all that. My wife, a veteran herself, and I have both had the dual-side block. Will and I were just at an Anschutz event in Denver for veteran mental health where Dr. Shauna Springer was speaking, and the block came up there too. Which is the other half of Chris’s message, the half most men skip. This thing doesn’t only live in you. It lives in your marriage and it lands on your kids. He treats it as a partnership, tells every operator to bring a spouse into the room, read the paper together, have the hard conversation. He’s 39 years married and says plainly that his own health is better because his wife is in it with him. There are a lot of guys still getting handed one pill for a twelve-system problem…
What to do about it
Get the blood work and the sleep study. Chris’s first move for a struggling midlife man is a hormone panel, a cardiometabolic panel, and a sleep study, because the snoring is usually apnea. They’re simple tests. Ask your doctor for them, and bring your whole picture into the room, not one tidy symptom.
Stop letting it get treated one box at a time. If low mood, low energy, bad sleep, and no focus got you an antidepressant and nothing else, know that those are also the symptoms of low testosterone and a stack of other things. Ask your doctor to look at the whole system the way Chris and Mark Gordon do.
Read the paper, then have the hard conversation. Chris’s own homework: print the free Operator Syndrome 2020 paper, read it with a highlighter, and sit down with your partner to work out what actually fits you. Start by seeing where you stand with our free Awareness Self-Assessment, about 5 minutes: focusnowtraining.com/assessment-page. Paid subscribers, Resource 2 is the full workup to bring to your doctor.
Bring your partner in. This lands on your marriage and your kids whether you name it or not, and Chris is adamant that recovery works best as a team sport. Reply and tell me the one person you’re going to let all the way in on this. I read every one.
Run one recovery rep this week. You don’t need the whole stack on day one. Chris’s couch-level starter is breathing, meditation, prayer, or quiet reflection. Pick one and do it today, then reply with the one you chose and I’ll build a follow-up on how to stack them without burning out.
This week on Men Talking Mindfulness
Dr. Chris Frueh, spelled F-R-U-E-H, is a clinical psychologist and professor who’s spent more than 30 years in the room with combat veterans and special operators. He’s the lead author who coined operator syndrome in a 2020 medical paper, the author of the book Operator Syndrome, and his work spans operators across all four combat-arm branches and several countries. Mark Gordon introduced us, so this one picks up the thread we started with Mark. His book and the free paper are at ChrisFrueh.com. Will and I both took this one, on the injury you can carry without ever seeing combat, and the real, reachable path back.
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Awareness to Action is our 12-week self-mastery course and community, built to turn this kind of knowing into a daily practice with real men doing the work beside you. Text A2A to 33777 or go to FocusNowTraining.com/A2A-course. On the fence? Reply with the word A2A and I’ll tell you straight whether it’s for you.
Until next time,
Jon Macaskill and Will Schneider
Focus Now Training and Men Talking Mindfulness
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