Being an introvert, I can usually pick up rather quickly on the “feel” of a patient who prefers the extroverted style of energy recharge. In fact, after about a half hour of a conversation with such an individual, I have usually sized up with adequate, for-the-moment accuracy how much “no-nonsense” energy I’m going to have to muster within myself for that individual–and thus whether, for the long haul, I’m the man for the job or whether a friendly referral to a more let’s-get-down-to-business colleague is in order.

With combat veterans who prefer the extroverted style, though, I end up with only a vaguely analogous feel. True, the end result is the same, i.e., a referral to a more “evidence-based” colleague (our current VA version of “let’s-get-down-to-business”) will be just as in order. Yet usually with extroverted combat vets some preliminary work is necessary, work that often can be bypassed with extroverts who have not gone to war.

You see, with extroverted combat veterans, there’s some Special Forces work I’ve got to do first before we can even get to “evidence-based.”

To start: all those who prefer the extrovert energy recharge come to psychotherapy the same way: pissed. Not angry, mind you, but pissed. Why?

Because their sadness, fear, shame, horror, all have forced the extrovert back inward, back to where they least want to be, back into the quieter, more individualized world of the hurting soul, back to foreign, if not downright hostile, territory, back to the spot miles away from their energy grid, their PX, their supply line “out there” in the world of social relationships and cherished goals.

For extroverted combat vets, though, the whole scenario ratchets itself up about ten levels, because not only have extroverted combat vets been forced into uncomfortable territory, they are practically being sucked into and absorbed by that territory, i.e., by their War Within.

Or as I might otherwise put it, by their Tractor Beam from Hell.

Extroverts come to therapy with one cry and one cry only, “Doc–get me outta here!” Extroverted combat veterans are no different; they exclaim the same. They do so, however, with a desperation that is sometimes panicked, sometimes defeated, but always one that sucks in and then threatens to absorb my breath in much the same way that The War has sucked in and absorbed their very psychological being.

For The War Within keeps demanding, keeps radiating, “Get back here. I own you now. It’s just us. There is no world out there for you. It’s just you and me, friend. You and me.”

Think of it this way:

The War is holding these combat veterans prisoner in an isolated cell of the soul, the dimensions and location of which the extroverted patient can’t even begin to fathom, let alone overcome. The veteran needs a Special Forces team that is familiar enough with the territory and with the language spoken there to allow one member of that Team (i.e., the therapist) to insinuate himself or herself just enough to procure access to the source of all the trouble (i.e., The War) and then to intercept the tractor beam long enough to give the combat vet time to dash out the side door and then run like there’s no tomorrow, back to Home Base, back to the world of social interaction, of focused goals in the outer world–back to the world of extroverts’ energy grids and supply lines.

In other words, when a combat veteran who prefers the extroverted energy recharge enters my office, I have to hunker down into search-and-rescue mode–and fast, baby.

It’s as if the veteran and I are caught up in the opening sequence of some Bruce Willis action flick in which the attractive protagonist, let’s say, the Ryan Goslings or the Scarlett Johannssons of the military world, slip me the piece of paper with the words Help Me scrawled on it, pierce me with a gaze that begs me to ignore whatever strength I see on the outside and realize the helplessness that they are feeling on the inside, realize that Ryan, Scarlett and I have precious little time, that if I don’t make my move right now, brother–and I mean right now–they will be whisked away to parts unknown, to fates, sadly, all too knowable.

My only problem? The War Within has beaten them, demoralized them, humiliated them to the point at which they believe that even if that tractor beam can be intercepted, they will not be able to move. They “know” that they are too wounded, broken, exhausted. They are no longer who they once were. They are shattered, incapacitated, with psychological legs broken, spiritual eyes gouged out.

So I have to put on my most insistent, my most  “don’t-give-me-that-s***,” my most  Bruce-Willis attitude and provide them some quick, to-the-point (as my father was often fond of saying) “gentle reminders” of just who they are, whether or not they remember that–or trust what they think they remember.

Yes, it’s kind of hard to imagine a psychoanalytic Bruce Willis. Believe me, I know. Try living it, why don’t you.

Yet we ain’t talking the couch here, friends. Somebody’s gonna die if this psychological room don’t get cleared and cleared fast. I’m paid the big bucks to know that. And to follow through.

Remember: I can play an extrovert on TV.

And then once the room is ever-so-temporarily cleared, it’s as if I relay to Ryan and Scarlett my final, staccato instructions, “Get down those stairs, hang a hard left, and you’ll see Jude Law/Nicole Kidman at the end of the alley. They’ll show you how to mentalize, how to sit with your out-of-control emotions, how to think clearly again, the whole nine yards. Trust me: they know what they’re doing. Learn what they say, do what they say–and then make a beeline back home like all get-out.

“Once you’re free, once you’re back out in the real world of energy grids and supply lines, you do just what they told you to do whenever that tractor beam refinds you–for refind you, it will. You do what they tell you over and over and over. And then you do it some more. Never look back. Stay close to the grid. Know where your supply lines are at all time. And keep moving, kid, keep moving. Got it?”

The lucky ones, of course, get a Brangelina for a therapist, someone who can both intercept and then instruct.   My patients have to make do with they have (i.e., me).

Still, you know what’s so wonderful about this job I have?

If you can just get an extroverted combat veteran to this point, he or she will take it from there.

Remember: all-volunteer military, all-intensity, all-the-time. Ryan and Scarlett are fast on the uptake and unafraid to plow ahead–once they have remembered who they are. They’re Ryan Gosling and Scarlett Johansson, after all. They’re hot. What more needs to be said?

They’re the easy ones.

Or shall I say, they’re the ones with the power grids, the supply lines to go back to. They’re the ones with families who are willing to do what they can to understand and adjust as much as they can. They are the ones who have jobs to return to or who have skills that can be more easily translated into the civilian world, the ones who find employers who respect them for their discipline and their loyalty, who are flexible with their physical and emotional challenges.

Thankfully, theirs is not a small group.

Sadly, though, it is by no means a large one.

Far more challenging, both for me and for the combat veteran, is the all-too-frequent situation in which the veteran returns home to a disillusioned spouse, a family that just doesn’t want to know, that just wants the combat veteran to “move on, why don’t you. I mean, you’re alive, count your blessings,” to a marketplace that just can’t seem to get it in their noggins that this ex-military, potential employee in front of you can learn whatever it takes as quickly as it takes–and multitask all the while getting three of the jobs done simultaneously.

In other words, far more challenging is the situation in which the combat veteran has, at least for the moment, escaped the clutches of The War Within, only to discover that the energy grids “out there” in their life are down and that the supply lines are nowhere to be seen.

This is not good.

You see, combat veterans who return home to a family and a world that is more accommodating, more encouraging: they reconnect with their extrovert recharge sources. They can get at least a semblance of their mojo back. They can begin to feel more alive again, feel the intensity being replenished. They can reboot and reclaim what it takes to fight off the inevitable pull of The Tractor Beam of The War Within, those feelings that arise on the anniversary of their best friend’s death, his birthday, the birthday of the kid whom that friend never saw, the smell of the air that reminds the combat veteran of boot camp, of AIT, the sudden realization that the guy behind the counter at the 7-11 looks, God, just . . . like . . . him.

The War Within never leaves. Its Tractor Beam never shuts off entirely. The extrovert combat veterans will never again be free to experience their energy, their energy recharges without having to keep some in reserve, without having to hold some back for that dreaded day when the beam refinds them, tries again to latch onto them, forces them to fight, even if briefly, a fight that they’d never before had to fight, forces them to do so year after year after year.

In short, it will never be as it was pre-deployment.

But if there are no energy grids out there to find, if all familiar supply lines have dried up, that last statement can become one that, if not addressed, will lead even the strongest Gosling or Johansson to despair, to drug dependence, to death.

Special Forces usually get in and then get out. They’re lucky. When I have to work with an extroverted veteran who has returned to chaos, to indifference, to rejection, I have to move from Bruce-Willis mode to Tom-Hanks mode, to the mode of the dogged persistence of the lawyer in Philadelphia and the unshakeable faith of Forrest Gump.

I need to realize that the combat veteran needs me–and absolutely hates having to need me. I have to be ready to bow out when the time comes, but not an instant sooner. I have to be ready to endure the slings and arrows of Ryan and Scarlett as they tell me–quite rightfully, I might add–that I have no clue how hard it is for them not to have family there to support them, not to know how to make new friends, not to be sure that they dare  re-connect with their surviving combat buddies, lest all of them remember what they’re trying their damndest every day to forget.

Remember:   inner world is my home, my source of strength. I know without knowing what it can offer in terms of life passion, quiet resolve. I indeed have no clue what it is like to live life without that knowledge.

My extroverted Ryan or Scarlett has no such similar intuition about the inner life of the soul. They come to me begging me to recharge their batteries just enough to get them through the next couple weeks, provide them enough nourishment so that they don’t lose any more psychological weight than they already have. They ask me over and again, with that not-so-quiet desperation, “When will it be over, Doc? When will I feel better?”

It’s easy enough for me to know that if they will just hang in there, just trust their extroverted selves enough to give themselves the space to plug back in as soon as they find an adequate grid, to ask for the food that’s theirs for the taking once they find a supply line that’s from reliable, friendly sources–then they’ll be on track to gather and use what their luckier brothers and sisters have already found.

It’s hard for both of us, though, to live that. Never impossible. Always hard.

Thank God, though: my Ryan, my Scarlett, they’re military, intensely-driven military. That’s what makes this difficult job of mine not only tolerable, but ultimately so rewarding. If I can just earn their trust enough to give me a shot, to accept by faith that I know what I’m talking about, that if both of us just hang in there long enough, a more-than-adequate grid, a more-than-reliable supply line will be found–if only I can get them there, then they’re golden. They’ll use that iPad in ways previously inconceivable to help them overcome many of the aftereffects of the traumatic brain injury. They will run the Indianapolis 500 Mini-Marathon on that prosthetic leg. They will lead a local Vet-to-Vet group, speak to a local Rotary Meeting, and let younger, less-faith-endowed veterans know that, yes, it is possible to get back your mojo.

Hard work–and faith–can pay off.

Yet it is at that point that I have to turn back to my fellow introverts, the ones who look at these extroverts and don’t fully understand the suffering that they had to endure to get them back to their grids, their supply lines. The ones who just see sprinting acts of scientific wonder, who hear testimonials that’ll bring a tear to Schwarzenegger’s eyes (let alone Willis’s), who wish, dear God in Heaven, if only my energy grid, my nourishment were “out there.”

Rather than sitting here, inside me, no more than a good ten feet away from The War Within.

It’s a whole different ball game for them–and for their therapists.

It’s not even the same sport.