Healing Combat Trauma

Instructions for Making Your Own Fatigues Clothesline Shirt

If you're intrigued -- as many veterans who've suffered Military Sexual Trauma (MST) are -- with Regina Vasquez' great project, "Fatigues Clothesline," which we wrote about, here -- and you're considering making your own shirt to send to the collection, here are Vasquez' instructions on how to do it: 

 My uniform...

I will use my uniform blouse as an example of what to use for the Fatigues Clothesline. You can use any uniform blouse as long as it is military-related.

Vasquez says, "This is the most important part of the project. Our veterans need to do this because a simple T-shirt won't do." Using a uniform shirt makes a much bigger impact -- "a huge statement that this (military sexual trauma) is not right, and creates a whole new level of awareness. No longer a battle of the branches but more of a sense of, "let's help each other heal."

Step 1

Start with a uniform blouse. If you want to use a dress blouse do so; you can use whatever uniform blouse you want. Make sure your name is not on the blouse you decided to use. I will take mine off when I am finished. Remember, we do not want to use any names on our uniform blouse. Our goal is to voice in a discreet manner what had happened to us while serving at the same time educate others. This is a strong tool if we use this wisely. This cause does not merit discrimination against sex, gender, or the branch of service you served. It affects everyone.

Step 2 

Turn your uniform blouse inside out. The reasons why I ask you to turn your uniform blouse inside out: We as Soldiers, Sailors, Airmen, and Marines at one point took pride or are still taking pride in serving our Country. We do so by wearing our uniform, by turning it inside out we are allowing others into our world by reading what affects us today. I cannot stress what a great opportunity it is to voice it in a discreet way by allowing others to read your story.

Step 3 

Write, draw, do whatever you want in order to tell people what happened to you.  

Reminder...

(Vasquez' advice):

It is taking me some time to finish, but I am doing it. Writing my story on a uniform blouse is so much different than on a regular white T-shirt. Just the texture and color alone gives me memories of what happened. Remember when you start, prepare yourself to stop when you start to feel like you can't take it anymore. Take some time out, listen to your favorite music, go for a walk, or simply talk to a friend. When you are finished calming down and you feel ready, start again. The rewards of finally being heard feels amazing. I am here with you 110% spiritually. If you are not able to finish, it is OK. I don't blame you. I blame the person who did this to you. You are not the one at fault. You are a remarkable individual and sometimes it takes more time to talk. It took me 12 years to reach this place I am at. You are not alone.

Editor's note: Send your completed shirt to Vasquez at the following address. The project is open to both male and female veterans.

Fatigues Clothesline

c/o Regina Vasquez

P.O. Box 194

San Marcos, TX 78667-0194

The Fatigues Clothesline Project: One Former Marine Making a Difference on Military Sexual Trauma

In true Margaret Mead spirit -- "“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has" -- meet Regina Vasquez.

Vasquez is a remarkable wife, mother of five(!), college student, and former Marine, with a great project underway that deserves widespread support. (The project is for both men and women veterans.) She writes:

"I am a Marine disabled vet who experienced Military Sexual Trauma along with gender discrimination.

One day while getting ready for college I had an epiphany and now I know what I need to do. For the longest time, for about 12 years I lived with the vision in my head of the two men raping me. About a year ago I got tired of it and decided to get help. I went through group counseling along with individual counseling only to find out that yes I needed to talk to someone and now I'm ready to make it public so I am able to help those who suffered like me move past it all.

I participated in a Clothesline Project for sexual trauma survivors. For this clothesline project we got to write or make art on our T-shirts by telling our story. When we were done we all got to hang it in front our town's courthouse on a clothesline, hence The Clothesline Project's name. 

I didn't mean to take a lot of attention away from the other gals because I felt they need the validation as well but my T-shirt gained so much attention. While standing behind them acting like an observer I heard complete strangers say "I can't believe this kind of things happen in our military" and such. 

This is where my epiphany came from: Why not bring the public in by making a "Fatigues" Clothesline Project for all the women and men who did serve and are still serving our great Nation? It will be discreet, meaning no names, but still be able to have some validation and justice for our souls. I named it "Fatigues" because one fellow veteran pointed out, it is what we were wearing while going through it all and after suffering for so long we feel fatigued. 

What I'm asking from you is to take time and I know how painful it is but well worth it in the end   because for some of us, we were denied our justice due to circumstances. For some of us we may not want to tell people what happened to us. This is a good tool in helping with the process. You will be able to tell your story and no one will know who it came from and still gain the satisfaction of knowing your story is being told and heard. I want you to do this for me, please take a uniform shirt and turn it inside out. Reason for turning it inside out, it's because even though we were raped, harassed, any kind of abuse whether it be verbal abuse or physical we still take pride in serving our nation but what we go through is what we cover up with that pride for our Nation by wearing the uniform. Freedom isn’t free, this is another way of telling the public what we endured for their freedom.

So I’m asking again, no names, your story on a uniform shirt turned inside out about what you experienced while serving our country’s freedom and in return earn validation, justice for your soul and a chance to be heard. 

My goal is to hang all the uniform shirts up in a year or a year and a half in front of our Nation’s White House so that everyone will see what we go through by serving for their freedom. I want to hang them up on a national holiday, Veteran’s Day, by next year or if not, the following year. 

This is a safe way of being heard for all of us. No command getting involved, no anyone but our freedom of speech through our uniform shirts. By doing this it will allow civilians a chance to better understand us and to educate them on the matter. 

Please send your completed shirts to:

Fatigues Clothesline
c/o Regina Vasquez
P.O. Box 194
San Marcos, TX 78667-0194

Says Vasquez, about the shirts: "I will take them, protect them, will not share who they came from and guard them with my heart till it’s time to hang them."

Editor's note: Please share this post (article) with anyone you know who may have experienced military sexual trauma. Not everyone will want to participate in the project, but many will. The outpouring of support from other veterans for this project has been impressive indeed. Said another MST survivor, "(MST) is painful, powerful and more common than people realize. Thank you for being our voice."

Instructions on making the shirts will follow in another blog post, but for more information, see this graphic, which clearly shows the applicability to men and women veterans.  

From the Canadian Side of the Street: A Military Author's Take on Veterans Suffering from War and PTSD

One of the many blessings of the new media -- social media like Facebook -- are the interesting, talented people one meets within that. One such person is Bonnie Toews, a Canadian former journalist and novelist with a longtime background in writing about the military. I forwarded her an article from the Montreal Gazette last week about social workers quitting because of burnout in Canada, meaning that fewer will be available to serve returning veterans with PTSD, and this is what she wrote on her website in response:

Outrageous failure of government assistance to returning Afghanistan vets

"It is wonderful that we celebrate the lives and courage of fallen soldiers when they are repatriated to CFB Trenton and paraded down the Highway of Heroes, but the question that is never answered: who looks out for the returning vets? Especially those whose minds, bodies and spirits have been shattered on a continual rotation of tours through the past eight years.

It is disgusting and absolutely unacceptable to hear that Canada's Veterans Affairs is cutting back on social workers because WWI and WWII vets are dying off. 

Excuse me, but Canada has a whole new generation of vets who have served in Afghanistan for eight years. By next year it will be nine years. The war in Afghanistan has lasted longer than either world war in the 20th Century and soldiers have been repeatedly rotated through three and four tours because our forces aren't large enough to handle a deployment this long and this demanding. These vets and their families need help to mend their lives back together. 

Kevin Dougherty in Montreal's newspaper, The Gazette, writes that soldiers suffering from Post Traumatic Stress Disorder can wait up to four months before seeing a social worker, a necessary step to integrate them back into society and return them to the labor market. 

Why? Because federal social workers each have a caseload of 40 clients to their provincial counterparts, who carry a caseload of 20 clients each. There are not enough social workers to contend with the need, and under such strained resources, these caregivers burn out, depleting veterans' social services even further. 

People forget that soldiers returning home are not the only victims of the wars they've fought. So are their loved ones, families and friends. They need as much social assistance as the soldiers themselves. Those coming home are forever changed. They have experienced things the rest of us can't imagine. They carry this psychological burden for the rest of their lives. 

In 1994, in Rwanda, I was briefly introduced to that world of theirs. I was one of the few North American journalists covering the massive humanitarian effort following the genocide against the Tutsis and moderate Hutus in Rwanda. One peacekeeper after another told me what they saw, incomprehensible mass slaughter with no human respect whatsoever and they were forced to observe because the UN didn't give them the mandate or size of force to quell the madness. Soldiers trained to fight and defend forced to stand down. Can you imagine the helpless rage they experienced? Yet, when I came home, I faced the same apathy from friends, co-workers and the public as they did. My husband proudly explained that I had been in Rwanda and time and time again I was asked, "Did you go there on holiday?" 

People didn't even know what was going on, and were indifferent when I chose to explain. I, like so many soldiers, learned not to talk about it because no one really cared to listen. 

This time the public must get behind their vets and demand the social services they deserve and need. This is the most important tribute we can give our returning vets for the sacrifices they've made on behalf of our country."

 -- Bonnie Toews. A longtime journalist reporting for logistics and private security magazines and now a novelist, speaks out for the victims of genocide and war, from the peacekeepers and coalition forces trying to save suppressed peoples to the children and innocent civilians caught in the crossfire of opposing powers, ideologies and cultures. Current writing "Trilogy in Treason." Member of Military Writers Society of America, American Authors Association and ACFW. Her website is linked here.

Editor's note: Find us on Facebook, here; follow us on Twitter @HealingPTSD.

Busting Out of the Bunker at Last...Made to Be Social Beings, We Die in Isolation

Following up on the "Bunker" post of the other day, about the protective isolation of the bunker for the combat vet with PTSD, it seemed high time to write "the rest of the story," about what the subject of "Eyewitness to Combat" sees now about the bunker mentality, and how and whether it's possible ever to overcome it. (So here's a picture of his bunker in Vietnam, to illustrate it.)

What follows are direct remarks from the vet, from a few weeks ago, about this exact topic. I'll add a few words where I have to, to keep the flow going, but the thoughts and the wording are his:

On the problem of the bunker:

"We are made to be social beings. We die in isolation. And that’s why when we withdraw into a hole, we are withdrawing into a grave -– just one that isn’t covered up yet.

With me I wanted to get out and I wanted to be with people. I wanted to enjoy my surroundings. I wanted to go to parties. I really did. I wanted to do that. But I had this deep ingrained fear that if I was around too many people, too long I would talk too much, say too much, and they would figure out who I really was, and not like me. And every place I went, it seemed that I was always pissing somebody off. Making somebody angry at me, and that rejection was more than I could handle. So it was easier for me to decide that I just hate everybody, and don’t want anybody around me but animals. And crawl back in my bunker, and hide. But then I would die there. Because what I really wanted to do was go back and be with people who cared about me, somebody who would love and accept me and who I could have fun with. Every time that something would draw me out of the bunker, I would do something stupid, have my PTSD moment, and have everyone around me direct me back to my hole.

We are supposed to be social; we are supposed to belong. For those of us who are Marines, we belong to one another, we belong to the Corps, we belong to the men who came before us, and the men who will come after us. We belong to something bigger than ourselves, and that’s what makes us Marines for life. This is not unique to the Marine Corps however; for we all have an innate, ingrained need to belong to something bigger than ourselves; to something that accepts our faults, that builds upon our good deeds, good qualities, that involves people. Be it religion, be it Indian culture, be it motorcycle clubs, be it national associations. We all have a need to belong. The problem arises in our isolation creating a void that is filled with the wrong associations/influences. For we WILL belong to something, good or bad; harmful or helpful. Churches prey on that need to belong. (We've both had bad experiences with churches, so we give the secret fist-bump to each other at this point.)  

Now, all veterans belong to one another. Their bond is in their service, that transcends the specific branches and time.

People go back in the bunker to heal, to hide from being hurt; or to hide from hurting others. They stay there and depression sets in; and they cannot get out by themselves. Someone has to physically go in and bring them out, just like (my guy friend, a Navy seal) did with me; just like you did with me.

He encouraged me; he listened to me; he understood me; he had been where I was. He said, "I don’t know how to help you; I love you; I care for you. But I know if you don’t want to do something, you wouldn’t do it. So what I want to do is share a dream with you that I’ve had since I got out of the Navy. Reasonable or not. But I need your help to do this. And when you feel like you can come out, call me. And he left a stack of papers about a foot high. I spent a week staring at them, and it interrupted my depression! And he'd put one of the most interesting articles on the very top. He had made me a part of what he was doing. I just wanted to be and do something that people wouldn’t hate me for; wouldn’t criticize me for. Because the aftereffect of ‘Nam was so bad, because we gave so much; and received so little. And we had done MORE than we could do over there. I just wanted to do something where people didn’t hate me."

(That Navy Seal friend is someone he'd previously helped himself; stood up for him so he wouldn't go to prison for his third arrest.) "I’m the one who walked in there and walked him out of his depression. Blood brothers, combat vets. He was a friend."

I mention the name of another friend of his, who he served with in Vietnam, who was injured on his same kill day/alive day, and who used to call him up to see if they could go be mercenaries in South America together. It all sounded like an elaborate, not so cleverly-disguised death wish. Very Butch Cassidy and the Sundance Kid. When I first knew him, there was a real pull to that. Now, further down the healing path, not so much. I ask him about that guy. A lot more reasonable now, he reflects, though he knows the allure, "That’s not the way to go; it’s not the way to make you happy. It’s just another way to get yourself killed. Problem is, sometimes it works; sometimes it doesn’t."

How much time has he spent in his bunker over the years?

"Years. Probably spent 20% of my life in a bunker, hiding, wanting to die, not having the nerve to shoot myself; hoping that the diseases and the meds would finally do me in.

I just didn’t know how to be happy. There was no joy in my life. There’s no reason to live. My family used to ask me, 'How can you look at what you’ve done, and tell me that you have no purpose in life? You don’t understand.' Problem was, I didn’t understand. I did not know why I didn’t have the capacity to have joy, to love anyone or to have fun. I just know I’d tried religion, I’d tried everything the VA could throw at me, in-house therapy, group therapy, self-help, medication, I tried working myself to death, I tried getting rich, I tried doing stupid things to harm myself (go back into combat situations), where maybe if I revisited it; I tried going to The Wall; and something would just not allow to want to live, or be happy, or enjoy being in my life. I couldn’t look around and see the flowers, let alone smell them. All the roses in my life were wilted; not because they were, but because of my vision of them was wilted."

My self-esteem, my sense of self-worth, my self-pity, and sense of total uselessness overwhelmed everything else. No matter how hard I tried, everything I touched was going to turn to shit. I heard it from my dad, and then I began to believe it was a generational curse. A curse is only a curse if you decide it’s going to be a curse. I understand the Universe. I understand me and the necessity of believing in yourself and believing in others. Politically the world may seem like a shitty place; but it’s always seemed like a shitty place. World’s always been a bad place, and it’s always been full of good people, and bad ones. And we have the right to choose the ones that we’re with. And we have the right to choose whether we’re going to be happy or sad, or doing something that’s worthwhile or not. Money is essential but money’s not the end. Money is only the means to an end, and yet we lose that perspective.

I’m no longer willing to let other people and their misery dictate whether I’m happy or sad. It’s up to them to walk through that door. Sick and tired of being sick and tired, that they’d rather die than continue on. Then they’ll walk through that door and want help and accept it. As long as they have one ability to resist, they will."

We talk about two guys we know, combat vets from different eras -- Gulf War and Vietnam. Neither one seems to really "get" where they need to go with this recovery stuff. When they're doing well, they're broadcasting their healing to the world; when they're down, they're completely off the grid, hospitalized for suicidal ideation and attempts. My mind reels from this. I wish when they were doing better they'd put more time into actually finding a way out; not just broadcasting it, so their lows wouldn't have to be so low, since their highs seem...unnaturally, or at least unsustainably high. It reminds me of a friend who says, about people who complain but do not attempt to solve, "It must not be bad enough for them yet." 

He weighs in: "They haven’t lost ALL their resistance. One of two things happen when people reach that level: they either commit suicide, or they get help. What makes the difference? A friend. A friend who can walk in under that and take them by the hand and walk them out. Just like in combat, if you get wounded, you can’t walk yourself out. Someone to grab you by the nape of your neck and drag your ass out of there. You can’t do it by yourself."

He continues: "If vets who have been healed don’t go and get vets who haven’t, then no one else will. In this situation the Marine Corps phrase of “we take care of our own” is literal; if we don’t, no one else will: not the vet’s family, not his relatives; no one. Only a vet can walk out a vet."

But yet, I helped you...and I'm not a vet. But you came looking for the help, too. He replies, "But you were a friend, a sincere, concerned friend. A friend like that, another vet; not the government...."

Editor's note: The photo above is of the "Eyewitness to Combat" Marine with two of his buddies, very Three Musketeer-y, circa 1966 or 1967.

Provider Burnout among Combat Stress Healthcare Practitioners

It's been interesting to follow the Tweets from the conference at Mass. General Hospital this Friday and Saturday, on the "Complexities and Challenges of PTSD and TBI." It sounds like it was a great conference. One of the items that stood out to me was the statistics being shared about provider burnout. Check these out:

"Not enough social workers, therapists, etc. to help all the people who need help."

"146,000 mental health providers in U.S. Medical Command (MEDCOM),...a huge centralized training that's re-assessed annually for improvements...now (with) significant training resources in place to help providers manage stress." 

Studies that MEDCOM has done indicate that provider "burnout" is approximately "35% among deployed psychiatrists," "20% in deployed psychologists," "15% in deployed social workers," and "26% in non-deployed." (Source: LTC Graeme C. Bicknell, PhD, LISW, LTC, MS, Deputy Chief, Behavioral Health Division US Medical Command.)

We've written about "Caring for the Caregivers" frequently on this website, most recently here, in a post entitled, "Too Long a Sacrifice Can Make a Stone of the Heart:The Tao of Self-Care." Acknowledging provider burnout is another aspect OF "caring for the caregivers." The takeaway? Combat stress injures troops AND mental health providers; servicemembers and practitioners alike need stronger support. 

(There's a great article by Charles Figley on the topic, "The Art and Science of Caring for Others without Forgetting Self-Care, linked here, suggested by one of the readers on the Facebook site for this website, which is linked here.)

Editor's note: You can follow the PTSD Conference, now over, on Twitter, @PTSDConference; and you can follow this website on Twitter @HealingPTSD.

Victimology -- The Temptation to Stay Stuck

Every behavior has a potential payoff, or we wouldn't engage in them. This is particularly applicable to people who have suffered for years, not months, with their situation, and where the groove has most definitely become a rut.The subject of "Eyewitness to Combat" talks about how being a "f*cked-up Vietnam vet" was a mask he could wear at times -- not that those times were always under his control -- in order to get other people to back off or keep their distance. Carolyn Myss, author of the New Age classic, "Why People Don't Heal and How They Can," talks about how attached people can get to their "wounds" -- to the point that they introduce them almost immediately into conversations with strangers, or overly bond with their friends and companions over them, with the ultimate experience being that it becomes very difficult for them to move on. "Love me, love my wounds" seems to be an unspoken demand of those too attached to their victim-hood.

This isn't to say that everyone who suffers becomes a victim -- nothing of the sort. Or that everyone who flaunts their wounds, so to speak, is doing so intentionally. But for any of us who have suffered, it's important to examine the unconscious temptations behind victim-hood, lest we accidentally fall into the quicksand and get stuck. 

Bev Smallwood, Ph.D., has a book called, "This Wasn't Supposed to Happen to Me: 10 Make-or-Break Choices When Life Steals Your Dreams and Rocks Your World." She talks about how different survivors of the same experience (say, Hurricane Katrina) might all suffer, but won't all adopt the same attitudes of victim, surviver or thriver. In a chapter entitled, "Poor me," she mentions several of the potential payoffs for over-identifying with the "victim" point of view: "'Victims' don't have to be responsible for their attitudes and actions;" "'Victims' get others' sympathy and support...for a while;" and "'Victims' feel self-righteous and justified." There's even a short quiz: "After all I've been through, I've learned that you just can't trust people;" "I admit that I have a tendency to blame others when things go wrong in my life;" "I often have pity parties;" "People have told me that I complain too much;" and "I feel angry when people try to get me to make personal changes and begin to move on. They just don't understand."

Contrast those self-defeating sentiments with those in the "Survivor's Pledge," which we wrote about several years ago, here: 

The Survivor's Pledge:

I will not be a victim.

I will rise above.

I will give back.

I will change the world.

There's also an ultra-fabulous chart comparing and contrasting the states of "victim," "survivor," and "thriver" -- with "thriver" being obviously the most desirable state, linked here. A wonderful OIF vet, with MST and PTSD, shared it with me a few months ago, and it's a keeper. When I shared it with the subject of "Eyewitness to Combat," another overcomer, he loved it too, and said, "PTSD is on the left, surviving is in the middle, and healing is on the right." As someone who's experienced all three states, that's how he chose to describe them... Not everyone is at the same place in their healing trajectory, but at the very least, it could serve as some inspiration for what improvement would look like, and how to get there...incrementally.

Quotable Quotes -- The Dalai Lama on Life Purpose and Satisfaction

That Dalai Lama -- he's amazing! If "personal outlook" were a software package, I'd ask for the Dalai Lama upgrade: because I like how he thinks. So compassionate and kind and reasonable, but not afraid of science. A fascinating, compelling combination. 

Some of his great quotes lately:

"We can't be useful to ourselves unless we're useful to others. Whether we like it or not, we're all connected, and it is unthinkable to be happy all by oneself. Anyone concerned only with his own well-being will suffer eventually. Anyone concerned with the well-being of others takes care of himself without even thinking about it. Even if we decide to remain selfish, let us be intelligently selfish -- let us help others." -- The Dalai Lama.

And another:

"Once you shift your focus from yourself to others and extend your concern to others, this will have the immediate effect of opening up your life and helping you to reach out. The practice of cultivating altruism has a beneficial effect not only from a religious point of view but also from a mundane point of view; not only for long-term spiritual development but even in terms of immediate rewards."

And another:

"The world's major religious traditions all give the development of compassion a key role. Because it is both the source and the result of patience, tolerance, forgiveness and all good qualities, its importance is felt to extend from the beginning to the end of spiritual practice. Even without a religious perspective, love and compassion are clearly of fundamental importance to us all."

And another:

"Satisfaction is characterized by inner peace. It arises from generosity, honesty and what I call ethical conduct, a way of behaving that respects others' rights to be happy."

---

Bringing this all back around to veterans with combat-based PTSD and their families, think how crucial what he's expressing are. Eighteen veterans a day kill themselves -- a shocking statistic -- and we seem to be at the beginning, not the middle or the end -- of that particular trend. Army and Marine suicides -- they see the bulk of the action, after all, in these wars -- are both up, despite the "best of intentions" on the part of the services to bring down the numbers. Pep talks on prevention and more prescriptions aren't solving the problem, nor are they likely to. Because, as one combat vet with PTSD said, "pep talks are hard to take seriously because that is for the normal life of a normal person, not for a veteran contemplating suicide because of combat trauma." True, that.

It's coming up on two years, shortly, of my first phone conversation with the combat vet, a Vietnam vet, Marine, with 40 years(!) of severe, chronic PTSD, which plagued his life, despite "all the best" of what the VA threw at him (his words, not mine), including an inpatient, residential PTSD program that was cutting-edge at the time. (Would it surprise you to know that most of his classmates in that program, according to him, are now dead, also from suicide?) After our first conversation, which seemed relatively pleasant and positive, he followed up with an email about wanting to drink and put a gun in his mouth to end it all, because he was sure God hated him; after all, he himself did. Sparkly stuff. Lots of unicorns and rainbows and fluffy clouds there...not one bit.

Of course, the end of his story is quite a bit more positive, mostly because it didn't end. He's made the transition from bleak, grim and grisly to mostly inspirational and awesome. And it took a while, a solid footing, a hand reaching across the abyss and pulling him up and out -- a hand which he importantly grabbed (it doesn't work if you don't ;-). It took some specific therapeutic treatments to help remove trauma from the body. We tried a few, intentionally, and they worked; there are others that might as well. And it took a huge motivation on his part to reach out -- however ugly his mess at the time -- to get some help and be real about where he was really at. For years, decades really, he'd been the one other vets' wives called to take the gun out of the mouths of their husbands. Now he finally had some hope to offer others. But it took commitment on his part, believing that the hope was out there, and going after it with all he had. Not always pretty, but effective :-)

(He's the veteran in the "Eyewitness to Combat" series on the site. Here are two items about his turnaround, linked here and here. The second is in his own words.)

Anyway, the upshot of the whole experience is wanting to build a program to bring other combat veterans with PTSD through, and help their families as well, who are often left holding the bag (of misery) but not really getting the help they need either. Combat veterans with PTSD have often lost their life purpose completely, and as we've been talking about lately, purpose is key.

The "eyewitness to combat" veteran, described above -- he and I share a purpose. It's helping others overcome. It's possible. And as the Dalai Lama says, that's being intelligently selfish -- taking care of those 18 vets a day who'll be killing themselves, BEFORE it happens. So it doesn't HAVE to happen. That's the best use that you and I could put our time and energy and compassion to. Please join in helping others so that they don't have to suffer so intensely, when there is a way out.

Editor's Note: A California-based psychology grad student is doing a Ph.D. thesis on Iraq vets with PTSD and life purpose. If you qualify based on the above criteria, he'd like to talk to you, and will pay you $50 for your efforts if you participate. Here's the link to his study. His brother is a combat vet. 

Additionally, you can "follow" the Dalai Lama on Twitter -- @DalaiLama -- and you can follow us on Twitter as well @HealingPTSD.

Prevention Talk and Prescriptions Apparently Not Doing It: Army and Marine Suicides Both Up

"The grand essentials of happiness," Allan Chalmers wrote, "are something to do, something to love, and something to hope for." Those words echoed in my mind yesterday when I met a remarkable woman vet in Seattle, who ten years ago was homeless, suffering from MST and PTSD. (Today she's a vital, contributing member of her community, solving problems for herself and other veterans in need, on a large scale.) 

We were talking about suicide prevention, a cause close to her heart, because she'd lost a daughter to suicide, and recently a friend as well (Orrin McClellan, who we wrote about recently on this site.) We were talking about suicide, and how Army and Marine numbers are still up, despite prevention strategies. She said, pointedly, that she'd learned that veterans (and others) who are struggling with suicide need "three things" in their lives to keep from killing themselves. What they need are: "a reason to live, a way to live, and a purpose to live for."

Salon magazine had an excellent but gut-wrenching article earlier this week by Mark Benjamin called "A Predictable Suicide at Camp Lejeune," subtitled, "A doctor warned that mental health care for violent, disturbed Marines was inadequate. Sgt. Tom Bagosy proved it." The story profiled the violent death of Marine Sgt. Tom Bagosy, 25, on the way out of the Deployment Health Center. (Bagosy leaves a wife and two children.) Less than a year ago, Salon had run another article by Mark Benjamin about a Marine Corps psychiatrist, Dr. Kernan Manion, and his specific, whistle-blowing warnings about the inadequacy of mental health care at Camp Lejeune -- warnings he took all the way to the president, and seemingly for which he was fired a few days after voicing them. (Here's the link to that earlier article, including his warnings.)

Marines initiated a new suicide prevention program last year; but suicides have only increased. They lead the services at this point. Army numbers are up as well. According to a report released Thursday, and carried on CNN, 32 soldiers killed themselves in June, "the highest number in a single month" since Vietnam. Twenty-one of of the soldiers were active duty, 11 were inactive Guard or Reserve; and seven of them killed themselves while deployed. A quote from the article, "Army officials admit they still haven't answered the question of why troops are committing suicide at a record rate."

While Marines sometimes mock the Army's slogan of an "Army of One" -- preferring instead to focus on the group -- the reality is, both branches are seeing heavy combat and neither one is excelling at helping troops not commit suicide. New programs get trotted out, new initiatives, new videos. But none of them are getting the job done: not alone, not together. Troubled troops and veterans are simply not listening; or not hearing what they need to hear. And what would that be?

Well, Mass. General Hospital is having their second annual conference right now on the "Complexities and Challenges of PTSD and TBI," and they're doing a great job "Tweeting" the speakers' points in real time. Here are a few excerpts of note, starting with a crucial one: "Only 30% of troops self-identify as needing help before committing suicide -- despite all the proactive intervention points." And again: Only 42% of troops who screened positive for mental health problem actually sought help from doc or spiritual advisor." PTSD is initially difficult to distinguish in troops because upon their return home, "initial relief and euphoria" at being back can mask it. But over time,"After 8-10 weeks and adjusting to a different life schedule at home, symptoms start to present."

This fits right in with the stories you hear from people coming back, that they don't want to talk about it or think about it (PTSD); they just want to get on with their lives, and fit right back in to where they were before. It's later on, when this adjustment doesn't work, that things get more stressful. High unemployment can't help: veterans' unemployment is significantly higher, in the recession, even that the national average. And troops have gone from being highly focused on the battlefield and engaged in their warrior purpose to losing that and perhaps not being able to replace it immediately with another. They've also gone from a high level of camaraderie with their buddies often to being quite geographically separated from those they were close to when deployed. Marriages and family life can be rocky as well. The relationship they were dying to get back to on the battlefield may have evaporated by the time they got home; or not make the adjustment intact. Again from the MGH conference: "78% of marriages end in divorce for first-time deployment troops."

Against all these backdrops of difficulty -- and an awareness that the "gold standard" of treatment is still talk therapy and psychopharmaceuticals -- the problem persists, compounded by sleeping pills that can be dangerous, and the ever-present self-medication strategies of alcohol and street drugs. It's hard to get the formula right for the correct medication(s) at the correct dosage(s), and until that happens, veterans frequently talk about feeling numb, in a stupor, not feeling like themselves, etc. Vets don't necessarily want to talk about what they've been through -- except perhaps with one another, and even then, not that much -- and ignorant questioning about how many people they've killed while they were over there, etc., just exacerbates the problem. So enough of the bad news...of which there is plenty...what can vets possibly do to increase their chances of surviving and adjusting? Because I highly doubt it's gonna be another prevention video or poster that does the trick, however well-meaning.

If everyone wants an easy answer, maybe they won't like this. But it seems to be that it's time to return to replacing one purpose (warrior) with another (warrior on the homefront), and putting some time and thought, effort and resources into what that will be. One veteran who made the transition from serving to the fire department, felt he literally replaced his one purpose, and one set of buddies with another; and that "substitution of purpose," as it were, was what helped him survive. But not every vet will be so lucky, or have or make that opportunity. 

If we take a look back at the Chalmers quote that opened this discussion, what are the three "grand essentials" for happiness (i.e., well-adjustment) that he cites? Something to do, love and hope for. And what are the three things that help a vet prevent suicide, according to the suicide counselor vet? Three very similar things: a reason to live, a way to live, and a purpose to live for. Veterans are warriors...and cast aside from their purpose, without an effective way to replace that immediately, it's possible they flounder. As a society, as those who "support" our troops -- whether professionally or personally -- what can we do to make sure that they have all three? With a little reflection, we can see where they had them in combat. Something to do (be a warrior); something to love (family, country, buddies, the mission); and something to hope for (winning; getting back home alive; reuniting with family and friends; keeping your buddies alive). What I suspect, sadly, is that from those adrenaline-charged heights, life on the home front, potentially unemployed, over-medicated, and disconnected from family and friends, there can become a time when there's not enough "reason" to live; there's not enough way to live; and there's definitely a loss of purpose to live for.

A better use of resources than more videos, etc., though would be: focusing on what would it take to give veterans their purpose back? And not entirely how could be do it for them, but how could they join in that mission themselves? Every veteran affects the lives of 50 other people, minimum; so whatever happens with them back on the home front is a ripple effect. Let's focus some energy on the topic of continuing life with a purpose; versus watching on with sadness and despair the continuing tragedy of young vets (and older) taking their own lives. They've given too much; and they deserve so much better. So while pep talks on prevention and prescription pharmaceuticals don't seem to be doing the total job when it comes to suicide prevention, maybe it's time to bring back talk about purpose -- and how to continue that successfully, after the deployment is over and the uniform is hung up for the time being.

In a related side note, apparently mental health plummets when distressed individuals can't "do" to solve their situations with personal effort. There's been talk in the news lately about mental health issues soaring in the Gulf states after the BP eco-disaster, and that money needs to be set aside to help with those; but in that, there's also discussion of what happened after Hurricane Katrina. Apparently, after the hurricane hit, those affected started immediately to do what they could to restore their lives. (Think of all the news footage we've seen of residents after large-scale disasters, sawing up downed trees, hauling lumber to shore up makeshift housing, etc.) What's now surfacing anecdotally are stories about while this busy-ness after the disaster was therapeutic for people -- helped them to get their minds off the tragedy by putting themselves back to work -- when FEMA came through and made everything grind to a halt while they inventoried the situation -- people's grief and despair rose up in waves, with nothing to "do" to distract them.

Much is made of the "adrenaline rush" of combat, and how it's very hard (hmmn, likely impossible) to match that in civilian life -- but at the same time, there's also definite "purpose" -- of getting the job done, of keeping your buddies alive, etc. After combat...it's suddenly very quiet, and boring by comparison. "War is hell, but peace is boring!" some veterans joke. Cast adrift without the shared common and energizing purpose of combat, in their early 20s, veterans need quickly to find something to "do" that matters to them -- something they can live for, love and enjoy, that satisfies them and makes life worth living. Sadly, far too many people are checking out when they can no longer find a reason to live, and in tragic stories like that of Marine Sgt. Tom Bagosy, or Orrin McClellan, you get the impression they don't feel like they had any other choice. Tragic. Not just for them, but for the people they left behind, whose lives will also forever be marked by this experience. Such a tremendous loss...and possibly, preventable: If not for them, at least for some others. Let's try.

Quotable Quotes -- Rob Brezsny on What Qualifies as "Information" on a Subject, Even PTSD

Here's a great quote from American free thinker Rob Brezsny. I like it because it goes to the heart of what we're trying to do on this site. It's not the "same 'ol, same 'ol" -- it's an attempt to get people thinking differently about a topic that ruins many people's lives, yet within which there is still to be found a certain amount of hope.

This website has been going on for almost five years now. Tens of thousands of hours worth of researching, reading, interviewing experts, thinking and composing the almost 800 articles on the site, 200 recommended books, and dozens of experts. We when started, back in very early 2006, there really wasn't anything out there about PTSD and veterans on the Web, for troops coming back from the wars in Iraq and Afghanistan and their families. I Googled it plenty to make sure I wasn't intruding on someone else's "space." In fact, Ilona Meagher was starting her work at about the same time, but Google hadn't picked up either of us yet. A few months later, when I found her site, I made a point not to read it, so that we could each keep to our original point of view, and not be accused of overlap.

I even chose the name, "Healing Combat Trauma," in a fit of inspiration -- because it was expressly intended to give people HOPE, who might be lacking it, or beaten down by the sheer overwhelming nature of what they had, that they could still get better. Something to cling to, that might help move them out of a state of despair, discouragement and demoralization into a sense that there was something still worth looking for, not to mention living for. "Without hope, the people perish" -- the Bible says. It's a very true statement. And there's nothing like illness to make people give up hope, because of feeling poorly in body, mind and spirit.

Today, almost five years later, the "landscape" surrounding this topic has changed quite a bit, but it's also heartening that people are beginning to find that we're out there and like what they see. The need is greater than it ever was. At least 18 veterans a day kill themselves because they've frankly given up, or feel too miserable to carry on, with the "best" of what they've been offered from the status quo (which fortunately is also improving, but maybe not fast enough, or in enough flexible directions to satisfy the need.) I made a decision early on that I didn't want to "just" report the news -- "misery everywhere! report at 11" -- because that was too easy to do, and didn't require any original thought. We're not cutting and pasting here; we're reading, analyzing, thinking, and talking to people who know -- and then sharing that information with you. 

And there's a certain amount of resistance. On Facebook, where there's a fan page for this site, linked here, with approximately 2,500 members, people occasionally recoil in horror when they read the title. "Healing" Combat Trauma? Why, they sputter, you can't HEAL combat trauma -- my doctor said so! And I just saw him. Of course, we've covered that topic, ad infinitum, but the basic interpretation is, there's a difference between "healing" and "curing" -- and healing is a nice continuum of improvement from bad to better that anyone can jump right on, at any given time -- especially when they're ready to, and not a moment before. "Healing" isn't something you want to drag unwilling people into; but it's also something that is available for those who want it, at whatever degree they can access it. (Even the VA, at least at the level of the National Center for PTSD, and their clinical training which I got to attend in May, is talking about switching the emphasis from a focus on "symptomology" to "functionality" with PTSD -- a needed improvement.)

I had the "healing versus curing" conversation many times with the subject of "Eyewitness to Combat," whose own story of great improvement is highlighted here, in his own words. After going to one treatment or another that appeared to improve him, he would be excited about thinking that he was now "cured" -- despite 40 years of chronic, severe PTSD, and having tried most of what VA had to offer, including a stint in an inpatient, residential treatment program for PTSD that was cutting edge at the time. I tried to explain to him, patiently and not always successfully, that healing wasn't a toggle switch between "ill" and "well," but a path from one to the other, which he was now on, and which he'd continue to be on, through the various things that we'd try and the progress that he'd make. It's also something that doesn't always need a practitioner to facilitate. Practitioners are important, but there are also things that a person can do for him or herself, to improve their overall health and well-being. And sometimes it's important to wedge people's minds open just a little tiny bit...in order that they can encounter something new, that might change their world view, which might (ultimately) help change their lives. Worth it.

Which brings us to the quote of the hour. It's an interesting one, because Rob Brezsny hones in on how something people aren't used to -- the idea that you can "heal" PTSD, for instance -- ruffles some feathers, and shakes some people up. But if they already knew it, what would be the point of hearing it again? Sometimes we have to step away from our preconceived ideas about what "can" and "can't" happen to enter the realm of the possible. In sickness, which is so laden with discouragement and guilt -- as well as hype and manipulation, sometimes -- that's no different from any other area. So let's see what Brezsny has to say about what qualifies as "information" on a topic:

"Let's define information as data and ideas that are new to you. If it's something you already know, then it's trivia or propoganda or dogma, not information. In fact, let's be tempted to use the terms "information" and "novelty" interchangeably. If you're not surprised, if your curiousity isn't piqued, then the message streaming your way may not qualify as information." -- Rob Brezsny.

Going to the Bunker: A Combat Veteran with PTSD on the Purpose of Protective Isolation

Every combat veteran with PTSD knows what is meant by their "bunker," or what "going to their bunker" means. It's a walled-off, isolated situation that allows them to get some space to themselves, away from other people (including family and friends), when they feel particularly triggered, and they need to stay in there for, well, as long as they're going to. They come out when they're ready, and not a moment before. Obviously this situation can be very frustrating to others in the vet's life, but for the vet it affords him or her some very necessary, protective isolation.

The rest of us who aren't combat vets with PTSD I suppose could think of it as the vet putting himself or herself in a time-out from the world, by taking themselves out of the mix, and away from people and stimulation, both bad and good. And the time-out will be over when it's over, because they decide when it's up.

The recent Fourth of July with its fireworks that remind many vets of combat was a classic bunker situation. Many, many vets were making plans before the Fourth for how to protect and insulate themselves from being triggered by the fireworks (noise, smoke, crowds). One Gulf War vet with PTSD who had already isolated himself, wrote of putting a pillow over his head and just wanting it to be over, so that he didn't have to experience it. The next day, fireworks all exploded, he was better. But during, he had to be in the bunker. Another combat vet with PTSD, from the Iraq war this time, talked about staying in her bunker for days, making brief provision runs, every fourth day or so, to the grocery store and then...back to her bunker. When she needed to be in her bunker...

The bunker concept/construct is so typical to combat vets with PTSD that I thought I'd ask one who I know fairly well how he'd describe it. He has decades of PTSD "experience" under his belt, and I've also seen him retreat to his bunker at various times. A month one time, a week another time, the last time, a day. Sometimes even a few hours. But however long the episode lasts, during that time: totally unreachable. And realistically, you better not even try...because it just makes the situation worse. 

The more chances I've had to experience this with him, the more certain I can be that, short time or long, he'll emerge from his bunker, when he's good and ready, and with a new and improved outlook on why he went in the bunker in the first place. (For those who don't know, the bunker can be anywhere...a shed, a garage, a spot in the woods, a room in a house, even a chair. But it's sacred, inviolate, untouchable space...and the vet goes there in retreat, partly to spare those around him, but also strongly to get control over what he's feeling. (He or she, obviously.) So I figured he'd be able to offer his personal/expert advice on this.

Here's how the conversation went.

Me: "What typically sends vets to their bunkers?"

Him: "Any situation -– losing a job, losing their cool, a fight with their kid -- that makes them lose control sends them back to their bunker, so they can regain control. It may not be much, but while they're there, at least they have control over that little room they're in."

Me: "What's the longest time you've ever spent in your bunker?"

Him: "A year."

Me:  "!!!"

And then he clarified. (Remember, this is just his opinion, but it's worth sharing, because of the number of vets he knows and has observed, as well as what he knows about himself.) "Each time a vet goes into their bunker, they go in for a longer period of time. Until one time they go in and they don’t come out." (He does know an awful lot of other vets who have sadly killed themselves. That happens in bunkers, too. No wonder families and friends are justifiably concerned.)

The progression he just mentioned...vets spending longer and longer times each time in their bunkers...is actually the opposite of what he's been doing, since I've known him (which coincides with his getting better). Each time he goes to his bunker, it's both less frequent, and for shorter and shorter times each time, to the point that the last "bunker" episode I observed him in was actually only about half an hour.

In the middle of a frustrating conversation, not quite an argument, but one where emotions were high and we weren't communicating smoothly, he "withdrew" to his bunker of self-enclosed, protective space -- without moving from the couch he'd been sitting on. I saw him cross his arms, very agitated, close his eyes, and start doing something that looked like huffing and puffing. Even on an animal instinct level I knew, give this person his space. All the body language was daggers. I stepped away, and a short while later, he bounced back, and resumed where things left off, able to manage the conflict without any undue strain. Turns out what he'd been doing during the huffing and puffing phase was actually deep breathing, to calm himself down and regain control. Very smart. On the outside, he looked furious. On the inside, he was doing what he could to get back under control. As a result, he was able to "emerge" from his bunker in record time -- which speaks to the tremendous benefits of learning coping skills and stress-reduction techniques, as he has.

When I first knew this vet, he talked about what he'd learned at an inpatient PTSD program at the VA years ago. It was the cutting-edge program at the time, and he speaks of it with great appreciation, even though many of the guys he went through the program with sadly did not make it. ("Did not make it" is euphemistic code for "sadly, later killed themselves.") One of the biggest things he learned in the program, according to him, was about "red flags" and "triggers," and how to get away before you make things worse. Heading for the bunker, just like in the description of the vet with the pillow over his head,  is one way to keep things from getting worse. For the vet, that is -- for the family or loved ones, it's very difficult to experience, and hard to ignore, though one of the secrets seems to be, going on with your own life, while maintaining a compassionate (but not nagging) concern for how they're doing.

One of the distinctions he likes to make, though, between what he learned from the behavioral modification skills, above, in the VA program, and what he's learned since then, following more of a healing path, is that now he has some ability to not just "avoid" triggers but also "deal with" situations as they come up. The red flags still show that the problem is coming, but instead of being ONLY triggered, there are now new ways to deal with it that don't only involve avoiding or isolating.

The situation above, of being in conflict but being able to "be" with it, and breathe through it, meant that the conflict didn't have to explode into a multi-day saga or a physical exit to an actual bunker, which could last for weeks or months -- or even a year(!) Ahhh, progress is a beautiful thing...

Editor's note: For Part II, "Busting Out of the Bunker at Last," go here.

Quotable Quotes -- Rumi on "There Is Another View..."

We haven't shared any more quotes about the Tao of Healing lately, although there is a whole series of them on this site, linked here. However, this one, by 13th century Persian mystic philosopher Rumi, while not strictly "about" healing -- nevertheless speaks directly to the change in "vision" that's necessary in order to rise above the discouragement and defeat that sickness or disorder can imply. 

There's a famous Einstein quote that (paraphrased) says no problem can be solved at the same level at which it was created; it always needs a view ones step higher. This quote from Rumi reinforces Einstein's point, but I choose to look at it as how to view illness and health...

"Are you searching for your soul? Then come out of your own prison. Leave the little stream and join the river that flows to the ocean. Like an ox, don't pull the wheel of this world on your back. Take off the burden. Whirl and circle. Rise above the wheel of the world. There is another view." -- Rumi 

Veterans, PTSD and Suicide: The Overlooked Element of Contagion

This is an article I'd first started writing two years ago now. I did the research, and located the main, most often-cited study's principal investigator, long since retired, and asked him to confirm whether the trend is still true, though he first published it back in the 1970s. He affirmed that it was. What it is is an important and often-overlooked "connection" that will make more sense when we start describing it. It also fits into the category of things where the information is out there, but for some reason is also strangely ignored. Another instance was a few years ago, when the military kept saying, "We don't know what PTSD is tied to"; essentially, "we have no idea." Yet at the time, and this goes back several years now, I was able to read through the existing literature and learn, PTSD is tied to combat exposure. In other words, the more combat, the greater the chances of developing PTSD. And I wrote about it, here, at the time the military was saying, in essence, we don't know what it's linked to.

So it isn't that that wasn't known...it's that no one was paying attention to what was out there. (And these days, several  years later, they ARE admitting publicly that more exposure = greater chance of developing PTSD. But it does make me laugh a little bit to hear that now, thinking, we were talking about it here well before that was being said publicly. And not because of some strange prophetic abilities on our part; just from reading the available literature, and drawing what seemed like obvious conclusions.)

There's the old saying that "those who refuse to learn from history are condemned to repeat it." Well, much of what's known about PTSD has been known for decades now, with another fair part of the knowledge base has been increasing exponentially. I read an article the other day about a Harvard-trained psychiatrist who worked at the V.A. in Boston during the Vietnam war, and was "shocked" to learn that there wasn't a single book on war trauma in the library there. Today, one would hope, that situation has changed quite a bit. 

But to the point at hand...

As I read through my Twitter feed today (you can follow us @HealingPTSD on Twitter), I noticed several suicides being Tweeted by various sources. One was that of Mel Turpin, a former All-American basketball player and NBA star, dead at 49; and then the troubling news, especially to us in the veterans community, of a Marine Corps veteran, James F. Popkowski, 37, who apparently died in a "suicide-by-cop" or armed confrontation outside the V.A. in Bangor, Maine. (See those stories linked here and here, as well as a longer quasi-obituary of Popkowski, here.) At first the headline said only "an armed man" had died in a confrontation with police near a local VA -- and as soon as I read that, I hoped -- but yet somehow knew -- that it would be a veteran, with a painful story of his own. Later the news matured to show that in fact he was a veteran, who was struggling with this illness (cancer) and its treatment. But the fact he was a veteran and committed suicide reminded me instantly of the news from the last few days, where the Seattle Times did such a good job covering the suicide of a veteran with PTSD from Whidbey Island, Orrin McClellan. (I wrote about Orrin's life and death here and here.) So many suicides in the media, and superstitious types tend to think those run in threes -- though technically McClellan's death was in mid-May, with the coverage of it in the media happening over the last few days.

I need to branch off in two different directions here, to cover this material. 

One is to talk about the V.A. suicide's statements about his own condition, because veterans with PTSD and their family members may recognize their own veterans in those words. And the other is to introduce something very different, which is the effect that media coverage of suicides has on "successful" suicide attempts by others during the same general news cycle, especially young men (who are, after all, the majority of those who serve.) 

On that second point, as the military has generally speaking tried and failed to lower the suicide rate lately, I haven't seen much recognition (OK, any) of the idea that suicides are to some degree contagious. There's quite a bit of medical literature on the subject...and it's been documented in studies around the world, starting in the 1970s, that suicides reported in the news will have a demonstrated effect on increasing suicide attempts from specific populations who hear the news. Since suicide is a broad category -- many single-car or single-motorcycle accidents are also suicides -- and the military attempts periodically to crack down on motorcycle safety, etc., it would also be wise to enlarge the conversation to not only what other methods qualify as suicides, but also to take a look at how one suicide making the news can, depending on how it's portrayed, have an effect on increasing the number of other suicides that take place in the same general time frame, especially among those prone to committing suicide, because of depression and other factors. And we haven't even mentioned yet here the effect that some prescribed pharmaceutical medications can have on increasing suicidal thoughts.

(While it's somewhat unlikely that Popkowski, in Maine, was reading the Seattle Times' coverage of Orrin McClellan's death -- one, we never know; and two, in the age of the Internet, geographical barriers have disappeared and the news is instantaneous -- especially if you include other social media, like Facebook and Twitter, which can serve as additional sources of the same news. We're so much more wired now than when these studies first started being done, so we can't assume Popkowski didn't read the Seattle Times coverage, even though it's most likely that he didn't. For the sake of this argument -- because if it didn't happen with this case, it surely does with others, let's pretend that Popkowski did spend some time over the last few days reading the coverage of McClellan's suicide on the Internet.)

There's enough material to cover here that I need to go as far as I can with it now and then circle back around to it again soon. We'll introduce the science (below) but also cover what Popkowski said about his failing health, because his words will resonate with other veterans, who struggle not with cancer but with PTSD.

According to the article in the Portland, Maine Press Herald today, Popkowski, who had undergone a stem cell transplant for his cancer back in 2003 at the National Institutes of Health, struggled valiantly with the effects of the cancer and its treatment (both difficult), as well as sleep problems, depression and the like. In a letter to the editor of the magazine "New Scientist" back in 2008 he wrote,

"Suicide is like a little devil, always on my shoulder and always tempting me. Concern for the care of my three dogs after I am gone, my dogs being the only things I feel anything resembling passion for, is the only thing I think that has kept me from pulling the trigger on the loaded pistol, which rests next to my pillow."

He continued,

"The best way to describe the mental and emotional issue is that I am numb and passionless. Nothing brings joy or pleasure. I graduated magna cum laude with a (Bachelor of Science degree) in computer info systems and business management in just three years. Now, I cannot mentally focus enough to read a newspaper."

He added,

"I have lost count of the number of sleep aids NIH and my local VA have tried. Like the anti-depressants, none have worked."

And he described leaving his bunker, in terms that a veteran with PTSD would understand, only for brief forays out to re-provision with groceries and return, if his health even allowed him that. He wrote:

"For weeks at a time I will only leave my house once, and only briefly at night, to buy groceries and other supplies. Most of the time, the only time I drag myself into the shower, is when I have to go into town to buy groceries."

---

Now, we hope that no veteran ever crosses the bridge to suicide in his or her lifetime, and especially is not discouraged enough reading news of how another distressed veteran felt to contemplate it. Please use the resources at your disposal, including hotlines, buddies, and compassionate others as lifelines to not give up hope, because there IS hope, and you can get better. But for the rest of us, we need to keep pushing on with this narrative because there's something to learn here, including for decisionmakers who wonder about how better to educate about suicide prevention. This is where the element about the notoriety/publicity level of a suicide influences other at-risk populations.

To the science on this.

• Back in 1977, in the journal Science, DP Philips showed that "motor vehicle fatalities" (including "suicides by motor vehicle") increase in the time frame "just after publicized suicide stories." From the abstract: "The average increase in motor vehicle fatalities is 9.12 percent in the week after a suicide story. The more publicity given to the story, the greater the rise in motor vehicle deaths thereafter. This rise apparently occurs because suicide stories stimulate a wave of imitative suicides, some of which are disguised as motor vehicle accidents."
• In 2006, an Australian journal, Social Science Medicine, published a similar study, further demonstrating the "relationship between media reporting of suicide and actual suicide." They studied data on "4,635 suicide-related items appearing in Australian newspapers and on radio and television news and current affairs shows between March 2000 and February 2001. The study found that 39% of media items were followed by an increase in male suicides, and 31% by an increase in female suicides. Media items were more likely to be associated with increases in both male and female suicides if they occurred in the context of multiple other reports on suicide (versus occurring in isolation), if they were broadcast on television (versus other media), and if they were about completed suicide (versus attempted suicide or suicidal ideation). Different item content appeared to be influential for males and females, with an increase in male suicides being associated with items about an individual's experience of suicide and opinion pieces, and an increase in female suicides being associated with items about mass- or murder-suicide." They concluded, "Further research on this topic is required, but in the meantime there is a need to remain vigilant about how suicide news is reported. Mental health professionals and suicide experts should collaborate with media professionals to try to balance 'public interest' against the risk of harm."
  
• Versions of the original study were repeated over and over in the intervening years, and 30 years later, in 2007, the International Journal of Epidemiology published a study which showed "the influence of media reporting of the suicide of a celebrity on suicide rates," where a male television celebrity in Taiwan committed suicide, followed by a wave of somewhat "copy-cat" suicides among young men. (The "celebrity" element may initially confuse, but think of it this way -- it's a well-publicized suicide when it happens, which means it reaches most of the target audience. It also happens, according to other studies, when non-celebrities commit suicide. The distinguishing factor is how well publicized the suicide is/how much media attention or coverage is given to it. The more coverage, the more people know about it, including those in somewhat fragile populations.) Back to the study's results: "After controlling for seasonal variation, calendar year, temperature, humidity and unemployment rate, there was a marked increase in the number of suicides during the 4-week period after media reporting (relative risk = 1.17, 95% CI 1.04-1.31). The increase was in men (relative risk = 1.30, 95% CI 1.14-1.50) and for the individuals using the same highly lethal method (hanging) as the TV  actor did (relative risk = 1.51, 95% CI 1.25-1.83). However, the age groups in which the increase occurred were younger than the age of the celebrity. CONCLUSIONS: The extensive media reporting of the celebrity suicide was followed by an increase in suicides with a strong implication of a modelling effect. The results provide further support for the need for more restrained reporting of suicides as part of suicide prevention strategies to decrease the imitation effect."
• Also in 2007, a study was conducted in Taiwan around the fact pattern of the same television celebrity's suicide and published in the Journal of Affective Disorders. It attempted to define the "influence of media reporting of a celebrity suicide on suicidal behavior in patients with a history of depressive disorder," and what it found was "Among 438 depressive patients exposed to the media report, 38.8% reported an influence on subsequent suicidal behaviors, including 24 (5.5%) with a suicide attempt. The risk of such influence was highest among patients in a severe depressive state just prior to the media report (adjusted OR 7.81, 95% CI 3.28-18.59). Such influence on a subsequent suicide attempt was highest in patients with a most recent suicide attempt within one month prior to the media reports (adjusted hazard ratio 11.91, 95% CI 3.76-37.72)." The authors concluded, "This study has provided more convincing evidence suggesting negative influences of media reporting of a celebrity suicide on subsequent suicidal behaviors among depressive patients. Particular attention in terms of potential negative media influences should be paid to patients who are younger and currently depressed and have made a recent suicide attempt."
• This year (2010), another Taiwanese study took a look at suicide rates after media reporting of another celebrity suicide, this time a female singing star. Their premise was that "Suicide attempters are known to be vulnerable to the influence of media reporting of suicide events. This study investigates possible influences of media reporting of a celebrity suicide on subsequent suicide attempts and associated risk factors among suicide attempters." In their study, "Sixty-three suicide attempters registered in a surveillance system of Taipei City Suicide Prevention Center were assessed using a structured interview soon after media reporting of the suicide of a young female singing star." Their results? "Forty-three (68%) respondents had encountered with the suicide news. Among them, 37% reported being influenced by the media reporting on their subsequent suicide attempts." Most hard-hit by the news? "Men (adjusted OR 6.36, 95% CI 1.29-31.44) and younger age groups (adjusted OR 4.93, 95% CI 1.04-23.45) were more susceptible to the media reporting." And the authors concluded, "This study has provided further evidence for suicide imitation among vulnerable people encountered with media reporting of celebrity suicide, and for the need to actively restrain reporting of suicides to decrease the imitation effect."

It's also true that young men -- the dominant demographic of who the all-volunteer military is these days, though approximately 11% are women -- are more prone to suicide than other age groups. Back to the science:

• According to statistics from a fact sheet on youth and violence provided by the CDC, "In 2005, 17% of high school students seriously considered attempting suicide, and 13% made a plan about how they would attempt suicide during the 12 months preceding the survey." (The reference cited is CDC. Youth Risk Behavior Surveillance - United States, 2005.  Morbidity and Mortality Weekly Report 2006; 55 (SS-5): 1-112.)
• Similarly, according to the CDC, "approximately 14% of all deaths among children and adolescents aged 5-19 years result from suicides."  The numbers climb according to age ranges, with younger children having the fewest, and older children the most.  Suicided ages 10-14: 283.  Suicides ages 15-19: 1,700.  (The reference cited is CDC, National Center for Injury Prevention and Control, Office of Statistics and Programming. Web-based Injury Statistics Query and Reporting System (WISQARS). Online at http://www.cdc.gov/ncipc/wisqars/. Accessed September 6, 2007.)

There's more that we could talk about here -- responsible reporting guidelines about suicide, when disseminated and implemented, seem to have the effect of reducing the number of copycat suicide attempts after a successful publicized suicide (a study in Austria shows that) -- but the intended effect here, which we can elaborate on in future posts, is to introduce the idea that one publicized suicide by, say, a veteran, can also most likely encourage an increased number of suicide attempts, some of them successful, by members of at-risk populations, such as young/depressed/men. Do any of those words correlate with anyone who might be suffering from PTSD, or taking medications that might also increase suicidal thoughts? And we haven't even added into the mix the effects of alcohol, which many PTSD sufferers self-medicate with, and how that would affect suicidal thinking. There's much, much, much more to talk about on this topic -- not just here on this site but nationally -- but we hope this dense, rather convoluted post has at least gotten you thinking about not so much that we need to protect veterans with PTSD from seeing or reading the news, which might contain an item about another veteran's suicide -- but that suicides can almost go in waves (read the literature on prison populations, etc. for this), where one suicide spurs others in the same population -- because publicity surrounding a suicide has the unintended consequence of increasing suicidal tendencies in other affected people. Since many, many veterans with PTSD are to a degree on edge already...it might be good to realize the effect that reading about another veteran's demise could have on an already depressed, stressed or demoralized individual.

And since the larger goal for all of should be preventing suicides among PTSD-injured veterans, it's highly worth having this conversation.

Too Long a Sacrifice Can Make a Stone of the Heart: The Tao of Self-Care

"Too long a sacrifice can make a stone of the heart," wrote Irish poet William Butler Yeats. He wasn't necessarily a caregiver to anyone, like a veteran, with PTSD -- but he sure seems to understand the predicament. 

The "365 Tao" book that I'm so fond of -- what's not to love about an item at Amazon that has 65 ratings, and they're ALL five stars?! -- had a wonderful item today about how caring for another appropriately is wonderful, but that there is "too much" of a good thing, and it can backfire terribly on the caregiver. Read what it says:

CARING

"Don't go out looking for good deeds to do

But if one comes your way, do not refuse.

If you meet someone who is suffering, you must help them."

And then, importantly:

"Those who follow Tao believe in using sixteen attributes on behalf of others : mercy, gentleness, patience, nonattachment, control, skill, joy, spiritual love, humility, reflection, restfulness, seriousness, effort, controlled emotion, magnanimity, and concentration. Whenever you need to help another, draw upon these qualities. Notice that self-sacrifice is not included in this list. You do not need to destroy yourself to help another. Your overall obligation is to complete your own journey along your personal Tao. As long as you can offer solace to others on your same path, you have done the best that you can."

It's so crucial to note what the author says about "notice that self-sacrifice is not included in this list." (And, previously, that non-attachment was.) So many people on this path or journey, trying to help vets with PTSD, in their own families, their brothers and sisters they served with, etc., are bound to follow the completely self-sacrificing path. We understand that impulse...but see where it leads? It leads to personal disaster. Please take better care of yourself than that. It's not necessary to give your complete and entire all to do your best, to give your best. There has to be a "you" left at the end of the day, or the night. Please find and treasure that self...and don't let it be destroyed, even in the guise of being...the care-giver. 

What can you do for yourself today to improve your health and stress level? What nurtures you and gives you peace of mind? Is it exercise, spending time with friends, having alone time -- what is it? There are many things you can do for yourself that are inexpensive and take good care of you. Please make a list for yourself of what those are, and find a way to bring them back into your life. It will make a world of difference. Some of the very same recommendations or suggestions for veterans with PTSD are ones you might like yourself. A simple exercise like Qi Gong, which creates a feeling of being "relaxed, balanced and energized" -- is just one example of positive self-care, and there are many others.

At the opposite extreme, of not taking care of yourself, what can we guess happens with too long a sacrifice, for others, no matter how worthy, needy or deserving? According to the poet, it can "make a stone of the heart." And following this along...what happens to a stone heart? It shatters and breaks. Keep a soft heart...take care of yourself first...so you can continue to care for others. Not instead of yourself. Importantly, after yourself. So that you can give the best care of all...and not be depleted, broken or crushed. 

Anatomy of a PTSD Suicide: Orrin McClellan Was "Only Halfway Home" from War

"Happy families are all alike," wrote Leo Tolstoy, the famous Russian novelist (and combat veteran), in the opening lines of "Anna Karenina," adding, "every unhappy family is unhappy in its own way." And certainly few families are unhappier than those who've lost someone they love deeply to suicide, as Orrin McClellan's parents have, who've recently lost their Airborne soldier son to the aftermath of PTSD.

We wrote about Orrin McCllelan yesterday, the 25-year-old OEF veteran who took his own life in May of this year. The article, "Anatomy of a Suicide: OEF Veteran Orrin McClellan, RIP from PTSD," is linked here. The underlying Seattle Times article, also from yesterday's paper, is very good, and combines multimedia with the telling the story of McClellan's all-too-short life and struggle. It also documents the pain and suffering McClellan's parents are going through.

There is no "purple heart" for PTSD. There is no "war memorial" that lists those who died by suicide from PTSD, even when combat was the most likely explanation. And maybe there should be... But in the meantime, all we can do is try to reconstruct what we can find about who Orrin McClellan was in the 25 short years he was here.

Digging around on the Web, we can find out much about who McClellan was. The exercise becomes less macabre, or voyeuristic, than the assembling of an online shrine to the memory of someone we never knew, who's now too soon gone. There are the two online journals that McClellan kept, at MySpace and LiveJournal. There is his photo stream on Flickr. There is an obituary by a caring friend, who attended his memorial service. There is McClellan's listing at an online dating service, "Hot or Not," which he set up when he was in Afghanistan, and elsewhere pans with the single word, "whatever." There are some videos that a friend shot of him, who mourns his passing and wishes he had captured a few more shots of McClellan while he was still alive. There are the photos and the poems that his family shared with the Seattle Times, that are part of the original article. And there is a truly beautiful video about his deployment to Afghanistan, called "They Carry," that McClellan himself pieced together, shown on YouTube, and set to music: not heavy metal, but classical...He uploaded it in late September, 2007, after he got back from Afghanistan, and it carries the interesting descriptor: "this generation's wars from eyes on the ground...the faces and names are placeholders. those who were there remember. the rest can only watch." WELL worth viewing...

His interests, as he discloses them on one of the two online journals he kept, are nothing out of the ordinary: places he's been, music he likes, hobbies: "airborne, american beauty, army, dave barry, death cab for cutie, flickr, glen phillips, haruki murakami, italy, langley, lava lamps, led zeppelin, military, muse, orbital, photography, pink floyd, quentin tarantino, seattle, the big lebowski, toad the wet sprocket, vicenza, washington, whidbey island."

There's his brief description of the key dates and places in his short life, again from an online journal:

"Born in Milwaukee, WI. But home is between the Cascades and Olympics on the Puget Sound. Grew up in Langley, on Whidbey Island, Washington. Enlisted in the Army in late '03, started Basic in Feb '04, Airborne School that June, got to Italy that July, and to Afghanistan Mar '05. Getting out Feb '07."

(In September of 2007, he uploaded the excellent video, "They Carry," of his time in Afghanistan.")

And then there are the news items about him, focusing on an arrest, locally. And what look like three court cases: in July of 2008, January of 2009, and September of 2009, listed on King County Superior Court's website.

In July of 2008, he was in the local paper, for assaulting some cops at a concert, allegedly threatening to kill them, gouging one of their eyes, and basically asking for them to shoot him. In October of 2008, he's back in the news locally, after being acquitted of assaulting and threatening police officers in the earlier event. He spent time as an inpatient at the VA for PTSD. He also lived too far away to make regular treatment a likelihood, and getting there, via a ferry trip and highway driving on I-5, was triggering.

His parents, who describe themselves as self-employed and dedicated (i.e., more available than most) seem to be doing everything in their power to help him, but he is melting down. The previous article, yesterday, describes some of the symptoms of his raging PTSD. The two articles in the local papers also detail the attempts his family made to get him help.

In one of the articles, his mother is quoted as saying, "We must not stop with research and development of the healing of visible wounds and helping the veterans become whole with prostheses for severed arms and legs. We have a responsibility to get just as expert at healing the inner wounds of the body, mind, emotions and spirit.”

She also goes right to the heart of the matter when she says, also quoting from those articles, "Our military is well-versed at training our sons and daughters to be experts in weapons, combat and killing, and distrust of the other, but they fail to complete their warrior training of our troops by failing to train them in the skills of regulating the emotional responses of the body, mind and spirit after experiencing the traumatic horrors and terrors of war, and in the skill of reintegrating into families and communities.” 

When she talks about her son's difficulties, she is very clear: "Our son, only halfway, came home from the war; half of him is still fighting over there, within his body, mind, heart and soul,” Gorman said. “Every day, all the time.”

Unfortunately, on May 18, 2010, Orrin McClellan lost that fight. And his family, and everyone concerned about combat veterans and PTSD in America, grieves with them.

Anatomy of a Suicide: OEF Veteran Orrin McClellan, RIP from PTSD

The Seattle Times has an article in yesterday's paper about a young Whidbey Island OEF veteran who unfortunately killed himself in May of this year. Orrin Gorman McClellan served with the 173rd Airborne Brigade Combat Team in Afghanistan in 2005-2006. He took a lot of photos of his experience in Afghanistan, and he also wrote, poignantly, about his experiences as a soldier in an online journal, where he wrote every day. (The article doesn't reveal the location of that journal.) In what's known in the journalism biz as a "package," the article also has two multimedia presentations included with it: a video of his parents leafing through a book they're putting together of poems Orrin wrote, linked here, and a video narrated by his parents of some of his photography from Afghanistan, linked here. "I've become numb," McClellan writes, "but not comfortably so."

It's wrenching watching his parents in the videos sit side-by-side on the couch, in a tableau no doubt repeated across America, as the parents of the approximately 18 veterans a day who kill themselves must do, trying to make sense of why Orrin had to go, and still actively grieving, trying to come to terms with their own loss. In Orrin's case, his mother is a social worker, who the article says specializes "in the treatment of traumatized individuals." Of course, not even a mother with this background can necessarily save her son, which only adds to the tragedy. It says his mother even "took a counseling job with the Whidbey Island NAS and helped her son navigate through the VA system." He was retired with a 100% disability due to PTSD. The article quotes the mom as saying that as a community, we all need to listen better to our vets. And practice "deep listening" to their stories of what they've gone through.

What makes the article good, from this reader's perspective, is that it positions Orrin McClellan's death against the backdrop of the statistics of veterans suicides across the country, and then projects how those statistics affect Washington state, where the Seattle Times is based, and where Orrin lived. Eighteen deaths of veterans a day, the number of suicides approximating deaths in combat this year -- these are shocking statistics, but like so many others, we become numb to them over time. Bringing it closer to home, those same statistics mean of the almost 36,000 OIF and OEF veterans from Washington state, a dozen would be lost to suicide. In 2010, Orrin McClellan was sadly one of that number.

(Army veteran Chris Loverro, who served with the Stryker brigade from Fort Lewis, Washington, did a poignant video of his own about PTSD and suicide in the life of a veteran. We've shown it in a recent article, linked here.)

McClellan's mother, Judith Gorman, says that her son never really came all the way back home, because of his PTSD. Retired Army General Eric Shinseki, now head of the VA, is also quoted in the article, as ruminating -- perhaps not about McClellan's death in particular but about veterans' suicides in general -- that he often asks himself, "Why do we know so much about suicides, but so little about how to prevent them?" That's a fabulous quote, but it's also quite a profound question.

Edwin Shneidman, the so-called "father of suicidology" -- who ironically got his start leafing through files at the VA, reading suicide notes of veterans -- is someone we've written about a fair amount on this site. He's also known as the originator of the concept of a "psychological autopsy," where someone, reasoning backwards from the fact of the a person's death, tries to reconstruct the extent and timing of the stressors in that person's life, to determine how and why it became too much for them (the "when" having already been determined.)

I'm not sure, but I would hazard a guess that, other than the families of veterans who commit suicide, who are directly involved, there isn't much of an effort made on a larger level to reconstruct what stressors became unbearable in the lives of those who kill themselves, during or after military service. Perhaps a broader study into this, a la Shneidman's methods, would produce important or helpful conclusions.

McClellan's story is in many ways all too typical...except for the social worker mother, and the wonderful legacy he left behind in the poems he wrote and photographs he took. He struggled, as many veterans with PTSD do, with drugs and alcohol, with trying to fit back into his life, with impulse control, with hypervigilance, with nightmares, with combining alcohol with prescription medications, with grief and perhaps blaming himself over the deaths of two close friends. And he struggled with long drives to the VA, which was located quite a distance from his home.

His parents sound like amazing people, who tried so hard. They even established a Veterans Resource Center, on the island where they lived, "to offer referrals, networking and other assistance," to help other veterans in addition to their son. In the wake of his son's death, they may also publish a book of his writings, to raise awareness about PTSD.

Digging around on the Web, especially within social media, it wasn't hard to find some of McClellan's thoughts. He had two journals where he kept his writings, one on MySpace and one on LiveJournal. I've chosen not to link to them, to protect his privacy in case that's an issue. But in one he quotes from T.S. Eliot's famous poem, "The Hollow Men," which closes with the memorable lines about "this is how the world ends, not with a bang but a whimper."

It also contains an entry from September of 2008, while McClellan was actively struggling with PTSD, but a full year and a half before he ended his life. In an entry called "What the hell happened to me?" he writes:

"I read some entries in my journal from two years ago" 

[2006, the end of his Afghanistan deployment and beyond]

I love who I was.

Why did I do this to myself?

Was it war?

Did I implode from all the shit I saw?

Or was it something else?"

Questions really with no answer. He goes on for a bit more, and then concludes with the poignant question:

Why did I let myself

Get so lost?

RIP Orrin McClellan, gone too soon, and comfort to your family and your friends.

Editor's note: The photo is of a point on Whidbey Island, a thoroughly beautiful place in Washington state.

Literary Fireworks! Combat Vets Celebrate the Fourth with 5...7...5...Haiku

War poetry has a long and storied history; combat veterans and haiku, not so much. But that may all be changing, thanks to Susanna Speier's innovative "Politiku" -- the application of the traditional Japanese short-form poem familiar to schoolchildren everywhere, with its three line structure of five, seven and five syllables apiece, which can also be a suitable vehicle for expressing profound and personal reflections on trauma.

Speier has already developed some fans for her Politiku concept -- it appears regularly as a column in the Huffington Post -- but thanks to an introduction by the very kind and genuine Craig Newmark, Speier and Healing Combat Trauma connected this week over Speier's interest in bringing the Politiku work to combat veterans.

Speier has a lovely and appealing presentation she's been working on, but as we discussed it further, one particularly timely theme -- it being July Fourth and all -- leapt into Speier's mind. "Fireworks" would make a perfect theme. To most Americans, celebrating with their families on the Fourth, fireworks represent one gigantic surge of pyrotechnic patriotism, awing small children and grownups alike as they soar into the air and explode with fabulous colors and ear-popping, ground-shaking reverberations. It's America's birthday, after all, but in place of the cake and candles we get...concerts, barbecues, parades and FIREWORKS!

For the combat veteran, however...and only approximately 11% of our population has served in the military...fireworks can remind them a little too much of the sights and sounds of combat. Many combat veterans, especially those with PTSD, find themselves dreading the Fourth and the fireworks in particular; and often find themselves unable to explain this (satisfactorily) to family and friends. Quite a few vets make plans beforehand to "head to their bunkers," and not come out until it's over. Others talk about how their own veteran dads, growing up, spent the holiday every year, in a haze of drugs or alcohol, waiting out the celebration. Some veterans feel bad about not being able to join in the celebration, but they can't; and some families of affected combat veterans wonder whether to leave their veteran home while they go enjoy the show...or miss the celebration themselves while not being able to bridge the gap with what their loved one is experiencing.  

So into this mix comes Speier, Politiku, and the idea of having combat veterans write a haiku, with 5/7/5 syllabication, to express their feelings around fireworks, and what it reminds them of, or what it causes them to miss. We put the post out on Facebook, on the Healing Combat Trauma fan page, as well as my personal page, and got some interesting results. Speier is collecting more over at her site and in the comment section of the Huffington Post article, and assures that the combat veteran/haiku author's anonymity will be protected, if desired.

Here's a sample haiku to get you started, written by, erm, Healing Combat Trauma: 

Blue night red rockets

White sparklers Percussion blasts

Vets feel more than Fourth

And here's a better one, written by Angela Peacock, U.S. Army veteran, who served in Baghdad during the early days of the Iraq war, and who has allowed her name to be used:

Fire lights up the sky

Like old memories burning

Too much for my nerves

If you'd like to be part of this project, go here and read the FAQs on what Politiku is and how to write them; or just dive in and send your Politiku/Haiku in as a "comment" in any of the threads listed above, and we'll make sure to get your poem(s) headed in the right direction. Also add whether you'd like your name on or off the submission, if it's used. (Be wise about whether you want to have your name and PTSD associated in the same subject on future web searches, if you're thinking about employment prospects...)

And, if you'd just like to think more about poetry in general, and war poetry or combat veterans and poetry in particular, there are two sources right here on this site. One is the collection of articles on poetry, linked here; and the other is the list of "war poetry" books, which can be found along the upper right hand side of this website. Enjoy!

Kind Words from a Mentor and Friend about "Healing Combat Trauma"

Unsolicited feedback can be encouraging, especially when it's positive. Had a very nice surprise of that kind this past this past week when I received a lovely and unexpected email from Arthur Egendorf, Ph.D., a dear mentor and friend, whose own work with war veterans recovering from trauma gave me practical hope that good, heartfelt work could be done in this area.

(Egendorf is a Vietnam veteran [Army intelligence] with a Ph.D. in psychology from Harvard, and a lifelong interest in therapeutic healing modalities, beginning with talk therapy and branching out from there. He was one of the originators, in the 1970s, of the "rap groups," that allowed returning Vietnam veterans to have someplace to go and peers to talk with, when they weren't willing to take part in the services offered by the V.A. In any history of the Vietnam era that focuses on PTSD and veterans, such as Gerard Nicosia's encyclopedic "Home to War: A History of the Vietnam Veterans' Movement," Egendorf is one of a handful of experts from the time whose name keeps coming up.) 

I'll write more later in the month, as a certain anniversary date rolls around, about how much his award-winning book "Healing from the War: Trauma and Transformation after Vietnam," (sadly, now out of print) was put to constructive use with one veteran, whose life it helped to change. It's fair to say that my copy of his book is fairly well completely yellow from highlighting key passages, thoughts and inspirations, so it was especially gratifying to receive these unsolicited kind words from him.

Dear Lily,

In dedicating so much of yourself to the men and women who risk and give their lives for duty, honor, country you do all of us, this mostly sleep-walking America, a great service.  As tireless, fearless, noisy (when necessary) and deeply caring witness you give our soldiers and veterans what they deserve from this entire country but get from only very few.  As one who knows a bit of what it takes to love and care for bloodied and pained survivors who've fought for all of us and then have been mostly ignored, I salute and cheer you on to keep waking us up.  Keep shaking us, Lily.  Keeping making us see how much those who've served have given to us, and how much we owe our thanks, respect and unending care.  You go girl.  

Artie Egendorf 

Editor's note: For more of an introduction to Egendorf's work, here are a few posts that mention him, linked here, here, here (this one in particular, called "A Hand Across the Abyss: How Openness Helps Heal"), and here, among others.

More Praise for "Healing Combat Trauma"

Belleruth Naparstek, Ph.D. is a psychotherapist, author, and guided imagery pioneer who is also the author of Invisible Heroes : Survivors of Trauma and How They Heal, and Health Journeys: A Guided Meditation for Healing Trauma (PTSD), two items that have helped many veterans interested in healing to make definite forward progress.

This past year, Naparstek published an important and educational article in the Huffington Post in May called "Note to Colleagues: Please Stop Saying Post Traumatic Stress is Incurable," linked here, as well as one in February called "Returning Troops from Iraq and Afghanistan are Different From Our Vietnam Vets," linked here, both of which are "required reading" for those who want to understand what obstacles face veterans and clinicians alike in treating combat-based post-traumatic stress.

Just the other day I happened to read an article on Naparstek's own HealthJourneys site where she mentioned our very own Healing Combat Trauma as "an excellent site" and referred readers to it. Very gratifying praise indeed from a someone who's a true pioneer in thinking about and working with trauma survivors.

June 27, 2010 is "National PTSD Awareness Day"

Amazingly enough -- and suddenly, because the U.S. Senate just passed it -- tomorrow is "National PTSD Awareness Day." Even MORE amazingly, the text of the resolution is very veteran-focused (yippee!).

Here's the full text of the bill. Enjoy! My only quibble is that the numbers seem a little on the low side, but mebbe not. (Actually, the advocacy group Veterans for Common Sense, led by veteran and former VA bureaucrat, Paul Sullivan, lists the numbers as much higher. See link here for current information.)

And, of course, a focus on treatment through integrative medicine would also be nice. It alludes to, but does not mention directly MST (military sexual trauma), which plagues women and men in the Armed Forces AND which unfortunately also leads directly to PTSD. The combination is often too much to bear. With all those caveats, it's still a great bill, and we appreciate any and all emphasis on the topic, as beneficial to veterans, their loved ones, their caregivers, decision-makers, and the general larger community of humankind. 

Thanks especially are due the Vietnam veterans, who never gave up (you're still out there, I know! patiently waiting for it to be your turn; the media, for highlighting the problem and ensuring that greater awareness might result in better options for veterans and their communities; veterans' families, loved ones and employers, for not giving up on the veterans in their midst; and the legislators, who passed this bill and in so doing, created more national focus on the post-deployment adjustment difficulties of those who served. Thank you!

RESOLUTION

Designating June 27, 2010, as ‘‘National Post-Traumatic Stress Disorder Awareness Day’’.

Whereas the brave men and women of the United States Armed Forces, who proudly serve the United States, risk their lives to protect the freedom of the United States and deserve the investment of every possible resource to ensure their lasting physical, mental, and emotional wellbeing;

Whereas 12 percent of Operation Iraqi Freedom veterans, 11 percent of Operation Enduring Freedom veterans, 10 percent of Operation Desert Storm veterans, 30 percent of Vietnam veterans, and at least 8 percent of the general population of the United States suffers from Post-Traumatic Stress Disorder (referred to in this preamble as ‘‘PTSD’’);

Whereas the incidence of PTSD in members of the military is rising as the United States Armed Forces conducts 2 wars, exposing hundreds of thousands of soldiers to traumatic life-threatening events;

Whereas women, who are more than twice as likely to experience PTSD than men, are increasingly engaged in direct combat on the front lines, putting these women at even greater risk of PTSD;

Whereas—

(1) from 2003 to 2007, approximately 40,000 Department of Defense patients were diagnosed with PTSD;

and

(2) from 2000 to 2009—

(A) more than 5,000 individuals were hospitalized with a primary diagnosis of PTSD; and

(B) more than 500,000 individuals were treated for PTSD in outpatient visits;

Whereas PTSD significantly increases the risk of depression, suicide, and drug and alcohol related disorders and deaths;

Whereas the Departments of Defense and Veterans Affairs have made significant advances in the prevention, diagnosis, and treatment of PTSD and the symptoms of PTSD, but many challenges remain; and

Whereas the establishment of a National Post-Traumatic Stress Disorder Awareness Day will raise public awareness about issues related to PTSD: Now, therefore, be it

Resolved, That the Senate—

 (1) designates June 27, 2010, as ‘‘National Post-Traumatic Stress Disorder Awareness Day’’;

 (2) urges the Secretary of Veterans Affairs and the Secretary of Defense to continue working to educate servicemembers, veterans, the families of servicemembers and veterans, and the public about the causes, symptoms, and treatment of post-traumatic stress disorder; and

 (3) respectfully requests that the Secretary of the Senate transmit a copy of this resolution to the Secretary of Veterans Affairs and the Secretary of Defense.

Editor's note: And if you want to know why we do what we do, here it is. It can change someone's life. Here's how the Vietnam vet, Marine, subject of the "Eyewitness to Combat" section of this site, is doing after a year of addressing his 40-year solid case of chronic, severe PTSD. He came, he saw, he conquered. Other veterans can too. We give them HOPE. First awareness, then treatment, and the chance of getting their life back. (H)Oorah. (Here's the link.)

Paying Tribute at "The Tribute Wall..."

One of the most remarkable experiences, at last week's third annual "The Brain at War" conference in San Francisco, was visiting the Marines' Memorial Club & Hotel in Union Square, where the conference was held.

Unbeknownst to me and many of the other conferences' participants, the Marines' Memorial is both swoon-worthily fantastic as a venue AND happens to house a one-of-a-kind tribute to OIF and OEF veterans who have been killed in action. The so-called "Tribute Wall" is on the 10th floor, mezzanine, and Major General J. Michael Myatt, USMC (Ret.) encouraged us all, during the conference, to take some time and pay honor to those servicemembers who had given the   ultimate sacrifice. 

True to my nonexistent personal GPS, I first mistakenly went to the wrong floor -- the library, on the 11th (which was cool, but not the same) -- and finally found my way to where I was supposed to be. The polished black plaques, listing fallen warriors by name, branch, and date of death, cover the four walls of the memorial room, and then stretch out beyond it, covering a "fifth" wall completely in the adjoining room, and continuing to advance.

If you know when a friend or loved one died in combat, you're able to find the plaque's general location by scanning the wall to find the correct year, then reading vertically to find the approximate location of the date.

If you know only a name, but not the date, it's safest to look up the name of the servicemember in the frequently-updated list kept in a binder in the center of the room, again listing by name, branch of service, and date of death.

In my case, I went to a section of the wall to find those who died on a certain tour of Marines in the Sunni Triangle, back in '05/'06, then went back to find the names of friends of friends and take photos for them of their loved ones' plaques.

There are some surprises. One is, see photo at left, that two "major league" departed heroes, among all the rest of the great departed heroes, Pat Tillman (Army) and Jason Dunham (Marines) died on the same day. Until I saw their plaques resting above each other on the "Tribute Wall," I can't say that I realized that. 

There's also a guest book which people can sign, to leave their memories and condolences; and there's a flag display of the flags of all the branches in the center of the room. There's also a framed photograph of Marine General James T. Conway, (at this writing, current Commandant of the Marine Corps) from the front cover of a Marine magazine, visiting the wall; and another framed "thank you" note he wrote, expressing his appreciation to the Gold Star families for the exhibit.

I found myself returning to this generation's "Wall" time and time again during the conference, sneaking away from the (great) presenters to put myself back in touch with the very great losses of these wars, in terms of men and women who were dearly and deeply loved by those they left behind. I racked my brain and texted friends for the names of friends they had lost on their tours, to make sure I got photos of their loved one's plaques.

In numerous trips to the Tribute Wall ("Room" is more like it, since the plaques cover at least five walls by now), I rarely saw another visitor. Only one couple, the wife or girlfriend tagging behind the husband or boyfriend, who looked like a veteran, searching out key names on the wall. I heard that a number of conference participants also went to pay their respects. I didn't run into them, which doesn't mean they weren't there. What the hushed and reverent silence in the room did mean, though, and the literally thousands of plaques, each representing a servicemember important and loved to many friends and family, is how little we typically recognize the ultimate sacrifice of those who   gave their lives. I feel blessed and honored and frankly, grateful, that I got to pay my respects at the Tribute Wall for those who gave so much.

If you're ever in San Francisco, and you can handle seeing the sheer enormity of OIF and OEF deaths honored in one single "room," you owe it to yourself -- nay, them -- to go by the Marines' Memorial Club & Hotel, head to the 10th floor, Mezzanine, and pay your respects, so that their sacrifice is not in vain.

Editor's note: Servicemembers who were KIA from all branches of the Armed Forces are represented on "the wall," not just Marines.

"The Brain at War" Conference in San Francisco

Last Thursday I had the opportunity to attend the third annual "The Brain at War" conference, put on by the NCIRE, The Veterans Health Research Institute, in San Francisco, CA. More on that later, because things are really busy around here right now. But it was a great conference, and the second excellent training I'd been able to attend, within the past 30 days. (The first being the superlative clinical training program in PTSD, put on by the National Center for PTSD in Menlo Park, CA. An article about that program is linked here.)

Some personal recaps and observations:

The Brain at War featured a number of interesting speakers, including Heidi Kraft, Ph.D., the author of "Rule Number Two," whose presentation was really the emotional anchor of the day. (Kraft now serves as the Deputy Director of the U.S. Navy Combat Stress Control Program.) She talked compellingly about her experience in Iraq, and in particular the events and emotions surrounding holding the hand of a dying Marine, who later became famous to the nation as Cpl. Jason Dunham, who was posthumously awarded the Medal of Honor. (He's also the subject of an excellent book, "The Gift of Valor," by Wall Street Journal reporter Michael Phillips.) 

Her speech was probably the first time, in almost five years of writing and editing this site, that I got to let the power of the stories I've heard, from various suffering servicemembers, vets and their families, really sink in. As Kraft told her story, of pain, empathy and loss, and the bond it built with Dunham's family, that continues to this day, I tapped into my own reserve of painful memories of stories I know, and couldn't stop crying. Looking around the large conference room, I saw I wasn't remotely alone in that, though; even men in suits were dabbing both eyes with their handkerchiefs and napkins. She also had a powerful, powerful poem that she wrote about the highlights and lowlights of the Iraq tour, called "The List," that she read to those assembled, and which is featured prominently in the book she later wrote, above.

There were many highlights of the program, including hearing from the National Guard about what they're doing to secure better mental health for their servicemembers, who don't have the same access that other branches do. The California National Guard has a good "Combat Stress Control" program, with handouts like this tip sheet, "Helping a Soldier Buddy in Distress," linked here. They've also got a superlative poster, "Never Let Your Buddy Fight Alone (against PTSD)" that emphasizes the importance of Guardmembers in one another's lives. An U.S. Army National Guard leader, Major Paul E. Gonzales, from Kansas' National Guard, talked convincingly about the challenges Guardmembers face after deployment, accessing mental health services, when they're frequently hours away from the nearest facility. 

Another true highlight was, through the miracle of Skype, hearing and seeing USAF Major Jennifer J. Hatzfeld, Ph.D., R.N., report in from Afghanistan about her tour of duty there and what it's been like. And Chris Loverro, a UC Berkeley grad now filmmaker, and part of the U.S. Army's Stryker Brigade from Ft. Lewis, Washington in Iraq, talked openly about his struggles with PTSD upon returning from war, and showed a short film he's made about the "Hidden Casualties" among veterans. The short film's message was raw and powerful, and hit home with many in the audience.

Hidden Casualties from chris loverro on Vimeo.

(Army) Brigadier General Loree Sutton was in attendance at Thursday's program, and seemed to be an enthusiastic supporter of all things health and wellness related to the military and PTSD (and TBI). Sadly, in news that went over the wire yesterday, Sutton resigned her position as the head of the Defense Centers of Excellence (DCoE). See news item, linked here. The timing was significant: it's the same week that the privately-funded National Intrepid Center of Excellence for Psychological Health and Traumatic Brain Injury opened on the Navy campus in Bethesda, Maryland for the treatment of TBI and PTSD. Although the opening was a big deal -- and the fact that the money was raised privately also is -- apparently no cabinet members, no White House representatives, no senators and only two congressmen showed up. So the "war" ... on the brain... at war... appears to continue.

It was gratifying to see a certain portion of the event, as well as a small-group discussion afterwards attended by maybe a dozen participants, devoted to the discussion of integrative medicine and PTSD. (The discussion leader, an M.D., said she was also in the process of leaving the military.) Let's hope that despite the apparent setbacks and detours that progress can still be made on treating PTSD with integrative medicine. 

The building the conference was held in -- an A+ facility called "The Marines' Memorial Hotel & Club," in San Francisco's Union Square -- was fantastic. "Like the Harvard Club for Marines!" I exulted, to anyone who'd care. It's worth a return trip to San Francisco just to revel in the exhibits on each floor. (The food was also superb.) There's an excellent library on the 11th floor, many things on other floors I didn't get to see, but a true "draw" and it's quite powerful is the "Tribute Wall" on the 10th floor, Mezzanine, which honors the fallen heroes of every branch who have given their lives in the OIF and OEF campaigns. I'll probably have to reserve writing about that for another time, but I kept stealing away from the presentations to go back to that memorial, taking photos of the plaques commemorating those who died who were important to vets who are special to me. The memorial has black stone plaques, engraved with the servicemember's name, branch of service, and date of death, and they're embedded into the walls (the exhibit covers five walls by now, one full room and stretching outwards from that) roughly chronologically, vertically. There's a guest book in the room to sign, and also a guidebook, which must be updated regularly, listing servicemembers KIA by name, branch of service, and date of death. Once you find the date of death, you know approximately where their plaque on the wall will be located, and you just go looking for it. Pretty impressive, and moving, exhibit, giving honor to those to whom honor is very much due. (For more on that, see link here.)

Praise for "Healing Combat Trauma"

Had a nice surprise at the week-long clinical training in PTSD at the National Center for PTSD. Picked up a copy of Ray Scurfield, Ph.D.'s comprehensive "War Trauma Resources," and in it read something very nice he said about this site: "Lily Casura’s very rich compendium -– she has over 100 categories of information! -- of books, article, commentaries, resources, other readings and information regarding military, veterans and their families. I am most impressed with Lily’s passion, dedication and abilities as an advocate for vets and their families." -- Ray Scurfield, Ph.D.

 Scurfield is and was one of my first heroes in this because of his longtime work with veterans healing from war trauma, so it's extra-nice to hear something like this from him. In addition to the resources he provides nationally, Scurfield is also the author of three key books about veterans and PTSD: A Vietnam Trilogy, Healing Journeys, and War Trauma.

Quotable Quotes -- José Narosky on All Soldiers Are Wounded

 "In war, there are no unwounded soldiers." -- José Narosky