Healing Combat Trauma

Women Vets' Experience of Sexual Assault in Combat Adds to PTSD Woes

An article in today's Cleveland Plain Dealer addresses a topic rarely discussed: sexual assaults against women military in combat, which of course are another cause of PTSD for women veterans (and some men).  Sometimes these sexual assaults also trigger previously suppressed or repressed memories among the victims, adding to the trauma.

VA Grossly Underestimated Number of Returning Vets with PTSD?

A noteworthy article in today's edition of the Kansas City Star says that the VA radically underestimated the number of returning vets with PTSD from the wars in Iraq and Afghanistan.  Fully one third of returning vets may demonstrate symptoms of PTSD.  Says the article, "Instead of 2,900 new cases that it reported in February to a veterans advocate in Congress, the increase could be 15,000 or more, according to the VA."

A former Army nurse in Vietnam who works at the Kansas City VA Hospital says, “Every single Iraq vet who comes in, I give them a list and say, ‘How many of these (PTSD) symptoms do you have?’ It’s almost nine out of 10.”

Apparently the VA underestimated the size of the problem, and with budget cuts to the system, current concern is that the number of returning vets needing treatment -- in addition to the vets from former wars like Vietnam and the Persian Gulf War -- threatens to overrun the VA's ability to deliver appropriate services in a timely manner.

14th Annual Tri-Service Mental Health Conference Held @ Camp Pendleton

The San Diego Tribune has an excellent article online today about the 14th Annual Tri-Service Mental Health Conference, which just took place at Camp Pendleton.  The article is full of great quotes about the state of treatment for combat trauma in the military today, and whether the status quo can deliver the care adequately.  Excellent article, well worth reading.  Pretty much everything in it is quotable and worth remembering.  The conference was begun 14 years ago by two colleagues who were concerned about the mental health care available for friends who had served in the Persian Gulf War.

NH National Guard Program for Vets

Nationwide, National Guard soldiers and other reservists seem to be particularly prone to experiencing combat trauma and PTSD.  Why this is, isn't clear -- whether because they weren't expecting to see as much as action as they had, or because overall they may lack as much training as the fulltime military receives in terms of what to expect.  In either case, reservists have been disproportionately affected by combat trauma.  Some states, Minnesota and New Hampshire in particular, are taking steps to focus on returning reservist vets, to help them re-integrated better upon return.  New Hampshire Public Radio talks about a program for NH vets that's being touted as a national model.  A rough transcript of the recent program is here.

Remembrance of Great Pain

Michael Fay, extraordinarily talented USMC combat artist, has a post on his blog today entitled "Remembrance," about a Marine he sketched with the weight of the world visible on his face -- it is a gorgeous drawing -- and the later realization, when the family contacted him, that this emblematic Marine later committed suicide.  Fay doesn't say explicitly that the suicide was caused by the extreme combat experience; however, he makes several allusions to what we can only surmise is combat trauma, e.g., Fay's desire, through posting about the portrait, "to keep before people's eyes those wounds which are rarely seen, heal the slowest, and often kill; the wounds that pierce the very soul of a person."  Fay is an extraordinarily gifted artist; all of his drawings are almost equally moving and beautifully-drawn; and the portrait of the Marine is especially gripping, even though at the time the outcome of his life had not yet happened.  It is crushingly sad to think of someone fighting so long and hard, as this Marine did, and yet succumbing to pain greater than he could bear.

Is the Army Doing Enough in Suicide Prevention?

There's an editorial in today's Fayetteville, North Carolina's Observer about the U.S. Army's efforts re: suicide prevention in its ranks, basically asking the question about whether the Army is doing enough.  As the editorial says in part:

"Are all of the stress teams, suicide-prevention classes, counseling, psychotherapy and intervention enough?  Few would dispute a spokesman’s assurance that “we do take suicide prevention very seriously.” But should the Army do more thinking outside the box? Are its people doing enough to identify and evaluate recruits with pre-existing, even hereditary conditions? Is there too much emphasis on active duty vs. reserves and too little on troops who, whatever their current status, are exposed or have recently been exposed to the blunt psychological trauma of combat? Is there anything to be learned by studying both self-directed violence and “domestic” violence as different facets of a single problem?

"Intervention is fine, but intervention is a strategy for preserving the lives of people already so deeply troubled that they’re trying to end them. What is the strategy for keeping people who live, month after month, in the most trying conditions imaginable from reaching that point? Are the education, the budgets and the staff equal to the challenge?"

Texan Iraq Vet with PTSD

There's an article in today's Dallas-Fort Worth Star-Telegram about a young Army vet, 21, who returned from Iraq suffering from Post-Traumatic Stress Disorder, and went AWOL with the help of his family, rather than return to Iraq.  It's not the greatest article -- it says very little, and terminates well before covering even the story it was attempting to cover -- but at least it counts as coverage on this singularly-important topic.

The most troubling items in the albeit quite short article?  The 21 year old vet's emotional stress was so bad, his hair was falling out in patches (photographs accompany the article); and his parents, who found his suicide note (fortunately, he has not committed suicide) turned to the newspaper in town to get some help, when they couldn't figure out where else to turn.  The newspaper profiled the family in a front page article, which exposed the family to criticism.  And the son ended up having to do jail time for going AWOL, but claims he is doing better now (article doesn't clarify why he would be doing better now, though.)

Marine Parents Conference This Weekend in Houston, TX

MarineParents.com is sponsoring their 7th annual conference this weekend at the Crowne Plaza hotel in downtown Houston, TX.  They have a superb lineup of speakers, not a few of whom should be able to speak about the topic of combat trauma, including Nate Fick, author of "One Bullet Away: The Making of a Marine Officer" (see sidebar), Bridget C. Cantrell, Ph.D., author of "Down Range: to Iraq and Back," (see sidebar) and Michael M. Phillips, embedded Wall Street Journal reporter and author of "The Gift of Valor" (see sidebar).  Not having seen the actual schedule, it's impossible to predict whether anyone's speaking on the exact topic of healing combat trauma; but it's likely that many will be alluding to the experience of combat trauma in their speeches and side discussions.  If we get a copy of the schedule from this outstanding-looking conference, we'll be sure to update the blog with more detailed information.

It's very impressive that Tracy Della Vecchia, a Marine mom, set up MarineParents.com, a highly comprehensive website, originally out of her own love and concern and as an effort to communicate with and support one of her deployed Marine sons.  As she worked on the original site, she found out how important and necessary getting information out was to other mothers like her.  Today, the enormous and impressive, volunteer-staffed site, which seems in its way as big as forums on CompuServe were in their day, is a true testament to the other power of one person wanting to get something done that would help others.  Many, many parents and other family members today of deployed Marines are probably very and rightly thankful to Ms. Della Vecchia and her far-sighted, far-reaching work on that site.

Army Admits Troop Suicides "On the Rise"

An article on Yahoo! today reported that the Army admits that troop suicides have been on the rise.  While the numbers and the increase may not be staggering, there's also some sense (outside the scope of the article) that suicides are actually being under-reported, for various reasons.  Some would also argue, any suicides are too many.  But life is hard, and combat can make it even harder.  Then the various "tools" people employ to handle the pain and the stress may make matters worse as well.  In any case, this is going to be a topic to watch over the coming years.  There was some argument about sucides among troops in Vietnam: that more Vietnam veterans died from suicide than died in the war itself; although this conclusion was often disputed, it was equally often contended to be true.  There's also been some statistic floated about that suicides among the children of Vietnam veterans are three times as high as would be characteristic of the same age group in the general public.  If this story is true, what about the situation is making it so difficult, and what, if anything, can be done to "combat" it (no pun intended).  It's hard to conscience that life is so difficult for returning combat veterans; it would be nice to think the price they'd already paid would be price enough.  Apparently not, though.  Keep this topic in mind over the coming months and years -- see how it develops.

Documentaries Now Available on DVD

Two fantastic documentaries about combat trauma and returning veterans are now available for purchase:

The excellent and recent New England Cable News documentary, "Hidden Wounds," is available for purchase by sending $20 to Doreen Vigue, Director of Communications, New England Cable News, 160 Wells Avenue, Newton, MA  02459-3302.  NECN plans to show this documentary again on Memorial Day, 2006.  You can learn more about local, New England-area showings of this timely documentary by clicking on this link.

The PBS/Frontline documentary, "The Soldier's Heart," is available for purchase at www.ShopPBS.org online, or by clicking this link for DVD, or this link for VHS.  Amazingly, if you've got the time and the high-speed Internet connection to make it worth your while, you can also watch the entire program online, by clicking this link.

(Both are very much worth your while.)

PTSD Among Caregivers

We saw from the recent posts about Dr. Gene Bolles' time at Landstuhl Regional Medical Center in Germany (see previous blog entries) that combat trauma can affect caregivers deeply as well, including experienced medical personnel responsible for the care of injured troops.  A recent story in the Tacoma, WA News Tribune tells how one combat nurse was so affected by her work in a battlefield hospital in Iraq that she herself attempted suicide.  Thankfully, she survived the attempt and is today recuperating and attempting to piece her life back together, including by writing about her experiences.  But it's a sobering tale indeed of the tremendous price paid by those who care for the wounded as well.  Functioning in a combat zone, working incredibly long shifts with little time off, and handling a literal avalanche of horrific injuries day after day, it's not surprising that this work would affect the caregivers deeply.  Read this story of a heroic nurse's reunion with one of her severely injured patients, giving hope to them both.

PTSD and Alcohol Abuse

Alcohol is commonly used as "self-medication" by those who are suffering from combat trauma.  If nightmares where they're revisiting combat stress and combat scenes keep people awake, alcohol has traditionally been a way (not necessarily a constructive way, but certainly an easily accessable, socially acceptable one) to de-stress before sleep, and try to avoid the nightmares.  Unfortunately, of course, it usually doesn't work to improve things, and there can be a huge rebound effect; or, heavy drinking can cause other problems.  So at most it's a stop-gap solution, despite its popularity.  A fact sheet from the VA discusses alcohol use and PTSD.  Click here for the link.

Want To Be in a PTSD Study?

An interesting article in the St. Louis Post-Dispatch describes the work of a Washington University (St. Louis, MO) researcher who's looking for subjects for a study she's conducting on PTSD.  Her ideal subjects would be military being deployed to Afghanistan or Iraq for their first time.  Her contact information is below, but frankly, the article is well worth reading, to get a picture of where her research is headed.  Interesting and promising research...two thumbs up :-)

Rumi Kato Price, Ph.D.
Age: 54
Education: B.A. in philosophy, Ochanomize University in Tokyo; master's and Ph.D. in sociology, University of California at Berkeley.
Residence: Clayton
Family: Daughter, 21
E-mail contact: syl@rkp.wustl.edu
Web site: http:///www.rkp.wustl.edu

A description of the study, from her department's website:

Description of project:
The Soldier's Young Legacy (SYL) Registry is a project to archive information from military personel being deployed in Operation Iraqi Freedom and Operation Enduring Freedom in Afghanistan, to help improve treatment for war veterans upon returning to the United States. Currently, we are designing a study to interview military and contractor personnel who are scheduled to be deployed to Iraq and Afghanistan to examine types of biological changes due to traumatic experience that may affect their well-being when returning to civilian life. We would like to obtain biological measures shown to be associated with acute or chronic psychological stress and of post-traumatic stress disorder (PTSD) prior to deployment and to conduct follow-up examinations after return to the United States. The contribution of providing biological and life history information to the archive is YOUR YOUNG LEGACY for aiding FUTURE veterans.

Eligibility for the study

• Men and women in the U. S. Military who will be deployed to Iraq or Afghanistan
• Men and women with no prior combat exposure.

What does participation involve before deployment?

• A magnetic resonance imaging (MRI) of the brain to obtain baseline estimates of brain structure
• Collection of blood and saliva
• Memory, learning, and personality tests
• An in-person interview.

You will be paid for your time and effort.

If you would like more information about joining their study click here.

"Suffering Caused by the Sheer Horror of War"

Dr. Gene Bolles (see previous post) talks at length about the reactions of injured military under his care to what they had seen and heard, and conveys in a compelling way the debilitating nature of what vets have undergone in wartime.  Bolles was the chief surgeon at Landstuhl Regional Medical Center in Germany for several years during the current Iraq war, and he says that his unique position as a civilian, not a military leader, allowed some of the injured to confide in him what they were really feeling about what they'd seen and done, without fear of repercussion.  Bolles talks about that, and more, in the linked article, from a politically biased (but nonetheless interesting) website.

Many, many things Bolles says stand out.  Almost too many to list, conscientiously.  See what stands out to you when you read it.  He sounds like a very reasonable, very experienced, and very compassionate individual who himself is bearing the burden of such an onslaught of trauma.

Landstuhl Doc Calls Vets an Inspiration

Dr. Gene Bolles is a Colorado neurosurgeon and Vietnam vet who volunteered to go to work at Landstuhl Regional Medical Center in the Iraq war.  (Landstuhl is significant because it's where badly injured military are stablized once they're airlifted from Iraq, and before being returned to the States to recuperate further in key trauma hospitals in the U.S. like Bethesda and Walter Reed.)  Bolles, who is not pro-war, looks at himself as old enough to be a grandfather to some of the troops he's operated on.  But he is uniformly moved by their tremendous courage in the face of truly awesome suffering and tragedy.  Read Bolles to get a mature doctor's view of how heroic the current vets are, with all that they endure.  It's hard not to admire Bolles quite a bit in the process, and to see and feel the toll that so much carnage has taken on him as well.  If we assume the vets are stoic, we perhaps assume that of their caregivers as well.  And it's better that we enlarge our view, and make it fuller and more complete.  (The op-ed piece was published in the New York Daily News.)

A segment on PBS' News Hour, with Jim Lehrer, entitled "War Wounds," which interviews Dr. Bolles and several others, makes it clear that Bolles himself is affected by what he's seen and experienced, to the point that he has a hard time relaxing or falling asleep.

Possible Genetic Link to PTSD?

A potentially overlooked article from August, 2005's Psychiatric Times takes a look at the link, if any, between genetics and PTSD.  The introductory paragraph provides some key facts about PTSD, and reminds us that not everyone who has been exposed to the same triggers will develop symptoms.  Says the article, "Over 50% of U.S. women and 60% of men report having experienced a traumatic event at some point in their lives. However, only a minority (approximately 10% of women and 5% of men) report having ever developed posttraumatic stress disorder, the most prominent psychiatric disorder associated with traumatic events (Kessler et al., 1995). This disparity between the prevalence of exposure to traumatic events and the development of PTSD has driven research to determine the etiology of PTSD and identify factors that increase risk for the disorder. One area of research that has received relatively little attention is genetics."

The article, which to some extent is a literature review (much like this blog!), contends that further study of the possible genetic link to PTSD might be worthwhile in isolating which drugs PTSD sufferers respond to and why.  In other words, pursuing the "better health through chemistry" approach by using pharmaceuticals to target psychological trauma.  Certainly an effective way, but not necessarily the only way, to approach the problem, one might think.  (And we're not talking Tom Cruise here, either -- just to be clear.)

Metrics of War: The Psychological Body Count

A flurry of postings today while we attempt to catch up summarizing reading we've done over the last several weeks, with no time to post the results, as it were.

An interesting article from the Iowa City, IA's Press-Citizen, that's a Q&A session with Dr. Maureen McCue, coordinator of the Iowa chapter of the progessive and esteemed "Physicians for Social Responsiblity."  McCue is talking about PTSD and the trauma of war, and she recently organized a conference entitled, "The Medical Consequences of War."

Two good quotes from the article:

"The reported rate of PTSD, post-traumatic stress disorder, is markedly higher than in recent wars because of the nature of the fighting within the population centers. The soldiers have no way of knowing where or who the enemy is. They feel surrounded by danger and are being told to suspect anyone and everyone. Thus, they have even been forced to kill women and children at close range. This is extremely disturbing and has very long-lasting effects."

Also,

In response to a question about whether psychological problems are more prevalent than physical problems for vets upon homecoming, McCue gives us the first practical metric on the topic.  She says that they are, by far.  "For every soldier killed, almost 10 times as many are wounded and 10 times that many come home with mental health problems."  As of tonight, more than 2300 troops have been killed.  If what McCue postulates is even generally true, that's some pretty frightening math we're contemplating...

"Sh*t, Meet Fan"

Independent "journalist" Jay Shaft has been passionately pursuing a cause of his own recently, sharing the trials and tribulations of troops who apparently got quite a bit more than they bargained for, when they signed up to go to Iraq or Afghanistan.  Shaft, who paints himself as a counter-culture revolutionary with little obvious background in conventional journalism, nevertheless claims to have interviewed military members with bad attitudes about the war, extensively, and shares their letters in some of his writings. (The article in question is "Letters from Iraq, Part I.")  It's tempting to apply the expression, "like watching a train wreck," to the letters he produces.  They are written by people on the verge -- and sometimes seemingly past -- full emotional collapse.  They don't want to be in war, they're fully traumatized by what they've seen and done, and they feel like no one is listening to their pain.  Shaft is.  (Can that be his real name, or is this a bad sixties reference?  Can you dig it?!)  And Shaft is equally hell-bent, and more power to him, on making sure those voices get heard.  Now, for whatever its worth, the only we became aware of Shaft's work was through a website based in New Zealand.  Maybe what he's saying is just too radical for the American media to pick up.  Not really sure.  But his compilation of outraged cries for help is highly worth reading, if only to sensitize us to what it feels like to be somebody who really doesn't want to be there, well after the fact they've figured that out, and for whom war has become true personal and psychological torture of the self.  The scary sensation in Shaft's writing is that we're encountering people with fullblown PTSD symptoms, and they're frequently still very much in the military, contemplating anything, including sadly suicide, as a way to get out.  These people are desperate, and Shaft is giving them a voice -- their own.  Not to be missed, for the sheer power of the content.  It's like listening to real-time interviews with passengers on the Titanic as they drown.  Very intense stuff.  So far Shaft's work is the most radical we've read, about how participants feel about the war when it's lost its appeal for them, to put it mildly.  It'll be interesting to see whether Shaft's work will be discredited or sought out.  In either case, he's a radical man on a radical mission -- and it'll be worth watching to see what comes of it.

When Torture Follows You Home

Several months ago, the L.A. Times, which this year seems to be outpacing many of the other American leading newspapers for its independent and relatively in-depth reporting of aspects of the Iraq war, published a troubling Op-Ed piece about a writer's involvement with an Afghanistan war veteran who went on to commit suicide. Troubling aspects abound in the opinion piece, including the writer's admission at the end that really, she probably should have done more than she did to make sure the vet got help (sounds true, so far as it goes).  But most troubling of all is the implication that this Marine committed suicide over what he saw -- acts committed by others that he felt powerless to stop.  Actions on our side, essentially by what amount to CIA contractors who were torturing detainees.  The prospect of those actions is of course troubling (there's that word again), but even more so, the consequence of how they could affect someone else's conscience so deeply that he felt that suicide was his only solution.  That's a very, very sad outcome indeed.  It makes you wonder, though.  War is hard enough on direct combatants, ostensibly because of the actions they have to perform to get by and get through.  It's hard to contemplate that sometimes, what veterans see others doing, that goes against their conscience, is too painful for them to bear.  Such seems to have been the case with the Marine whose suicide this opinion piece describes.  This article is called, "For One Marine, Torture Came Home."  If the dead man's allegations are true, it's crushingly sad that he found no other way out than to take his own life.

How Trauma Affects the Brain

Another article you might have missed from last summer, available online now through "Health on the Net Foundation" (a reputable source, we might add, for those who wouldn't otherwise know; they're endorsed by the United Nations and the World Health Organization), talks about recent medical research into the effects of trauma on the brain.  The article is entitled, "Brain Region May Govern Resilience to Trauma," and subtitled, "Study could explain why some people react severely to emotional stress."   The article, which is mercifully short, for those whose attention span is short where science is concerned, talks about how people respond differently to fear, and process memories differently as well -- and science has been looking into why that is, and what can be done to improve physiological functioning, where trauma is concerned.  Very interesting article, and worth reading to keep up to date on where medical research is going with this all-important topic.

Lack of Care Called "Morally Reprehensible"

An article from last summer, published online in the National Gulf War Resource Center, Inc, details Massachusetts state representative Marty Meehan's attempt to get a bill passed that would mandate more extensive psychological screeing of war vets on their return home.  Of particular concern to Meehan are situations like that of his friend, Iraq veteran Daniel Cotnoir, whose apparent PTSD symptomology caused problems in his civilian life, for which he is shortly to go on trial in Massachusetts.  (See other entries in this blog to that effect, or for further background on the Cotnoir story.)

In Meehan's words: "Eight-six percent of our troops in Iraq and Afghanistan have been exposed to combat and one in five has suffered from major depression or post-traumatic stress syndrome,'' he said. ``It's morally reprehensible to send our brave young men and women into Iraq and then not try to make them whole – mentally as well as physically – when they come home."

There are a lot of great quotes in this article, which alone make it worth reading.  Meehan takes a strong stand on this topic, and is passionate in its defense.  It'll be interesting to see whether his point of view can gather traction with his colleagues, or not.  In any case, he seems to be making an impression as a friend of veterans and veterans issues.  Two other Meehan quotes from the article: "Senior officers must be encouraged to talk openly about their own (stress) experiences so that our troops can feel comfortable about seeking treatment without fear of repercussion.''  And, ``It's unconscionable,'' he said, that the armed services merely administer a questionnaire about post-traumatic stress disorder, not a real exam. ``Many of them just want to get home. They fill out the questionnaires in a rush.''

PTSD Veteran on Trial

This coming week -- Thursday, to be precise -- decorated Iraq war veteran Daniel Cotnoir, who served under grueling conditions that few of us can even imagine, doing mortuary detail in the war, goes on trial in Massachusetts for actions that aren't hard to see as a result of extreme combat-related stress.  It will be "interesting" to see how his case turns out, from a legal point of view, but from a humane point of view, only interesting if Cotnoir is treated with compassion and concern, and routed in the direction of further help that's needed, not jailtime which leaves the problem intact.  In honor of the upcoming court case, which frankly unsettles us to think it's even going forward, here's a link to one of the more short 'n factual pieces in the news media about Cotnoir's actions, published shortly after he was arrested last summer.  The article is entitled, "Hero Marine Returns Fire."  Another newspaper column, also published contemporaneously, did a marvellous job of painting a picture of what Cotnoir must have been exposed to, versus the unforgiving nature of society once he returned.  This one has a great, and poignant though accurate, title: "Marine bears up under Iraq's horrors, but cracks at home."  Both are worth a read.  Praying readers may be tempted to throw a prayer or two heavenward on Cotnoir's behalf, as well.  It probably wouldn't be a bad idea whatsoever.

Getting to Know the War Itself

In Patience H.C. Mason's classic book about PTSD and combat trauma, Recovering from the War, she makes the point that in order to understand the veterans in our lives, we have to know, or should want to know, more about what they actually went through in the war itself.  Now, the war she's talking about is Vietnam; but if her point is true, it's true about the war today as well -- Iraq and Afghanistan.  Her point was that you'll need to take the initiative to learn about the war, because the veterans, well, they don't always want to talk about it directly, and if they do, it's probably going to be with each other, but not with those who didn't go.  Patience spends a hefty first third of her book describing the Vietnam war, as those who lived it might have experienced it, in order to set the context for her readers.

Today, compassionate citizens who are so inclined, can make up their own reading list about the war.  A proliferation of books, particularly personal narratives of those who served, are available at local libraries and online booksellers, like Amazon (see sidebar).  When you're done reading, you can always donate the books to wonderful organizations like BooksforSoldiers.com, which sends "care packages for the mind" to deployed military overseas.  (That's just a brief non-commercial interruption, though -- back to our regularly scheduled program.)  Libraries catalog books by type of book, as well as by author, title, and all their other key data points.  The list of "personal narratives, American" for "Iraq War" number 39 and counting.  That's a whole lot of books, and at least 39 ways to get more in touch with what our current crop of veterans were going through when they were in the war.

A Wounded Warrior Speaks

The L.A. Times recently carried an Op-Ed piece from Lt. Col. Timothy Maxwell, a severely injured Marine who wanted to speak out about his experience of going, as he put it, from the "A Team" (before injury) to the "B Team" (after injury).  Frequently in this war we hear of people who in a previous war might have died, their injuries were so severe; but thanks to their stronger, protective armor, or faster battlefield care, or any combination of that and sheer luck, some wounded manage to survive what otherwise would have been certain death.  Lt. Col. Maxwell is one such person.  HIs injuries were devastating; and his aggressive stance, post-injury, to do whatever takes to get back to health is impressive and laudable.  But even with the phenomenal focus, willpower and drive he brings to the situation, Maxwell has to admit, it's no easy job being injured, or coping with the feelings of failure and frustration that arise when a great deal of your career self-esteem is tied up in your physicality and ability to perform.  Since no one can do a better job capturing that sense than someone actually going through it, Maxwell's op-ed article is well worth reading.  It's also great to see that in Maxwell's future plans are caring directly for other injured military, and making sure they and their families get what they need to survive what can be a very long, very tiring battle of its own: the battle back to health and wholeness.  Read Maxwell's piece - it's highly recommended.  And he pulls no punches about what an easy task getting well is going to be, for him or any of the other injured.

The Other Half of the Contract

The grueling nature of war continues.  Tonight (tomorrow already in Iraq), 2 Marines died and 22 were injured in the Anbar province.  (That's 22 people, who if they live, and we surely hope they do, will have some potentially pretty horrible memories to integrate into their future lives.  Not all will be able to, statistically.)  An acquaintance whose young Army son came back from Iraq and took his own life, told us he would have celebrated his next birthday on Monday.  The war affects us, not only through who died, but also through who was injured and who was left behind.  The repercussions of what the warriors saw and felt and experienced is theirs to carry, as well as ours to reach out and attempt to comfort, and try to understand, or at least acknowledge, respect and value.  A family member of a young wounded Marine recuperating from amputations in Bethesda, mentions that the Secretary of State was there today, and it was "her first visit to the 5th floor," where the seriously wounded are recovering. 

If that family member's impression was correct, the impression is that our government has some work to do, in showing practical compassion and concern for the very troops it sends into battle on behalf of a greater cause.  Our concern is that they not be forgotten, dropped, neglected or otherwise shuffled aside, once they come home from the war we send them to fight.  It only seems fair: the other side of the implied contract.  We send you off to war: we ask you to put it all on the line, to risk everything; when you come home, we honor and take care of you for what you did, and appreciate your sacrifice.  It's clear we understand "Side A" as a country; let's hope we don't fail to execute "Side B" just as fully and completely...

The Ineffable Sadness of Seeing

Tonight we heard a very sad story from a friend, whose young son killed himself after returning from Iraq.  The chaplain from her son's unit, who had served with the Army reserve in Iraq, a middle-aged pastoral leader in civilian life, had been routed to Louisiana to help with Hurricane Katrina "efforts" after returning from Iraq.  As with some others (e.g., the USMC's "Marlboro Man"), this seems to have been just the "1-2 punch" of too much devastation in too short a time to deal with, having seen so much chaos and tragedy in his time in Iraq.  The chaplain's marriage did not survive, and the man is currently living in a homeless shelter.  If the combination of "too" much war and devastation is what eventually broke this man's spirit, and we hope only temporarily, we feel nothing but compassion and great, great sadness for this loss.  Perhaps we are asking people to "handle," without resources, much more than they are able.  May it not be the case tomorrow, as well.

In the words of the Eagles' song by Don Henley, "There's a hole in the world tonight...don't let there be a hole in the world, tomorrow."

"A World of Hope and Hurt" @ Walter Reed

A nice article in today's Vail Daily  -- yes, we are scanning the globe to bring you the best of the best even from resort areas primarily known for skiing ;-) -- talks about what it's like to work at Walter Reed hospital these days, for the staff, dealing with incoming combat trauma cases all day, every day.  It's both sobering and inspiring, not to mention incredibly draining, on the staff -- oh, wait -- let's not spoil the point of the article -- and, there's inspiration abounding, on the part of the young veterans who are dealing with life-altering injuries.  Great perspective on the topic of healing combat trauma, from the perspective of those who work with it daily.  Worth a read.  Two ski tips crossed (like two thumbs up?!)

One good quote from the article: "But the cumulative effect of nearly 4,900 patients, including 1,458 battle casualties, has done more than change the institution. It has deeply affected the hundreds of doctors, nurses and therapists who work there--who have been inspired by the resiliency and motivation of the individuals in their care, yet shaken and exhausted by the magnitude of loss."

One combat surgeon's comment, also quoted in the article, is lovely.  As the article says about him, "The last several years at Walter Reed have been the most demanding of his career but also among the most humbling and rewarding. He marvels at the soldiers' attitude, their gratitude, their perseverance.  "What this has taught me is, our youngest generation is magnificent,'' he says. 
It has renewed his faith in America."

Legislation Proposed for "Healing the Invisible Wounds" of Combat

An article in Tuesday's Navy Times describes a bill being proposed in the Senate to provide more funding for veterans' issues, particularly counseling services.  According to the article, "The bill, S 2500, the Healing the Invisible Wounds Act of 2006, aims to prevent the Bush administration from cutting disability benefits for veterans with combat stress and to improve counseling and readjustment services for National Guard and reserve members, sponsors said."

(Since the purpose of this blog is informational without succumbing to political agendas, we'll safely leave it at that.  Good to know someone's thinking about this topic, though, on whatever side of the aisle.)

Max Cleland, Decorated Vietnam Vet and Former VA Head, Has Combat Trauma

There's a very interesting article from the April 3rd issue of Salon, by Max Cleland, Vietnam era triple amputee, and head of the Veteran's Administration under President Jimmy Carter.  Cleland worked hard to establish VA medical centers across the country and to establish the diagnosis of PTSD.  In this article, he reflects on his own experience with the Vietnam war, and the concern he feels over what Iraq veterans are experiencing in combat and afterwards.  And he makes a very telling admission, about how combat trauma has affected him, even decades later:

"I go to Walter Reed Hospital now for trauma counseling. For my own self. Because it never ends. I've got post-traumatic stress disorder. Didn't know I had it. Anxiety and fear and all that crap. And it never goes away. But you can submerge it into a higher cause like politics.

"So here I am, back at Walter Reed, thirty-seven years later, dealing with the trauma of Vietnam. I never got the counseling back then. But I look down the hall, and it's still 1968. Seeing all these young Iraq War veterans blown up, missing arms and legs and eyes, I just can't stand it. It triggers all of my stuff from Vietnam. And these young men had the same grit and courage that we had going off to war. You go up to 'em, and say, "How ya doing, son?" "Fine, sir!" they answer. But years later, it will take its toll. They just don't know yet."

A link to the full article is here.

Also in the article, Cleland remarks about the declining budget dollars available to fund crucial VA services, like counseling for returning vets and their families.  Says Cleland, "Looking back on my career, I am proud of being the Veterans Administration head and dealing with the aftermath of the Vietnam War, in particular, putting together the program for veterans' centers, which deals with the emotional aftermath of war for veterans and their families. Thank God for that program, because it is being swamped by a new crew of Iraq War veterans. They are dealing with depression, anxiety attacks -- stuff like that.  We have created a quarter of a million Iraq War veterans. In Vietnam, we had eight and a half million veterans.  We are adding to that quarter of a million number every day.

"Walter Reed is swamped with bona fide casualties.  Particularly amputees. The VA is swamped. They don't have enough resources. Senator Craig, a hard-core Republican from Idaho who is on the Senate Armed Forces Committee, admitted that the VA medical program was about a billion dollars short. The private counseling program is where it is most short. That is what ought to be beefed up. With all these Iraq War veterans coming home, their families will also need counseling."

Coping with Combat Stress Seminar

The "Wounded Warrior Project" is having another conference on coping with combat stress.  (They've got to get better at giving lengthier advance notice of these, if they really want more people to know about them.)  Here's the info from their newsletter, delivered today:

WOUNDED WARRIOR PROJECT COPING WITH COMBAT STRESS SEMINAR Are you, or is someone you love, a recently returned service member who served in combat during Operations Enduring or Iraqi Freedom? If so, you or your loved one may, understandably, be experiencing stress while readapting to everyday civilian life. On April 9thth and 10th, 2006, the Wounded Warrior Project will be holding a two-day seminar at the Clarion Prince Charles Hotel in North Carolina entitled “Coping with Combat Stress”. The program, which is open to recently returned service members from Operations Enduring or Iraqi Freedom and their families, will educate the participants on how to identify and deal with the symptoms of combat stress and will demonstrate various relaxation and coping techniques. Professionals from the Saint Vincent Catholic Medical Centers/World Trade Center Healing Services will be leading the workshop. The Wounded Warrior Project (WWP) is a nonprofit organization aimed at assisting those men and women of the United States Armed Forces who have been severely injured during the wars on terrorism in Iraq, Afghanistan and other hot spots around the world. Beginning at the bedside of the severely wounded, WWP provides programs and services designed to ease the burdens of these heroes and their families, aid in the recovery process and smooth the transition back to civilian life. The Coping with Combat Stress seminar will be held at the Clarion Prince Charles Hotel, which is located at 450 Hay Street, Fayetteville, NC 28301. The two-day seminar is free of charge. Participants are expected to attend both days’ sessions and, accordingly, accommodations in Manhattan [??? they may be referring to their previous seminar, and this may be left in as an inadvertent typo] may be available. Space is limited so please register as soon as possible. For more information about the combat stress seminar, please contact Jeremy Chwat at 646-452-5422 or via e-mail at: jchwat@woundedwarriorproject.org.

"War without End" Series

The San Francisco Chronicle has an excellent, four part series, cleverly titled, "War without End," that profiles two injured Army soldiers from Fort Lewis, Washington, as they navigate the trials and challenges of homecoming as double-amputees.  The series covers quite a lot of ground, focusing in llarge part on the two soldiers' months of endless surgeries and relentless physical therapy appointments, as inpatients at Walter Reed hospital in Washington, D.C., and the challenges of adjusting to homecoming with their families as caregivers, once they are discharged.  Learning to walk again, dealing with the painful struggles of jagged bone growth that sets in as a side-effect of their injuries, and learning how to cope with the various indignities of not being able to "do" for yourself in the same ways, are all issues these (and many other) veterans are facing right now. The series is excellent because it provides a really detailed view into these two soldiers' lives, without straining for pity or pathos. The soldiers themselves, Sgt. Brent Bretz and Sgt. Michael Buyas, manage to find their own coping skills, and regain a sense of humor and of purpose, over the long months they wage war with their injuries.  Sadly, with so many injured veterans, series like these could crop up in every paper in America, in every week.  But it's also very helpful to have a long-term look into the difficulties of coping with significant war injuries.  The link to the complete series is here.

On the psychosocial front, one of the interesting aspects of the article is how each man had found real purpose as a soldier, and then wondered if that purpose would be lost, once they left Iraq injured and had to work so hard to regain their strength and health back here.  It's also interesting to see how vitally important the camaraderie of the other guys in the same unit are to the injured vets - it gives them something even their doting families and caregivers can't provide, another vote for "healing in community" with others who have undergone the same experiences.  It seems to add to the veterans' psychological health and wellbeing, if not the physical as well.  Excellent series.