Healing Combat Trauma

Sen. Patrick Kennedy's PTSD Veterans Bill

In more good news coming out of Rhode Island -- John Powers, you still rock -- U.S. Representative Patrick J. Kennedy (D- RI) recently sponsored legislation intended to address the psychological side of combat and PTSD.  Kennedy calls PTSD, somewhat mistakenly, "the signature wound" of the current wars in Afghanistan and Iraq.  In truth, it was probably the signature wound of the Vietnam War, which is why we're more aware of it now; but it's clearly making a resurgence now, along with closed head trauma and amputations resulting from IEDs, which have seen a huge surge in the current wars, particularly in Iraq.  Still, hairsplitting on this hardly matters, what counts is the increased attention for veterans' health that Kennedy's bill is intended to create.  Read more about Kennedy's proposed legislation in this article from the Providence Journal Bulletin.

Women Combat Vets and PTSD

NPR has a story today on "All Things Considered" about the special hardships of women combat vets, and how they're often at risk for the dual assault of PTSD and sexual trauma from their combat experience.  This story illustrates that gender differences can exist in how men and women experience PTSD. 

John Powers - Whoever He Is, Rocks!

There's an article cited today on the consistently excellent IAVA blog that's well worth reading -- and celebrating! -- about one John Powers, 23 years old, formerly of Cumberland, RI, a non-veteran/private citizen, who created what sounds like an extraordinarily helpful, and exhaustive veteran's resource guide, as a testament to a veteran friend in need.  Woo hoo!  Here's a link to the Veterans Task Force in Rhode Island, but it's strangely silent about the guide, although ideally in the future there will be more info forthcoming from them on it.  My sense is everyone is gonna want one of these!

Powers' fantastic, selfless work brings to mind the alleged Abraham Lincoln quote, to wit: "Honor...to the citizen who cares for his brother in the field, and serves, as best he can, the same cause." To that we might add, the brother or sister in the field, or returned home from same.

It's as good a time as any, then, to mention some of the other do-gooding efforts by other individuals and organizations on behalf of veterans, some of which have gotten less fanfare than others.  They include: Homes for Our Troops -- building and remodeling specially adapted homes for the most severely wounded of our veterans, like triple-amputee Joey Bozik and his wife, Jayme, who consistently blogged about his recovery; Helmets to Hardhats -- finding construction jobs for returning veterans; the Wounded Warrior Project -- providing disabled sports opportunities for veterans; Quilts for Soldiers -- quilted comfort for veterans and their families; Sew Much Comfort -- volunteers sewing adaptive clothing for injured, hospitalized and rehabilitating troops; and the adorable Jessica Porter's project, begun as a teenager, Operation Homefront Quilts (see also this link) -- a way to make sure every returning veteran's service is honored.  There's also the Minnesota organization, CaringBridge, which provides informational websites free of charge to injured vets (among others) and their families, to keep people posted on their conditions.  And in case all this do-gooding is too hard on the eyes, there's the fundraising calendar of Freedom is Not Free -- featuring the hunkadelic, practically NSFW cover pic of Rudy Reyes, formerly seen with a few more clothes on, in Nate Fick's fantastic book, "One Bullet Away: the Making of a Marine Officer" (see sidebar).

Leaving the War Behind, When the War Won't Leave You

There's a truly superb article in today's New York Times, written by Conrad Mulcahy, called "Outward Bound, Looking In," about a unique Outward Bound experience in the wilderness for veterans.  The article describes the course of a particular recent trip, and it's both profound and subtly written -- a true joy to read.  The trip described, which took place in the Colorado mountains, seemed to be both cathartic and bonding for its varied participants, veterans from Iraq, Afghanistan and Vietnam.  (Outward Bound itself, with umpteen courses worldwide, even has its own quasi-military roots, as the article describes.)

Part of the purpose of the trip for the veterans who went seemed to be come to terms with how to leave the war behind, to the extent that's even possible.  Said one young Marine who participated, echoing many other veterans' points of view, “I wish that civilians and policy makers really understood, at an emotional level, the tremendous toll and cost of war on those who actually experience it."  "As another recent veteran added, “I think if there’s one message I could get across to the public, it’d be to not give up on us,” he said as the group walked through the mountain sunshine to the trailhead."

A fascinating article, written with aplomb, about a seemingly life-affirming experience in the wilderness for combat veterans.  For more information about Outward Bound wilderness programs for veterans can be found here.

Patient Advice for Those "Home from War"

Patience Mason, author of one of the finest post-Vietnam era books on healing from combat trauma and PTSD (see sidebar), has released a wonderful article on her blog about how to handle coming "home from war."  She directs readers to the PDF copy of the article if they'd like to read it in its most legible form.  That article is linked directly here, from her publishing company, Patience Press.  If you want to learn more about Patience Mason (and you should!), here's a link to more information she's provided.  Her book, Recovering from War, is one of the seminal works on combat trauma and its effect on veterans and their families alike.  Well worth reading and well worth familiarizing yourself with.  Patience is often said to be a virtue - but this Patience is also a very important ally for veterans and families in recovering from PTSD.

Back from Hell: Treating PTSD with Massage and Other Bodywork Therapies

An interesting article recently published online talks about the therapeutic benefits of touch (massage therapy, in this case) for PTSD, without making it seem like either a panacea, or a complete walk in the park.  Kudos to the article's author for acknowledging the difficulties faced by this client population, and the special sensitivities needed.  Bodywork modalities like massage therapy, craniosacral therapy, possibly even Reiki and therapeutic touch, hold some promise for treating combat veterans, provided the practitioners are educated about the special challenges of that population, and provided the participants are willing.  (The attached photo is of a crayon drawing, done by one appreciative child patient, depicting his practitioner's healing hands.)

The article is well worth reading, and is excerpted in part below:

Traumatized in war, often faced with family and job relationship difficulties, and also frequently confronted with government bureaucracy, veterans deal with high levels of anger. One study stated, "Anger management intervention is an integral part of post-traumatic stress disorder treatment in the Department of Veterans Affairs facilities across the country."11 The presence of intense anger, along with other deep emotions, can cause a veteran -- triggered during therapy -- to undergo an explosive emotional release. "PTSD may cause a person to fly into a rage for no apparent reason or strike out in fear at inappropriate targets."12

"Vets tend to have a more violent type of reaction if a memory comes up," explained Chris Smith, director of education at the Colorado School of Healing Arts in Lakewood, Colorado. Smith, who is also a massage therapist and instructor for the school's 100-hour program in Trauma Touch Therapy, explained, "It takes a therapist who can stay grounded and isn't afraid of the intense emotional outbursts." Because of their war-time experiences, she said, veterans in therapy may tend to be "less resourced" in how to handle stress and "more hyperaroused" than other trauma clients.

According to some therapists who work closely with veterans, the VA and other group programs provide only limited help for veterans. After a certain amount of time has passed, these therapists say talking about the trauma in a group setting can become a useless "rehashing" of the horrors. To emerge from the sense of victimization may likely demand hard, individual work in therapy on the part of the patient. It generally requires facilitation by an extremely grounded and well-versed therapist. If the veteran chooses to try an alternative therapy, such as massage, the process will likely necessitate participation not only in bodywork sessions, but also in simultaneous sessions with a psychotherapist.

One massage therapist who has worked with veterans visited a VA hospital to learn more about PTSD and observed that many of the veterans were in extremely serious condition. "For many vets, the only answer is a great deal of isolation and seclusion and often medication that can have so many other side effects. They often cope by removing stimulation as much as possible," she said.

It seems like a good time to re-mention the fabulous Claude Anshin Thomas passage in his book, At Hell's Gate (see sidebar), about suffering not being the enemy.  Click this link to bring back that earlier blog entry.

Resilience Improves PTSD Recovery - You Don't Say!

In continuing news from the "gee, we wish we'd known about that event before it happened" department of ineffective P.R., we find today that there's another session of the American Psychological Association's annual meeting devoted to recovery from PTSD that it's too late to go to.  Hmmmn.  The groundbreaking news, according to the press release, is that (quote):

Being deployed in combat is associated with high rates of stress-related symptoms that appear to increase after soldiers return home. Building resiliency and recognizing stress-related problems early on can prevent post-trauma stress and other problems during and after a tour of duty, say psychologists.

Adler will describe a study showing that resilience helps lessen the effect of combat after being deployed in a war zone. Those soldiers who scored high in resilience suffered fewer post-trauma symptoms. Additionally, those who perceived that their unit/organization supported them demonstrated even greater resilience.

Not to diss professional psychology, but seriously, on what level is that not common sense?  Resilience is by definition the ability to bounce back from a traumatic event, relatively unscathed, both durably and quickly.  (If you're not convinced, see this dictionary definition.)  So of course the more resilient a person is, the greater their ability to handle even combat trauma.  However, attention might be better spent isolating and analyzing the factors that go in to improving one's ability to respond resiliently, e.g., the presence or absence of levels of specific neurotransmitters in the brain, the previous level of acute or chronic stress of the individual, the set of coping strategies they've practiced before deployment.

As to the other main point, that those who felt support from their unit did better, that too is fairly commonly known -- see any of Jonathan Shay, M.D., Ph.D.'s books on combat trauma, including "Achilles in Vietnam" and "Odysseus in America" (see sidebar).  Now, if we could only find a way to send just resilient individuals in highly connected, supportive units to war -- oops.  Can't happen.  Got to deal with the cards as they're actually dealt.

Come to think of it, on the level that the stress of deployment bleeds over into the family life of those deployed, it's fair to say that those two items apply: the more resilient do better, as do the ones with better social support networks.  However, much greater attention needs to be paid here, to move beyond the superficial and obvious.

American Psychological Association on PTSD

It's never fun to learn about an event that might have been good to go to, after it's already happened.  Such is the case with the P.R. we just received, via a source in the UK, about an event at the American Psychological Association (APA)'s annual meeting in San Francisco today, that sounds like it would have been interesting, about PTSD and combat veterans.  (The general release date for the P.R. was the date the event actually happened -- ack.)  However, here's a bit of the info about what was being covered:

"Jaine L. Darwin, PhD, a private practitioner in Cambridge, Mass., and Walter E. Penk, PhD at Texas A & M University" (the presenters).  Presentations will address the positive effects of work for returning soldiers and describe how reservists and their extended families are affected by the multiple deployments in the wake of September 11, 2001 and the war in Iraq at the American Psychological Association’s 115th Annual Convention" at the Moscone Center in downtown San Francisco.

Whatever the SOFAR organization is, it's not particularly well-publicized (hmmmn -- see above.)  It's pretty much impossible to find more info about it on the Web.  But if you go to the APA's general website, you do find a segment devoted to PTSD and PTSD resources.  Here's the link to that.

When Pharmaceuticals Fail - PTSD Drug Treatment Termed Ineffective or Worthless

"Common PTSD Drug No More Effective Than a Placebo" reads the title of an article published recently in Medical News Today.  It details the results of a study published in the December 1, 2006 issue of the American Journal of Psychiatry.  Not to sound like a Scientologist here, ooh no, but it's interesting to read that a common pharmaceutical approach to an illness like PTSD may have little or no value, according to psychiatristric researchers.  The question is: is anyone still being prescribed it?  And the guess is, yes, despite what this study indicates.

Says the article, in part, "Guanfacine, a medication commonly prescribed to alleviate symptoms of post-traumatic stress disorder, is no more effective than a placebo, according to a study led by researchers at the San Francisco VA Medical Center.

"There was no benefit at all, and there were several adverse side effects," says lead author Thomas Neylan, MD, medical director of the PTSD treatment program at SFVAMC."People with symptoms of PTSD should probably stay away from this drug and others of its type."  Interesting...

And Now for a Little Interlude of Beauty...

It's great to see that USMC Warrant Officer and Marine combat artist Michael Fay has his blog, Fire and Ice, back up and running on Blogger.  We've covered the compelling beauty of his work before here.  [Honestly, I'm not sure I would have trusted Blogger again after the unfortunate/deliberate hacking incident, which allowed someone else to end up with Mike's site after it got an astronomical number of hits following press coverage of him and his work in mid-April by the BBC, but that's an aside.]  Fay's blog "warrants" our attention because he's a combat artist with many tours of duty to his credit who's also got a tremendous ability to capture the experience of war in its combatants' faces.  Fay's work is now on display at the James A. Michener museum in Doylestown, PA, through October 21, 2007, as well as at the National Museum of the Marine Corps, USMC Combat Art Gallery, in Triangle, VA.  If you're in the area, check it out in person -- it's phenomenal.  If you don't have the luxury of visiting, be sure to check it out on his reconstituted, fortunately resuscitated blog.

Military Vastly Underreports PTSD Cases

According to an article published earlier this week in the Hartford Courant, the military is likely vastly under-reporting and under-diagnosing the number of PTSD cases it sees among returning veterans, and the figures are off by quite a lot, irrespective of the difficulties surrounding a topic associated with some stigma to the sufferers.  Early figures coming back from the wars in Iraq and Afghanistan, reported earlier in articles like this one on this site, place instances of PTSD closer to one in three(!) of returning troops -- so figures mentioned in this article of lower than 5% are obviously too low.  Here are some excerpts from the article, but go to the full-text one on the Hartford Courant's site to read the whole thing. 

Says the article, "Only about 3 percent of soldiers who have served in combat since 2003 have been diagnosed by the Army with post-traumatic stress disorder - far fewer than the numbers who have screened positive for PTSD symptoms in recent Army studies, suggesting that the disorder is being under-reported and under-diagnosed.

New figures released to The Courant by the Army's Office of the Surgeon General show a total of 23,788 soldiers, most of them deployed to Iraq or Afghanistan, who have been diagnosed by the military with PTSD in the past four years.

The number represents about 3.2 percent of the more than 745,000 soldiers who have been deployed. A recent Army study of soldiers serving in Iraq, based on anonymous surveys, found that 17 percent met the criteria for PTSD, while other military studies have estimated the prevalence of the disorder at 15 to 20 percent. "

(Thanks to the IAVA blog for alerting us to this story.)

EMDR for Trauma: The Eyes Might Have It

The military-oriented news site, the Stars and Stripes, has an article today about how EMDR is becoming a treatment of choice at Landstuhl Regional Medical Center.  Hmmmn.  It's a little disappointing that the military is just now hearing about EMDR, which has been around since the late 1980s, and initially came into prominence as a way to treat Vietnam veterans and other trauma survivors, to lessen the impact of their violent memories.  EMDR, or Eye Movement De-sensitization and Reprocessing therapy, was developed by Francine Shapiro, Ph.D.  If you would like to read more about Francine Shapiro, Ph.D., EMDR, find out more about the history of EMDR, learn whether or not EMDR works for PTSD, or how to find a clinician trained in EMDR in your geographical area, click the hyperlinks for more information.  There are also a number of books published about EMDR, by Shapiro and others, and they're listed in the sidebar, about halfway down.  If you're a clinician and you'd like to find out more about being trained in EMDR, visit Dr. Shapiro's website for more information.

Editor's note: EMDR shows much promise for treating PTSD and symptoms of combat trauma.  It is not talk therapy, nor is it a pharmaceutical-based approach.  It is, however, not the only treatment low-tech, high-touch therapy that shows promise for treating combat trauma.  However, with almost 30,000 troops injured in Iraq and Afghanistan, plus affected family members -- because not only servicepeople suffer from trauma's effects, but also their family members can -- it's very much a significant step in the right direction.

Brain Enzyme Targets PTSD Memories

(We're catching up on some recent news here.)  An article published in the BBC online a few days ago mentioned the success of researchers at MIT in isolating a single enzyme in the brain that may hold promise for PTSD research.  The research is still a long way off from being tested with human beings, but it's of interest to anyone following PTSD in the news, particularly as it relates to healthcare.  The only concern is, the "single bullet" theory (no pun intended) in medicine often turns out to be hype.  For complex, multifactorial illnesses, of which combat trauma may turn out to be one, pinning hopes on a single brain enzyme and a strictly biochemical solution may be a bit much.  That said, if it works, bring it on!  The number of untreated PTSD sufferers continues to grow.

PTSD: The Hardships of Homecoming

A reporter colleague turned us on today to a series of articles she'd written in the Herald News of West Paterson, NJ recently, profiling a soldier and his family having difficult re-adjustment issues back from the war with untreated PTSD.  The two-article series draws a vivid and compelling picture of the difficulty of life back on the home front, for both the combat veteran with PTSD, and his immediate family, who often bears the brunt of re-adjustment turmoil.  The first article in the series is linked here; the second is linked here.  The reporter, Andrea Gurwitt, does a great job painting a picture of the hardships involved: the scene at the child's birthday outing at Chuck E. Cheese is particularly poignant.

Good News: Dole-Shalala Commission Urges Overhaul of Veteran Care

The Washington Post announces today that the Dole-Shalala commission which has been evaluating the convoluted mess of veterans' care in the U.S. has come up with its finding, and will be pressing President Bush for a response.  The article detailing the commission's important findings is here.  Fellow blogger Larry Scott, at VAWatchdog.Org, has a copy of the draft version of the commission's findings, which surely would make interesting reading as well.  Here's a link to the downloadable version of the PDF on his site.  If you want to learn more about the actual commission, read the report at its site, and/or watch the video on YouTube, here's the link to the commission itself.

More Books on Healing Combat Trauma and PTSD

It's heartening to see a few more books published on a topic near and dear to our heart: healing combat trauma and/or PTSD (see sidebar for titles; scroll all the way down).  War and the Soul:Healing Our Nation's Veterans from Post-traumatic Stress Disorder, by Edward Tick.  And (great title!) Moving a Nation to Care: Post-Traumatic Stress Disorder and America's Returning Troops, by fellow blogger, Ilona Meagher.  The first book looks like it was published several years ago, so isn't new, but the second book is new.  Let's hope this heralds a (re)surgence of interest in this vital topic!

Jonathan Shay, Combat Trauma Expert

A wonderful profile that's still on the Web is the one profiling prolific combat trauma expert Jonathan Shay, M.D., in the New York Times from 2003.  Click here to find it on its website.  Shay is a towering figure in the field, having written several of the pre-eminent works (see sidebar), and the profile tells an interesting story of the turns Shay's own life took leading him to the study of combat trauma, and helping veterans survive the turmoil of their post-combat lives.  (Shays' books include "Achilles in Vietnam: Combat Trauma and the Undoing of Character," and "Odysseus in America: Combat Trauma and the Trials of Homecoming."

Veterans Group Has a Great Website AND a Blog!

The Iraq and Afghanistan Veterans of America ("IAVA"), the "first and largest" group of current war veterans, not only has a great website that we've been reading for quite a while, they also have a great blog.  Pull current information from it with an RSS reader, or use Google's new Blogreader gadget, that you can add to your home page in Google.  (You do have your home page set to Google, don't you?!)  For that matter, use the Google blog reader to with postings on this blog as well.

Wrongful Death Suit in Marine Suicide Filed by Family Against the VA

The Boston Globe reported in an article published this week that the family of Jeff Lucey, a Marine corporal who sought and was denied psychiatric care at the VA in Massachusetts, and later killed himself, has filed a wrongful death suit against the VA.  Jeff Lucey (pictured here with his parents, in a screen grab from NECN) is one of the subjects profiled in the excellent documentary aired on New England Cable News ("NECN") a while back, called Hidden Wounds, also featuring Nate Fick.  On April 6, 2007, NECN also aired a video discussion with Lucey's parents, around the topic of "Is There Adequate Medical Care for Veterans?"  (I think we know the answer to that one...)  Check out the NECN archives for information about that story.