Healing Combat Trauma

Chronic, Systemic Neglect of Veterans Healthcare Goes Back Years

Quite by accident, I came across a treasure trove of articles today, by Salon's national correspondent, Mark Benjamin, on the chronic problems with delivering high quality care at the VA that go back years.  Do yourself a favor and read some of the articles he's written, cited and linked below, and enlarge your own perspective on how the VA operates.  It's also interesting to read Benjamin's recent articles, which tell some of the backstory of the current candidate for head of the VA, James Peake, M.D., who's now about to be confirmed as the same.  Despite the fact that he's a Vietnam vet with umpteen years of medical training and experience, it seems that when it comes to managing veterans' healthcare, he didn't do such a great job in a previous, similar post.  And there's a potential conflict of interest: the private company he's worked has made multiple millions of dollars contracting services with the Department of Veterans Affairs. Hmmmn. If you want some interesting background on some of the key players and the overall perspective on the VA, do yourself a favor and read some of Benjamin's reporting.  It's excellent, and raises some important questions that will likely go unanswered.

Here's a list of several recent stories by Mark Benjamin on the topic, followed by a list of earlier, also significant ones:

• Bush's careless choice for Iraq vets
  James Peake, Bush Nominee for VA: Will he help Iraq vets who need healthcare? 
  By Mark Benjamin.  Originally published 11/05/07.
• The Pentagon's chronic neglect of Iraq vets
  Military officials knew long ago about the failure to take care of America's war wounded at the beleaguered Walter Reed hospital.
  By Mark Benjamin.  Originally published 04/25/07.
• Walter Reed, on the cheap
  The Pentagon's top civilian official in charge of military healthcare wanted more money for bullets and bombs, and fewer benefits for soldiers.
  By Mark Benjamin.  Originally published 03/06/07.

And some earlier, excellent ones:

• Gen. Kiley knew about vets' outpatient scandal
  Veterans groups told the Army surgeon general about the shockingly bad mental health treatment at Walter Reed two months before the latest expose, but there's no evidence he followed up.
  By Mark Benjamin.  Originally published 02/27/07.
• The long-term wounds of Walter Reed
  Despite military officials' "surprise" at recent coverage, Salon exposed inadequate care and an overwhelmed system unfriendly to vets beginning two years ago.
  By Mark Benjamin.  Originally published 02/23/07.
• Losing their minds
  More U.S. soldiers than ever are sustaining serious brain injuries in Iraq. But a significant number of them are being misdiagnosed, forced to wait for treatment or even being called liars by the Army.
  By Mark Benjamin.  Originally published 01/05/06.
• Behind the walls of Ward 54
  They're overmedicated, forced to talk about their mothers instead of Iraq, and have to fight for disability pay. Traumatized combat vets say the Army is failing them, and after a year following more than a dozen soldiers at Walter Reed Hospital, I believe them.
  By Mark Benjamin.  Originally published 02/18/05.
• Insult to injury
  Some wounded soldiers back from Iraq are having to pay for meals at Walter Reed Army Medical Center. Veterans' groups say it's another symptom of fighting a costly war on the cheap.
  By Mark Benjamin.  Originally published 01/27/05.
• Sticker shock over shell shock
  The U.S. government is reviewing 72,000 cases in which veterans have been diagnosed with severe post-traumatic stress disorder, claiming that misdiagnosis and fraud have inflated the numbers. Outraged vets say the plan is a callous attempt to cut the costs of an increasingly expensive war.
  By Mark Benjamin.  Originally published 08/09/05.

What Does It Mean to Reach the Breaking Point?

What does it mean when an individual -- or a system, such as the VA -- reaches its breaking point?  Do they even know?   And what can we learn from what makes some, or even many or most, snap under the strain, when others (a few) manage to survive and find meaning, not crushing, in their suffering?

Viennese psychiatrist and Holocaust survivor -- concentration camp survivor might be more accurate -- Viktor Frankl wrote Man's Search for Meaning, considered one of a handful of hugely influential books in the 20th century. Like Elizabeth Kubler-Ross, who "systematized" the steps around death and dying, and postulated that everyone goes through them, Frankl took a look, as a psychiatrist, at the tremendous suffering he and other concentration camp inmates had experienced, and drew a few conclusions.  In his opinion, there were three main stages that everyone who suffered tremendously would undergo: shock, apathy, and either giving up, or choosing to find some sort of meaning in the suffering.

As the news we read is saturated more and more with ever more instances of veterans snapping under the pressure and the strain, and committing suicide, or going AWOL rather than return to Iraq, or lashing out at their loved ones in some extreme way; or the system itself snapping under the strain -- we are literally watching people and organizations hit their breaking points.  Some will survive, but many will not, and it's not a value judgment on the ones who do not.  Projects like the PTSD Timeline chronicle the incidences of individual combat veterans reaching their breaking points, sadly enough.  But the stressors on the system are also enormous -- the toll that combat doctors and nurses are under in treating massive injuries hour after hour in Balad, Landstuhl, Walter Reed, etc., and the various trauma hospitals where severely injured veterans are sent across the country -- the toll that the VA is under, which much greater demand for its services than can be safely delivered.  And we need to ask the question -- whether it's an individual veteran or a system supporting veterans -- what does the "breaking point" actually look like?  Will we know it when we arrive at it, or will we find out in retrospect that we just passed it, too late to do anything about it?  And is there anything constructive to be learned from those who reach the same crossroads -- either individuals or systems -- but bend, and do not break?  More questions than answers, to be sure, but questions that are both timely and need to be asked.

Discarded Veterans "Homeless for the Holidays"

Before my old and very crappy laptop melts my lap completely tonight, or just plain dies -- I'm on the road, so having to post with this -- I didn't want to let Thanksgiving Day go by without a mention of a very serious issue, so well covered by another blogger: the concept of homeless veterans.  New studies are coming out that say at least 1 in 4 homeless are veterans, but the numbers could be actually much higher.  For some truly insightful and comprehensive coverage of how veterans have historically been "discarded" -- a very striking word indeed, and one that carries a lot of meaning -- read the wonderful OldTimer's Wordpress blog, linked here.  The whole blog is great, but his extensive piece on the history of veterans being treated poorly, and becoming homeless -- not just in this war, but in a whole series of them in the past, is especially worth reading at this time.  What could be more painful than serving honorably and getting cast aside, to fend for yourself at this (holiday or any other) time -- as opposed to having the country you served look out for you?  It's a terrible tragedy that we as citizens are also responsible for, because we let it go on.  In this burgeoning holiday season, please take more than a moment to think of the fate of homeless veterans, and what we OUGHT to be doing for them.  As an total, overall issue, we haven't exactly excelled with the topic of helping the homeless in our society.  But having homeless veterans casts a real shadow of shame on us as a country.  Please think about what more we could be doing, and begin to take steps to help solve this crisis.  To paraphrase a quote I'm frankly too sleepy to go look up, we'll be judged as a society by how we treat the least of our citizens -- and our homeless, by default, end up being them.  If you need to be sensitized to how important shelter is, just do a little reflection yourself, or be intellectual about it and read about Maslow's Hierarchy of Needs.  If you want to be moved by someone who gets their plight and cares, read OldTimer's excellent blog entries on the same, linked here.  Thank you and good night.

"Listening is an Act of Love" -- Book & Project

Just in time for the holidays -- when families and friends traditionally gather to spend gobs of potentially boring OR bonding (and sometimes, both!) times with one another -- here's an idea whose time has definitely come.  Listening is an Act of Love is a new book by Dave Isay, as part of the national StoryCorps Project, which encouraged average citizens to tell their stories to interested others, who recorded them and assembled them for future listeners, in no less than the Library of Congress, so they'll be available to all Americans.  Here's what some impressive people had to say about the project:

"Dave Isay's vision of collecting the everyday stories of Americans is so simple and yet so powerful. Listening Is an Act of Love will make you laugh, cry and think. These stories come from the souls of individual Americans. Collectively, they are who we are as a people. You cannot read this book without feeling proud of your country." -- Former U.S. Senator Bill Bradley

"StoryCorps asks Americans to reflect upon their experiences, their times of travail, their achievements. In so doing, these individuals create an encompassing national narration: a people's hopes, fears and aspirations, all rendered poignantly to attentive listeners whose respect has enabled, finally, a presentation of a people's mind, heart, soul." -- Dr. Robert Coles, James Agee Professor of Social Ethics, Harvard University

"This book is absolutely remarkable. Listening is an Act of Love is history in the richest sense of the word, the kind that makes people feel like they count. It's a celebration of the lives of the uncelebrated. In our world today people feel helpless, but once they speak of their lives they become alive! This is what our country is all about. Never has a book been more timely or necessary."  -- Studs Terkel, prolific writer and master oral historian.

Here are three ways to get involved: 1) buy copies of the book, for yourself and to give as holiday gifts this season.  2) interview some people you know who might have stories to tell -- get them talking about the stories only they can tell, and record them for posterity, too, as part of this project.  Details on how to do that at the StoryCorps Project website, linked here.  (Don't force anyone to talk about anything they don't want to, but be a receptive, inquisitive audience for those who do.)  3) go to a book signing of the author, whose book tour is about halfway complete at this point.  Details on the book tour linked here.

Some background information about StoryCorps:  StoryCorps is an independent nonprofit project whose mission is to honor and celebrate one another’s lives through listening.  By recording the stories of our lives with the people we care about, we experience our history, hopes, and humanity. Since 2003, tens of thousands of everyday people have interviewed family and friends through StoryCorps. Each conversation is recorded on a free CD to take home and share, and is archived for generations to come at the Library of Congress. Millions listen to our award-winning broadcasts on public radio and the Internet. StoryCorps is the largest oral history project of its kind, creating a growing portrait of who we really are as Americans.

Editor's Note: The book title itself is interesting.  Sounds a little bit like the Paul Tillich quote we wrote about earlier, here, that the "first duty of love is to listen."

Journalism As the First Draft of History

"Journalism is the first rough draft of history" -- attributed to Phil Graham, publisher and co-owner of the Washington Post.

I read this quote for the first time today and just loved it.  In the context of all the good journalism that's come out lately, particularly from the Washington Post and the Boston Globe and NPR, but also CNN and CBS and others, documenting the plight of returning combat veterans and the care they receive (or don't), it's wonderful to know that ultimately what the journalists are doing is writing the first rough draft of history.  In the case of the recent series in the Boston Globe by Charles Sennott, the Globe gave Sennott a year to cover the return of a Marine battalion, the 1/25th, from Iraq -- and really absorb the adjustment experiences of the group, in order to write a full, comprehensive and compelling series of stories about them. 

In the future, we're going to be able to look back on this time as when individuals who maybe didn't have any direct relationship to a returning combat veteran nonetheless got educated, informed, or even become activists for the cause of veterans issues, particularly as they concern aftercare for combat-related injuries, both bodily and psychological.  Wouldn't that be a wonderful turn of events?   Making history is better than reading about it, certainly, but interestingly enough, journalists get to write its first draft.  We owe them a certain amount of thanks for that effort, especially when previously dark areas like veterans' care have the blinding light of public criticism finally shone upon them.  Not everyone looks up to notice how often it was journalists holding the spotlight.

Vermonters Get Help for PTSD / Combat Trauma

The Boston Globe reports today a program to help returning veterans with combat injuries from TBI to PTSD has been expanded, thanks to a Federal grant.  Says the Globe:

A Department of Defense appropriations bill signed by President Bush contains $3 million for expanding the Vermont National Guard Outreach program and another $3 million for other states to reach out to troops returning home from Iraq and Afghanistan.

The program, which began about a year ago, also reaches out to soldiers back from Army Reserve units or active duty soldiers who have returned to civilian life.

Vermont U.S. representative, Bernie Sanders, quoted in the article, a political independent (like many Vermonters!), says, "This is a hugely important issue, because we are seeing a staggering number of people coming home with PTSD and traumatic brain injury," said Sanders, I-Vt. "It is terribly important that these people get the help they need and in order to do that, we need to do this effectively."

The Federal funding will go towards "boosting the number of outreach workers and establishing a toll-free 1-800 number for veterans to call," said Jim MacIntyre, coordinator of the Vermont National Guard Outreach team, quoted in the article, continuing, "It's a positive step...the need is growing every day."

It looks like matching funds are being made available for other states to do what Vermont is doing; but  props to Vermont for leading the way in securing Federal funding for this very necessary outreach.  (Click here for a link to the article.)  For more information about this program, especially as it affects Vermont, read this press release from Rep. Sander's office, online.  Click here for that link.

Life Preservers for Navigating an Ocean of Grief

Particularly relevant to our readers, now that the holiday season is upon us, it's time to talk about grief, and its relationship to the survivor of combat trauma; the veteran, and his or her family.  For the emotion grief is also part of combat trauma: both the direct grief of the veterans themselves, that never leaves, of the horrors of war, of seeing buddies die, of doing things, and seeing things, that sometimes bring them shame and agony -- and the direct or indirect grief of the family members, when trauma or PTSD drives a veteran to hopelessness, homelessness, or suicide.  There's also the indirect combat trauma-based grief: grief that comes when a veteran dies.  Grief is a normal, healthy, healing process, that, like combat trauma, can be a "normal reaction" to an abnormal situation occurring. 

What is grief?  Heavy-hearted woe, suffering, and pain, when recollecting a previous event or loved one who is no longer here.  According to Roget's Thesaurus, "grief" is "Mental anguish or pain caused by loss or despair: heartache, heartbreak, sorrow.  Grief is, according to the dictionary, "deep mental anguish, such as that arising from bereavement.  See "regret" (yikes.)  The word itself comes from a root word meaning to harm (aggrieve.)  Poets have handled it deftly over the years.  Think of Emily Dickinson's lines on grief:

I MEASURE every grief I meet      

  With analytic eyes;      

I wonder if it weighs like mine,    

  Or has an easier size.   

 

I wonder if they bore it long,        

  Or did it just begin?    

I could not tell the date of mine,   

  It feels so old a pain.   

 

I wonder if it hurts to live,    

  And if they have to try,        

And whether, could they choose between,   

  They would not rather die.

Fortunately, several books shed light on the experience of losing a combat veteran spouse -- these two are from deaths in the Vietnam war era, but the principles apply today as well.  The books are, Grief Denied: A Vietnam Widow's Story, by Pauline Laurent, and Sacred Shadow, Sacred Ground: A Vietnam War Widow's Journey through Unresolved Grief, by Glenda Carter.  Both are five stars on Amazon.com.  (See sidebar for books, or click on their hyperlinks, above.)  Laurent is one of the authors featured in Maxine Hong Kington's edited anthology, "Veterans of War, Veterans of Peace, discussed earlier in this blog; and she's featured in the Bill Moyers documentary on the book as well. 

There's also a very good psychological help guide on the Web, at HelpGuide.org, which describes the difficulty of grief and loss, and possible ways to handle them constructively.  The guide is called, "Coping with Grief and Loss: A Guide to Grieving and Bereavement."  It has many good parts, including how to take care of yourself when you're suffering, and the special issues relating to grieving a death by suicide.  Click here for that link.  There's also a related guide to helping or supporting someone else who is grieving: "helping your child, friend or parent cope with the death of a loved one."  Click here for that link.  They also have some very good material on combat trauma and PTSD.  Click here for that link.  There's also a very pleasant, British, low-key book called Free Yourself from Harmful Stress, that also is worth checking out.  I don't have my copy handy so I can't remember if it covers combat trauma or not -- it might not.  But it does cover all garden-variety psychology health issues, and is written in a very straightforward, pleasant and constructive manner.

[Editor's Note: Helpguide was created in 1999 by the Rotary Club of Santa Monica with active participation by Rotarians Robert and Jeanne Segal following the tragic suicide of their daughter Morgan. Since then, a dedicated team of talented people have collaborated to create a free, non-commercial resource for people in need.  Helpguide’s mission is to empower you and your loved ones to understand, prevent, and resolve health challenges.  Helpguide served over eight million visitors during the past 12 months and is growing by 20% per year. ]

Rudy Reyes - Serious Veteran Eye Candy

Marine Sergeant (Retired) Rodolfo "Rudy" Reyes -- USMC 1st Recon Iraq war veteran, indisputable eye candy, soon-to-expire-cover pic from the 2007 "American Heroes" calendar from FreedomIsNotFree.org, frequent search term within this site -- we salute you.  It's a belated Veterans' day thing and/or an early birthday present to myself!  Mostly everyone who comes to this site, comes through a link or through a fairly heavy, intellectual, serious search about combat trauma, PTSD, signs and symptoms, treatment protocols that work, etc., etc.  But every once in a while, and not that infrequently, actually, somebody comes who is just looking for pics of Rudy Reyes.  I feel ya.  I can completely understand why.  So in the spirit of honoring yet another veteran who serves the cause, in his own special way, here's not just pics but actual VIDEO about Rudy Reyes, from the Freedom is Not Free website, and check this out -- there's actually some very good points being made about veterans aftercare and its affordability, or lack thereof.  Go, Rudy!

(If you've read Evan Wright's Generation Kill, or Nate Fick's One Bullet Away, both about the platoon in the 1st Reconnaissance battalion in which Fick and Reyes served in Iraq, you've been introduced to Rudy Reyes already.  Here's a pic of Nate Fick and Rudy Reyes from their tour in Iraq with 1st Recon that was on the web a while back, probably from Wright's book.  And here's the cover pic of Rudy Reyes from the current philanthropic calendar for Freedom is Not Free, before it got airbrushed a bit more.   Swoon, faint, thud...).

Editor's Note: Apparently Generation Kill is going to become a 7-part miniseries on HBO, and Rudy Reyes is tapped to play himself.  Hre's the link to the news on HBO (see item from June 1, 2007).

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Update: I recently got a chance to communicate with former First Recon Marine and current international heartthrob, Rudy Reyes, one of the stars of the HBO miniseries about Generation Kill (linked here), and learn what his future plans are -- and they're exciting.  (Searches for Rudy Reyes skyrocketed this week, coming from places as disparate as Jack in the Box and the U.S. Senate, and from Alaska to Argentina.  I joke that everyone but the Pope searched for Rudy Reyes this week, and perhaps even him.  Reyes just got an agent -- William Morris -- (he's gonna need one!) -- there are some stupendous shots of him on the Web -- and there are plans for him to release an undoubtedly hotly-anticipated workout video and more, based on the concept of "Hero Living."  Can't wait to see what that's all about. (My semi-educated guess is his eventual website will be, www.RudyReyes.com, but currently there isn't any content posted there -- so check back periodically to see when it is.)

The Slogan for Our Era: "No Vet Left Behind"

Shortest blog post I could possibly offer: isn't that concept fundamentally what we are looking for?  With all the (thankfully increasing) coverage in the national media about failures in the system, isn't that really what the goal is?  That no vet is left behind -- not in terms of aftercare for bodily or psychological injury from wartime.  That no one falls through the cracks, that the system works efficiently and effectively, and that no veteran or veteran's family is unduly put through more financial or emotional chaos because of the system not working.  "No vet left behind" -- let's seriously make it our goal.

In the Vietnam war, a rallying cry for those concerned with military who prisoners of war ("POW") or missing in action ("MIA") was, "you are not forgotten."  (See flag, above.)  A rallying cry for us today should be, similiarly, "no vet left behind."  I guess we need our own flag, yet to be designed.

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In the tacky and tasteless "humor" department -- pretty unfunny, if you ask me -- there's a T-shirt being sold on the Web that calls itself the "tasteless veteran's T-shirt," at ThreadPit.com.  For $14.95, plus shipping and handling, you can wear a shirt that says, "Get Ready, America!  It's time for a whole new generation of emotionally disturbed veterans."  I so love people making insensitive fun of things they couldn't possibly understand -- because if they did, they would no longer find them funny.  Yikes.  Maybe they wouldn't mind donating the proceeds from the sale of that T-shirt to say, buying Thanksgiving meals for some of the many homeless veterans in our nation. 

CNN This Weekend - A Special Report on the Broken-Down VA System

(Yikes.  The bad press continues...)  On CNN this weekend, Dr. Sanjay Gupta, CNN's chief medical correspondent, takes a look at the VA and how it's treating returning veterans.  Here's what CNN has to say about the series, from its site:

Broken Government

Meet Iraq war heroes who barely escaped death, sacrificed limbs and then came home to a broken bureaucracy that let them down. Marine Sgt. Ty Ziegel, Army Maj. Tammy Duckworth, and Army Sgt. Garrett Anderson share the intimate details of their survival on the battlefield, and the war they would end up fighting on their soil. CNN’s Chief Medical Correspondent Dr. Sanjay Gupta investigates the shocking reality of what happens to so many wounded warriors once they return from the battlefront in Waging War on the V.A.

Watch this Saturday and Sunday at 8 p.m. and 11 p.m. ET.

•A family of warriors
•Iraq War Vet Let Down by V.A.
•The price of war

Problems in the VA - A Forseeable Crisis

CNN has a good story today about how "Wounded Warriors Face Homefront Battle with the VA."  Click here for the link.  CNN focused on some compelling examples to tell the tale: combat veterans whose extensive injuries were at first rejected as "not service-related"(!!!) or who had a hard time collecting reasonable benefits, despite incredibly grave and comprehensive injuries.  The subtext in the story, though, is how when the individuals involved were able to "apply some pressure" or "put the heat on" the VA through, say, elected officials, or other prominent advocates, all of a sudden, things changed on a dime, and their cases were handled differently, overnight.  An apologist for the VA, in the story, says, essentially, "oops, this just makes us want to do a better job," and someone else says, "gee, we really had no idea the system wasn't up to handling this volume of cases."  Well, seriously, folks -- we're in a war.  Actually, we're in several.  And this shouldn't actually be "news" to a department called VETERANS affairs.

For even a casual reading of the news shows you, there's a lot of people getting injured, not just killed, in this war; and the injuries are more substantial than people used to even be able to survive.  That was one of the first pieces of information that came out of this war, medically.  And that was covered in the generic, popular media -- it was a cover story in Time or Newsweek, going back several years now.  (The kevlar helmets, for example, are "saving lives" of those who earlier would certainly have been killed by explosive blasts; but now those surviving face extensive aftercare, etc., etc.)  For every person killed, there are probably roughly 10 injured, and many of the injured, are injured severely.  Is this another "Hurricane Katrina" situation?  Where because we have political appointees in jobs that ought to call for skills and smarts and forward thinking, we get mowed down by catastrophes that firmly need plans in place to handle, before they happen?  Or certainly the ability to snap into action once they happen? 

Read the story, but get annoyed.  It shouldn't take a 23 year old, with extensive burn injuries, and a heavily compromised future quality of life, plus pressure from his senator -- we're going to use that example generically, not about one person in particular -- to get the VA off its ass and responsive to his particular case.  We've seen this time and time again -- media coverage, 11th hour, about some very deserving veteran's case, FINALLY gets someone "in the system" spurred into action, to resolve THEIR case -- not all the cases, in general -- or revamp the system.  What's wrong with this picture?  The problem is widespread, the need for care is compelling, and EVERYONE'S CASE COUNTS -- not just the ones who've had (thankfully for them) media attention (the spotlight) turned on them.  Get with it -- these are our veterans, and they deserve care.  Not one at a time, as a GROUP.  Seriously.

Because -- and here's another thing, while we're on the subject -- for every young veteran who gets incensed and motivated to wrangle with the system, and INSIST on better treatment -- how many others give up, or give in -- or worse, end up harming themselves because they just don't have that same will to fight.  You know how human nature is.  How many people, who've been traumatically injured, should be expected to fight for their own care?  Isn't it overwhelming enough to be seriously injured?  Or have a family member who is?  Those are situations that take plenty of care and attention and backbone just to endure -- let alone, fighting with the VA for the care that's deserved.  (Not to mention, now we have veterans of previous wars, such as Vietnam, coming out of the woodwork and saying, "crap, now I realize what I have -- PTSD," many years later -- and they're putting an additional demand on the VA's service -- but deservedly so.  Some injuries take a while to manifest, and some people take a while to realize they need care.  That's just common sense; and completely understandable.  Which is a kissing cousin to "forseeable" -- as in, the things you PLAN for, when your job is anticipating or delivering care.  In business, something getting "popular" (the analogy here is injuries) causes the business to ramp up production so they can fill the orders and supply more.  Supply and demand, baby -- it's basic.  A lot of veterans getting injured -- demand for services just increased.  Supply of care -- that's the VA system -- needs to ramp up on a par, and fast.  What's the old adage in business? You can have things 'good,' 'fast,' or 'cheap' -- so long as you just want two of those, and it can be any two. With the VA and healthcare for combat veterans -- are they getting even two of the above?  Or just one -- "cheap," which ends up costing dearly in the long run...both to veterans, and to the country, when the system has to eventually be fixed.) 

In summary, combat veterans and their families having to combat the VA for their care?  How about if we let combat happen in the field; and service in the VA, instead, for those who've already served.

More Coverage on "New England's Own" Readjusting to Life after Combat

Emily Rooney, from WGBH -- Boston's public television station -- does a great piece interviewing Charles Sennott, from the Boston Globe, who spent a year covering a battalion of Marines' return from Iraq, and Sgt. Mark Wills, one of the Marine reservists, from the same battalion. Both Sennott and Wills are a great interview, and highlight various issues, pro and con, about readjustment issues, including combat trauma; and Rooney does a nice, pleasant, competent job talking to them about their experiences. Excellent, informative stuff about veterans issues -- well worth watching.  Click here for the link.  Click here to read the earlier blog entry that mentions Sennott's excellent, recent series in the Globe, called "A Promise to Keep."  One additionally interesting factoid is that the Marine battalion that Sennott profiles, the 1/25th, is almost entirely made up of reservists, whose issues can be slightly different on returning, because they typically only see each other about once a month, unlike active duty.

(For a multipart series on the same battalion's homecoming and aftermath, focused more on the injury and recovery of Cpl. Patrick Murray, see the series in the Providence Journal-Bulletin, linked here.  That includes video as well.)

If you want to see the other excellent videos from the Sennott series in the Globe, "A Promise to Keep," including "Coming Home," "The Roulette Wheel of Death," and "Moving On," check out the earlier blog entry, linked here.  Kudos to the Boston Globe for giving Charles Sennott a year to follow this story and do it justice, and to Emily Rooney, for doing a great job, too, highlighting the work in a much shorter amount of time.

The Sacred Brotherhood of Veterans

This is a post I've been meaning to write for a while - because the incident that spurs it, while still a few weeks old, didn't get nearly the coverage that it could have, so it's still going to count as "news."

It seems clear that if returning combat veterans end up getting better treatment (and hmmmn, we're still waiting for that) these days, from the VA and from society at large, it will in large part be because of what earlier veterans -- in particular, Vietnam veterans -- experienced.  The Vietnam vets' unfortunately "bad" experience will somehow work to create a noticeably "better" experience for current combat veterans.  At least, that's the hope.  And not just ours, but many Vietnam veterans as well, who frankly have suffered enough, and if there's any benefit to their suffering whatsoever, want to see that it means the next generation might suffer a little bit less, in trying to uncoil themselves from combat and readjust to civilian life.  When I think of this phenomenon, I really do picture a bridge, or chain of arms -- from one part of the sacred brotherhood of combat vets to another -- reaching out, to make sure that they make their way across what can be very troubled waters.  Of course now the "sacred brotherhood" also includes women veterans as well, but rather than get lost in some murky, cumbersome language, let's just call it the brotherhood and realize it includes women vets as well.  Whoever's been through combat, innately understands what it took to live that experience, and instinctively can help others going through that, and ideally help them come to terms with their loss.

The point of bringing this up -- the focal point of this post -- is to introduce one great example of a  Vietnam veteran who, despite his rank, really didn't "forget" what it was like to go through combat, no matter how many years ago.  When General Peter Pace stepped down in early October as the Chairman of the Joint Chiefs of Staff, he apparently went straight from his good-bye ceremony to the Vietnam Wall.  And at the Vietnam Wall, to the shock and surprise of many onlookers, who came across these tokens over the next few weeks, he left three index cards, laid against the wall.  With his four stars rank pinned to each of them, and a handwritten note to each of the three buddies he'd lost, in the Vietnam War.  The notes each said something like, "These are yours, not mine! With love and respect, your platoon leader, Peter Pace"

Here's a couple of photos of General Pace's mementos, close-up and in place; and a link to a video at CNN, describing what happened.  Props to blogger Old Sarge for pointing this out, and giving us permission to republish the photos.  For a link to the Wikipedia entry on General Peter Pace, click here.

Empty Gestures: Is Veterans Day a Lip-Service Holiday Already, Even Though We're at War?

I'm just curious, because, for a Federal holiday, if I had to guess, I'd say that the majority of people actually celebrating -- meaning, giving honor to, paying respects to -- Veterans' Day were veterans themselves, veterans' families, and a very few interested others.  Everyone I talked to yesterday was at work - no holiday at all - and when I went to the supermarket later in the day, was surprised to see the Wells Fargo branch at the supermarket was open, with a long line of customers.  "We're open on Veterans' Day!" their printed sign proclaimed enthusiastically, as though we'd all really be cheered to know that honor was being ignored in favor of convenience and commerce. I, for one, wasn't that happy to see that.  To me, it just underscored the point that too few Americans are affected by this war, who don't personally have some skin in the game.  And that's not good, or right, AND it doesn't auger well for the future of veterans issues.  Issues that affect veterans directly affect all of us, as a society, and most of all, show our ability and capacity to care.  If what Paul Reickhoff says in this interview with MTV is true, and fewer than 1% of Americans are "suiting up" for this particular "game" -- the wars we're involved in, in Iraq and Afghanistan -- it's even more evidence of how veterans and their issues are getting marginalized.  Not good.  Veterans' Day -- and veterans issues -- aren't meant to be some insular, "you had to be there to get it" type of thing, affecting only the few, the proud, the actual deployed military  They'll always mean more, or mean differently, to those who served, but they are fundamentally, and foundationally, important to us all. Or ought to be.

[What did I personally do/the results of the Hyprocrisy Check(TM): I took time out to thank the veterans I personally knew; and the vet supporters, because their work counts as well; I wrote some more on the topic; read some articles about veterans issues, joined a live chat with a reporter who'd recently covered veterans issues about his coverage of same; and talked with a friend whose husband is getting ready to deploy again; then finished out the night watching some videos from his time in Iraq.  Not much, maybe, but way more than lip service.  If it's graded pass-fail, I'll give that a pass :-)]

Some Things Never Change: Observations of a Civil War Combat Nurse on Trauma

It was interesting, a few weeks ago, reading Louisa May Alcott's first book, entitled Hospital Sketches, about the assignment she sought [as in, asked for -- volunteered for] as a combat nurse in the Civil War.  The work took her to Washington, D.C., where she bandaged and cared for the wounded, and became ill there herself, with a disease whose treatment, years later, many think brought about her early death.  The book was short and and easy reading, written in a mid-19th century style that is not popular today, but it was easy to understand both her motivations for being there; as well as her observations about the wounded who she treated.  It's interesting how some things never change: the acts of bravery, brothery love and kindness, the heartbreak of not being able to say goodbye to your comrades who die; the survivors' guilt, and so forth.  Potent stuff, then as now.  In Balad, at Landstuhl, Walter Reed, Bethesda, the Mologne House, and VA hospitals around the country, these same scenes are playing out, many years later.  And doctors and nurses are no doubt experiencing a fair amount of combat trauma of their own.

(In an aside, too, we know that combat trauma has existed as long as there's been combat.  A study a few years ago even went back to original medical records from the Civil War era, to prove that combat trauma existed then, though called by other names, making that study a first of its kind.  The term "Post-Traumatic Stress Disorder" has only been around since the 1980s.  The underlying concept, however, is as old as war itself.)

In Alcott's Hospital Sketches, however, the part that stood out the most to me was an item she wrote about a young veteran, clearly suffering from combat trauma.  We'll include that towards the end, here.  First, though, a general observation about her first time seeing the ward of injured veterans:

"There they were! "Our brave boys," as the papers justly called them, for cowards could hardly have been so riddled with shot and shell, so torn and shattered, nor have borne suffering for which we have no name, with an uncomplaining fortitude, which made one glad to cherish each as a brother.  In they came, some on stretchers, some in men's arms, some feebly staggering along propped on rude crutches, and one lay stark and still with covered face, as a comrade gave his name to be recorded before they carried him away to the dead house.  All was hurry and confusion; the hall was full of these wrecks of humanity, for the most exhausted could not reach a bed till duly ticketed and registered; the walls were lined with rows of such as could sit, the floor covered with the more disabled, the steps and doorways filled with helpers and lookers-on; the sound of many feet and voices made that unusually quiet hour as noisy as noon; and, in the midst of it all, the matron's motherly face brought more comfort to many a poor soul, than the cordial draughts she administered, or the cheery words that welcomed all, making of the hospital a home."

"The sight of several stretchers, each with its legless, armless, or desperately wounded occupant, entering my ward, admonished me that I was there to work, not to wonder or weep; so I corked up my feelings, and returned to the path of duty, which was rather "a hard road to travel" just then."

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Here's the item about the young boy suffering from combat trauma:

"The night whose events I have a fancy to record, opened with a comedy, and closed with a great tragedy; for a virtuous and useful life untimely ended is always tragical to those who see not as God sees.  My [nursing] headquarters were beside the bed of a New Jersey boy, crazed by the horrors of that fateful Saturday [in a recent battle].  A slight wound in his knee brought him there; but his mind had suffered more than his body; some string of that delicate machine was over strained, and, for days, he had been reliving in imagination, the scenes he could not forget, till his distress broke out in incoherent ravings, pitiful to hear.  As I sat by him, endeavoring to soothe his poor distracted brain by the constant touch of wet hands over his hot forehead, he lay cheering his comrades on, hurrying them back, then counting them as they fell around him, often clutching my arm, to drag me from the vicinity of a bursting shell, or covering up his head to screen himself from a shower of shot; his face brilliant with fever; his eyes restless; his head never still; every muscle strained and rigid; while an incessant stream of definite shouts, whispered warnings, and broken laments, poured from his lips with that forceful bewilderment which makes such wanderings so hard to overhear.

And another:

"...when the echo of a sob caused us to glance among the eds.  It came from one in the corner -- such a little bed! -- and such a tearful little face looked up at us, as we stopped beside it!  The twelve year old drummer boy was not singing now, but sobbing, with a manly effort all the while to stifle the distressed sounds that would break out.

"What is it, Teddy?" I asked, as he rubbed the tears away, and checked himself in the middle of a great sob to answer plaintively: "I've got a chill, ma'am, but I ain't cryin' for that, 'cause I'm used to it.  I dreamed Kit was here, and when I waked up he wasn't, and I couldn't help it, then."

The boy [had come in] with the rest, and the man who was taken dead from the ambulance was the Kit he mourned.  Well he might; for, when the wounded were brought from Fredericksburg, the child lay in one of the camps thereabout, and this good friend, though sorely hurt himself, would not leave him to the exposure and neglect of such a time and place; but, wrapping him in his own blanket, carried him in his arms to the transport, tended him during the passage, and only yielded up his charge when Death met him at the door of the hospital which promised care and comfort for the boy.  For ten days, Teddy had shivered or burned with fever and ague [chills], pining the while for Kit, and refusing to be comforted, because he had not been able to thank him for the generous protection which, perhaps, had cost the giver's life. The vivid dream had wrung the childish heart with a fresh pang, and when I tried the solace fitted for his years, the remorseful fear that haunted him found vent in a fresh burst of tears, as he looked at the wasted hands I was endeavoring to warm:

"Oh!  If I'd only been as thin when Kit carried me as I am now, maybe he wouldn't have died; but I was heavy, he was hurt worser than we knew, and so it killed him; and I didn't see him, to say good bye."

This thought had troubled him in secret; and my assurances that his friend would probably have died in any event, hardly assuaged the bitterness of his regretful grief."

{Editor's Note: it would be interesting to see if where she served was actually Mologne House.  She describes it as being unbelievably dreary, and the former site of a hotel, and somehow connected to, or on the grounds of, the main military hospital complex in Washington, D.C. Hmmmn.  Trivial pursuit, but interesting nonetheless. Okay, just to me :-)]

The Potential for Compassion Fatigue

Have you ever heard of the term, "compassion fatigue"?  It's an interesting phrase, that came into public discourse about ten years ago, give or take a few years.  And it generally means the burnout that the public gets from being continually poked and prodded by the media to care about a particular hot topic of the day.  For example, if an earthquake or a hurricane strikes, and day after day the casual viewer, or reader, gets bombarded with stories about hard-hit victims, down on their luck, and continual pleas from organizations like the Red Cross and others to give, and make the victims' lives easier.  (No slam against the Red Cross here, just using it as an example.)  The concept is that on Day One, Mr. or Ms. Casual Observer may actually care, may have his or her heartstrings tugged, may dig deep into his or her wallet to contribute to the cause.  But by Day Whatever -- name one a few days subsequent -- Mr. or Ms. Casual Observer no longer cares, and in fact is irritated by the repeated pleas for charity and concern.  They basically want to get back to their lives, and whatever pool of interest in the story initially, and common concern for their fellow man, has since dried up.  "Compassion fatigue" comes from pushing the same button too many times -- eventually it sticks in the closed position.

Why talk about "compassion fatigue" here?  For two reasons.

One, we're in it for the long haul, with returning veterans and combat trauma / PTSD.  While media attention currently is heavily focused on the topic -- great! -- it hasn't always been so (Vietnam, or even way more recently than that -- last year at this time, for instance) -- and it won't always continue to be so.  Other stories will "bump" combat trauma off the news, but the problem, very significantly, will not be going away.  We'll just hear about it less, over time, because news media and the unconcerned public (those not affected by it directly, and those who don't care, period) will lose interest.  Significantly, though, the problem will not go away, just because at times we'll hear less about it.

Two, compassion fatigue is actually a risk for caregivers.  It's another definition of the same term, and it's a problem of the secondary stress created by something like caring for someone with combat trauma or PTSD.  Caregivers, too, burnout: whether they are spouses, family members, or even therapeutic providers.  In fact, "compassion fatigue" among caregivers is a topic in its own right, that some psychologists have studied and written about.  There are resources out there for that, too.  So if you're caring for someone with PTSD or other battle-related, combat injuries, be aware that burnout is a very real risk. Someone has to take care of the caregiver, too.  Make sure that you're doing what you can to get adequate rest, nutrition, and stress release of your own.  Because caring for someone injured is an extremely difficult task (notice, we did not say "burden"), with physical and psychological costs of its own, not to mention financial, so please be sure to get adequate support for yourself, if you find yourself in this role.  It's basically a given that your work is stressful.  Support is not a given, so please do what you can to find it.  And if you know someone who's caring for a wounded or injured veteran, please do what you can to lighten their load, in whatever supportive way you can find to contribute.  The veteran and his or her family will be grateful.

Compassion fatigue?  There may come a time when we burn out on this topic as a nation (let's hope not, but we may); however, for those caring for an injured veteran, compassion and care will undoubtedly take its toll.  Let's do what we can to help.

Happy Veterans Day - And a Promise to Keep

Happy Veterans Day to veterans and their families, who sacrifice so much.  Please take some time out today to think about, and thank, veterans and their sacrifice, because it's substantial, and dramatically under-acknowledged.

It's a little late to be mentioning this -- sorry! -- but if you want to "learn more about Veterans Day" and what it means; and/or download a poster about it for work; or a teacher's guide, there's information about that at the Department of Veterans Affairs website.  The link to the information and downloads page is here.

The Boston Globe had a great article yesterday that we'll be blogging about soon, called "A Promise to Keep," about the return of a New England battalion of Marines from Iraq, and how it's been working out for them since.  Wonderful writing by Charles Sennott, that really hits on a number of the key issues with veterans, as well as tells some dramatic stories of their experience in Iraq.  Go here to read that.

Worst news of this Veterans Day?  That approximately "1 in 4" homeless are Veterans.  (More on that later.)

Here's video from the Globe series:

Nate Fick's Inspirational Stance on Veterans Care

Last year around this time I had the pleasure of meeting Nathaniel Fick, author of the stupendous One Bullet Away: the Making of a Marine Officer.  (Here he is at the Marine Ball at the Harvard Business School, where he is an MBA candidate, signing a few copies of his book.)  Whenever I think of combat trauma, I think of how inspirational Fick's own words on the subject were.  Writing in an article in the Boston Globe from August 28, 2005, entitled, "Coming Home...to What?" Fick wrote about the need to take veterans' psychological health seriously on their return from combat, possibly even mandating screening for combat trauma/PTSD.  Said Fick at the time:

The screenings are only one step in the long process of reintegrating combat veterans, but mandating them would correct a dangerous oversight and better serve both veterans and the communities where they live. To have value, though, the screenings must be done right.  Members of the active-duty forces are already subject to post-deployment mental evaluation, as are the National Guards of several states. These screenings often involve little more than filling out forms.

I remember slogging through my own mental health questionnaire after leaving Iraq, answering questions such as ''Did you ever feel that your life was in imminent danger?" Yes.  Or ''Check all that apply: I saw the dead bodies of a) enemy combatants; b) American forces; c) civilians; d) all of the above." D.

Answers like mine should have prompted some sort of follow-up, but none came.

Psychological screenings in a vacuum are worse than a waste of time because they give a false sense that someone has been ''cleared." The main lesson of my experience is that the recovery process takes time, and healing only happens in community. Screenings can be gateways to those communities, both formal ones such as therapy groups and counseling sessions, and the informal networks of friends, neighbors, and colleagues with whom we live.

In a war whose burden is borne almost exclusively by the tiny minority in uniform and their families, veterans' care is one place we can all make a difference."

Nate Fick's book, One Bullet Away: the Making of a Marine Officer, is well worth reading, as is the rest of his writing.  But most of all, I appreciate his inspirational stance on veterans issues -- that taking care of veterans really is the second half of the social contract, if the first half is sending them off to war on our behalf.

Religious-Centered Approach to Combat Trauma

(I feel like I'm just posting this under duress.  Religion has a tendency to muddy the waters, at the very least, and sometimes do quite a bit more harm that good.  Regardless...)

Just became aware of a book that talks about healing combat trauma from a Christian perspective, called The Combat Trauma Healing Manual: Christ-centered Solutions for Combat Trauma.  I've added it to the book list on left.  Approach with a degree of caution, though.  For one thing, it's self-published. (Not that that's necessarily a bad thing, but it can mean it wouldn't have been published otherwise.)  For another thing, and it's hard to say this without seeing it first, but just in case, puhlease do not take a book like this and use it INSTEAD of getting help.  In addition to, perhaps, if it meshes well with your personal belief system, but please pretty please, not in place of getting actual help.  The number of people in the world who go off their medications, or throw them away, believing that they no longer need them because a little talk with [insert name of any spiritual or motivational leader] has made them all better, is probably pretty darn shocking.  Please, consider spiritual healing as an adjunct to, not a replacement for, actual therapeutic healing.  And now back to our regularly scheduled program.

(Someone once joked that all healing is fundamentally spiritual, anyway.  Doesn't come any other way.  Or at least feels that way, when it does.  Enough said.)

Bill Richardson's Plan for Veterans - the Heroes Health Card

This blog's stance is intentionally apolitical, meaning, we're not getting involved.  There's enough slant and bias in the world without adding to it -- our focus is intentionally on those who serve, and helping them get the care they deserve.  Full stop.  That said, it's always nice to hear anyone jumping on the same bandwagon about care for veterans.  Apparently, Bill Richardson, governor of New Mexico, who's running for president, has a platform that includes a few benefits for veterans that seem worth noting.  He calls it "Keeping Our Promise," which is really the general idea, and states, among other things:

"I believe that we, as a nation, have a lifelong duty to our veterans," Governor Richardson said. "As President, I will reduce federal income taxes by five percent for all veterans for the rest of their lives. Senator Jim Webb-- one of our nation's greatest veterans-- is exactly right on this issue, and I will fight for his proposal. I also will eliminate federal income taxes on all troops in their first year out of the military. It is our responsibility to ease the frequently difficult transition from military to civilian life.  President Bush cut taxes for our nation's wealthiest citizens. I will cut taxes for our nation's bravest citizens."

More to the point, or at least to our point, he suggests:

Richardson laid out his plan to ensure that veterans receive the best possible health care, beginning with mandatory funding for the Department of Veterans Affairs (VA).

"When I am President, all veterans will be offered a Heroes Health Card," Richardson said. "If it is inconvenient for them to get to a VA hospital or clinic, you know where my plan would allow them to receive care? Wherever they need it. As we expand choice, we also must ensure that the VA system is the strongest it can be. I will guarantee full mandatory funding for the VA. No more year-to-year discretionary funding. No more political calculation. No more playing games with the health of our veterans.

"We also must recognize that not every injury can be treated with bandages and stents. Mental trauma, post-traumatic stress disorder and traumatic brain injuries also are battlefield injuries."

Given the fact that it seems like the VA cannot keep up with the demand for care it's experiencing, or at the level we would like, outsourcing doesn't seem such a bad idea.  I like the idea of veterans being able to receive competent, qualified, affordable care wherever is accessible to them, because "waiting for treatment" and "combat trauma/PTSD" really aren't a good combination.  Nor does it say how much we value veterans' service to make them wait to be seen, or treated in any substandard way.

Richardson apparently got sensitized to veterans issues because he serves in a state that has more  veterans per capita than pretty much anywhere else in the United States.  His office says that "one of his proudest accomplishments in New Mexico has been the purchase of a $400,000 insurance premium for every member of the state's National Guard, a step since taken by eighteen other states around the country."  Cool.  Much better to be an opinion leader than a follower.

Considering that it's apparently "National Military Family Appreciation Month" -- who knew -- it's also nice to see Richardson taking veterans' families into account.  Anyone who's watched the enormous sacrifice that goes on when a family member is wounded in action has to give that special honor.  Says Richardson:

"Often, spouses and parents are forced to leave their jobs in order to care for a wounded soldier," Richardson said. "As President, I will offer a comprehensive disability insurance policy to average $40,000. This policy would cover the necessary expenses when a spouse, parent, or other family member stays by the side of a wounded veteran during his or her recovery process. My plan also will offer up to a year of paid leave to provide financial stability for the families of recovering veterans."

Governor Richardson criticized President Bush's handling of the crisis at the Walter Reed Army Medical Center and said that when he becomes President, he will be accountable for the treatment of our veterans.

"The conditions that the world saw at Walter Reed were an insult to our veterans and an embarrassment to our nation," Richardson said. "President Bush should have stood up and taken responsibility, but as in so many other cases, he did not. Instead, we saw another game of Washington musical chairs. When the music stopped, the President scrambled to find himself a comfortable place to sit, well out of the way. When I am President, I will not sit back and watch our veterans suffer."

There's not much more to read in Richardson's press release than what I've quoted here, but if you're interested in reading more about his plans, here are two links:

To read Governor Richardson's policy for Veterans and Military Families, click here.

To see Governor Richardson's "Heroes" ad on veterans, click here.

The 201st Post - Thank You for Reading

Just a quick note to say, we've arrived at 200 posts so far.  (This is the 201st.)  There have been a few lulls here and there, but the posting has been fairly consistent for the past few months, and that's the overall plan here.  A few cross-country moves were impeding progress there for a while, but we're back.  Thanks for reading this (subscribing is even easier -- that way the posts come to you! Click this link.) 

Healing Combat Trauma is a crucial topic, and as one Marine friend said, who served in Iraq and Afghanistan, one that will be with us, unfortunately, for the rest of our professional lives.  All too true.  Thanks to the literal worldwide readership, including folks from the rest of the English-speaking world, the Middle East, and the Far East.  And to those a little closer to home: the VA, the DOD, various veterans organizations, various national news organizations, universities across the U.S., and of course, many private individuals who care.  Even a few law firms scrounging around for material about veterans with PTSD who later commit suicide, to help them build their cases, which we'll be seeing more off, over the next few years.  And a particular shout-out of deserved thanks to the cadre of fellow bloggers and journalists who have a heart for this particular topic as well. 

To all of you - thanks for reading, thanks for listening, thanks for caring about this topic.  We need to keep the spotlight on this topic, for the sake of those who are going through it; and for those who've already experienced it.  There's no easy fix; no single, silver bullet cure that will make all the difference.  But the funding needs to be there, the public concern, and the wise spending on alternatives that work, where and how they come to light.  In the meantime, thank you for listening.  We need to stand behind, and beside, those who served, until they get the care, and the compassion, they deserve.

Note: If you haven't checked out the increasingly massive bibliography / library here, please do.  It's divided into therapeutic selections on the left, and first person narratives about various wars in our collective lifetimes, from those who served in them, on the right.  Selections are added as frequently as we learn about them.

British Soldiers Journey Back to Confront Ghosts from Combat Past

Because a percentage of our readership comes from abroad, and because the topic we cover is relevant internationally, today we note that the British press reported yesterday in two different articles how veteran combatants from the Falklands conflict are journeying back to confront the ghosts of their combat experience.  The Scotsman (Scotland) and the Guardian (England) both have articles on the subject, with much shared content between the two. 

The award-winning Guardian, consistently a great source of news and perspective, notes that "Two hundred and fifty Falklands war veterans - many still suffering psychological trauma from the conflict - will return to the islands this week. Their arrival and tour around local battlefields is timed to coincide with the 25th annual Remembrance Day Service [the British version of our Veteran's Day] since the 1982 Argentinian invasion." Furthermore, "among the former servicemen and women flying out are a group diagnosed with post-traumatic stress disorder (PTSD) who are hoping to exorcise the ghosts of the past."

The excellent Guardian also has new video they've created to honor the 25th anniversary of the war -- "watch the soldiers who were there relive their experiences and follow the war as it unfolded" -- and, if you're a history buff or just blank on what the Falklands War was all about, there's WIkipedia and this interactive guide on the Guardian's own site to clear up the confusion.

The Scotsman adds detail as well:

"SEVENTY former servicemen still battling with the psychological trauma of fighting in the Falklands War will fly to the islands today to face the ghosts of 25 years ago. The men, suffering post-traumatic stress disorder (PTSD), are among a group of 250 veterans from the 1982 conflict taking part in an anniversary pilgrimage to the battlefields in the South Atlantic.

For most of the men on the heavily over-subscribed [meaning, far more people signed up than were actually able to go] visit it will be their first time back since the British victory over Argentina.  The islanders - the population is less than 3,000 - are throwing open the doors to accommodate the party, including 15 relatives of those who died in the conflict, in their homes.  Organizers of the visit said that many local people have taken a week off work and offered their services as drivers for the party. One has even put a plane at their disposal to take them to outlying islands where they fought.

The event is being organized jointly by the main Falklands veterans body the South Atlantic Medal Association, and Combat Stress, the charity that works with ex-servicemen and women who are suffering psychological disabilities.  Combat Stress is providing around ten trained clinical support staff.

As well as those suffering PTSD many making the visit suffered major physical injuries such as losing limbs. Colonel Mike Bowles (retired), the chairman of the organizers, said: "Some of these guys did go through horrific experiences and saw horrific things. "I think going back and being able to be in a place and think about it and sit and maybe have some people around you, does help people come to terms with it."

But Col Bowles said the trip was also about seeing how the islands that they fought to liberate are thriving in 2007, and meeting the islanders themselves.  A total of 255 British servicemen and more than 600 Argentineans were killed in the war which ended the 74-day occupation of the islands.

Editor's Notes: (Highly miscellaneous.)  We've written about Combat Stress before.  See hyperlink.  It's the British variant on our term, combat trauma.  It's also the name of a service organization for combat veterans who suffer from PTSD in England. 

On a more serious note, notice how this event is happening 25 years after the conflict.  There seems to be a gigantic, painful lag in experiencing symptoms and confronting the past -- perhaps because of how painful it is, or how deeply the memories are buried.  This is consistent with our Vietnam veterans making trips back to Vietnam in recent years to confront the ghosts of their pasts there, and with decorated war heroes from that conflict, such as Max Cleland, who for many years headed the VA, taking 20+ years to realize that he was suffering from combat trauma himself.  In other words, it's likely to be a long, hard wait for veterans from Iraq and Afghanistan to be able to confront these experiences themselves, though we hope through many related efforts the cycle time is much shorter, for their sake. 

As Maxine Hong Kingston told me when I asked her how quickly vets were interested in writing (even for themselves) about what they'd gone through, she said that in her experience it had taken 20 years to come forward.  Perhaps that time from now on can be shorter -- but I think it underscores the gravity of the experience, and what these veterans have suffered, that it generally speaking takes that long.  Ouch.  Let's have as a goal, trying to close that particular loop, gracefully and graciously, with current veterans in a whole lot less time.

Doctors with Troubled Pasts Working in the VA?

NPR has an "interesting" story today on "All Things Considered" -- interesting in the sense of "discomforting and potentially troubling" -- about a woman whose husband passed away after routine gallbladder surgery at the VA hospital in Marion, Illinois.  Turns out he was the third patient who died in as many weeks, under the same doctor's care -- a doctor who'd faced allegations of concern about patients' death in his care earlier in Massachusetts, where he worked previously, and at least two malpractice claims.  The doctor, 69, who was born and educated in Bolivia, seems to have initially been a good doctor.  However, NPR reports, "Problems on his record began to surface about 10 years ago. But he didn't need any state license to practice medicine for the VA. As a federal institution, the VA is exempt from state regulations." 

NPR continues, "Before he was hired by the Marion VA in January 2006, the state medical board in Massachusetts was investigating [the doctor] for at least eight complaints against him alleging dangerously substandard care, including two deaths.  But VA officials say they couldn't have known about that, because Massachusetts is one of several states that doesn't report such investigations until they are complete."

Sen. Richard Durbin (D-IL) says there were other warning signs, though. "The fact is, this doctor had two malpractice claims filed against him in Massachusetts and one disciplinary action taken by a hospital," Durbin said. "Regardless, he was still hired by the Veterans Administration."

The story also says that "whistle-blowers from within the Marion VA hospital...claim they had warned administrators for some time that [the doctor] was dangerous to patients," and changed some patient's records, while destroying others. 

Now, according to NPR, "the Senate Committee on Veterans Affairs will hold a hearing in Washington on Tuesday on the Marion VA hospital's recent problems, and on broader concerns about the medical hiring and quality-control practices within the entire VA.

A second doctor at Marion has been suspended after it was discovered that he, too, had faced disciplinary action in another state. Some fear there could be other doctors with troubled pasts working in VA hospitals across the country."

At the risk of fear-mongering, this is exactly what we have to worry about.  About a year and a half ago, I was looking through a Federal jobs register, and realized that psychiatrists in the VA earn about what systems analysts do -- but they're responsible for people's health and wellbeing, not to mention, considerable patient loads -- not computers or networks or software, inanimate objects, without a pulse.  And psychiatrists have had to go to medical school, which is substantially expensive, and often leaves new doctors with debt for years and years to come in their professional lives.  The salary I saw quoted at the time was $80,000* a year.  Granted we're mixing "psychiatrists" and "doctors" here, but they both have M.D. degrees.  What the NPR story and my own observation from the job search make me wonder is, how high quality is the care the VA is giving, and more importantly, what sort of doctors end up taking jobs that pay so little, when they're able to get jobs in other hospitals and in private practice that pay so much more?  The VA wouldn't be the first institution in human history to cut corners on quality patient care, but seriously -- don't our veterans deserve better?  Perhaps even most of the doctors in the VA system -- let's be charitable here -- are wonderful.  But if situations like the one in Marion, Illinois illustrate anything, it's the need to check what the standards really are, in a system that's already overburdened.

Editor's note: some exceptional doctors chose to work in the VA system, including the eminent "Friend of Veterans" Jonathan Shay, M.D., Ph.D., recent winner of a MacArthur genius grant, and often positively remarked upon on this blog.  At the very least, though, let's take the warning from this story, and a) scrutinize better who's delivering the care to our veterans and b) offer to pay them a decent  wage so that we can attract more and potentially better candidates.  Our veterans deserve it.

* While this salary seems extremely low, a fact-check tonight at USAJobs.opm.gov, "the Federal Government's official one-stop source for Federal jobs and employment information," produces several "staff psychiatrist" jobs paying $90,000.00.  While some salaries seemed reasonable, others, such as occupational therapists and nursing assistants, two vital jobs to patient care, seemed extremely low, in terms of paying a living wage.  Like much else having to do with veterans care, this topic invites more thorough investigation and adjustment to prevailing standards in the communities they serve.

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A post-script: as the news heats up, particularly in Illinois, on this particular topic, one related item  comes to mind.  Years ago, Pulitzer Prize winning journalist, James B. Stewart, wrote a non-fiction book called Blind Eye: The Terrifying Story of a Doctor Who Got Away with Murder, and the subject of that book was Michael Swango, an Illinois native and fomer Marine, who served at various VA hospitals in the U.S., among other posts, leaving a trail of bodies in his wake.  Swango was hired by several VA hospitals, even in the midst of concerns about his past.  [He had a bad habit of poisoning co-workers, among other things.]  So it does make you wonder how scrupulous the hiring practices are at the VA; or whether it can be considered somewhat of an "employer of last resort" for those unable to find assignments elsewhere.  Let's hope not.  While casting that aspersion risks doing a dis-service to the truly talented who chose sacrificially to work there; at the same time, it's important to raise the profile of care for the wounded, and not create (or sustain) the impression that we're just warehousing veterans anyway; any ol' candidate can do the job.  Maybe that's the VA of the past -- let's hope it's not going to be the VA of the future.  (For a look at Swango's crime resume, check this link to it at CourtTV.com.)

Post-Traumatic Stress Disorder for Dummies

Just a quick update to let you know that the new book, Post-Traumatic Stress Disorder for Dummies, is now available from Amazon.  (Click here for that link.)  Previously it had just been availlable from the publisher, Wiley.  The book is so new no one but the publisher has reviewed it, but it will be interesting to read and evaluate, since so many people will be "getting their news" about PTSD from here.  "For Dummies" books generally do a great job at laying out the general landscape of a problem or condition, and covering each of the potential solutions to it in some depth.  What will be interesting to see is whether the author promotes one particular form of treatment over another; or just lays them out there as virtually equally-weighted opportunities.  And whether they cover natural medicine options in any depth beyond surfacey; in addition to pharmaceuticals and psychotherapy.

Writing Down the Bones

If you're in the San Francisco/San Jose Bay Area this weekend, you might think of attending the Mindfulness & Writing Retreat, led by Maxine Hong Kingston, Wendy Johnson, & Therese Fitzgerald to be held Friday, November 9th through Sunday, November 11th at the Ben Lomond Quaker Center, in Ben Lomond, CA.  For further information, contact the Community of Mindful Living, at (831) 338-8026.  There's a Zen Buddhist / silent meditation retreat component to this, but my understanding is that it's also about veterans and writing out the painful experiences they've endured, to the degree they feel ready or interested in doing so.  The cost is under $200 for the three day retreat, and the accommodations are intentionally fairly bare-bones.  And it sounds like it's an annual Veterans' Day weekend event for Maxine Hong Kingston and the writing group of veterans.

Maxine Hong Kingston's recent book, an anthology of pieces by veterans and interested others, is called Veterans of War, Veterans of Peace. It's the winner of the 2007 Northern California Book Reviewers Special Award in Publishing, and was recently featured in a special by Bill Moyers on PBS.  The publisher, Koa Books, calls it "a harvest of creative, redemptive storytelling—nonfiction, fiction, and poetry—spanning five wars and written by those most profoundly affected by it."  And Moyers says, ""No one I know personally has done more to help veterans themselves bear witness to unspeakable experience than Maxine Hong Kingston."

For more than twelve years, National Book Award-winning author Maxine Hong Kingston has led writing- and-meditation workshops for veterans and their families. The contributors to this volume—combat veterans, medics, and others who served in war; gang members, drug users, and victims of domestic violence; draft resisters, deserters, and peace activists—are part of this community of writers working together to heal the trauma of war through art. On Friday, May 25, 2007, Bill Moyers Journal on PBS featured Maxine Hong Kingston and Veterans of War, Veterans of Peace.

Reading their words, we witness worlds torn apart then rebuilt. This epic and timely work is the distilled wisdom of warriors and their loved ones, expressing themselves with breathtaking artistry and truth.  Maxine Hong Kingston’s books—The Woman Warrior, China Men, Tripmaster Monkey, The Fifth Book of Peace, and others—have won critical praise and national awards. President Bill Clinton presented her with a National Humanities Medal in 1997.

John (Super) Powers, Friend of Vets

John Powers is the singular driving force behind something truly amazing, called "the Resource Guide for Veterans," now available for download in PDF form on his exceptionally thorough website, Operation Vets, linked here.  (Be sure you have a copy of the free Adobe PDF Reader before attempting to download.  You can get that here.) 

The focus of the Veterans' Guide is on Rhode Island, the smallest state in the country, although the structure of it could be expanded to cover every state in the entire country -- let's just say, we can imagine all of them need one!  John, a recent college graduate, worked on the Guide for over a year, and the work he did is both comprehensive and totally original --to the best of our knowledge, there is no other guide in the U.S. like this.  The quality of the work that John did -- before he even began the graduate degree program in social work that he's now enrolled in -- was a true "labor of love," inspired by a veteran friend of John's from high school days, who'd gone on deployment and come back troubled.  John Powers was recently profiled by Vietnam veteran and journalist Bob Kerr in the Providence Journal Bulletin.  Read the original article here.  Wherever John goes in life, from this point forward, he's already done some of what anyone else would consider their best work, in a lifetime of effort.  In honor of the upcoming Veteran's Day, be sure to check out both John's site, and his superlative guide.  John is a true, though young, hero and authentic "FOV" -- "Friend of Veterans."

(If by chance you happen to be on Facebook, check out the group called "From Combat to Campus: Vets in School," that we recently started together, to give veterans who are in school for the first time, or back in school after deployment, some resources and ability to connect with one another.  That's the non-profit commercial interruption.  Now back to the regularly-scheduled program.)

Here's what John has to say about his site:

Operation Vets was created in July 2007. The ideas and the resource guide I created began in October 2006. After graduating from high school in June 2002, one of my childhood friends went off to the Marines as I enrolled at the University of Rhode Island. When he came home for Operation Enduring Freedom in 2005, I saw how war can drastically affect a persons life. The transition from soldier to civilian was not easy for him, nor was it easy for all of our returning soldiers.

I wanted to learn more about combat, the effects of being in war, the effects it has on the families back home and more importantly I wanted to find out how I could help and truly “Support our troops”. I began reading, writing, and researching all the resources available to soldiers and families. I realized the Department of Veterans Affairs (VA) system was being overloaded with new veterans filing claims, for physical ailments, combat stress injuries, anxiety, depression, post traumatic stress disorder, the list goes on. The process of filing claims through the VA system can be stressful and time consuming.

As I found out through talking with soldiers coming back from War, they don’t need anymore stress than they already have to deal with. I fully understood that not only are the soldiers affected, but the families are directly affected as well. They need support and help just as much as the returning soldiers do. If soldiers and families don’t get the help they need it could have devastating affects on the soldier, the family, the children, and society in general. Our country is undoubtedly in a time of War and politics rule the news stations. I am trying to take the politics out of the equation and focus on our soldiers, our veterans, and their families.

Soldiers stories need to be heard, wounds need to be healed, regular civilians need to get involved and our country needs to unite just like it did after the attacks on 9/11. I refuse to allow our returning soldiers to “slip” through the cracks as many have, since returning from Iraq or Afghanistan and even Vietnam. These soldiers served our country and it’s time we serve our soldiers.

Read other blog entries we've done about John and his commitment to veterans here and here.

"War Happens - But How Are We Gonna Help Those Who Served?"

Yes, this site has undergone a complete redesign.  I couldn't stand it anymore, and I hope the new look is cleaner, fresher, cooler.  The content has stayed the same; only the design has changed.  Let's hope it's more refreshing.  I'm still looking for somewhere to stash the quote, above, which is really the tagline of the blog.  So far, can't figure out where to put it -- but that may change with time.  Enjoy the new look -- I hope it makes finding the information easier.  At 195 posts so far, we've covered all kinds of topics relevant to healing combat trauma, with more to come.  Stay tuned; don't change the channel.  Our topic isn't going away anytime soon...unfortunately.  So we're here to cover it; and talk about whatever works.

Harvard Study Says Almost Two Million Vets Lack Health Insurance

Ye Olde Alma Mater, Harvard University, published the results of a study earlier this week, showing that one in eight uninsured Americans is a veteran, and the numbers of uninsured veterans have continued to rise sharply since 2000.  Not good news for those who need continuous (meaning, uninterrupted) healthcare to resolve longstanding, chronic conditions like PTSD and the results of combat trauma.  Click here to read the story.  There are some pretty shocking statistics in there to absorb.  Says one doctor quoted in the article, "Only the government can put men and woman into military service and only the government can guarantee that they are covered after they serve." 

The study was conducted by researchers from Harvard Medical School, and published in the December, 2007 issue of the American Journal of Public Health.